(Reuters) -Khrom Capital Management, one of the largest shareholders of Acadia Healthcare, has called on the company’s board to launch a formal strategic review, including a potential sale, citing years of poor performance and governance failures.

The investment manager, in a letter to the company’s board, also highlighted eroding shareholder confidence in leadership and incremental changes that are no longer sufficient, Acadia said on Wednesday.

Khrom owns a 5.5% stake in the behavioral health provider.

The investor criticized the company’s board for a lack of accountability, citing long director tenures, minimal stock ownership and delayed governance reforms.

Acadia did not immediately respond to a Reuters request for comment.

Khrom also backed proposals from fellow activist Engine

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