Page 1
www.harriswilliams.com
Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which is a private limited company incorporated under English law with its registered office at 5th Floor, 6 St. Andrew Street, London EC4A 3AE, UK, registered with the Registrar of Companies for England and Wales (registration number 7078852). Harris Williams & Co. Ltd is authorized and regulated by the Financial Conduct Authority. Harris Williams & Co. is a trade name under which Harris Williams LLC and Harris Williams & Co. Ltd conduct business.
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
www.harriswilliams.com
Page 2
PAGE |
www.harriswilliams.com
WHATWE’RE READING
1
CONTENTS
PUBLIC MARKETS OVERVIEW
EQUITY MARKETS OVERVIEW
M&A OVERVIEW
DEBT MARKETS OVERVIEW
HEALTHCARE & LIFE SCIENCESPUBLIC COMPARABLES
M&A TRANSACTIONS
CONTACTSTurner BredrupManaging [email protected] +1 (804) 915-0110
James ClarkManaging [email protected] +1 (804) 915-0119
Andy DixonManaging [email protected] +1 (415) 217-3419
Cheairs PorterManaging [email protected] +1 (804) 915-0130
Geoff SmithManaging [email protected] +1 (804) 915-0195
Paul [email protected] +1 (804) 932-1326
Whit [email protected] +1 (804) 932-1321
Eugene BordVice [email protected] +1 (804) 915-0180
Tyler BradshawVice [email protected] +1 (804) 887-6121
Mervyn HanVice [email protected] +1 (804) 887-6087
Andy HewlettVice [email protected] +1 (415) 217-3427
Ricky NgVice [email protected] +1 (415) 217-3437
Nick OwensVice [email protected] +1 (804) 887-6027
GOVERNMENT | US SPENDS MORE ON HEALTHCARE WITHOUT BETTER OUTCOMES
“The U.S. spends more on healthcare, but we don’t have the same health outcomes
[as other countries],” said Cynthia Cox, associate director at the Kaiser Foundation.
Viewed from a global perspective, the current U.S. healthcare impasse underscores
just how poor health outcomes for people in the United States are when compared
with other countries. In 2015, the United States spent almost three times on healthcare
as the average of other countries with comparable incomes, while life expectancy is
shorter than for people in 30 other countries, data from the World Health Organization
showed. On average, life expectancy in the United States is 79.3 years. Additionally,
the U.S. lags in health insurance access, as only 90.9% of citizens are covered by
health insurance, trailing behind 12 other countries.
“It doesn’t appear that people in the U.S. use more healthcare in general. We go to
the doctor less often than people in other countries and get hospitalized less, so it’s
not like we are making greater use, but we are paying more for the things we do
use,” David Squires, President of the Commonwealth Fund said.
A link to the original article can be found here.
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
ECONOMY | HEALTHCARE PRICING FALLS TO LOWEST GROWTH RATE IN A YEAR
According to a report from the Altarum Institute, hospital cost-cutting and
competition have caused healthcare prices to slip to their lowest rate of growth in a
year. Prices across hospitals and other healthcare sectors rose just 1.6% in May
compared to a year ago, driving the 12-month moving average for healthcare price
increases to 1.9%.
The slowing increase is a result of cost-cutting initiatives that have been in place for
several years, better price transparency demands from consumers, and
unprecedented shopping for procedures. The Altarum Insitute projects that this trend
will only continue as more consumers switch to high-deductible health insurance
plans.
"It appears that in addition to the significant uncertainty introduced by the continuing
Affordable Care Act repeal-and-replace saga, economy-wide prices are once
again putting downward pressure on healthcare prices," Paul Hughes-Cromwick of
Altarum said in an analysis of the price report.
A link to the original article can be found here.
DATA | ACOS NOW COVER 10% OF U.S. POPULATION
Hailed as one of the primary vehicles for driving the industry away from fee-for-service
arrangements, accountable care organizations now cover roughly 10% of the U.S.
population, according to Leavitt Partners and the Accountable Care Learning
Collaborative. The groups found that 923 public and private ACOs were operating
nationwide as of March 31. "Since the first quarter of 2016, 138 new ACOs began
operation, and 46 ACOs dropped their accountable care contracts, representing a
net increase of 92 organizations becoming ACOs, or an 11% growth," they reported
June 28 in the Health Affairs blog.
A link to the original article can be found here.
Page 3
PAGE |
Specialty Pharmacy
Physician Practice Management
Dialysis Services
Retail Pharmacy
Behavioral Health / Management
Assisted Living
Acute-Care Hospitals
Healthcare Staffing
Specialty Pharmacy Management
Medical / Surgical / Dental Supplies & Distribution
Dental Products
Information Services
HW&Co. HCLS Composite Index
S&P 500
Life Sciences Tools
Medical Devices and Products
Contract Pharma Manufacturing
Specialty Managed Care
Durable Medical Equipment
Surgicenters / Rehabilitation
HMO - Medical
Clinical Laboratories
Diagnostic Imaging
Home Care, Hospice, and Home Infusion
Contract Research Organizations
Disease Management
(75.0%) (65.0%) (55.0%) (45.0%) (35.0%) (25.0%) (15.0%) (5.0%) 5.0% 15.0% 25.0% 35.0% 45.0% 55.0% 65.0% 75.0% 85.0% 95.0% 105.0% 115.0% 125.0% 135.0% 145.0% 155.0%
PUBLICMARKETS OVERVIEW(1)
2
Key Trading Statistics (detail begins on page 6)
Public Company Sector Performance
(12-month % change in stock price)
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
Change in Stock Price
3 mos. 12 mos. Revenue EBITDA Revenue EBITDA
Clinical Laboratories 3 $49,787 7.1% 36.5% 2.5x 12.8x 2.5x 12.1x
Contract Pharma Manufacturing 2 9,033 13.9% 20.0% 4.2x 16.9x 3.8x 14.6x
Contract Research Organizations 8 61,887 22.5% 46.2% 3.1x 15.8x 3.0x 13.1x
Disease Management 2 9,018 32.8% 132.7% 3.2x 20.4x 3.0x 14.1x
Healthcare Staffing 4 20,060 (0.3%) (4.8%) 1.3x 13.0x 1.2x 9.9x
HMO - Medical 8 418,873 14.5% 32.2% 0.9x 12.0x 0.8x 10.1x
Information Serv ices 12 46,714 12.7% 12.7% 4.3x 17.8x 3.9x 13.1x
Specialty Managed Care 3 9,842 9.7% 20.1% 1.7x 10.5x 6.3x 31.6x
Specialty Pharmacy 1 1,124 (7.0%) (57.7%) 0.3x 12.3x 0.2x 10.6x
Retail Pharmacy 3 211,138 (6.0%) (16.0%) 0.6x 10.1x 0.6x 9.6x
Specialty Pharmacy Management 2 52,270 4.3% (4.7%) 0.6x 8.4x 0.5x 7.7x
Dental Products 2 153,232 6.2% 11.7% 4.4x 18.3x 4.2x 15.4x
Durable Medical Equipment 3 19,492 11.4% 23.2% 2.8x 16.6x 2.6x 14.8x
Life Sciences Tools 4 162,708 12.3% 16.6% 4.3x 16.9x 4.2x 14.8x
Medical Devices and Products 13 859,002 6.8% 18.6% 4.8x 17.3x 4.6x 15.0x
Medical / Surgical / Dental Supplies & Distribution 6 120,246 4.9% (1.0%) 0.2x 9.8x 0.2x 9.6x
Acute-Care Hospitals 4 107,665 3.9% (7.3%) 1.0x 8.2x 1.0x 7.5x
Assisted Liv ing 2 9,242 11.1% (9.3%) 2.4x 14.2x 2.3x 12.5x
Diagnostic Imaging 3 11,303 29.2% 45.1% 1.6x 8.8x 3.4x 16.2x
Dialysis Serv ices 3 60,642 6.8% (16.2%) 1.8x 9.1x 1.7x 9.3x
Home Care, Hospice, and Home Infusion 6 9,254 19.3% 45.5% 1.7x 18.1x 1.6x 13.7x
Long-Term Care 3 6,758 16.4% 3.6% 0.8x 9.8x 0.7x 6.4x
Physician Practice Management 1 7,472 (13.1%) (16.7%) 2.3x 11.4x 2.1x 11.5x
Behavioral Health / Management 5 26,737 (2.5%) (10.9%) 1.2x 9.3x 1.1x 7.4x
Surgicenters / Rehabilitation 4 16,615 12.8% 26.8% 1.9x 10.6x 1.7x 10.1x
Payor, Provider, & Pharmacy Support Serv ices 48 $889,748 9.5% 18.9% 1.4x 12.4x 1.3x 10.4x
Products & Devices 28 $1,314,680 7.9% 13.4% 4.3x 16.3x 4.0x 13.9x
Provider-Based Serv ices 31 $255,689 4.0% 8.3% 1.8x 10.6x 1.7x 9.6x
HW&Co. HCLS Composite Index 107 $2,460,117 9.2% 13.9% 3.1x 14.5x 2.9x 12.3x
S&P 500 2.3% 15.5%
Pro
du
cts
&
De
vic
es
Pro
vid
er-
Ba
sed
Se
rvic
es
Median TEV/
Forward MulitplesSectorNumber of
Companies
Aggregate
Enterprise Value
($ mm)
Median TEV/
LTM Multiples
Pa
yo
r, P
rov
ide
r, &
Ph
arm
ac
y
Su
pp
ort
Se
rvic
es
Page 4
PAGE |
125.6%
133.2%
146.8%
40%
60%
80%
100%
120%
140%
160%
180%
Jul-14 Oct-14 Jan-15 Apr-15 Jul-15 Oct-15 Jan-16 Apr-16 Jul-16 Oct-16 Jan-17 Apr-17 Jul-17
S&P 500 Dow Jones U.S. Healthcare Index HW&Co. HCLS Index
EQUITYMARKETS OVERVIEW
3
Healthcare & Life Sciences Industry Stock Performance(1)
Top Equity Offerings(2)
(by proceeds)
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
Closing Date Issuer Ticker Transaction Type Gross Proceeds ($ mm)
06/28/17 Bluebird Bio, Inc. NASDAQ:BLUE Follow-On $400.1
06/06/17 Exact Sciences Corp. NASDAQ:EXAS Follow-On 259.5
06/22/17 Avexis, Inc. NASDAQ:AVXS Follow-On 250.3
06/15/17 Loxo Oncology NASDAQ:LOXO Follow-On 226.8
06/28/17 Mersana Therapeutics NASDAQ:MRSN Initial Public Offering 75.0
06/14/17 Genmark Diagnostics, Inc. NASDAQ:GNMK Follow-On 75.0
06/29/17 Dova Therapeutics NASDAQ:DOVA Initial Public Offering 74.8
06/22/17 Sangamo Therapeutics, Inc. NASDAQ:SGMO Follow-On 72.5
06/29/17 Akebia Therapeutics NASDAQ:AKBA Follow-On 58.0
06/29/17 Aileron Therapeutics NASDAQ:ALRN Initial Public Offering 57.0
06/15/17 Pacific Biosciences of California, Inc. NASDAQ:PACB Follow-On 47.8
06/23/17 Spring Bank Pharmaceuticals NASDAQ:SBPH Follow-On 37.5
06/27/17 Avenue Therapeutics NASDAQ:ATXI Initial Public Offering 33.0
06/14/17 Athenex NASDAQ:ATNX Initial Public Offering 33.0
06/06/17 Aeglea Biotherapeutics NASDAQ:AGLE Follow-On 12.3
06/16/17 Interpace Diagnostics Group, Inc. NASDAQ:IDXG Follow-On 10.8
06/06/17 Microbot Medical NASDAQ:MBOT Follow-On 10.1
Page 5
PAGE |
HC&LS Industry Number of
Segment Companies
Healthcare Facilities 27
Healthcare Serv ices 127
Healthcare Equipment 39
Pharmaceuticals 21
Healthcare Technology 10
Life Sciences Tools & Serv ices 4
Healthcare Supplies 8
Healthcare Distributors 5
Biotechnology 17
Managed Healthcare 6
M&A OVERVIEW(1)
4
Announced Healthcare & Life Sciences M&A
Healthcare & Life Sciences M&A Trends
Announced Private Equity M&A Activity
QUARTERLY M&A ACTIVITY
HEALTHCARE TRANSACTION HIGHLIGHTS
ANNOUNCED HEALTHCARE & LIFE SCIENCES TRANSACTIONS
MEDIAN HEALTHCARE & LIFE SCIENCES TRANSACTION MULTIPLES
PEG INVESTMENTS BY SEGMENT (LAST 3 YEARS) PEG INVESTMENTS AND EXITS
Note: Transactions based on publicly available information
LTM DEAL STATISTICS
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
$101.6 $108.2
$236.6
$576.0
$277.9
$99.3
0
200
400
600
800
1,000
1,200
1,400
$0
$50
$100
$150
$200
$250
$300
$350
$400
$450
$500
$550
$600
2012 2013 2014 2015 2016 2017YTD
Nu
mb
er o
f Tran
sac
tion
sAg
gre
ga
te T
ran
sac
tio
n V
alu
e
($ in
billio
ns)
Volume Total Deals
10.9x 10.0x
13.6x 14.2x
13.0x 12.7x
0.0x
0.5x
1.0x
1.5x
2.0x
2.5x
3.0x
3.5x
4.0x
4.5x
5.0x
0.0x
2.0x
4.0x
6.0x
8.0x
10.0x
12.0x
14.0x
16.0x
18.0x
2012 2013 2014 2015 2016 2017YTD
EV
/ LTM S
ale
s Mu
ltiple
EV
/ L
TM E
BIT
DA
Mu
ltip
le
EBITDA Multiple Revenue Multiple
290 280 291 303 313
368
309 306
250225
182 175152
1410
1611
12
15
18 21
48
49
45 52
34
0
50
100
150
200
250
300
350
400
2Q14 3Q14 4Q14 1Q15 2Q15 3Q15 4Q15 1Q16 2Q16 3Q16 4Q16 1Q17 2Q17
Nu
mb
er
of Tr
an
sac
tio
ns
PE Buyer Strategic Buyer
116
77
44
68 67 6661 62
56
163
8693
52 48
78
124
139 143 144
130
41
10
20
40
60
80
100
120
140
160
180
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017YTD
Nu
mb
er
of Tr
an
sac
tio
ns
Number of Investments Number of Exits
Announced Target Buyer
6/26/2017 Spine & Sport Foundation, Inc. Gryphon Inv estors, Inc.; Cora Health Serv ices, Inc.
6/21/2017 La Cumbre Dental Gryphon Inv estors, Inc.; Bright Now! Dental, Inc.
6/20/2017 Dermatology Associates of Oklahoma LLC CI Capital Partners LLC; Epiphany Dermatology PA
6/19/2017 Best Doctors, Inc. Teladoc, Inc.
6/19/2017 PAREXEL International Corp. Pamplona Capital Management LLP
6/14/2017 Attentus Medical Sales, Inc. New Mountain Capital LLC; Medical Specialties Distributors LLC
6/8/2017 StatLab Medical Products, Inc. Cressey & Co. LP
6/7/2017 Keller Medical, Inc. Allergan Sales LLC
6/7/2017 GreatCall, Inc. GTCR LLC
6/6/2017 Albany Molecular Research, Inc. The Carlyle Group LP; GTCR LLC;
6/5/2017 National Spine & Pain Centers LLC Av ista Capital Holdings LP
6/2/2017 St. Anthony's Medical Center Mercy Health
Aggregate Number Median Transaction Multiples
Value ($bn) of Deals TEV/Rev TEV/EBITDA
$200.6 914 5.2x 14.4x
Page 6
PAGE |
DEBTMARKETS OVERVIEW
Key Credit Statistics(3)
QUARTERLY HEALTHCARE LOAN VOLUME AVERAGE SPREAD ON HEALTHCARE LOANS
Select Healthcare & Life Sciences Debt Offerings(4)
(by deal amount)
CREDIT METRICS AVERAGE SECONDARY SPREAD
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
$0
$3
$6
$9
$12
$15
$18
$21
$24
1Q12 3Q12 1Q13 3Q13 1Q14 3Q14 1Q15 3Q15 1Q16 3Q16 1Q17
Loa
n V
olu
me
by
Qu
art
er
($ in
billio
ns)
Pro Rata Institutional
L + 0
L + 100
L + 200
L + 300
L + 400
L + 500
2011 2012 2013 2014 2015 2016 1Q17
Av
era
ge
Sp
rea
d O
ve
r LI
BO
RRevolving Credit / Term Loan A Weighted-Average Institutional
L + 0
L + 200
L + 400
L + 600
1Q12 3Q12 1Q13 3Q13 1Q14 3Q14 1Q15 3Q15 1Q16 3Q16 1Q17
Av
era
ge
Sp
rea
d O
ve
r LI
BO
R
0.0x
2.0x
4.0x
6.0x
Debt/EBITDA Senior Debt/EBITDA EBITDA/Cash
Interest
EBITDA -
Capex/Cash
Interest
EB
ITD
A M
ultip
le
2011 2012 2013 2014 2015 2016 1Q17
Date Effective Borrower Name Description Amount ($ mm) Tranche Rating Spread
06/23/17 US Anesthesia Partners Offices/clinics of med'l doctors $1,400.0 Term Loan B B1 / B L+ 325
06/26/17 Surgery Center Holdings Inc General med'l/surgical hospitals 1,365.0 Term Loan B B1 / B L+ 325
06/23/17 Zelis Healthcare Health and allied serv ices, nec 350.0 Term Loan B B2 / NR L+ 325
06/02/17 National Spine & Pain Centers Specialty outpatient clinics, nec 285.0 Term Loan B NR / NR L+ 450
06/07/17 CityMD General med'l/surgical hospitals 255.0 Term Loan B B3 / B- L+ 400
06/01/17 All Metro Health Care Serv ices Inc Home health care serv ices 255.0 Term Loan B NR / NR L+ 475
06/30/17 AAC Holdings Inc Specialty outpatient clinics, nec 250.0 Term Loan B B3 / B- L+ 675
06/30/17 1920 Cleveland Road West Skilled nursing care facilities 87.5 Term Loan NR / NR L+ 400
06/16/17 Tessellate LLC Health and allied serv ices, nec 70.0 Term Loan NR / NR L+ 200
5
Page 7
PAGE |
Stock Price
% Change 52 Week
6/30/2017 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
Clinical Laboratories
Laboratory Corporation of America Holdings $154.14 7.1% 18.3% $154.82 $119.51 $15,769 $5,921 $366 $21,648 $9,721 $1,927 $1,422 Mar-17 Dec-16 $10,059 $2,067 $1,725 2.2x 11.2x 2.2x 10.5x
Quest Diagnostics Incorporated 111.16 13.0% 36.5% 111.87 79.12 15,210 3,731 367 19,149 7,551 1,498 1,249 Mar-17 Dec-16 7,774 1,581 1,328 2.5x 12.8x 2.5x 12.1x
VCA Inc.(*) 92.31 0.9% 36.5% 92.87 59.51 7,502 1,386 90 8,990 2,632 509 397 Mar-17 Dec-16 2,946 583 469 3.4x 17.7x 3.1x 15.4x
Number of Companies 3 Median: 7.1% 36.5% Total $38,480 $49,787 $19,903 $20,779 2.5x 12.8x 2.5x 12.1x
Market Cap. Weighted Average: 8.2% 29.1% 2.6x 13.1x 2.5x 12.1x
Contract Pharma Manufacturing
Cambrex Corporation $59.75 12.5% 15.5% $62.95 $38.30 $1,946 $0 $99 $1,894 $501 $163 $136 Mar-17 Dec-16 $557 $175 $145 3.8x 11.7x 3.4x 10.8x
West Pharmaceutical Serv ices, Inc. 94.52 15.3% 24.6% 99.91 70.17 6,952 229 169 7,139 1,535 322 231 Mar-17 Dec-16 1,670 387 281 4.7x 22.1x 4.3x 18.4x
Number of Companies 2 Median: 13.9% 20.0% Total $8,898 $9,033 $2,036 $2,227 4.2x 16.9x 3.8x 14.6x
Market Cap. Weighted Average: 14.7% 22.6% 4.5x 19.9x 4.1x 16.8x
Contract Research Organizations
Albany Molecular Research, Inc. $21.70 58.5% 61.5% $22.17 $13.01 $932 $641 $35 $1,526 $629 $60 $1 Mar-17 Dec-16 $750 $145 $99 2.4x 25.4x 2.0x 10.5x
Catalent Inc 35.10 23.1% 52.7% 38.73 21.83 4,386 2,049 269 6,231 1,991 387 244 Mar-17 Jun-16 2,117 480 295 3.1x 16.1x 2.9x 13.0x
Charles River Laboratories International, Inc. 101.15 12.9% 22.7% 102.32 67.20 4,819 1,197 136 5,977 1,772 405 270 Apr-17 Dec-16 1,892 467 379 3.4x 14.8x 3.2x 12.8x
ICON Plc 97.79 21.8% 39.7% 100.87 69.05 5,259 349 319 5,444 1,698 388 330 Mar-17 Dec-16 1,770 414 353 3.2x 14.0x 3.1x 13.2x
INC Research Holdings, Inc. 58.50 29.1% 53.4% 61.10 37.27 3,167 488 165 3,548 1,579 230 170 Mar-17 Dec-16 1,113 270 243 2.2x 15.4x 3.2x 13.1x
PAREXEL International Corporation 86.91 38.0% 38.2% 87.50 51.16 4,437 700 284 4,865 2,428 345 241 Mar-17 Jun-16 2,203 397 288 2.0x 14.1x 2.2x 12.3x
PRA Health Sciences, Inc. 75.01 15.0% 79.6% 79.98 39.25 4,686 821 125 5,604 1,869 278 210 Mar-17 Dec-16 1,943 365 339 3.0x 20.2x 2.9x 15.3x
Quintiles IMS Holdings, Inc. 89.50 12.0% 37.0% 91.81 65.01 19,636 8,345 905 28,693 7,724 1,327 838 Mar-17 Dec-16 8,257 2,108 1,440 3.7x 21.6x 3.5x 13.6x
Number of Companies 8 Median: 22.5% 46.2% Total $47,322 $61,887 $19,691 $20,045 3.1x 15.8x 3.0x 13.1x
Market Cap. Weighted Average: 19.0% 43.2% 3.2x 18.4x 3.1x 13.4x
Disease Management
Alere Inc. $50.19 26.3% 20.4% $50.32 $31.47 $4,385 $2,944 $655 $7,278 $2,378 $293 $19 Mar-17 Dec-16 $2,452 $501 $381 3.1x 24.8x 3.0x 14.5x
Tiv ity Health, Inc. 39.85 39.3% 245.0% 40.45 11.48 1,562 207 83 1,740 516 109 106 Mar-17 Dec-16 581 128 124 3.4x 15.9x 3.0x 13.6x
Number of Companies 2 Median: 32.8% 132.7% Total $5,947 $9,018 $2,894 $3,032 3.2x 20.4x 3.0x 14.1x
Market Cap. Weighted Average: 29.7% 79.4% 3.1x 22.5x 3.0x 14.3x
Healthcare Staffing
AMN Healthcare Serv ices, Inc. $39.05 (2.6%) (2.3%) $44.99 $26.00 $1,871 $362 $55 $2,241 $1,929 $227 $196 Mar-17 Dec-16 $2,073 $266 $224 1.2x 9.9x 1.1x 8.4x
Envision Healthcare Holdings, Inc. 62.67 2.1% (19.2%) 81.34 53.12 7,361 5,833 312 13,849 4,850 882 690 Mar-17 Dec-16 8,315 1,112 913 2.9x 15.7x 1.7x 12.5x
Cross Country Healthcare, Inc. 12.91 (9.4%) (7.3%) 16.38 10.54 470 36 13 494 845 39 30 Mar-17 Dec-16 928 54 41 0.6x 12.6x 0.5x 9.1x
On Assignment, Inc. 54.15 13.4% 46.5% 55.15 32.05 2,860 617 24 3,476 2,485 260 199 Mar-17 Dec-16 2,726 325 246 1.4x 13.4x 1.3x 10.7x
Number of Companies 4 Median: (0.3%) (4.8%) Total $12,562 $20,060 $10,109 $14,042 1.3x 13.0x 1.2x 9.9x
Market Cap. Weighted Average: 3.5% (1.3%) 2.2x 14.2x 11.3x
TEV/ Fwd MultiplesForward Twelve Month
EstimateCompany NameLTM
Period
Latest
FYE Date
TEV/ LTM MultiplesEquity
Mkt.
Value
Total DebtCash and
Equiv.
Total Ent.
Value
(TEV)
Latest Twelve Months
(LTM)
PUBLIC COMPARABLES
6
Payor, Provider, & Pharmacy Support Services(1)
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
* To be acquired by MARS, Inc. in a $9.1 billion take-private transaction announced January 9, 2017.
Page 8
PAGE |
PUBLIC COMPARABLES
7
Payor, Provider, & Pharmacy Support Services(1)
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
Stock Price
% Change 52 Week
6/30/2017 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
HMO - Medical
Commercial:
Aetna Inc. $151.83 19.6% 24.3% $155.15 $104.59 $50,362 $9,423 $17,996 $57,822 $62,629 $3,421 $3,800 Mar-17 Dec-16 $62,376 $5,708 $4,951 0.9x 16.9x 0.9x 10.1x
Anthem, Inc. 188.13 12.6% 43.2% 194.94 114.85 49,852 17,143 4,075 61,241 87,232 6,585 5,625 Mar-17 Dec-16 91,203 6,052 5,332 0.7x 9.3x 0.7x 10.1x
Cigna Corporation 167.39 13.4% 30.8% 173.21 115.03 42,854 4,763 1,968 44,151 40,173 3,898 3,790 Mar-17 Dec-16 42,530 4,763 4,101 1.1x 11.3x 1.0x 9.3x
Humana Inc. 240.62 16.3% 33.8% 241.96 150.00 34,725 5,250 3,877 32,647 54,341 3,400 2,109 Mar-17 Dec-16 55,151 3,801 3,384 0.6x 9.6x 0.6x 8.6x
UnitedHealth Group Incorporated 185.42 12.4% 31.3% 188.66 132.39 178,682 33,901 10,430 202,303 189,046 15,819 13,407 Mar-17 Dec-16 208,865 18,045 15,989 1.1x 12.8x 1.0x 11.2x
Number of Companies 5 Median: 13.4% 31.3% Total $356,475 $398,162 $433,421 $460,125 0.9x 11.3x 0.9x 10.1x
Market Cap. Weighted Average: 13.9% 32.2% 1.0x 12.4x 0.9x 10.4x
Government:
Centene Corporation $79.88 10.7% 11.9% $85.80 $50.00 $13,762 $4,647 $4,068 $13,866 $45,378 $1,949 $1,571 Mar-17 Dec-16 $48,874 $2,053 $1,631 0.3x 7.1x 0.3x 6.8x
Molina Healthcare, Inc. 69.18 51.0% 38.6% 72.15 42.56 3,944 1,654 2,819 2,330 18,343 561 299 Mar-17 Dec-16 20,228 591 415 0.1x 4.2x 0.1x 3.9x
WellCare Health Plans, Inc. 179.56 28.8% 67.4% 184.88 102.97 7,989 2,080 4,054 4,515 14,651 694 622 Mar-17 Dec-16 17,837 772 671 0.3x 6.5x 0.3x 5.8x
Number of Companies 3 Median: 28.8% 38.6% Total $25,694 $20,711 $78,372 $86,939 0.3x 6.5x 0.3x 5.8x
Market Cap. Weighted Average: 22.5% 33.3% 0.3x 6.5x 0.2x 6.0x
Information Services
Data/Analytics:
Castlight Health, Inc. $4.15 10.7% 4.8% $5.50 $3.05 $316 $0 $103 $332 $107 ($49) ($52) Mar-17 Dec-16 $151 ($22) ($24) 3.1x NM 2.2x NM
Inovalon Holdings, Inc. 13.15 7.1% (27.0%) 20.05 8.60 832 259 533 1,635 433 85 44 Mar-17 Dec-16 465 114 75 3.8x 19.2x 3.5x 14.4x
National Research Corporation 31.99 19.1% 43.6% 49.29 32.14 731 3 35 1,117 112 38 33 Mar-17 Dec-16 118 NA NA 10.0x 29.8x 9.4x NA
Number of Companies 3 Median: 10.7% 4.8% Total $1,879 $1,117 $652 $734 3.8x 24.5x 3.5x 14.4x
Market Cap. Weighted Average: 12.4% 5.8% 6.1x 24.1x 5.6x 14.4x
eHealth:
WebMD Health Corp. $58.65 10.1% 0.9% $65.00 $48.10 $2,213 $1,046 $1,034 $2,934 $701 $194 $163 Mar-17 Dec-16 $730 $241 $173 4.2x 15.1x 4.0x 12.2x
Number of Companies 1 Median: 10.1% 0.9% Total $2,213 $2,934 $701 $730 4.2x 15.1x 4.0x 12.2x
Market Cap. Weighted Average: 10.1% 0.9% 4.2x 15.1x 4.0x 12.2x
Hospital/Physician:
Allscripts Healthcare Solutions, Inc. $12.76 0.7% 0.5% $15.17 $9.80 $2,315 $1,328 $104 $3,970 $1,618 $246 $58 Mar-17 Dec-16 $1,768 $365 $260 2.5x 16.1x 2.2x 10.9x
Athenahealth, Inc. 140.55 25.0% 1.8% 149.55 90.11 5,599 284 98 5,751 1,112 181 34 Mar-17 Dec-16 1,309 295 150 5.2x 31.8x 4.4x 19.5x
Cerner Corporation 66.47 12.3% 13.4% 69.28 47.01 21,957 550 532 22,365 4,919 1,496 976 Apr-17 Dec-16 5,411 1,802 1,288 4.5x 15.0x 4.1x 12.4x
Computer Programs and Systems, Inc. 32.80 16.9% (17.8%) 42.02 18.25 444 146 2 583 262 31 17 Mar-17 Dec-16 279 51 27 2.2x 18.9x 2.1x 11.4x
HMS Holdings Corp. 18.50 (8.0%) 5.1% 24.00 15.94 1,552 198 168 1,613 490 104 52 Mar-17 Dec-16 600 145 76 3.3x 15.6x 2.7x 11.1x
Premier Inc. 36.00 12.9% 10.1% 36.28 28.27 1,863 384 236 4,776 1,353 383 282 Mar-17 Jun-16 1,646 556 406 3.5x 12.5x 2.9x 8.6x
Quality Systems, Inc. 17.21 13.4% 44.5% 17.55 10.61 1,079 16 43 1,041 510 79 38 Mar-17 Mar-17 527 81 37 2.0x 13.2x 2.0x 12.8x
Advisory Board Company 51.50 10.3% 45.5% 54.50 24.85 2,090 602 150 2,566 797 140 60 Mar-17 Dec-16 830 208 81 3.2x 18.3x 3.1x 12.3x
Number of Companies 8 Median: 12.6% 7.6% Total $36,900 $42,664 $11,060 $12,369 3.3x 15.9x 2.8x 11.9x
Market Cap. Weighted Average: 12.7% 12.7% 4.2x 17.7x 3.8x 13.1x
Total Ent.
Value
(TEV)
Latest Twelve Months
(LTM)LTM
Period
Latest
FYE DateCompany Name
Equity
Mkt.
Value
Total DebtCash and
Equiv.
Forward Twelve Month
EstimateTEV/ LTM Multiples TEV/ Fwd Multiples
Page 9
PAGE |
PUBLIC COMPARABLES
8
Payor, Provider, & Pharmacy Support Services(1)
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
Stock Price
% Change 52 Week
6/30/2017 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
Specialty Managed Care
Assurant, Inc. $103.69 8.6% 20.1% $106.02 $78.50 $5,681 $1,067 $0 $6,078 $6,558 $782 $0 Mar-17 Dec-16 $6,401 NA $683 0.9x 7.8x 0.9x NA
CorVel Corporation 47.45 9.7% 9.9% 49.50 31.00 890 0 29 900 519 69 48 Mar-17 Mar-17 NA NA NA 1.7x 13.1x NA NA
HealthEquity Inc 49.83 22.0% 64.0% 54.95 27.45 2,989 0 196 2,864 190 58 44 Apr-17 Jan-17 246 91 59 15.1x NM 11.7x 31.6x
Number of Companies 3 Median: 9.7% 20.1% Total $9,559 $9,842 $7,267 $6,647 1.7x 10.5x 6.3x 31.6x
Market Cap. Weighted Average: 12.9% 32.9% 5.4x 8.5x 4.6x 31.6x
Retail Pharmacy
CVS Health Corporation $80.46 2.0% (16.0%) $98.66 $69.30 $81,972 $27,433 $2,302 $108,412 $178,825 $12,913 $10,436 Mar-17 Dec-16 $188,850 $12,969 $10,302 0.6x 8.4x 0.6x 8.4x
Walgreens Boots Alliance Inc 78.31 (6.0%) (6.0%) 88.00 75.18 83,799 19,210 12,253 92,619 116,701 7,118 5,426 May-17 Aug-16 127,997 9,607 8,041 0.8x 13.0x 0.7x 9.6x
Rite Aid Corporation(*) 2.95 (33.3%) (60.6%) 8.77 2.61 3,108 7,240 221 10,107 32,442 1,000 428 Jun-17 Mar-17 31,242 984 366 0.3x 10.1x 0.3x 10.3x
Number of Companies 3 Median: (6.0%) (16.0%) Total $168,880 $211,138 $327,968 $348,089 0.6x 10.1x 0.6x 9.6x
Market Cap. Weighted Average: (9.7%) (29.0%) 0.9x 10.6x 0.8x 9.4x
Specialty Pharmacy
Diplomat Pharmacy, Inc. $14.80 (7.0%) (57.7%) $38.94 $12.25 $995 $137 $17 $1,124 $4,493 $91 $36 Mar-17 Dec-16 $4,845 $106 $84 0.3x 12.3x 0.2x 10.6x
Number of Companies 1 Median: (7.0%) (57.7%) Total $995 $1,124 $4,493 $4,845 0.3x 12.3x 0.2x 10.6x
Market Cap. Weighted Average: (7.0%) NM 0.3x 12.3x 0.2x 10.6x
Specialty Pharmacy Management
Express Scripts Holding Company $63.84 (4.1%) (15.8%) $80.02 $57.80 $37,891 $15,528 $3,164 $51,000 $100,317 $7,276 $5,202 Mar-17 Dec-16 $103,056 $7,455 $7,144 0.5x 7.0x 0.5x 6.8x
PharMerica Corporation 26.25 12.7% 6.4% 28.72 19.20 816 467 15 1,270 2,133 130 70 Mar-17 Dec-16 2,466 147 119 0.6x 9.8x 0.5x 8.7x
Number of Companies 2 Median: 4.3% (4.7%) Total $38,707 $52,270 $102,450 $105,522 0.6x 8.4x 0.5x 7.7x
Market Cap. Weighted Average: (3.7%) (15.3%) 0.5x 7.1x 0.5x 6.9x
TEV/ LTM Multiples TEV/ Fwd MultiplesCompany Name
Equity
Mkt.
Value
Total DebtCash and
Equiv.
Total Ent.
Value
(TEV)
Latest Twelve Months
(LTM)LTM
Period
Latest
FYE Date
Forward Twelve Month
Estimate
* Half of Rite Aid’s stores to be acquired by Walgreens in a $5.1 billion transaction announced June 29th, 2017.
Page 10
PAGE |
PUBLIC COMPARABLES
9
Products & Devices(1)
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
Stock Price
% Change 52 Week
6/30/2017 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
Dental Products
3M Company $208.19 8.8% 18.9% $214.57 $163.85 $124,414 $11,711 $2,314 $136,860 $30,385 $8,593 $7,037 Mar-17 Dec-16 $31,407 $9,282 $7,754 4.5x 15.9x 4.4x 14.7x
DENTSPLY SIRONA, Inc. 64.84 3.5% 4.5% 65.68 55.00 14,863 1,551 363 16,371 3,873 789 486 Mar-17 Dec-16 4,106 1,015 897 4.2x 20.8x 4.0x 16.1x
Number of Companies 2 Median: 6.2% 11.7% Total $139,277 $153,232 $34,258 $35,513 4.4x 18.3x 4.2x 15.4x
Market Cap. Weighted Average: 8.3% 17.4% 4.5x 16.4x 4.3x 14.9x
Durable Medical Equipment
Hill-Rom Holdings, Inc. $79.61 12.1% 57.8% $81.33 $49.42 $5,236 $2,402 $219 $7,536 $2,678 $579 $371 Mar-17 Sep-16 $2,863 $619 $493 2.8x 13.0x 2.6x 12.2x
Invacare Corporation 13.20 11.4% 8.8% 16.65 8.00 423 149 79 502 1,018 (11) (25) Mar-17 Dec-16 990 5 (11) 0.5x NM 0.5x NM
ResMed Inc. 77.87 8.9% 23.2% 79.44 56.59 11,043 1,168 827 11,455 2,029 568 457 Mar-17 Jun-16 2,239 658 535 5.6x 20.2x 5.1x 17.4x
Number of Companies 3 Median: 11.4% 23.2% Total $16,702 $19,492 $5,724 $6,092 2.8x 16.6x 2.6x 14.8x
Market Cap. Weighted Average: 10.0% 33.7% 4.6x 17.9x 4.2x 15.7x
Life Sciences Tools
Agilent Technologies, Inc. $59.31 11.2% 33.7% $61.15 $42.92 $19,058 $2,043 $2,389 $18,933 $4,324 $965 $740 Apr-17 Oct-16 $4,572 $1,111 $1,013 4.4x 19.6x 4.1x 17.0x
Becton, Dickinson and Company 195.11 6.2% 15.0% 196.59 161.29 44,359 10,306 556 52,258 12,320 3,265 2,197 Mar-17 Sep-16 12,461 3,869 3,083 4.2x 16.0x 4.2x 13.5x
Thermo Fisher Scientific Inc. 174.47 13.4% 18.1% 176.92 139.07 68,256 17,071 734 85,096 18,744 4,759 2,953 Apr-17 Dec-16 20,412 5,289 4,865 4.5x 17.9x 4.2x 16.1x
VWR Corp. 33.01 17.4% 14.2% 37.25 24.42 4,351 2,181 142 6,422 4,555 447 314 Mar-17 Dec-16 4,705 520 476 1.4x 14.4x 1.4x 12.3x
Number of Companies 4 Median: 12.3% 16.6% Total $136,024 $162,708 $39,943 $42,149 4.3x 16.9x 4.2x 14.8x
Market Cap. Weighted Average: 10.9% 19.2% 4.3x 17.4x 4.1x 15.3x
Medical Devices and Products
Abbott Laboratories $48.61 9.1% 23.7% $49.59 $37.38 $84,352 $23,974 $8,860 $99,647 $22,303 $4,399 $2,619 Mar-17 Dec-16 $26,997 $7,716 $6,215 4.5x 22.7x 3.7x 12.9x
Baxter International Inc. 60.54 15.9% 33.9% 61.52 43.13 32,810 2,787 2,858 33,276 10,263 2,050 1,284 Mar-17 Dec-16 10,589 2,468 1,737 3.2x 16.2x 3.1x 13.5x
Boston Scientific Corporation 27.72 13.4% 18.6% 28.51 19.67 37,960 5,514 283 43,767 8,582 2,093 1,273 Mar-17 Dec-16 9,176 2,602 1,788 5.1x 20.9x 4.8x 16.8x
ConforMIS Inc 4.29 (17.0%) (38.9%) 10.93 3.79 188 15 64 134 80 (55) (58) Mar-17 Dec-16 89 (55) (60) 1.7x NM 1.5x NM
C. R. Bard, Inc. 316.11 27.2% 34.4% 316.95 203.63 22,892 1,752 1,070 24,296 3,779 1,187 975 Mar-17 Dec-16 4,028 1,349 1,220 6.4x 20.5x 6.0x 18.0x
Danaher Corporation 84.39 (1.6%) 10.2% 102.79 75.71 58,577 11,950 804 70,706 18,707 4,227 3,103 Mar-17 Dec-16 18,346 4,380 3,157 3.8x 16.7x 3.9x 16.1x
Hologic, Inc. 45.38 6.3% 31.2% 46.80 33.67 12,707 3,308 1,140 15,148 2,894 1,006 560 Apr-17 Sep-16 3,291 1,103 1,013 5.2x 15.1x 4.6x 13.7x
Johnson & Johnson 132.29 6.1% 9.1% 137.00 109.32 356,367 32,370 39,343 357,420 72,236 25,283 21,508 Apr-17 Jan-17 77,585 28,043 24,615 4.9x 14.1x 4.6x 12.7x
K2M Group Holdings, Inc. 24.36 19.0% 57.0% 24.89 15.39 1,037 73 39 1,063 242 (4) (34) Mar-17 Dec-16 286 16 (20) 4.4x NM 3.7x NM
Medtronic plc 88.75 9.6% 2.3% 89.72 69.35 120,614 33,441 13,708 143,342 29,710 8,922 6,005 Apr-17 Apr-17 31,127 10,027 9,053 4.8x 16.1x 4.6x 14.3x
Penumbra, Inc. 87.75 3.7% 47.5% 91.00 56.05 2,951 0 233 2,541 279 (3) (5) Mar-17 Dec-16 349 4 2 9.1x NM 7.3x NM
Stryker Corporation 138.78 5.2% 15.8% 145.62 106.48 51,871 7,219 3,279 56,579 11,785 3,172 2,578 Mar-17 Dec-16 12,600 3,606 3,288 4.8x 17.8x 4.5x 15.7x
Teleflex Incorporated 207.76 6.8% 17.2% 211.22 136.53 9,345 2,089 689 11,084 1,931 522 399 Apr-17 Dec-16 2,149 666 578 5.7x 21.2x 5.2x 16.7x
Number of Companies 13 Median: 6.8% 18.6% Total $791,670 $859,002 $182,791 $196,612 4.8x 17.3x 4.6x 15.0x
Market Cap. Weighted Average: 7.7% 13.0% 4.8x 16.5x 4.4x 13.9x
Medical / Surgical / Dental Supplies & Distribution
AmerisourceBergen Corporation $94.53 6.0% 19.2% $97.85 $68.38 $20,641 $4,455 $2,404 $22,963 $149,759 $2,341 $1,930 Mar-17 Sep-16 $164,895 $2,436 $2,132 0.2x 9.8x 0.1x 9.4x
Cardinal Health, Inc. 77.92 (4.6%) (0.1%) 85.52 62.70 24,614 5,461 1,368 29,008 128,394 3,258 2,557 Mar-17 Jun-16 138,284 3,375 2,922 0.2x 8.9x 0.2x 8.6x
Henry Schein, Inc. 183.02 7.1% 3.5% 186.99 146.23 14,519 1,399 63 16,683 11,782 1,005 831 Apr-17 Dec-16 12,574 1,093 902 1.4x 16.6x 1.3x 15.3x
McKesson Corporation 164.54 10.1% (11.8%) 199.43 114.53 34,793 8,545 2,983 43,759 198,533 371 (539) Mar-17 Mar-17 206,464 4,437 3,732 0.2x NM 0.2x 9.9x
Owens & Minor, Inc. 32.19 (6.2%) (13.9%) 38.28 30.43 1,970 564 127 2,369 9,596 255 202 Mar-17 Dec-16 9,866 266 213 0.2x 9.3x 0.2x 8.9x
Patterson Companies, Inc. 46.95 3.7% (2.0%) 50.05 36.46 4,523 1,072 95 5,464 5,683 498 414 Apr-17 Apr-17 5,769 435 374 1.0x 11.0x 0.9x 12.6x
Number of Companies 6 Median: 4.9% (1.0%) Total $101,060 $120,246 $503,747 $537,853 0.2x 9.8x 0.2x 9.6x
Market Cap. Weighted Average: 4.7% (0.0%) 0.4x 11.0x 0.4x 10.3x
TEV/ LTM Multiples TEV/ Fwd MultiplesCash and
Equiv.Company Name
Equity
Mkt.
Value
Total Debt
Total Ent.
Value
(TEV)
Latest Twelve Months
(LTM)LTM
Period
Latest
FYE Date
Forward Twelve Month
Estimate
Page 11
PAGE |
PUBLIC COMPARABLES
10
Provider-Based Services(1)
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
Stock Price
% Change 52 Week
6/30/2017 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
Acute-Care Hospitals
Community Health Systems, Inc. $9.96 11.7% (17.3%) $13.59 $4.15 $1,142 $15,245 $247 $16,770 $17,925 $2,027 $989 Mar-17 Dec-16 $15,529 $2,006 $1,078 0.9x 8.3x 1.1x 8.4x
HCA Healthcare Inc 87.20 (2.3%) 13.2% 91.03 67.00 31,994 31,514 803 65,505 41,853 8,160 6,152 Mar-17 Dec-16 44,503 8,705 6,571 1.6x 8.0x 1.5x 7.5x
LifePoint Health, Inc. 67.15 1.5% 2.7% 70.95 50.60 2,711 2,910 126 5,716 6,414 738 383 Mar-17 Dec-16 6,670 819 457 0.9x 7.7x 0.9x 7.0x
Tenet Healthcare Corporation 19.34 6.4% (30.0%) 31.84 14.06 1,944 15,218 572 19,674 19,390 2,142 1,283 Mar-17 Dec-16 20,084 2,600 1,714 1.0x 9.2x 1.0x 7.6x
Number of Companies 4 Median: 3.9% (7.3%) Total $37,791 $107,665 $85,582 $86,787 1.0x 8.2x 1.0x 7.5x
Market Cap. Weighted Average: (1.2%) 9.3% 1.5x 8.1x 1.4x 7.5x
Assisted Living
Brookdale Senior Liv ing Inc. $14.71 11.5% (4.7%) $18.62 $10.65 $2,739 $5,167 $89 $7,809 $4,931 $779 $263 Mar-17 Dec-16 $4,591 $704 $195 1.6x 10.0x 1.7x 11.1x
Capital Senior Liv ing Corporation 15.21 10.7% (13.9%) 19.92 12.65 461 1,014 26 1,433 454 78 14 Mar-17 Dec-16 491 103 22 3.2x 18.3x 2.9x 14.0x
Number of Companies 2 Median: 11.1% (9.3%) Total $3,200 $9,242 $5,385 $5,082 2.4x 14.2x 2.3x 12.5x
Market Cap. Weighted Average: 11.4% (6.1%) 1.8x 11.2x 1.9x 11.5x
Long-Term Care
Kindred Healthcare, Inc. $11.65 36.3% 3.2% $12.55 $5.65 $998 $3,369 $228 $4,374 $7,150 $515 $361 Mar-17 Dec-16 $6,703 $531 $400 0.6x 8.5x 0.7x 8.2x
National HealthCare Corporation 70.14 (2.1%) 8.3% 78.99 62.58 1,066 149 209 1,008 936 103 63 Mar-17 Dec-16 NA NA NA 1.1x 9.8x NA NA
Ensign Group, Inc. 21.77 16.4% 3.6% 23.18 16.51 1,104 267 41 1,376 1,713 120 79 Mar-17 Dec-16 1,824 300 136 0.8x 11.5x 0.8x 4.6x
Number of Companies 3 Median: 16.4% 3.6% Total $3,168 $6,758 $9,800 $8,527 0.8x 9.8x 0.7x 6.4x
Market Cap. Weighted Average: 16.4% 5.1% 0.8x 10.0x 0.7x 6.3x
Diagnostic Imaging
Alliance HealthCare Serv ices, Inc. $13.30 29.8% 113.1% $13.60 $5.73 $144 $543 $21 $798 $512 $127 $60 Mar-17 Dec-16 NA NA NA 1.6x 6.3x NA NA
RadNet, Inc. 7.75 29.2% 45.1% 7.98 5.25 366 636 8 992 897 113 46 Mar-17 Dec-16 NA NA NA 1.1x 8.8x NA NA
Varian Medical Systems, Inc. 103.19 13.2% 41.7% 106.70 76.94 9,485 547 706 9,514 3,121 558 481 Mar-17 Sep-16 2,812 587 501 3.0x 17.1x 3.4x 16.2x
Number of Companies 3 Median: 29.2% 45.1% Total $9,995 $11,303 $4,530 $2,812 1.6x 8.8x 3.4x 16.2x
Market Cap. Weighted Average: 14.0% 42.9% 3.0x 16.6x 3.4x 16.2x
Dialysis Services
American Renal Associates Holdings, Inc. $18.55 10.1% (36.0%) $29.05 $15.47 $578 $566 $84 $1,367 $755 $150 $115 Mar-17 Dec-16 $803 $108 NA 1.8x 9.1x 1.7x 12.6x
DaVita Inc. 64.76 (5.5%) (16.2%) 78.77 54.50 12,602 9,089 1,785 21,131 14,861 2,465 1,724 Mar-17 Dec-16 15,524 2,500 1,743 1.4x 8.6x 1.4x 8.5x
Fresenius Medical Care AG & Co. KGaA 96.00 6.8% 7.9% 100.63 75.71 29,530 8,819 715 38,144 18,709 3,560 2,756 Mar-17 Dec-16 21,464 4,092 3,163 2.0x 10.7x 1.8x 9.3x
Number of Companies 3 Median: 6.8% (16.2%) Total $42,710 $60,642 $34,325 $37,792 1.8x 9.1x 1.7x 9.3x
Market Cap. Weighted Average: 3.2% (2.3%) 1.9x 10.1x 1.7x 9.1x
Home Care, Hospice, and Home Infusion
Home Care / Hospice:
Addus HomeCare Corporation $37.20 15.3% 113.4% $40.75 $17.35 $432 $24 $19 $436 $410 $34 $27 Mar-17 Dec-16 $441 $39 $31 1.1x 13.0x 1.0x 11.3x
Almost Family, Inc. 61.65 26.1% 44.7% 62.95 35.21 855 130 14 948 671 56 51 Mar-17 Dec-16 853 76 69 1.4x 17.0x 1.1x 12.4x
Amedisys, Inc. 62.81 21.9% 24.4% 65.91 34.58 2,118 92 48 2,185 1,459 95 76 Mar-17 Dec-16 1,573 152 129 1.5x 22.9x 1.4x 14.4x
Chemed Corporation 204.53 10.2% 50.0% 216.01 130.05 3,289 147 47 3,536 1,592 224 189 Mar-17 Dec-16 1,686 261 211 2.2x 15.8x 2.1x 13.6x
LHC Group, Inc. 67.89 25.5% 56.9% 69.35 32.04 1,241 79 17 1,301 939 86 74 Mar-17 Dec-16 1,065 91 88 1.4x 15.1x 1.2x 14.3x
Number of Companies 5 Median: 21.9% 50.0% Total $7,935 $8,406 $5,071 $5,619 1.4x 15.8x 1.2x 13.6x
Market Cap. Weighted Average: 17.7% 2.9% 1.7x 17.6x 1.6x 13.6x
Home Infusion:
BioScrip, Inc. $2.72 56.9% 6.5% $3.43 $0.98 $328 $472 $21 $848 $915 $28 $4 Mar-17 Dec-16 $844 $57 $27 0.9x 30.8x 1.0x 14.8x
Number of Companies 1 Median: 56.9% 6.5% Total $328 $848 $915 $844 0.9x 30.8x 1.0x 14.8x
Market Cap. Weighted Average: 56.9% 6.5% 0.9x 30.8x 1.0x 14.8x
TEV/ Fwd MultiplesTEV/ LTM MultiplesCompany Name
Equity
Mkt.
Value
Total DebtCash and
Equiv.
Total Ent.
Value
(TEV)
Latest Twelve Months
(LTM)LTM
Period
Latest
FYE Date
Forward Twelve Month
Estimate
Page 12
PAGE |
Stock Price
% Change 52 Week
6/30/2017 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
Physician Practice Management
Specialty:
MEDNAX, Inc. $60.37 (13.1%) (16.7%) $76.96 $53.80 $5,615 $1,902 $53 $7,472 $3,266 $653 $558 Mar-17 Dec-16 $3,621 $651 $541 2.3x 11.4x 2.1x 11.5x
Number of Companies 1 Median: (13.1%) (16.7%) Total $5,615 $7,472 $3,266 $3,621 2.3x 11.4x 2.1x 11.5x
Market Cap. Weighted Average: (13.1%) (16.7%) 2.3x 11.4x 2.1x 11.5x
Behavioral Health / Management
AAC Holdings, Inc. $6.93 (18.4%) (69.6%) $24.38 $5.99 $167 $198 $6 $342 $287 $21 $2 Mar-17 Dec-16 $311 $56 $23 1.2x 16.2x 1.1x 6.1x
Acadia Healthcare Company, Inc. 49.38 12.8% (10.9%) 57.29 32.54 4,337 3,281 43 7,547 2,873 585 444 Mar-17 Dec-16 2,984 659 484 2.6x 12.9x 2.5x 11.4x
Civ itas Solutions, Inc. 17.50 (2.5%) (16.0%) 23.20 15.40 653 635 18 1,271 1,438 148 75 Mar-17 Sep-16 1,555 172 86 0.9x 8.6x 0.8x 7.4x
Magellan Health, Inc. 72.90 5.3% 10.8% 84.71 49.50 1,729 636 614 1,779 5,025 272 164 Mar-17 Dec-16 6,151 342 190 0.4x 6.5x 0.3x 5.2x
Universal Health Serv ices, Inc. 122.08 (2.8%) (9.0%) 138.77 99.72 10,918 3,899 63 15,797 9,929 1,697 1,274 Mar-17 Dec-16 11,782 1,848 1,417 1.6x 9.3x 1.3x 8.5x
Number of Companies 5 Median: (2.5%) (10.9%) Total $17,804 $26,737 $19,553 $22,784 1.2x 9.3x 1.1x 7.4x
Market Cap. Weighted Average: 1.6% (8.3%) 1.7x 10.0x 1.5x 8.9x
Surgicenters / Rehabilitation
Surgery Centers(*):
Surgery Partners, Inc. $22.75 16.7% 27.1% $24.05 $13.60 $1,110 $1,480 $67 $2,506 $1,165 $246 $205 Mar-17 Dec-16 $1,421 $229 NA 2.2x 10.2x 1.8x 10.9x
Number of Companies 1 Median: 16.7% 27.1% Total $1,110 $2,506 $1,165 $1,421 2.2x 10.2x 1.8x 10.9x
Market Cap. Weighted Average: 16.7% 27.1% 2.2x 10.2x 1.8x 10.9x
Rehabilitation:
HealthSouth Corporation $48.40 13.7% 24.7% $49.71 $36.97 $4,335 $2,953 $144 $7,954 $3,711 $826 $651 Mar-17 Dec-16 $4,057 $837 $656 2.1x 9.6x 2.0x 9.5x
Select Medical Holdings Corporation 15.35 16.3% 41.2% 15.60 10.08 2,037 2,816 65 5,278 4,309 458 305 Mar-17 Dec-16 4,551 563 396 1.2x 11.5x 1.2x 9.4x
U.S. Physical Therapy, Inc. 60.40 (7.9%) 0.3% 78.00 51.96 760 64 25 877 367 59 50 Mar-17 Dec-16 423 62 59 2.4x 14.8x 2.1x 14.0x
Number of Companies 3 Median: 13.7% 24.7% Total $7,132 $14,109 $8,387 $9,031 2.1x 11.5x 2.0x 9.5x
Market Cap. Weighted Average: 12.2% 26.8% 1.9x 10.7x 1.7x 9.9x
TEV/ LTM Multiples TEV/ Fwd MultiplesTotal Ent.
Value
(TEV)
Latest Twelve Months
(LTM)LTM
Period
Latest
FYE Date
Forward Twelve Month
EstimateCompany Name
Equity
Mkt.
Value
Total DebtCash and
Equiv.
PUBLIC COMPARABLES
11
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
Provider-Based Services(1)
* Figures are adjusted for minority interest.
Page 13
PAGE |
Enterprise Enterprise Value / LTM Private Equity
Announced Target Seller Buyer Value ($mm) Sales EBITDA EBIT Involvement
6/1/2017 Magan Medical Clinic, Inc. - HealthCare Partners LLC; HealthCare
Partners Holdings LLC
- - - - No
6/1/2017 McCoy Medical Technologies LLC - TeraRecon, Inc. - - - - No
6/1/2017 Pediatric Gastroenterology Associates PLLC - Gastro Health LLC - - - - No
6/1/2017 Colorado Choice Health Plans - Melody Health Insurance, Inc. - - - - No
6/1/2017 DirectMed Parts & Serv ice LLC - Sage Capital Partners - - - - Yes
6/1/2017 Professional Healing Solutions LLC - ASP Global LLC - - - - No
6/2/2017 Innovative Food Processors, Inc. - Balchem Corp. - - - - No
6/2/2017 St. Anthony's Medical Center - Mercy Health - - - - No
6/5/2017 National Spine & Pain Centers LLC - Avista Capital Holdings LP - - - - Yes
6/5/2017 Wide Horizons Intermediate Care Facility - The Ensign Group, Inc. - - - - No
6/5/2017 Heritage Park Healthcare & Rehabilitation Center Covenant Dove LLC The Ensign Group, Inc. - - - - No
6/5/2017 Utah Valley Healthcare & Rehabilitation - The Ensign Group, Inc. - - - - No
6/5/2017 Meadow View Nursing & Rehabilitation - The Ensign Group, Inc. - - - - No
6/6/2017 Albany Molecular Research, Inc. - The Carlyle Group LP (Corporate Private
Equity); GTCR LLC; Albany Molecular
Research, Inc. /Private Group/
$1,540.4 26.7x - - Yes
6/6/2017 Beryllium Discovery Corp. - UCB SA - - - - No
6/6/2017 Genetics of Memphis, Inc. - Poplar Healthcare PLLC - - - - No
6/6/2017 Daly Care - Sunny Days In-Home Care LLC - - - - No
6/7/2017 BioVision, Inc. - Boai NKY Pharmaceuticals Ltd. $290.0 - - - No
6/7/2017 Keller Medical, Inc. - Allergan Sales LLC - - - - No
6/7/2017 GreatCall, Inc. - GTCR LLC - - - - Yes
6/7/2017 MaGil IRB, Inc. - Chesapeake Research Review, Inc. - - - - No
6/7/2017 Quorum Health Corp. /2 Hospitals/ Quorum Health Corp. UPMC Italy SRL; UPMC Susquehanna - - - - No
6/7/2017 Beacon Children's Hospital - Perimeter Healthcare LLC - - - - No
6/8/2017 StatLab Medical Products, Inc. - Cressey & Co. LP - - - - Yes
6/8/2017 Diabetes Hands Foundation - Beyond Type 1 - - - - No
6/9/2017 Rehaba, Inc. - South American Gold Corp. - - - - No
6/9/2017 Solos Endoscopy, Inc. - American Medical Group LLC - - - - No
6/12/2017 Miramar Labs, Inc. - Sientra, Inc. $17.3 - - 17.3x No
6/12/2017 Gloucester Street Capital LLC - iAnthus Capital Holdings, Inc. $27.1 - - 27.1x No
6/12/2017 med fusion LLC - Quest Diagnostics, Inc. - - - - No
6/12/2017 ClearPoint Diagnostic Laboratories LLC - Quest Diagnostics, Inc. - - - - No
6/12/2017 Ascent Medical Group LLC - Siromed - - - - No
6/12/2017 Ommdom, Inc. - Inv itae Corp. $5.5 - - 5.5x No
6/13/2017 Mi Casa Es Su Casa, Inc. - Civ itas Solutions, Inc. - - - - No
6/14/2017 InterValve, Inc. - Hangzhou Venus Medtech Co. Ltd. - - - - No
6/14/2017 Attentus Medical Sales, Inc. - New Mountain Capital LLC; Medical
Specialties Distributors LLC
- - - - Yes
6/14/2017 Captify Health, Inc. - Continuum Healthcare LLC - - - - No
6/15/2017 C3 Global Biosciences - My Cloudz, Inc. - - - - No
6/15/2017 Alliance Protein Laboratories, Inc. - KBI Biopharma, Inc. - - - - No
6/18/2017 Zoobeedu, Inc. - Free Flow, Inc. - - - - No
6/19/2017 Best Doctors, Inc. - Teladoc, Inc. $440.0 - - - No
6/19/2017 Douglasv ille Medical Center - SG Property Serv ices LLC - - - - No
6/19/2017 Refine LLC /Refine™ Support System/ Refine LLC Sinclair Pharma Plc $11.3 - - 11.3x No
6/19/2017 PAREXEL International Corp. - Pamplona Capital Management LLP $4,913.1 14.4x 20.7x - Yes
6/19/2017 Integrated Photonics, Inc. - I I -VI , Inc. $47.5 - - - No
6/19/2017 Innovate Biopharmaceuticals, Inc. - Monster Digital, Inc. - - - - No
6/19/2017 InfuSystem Holdings, Inc. - 22NW Fund LP $80.5 7.5x - - No
6/20/2017 Greater Nashville Perinatology Plc - MEDNAX, Inc. - - - - No
6/20/2017 Hoth Therapeutics, Inc. - Spherix, Inc. - - - - No
6/20/2017 Hallmark Hospice - Dorilton Capital Advisors LLC; Traditions
Hospice of South Houston LLC
- - - - Yes
6/20/2017 California Medical Innovations LLC - Morgenthaler Management Corp.;
Polytek Development Corp.
- - - - No
6/20/2017 eHealth Solutions, Inc. - MatrixCare, Inc. - - - - No
6/20/2017 Choice Family Dentistry Center - Premier Dental Serv ices, Inc.; Western
Dental Serv ices, Inc.
- - - - No
6/20/2017 Dermatology Associates of Oklahoma LLC - CI Capital Partners LLC; Epiphany
Dermatology PA
- - - - Yes
6/21/2017 La Cumbre Dental - Gryphon Investors, Inc.; Bright Now!
Dental, Inc.; Triangle Capital Corp.
(Private Equity)
- - - - Yes
6/22/2017 Electrical Geodesics, Inc. - Philips Holding USA, Inc. $37.3 - - 37.3x No
6/22/2017 Medic Systems, Inc. (Louisiana) - Beacon Occupational Health & Safety
Serv ices, Inc.
- - - - No
6/22/2017 Hitchcock Healthcare, Inc. - Aiken Regional Medical Centers LLC - - - - No
M&A TRANSACTIONS
12
Announced U.S. Healthcare & Life Sciences M&A(1)
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
Page 14
PAGE |
M&A TRANSACTIONS
13
Announced U.S. Healthcare & Life Sciences M&A(1)
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
Enterprise Enterprise Value / LTM Private Equity
Announced Target Seller Buyer Value ($mm) Sales EBITDA EBIT Involvement
6/20/2017 Choice Family Dentistry Center - Premier Dental Serv ices, Inc.; Western
Dental Serv ices, Inc.
- - - - No
6/20/2017 Dermatology Associates of Oklahoma LLC - CI Capital Partners LLC; Epiphany
Dermatology PA
- - - - Yes
6/21/2017 La Cumbre Dental - Gryphon Investors, Inc.; Bright Now!
Dental, Inc.; Triangle Capital Corp.
(Private Equity)
- - - - Yes
6/22/2017 Electrical Geodesics, Inc. - Philips Holding USA, Inc. $37.3 - - 37.3x No
6/22/2017 Medic Systems, Inc. (Louisiana) - Beacon Occupational Health & Safety
Serv ices, Inc.
- - - - No
6/22/2017 Hitchcock Healthcare, Inc. - Aiken Regional Medical Centers LLC - - - - No
6/23/2017 Spectrum, Inc. - Repligen Corp. $366.7 - - - No
6/26/2017 Georgetown Translational Pharmaceuticals, Inc. - OXIS International, Inc. $0.7 - - 0.7x No
6/26/2017 Strategic Veterinary Pharmaceuticals, Inc. - Kindred Biosciences, Inc. $3.8 - - 3.8x No
6/26/2017 Spine & Sport Foundation, Inc. - Gryphon Investors, Inc.; Cora Health
Serv ices, Inc.
- - - - Yes
6/27/2017 Innovative Surgical Solutions LLC - Codman & Shurtleff, Inc.; DePuy Synthes
Products, Inc.
- - - - No
6/27/2017 Cape Cod Healthcare Inc. /Outreach Laboratory
Serv ices Bus/
Cape Cod Healthcare, Inc. Quest Diagnostics, Inc. - - - - No
6/27/2017 Brookdale Senior Liv ing, Inc. /5 Liv ing Facilities/ Brookdale Senior Liv ing, Inc. The Ensign Group, Inc. - - - - No
6/27/2017 Liberty Medical Holdings LLC - Cardinal Health, Inc. - - - - No
6/27/2017 Altor BioScience Corp. - NantCell, Inc. - - - - No
6/28/2017 The Spectranetics Corp. - Royal Philips NV $1,956.3 - - - No
6/28/2017 Girard Medical Center North Philadelphia Health System Meridian Behavioral Health Systems LLC $10.0 - - 10.0x No
6/29/2017 ArborGen, Inc. International Paper Co.; WestRock Co. Rubicon Ltd. $42.5 - - 29.0x No
6/29/2017 CardioProlific, Inc. - Royal Philips NV - - - - No
6/29/2017 Anesthesia Associates of New London PC - Envision Healthcare Corp. - - - - No
6/29/2017 Imprimis Pharmaceuticals, Inc. /Sinus Bus/ Imprimis Pharmaceuticals, Inc. Creative Pharmacy Solutions Central
LLC
$0.5 - - 0.5x No
6/30/2017 Grove Medical Equipment LLC - SleepQuest, Inc. - - - - No
Page 15
Energy, Power & Infrastructure
IndustrialsHealthcare & Life Sciences
Transportation & Logistics
Aerospace, Defense & Government
Services
Business Services
Building Products & Materials
Technology, Media & Telecom
Specialty Distribution
Consumer
PAGE |
HARRIS WILLIAMS & CO. OFFICE LOCATIONS
UNITED STATES EUROPE
FrankfurtBockenheimer Landstrasse 33-3560325 Frankfurt, GermanyPhone: +49 069 3650638 00
London63 Brook StreetLondon W1K 4HS, EnglandPhone: +44 (0) 20 7518 8900
NETWORK OFFICES
Beijing
Hong Kong
Mumbai
New Delhi
Shanghai
Harris Williams & Co. has a broad range of industry expertise, which creates powerful opportunities.Our clients benefit from our deep-sector experience, integrated industry intelligence andcollaboration across the firm, and our commitment to learning what makes them unique. For moreinformation, visit our website.
Richmond (Headquarters)1001 Haxall Point9th FloorRichmond, Virginia 23219Phone: +1 (804) 648-0072
San Francisco575 Market Street31st FloorSan Francisco, California 94105Phone: +1 (415) 288-4260
Washington, D.C. 800 17th St. NW2nd FloorWashington, D.C. 20006Phone: +1 (202) 207-2300
BostonOne International PlaceSuite 2620Boston, Massachusetts 02110Phone: +1 (617) 482-7501
Cleveland1900 East 9th Street20th FloorCleveland, Ohio 44114Phone: +1 (216) 689-2400
Minneapolis222 South 9th StreetSuite 3350Minneapolis, Minnesota 55402Phone: +1 (612) 359-2700
Healthcare & Life Sciences
OUR FIRM
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
14
Page 16
PAGE |
HARRIS WILLIAMS & CO.
15
SOURCES
Harris Williams & Co. (www.harriswilliams.com) is a preeminent middle market investment bank focused on the advisory needs of clients worldwide. The firm has deep industry knowledge, global transaction expertise, and an unwavering commitment to excellence. Harris Williams & Co. provides sell-side and acquisition advisory, restructuring advisory, board advisory, private placements, and capital markets advisory services.
Investment banking services are provided by Harris Williams LLC, a registered broker-dealer and member of FINRA and SIPC, and Harris Williams & Co. Ltd, which is a private limited company incorporated under English law with its registered office at 5th Floor, 6 St. Andrew Street, London EC4A 3AE, UK, registered with the Registrar of Companies for England and Wales (registration number 7078852). Harris Williams & Co. Ltd is authorized and regulated by the Financial Conduct Authority. Harris Williams & Co. is a trade name under which Harris Williams LLC and Harris Williams & Co. Ltd conduct business.
THIS REPORT MAY CONTAIN REFERENCES TO REGISTERED TRADEMARKS, SERVICE MARKS AND COPYRIGHTS OWNED BY THIRD-PARTY INFORMATION PROVIDERS. NONE OF THE THIRD-PARTY INFORMATION PROVIDERS IS ENDORSING THE OFFERING OF, AND SHALL NOT IN ANY WAY BE DEEMED AN ISSUER OR UNDERWRITER OF, THE SECURITIES, FINANCIAL INSTRUMENTS OR OTHER INVESTMENTS DISCUSSED IN THIS REPORT, AND SHALL NOT HAVE ANY LIABILITY OR RESPONSIBILITY FOR ANY STATEMENTS MADE IN THE REPORT OR FOR ANY FINANCIAL STATEMENTS, FINANCIAL PROJECTIONS OR OTHER FINANCIAL INFORMATION CONTAINED OR ATTACHED AS AN EXHIBIT TO THE REPORT. FOR MORE INFORMATION ABOUT THE MATERIALS PROVIDED BY SUCH THIRD PARTIES, PLEASE CONTACT US.
The information and views contained in this report were prepared by Harris Williams & Co. (“Harris Williams”). It is not a research report, as such term is defined by applicable law and regulations, and is provided for informational purposes only. It is not to be construed as an offer to buy or sell or a solicitation of an offer to buy or sell any financial instruments or to participate in any particular trading strategy. The information contained herein is believed by Harris Williams to be reliable, but Harris Williams makes no representation as to the accuracy or completeness of such information. Harris Williams and/or its affiliates may be market makers or specialists in, act as advisers or lenders to, have positions in and effect transactions in securities of companies mentioned herein and also may provide, may have provided, or may seek to provide investment banking services for those companies. In addition, Harris Williams and/or its affiliates or their respective officers, directors and employees may hold long or short positions in the securities, options thereon or other related financial products of companies discussed herein. Opinions, estimates and projections in this report constitute Harris Williams’ judgment and are subject to change without notice. The financial instruments discussed in this report may not be suitable for all investors, and investors must make their own investment decisions using their own independent advisors as they believe necessary and based upon their specific financial situations and investment objectives. Also, past performance is not necessarily indicative of future results. No part of this material may be copied or duplicated in any form or by any means, or redistributed, without Harris Williams’ prior written consent.
Copyright© 2017 Harris Williams & Co., all rights reserved.
DISCLOSURES
HEALTHCARE & LIFE SCIENCES
INDUSTRY UPDATE │ JULY 2017
1. FactSet.
2. Company Filings.
3. S&P.
4. PNC Debt Capital Markets.
5. Thomson Financial.
6. Bloomberg.