On June 14, 2024, Dr. Panneerselvam Palaniappan Shanmugam, the founder and managing director of Shanmuga Hospital Ltd. (Shanmuga Hospital), formally initiated the hospital's next steps toward expansion. Established in 1981 in Tamil Nadu, a southern state of India, Shanmuga Hospital became a reputed multi-specialty health care provider offering advanced medical treatments. In light of its tremendous growth, the hospital decided to expand its operations, needing ₹206.172 million for new infrastructure and medical equipment. At the time, the Indian stock market was booming and small and medium enterprise (SME) initial public offerings (IPOs) were at their peak. Being an SME, the hospital considered raising capital through an IPO on the SME platform. As the hospital navigated its funding strategy, it had to weigh the long-term implications of its route, such as ownership dilution, investor expectations, and financial sustainability. With these factors at play, the decision would shape the hospital's future and set a precedent for health care financing in the SME sector. During the board meeting, Dr. Shanmugam had to decide which financing option would best support the hospital's growth ambitions while maintaining financial sustainability and operational excellence.