Harris Williams & Co. Ltd is a private limited company incorporated under English law having its registered office at 5th Floor, 6 St. Andrew Street, London EC4A 3AE, UK, registered with
the Registrar of Companies for England and Wales under company number 7078852. Directors: Mr. Ned Valentine, Mr. Paul Poggi, Mr. Thierry Monjauze and Mr. Aadil Khan, authorised
and regulated by the Financial Conduct Authority.
Harris Williams & Co. Ltd Niederlassung Frankfurt (German branch) is registered in the Commercial Register (Handelsregister) of the Local Court (Amtsgericht) of Frankfurt am Main,
Germany, under registration number HRB 96687, having its business address at Bockenheimer Landstrasse 33-35, 60325 Frankfurt am Main, Germany. Permanent Representative
(Ständiger Vertreter) of the Branch Niederlassung: Mr. Jeffery H. Perkins.
INDUSTRY UPDATE │ JANUARY 2016
PAGE |
www.harriswilliams.de
H
EALTHCARE
&
L
IFE
S
CIENCES
2015 O
VERVIEW
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W
HAT
W
E
’
RE
R
EADING
2
CONTENTS
PUBLIC MARKETS OVERVIEW
EQUITY MARKETS OVERVIEW
M&A OVERVIEW
DEBT MARKETS OVERVIEW
HEALTHCARE & LIFE SCIENCES
PUBLIC COMPARABLES
M&A TRANSACTIONS
CONTACTS
Turner Bredrup
Managing Director
tbredrup@harriswilliams.com
+1 (804) 915-0110
James Clark
Managing Director
jclark@harriswilliams.com
+1 (804) 915-0119
Cheairs Porter
Managing Director
cporter@harriswilliams.com
+1 (804) 915-0130
Geoff Smith
Managing Director
gsmith@harriswilliams.com
+1 (804) 915-0195
Andy Dixon
Director
adixon@harriswilliams.com
+1 (415) 217-3419
Paul Hepper
Director
phepper@harriswilliams.com
+1 (804) 932-1326
Whit Knier
Director
wknier@harriswilliams.com
+1 (804) 932-1321
Jacques Fu
Vice President
jfu@harriswilliams.com
+1 (804) 915-0185
Andy Hewlett
Vice President
ahewlett@harriswilliams.com
+1 (415) 217-3427
Bill Kayser
Vice President
bkayser@harriswilliams.com
+1 (804) 915-0180
Nick Owens
Vice President
nowens@harriswilliams.com
+1 (804) 887-6027
PROVIDERS | CALIFORNIA HOSPITAL’S STARK VIOLATIONS
Tri-City Medical Center, an Oceanside, CA hospital, reached a $3.3 million
settlement over Stark violations. The hospital self-reported the violations back in
2011. Self-reporting most frequently occurs when operators become aware of
errors that may potentially violate the Stark Law and False Claims Act. Most
surprising in this instance was that nearly 100% of the hospital’s payment
arrangements with doctors and physician groups were in violation of federal law.
The reported incidents varied from above fair market value arrangements with the
former chief of staff to technical violations, such as operating under expired
agreements, missing signatures, etc. The executives who oversaw these contracts
are no longer associated with the hospital and Tri-City noted that all of its current
contracts are compliant. The Tri-City settlement marks yet another instance of
hospital systems entering into large settlements with the government over alleged
violations flagged through both self-reporting and whistle-blower lawsuits. A link to
the article can be found
here
.
Portugal-based Bial-Portela & Ca. S.A. announced this month that a patient has
died at the University of Rennes Central Hospital in France. The volunteer passed
away during experimental Phase I clinical trials. The drug utilized in the trial is an
inhibitor of fatty acid amide hydrolase which is believed to potentially reduce pain
and anxiety, among other neurological conditions. Biotrial, a private research
center conducting the clinical trial, has since contacted the 84 other volunteers to
complete medical examinations in search of similar side-effects. So far, the brain
damage incurred by the deceased patient has not been observed in any of the
other participants. The first phase of clinical development is marked by the first
time humans are subjected to the drugs in questions. A link to the article can be
found
here
.
OUTSOURCED CLINICAL SERVICES | OREGON DOCTORS UNIONIZE
A team of physicians in Oregon have found a unique way to combat the
common trend of outsourcing hospitalists over the last decade through unionizing
in the name of patient interests. As hospitals are pressured to measure quality and
performance, outsourced companies are better suited to manage the data
collection and management required to do so.
Despite the often higher
compensation associated with outsourced firms, doctors are alarmed by the
incentives – being rewarded by seeing more patients in the day isn’t in the best
interest of patients. Rather, more time with each patient means more ability to
exercise their professional judgement. Doctors at Sacred Heart in Oregon, in
response to being notified that the hospital’s parent PeaceHealth would solicit bids
to outsource their hospitalists formed a union to negotiate on behalf of the
doctors. While negotiations continue to drag on, the Sacred Heart doctors
continue to push for what they believe to be in the best interest of patients. A link
to the article can be found
here
.
PAGE |
Contract Pharma Manufacturing Specialty Pharmacy Management
Home Care, Hospice, and Home Infusion Healthcare Staffing
Specialty Pharmacy Contract Research Organizations HMO - Medical
Specialty Managed Care Dental Products Surgicenters / Rehabilitation Clinical Laboratories Life Sciences Tools HW&Co. HCLS Composite Index
Dialysis Services Physician Practice Management Medical / Surgical / Dental Supplies & Distribution Behavioral Health / Management Retail Pharmacy
Durable Medical Equipment Medical Devices and Products Information Services S&P 500 Long-Term Care Emergency Services Disease Management Assisted Living Acute-Care Hospitals Diagnostic Imaging (60.0%) (50.0%) (40.0%) (30.0%) (20.0%) (10.0%) 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% 80.0% 90.0%
Change in Stock Price
3 mos. 12 mos. Revenue EBITDA Revenue EBITDA
Clinical Laboratories 3 $37,677 14.0% 12.8% 2.4x 11.8x 2.2x 10.7x
Contract Pharma Manufacturing 2 5,841 15.0% 65.5% 3.4x 16.7x 3.2x 13.5x
Contract Research Organizations 8 35,439 12.0% 24.5% 2.7x 14.3x 2.6x 13.3x
Disease Management 2 7,820 (1.5%) (16.2%) 1.9x 13.3x 1.9x 12.1x
Emergency Services 1 2,322 23.0% (4.8%) 2.2x 8.2x 2.2x 8.1x
Healthcare Staffing 5 16,309 3.5% 31.3% 1.3x 12.5x 1.2x 11.6x
HMO - Medical 10 321,889 2.1% 20.9% 0.8x 10.0x 0.8x 9.9x
Information Services 13 42,323 10.9% 1.2% 4.7x 17.6x 4.4x 13.5x
Specialty Managed Care 3 7,141 1.9% 17.7% 1.7x 13.3x 5.6x 19.6x
Specialty Pharmacy 1 2,331 19.1% 25.0% 0.8x NM 0.8x NM
Retail Pharmacy 3 252,322 2.5% 4.3% 0.9x 11.9x 0.9x 11.3x
Specialty Pharmacy Management 2 75,733 15.5% 36.1% 0.7x 10.5x 0.7x 10.2x
Dental Products 3 117,421 17.4% 14.2% 3.5x 16.7x 3.5x 15.3x
Durable Medical Equipment 3 12,958 5.4% 3.8% 2.6x 16.2x 1.9x 11.8x
Life Sciences Tools 4 132,673 16.1% 10.1% 3.7x 16.9x 3.4x 13.4x
Medical Devices and Products 14 665,457 9.5% 3.1% 3.8x 14.5x 3.7x 13.2x
Medical / Surgical / Dental Supplies & Distribution 6 128,166 10.9% 6.5% 0.3x 11.9x 0.3x 10.0x
Acute-Care Hospitals 4 103,315 (15.3%) (24.0%) 1.1x 7.8x 1.0x 7.5x
Assisted Living 3 11,360 2.9% (23.4%) 2.3x 12.1x 2.0x 12.2x
Diagnostic Imaging 3 9,015 9.5% (27.6%) 1.5x 8.8x 1.7x 9.1x
Dialysis Services 2 55,818 4.2% 9.6% 1.8x 10.1x 1.8x 9.8x
Home Care, Hospice, and Home Infusion 6 6,167 5.1% 34.9% 1.4x 12.7x 1.3x 12.0x
Long-Term Care 3 6,269 1.3% (1.8%) 1.0x 9.0x 0.7x 7.9x
Physician Practice Management 2 8,033 (6.7%) 8.4% 3.0x 13.2x 2.9x 12.9x
Behavioral Health / Management 6 26,682 1.7% 5.1% 1.5x 11.1x 1.4x 10.6x
Surgicenters / Rehabilitation 5 19,077 2.2% 13.6% 2.2x 14.0x 2.0x 11.4x
Payor, Provider, & Pharmacy Support Services 53 $807,147 4.0% 13.3% 1.3x 11.7x 1.2x 10.8x
Products & Devices 30 $1,056,675 10.7% 2.7% 3.4x 13.8x 3.4x 12.8x
Provider-Based Services 34 $245,735 (2.3%) 2.5% 1.8x 10.5x 1.8x 9.9x
HW&Co. HCLS Composite Index 117 $2,109,558 7.0% 9.6% 2.5x 12.7x 2.4x 11.9x
S&P 500 6.5% (0.7%) Pr od uct s & D ev ices Pr ov id er -B a sed S er vi ces Median TEV/ Forward Mulitples Sector CompaniesNumber of
Aggregate Enterprise Value ($ mm) Median TEV/ LTM Multiples Pa yor , P rov id er , & P ha rm a cy S up p or t Ser vi ces
P
UBLIC
M
ARKETS
O
VERVIEW
3
Key Trading Statistics
(detail begins on page 6)
Public Company Sector Performance
(12-month % change in stock price)
PAGE |
40%
60%
80%
100%
120%
140%
160%
180%
200%
220%
Dec-12
Mar-13
Jun-13
Sep-13
Dec-13
Mar-14
Jun-14
Sep-14
Dec-14
Mar-15
Jun-15
Sep-15
Dec-15
S&P 500
Dow Jones U.S. Health Care Index
HW&Co. HCLS Index
E
QUITY
M
ARKETS
O
VERVIEW
4
Healthcare & Life Sciences Industry Stock Performance
Top Equity Offerings
(by proceeds)
181.4%
143.3%
159.1%
Closing Date
Issuer
Ticker
Transaction Type
Gross Proceeds ($ mm)
12/01/15
AmSurg Corp
AMSG
Follow-On
$466.8
12/10/15
Kite Pharma Inc
KITE
Follow-On
287.6
12/01/15
Neothetics Inc
NEOT
Follow-On
175.0
12/03/15
Portola Pharmaceuticals Inc
PTLA
Follow-On
172.5
12/15/15
Spark Therapeutics Inc
ONCE
Follow-On
141.0
12/09/15
Accelerate Diagnostics Inc
AXDX
Follow-On
109.3
12/18/15
MediciNova Inc
MNOV
Follow-On
100.0
12/04/15
Galena Biopharma Inc
GALE
Follow-On
100.0
12/02/15
Opexa Therapeutics Inc
OPXA
Follow-On
100.0
12/18/15
Collegium Pharmaceutical Inc
COLL
Follow-On
86.3
12/18/15
KemPharm Inc
KMPH
Follow-On
54.5
12/03/15
T2 Biosystems Inc
TTOO
Follow-On
36.0
12/18/15
IRadimed Corp
IRMD
Follow-On
25.3
12/24/15
Northwest Biotherapeutics Inc
NWBO
Follow-On
12.6
PAGE |
HC&LS Industry
Number of
Segment
Companies
Healthcare Facilities
48
Healthcare Serv ices
47
Healthcare Equipment
19
Pharmaceuticals
16
Healthcare Technology
15
Life Sciences Tools & Serv ices
15
Healthcare Supplies
9
Healthcare Distributors
5
Biotechnology
1
Managed Healthcare
4
Aggregate Number Median Transaction Multiples Value ($bn) of Deals TEV/Rev TEV/EBITDA
$591.3 1,349 2.06x 14.2x 69 94 113 79 42 71 65 65 61 62 57 60 62 95 49 50 80 120 139 144 143 131 0 20 40 60 80 100 120 140 160 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Nu m b er of T ra ns a ct ions
Number of Investments Number of Exits
291 200 209 304 248 304 290 279 292 303 312 369 308 22 16 12 18 15 22 14 11 15 11 13 14 19 0 50 100 150 200 250 300 350 400 4Q12 1Q13 2Q13 3Q13 4Q13 1Q14 2Q14 3Q14 4Q14 1Q15 2Q15 3Q15 4Q15 Nu m ber of Tran sact ion s
PE Buyer Strategic Buyer
12.8x 11.1x 10.9x 10.0x 13.6x 14.2x 0.0x 0.5x 1.0x 1.5x 2.0x 2.5x 3.0x 3.5x 4.0x 0.0x 3.0x 6.0x 9.0x 12.0x 15.0x 18.0x 2010 2011 2012 2013 2014 2015 EV / LTM Sa les Mult iple EV / LTM EBIT D A Mult iple
TEV / LTM EBITDA TEV / LTM Sales
$110.6 $141.4 $101.6 $108.2 $236.6 $576.0 0 200 400 600 800 1,000 1,200 1,400 $0 $50 $100 $150 $200 $250 $300 $350 $400 $450 $500 $550 $600 2010 2011 2012 2013 2014 2015 Nu m b er of Tr a ns a ct ions Agg reg a te Tr a ns a ct ion V a lu e ($ in b illi ons )
Aggregate Deal Value Number of Transactions
M&A O
VERVIEW
5
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
Announced Target Buyer
12/31/2015 Professional Anesthesia Associates, PC MEDNAX, Inc. (NYSE:MD) 12/31/2015 Chesapeake Research Rev iew, Inc. Linden LLC
12/22/2015 Spectrum Professional Serv ices, Inc. Beecken Petty O'Keefe & Company 12/18/2015 Equian, LLC New Mountain Capital, LLC 12/11/2015 Solutions Recov ery, Inc. American Addiction Centers, Inc. 12/8/2015 Senior Care Centers of America, Inc. Audax Group, Inc. 12/8/2015 Ci Medical Technologies, Inc. Technimark LLC 12/7/2015 Meridian Behav ioral Health LLC Audax Group, Inc. 12/7/2015 Upstream Rehabilitation Inc. Rev elstoke Capital Partners LLC
PAGE |
0.0x 2.0x 4.0x 6.0x
Debt/EBITDA Senior Debt/EBITDA EBITDA/Cash
Interest Capex/CashEBITDA -Interest EB ITDA Mu lti p le 2010 2011 2012 2013 2014 2015 L + 0 L + 200 L + 400 L + 600 L + 800 4Q10 2Q11 4Q11 2Q12 4Q12 2Q13 4Q13 2Q14 4Q14 2Q15 4Q15 A ver a g e Spr ead O ver L IBOR L + 0 L + 100 L + 200 L + 300 L + 400 L + 500 2010 2011 2012 2013 2014 2015 A ver a g e Spr ead O ver L IBOR
Revolving Credit / Term Loan A Weighted-Average Institutional $0 $3 $6 $9 $12 $15 $18 $21 $24 4Q10 2Q11 4Q11 2Q12 4Q12 2Q13 4Q13 2Q14 4Q14 2Q15 4Q15 Lo an V o lum e by Quar te r ( $ in bil lio ns )
Pro Rata Institutional
D
EBT
M
ARKETS
O
VERVIEW
6
Key Credit Statistics
QUARTERLY HEALTHCARE LOAN VOLUME
AVERAGE SPREAD ON HEALTHCARE LOANS
Select Healthcare & Life Sciences Debt Offerings
(by deal amount)
CREDIT METRICS
AVERAGE SECONDARY SPREAD
Date Effective Borrower Name Description Amount ($ mm) Tranche Rating Spread
12/01/15 Trilogy Finance Merger Sub LLC Skilled nursing care facilities $300.0 Revolver/Line >= 1 Yr. NR / NR L+ 425
12/31/15 MainStreet Health Holdings LP Skilled nursing care facilities $200.0 Term Loan NR / NR L+ 300
12/16/15 Life Care Centers of America Skilled nursing care facilities $150.0 Term Loan NR / NR L+ 300
12/17/15 Caring Brands International Home health care services $114.2 Term Loan NR / NR L+ 450
PAGE |
Stock Price
% Change 52 Week
12/31/2015 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
Clinical Laboratories
Laboratory Corp. of America Holdings $123.64 14.0% 14.6% $131.19 $105.77 $12,512 $6,681 $713 $18,496 $7,774 $1,567 $1,198 Sep-15 Dec-14 $8,488 $1,734 $1,201 2.4x 11.8x 2.2x 10.7x
Quest Diagnostics Inc. 71.14 15.7% 6.1% 89.00 60.07 10,198 3,731 123 13,907 7,527 1,489 1,180 Sep-15 Dec-14 7,496 1,512 1,211 1.8x 9.3x 1.9x 9.2x
VCA Inc. 55.00 4.5% 12.8% 62.45 47.55 4,435 881 75 5,274 2,080 391 310 Sep-15 Dec-14 2,132 403 327 2.5x 13.5x 2.5x 13.1x
Number of Companies 3 Median: 14.0% 12.8% Total $27,146 $37,677 $17,380 $18,116 2.4x 11.8x 2.2x 10.7x
Market Cap. Weighted Average: 13.1% 11.1% 2.2x 11.2x 2.1x 10.5x
Contract Pharma Manufacturing
Cambrex Corporation. $47.09 18.7% 117.8% $55.60 $21.25 $1,485 $30 $60 $1,455 $406 $111 $89 Sep-15 Dec-14 $432 $123 $106 3.6x 13.1x 3.4x 11.8x
West Pharmaceutical Services, Inc. 60.22 11.3% 13.1% 64.59 48.66 4,341 303 257 4,387 1,390 217 128 Sep-15 Dec-14 1,405 288 192 3.2x 20.3x 3.1x 15.2x
Number of Companies 2 Median: 15.0% 65.5% Total $5,826 $5,841 $1,796 $1,837 3.4x 16.7x 3.2x 13.5x
Market Cap. Weighted Average: 13.2% 39.8% 3.3x 18.4x 3.2x 14.4x
Contract Research Organizations
Albany Molecular Research Inc. $19.85 13.9% 21.9% $22.48 $14.34 $705 $360 $79 $985 $363 $44 $20 Sep-15 Dec-14 $412 $75 $49 2.7x 22.2x 2.4x 13.2x
Catalent, Inc. 25.03 3.0% (10.2%) 34.42 22.85 3,117 1,884 151 4,855 1,836 416 274 Sep-15 Jun-15 1,846 435 299 2.6x 11.7x 2.6x 11.2x
Charles River Laboratories International, Inc. 80.39 26.6% 26.3% 84.69 59.99 3,748 852 74 4,540 1,339 306 215 Sep-15 Dec-14 1,359 327 252 3.4x 14.8x 3.3x 13.9x
ICON Public Limited Company 77.70 9.5% 52.4% 84.14 50.91 4,447 350 235 4,480 1,562 323 267 Sep-15 Dec-14 1,580 336 280 2.9x 13.8x 2.8x 13.3x
INC Research Holdings, Inc. 48.51 21.3% 88.8% 51.69 22.17 2,595 475 136 2,934 887 198 142 Sep-15 Dec-14 913 218 199 3.3x 14.8x 3.2x 13.5x
PAREXEL International Corporation 68.12 10.0% 22.6% 76.17 55.36 3,627 483 158 3,952 2,036 301 213 Sep-15 Jun-15 2,142 344 250 1.9x 13.1x 1.8x 11.5x
PRA Health Sciences, Inc. 45.27 16.6% 86.9% 50.25 22.40 2,727 930 48 3,609 1,337 215 133 Sep-15 Dec-14 1,367 248 208 2.7x 16.8x 2.6x 14.5x
Quintiles Transnational Holdings Inc. 68.66 (1.3%) 16.6% 80.45 56.46 8,452 2,488 1,082 10,084 4,262 781 656 Sep-15 Dec-14 4,328 801 672 2.4x 12.9x 2.3x 12.6x
Number of Companies 8 Median: 12.0% 24.5% Total $29,417 $35,439 $13,621 $13,947 2.7x 14.3x 2.6x 13.3x
Market Cap. Weighted Average: 9.7% 34.2% 2.7x 13.9x 2.6x 12.9x
Disease Management
Alere Inc. $39.09 (18.8%) 2.9% $55.99 $36.37 $3,372 $3,602 $479 $7,105 $2,496 $552 $233 Sep-15 Dec-14 $2,494 $560 $454 2.8x 12.9x 2.8x 12.7x
Healthways Inc. 12.87 15.7% (35.3%) 23.30 9.93 464 252 2 715 783 52 31 Sep-15 Dec-14 765 60 9 0.9x 13.8x 0.9x 12.0x
Number of Companies 2 Median: (1.5%) (16.2%) Total $3,836 $7,820 $3,280 $3,259 1.9x 13.3x 1.9x 12.3x
Market Cap. Weighted Average: (14.6%) (1.7%) 2.6x 13.0x 2.6x 12.6x
Emergency Services
Air Methods Corp. $41.93 23.0% (4.8%) $54.98 $32.81 $1,648 $681 $15 $2,322 $1,062 $284 $202 Sep-15 Dec-14 $1,080 $288 $204 2.2x 8.2x 2.2x 8.1x
Number of Companies 1 Median: 23.0% (4.8%) Total $1,648 $2,322 $1,062 $1,080 2.2x 8.2x 2.2x 8.1x
Market Cap. Weighted Average: 23.0% (4.8%) 2.2x 8.2x 2.2x 8.1x
Healthcare Staffing
AMN Healthcare Services Inc. $31.05 3.5% 58.4% $37.47 $17.92 $1,481 $217 $14 $1,684 $1,340 $135 $115 Sep-15 Dec-14 $1,448 $160 $131 1.3x 12.5x 1.2x 10.5x
Cross Country Healthcare, Inc. 16.39 20.4% 31.3% 18.76 9.36 534 72 25 582 762 31 23 Sep-15 Dec-14 770 38 27 0.8x 19.0x 0.8x 15.5x
Envision Healthcare Holdings, Inc. 25.97 (29.4%) (25.1%) 45.95 20.33 4,849 2,239 130 6,988 5,124 578 403 Sep-15 Dec-14 5,388 600 404 1.4x 12.1x 1.3x 11.6x
On Assignment Inc. 44.95 21.8% 35.4% 51.00 30.60 2,373 785 29 3,129 2,064 215 169 Sep-15 Dec-14 2,053 241 159 1.5x 14.6x 1.5x 13.0x
Team Health Holdings, Inc. 43.89 (18.8%) (23.7%) 70.21 43.15 3,186 755 18 3,926 3,408 338 232 Sep-15 Dec-14 3,577 387 236 1.2x 11.6x 1.1x 10.2x
Number of Companies 5 Median: 3.5% 31.3% Total $12,423 $16,309 $12,698 $13,237 1.3x 12.5x 1.2x 11.6x
Market Cap. Weighted Average: (10.8%) (0.8%) 1.2x 11.6x 1.1x 10.2x
TEV/ Fwd Multiples Forward Twelve Month
Estimate
Company Name Equity Mkt. PeriodLTM FYE DateLatest TEV/ LTM Multiples Value
Total Debt Cash and Equiv. Total Ent. Value (TEV)
Latest Twelve Months (LTM)
PUBLIC
COMPARABLES
7
Payor, Provider, & Pharmacy Support Services
PAGE |
Stock Price
% Change 52 Week
12/31/2015 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
HMO - Medical
Commercial:
Aetna Inc. $108.12 (1.2%) 21.7% $134.40 $87.25 $37,701 $7,838 $1,797 $43,807 $59,950 $5,222 $4,561 Sep-15 Dec-14 $60,279 $5,630 $4,844 0.7x 8.4x 0.7x 7.8x
Anthem, Inc. 139.44 (0.4%) 11.0% 173.59 122.86 36,404 17,778 1,548 52,634 77,953 6,325 5,769 Sep-15 Dec-14 78,266 5,212 4,854 0.7x 8.3x 0.7x 10.1x
Cigna Corp(1) 146.33 8.4% 42.2% 170.68 100.67 37,695 5,205 2,381 40,599 37,276 3,991 3,659 Sep-15 Dec-14 37,828 4,126 3,552 1.1x 10.2x 1.1x 9.8x
Health Net, Inc.(2) 68.46 13.7% 27.9% 76.67 50.79 5,292 610 973 4,928 15,966 427 408 Sep-15 Dec-14 16,441 607 581 0.3x 11.5x 0.3x 8.1x
Humana Inc.(3) 178.51 (0.3%) 24.3% 219.79 137.45 26,459 4,129 1,597 28,991 53,256 2,697 2,429 Sep-15 Dec-14 54,396 2,923 2,567 0.5x 10.7x 0.5x 9.9x
UnitedHealth Group Incorporated 117.64 1.4% 16.4% 126.21 95.00 112,124 31,783 7,983 137,503 146,941 12,486 11,318 Sep-15 Dec-14 156,524 12,575 10,987 0.9x 11.0x 0.9x 10.9x
Number of Companies 6 Median: 0.6% 23.0% Total $255,674 $308,462 $391,341 $403,735 0.7x 10.5x 0.7x 9.9x
Market Cap. Weighted Average: 1.9% 21.3% 0.8x 10.1x 0.8x 10.0x
Government:
Centene Corp. $65.81 21.4% 26.7% $83.00 $50.93 $7,845 $1,281 $1,665 $7,619 $19,854 $853 $747 Sep-15 Dec-14 $22,600 $825 $707 0.4x 8.9x 0.3x 9.2x
Molina Healthcare, Inc. 60.13 (12.7%) 12.3% 82.37 49.37 3,372 927 2,164 2,135 12,728 490 407 Sep-15 Dec-14 14,211 511 411 0.2x 4.4x 0.2x 4.2x
Universal American Corp 7.00 2.3% (24.6%) 11.16 6.38 565 85 216 434 1,936 18 8 Sep-15 Dec-14 1,669 21 NA 0.2x 23.8x 0.3x 20.7x
WellCare Health Plans, Inc. 78.21 (9.2%) (4.7%) 98.79 71.40 3,449 1,213 1,423 3,239 13,808 448 409 Sep-15 Dec-14 13,875 526 435 0.2x 7.2x 0.2x 6.2x
Number of Companies 4 Median: (3.5%) 3.8% Total $15,231 $13,427 $48,326 $52,355 0.2x 8.1x 0.2x 7.7x
Market Cap. Weighted Average: 6.2% 14.5% 0.3x 8.1x 0.3x 7.8x
Information Services
Data/Analytics:
Castlight Health, Inc. $4.27 1.7% (63.5%) $11.99 $3.59 $404 $0 $147 $257 $68 ($79) ($81) Sep-15 Dec-14 $75 ($63) ($67) 3.8x NM 3.4x NM
Inovalon Holdings, Inc. 17.00 (18.4%) NM 33.75 16.51 2,565 285 167 2,136 407 137 117 Sep-15 Dec-14 441 154 126 5.3x 15.6x 4.8x 13.9x
National Research Corp. 31.99 8.5% (0.4%) 38.22 27.54 459 6 38 428 101 29 25 Sep-15 Dec-14 103 31 26 4.2x 14.6x 4.2x 13.9x
Number of Companies 3 Median: 1.7% (32.0%) Total $3,428 $428 $576 $619 4.2x 15.1x 4.2x 13.9x
Market Cap. Weighted Average: (12.4%) (7.5%) 4.9x 15.5x 4.6x 13.9x
eHealth:
WebMD Health Corp. $48.30 21.2% 22.1% $49.88 $37.57 $1,781 $803 $612 $1,972 $607 $129 $111 Sep-15 Dec-14 $632 $187 $126 3.2x 15.3x 3.1x 10.6x
Number of Companies 1 Median: 21.2% 22.1% Total $1,781 $1,972 $607 $632 3.2x 15.3x 3.1x 10.6x
Market Cap. Weighted Average: 21.2% 22.1% 3.2x 15.3x 3.1x 10.6x
Hospital/Physician:
Allscripts Healthcare Solutions, Inc. $15.38 24.0% 20.4% $15.78 $11.33 $2,907 $655 $91 $3,482 $1,382 $98 $15 Sep-15 Dec-14 $1,399 $246 $150 2.5x NM 2.5x 14.2x
Athenahealth, Inc. 160.97 20.7% 10.5% 170.42 110.68 6,250 300 117 6,432 880 68 4 Sep-15 Dec-14 925 180 90 7.3x NM 7.0x NM
Cerner Corporation 60.17 0.4% (6.9%) 75.72 55.82 20,584 631 262 20,751 4,103 1,133 835 Oct-15 Jan-15 4,425 1,418 1,062 5.1x 18.3x 4.7x 14.6x
Computer Programs & Systems Inc. 49.75 18.1% (18.1%) 62.98 36.04 562 0 28 524 184 35 32 Sep-15 Dec-14 184 33 29 2.8x 14.9x 2.8x 15.9x
HMS Holdings Corp. 12.34 40.7% (41.6%) 21.99 8.11 1,061 198 145 1,114 458 85 33 Sep-15 Dec-14 468 110 47 2.4x 13.1x 2.4x 10.1x
MedAssets, Inc. 30.94 54.2% 56.6% 31.24 17.00 1,837 798 0 2,634 764 218 100 Sep-15 Dec-14 765 237 78 3.4x 12.1x 3.4x 11.1x
Premier, Inc. 35.27 2.6% 5.2% 39.81 31.36 1,538 168 110 1,534 1,049 340 279 Sep-15 Jun-15 1,165 441 326 1.5x 4.5x 1.3x 3.5x
Quality Systems Inc. 16.12 29.2% 3.4% 18.75 12.00 981 0 99 870 499 57 44 Sep-15 Mar-15 502 82 42 1.7x 15.2x 1.7x 10.6x
The Advisory Board Company 49.61 8.9% 1.3% 60.38 40.70 2,078 560 56 2,582 722 76 35 Sep-15 Dec-14 775 170 53 3.6x 33.9x 3.3x 15.2x
Number of Companies 9 Median: 20.7% 3.4% Total $37,800 $39,924 $10,042 $10,609 2.8x 14.9x 2.8x 12.6x
Market Cap. Weighted Average: 10.9% 1.2% 4.7x 17.9x 4.5x 13.6x
Total Ent. Value (TEV)
Latest Twelve Months
(LTM) PeriodLTM FYE DateLatest
Company Name Equity Mkt.
Value
Total Debt Cash and Equiv. Forward Twelve Month Estimate TEV/ LTM Multiples TEV/ Fwd Multiples
PUBLIC
COMPARABLES
8
Payor, Provider, & Pharmacy Support Services
As of December 31, 2015.
(1) To be acquired by Anthem (NYSE:ANTM) in a $54.2 billion transaction announced July 24, 2015. (2) To be acquired by Centene (NYSE:CNC) in a $6.3 billion transaction announced July 2, 2015. (3) To be acquired by Aetna (NYSE:AET) in a $37.0 billion transaction announced July 3, 2015.
PAGE |
Stock Price
% Change 52 Week
12/31/2015 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
Specialty Managed Care
Assurant Inc. $80.54 1.9% 17.7% $87.20 $59.73 $5,303 $1,222 $1,544 $4,981 $10,400 $374 $236 Sep-15 Dec-14 $7,970 $980 $795 0.5x 13.3x 0.6x 5.1x
CorVel Corporation 43.92 36.0% 18.0% 46.20 29.27 865 0 25 840 496 63 44 Sep-15 Mar-15 NA NA NA 1.7x 13.3x NA NA
HealthEquity, Inc. 25.07 (15.2%) (1.5%) 35.78 16.11 1,445 0 85 1,320 116 31 24 Oct-15 Jan-15 125 39 25 11.4x NM 10.5x 34.1x
Number of Companies 3 Median: 1.9% 17.7% Total $7,612 $7,141 $11,012 $8,096 1.7x 13.3x 5.6x 19.6x
Market Cap. Weighted Average: 2.6% 14.1% 2.7x 13.3x 2.7x 11.3x
Retail Pharmacy
CVS Health Corporation $97.77 1.3% 1.5% $113.65 $81.37 $108,525 $27,222 $2,890 $132,742 $149,199 $11,186 $9,187 Sep-15 Dec-14 $153,006 $980 NA 0.9x 11.9x 0.9x NM
Walgreens Boots Alliance, Inc. 85.16 2.5% 11.8% 97.30 73.00 92,449 14,277 3,000 104,235 112,923 7,612 5,985 Nov-15 Aug-15 120,152 8,965 7,162 0.9x 13.7x 0.9x 11.6x
Rite Aid Corporation 7.84 29.2% 4.3% 9.47 5.88 8,204 7,367 226 15,346 29,314 1,327 846 Nov-15 Feb-15 30,896 1,408 838 0.5x 11.6x 0.5x 10.9x
Number of Companies 3 Median: 2.5% 4.3% Total $209,178 $252,322 $291,436 $304,054 0.9x 11.9x 0.9x 11.3x
Market Cap. Weighted Average: 6.7% 3.2% 1.0x 12.7x 0.9x 11.6x
Specialty Pharmacy
Diplomat Pharmacy, Inc. $34.22 19.1% 25.0% $52.33 $15.45 $2,202 $140 $16 $2,331 $2,992 $65 $44 Sep-15 Dec-14 $2,796 $46 $83 0.8x NM 0.8x NM
Number of Companies 1 Median: 19.1% 25.0% Total $2,202 $2,331 $2,992 $2,796 0.8x NM 0.8x NM
Market Cap. Weighted Average: 19.1% NM 0.8x NM 0.8x NM
Specialty Pharmacy Management
Express Scripts Holding Company $87.41 8.0% 3.2% $94.61 $68.06 $59,113 $15,687 $438 $74,370 $101,889 $6,928 $4,849 Sep-15 Dec-14 $102,229 $7,067 $6,645 0.7x 10.7x 0.7x 10.5x
PharMerica Corporation 35.00 22.9% 69.0% 36.96 20.25 1,066 337 40 1,363 2,031 134 83 Sep-15 Dec-14 2,014 137 88 0.7x 10.2x 0.7x 9.9x
Number of Companies 2 Median: 15.5% 36.1% Total $60,179 $75,733 $103,920 $104,243 0.7x 10.5x 0.7x 10.2x
Market Cap. Weighted Average: 8.2% 4.4% 0.7x 10.7x 0.7x 10.5x
TEV/ LTM Multiples TEV/ Fwd Multiples Company Name
Equity Mkt.
Value Total Debt Cash and Equiv. Total Ent.
Value (TEV)
Latest Twelve Months (LTM) LTM
Period Latest FYE Date
Forward Twelve Month Estimate
PUBLIC
COMPARABLES
9
Payor, Provider, & Pharmacy Support Services
PAGE |
Stock Price
% Change 52 Week
12/31/2015 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
Dental Products
3M Company $150.64 6.3% (8.3%) $170.50 $134.00 $92,751 $11,253 $1,605 $102,284 $30,695 $8,496 $7,108 Sep-15 Dec-14 $30,208 $8,328 $6,958 3.3x 12.0x 3.4x 12.3x
DENTSPLY International Inc. 60.85 20.3% 14.2% 63.45 49.42 8,521 1,157 236 9,443 2,722 567 443 Sep-15 Dec-14 2,693 617 523 3.5x 16.7x 3.5x 15.3x
Sirona Dental Systems Inc.(1) 109.57 17.4% 25.4% 113.58 86.29 6,129 80 518 5,694 1,161 312 254 Sep-15 Sep-15 1,240 363 322 4.9x 18.2x 4.6x 15.7x
Number of Companies 3 Median: 17.4% 14.2% Total $107,401 $117,421 $34,579 $34,141 3.5x 16.7x 3.5x 15.3x
Market Cap. Weighted Average: 8.0% (4.6%) 3.4x 12.8x 3.5x 12.7x
Durable Medical Equipment
Hill-Rom Holdings, Inc. $48.06 (7.6%) 5.3% $58.73 $44.69 $3,132 $2,233 $193 $5,182 $1,988 $295 $187 Sep-15 Sep-15 $2,681 $523 $383 2.6x 17.6x 1.9x 9.9x
Invacare Corporation 17.39 20.2% 3.8% 23.59 14.00 585 48 33 599 1,177 11 (10) Sep-15 Dec-14 1,144 15 (12) 0.5x NM 0.5x NM
ResMed Inc. 53.69 5.4% (4.2%) 75.33 48.99 7,498 501 822 7,176 1,710 485 413 Sep-15 Jun-15 1,784 523 449 4.2x 14.8x 4.0x 13.7x
Number of Companies 3 Median: 5.4% 3.8% Total $11,215 $12,958 $4,876 $5,610 2.6x 16.2x 1.9x 11.8x
Market Cap. Weighted Average: 2.5% (1.1%) 3.6x 15.6x 3.3x 12.6x
Life Sciences Tools
Agilent Technologies Inc. $41.81 21.8% 2.1% $43.59 $33.12 $13,888 $1,655 $2,003 $13,543 $4,038 $781 $528 Oct-15 Oct-15 $4,165 $946 $838 3.4x 17.3x 3.3x 14.3x
Becton, Dickinson and Company 154.09 16.2% 10.7% 157.50 128.87 32,693 12,822 1,424 44,052 10,282 2,631 1,805 Sep-15 Sep-15 12,651 3,550 2,698 4.3x 16.7x 3.5x 12.4x
Thermo Fisher Scientific, Inc. 141.85 16.0% 13.2% 143.65 14.00 56,612 13,321 503 69,430 16,806 4,061 2,384 Sep-15 Dec-14 16,868 4,179 3,814 4.1x 17.1x 4.1x 16.6x
VWR Corporation 28.31 10.2% 9.4% 28.83 20.60 3,719 2,053 123 5,649 4,308 448 324 Sep-15 Dec-14 4,289 452 375 1.3x 12.6x 1.3x 12.5x
Number of Companies 4 Median: 16.1% 10.1% Total $106,911 $132,673 $35,434 $37,974 3.7x 16.9x 3.4x 13.4x
Market Cap. Weighted Average: 16.6% 10.9% 4.0x 16.9x 3.7x 14.9x
Medical Devices and Products
Abbott Laboratories $44.91 11.7% (0.2%) $51.74 $39.00 $66,993 $8,355 $3,132 $69,317 $20,573 $4,716 $3,288 Sep-15 Dec-14 $20,542 $4,905 $4,033 3.4x 14.7x 3.4x 14.1x
Baxter International Inc. 38.15 16.1% (47.9%) 74.03 32.18 20,869 6,729 1,970 21,493 16,106 4,144 3,138 Sep-15 Dec-14 9,914 1,503 853 1.3x 5.2x 2.2x 14.3x
Boston Scientific Corporation 18.44 12.4% 39.2% 19.06 13.14 24,805 5,859 350 30,314 7,314 1,799 1,047 Sep-15 Dec-14 7,492 2,024 1,204 4.1x 16.9x 4.0x 15.0x
ConforMIS, Inc. 17.29 (4.3%) NM 26.93 13.33 704 1 139 565 61 (51) (53) Sep-15 Dec-14 65 (54) (57) 9.2x NM 8.7x NM
CR Bard Inc. 189.44 1.7% 13.7% 202.47 163.08 13,997 1,410 1,002 14,403 3,412 1,038 857 Sep-15 Dec-14 3,416 1,075 863 4.2x 13.9x 4.2x 13.4x
Danaher Corp. 92.88 9.0% 8.4% 97.62 81.25 63,649 15,012 1,834 76,899 20,662 4,665 3,655 Oct-15 Dec-14 20,804 4,691 3,714 3.7x 16.5x 3.7x 16.4x
Hanger, Inc. 16.45 20.6% (24.9%) 26.79 13.27 565 540 5 1,100 1,061 159 119 Jun-14 Dec-13 1,072 163 116 1.0x 6.9x 1.0x 6.7x
Hologic Inc. 38.69 (1.1%) 44.7% 43.00 25.60 10,946 3,674 491 14,127 2,681 975 484 Sep-15 Sep-15 2,841 1,082 971 5.3x 14.5x 5.0x 13.1x
Johnson & Johnson 102.72 10.0% (1.8%) 106.50 81.79 284,220 19,935 13,639 266,849 70,517 22,554 18,850 Sep-15 Dec-14 70,186 23,296 19,610 3.8x 11.8x 3.8x 11.5x
K2M Group Holdings, Inc. 19.74 6.1% (5.4%) 26.29 16.40 814 0 44 770 209 (13) (37) Sep-15 Dec-14 218 (1) (37) 3.7x NM 3.5x NM
Medtronic plc 76.92 14.9% 6.5% 79.50 55.54 108,161 35,920 2,378 126,850 25,819 7,713 5,433 Oct-15 Apr-15 28,704 9,895 8,200 4.9x 16.4x 4.4x 12.8x
Penumbra, Inc. 53.81 34.2% NM 59.36 38.59 1,608 0 159 1,449 167 4 3 Sep-15 Dec-14 178 1 (1) 8.7x NM 8.1x NM
Stryker Corporation 92.94 (1.2%) (1.5%) 105.34 89.81 34,945 3,490 3,163 35,061 9,849 2,644 2,259 Sep-15 Dec-14 9,943 2,662 2,480 3.6x 13.3x 3.5x 13.2x
Teleflex Incorporated 131.45 5.8% 14.5% 140.50 107.45 5,469 1,063 276 6,257 1,788 404 305 Sep-15 Dec-14 1,806 477 386 3.5x 15.5x 3.5x 13.1x
Number of Companies 14 Median: 9.5% 3.1% Total $637,746 $665,457 $180,220 $177,181 3.8x 14.5x 3.7x 13.2x
Market Cap. Weighted Average: 10.2% 2.2% 3.9x 13.6x 3.8x 12.9x
Medical / Surgical / Dental Supplies & Distribution
AmerisourceBergen Corporation $103.71 9.2% 15.0% $120.68 $89.52 $21,326 $3,493 $2,167 $22,601 $135,962 $1,547 $1,302 Sep-15 Sep-15 $148,115 $2,427 $2,225 0.2x 14.6x 0.2x 9.3x
Cardinal Health, Inc. 89.27 16.2% 10.6% 91.91 74.76 29,368 5,550 2,974 32,086 106,516 2,842 2,362 Sep-15 Jun-15 117,609 3,149 2,967 0.3x 11.3x 0.3x 10.2x
Henry Schein, Inc. 158.19 19.2% 16.2% 161.62 126.17 13,118 798 60 14,443 10,481 917 759 Sep-15 Dec-14 10,595 929 767 1.4x 15.7x 1.4x 15.6x
McKesson Corporation 197.23 6.6% (5.0%) 243.61 160.10 45,384 9,388 5,359 50,908 187,716 4,213 3,323 Sep-15 Mar-15 192,716 5,151 4,650 0.3x 12.1x 0.3x 9.9x
Owens & Minor Inc. 35.98 12.6% 2.5% 39.29 31.89 2,263 574 125 2,711 9,777 270 223 Sep-15 Dec-14 9,800 281 217 0.3x 10.0x 0.3x 9.7x
Patterson Companies, Inc. 45.21 4.5% (6.0%) 53.07 42.62 4,380 1,132 95 5,417 4,990 464 396 Oct-15 Apr-15 5,405 460 395 1.1x 11.7x 1.0x 11.8x
Number of Companies 6 Median: 10.9% 6.5% Total $115,840 $128,166 $455,441 $484,240 0.3x 11.9x 0.3x 10.0x
Market Cap. Weighted Average: 11.0% 5.1% 0.4x 12.7x 0.4x 10.6x
TEV/ LTM Multiples TEV/ Fwd Multiples Cash 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
PUBLIC
COMPARABLES
10
Products & Devices
As of December 31, 2015.
PAGE |
Stock Price
% Change 52 Week
12/31/2015 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA
Acute-Care Hospitals
Community Health Systems, Inc. $26.53 (38.0%) (50.8%) $65.00 $24.49 $3,136 $16,989 $186 $20,543 $19,557 $2,806 $1,668 Sep-15 Dec-14 $19,631 $2,923 $1,692 1.1x 7.3x 1.0x 7.0x
HCA Holdings, Inc. 67.63 (12.6%) (7.8%) 95.49 43.91 27,571 29,905 588 58,319 39,065 7,691 5,808 Sep-15 Dec-14 39,560 7,761 5,821 1.5x 7.6x 1.5x 7.5x
LifePoint Health, Inc. 73.40 3.5% 2.1% 88.18 58.61 3,195 2,206 313 5,232 5,107 650 372 Sep-15 Dec-14 5,262 707 423 1.0x 8.1x 1.0x 7.4x
Tenet Healthcare Corp. 30.30 (17.9%) (40.2%) 60.93 26.60 3,020 14,754 450 19,222 18,085 2,270 1,441 Sep-15 Dec-14 19,894 2,268 1,467 1.1x 8.5x 1.0x 8.5x
Number of Companies 4 Median: (15.3%) (24.0%) Total $36,921 $103,315 $81,814 $84,347 1.1x 7.8x 1.0x 7.5x
Market Cap. Weighted Average: (13.8%) (13.3%) 1.4x 7.7x 1.4x 7.5x
Assisted Living
Brookdale Senior Living Inc. $18.46 (19.6%) (49.7%) $39.89 $16.58 $3,411 $6,485 $70 $9,826 $4,240 $809 ($7) Sep-15 Dec-14 $4,975 $807 $37 2.3x 12.1x 2.0x 12.2x
Capital Senior Living Corp. 20.86 4.0% (16.3%) 27.75 19.20 616 752 35 1,333 404 71 19 Sep-15 Dec-14 411 83 20 3.3x 18.7x 3.2x 16.1x
Five Star Quality Care Inc. 3.18 2.9% (23.4%) 5.07 2.74 156 79 20 201 1,118 20 (15) Sep-15 Dec-14 1,365 35 2 0.2x 10.3x 0.1x 5.7x
Number of Companies 3 Median: 2.9% (23.4%) Total $4,183 $11,360 $5,762 $6,751 2.3x 12.1x 2.0x 12.2x
Market Cap. Weighted Average: (15.3%) (43.8%) 2.4x 13.0x 2.1x 12.5x
Long-Term Care
Kindred Healthcare Inc. $11.91 (24.4%) (34.5%) $24.66 $11.12 $998 $3,165 $121 $4,132 $6,539 $504 $349 Sep-15 Dec-14 $7,090 $597 $435 0.6x 8.2x 0.6x 6.9x
National HealthCare Corporation 61.70 1.3% (1.8%) 69.40 58.98 920 44 71 952 899 106 69 Sep-15 Dec-14 NA NA NA 1.1x 9.0x NA NA
The Ensign Group, Inc. 22.63 6.2% 2.0% 27.04 19.22 1,161 70 40 1,185 1,246 105 80 Sep-15 Dec-14 1,327 135 107 1.0x 11.3x 0.9x 8.8x
Number of Companies 3 Median: 1.3% (1.8%) Total $3,079 $6,269 $8,683 $8,417 1.0x 9.0x 0.7x 7.9x
Market Cap. Weighted Average: (5.2%) (11.0%) 0.9x 9.6x 0.7x 7.9x
Diagnostic Imaging
Alliance Healthcare Services, Inc. $9.18 (5.9%) (56.3%) $25.33 $6.73 $97 $552 $45 $695 $458 $116 $59 Sep-15 Dec-14 NA NA NA 1.5x 6.0x NA NA
RadNet, Inc. 6.18 11.4% (27.6%) 9.40 5.19 285 646 36 899 779 102 44 Sep-15 Dec-14 800 126 47 1.2x 8.8x 1.1x 7.1x
Varian Medical Systems, Inc. 80.80 9.5% (6.6%) 96.67 71.07 7,756 496 845 7,422 3,099 634 566 Oct-15 Oct-15 3,219 665 587 2.4x 11.7x 2.3x 11.2x
Number of Companies 3 Median: 9.5% (27.6%) Total $8,138 $9,015 $4,337 $4,020 1.5x 8.8x 1.7x 9.1x
Market Cap. Weighted Average: 9.4% (7.9%) 2.3x 11.5x 2.3x 11.0x
Dialysis Services
DaVita HealthCare Partners Inc. $69.71 (3.6%) (8.0%) $85.17 $67.34 $14,709 $9,198 $1,047 $23,036 $13,565 $2,486 $1,858 Sep-15 Dec-14 $13,756 $2,537 $1,905 1.7x 9.3x 1.7x 9.1x
Fresenius Medical Care AG & Co. KGAA 78.00 12.0% 27.2% 83.26 60.47 23,778 9,097 621 32,782 17,125 3,025 2,303 Sep-15 Dec-14 16,861 3,128 2,396 1.9x 10.8x 1.9x 10.5x
Number of Companies 2 Median: 4.2% 9.6% Total $38,487 $55,818 $30,690 $30,617 1.8x 10.1x 1.8x 9.8x
Market Cap. Weighted Average: 6.0% 13.7% 1.8x 10.2x 1.8x 9.9x
Home Care, Hospice, and Home Infusion
Home Care / Hospice:
Addus HomeCare Corporation $23.28 (25.3%) (4.1%) $38.08 $18.75 $257 $3 $15 $245 $335 $24 $19 Sep-15 Dec-14 $337 $25 $20 0.7x 10.2x 0.7x 9.8x
Almost Family Inc. 38.23 (4.5%) 32.1% 50.48 28.10 376 92 6 464 512 37 33 Oct-15 Dec-14 536 41 36 0.9x 12.7x 0.9x 11.4x
Amedisys Inc. 39.32 3.6% 34.0% 48.34 24.81 1,325 100 57 1,369 1,230 89 67 Sep-15 Dec-14 1,263 111 81 1.1x 15.4x 1.1x 12.4x
Chemed Corp. 149.80 12.2% 41.8% 160.12 100.49 2,528 138 38 2,628 1,524 218 190 Sep-15 Dec-14 1,537 230 189 1.7x 12.1x 1.7x 11.4x
LHC Group, Inc. 45.29 1.2% 45.3% 51.83 27.51 814 93 62 860 772 78 66 Sep-15 Dec-14 811 75 66 1.1x 11.1x 1.1x 11.5x
Number of Companies 5 Median: 1.2% 34.0% Total $5,299 $5,566 $4,373 $4,484 1.1x 12.1x 1.1x 11.4x
Market Cap. Weighted Average: 5.4% 37.4% 1.4x 12.7x 1.3x 11.6x
Home Infusion:
BioScrip, Inc. $1.75 (6.4%) (75.0%) $7.01 $1.30 $120 $449 $29 $601 $1,040 ($30) ($50) Sep-15 Dec-14 $1,013 $19 ($280) 0.6x NM 0.6x 31.4x
Number of Companies 1 Median: (6.4%) (75.0%) Total $120 $601 $1,040 $1,013 0.6x NM 0.6x 31.4x
Market Cap. Weighted Average: (6.4%) (75.0%) 0.6x NM 0.6x 31.4x
Total Ent. Value
(TEV)
Latest Twelve Months
(LTM) PeriodLTM FYE DateLatest
Forward Twelve Month Estimate Company Name
Equity Mkt.
Value Total Debt Cash and Equiv. TEV/ Fwd Multiples TEV/ LTM Multiples
PUBLIC
COMPARABLES
11
Provider-Based Services
As of December 31, 2015.
PAGE |
Stock Price
% Change 52 Week
12/31/2015 3 mos. 12 mos. High Low Revenue EBITDA EBIT Revenue EBITDA EBIT Revenue EBITDA Revenue EBITDA Physician Practice Management
Specialty:
MEDNAX, Inc. $71.66 (6.7%) 8.4% $86.09 $64.12 $6,739 $1,362 $61 $8,033 $2,689 $608 $548 Sep-15 Dec-14 $2,786 $625 $561 3.0x 13.2x 2.9x 12.9x
Number of Companies 1 Median: (6.7%) 8.4% Total $6,739 $8,033 $2,689 $2,786 3.0x 13.2x 2.9x 12.9x
Market Cap. Weighted Average: (6.7%) 8.4% 3.0x 13.2x 2.9x 12.9x
Behavioral Health / Management
AAC Holdings, Inc. $19.06 (14.3%) (38.4%) $46.60 $15.09 $427 $122 $11 $534 $175 $32 $26 Sep-15 Dec-14 $211 $43 $23 3.0x 16.5x 2.5x 12.3x
Acadia Healthcare Company, Inc. 62.46 (5.7%) 2.0% 85.62 54.41 4,478 2,134 51 6,570 1,594 342 286 Sep-15 Dec-14 1,788 401 317 4.1x 19.2x 3.7x 16.4x
Civitas Solutions, Inc. 28.79 25.6% 69.1% 30.23 16.69 1,068 650 42 1,676 1,367 142 71 Sep-15 Sep-15 1,421 162 77 1.2x 11.8x 1.2x 10.4x
Magellan Health, Inc. 61.66 11.2% 2.7% 73.00 45.40 1,518 262 97 1,590 4,311 208 149 Sep-15 Dec-14 4,553 246 47 0.4x 7.6x 0.3x 6.5x
Providence Service Corp. 46.92 7.7% 28.8% 56.92 36.03 721 482 107 1,175 1,984 112 56 Sep-15 Dec-14 1,879 109 50 0.6x 10.5x 0.6x 10.8x
Universal Health Services Inc. 119.49 (4.3%) 7.4% 148.57 101.20 11,767 3,098 40 15,136 8,765 1,654 1,260 Sep-15 Dec-14 9,678 1,644 1,276 1.7x 9.2x 1.6x 9.2x
Number of Companies 6 Median: 1.7% 5.1% Total $19,979 $26,682 $18,196 $19,530 1.5x 11.1x 1.4x 10.6x
Market Cap. Weighted Average: (1.6%) 8.9% 2.1x 11.6x 1.9x 10.8x
Surgicenters / Rehabilitation Surgery Centers(1):
AmSurg Corp. $76.00 (2.2%) 38.9% $87.42 $52.42 $4,126 $2,250 $187 $6,356 $2,444 $340 $294 Sep-15 Dec-14 $2,540 $490 NA 2.6x 18.7x 2.5x 13.0x
Surgical Care Affiliates, Inc. 39.81 21.8% 18.3% 40.99 27.88 1,576 809 94 2,290 976 146 96 Sep-15 Dec-14 1,023 173 NA 2.3x 15.7x 2.2x 13.2x
Number of Companies 2 Median: 9.8% 28.6% Total $5,702 $8,646 $3,420 $3,563 2.5x 17.2x 2.4x 13.1x
Market Cap. Weighted Average: 4.4% 33.2% 2.5x 17.8x 2.4x 13.0x
Rehabilitation:
HEALTHSOUTH Corp. $34.81 (9.3%) (9.5%) $48.37 $32.55 $3,183 $2,824 $802 $5,480 $2,857 $653 $527 Sep-15 Dec-14 $3,140 $682 $546 1.9x 8.4x 1.7x 8.0x
Select Medical Holdings Corporation 11.91 10.4% (17.3%) 17.20 10.07 1,562 2,375 23 4,220 3,420 363 275 Sep-15 Dec-14 3,716 401 286 1.2x 11.6x 1.1x 10.5x
US Physical Therapy Inc. 53.68 19.6% 27.9% 56.37 38.17 667 49 21 732 320 54 46 Sep-15 Dec-14 330 50 47 2.3x 13.6x 2.2x 14.7x
Number of Companies 3 Median: 10.4% (9.5%) Total $5,412 $10,431 $6,597 $7,187 1.9x 11.6x 1.7x 10.5x
Market Cap. Weighted Average: (0.0%) (7.1%) 1.8x 10.0x 1.6x 9.6x
Company Name Equity Mkt.
Value Total Debt Cash and Equiv. Total Ent.
Value (TEV)
Latest Twelve Months
(LTM) PeriodLTM FYE DateLatest Forward Twelve Month Estimate TEV/ LTM Multiples TEV/ Fwd Multiples
PUBLIC
COMPARABLES
12
Provider-Based Services
As of December 31, 2015.
PAGE |
Enterprise Enterprise Value / LTM Private Equity
Announced Target Seller Buyer Value ($mm) Sales EBITDA EBIT Involvement
hoh18.75
12/31/2015 Big Horse Holdings, Inc. - RedHawk Medical Products & Services,
LLC
$0.5 - - - No
12/31/2015 Professional Anesthesia Associates, PC - MEDNAX, Inc. (NYSE:MD) - - - - No
12/31/2015 Chesapeake Research Review, Inc. Audax Group, Inc. Linden LLC - - - - Yes
12/30/2015 CanX, Inc. - CannaVEST Corp. (OTCPK:CANV) $1.0 - - - No
12/29/2015 80% in Indiana University Health La Porte Hospital Inc and Indiana University Health Starke Hospital
Indiana University Health, Inc. Community Health Systems, Inc. (NYSE:CYH)
- - - - No
12/24/2015 90% Stakes in Four Companies Summit Healthcare Operating Partnership, L.P.
Best Years, LLC $4.9 - - - No
12/24/2015 Compressus, Inc. - Versata Enterprises, Inc. - - - - No
12/23/2015 Selah Genomics Inc. EKF Diagnostics Holdings plc (AIM:EKF) - - - No
12/23/2015 Community Portable X-Ray, Inc. and MetroStat Clinical Laboratory, Inc.
- Schryver Medical Sales And Marketing,
Inc.
- - - - No
12/23/2015 PhosImmune Inc. University Of Virginia Patent
Foundation; CIT GAP Funds; The Center for Innovative Technology, Endowment arm; Fanelli Haag PLLC
Agenus Inc. (NasdaqCM:AGEN) $44.9 - - - No
12/22/2015 Gray Harbor Imaging LLC South Sound Radiologists Inc., P.S. Grays Harbor Public Hospital District 2 $1.0 - - - No
12/22/2015 Medivet Biologics LLC Medical Australia Limited (ASX:MLA) - $2.1 - - - No
12/22/2015 Adult Day Center - NewCourtland Elder Services - - - - No
12/22/2015 ImageVision.net, Inc. - Invoice Cloud, Inc. - - - - No
12/22/2015 Qforma Inc. BelHealth Investment Partners, LLC QPharma, Inc. - - - - Yes
12/22/2015 Tampa Bay Emergency Physicians, PL - US Acute Care Solutions, LLC - - - - No
12/22/2015 Spectrum Professional Services, Inc. SV Life Sciences Advisers, LLC; EDG Partners, LLC
Beecken Petty O'Keefe & Company - - - - Yes
12/21/2015 National Research Corporation, OCS HomeCare and Hospice Analytics Division
National Research Corp. (NasdaqGS:NRCI.B)
ABILITY Network Inc. - - - - No
12/21/2015 Beckman Coulter Genomics Inc. Beckman Coulter, Inc. GENEWIZ, Inc. - - - - No
12/21/2015 Banner Life Sciences, LLC, Portfolio of 25 Products Banner Life Sciences, LLC Bionpharma Inc. - - - - No
12/21/2015 Magnolia Management, Inc., Four Nursing Homes Magnolia Management, Inc. Mid-Atlantic Health Care, LLC - - - - No
12/21/2015 Moorestown Foot Specialists LLC - Foot Health Centers, P.A. - - - - No
12/21/2015 Seabrook House, Inc., Seabrook West Facility Located in Tioga County Pennsylvania
Seabrook House, Inc. Summit Behavioral Healthcare, LLC - - - - No
12/21/2015 Northampton Manor, Devlin Manor, Julia Manor Health Care Centers, and Moran Manor Health Care Center
- Mid-Atlantic Health Care, LLC - - - - No
12/21/2015 Convaid, Inc. - Etac AB - - - - No
12/19/2015 Zoetis Inc., Ceratin Products And Related Manufacturing Sites
Zoetis Inc. (NYSE:ZTS) Huvepharma AD $40.0 - - - No
12/18/2015 USGP, LLC and U.S. Lithotripsy, L.P. USMD, Inc. US Lithotripsy Holdings, LLC $19.8 - - - No
12/18/2015 Bristol-Myers Squibb, Late-Stage HIV R&D and Preclinical and Discovery Stage HIV Research Assets
Bristol-Myers Squibb Company (NYSE:BMY)
ViiV Healthcare Company $2,905.0 - - - No
12/18/2015 The Medicines Company, Global Portfolio of 3-Hemostasis Drugs
The Medicines Company (NasdaqGS:MDCO)
Mallinckrodt Public Limited Company (NYSE:MNK)
$410.0 - - - No
12/18/2015 Immediate Medical Care Inc. - U.S. Healthworks, Inc. - - - - No
12/18/2015 Managed Healthcare Solutions, Inc. - Arthur J Gallagher & Co. (NYSE:AJG) - - - - No
12/18/2015 Texan Urgent Care PLLC - FastMed Urgent Care - - - - No
12/18/2015 Gemini Health LLC - Havas SA (ENXTPA:HAV) - - - - No
12/18/2015 Havas Gemini - Havas Health, Inc. - - - - No
12/18/2015 Equian, LLC Great Point Partners, LLC New Mountain Capital, LLC $225.0 - - - Yes
12/17/2015 LuvBuds, LLC - CannaSys, Inc. (OTCPK:MJTK) $0.2 - - - No
12/17/2015 Galena Biopharma, Inc., Certain Assets Galena Biopharma, Inc. (NasdaqCM:GALE)
Midatech Pharma Plc (AIM:MTPH) $29.8 - - - No
12/17/2015 Visiometrics, S.L. and Visual Performance Diagnostics, Inc.
Atlas Capital Group, LLC Halma plc (LSE:HLMA) $94.1 - - - Yes
12/17/2015 Matawan Pharmaceuticals, LLC, Generic Retin-A® Portfolio
Matawan Pharmaceuticals, LLC Perrigo Company Public Limited Company (NYSE:PRGO)
- - - - No
12/17/2015 Everest Inpatient Physicians and Geriatric Essentials
- Team Health Holdings, Inc. (NYSE:TMH) - - - - No
12/17/2015 Open Monoclonal Technology, Inc. Essex Woodlands Health Ventures Ligand Pharmaceuticals Incorporated (NasdaqGM:LGND)
$178.0 - - - No
12/17/2015 Central Maryland Rehabilitation Services, Inc. - Pivot Physical Therapy - - - - No
12/16/2015 Zenergy Sports Rehabilitation Clinic - Zenergy at Thunder Spring LLC - - - - No
12/16/2015 WCA Hospital - University of Pittsburgh Medical Center - - - - No
12/16/2015 RightCare Solutions, Inc. Domain Associates, L.L.C.; NewSpring Capital; Commerce Health Capital, LLC
Navihealth, Inc. - - - - Yes
M&A TRANSACTIONS
13
Announced U.S. Healthcare & Life Sciences M&A
PAGE |
M&A TRANSACTIONS
14
Announced U.S. Healthcare & Life Sciences M&A cont.
Enterprise Enterprise Value / LTM Private Equity
Announced Target Seller Buyer Value ($mm) Sales EBITDA EBIT Involvement
12/16/2015 The National Reference Laboratory for Breast Health, Inc.
Atossa Genetics, Inc. (NasdaqCM:ATOS)
NRL Investment Group, LLC $10.1 - - - No
12/16/2015 Northside Anesthesiology Consultants, LLC - Sheridan Healthcare, Inc. - - - - No
12/15/2015 Eco Science Solutions, Inc. (OTCPK:ESSI) - - - No
12/15/2015 Kreisers, Inc. - Seneca Medical, Inc. - - - - No
12/15/2015 Restorgenex Corporation (OTCPK:RESX) Fortress Investment Group LLC (NYSE:FIG); Seaside 88 Advisors, LLC; Ernest W. Moody Revocable Trust; Ally Bridge Group
Diffusion Pharmaceuticals LLC - - - - No
12/15/2015 Orthopaedic and Sports Medicine Consultants and Associates
- Premier Health Specialists, Inc. - - - - No
12/15/2015 Midwest Medical Supply Company, Inc. - Seneca Medical, Inc. - - - - No
12/14/2015 Newtown Physical Therapy, Inc. - ATI Holdings LLC - - - - No
12/14/2015 Sun Pharmaceutical Industries Ltd, US Factory in Bryan, Ohio
Sun Pharmaceutical Industries Limited (NSEI:SUNPHARMA)
Nostrum Laboratories, Inc. - - - - No
12/14/2015 Kaenon, Inc. - OluKai Inc. - - - - No
12/14/2015 100% in Xcelience, LLC and Remaining Stake in PowderSize, Inc.
- Capsugel Inc. - - - - No
12/14/2015 Legacy Medical Imaging, L.P. - BC Technical, Inc. - - - - No
12/13/2015 Capernaum Pediatric Therapy, Inc. - Fairview Health Services, Endowment
Arm
- - - - No
12/11/2015 Dynamic Care And Greco Physical Therapy and Sports Performance And ProActive Physical & Hand Therapy
- MOTION PT Holdings, Inc. - - - - No
12/11/2015 Criticare Systems, Inc. - Opto Cardiac Care Limited $3.2 - - - No
12/11/2015 Solutions Recovery, Inc. - American Addiction Centers, Inc. $13.0 - - - No
12/11/2015 Macon Gastroenterology Anesthesia Associates, LLC
- CRH Medical Corporation (TSX:CRH) - - - - No
12/11/2015 MDRX Medical Billing, LLC - Constellation Healthcare Technologies,
Inc. (AIM:CHT)
$30.0 0.9x 6.3x - No
12/11/2015 MedVet Chicago - MedVet Associates, Inc. - - - - No
12/10/2015 Wetsman Forensic Medicine, L.L.C. Enhanced Capital Partners, LLC American Addiction Centers, Inc. $21.1 - - - Yes
12/10/2015 Crealta Pharmaceuticals LLC GTCR, LLC Horizon Pharma USA, Inc.; HZNP Limited $510.0 - - - Yes
12/10/2015 Pathology, Inc. ABS Capital Partners, Inc.; CNF
Investments LLC; England Capital Partners, LLC
Laboratory Corp. of America Holdings (NYSE:LH)
- - - - Yes
12/10/2015 Advanced Answers On Demand, Inc. Primus Capital MDI Achieve, Inc. - - - - Yes
12/9/2015 Swiss Caps USA Inc. Aenova Group GmbH Marine Nutriceutical Corporation - - - - No
12/9/2015 BioSense Medical Devices, LLC - 800 Commerce, Inc. (OTCPK:ETHG) - - - - No
12/9/2015 Spring Creek Rehabilitation and Healthcare Center
- TL Management - - - - No
12/9/2015 100-Unit Assisted Living and Alzheimer's Care Facility in Virginia Beach, Virginia
- Greystone & Co. Inc. $27.5 - - - No
12/8/2015 Senior Care Centers of America, Inc. Clearview Capital, LLC Audax Group, Inc. - - NM - Yes
12/8/2015 Bohle Family Dentistry, PSC - Marquee Dental Partners, LLC - - - - No
12/8/2015 Ci Medical Technologies, Inc. Altaris Capital Partners, LLC Technimark LLC - - - - Yes
12/8/2015 Forest Laboratories, LLC, Pharmaceutical Facilities in Long Island, NY
Forest Laboratories, LLC Ropack Pharma Solutions - - - - No
12/8/2015 Precision Extrusion, Inc. - Pexco LLC - - - - No
12/8/2015 Halco Life Safety Systems Inc. - Lone Star Communications, Inc - - - - No
12/8/2015 Central Piedmont Surgery Center in Asheboro Asheboro Medical Properties, LLC Flagship Capital Partners, LLC; Broyhill Asset Management
PAGE |
M&A TRANSACTIONS
15
Announced U.S. Healthcare & Life Sciences M&A cont.
Enterprise Enterprise Value / LTM Private Equity
Announced Target Seller Buyer Value ($mm) Sales EBITDA EBIT Involvement
12/7/2015 Alliance Home Health Inc. - Sutter Care at Home - - - - No
12/7/2015 American HomePatient, Inc. Highland Capital Management, L.P. Lincare Holdings Inc. - - - - Yes
12/7/2015 InQuicker, LLC - Stericycle, Inc. (NasdaqGS:SRCL) - - - - No
12/7/2015 Meridian Behavioral Health LLC Triton Pacific Capital Partners, LLC Audax Group, Inc. - - - - Yes
12/7/2015 Medical Direct Club, LLC Fulcrum Equity Partners, Inc.; Nashville Capital Network, Investment Arm
Comfort Medical, LLC - - - - Yes
12/7/2015 G2N, Inc. - iMedX, Inc. - - - - No
12/7/2015 The IFH Group West LLC - The IFH Group, Inc. - - - - No
12/7/2015 Upstream Rehabilitation Inc. Charterhouse Equity Partners LLC Revelstoke Capital Partners LLC - - - - Yes
12/4/2015 Farm Design, Inc. - Flextronics International Ltd.
(NasdaqGS:FLEX)
- - - - No
12/4/2015 PMG Research, Inc. Frontier Capital, LLC ICON Public Limited Company
(NasdaqGS:ICLR)
- - - - Yes
12/4/2015 Chandler Emergency Medical Group PLC - Sheridan Healthcare, Inc. - - - - No
12/4/2015 Osmotica Pharmaceutical Corp. - Vertical / Trigen Holdings LLC - - - - No
12/4/2015 Salinas Valley PrimeCare Medical Group Incorporated
- Salinas Valley Memorial Health Care
System, Inc.
- - - - No
12/4/2015 Group Health Cooperative - Kaiser Permanente Inc. - - - - No
