Hospital Feasibility Study _500 Bed_indon

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Hospital Project Feasibility Study

Introduction

 Government Impetus

 Medical Profession in Bangladesh

 Clinics & Hospitals

 Demand-Supply Scenario

 Policies and Regulations

 Prospects of New Hospitals in Bangladesh

Operating Plan

 Clinical Specialties

 Non Clinical Specialties

Proposed Facilities

 Departments and Facilities

 Other Medical Facilities

 Emergency and Day Care facilities

Revenue Model

Capacity Utilization (5 Yrs. analysis)

Projected Income Statement

Revenue Projections

 Registration

 Consultation

 Bed revenue

 Surgery and Procedure

 Consumables and Pharmacy

 Diagnostics and Imaging Services

Overhead Budget

 Direct operating cost

 Manpower Budget

 General and Admin Overhead Budget

 Depreciation

 Finance Cost

Project Cost

 Medical Equipments

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 Cardiology  Neurology  Nephrology  Urology  Dermatology  Orthopedics  Gastroenterology

 Obstetrics & Gynecology

 ENT

 Ophthalmology

 Oncology

 Bio Chemistry Lab

 Clinical Pathology  Hematology Lab  Microbiology  Histopathology  Blood Bank  Operation Theaters

 Cardiothoracic, Coronary, Medical ICU

 Emergency  Physiotherapy  Cath Lab  MHC  Wards IPD  Laundry  Kitchen  CSSD  Waste Management  Central Services

 Plumbering & Sanitary works

 Water treatment plant & storage

 Sewerage treatment plant & disposal

 Internal electrification

 Substation

 Generator

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 Boiler & hot water system

 Fire fighting system

 Elevators

 Hospital Services

 Medical Gases, 2points / Bed

 Mortuary

 Workshop

 Incinerator

 Pharmacy

 Store/Medical Record

 Miscellaneous Fixed Assets

 IT & PABX

 Server & Networking

 Computer

 System software

 Hospital software

 Peripherals

 Nurse Call System

 PA system  TV/Audio  Vehicles  Ambulance  Cars -  Furniture

 Land and Land development

Projected Working Capital Requirement

Projected Income Statement (5 Yrs.) Marketing Plan

 Target Market

 Competitors Revenue Analysis

 Pricing

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Introduction

In Bangladesh, the government is primarily responsible for the provision of healthcare. The government institutions principally cater to the needs of mass population at subsidized rates. Since the patients are in great numbers, and there is a shortage of the facilities available, the quality of healthcare provided by the Government is not satisfactory. Efforts have been made to expand and improve the healthcare systems, but even with support from the donor community, this has never been successful to the desired level, because of the huge population. The resulting structural deficiency of the public healthcare system has created a vacuum in the supply of quality medical services, especially in relation to the demands of the upper-and-middle-class segments of the population. Although there exists a considerable number of private hospitals and clinics, facilities within these institutions have hardly met international standards of excellence. Added to this, there continues to be a mass exodus of people who wish, and have the ability, to avail healthcare of a higher "international" standard. This is evidenced by the large number of people traveling to destinations such as India, Thailand and Singapore every year. Moreover, not all the people going abroad are from the upper class, but are from the middle class as well.

Since independence, the government has been pursuing a policy of health development ensuring basic services to the people of the country. To achieve this goal, a number of development programs have been undertaken in the health sector during the past years. Among others the main constraints were lack of proper control and monitoring system, allocation of budget and skilled manpower. However, government has formulated national health policy providing strategy directives on major health issues including basic healthcare and services of acceptable quality; improvement in medical education, nutritional status, strengthening of planning and management capabilities. Bangladesh, characterized by its historical legacy of poverty and illiteracy, is challenged with many health problems.

Seeing this trend and feeling that there was a local need for few standard healthcare, the sponsors of UHSRL embarked on the Hospitals project.UHSRL an emerging private sector entrepreneur had been a vision to contribute something in improving the country’s terrible healthcare situation. In view of that the promoters of this group have agreed to build up a hospital to cater to the needs of mass people and started building up this most modern 210 beded hospital with all important medical facilities.

Capacity:

The Hospital will have initially 210 beds with an expandable capacity up to 300 bed as described below:

Bed Category

Number

Location

General Ward 49 8th,9th and 10th

Semi Private 68 8th,9th,10th and 11th

Single Cabin 2 11th

ICU(Intensive Care Unit) 10 6th

CCU(Coronary Care Unit) 10 7th

Recovery bed 4 6th Step down 8 7th Post Operative 11 6th Labor Observation 7 8th Nursery/Neo Natal 17 8th OT 8 6th,7th,8th

Emergency bed 6 Ground floor

Cath Lab 2 7th

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Medical Specialties:

 Internal medicine  Respiratory Medicine  General Surgery  Anesthesia  Orthopedics  Hematology  Cardiology  Interventional Cardiology  Cardiothoracic Surgery  Pulmonary  ENT

 Dental and Maxi facial Surgery  Ophthalmology

 Neurology  Neurosurgery

 Diabetes and Endocrinology  Nephrology

 Renal Transplant  Urology

 Hematology

 Dermatology and Venereology  Rheumatology

 Medical Oncology

 Obstetrics and Gynecology  Pediatrics and Neonatology  Pediatric Surgery

 Plastic & Cosmetic Surgery  Physical therapy

 Psychiatry

 Emergency Medicine  Dietary counseling  Diagnostic and Imaging  Lab Medicine

 Blood Bank.

Support Services:

The hospital is expected to provide the following support system for increasing efficiency.  Medical Records Room

 24 Hours Pharmacy  Ambulances

 Reception cum call centre  Biomedical Engineering Services  Sterile Supplies Department (CSSD)  Food & Beverage Section

 Communication & Software Systems  Mortuary

Medical and Other Equipment:

Most modern and latest equipment will be procured from the reliable suppliers according to the specification suggested by the experts in the field. The list of all such medical equipment for the proposed hospital is given under Medical Equipment list. The general equipment required for the building, such as the escalators, power substation, gas generator set, elevators, air conditioning

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system, fire fighting system etc. will also be soured as per the specification obtained from the electrical consultants.

Power Supply:

The hospital will have adequate supply of power, which will ensure that all the possibilities of failure will be curbed.PDB connection for supply of power for daily operations and it will be supplied from a 1000 KVA LT transformer from DESA.A captive power generation from gas based generator is also considered for backup power of 1000 KVA, which will ensure the hospital un-interrupted and continuous power supply.

Water Supply:

Water for the hospital will be sourced from the ground of the project site. The hospital will require about 200,000 liters of treated water and a small quantity of untreated water every day. A water treatment plant will be installed to obtain soft and pure water. Equipment, protecting water against bacterial infections will also be part of the water supply system. Necessary arrangement for deionizer water supply for dialysis ward will also be made.

Gas Supply:

Gas generator, kitchen and cleaning room of the hospital would use natural gas to be supplied through an underground pipeline by the utility provider.

Other Facilities

The hospital will be equipped with disinfecting rooms, incinerator for combustible wastes, infectious wastes and human tissues, treatment and disposal of sewerage of the hospital. Fumigation of operation theaters, communication services, vacuum and compressed air facility, medical gas facility, hospital workshop will also be taken care of. Bio-medical workshop for repairs, maintenance and the upkeep of hospital equipment and instruments is also going to be provided.

Government Impetus

Government is increasingly encouraging private sectors to invest in health care sectors. In this respect, government has decided to allow direct foreign investment and joint venture projects to establish hospitals in the country for the development of the Medicare services. The Government has also decided to allow appointment of foreign specialists in a proportionate rate in these hospitals. Therefore, UHSRL will be able to maintain the required standards in managing the hospital by employing foreign consultants/Trainer as and when required.

In order to encourage investment in the health-care sector, the government has declared five- (5) year tax-exemption for hospitals to be established between July 1995 to June 2010 for those that have more than 200 beds. The License Fee, Infrastructure Development Surcharge (IDSC), Value Added Tax (VAT) and Advance Income Tax (AIT) on hospital equipment an import stage have also been removed. However, customs duty @5% is payable on some specific equipment.

Health Care Challenges:

No health care system in the world is stable, and all systems would undergo considerable change in the next 10 years. The drivers of change in the industrialized nations are reaching the limits of welfare state, exhausting traditional methods and tools for containing costs and experiencing increased

consumer sophistication and demands.

Change is being driven in the developing world by the growth of the middle class, greater demands from that middle class, and the globalization of economics. The following factors will influence more changes in health care system:

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 Health transition  demographic, epidemiological, emergence of infectious diseases  Latest advances in the technology  diagnostic, therapeutic, preventive

 Discovery and innovation in organ transplantation  Robot and computer assisted medical interventions  Molecular biology

 Genetic engineering and therapy  Information super highway  Total quality management  Consumerism

 Cost-effectiveness  Ethical and legal issues  Research and development  Evidence-based medicine

The Environment

An organization’s environment consists of forces and conditions that surround in it. An organization’s success or failure is wholly dependent on how effectively it copes with the competing demands of its environment. A typical hospital has two environmental components: one external and the other internal. The external environment can be further subdivided into two: the general, and the task environment. The general environment consists of political legal dimension, economic dimension, socio- culture dimension, technological dimension, the organization’s internal dimension. These dimensions might affect its activities and pose a threat or opportunity to it.

The task environment includes those external groups and forces with which an organization has direct contact and transactions competitors, suppliers, regulators, patients, health care professionals and agencies, unions, and professional associations.

The primary components of the internal environment consist of the self, the tasks, the process and skills the formal organizational design, the organizational culture, the individual employees or people system, together with the leadership function and shared vision of the organization. Bay analyzing the forces in the general environment and determining the interactive effects these have on the task and internal environments, management can be develop appropriate strategies and structures to meet these demands.

Demographic

The main problem faced by hospital services is their increasing costs or the changes needed to make them more efficient. This always seems to come back to the lot of caring for and treating elderly people and the burden that such treatment imposes on the hospital services. There is a feeling that the combination of increasing demands from elderly people and increasing severity of their disabilities will require more and more hospital services and that little of this can be substituted for by services in the patient’s home. Quite a high preparation of the hospital beds for the acute specialties is occupied by elderly people.

Economic

Health care is a common concern for every country. The USA spends about 14 per cent its gross domestic product on health care. This compares with 9 per cent in Canada, France and Germany, about 6 per cent in Japan and the UK. And less then 2 per cent in India. The price of hospitals and other institutional care has been rising very rapidly in all countries. Interestingly, New Zealand and the UK have felt driven to make rapid and extensive changes to the administrative structure of its health services by splitting it into two groups: purchasers of health services, who plan the service and providers, provide the service itself (consultation, operations), employ staff, thus having an effect on

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the individual and the society, on the country and on patients they live longer and better. There are many types of managed internal market throughout the world, each with different approaches, different external limits, and different methods of funding. In the UK, each purchasing group is based on a geographical area and is given fields according to the population in that area. Each health authority decides which providers to purchase its society from. The essence of the managed market in the UK is that there is competition between the NHS Trusts, the public providers, private health providers and others, including voluntary groups for the health authority’s finance. Patients are expected to exercise a choice of what services they want through their general practitioner who is expected to act as their advocate in finding the best quality services. The pressures on health services to develop new approaches have come, in the main, from a combination of the medical profession and industry developing complex equipment or drugs. The pressure to find new solutions is fed, on the one hand, by professionals and their need to do research into new methods and on the other by private industry requiring developing new market.

Technological

The full development of scientific knowledge in medicine depends on:  The existence of knowledge which can be applied;

 People with the skills to apply the knowledge ;  Social and political acceptability of the advance  Financial backing for its development ;

 Marketing skills for the development ; and  Financial spread for widespread manufacture.

The speed of development of scientific ideas and making them into useful products is affected by social, economic, and political conditions. Pressure on hospitals to use new technology has often been driven by industry where developing these technologies may be a spin-off from other work. Several advances in technology have been taken up by the medical profession for the development of home and community – based of care. Developments in management methods are as useful to health service as any manufacturing company. Telecommunications and computer technology are good examples of this. Many of the new technologies will help with the development of a less institutionalized health service. The development of monoclonal antibodies will be especially useful in reducing the need for in-patient care. Some other technologies that will lessen the need for inpatient service in future include diagnostic kits and desk top analyses, assessment systems using personal computers, new vaccines, laparoscopy and endoscopy. Vascular catheters with or without lasers, laser microsurgery and vaporization (e.g. for tumors), computer-controlled prosthesis, treatment and drug delivery systems. Technology can provide more in training.

Consumer Choice

One of the most powerful ways of deciding whether the quality of care is reasonable is to ask the patients who have been treated by that service as to how it affected them. This is not simply because of a desire to please, or to boost the reputation of a service and, therefore, the people providing it. Patient satisfaction is important because satisfied patients are more likely to cooperate with the people giving them health care. They are more likely to take advice they have been given.

Future Trends

The proportion and types of surgical operations carried out in day units, in contrast to conventional care in a hospital is increasing steadily. The use of conventional care is spread to virtually all the specialties. Some surgeons have gone so far as to suggest that virtually all minor and moderately complex surgery can be performed on a day basis with considerable financial savings. Surgery is gradually giving way to medical care in a number of specialties, including cardiovascular, gastrointestinal, treatment of cancers, etc. Developments in immunological control will allow specific

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treatment to be given to destroy abnormal cells using medical, rather than surgical techniques. For other diseases, such as diabetes, given gene therapy is likely to be important in cutting down the long-term reliance on specialist help.

Quality Management

Quality health care has emerged as a watchword in the 1990s. Major concern to improve the quality of care includes:

 Concern for the consumer  Concern for the quality of care

 Concern for the quality of management.

The introduction of total quality management (TQM) assumes that in organizations every one will continually strive for improvement by removing the need for error detection, striving to get it right first time, every time; by being better able to define priorities for action by providing agree care at the lowest cost; by identifying and removing patient dissatisfaction; by increasing consumer satisfaction; by improving processes and out-come’ and by increasing productivity. TQM is a management philosophy that requires total commitment from all levels in the hospital. Its main objectives are:

 Strong customer focus  Scientific approach

 Continues process improvement  Total participation at all levels.

Quality begins with the values held by the organization providing the care. The people providing the service may spend time concentrating on the particular and processes which can be monitored, giving less time other, less tangible and therefore less measurable of the work. The development of clinical guidelines is an approved to improving the quality of care. It may concentrate the positive side of setting out best practice in some detail. It relies on experts to help set up the guidelines. The best guidelines have the advantage of cutting across different specialty boundaries, given by general practitioners and which need specialist care. Some basic measures to show the quality of care given include:

 Hospital mortality

 Adverse events (e.g. nosocomial infection)  Malpractice suits

 Disciplinary action against doctors  Sanction from peer reviews

 Doctor's performance in treating specific disease  Number of services available

 External evaluations  Specialization of doctors

 Patients’ assessment of their care.

Quality management systems include medical audit surgical audit, nursing audit, clinical quality circle TQM, etc.

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Project Cost:

The break up of the estimated project cost of hospital is as follows which has been computed as follows:

Project Cost

Taka

Medical & Surgical Equipment 906,994,779

Electrical Installations, Air Conditioning, Generator, Lift etc. 143,630,000

Computer & IT Systems 22,275,000

Furniture & Fixture 30,000,000

Office Equipment 2,500,000

Vehicle 25,000,000

1,130,3999,799

Medical & Surgical Equipment 906,994,779

Diagnostic And Imaging 235,988,450

Biochemistry 17,592,000 Hematology 10,150,750 Histopathology 4,559,000 Clinical Pathology 3,166,000 Microbiology Lab 9,663,034 Cardiology 22,190,000 Gastroenterology 10,376,160 Neurology 5,270,729 Emergency 5,000,000

Master Health Check 12,000,000

Blood Bank 8,398,968 Ward 2,500,000 Neonatal ICU 8,624,761 Labor Ward 1,500,000 Dermatology Department 10,000,000 Respiratory Medicine 3,555,058 Urology Dept. 50,000,000 Nephrology Dept. 31,445,532 Oncology Department 202,266,980

General Ot(6 Nos) 100,000,000

Anesthesia Unit 11,003,591

Surgical ICU 7,500,000

Physiotherapy Dept. 3,887,842

Ct Ot 35,000,000

Coronary Care Unit 10,000,000

Cath Lab 75,000,000 Ophthalmic Opd 4,732,064 Dental Dept. 3,125,986 Ent Opd 1,797,874 Pediatric Opd 200,000 Obs/Gyn 500,000

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DIAGNOSTIC AND IMAGING 235,988,450

MACHINE NAME Quantity

CT Scan Machine, Work Station,Monitor,Injector,console 1

Bon Dencito Meter 1

BP Apparatus (CT Scan) 1

Defibrillator 1

MRI Machine,Console,Injector(1.5 Tesla) 1

Anesthesia Ventilator (Datex) 1

Patient Monitor (Cardiac) 1

BP Apparatus (MRI) 1

1000mA Digital X-Ray machine 2

800 mA X-ray Machine 2

Mammography machine 1

OPG Machine 1

CR System (XG-5000) Fuji. 1

BP Apparatus 2

4D Color Doppler -Ultrasound Machine, Antrase 2

PACS(Picture Archiving and Communication System) 4

BIOCHEMISTRY 17,592,000 Bio-Chemistry Analyzer (Beckman Coulter CX9 or CX7) 1

Dade Behring Max Rxi 1

Immulite 2500 1

Water Purification System 1

Blood Gas Analyzer(Rapid Lab 1200Gas Analyzer) 1

Centrifuge Machine 2

Electronic Balance 1

Hot air Oven 1

PH meter 1

Pipette(different Range) 2

Refrigerator for Reagent 2

Freezer -20 degree Celsius 1

HEMATOLOGY 10,150,750 MACHINE NAME Quantity Hematology cell counter 2

Centrifuge 2 Coagulation analyzer (CA-550) 1

Electra Lab (Auto ESR) 2 Hot air Oven 1 Incubator 1

Microscope Olympus BX-41 1

Microscope CX-21 1

Spectra Photo Meter 1

Water Bath 1

Roller Blood Mixer 1

BP Apparatus 1

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Capillary Hb electrophoresis 1 Micropipette 5 05-20 micro liter 2 50-100 micro liter 2 100-1000 micro liter 2 1000 micro liter 2 Refrigerator 2 HISTOPATHOLOGY 4,559,000

Rotary Microtome (Thermo Shandon, Leica) 1

Tissue Embedding System (Thermo Shandon, Lexica) 1

Tissue Processor (Thermo Shandon, Lexica) 1

Tissue Floating Bath (Thermo Shandon, Lexica) 1

Cryostat (Thermo Shandon, Lexica) 1

Electronic Weight Machine 2

Hot Air Oven (Thermo Shandon, Lexica) 1

Microscope (Olympus, Nikon, Zeiss) ₂

Ph Meter 1

Refrigerator (Lg) 1

Centrifuge (Heraeus-Labofuge-300) 1

Cytosine (Centrifuge) Thermo Shandon, Lexica. 1

CLINICAL PATHOLOGY 3,166,000

Microscope 2

Urine Analyzer 1

Centrifuge (8 Hole) 2

Water Bath 1

Micropipette 4

(20-50 micro liter,100-1000 micro Litr.)

Refrigerator 2

MICROBIOLOGY LAB 9,663,034

Biological safety Cabinet Class ii 2

Automated Blood culture & TB Culture 1

Autoclave Machine 1

Automated Antibiotic Zone Reader 1

Slide Heater 1

CO2 incubator 1

Centrifuge Machine Labofuge 300(heraeus) 2

Electronic Balance(Meter Toledo) 1

Anaerobic Jar(Oxide) 1

Micropipettes(Eppendorf) 10

Multi channel Micropipettes(Eppendorf) 1

Hot air Oven 1

Incubator-1 2

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PH meter 1

VDRL Rotor 1

Water Bath 1

Needle and loop Steam Sterilizer 1

Neflowmeter 1

Pipette stand 2

Motorized pipette aid 1

Vortex Mixer 1

CARDIOLOGY 22,190,000 MACHINE NAME Quantity ECG Machine 2

TMT/ETT System 2

Color Doppler Echocardiography System 2

Hand Carried Color Doppler Echocardiography Machine

with Cart 1 Holter Analyzer 2 Defibrillator 2 Ambulatory BP Recorder 2 Glucometer (Accu-Check) 5 Printer-Laser color 1 Printer-Thermal B/W 2 Printer-Thermal color 1 Halter Recorder 4 Printer-Normal 1 Pulse Oximeter 1 BP Apparatus 5 GASTROENTEROLOGY 10,376,160

Complete Vedioscope(set) 1

Upper G I Scope 2

Colonoscopy 2

Duodenoscope(set) 1

Bronchoscope(set) 1

Sony Color Video Printer 1

Leakage Tester 2

Trolley 2

ORTHOPAEDICS 15,000,000

Universal Drill Machine(Hand operated) 4

Drill Machine(Electric) 2

Hacksaw with Blade 2

Amputation saw 2

Bone saw(Electric) 2

Interlocking nailing Set 5

Bone Skid 2

T-extractor for femoral head 2

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Electric plaster cutter saw 2

Arthroscopy Machine with Accessories 2

C-Arm Machine 2

Halter Cervical traction set 2

Sterilizer 2

High pressure electric suction apparatus 1

Infusion pump 2

Syringe Pump 2

Other Instrument Set 1

Plaster Cutter 2

Large Joint Arthroscopic with cannula & obturator 2

Orthopedic Accessories 2

NEUROLOGY 5,270,729

Niclet Vita port 16 Channel Ambulatory EEG System 1

EMG 1

Laryngoscope 1

Defibrillator 1

EMERGENCY 5,000,000

Patient Monitor 4 Defibrillator 2 ECG Machine 1 Ventilator-Critical Care 1 Ventilator-Transport 1 Syringe Pump 4 Infusion Pump 1 O.T. Light 1 Pulse Oximeter 1 Suction Machine 2 Ophthalmoscope 1 Auto scope 1 Laryngoscope 1 Spot Light 1 Nebulizer 1 BP Apparatus 6

MASTER HEALTH CHECK 12,000,000

X-ray Machine 1

ECG Machine 1

Ultrasound Machine 1

TMT/ETT System 1

Color Doppler Echocardiography System 1

Mammography machine 1

Printer-Thermal B/W 1

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BP Apparatus 4

BLOOD BANK 8,398,968

Platelet Agitator 1

Microscope-Diagnostic 1

Refrigerator 3

Centrifuge 1

Digital blood Shaker 3

Doner Couch 3

ELISA Reader 1

ELISA Incubator 1

ELISA Washer 1

Hamo Control 1

Hot Air Oven 1

Tube Sealer 2

Plasma Expresser 1

Plasma Thawing Bath 1

Refrigerated Centrifuge 1 Plasma Expresser 2 Lab Rotator 1 Water Bath 1 BP Apparatus 2 Incubator-Path 1 Weighting Machine 1 Ward 2,500,000

ECG Machine 6 Defibrillator 6 Infusion Pump 6 Syringe Pump 6 Pulse Oximeter 6 Ophthalmoscope 6 BP Apparatus 20 Nebulizer 6 Neonatal ICU 8,624,761

Auto scope 2 Baby Incubator 3 CPAP-Bubble 2 Infant Warmer 6 Laryngoscope 6 Light Source-Halogen 1 Nebulizer 2 Ophthalmoscope 2

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Patient Monitor 6 Phototherapy Unit 4 Phototherapy Unit-Reflective 1 Pulse Oximeter 2 Syringe Pump 6 Transport Incubator 2 Ventilator-Neonate 4 LABOR WARD 1,500,000

Fetal Monitor 3 Patient Monitor 1 Defibrillator 1 Pulse Oximeter 1 Infusion Pump 1 Syringe Pump 1 Suction Machine 1 Laryngoscope 1 Spot Light 1 BP Apparatus 2 Nebulizer 1 DERMATOLOGY DEPARTMENT 10,000,000

Laser Machine 1

Cooling Device 1

Diathermy Machine 2

Electro Therapy Unit 1

Spot Light 3

Diagnostic Lamp 1

Spot Light 1

UV therapy unit-Partial body 2

UV therapy unit 1

UV therapy unit-Whole Body 1

Woods Light 1

O.T. Table 1

O.T. Light 1

BP Apparatus 1

RESPIRATORY MEDICINE 3,555,058

PFT System 2

Nebulizer 2

BP Apparatus 2

UROLOGY DEPT. 50,000,000

Urodynamic system 1

Adult cyst scope with Accessories 1

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Paedtric cyst scope with Accessories 1

Paedtric Reset cope with Accessories 1

Flexible Cityscape with accessories 1

Pneumatic Lithotripter with accessories 1

End vision Digital Single Chip Camera 1

BP Apparatus 1

NEPHROLOGY DEPT. 31,445,532

BP Apparatus 10 CRRT Machine 2 Defibrillator 2 Dialysis Machine 20 Laryngoscope 2 Nebulizer 2 Patient Chair-Dialysis 2 Pulse Oximeter 2 Weighting Machine 2 WRO Plant 2 ONCOLOGY DEPARTMENT 202,266,980

Linear Accelerator : 1

- 6 and 15 MV (dual) photon energy - 4 electron (6,9,12,15)

- Dose rate for photon and electron energy up to 400Mu/min - 120 leafs Multiyear Collimator

- Portal vision

- ARIA (Oncology Information System) HDR (Brachytherapy) : 1 - 24 channel Brachytherapy - Different Applicators - Radiation Source

Treatment Planning System (TPS) : - TPS for Linear Accelerator / Eclipse - TPS for Brachytherapy

Simulator :

- 3D Digital Simulator with CT facility

OR

- CT Simulator

Treatment facilities :

2D, 3DCRT, IMRT (with Rapid Arc) and IGRT

Other Supporting facilities :

- Laser system (3-4 units)

- Water phantom and Dosimeter system

- Immobilization sets

- On line UPS (150-160 kva)

- Off line UPS for all the relevant computers

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- Intercom system (2 way communication)

GENERAL OT(6 Nos) 100,000,000

Machine Name Quantity

Air Darmatone 2

Automatic Tourniquet System 3

Bipolar Coagulator 3

Bipolar ESU Unit 2

Bipolar Irrigation Module 2

Blood/Fluid Warmer 5

Bp Apparatus 6

Bronchoscope 3

Camera Head 6

C-Arm Machine 2

C-Arm Trolley With Video Monitor 2

Cauvery Machine 5

Co2 Endoflator-Electronic 2

Drill Machine-Ent 1

Drill-Neuro With Foot Switch 2

Drill-Orthopedics 5

Dvd Recorder 4

Harmonic Scalpel 2

Irrigation & Suction 2

Laryngoscope 5 Laser Machine 1 Light Source-Halogen 6 Light Source-Xenon 6 Lipoplasty Device 1 Lithoclast 1 Micro Motor-ENT 1 Microscope-Operating 4 O.T. Light 6 O.T. Table 6 Patient Monitor 6

Patient Warming System 2

Phaco Emulsifier 1

Plaster Cutter 6

Power Control Unit 4

Printer-Thermal Color 4

SAW & Drill Drive Unit 6

Saw-Ortho 2

Skin Masher System 2

Suction Pump 4

Suction-Vacuum (Gomco) 2

Syringe Pump 6

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Video Monitor 6

Video Processor 6

Anesthesia Unit 11,003,591

7900, 7100 Ventilation Complete With Aestiva/5 And Accessories

7900 Ventilation Complete With Aestiva/5 MRI Software

And Accessories

Neonatal Ventilator(DEAR CUB 750PSV) With

Humidifier (Fisher & Paykel Mr410)

Surgical ICU 7,500,000

Patient Monitor 8

Ventilator-Critical Care 6

Blood Gas Analyzer 1

Bi-Pap Machine 1 Cpap Machine 1 Defibrillator 1 Ecg Machine 1 Infusion Pump 4 Pulse Oximeter 1 Syringe Pump 15 Bp Apparatus 4 Ophthalmoscope 1 Nebulizer 2 Physiotherapy Dept. 3,887,842

Bed For Manual Therapy 1

Bp Apparatus 2

Cervical Traction Unit 1

Chilling Unit 1

Cpm Machine 1

Electro Stimulator 1

Emg Equipment 1

Instrument For Resistance Exercise, 1

Laser Machine 1

Microwave Therapy Unit 1

Nerve Stimulator 1

Pack Heaters 1

Parallel Bar 1

Quards Exercise Table 1

Short Wave Therapy 1

Standing Frame-Adult 1 Standing Frame-Pediatric 1 Static Bi-Cycle 1 Tilting Table 1 Traction Unit 1 Treadmill- Physio 1

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Ultrasound Unit-Physio 1

Wall Wheel Bar 1

Wax Bath 1

CT OT 35,000,000

Act Machine 2

Auto Clave Machine- Table Top 1

Baloon Pump 2

Cautery Machine 2

Defibrillator 2

Fabricator 2

Harmonic Scalpel 1

Heart Lung Machine 2

Hemo Therm 2

Light Source-Xenon 3

O.T. Table 2

Pacemaker 2

Patient Monitor 3

Patient Warming System 1

Saw-Manman 1

Saw-Sternal 2

Suction Machine 5

Suction-Vacuum (Gumbo) 4

Syringe Pump 6

Syringe Pump-Dps Base 2

Ventilator-Anesthesia 2

CORONARY CARE UNIT 10,000,000

Patient Monitor 10 Ultrasound Machine 1 Ventilator-Critical Care 6 Defibrillator 3 ECG Machine 1 Infusion Pump 6 Pulse Oximeter 1 Syringe Pump 8 Pacemaker 1 Ophthalmoscope 1 Laryngoscope 1 BP Apparatus 4 Nebulizer 2 CATH LAB 75,000,000

ACT Machine 2

Patient Monitor 4

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Injector-Cathlab 2 Defibrillator 2 Pacemaker 2 Pulse Oximeter 2 Syringe Pump 3 BP Apparatus 2 Nebulizer 2 OPTHALMIC OPD 4,732,064

Topcon Ophthalmic Chair ₄

Topcon Slit Lamp With Electric Instruments ₂

A - B Scan 1

Applanation Tonometer 2

Auto chart projector 2

Auto Kerato - Refract meter 2

BP Apparatus 1

Lens meter 2

Microscope-Slit lamp 2

Ophthalmoscope 3

Ophthalmic Unit 2

Ophthalmic-Electric Instrument Table 3

Retinoscope 1

Trial lenses set & trial frame 2

Visual Field Analyzer 1

Dental Dept. 3,125,986

X-ray machine 1

Micro motor-Dental 2

Scalar Machine 1

Compressor Unit 1

Diagnosis and Therapy Unit-Dental 1

BP Apparatus 1

ENT OPD 1,797,874

Diagnosis and Therapy Unit-ENT 1

Doctors Chair Unit 1

Clinical Audiometer 1

Clinical middle Ear analyzer 1

Microscope-Operating 1 Video Processor 1 Camera Head 1 Light Source-Halogen 3 Suction Machine 2 Auto scope 3 BP Apparatus 1

(22)

PEDIATRIC OPD 200,000

BP Apparatus 5

Nebulizer 1

Auto scope 1

OBS/GYN 500,000

Fetal Doppler 1

Ultrasound Machine 1

BP Apparatus 8

Fetal Doppler 1

Computer and IT Systems:

Computer & IT Systems 22,275,000

HIS Software System 5,000,000

Hardware System _10,000,000

HP COMPAQ DC5100, INTEL P4 3.0GHZ WITH 17"

LCD MONITOR

HP Laser Jet 1015 Printer with cable

EPSON LQ-2180 PRINTER (24 PIN/480 CPS/136

COLUMN)

UPS 1500 VA ( SENDON CHINA)

Sendon 1200 VA UPS

TAPE BACKUP DRIVE

CISCO SWITCH 48 PORT with 2 GBIC

NETWORK INFRASTRUCTURE _5,000,000

PA SYSTEM, CONSISTS OF - SPEAKER ;

AMPLIFIER ; SPEAKER CABLE ; POWER CABLE _500,000

Multimedia Projector

_500,000

Brand : Hitachi Model CPX-880 Origin : Japan

EPABX System

1,000,000

EPABX System With Std Accessories

Operator Console Model Enhanced AC - WIN V 4.0

Digital Key Phones Opti point 500 STD

BARCODE LABEL PRINTER _200,000

Javeline J310 C Card Printer _75,000

Electrical Installations, Air

Conditioning,Generator,Lift etc.

143,630,000

(23)

Boiler (Hot water generating and distribution system) 7,880,000

Hot Water Generator _2,500,000

Re-Circulating Pump _350,000 Copper Pipe _3,000,000 GI Pipe _75,000 Gate Valve _1,500,000 Ball Valve _5,000 Check Valve _75,000

Pressure Reducing Valve _300,000

Pressure Gauge, Testing and commissioning _75,000

External Electrification _25,000,000

SUPPLY OF SWITCH GEAR:

INCOMING FEEDER: 500,000

OUTGOING FEEDER 1,000,000

Transformer 5,000,000

SUPPLY & INSTALLATION OF L.T. PANEL: 3,000,000

EL.T. PANEL 3,000,000

SUPPLY & INSTALLATION OF AUTOMATIC PFI

PLANT: 2,500,000

SUPPLY & INSTALLATION OF BUSBAR TRUNKING

SYSTEM: 3,000,000

CABLE WORKS: 2,000,000

Cable Tray/Ladder 3,000,000

Connection fee and Security 2,000,000

HVAC Systems 18,700,000

Chiller(Cooling Capacity 200 Ton) 5,000,000

Cooling Tower 800,000

Air Handling Units(10 Nos) 3,000,000

Centrifugal Pumps (2 Nos.) 500,000

Pipe Accessories 400,000

Metering Devices 300,000

Automatic Control System 800,000

Hepa Filter with Hood 400,000

Installation with Local Accessories 7,500,000

Medical Gas System 20,000,000

Oxygen Storage Tank(5,000 Ltr.) 3,000,000

Nitrous Oxide 800,000

Compressed Air 3,000,000

Vacuum System 3,500,000

Copper Pipe 5,500,000

Alarm Panel for Medical gas 2,000,000

OT Pendant 2,000,000

Ball Valve for Medical Gas 200,000

(24)

Gas connection for the Hospital building including Electrical

Panel

Fire Fighting Equipment Systems 5,000,000

Diesel Genset(1 MW) 12,500,000

Kitchen Equipment 1,000,000

Integrated Cantilever Cooking System 1

3 Burner Gas Range (1700*500*850) 1

Single Burner Range (400*500*850) 1

3 Burner Gas Range ( 1800*500*850) 1

Wet Grinder 2

Cantilever Chef Cooking Unit 1

2 Burner High Presses. Work Range (1500*750*850) 2

1 Burner High Press. Work Range (750*750*850) 1

Banquet Trolley food warmer 10 GN 2/1(75*64*166) 1

Fly Catch Machine 1

CSSD _10,000,000

i. Steam Sterilizer HS 6613 AR-2 ₁

ii. Rails For Baskets 6613 ₁

iii. Manual Basket Feeder 6613 ₂

iv. Loading Trolley Fixed 6613 ₂

v. Basket Spri 585*395*195 MM 6613 ₁₈

vi. Steam Sterilizer HS 6617 AR-2 ₁

vii. Rails For Baskets 6617 ₁

viii. Manual Basket Feeder 6617 ₂

ix. Loading Trolley Fixed 6617 ₂

x. Basket Spri 585*395*195 Mm 6617 ₁₈

xi. Decomat Model 4656 G3d ₁

xii. Op-Cart, 4 Levels 4656 ₁

xiii. An-Care Without Cassettes ₁

xiv. Cassette For Hoses 20 Mm ₁

xv. Cassette For Hoses 5-25 Mm ₁

xvi. Cassette For 4 Bellows ₁

xvii. Rack For 14 Kidney Bowls ₁

xviii. Instr. Tray 340*250*70 Mm Hs33 ₈

xix. Drying Cab. S-363-E S/S Door ₁

xx. Ultrasonic DTH 8510 ₁

xxi. Tank Cover, Stainless 8510 ₁

xxii. Tray, Stainless, 450*240*150 Mm ₁

xxiii. Contingency Parts ₁

Electrolux Laundry Systems 3,500,000

Table With Wash Up Sink With Drain and Overflow

Washer Extractor Model W 3250 N, 250 Liters Drum

Washer Extractor Model W 3600X 600 Liters Drum

Washer Extractor Model W 3330 N 330litres Drum

Tumble Dryer Model T 3650, 650 Liters Drum

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Rolltainer RT 511 For Transportation And Storage

Steam Irons Finishing Table F3ABI

Air Operated Laundry Press Wet Work

Garment Rack KS150

JFC Roll Container 25OL, PT02

Auxiliary Plant For Use With Steam Boiler _3,500,000

Feed Water Tank

Pressure gauge with siphon

Pressure reducing station for steam

Sptrax Thermodynamic stream trap

Sptrax Automatic air vent module

Sptrax Float trap Module

Instantaneous Hot water generator

Sptrax Flash vessel

Steam operated condenser

Thermometer, Pressure Gauge

Waste Water Treatment Plant 4,000,000

1 Set mixing jet aerator 3.0 kw

1 Set mixing jet aerator 3.0 kw, 1 set of a IOTA Cyclic

clarifier iii. tube, s sets level switches, 1 sludge pump

& discharge pipe to sludge holding tank.2 effluent

pumps, 3 sets of level switches

Electrical control panel, 1 lots electrical cable, 1 lots of

internal piping and fitting, 1 chlorine tank, 2 metering pumps

Installation, Commission & delivery

Riello UPS 7,500,000

Riello RT 12000 120KVA online UPS 2

Riello RT 6000 60KVA online UPS 2

Riello MDM1500 15 KVA online UPS 2

Waste Disposal System 1,600,000

Horizontal cylindrical autoclave, Capacity-50 Ltr. 1

Plastic shredder HS-25, Capacity- 25 Kg/Hr. 1

Destronix needle-cum-syringe destroyer 40

Puncture proof containers, Capacity-55 Ltr. 60

Fully Automatic High Speed Sterilizer 2

Water Purification Equipment 500,000

Reverse Osmosis system 12M3 /Day 1

Ultraviolet System Model UV. A-400 1

Incinerator

2,000,000

Capacity 50KG/HR, Origin-India 1

PEDROLLO WATER PUMP, 0.6HP, 240V, 50HZ, MODEL

- 3CRM 80

Refrigerator

_750,000

Brand: Toshiba

a) Model : GR-E9 ₂₅

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Capacity 1000 Kgs/ 13 person 2,000,000

MATV

500,000

Television (CRT) Plasma TV Cabling work Dish antenna control panels

EXTERNAL WATER SUPPLY

8,700,000

Deep Tube Well 6,500,000

Chlorination Plant 1,000,000

Water Supply Centrifugal Pump and other accessories 500,000

2 Units of Submersible Pump 700,000

CC TV 500,000

Camera with color monitor

Mortuary 1,000,000

8-Body Mortuary Chambers

Furniture & Fixture

30,000,000

Description Qty

Manual Bed 100

Electric Bed 100

Patient Attendant Bed 100

Bed Matress 300 TV with Trolley 100 Stretcher trolley 25 Ambulance Stretcher 2 Cupboard QL 960-2 25 Baby Trolley 10 Orthopedics Bed 15 Cupboard QL 860 2

Transitional Stretcher Trolley 1

Trolley For Oxygen Bottle 15

Appliances Trolley QL 811 10

Adjustable Stool For Surgical 10

Over Bed Table 175

Medical Material Trolley 10

Model DC 1011 Bassinet Cot 5

Model CA 3000 Medical Emergency Cart 20

Model WM 542 Doctor Surgical Stool Technology 10

Banquet trolley 8

Service trolley 4

3 Seater Sofa 50

2 Seater Sofa 50

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Nurses Locker 100

Doctors Locker 25

Medicine Shelve 12

Office Table For Directors With Side Table 3

Coffee Table 100

Discussion Table 15

Conference Table 1

Executive Dining Table 15

Staff Dining Table W/4 - Fixed Chairs 50

Chairs For Reception And Nurse Station 50

Chairs For General Staff 50

Chairs For Doctors And Department Heads 65

Chairs For Doctors And Executive Dining 50

Chairs For Director 3

Storage cabinet/shelve for director, CEO 5

Stool For Laboratory 25

Stool For Patient 50

Executives Table 50

Executive Chair 100

Visitor Chair 400

Nursing Trolley 25

X-RAY View Box (800*580*80 MM) 50

X-RAY View Box (1160*580*80 MM) 50

Appliance Trolley 50

Fan Shape Appliance Trolley 25

Dressing Trolley 25

Dressing Waste Trolley 18

Anesthetist Trolley 16

Surgical Instrument Trolley 16

Medication Material Trolley 16

Trays For Material Trolley 100

Iv Pump Stand 30

Patient Record Cabinet 25

Four Sections Screen 100

Three Sections Screen 100

Baby's Scale For Height 2

SS Revolving Stool 50

Scrub Station 8

Pharmacy cabinet 10

Consultants Chamber Cabinet 50

Examination Bed(Patient) 50 Steel Almirah 25 Steel Cabinet 50 Shoe Rack 50 Cafetaria Table 50 Cafeteria Chair 200

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Counter

2,000,000 Nurse Station 1,000,000 Dialysis 1 ICU/CCU. 2 Sick-nicu 1 Pre-Term Nicu 1

Labor & Delivery 1

Semi Private Room 1

Day Care Word 1

Surgical Step Dn. 1 Surgical I.C.U. 1 Pre-Operative Ward 1 Post-Operative Word 1 Neuro Medical/Surgical IC 1 CT-Post Operation 1 Pre-Post Angiography 1

Reception Counter

500,000

Information(Ground floor) 1 Diagnostic 1 O.P.D. (Cardiology) 1 O.P.D. 1 M.H.C 1 Blood Bank 1 Emergency recap 1 Endoscopy 1

Radiology & Imagine 1

Nuclear Medicine 1

Main entrance Lobby 1

Labor & delivery (F.F) 1

Billing 1

Work Counters in different locations:

500,000

Sample Collection 1 Sterilizer 1 TD Lab 1 Component Store 1 Serology 1 Dark-Room 1 Sample Collection 1 Sub-Sterile 1 Clean-Utility 1 Decontamination 1 Radio-Pharmacy 1

Office Equipment

2,500,000

Banknote counting Machine 5

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ELECTRONIC CASH REGISTER MACHINE ₂

SONY DIGITAL CAMERA ₁

Plain paper fax machine 1

Panasonic fax modem 3

Plain Paper Copier ₃

LAMINATING MACHINE ₁

SPIRAL BINDING MACHINE ₁

Vehicle

25,000,000

Description Qty.

Cardiac (Life Support) Ambulance 1

Toyota Ambulance (2000CC) 1

Car (Chairman/MD/CEO/DMS/MKTG.) 5

MICRO BUS (Office Pool) 1

Revenue:

Revenue forecasts are based on capacity utilization basis market dynamics and size. Overall growth has been projected compared to immediate preceding year is 20%, 20%, 20%, 20%,10%,10% and 10% in the year 2013, 2014, 2015,2016,2017,2018,2019 and 2020 respectively. While calculating revenue the industry average has been taken into consideration basis data collected from the top five hospitals/diagnostic centre of the city through interview. Projected counts (number of times) in different service types like consultations, investigations, Surgery & procedures and others, except pharmacy, has been estimated based on the capacity utilization of services while pharmacy sales based on the average prescription generated daily, monthly and yearly basis.

Capacity utilization:

There will be 49 clinical consultants chamber in the hospital where there will be two shifts. During day time from 9.00 am to 5pm one group will work while the second group will start from 5.30 pm and continue till 11.30 pm.At the initial years we are expecting to utilize capacity @ of 50%,55% 60%, 65%,70%,75%,80%,85% in the year 2012, 2013, 2014, 2015,2016,2017,2018,2019 and 2020 respectively.

Projected Income Statement(2014-2020)

2014 2015 2016 2017 2018 2019 2020 2021 Net revenue Taka Taka Taka Taka Taka Taka Taka Taka

Revenue from Healthcare Services 829,046,5 37 983,975,3 69 1,206,634,6 68 1,460,702,0 00 1,692,225,4 45 1,859,524,7 42 2,089,366,3 37 2,319,562,5 03 Direct operating expenses

Food & beverages

9,730,350 10,503,00 0 11,275,650 13,099,500 13,061,850 13,845,450 14,618,100 15,390,750 House keeping 2,925,005 2,955,717 2,986,752 3,018,113 3,049,803 3,081,826 3,114,186 3,146,885 Sterilization 973,035 1,102,815 1,243,140 1,516,431 1,587,676 1,767,069 1,958,965 2,165,633 Medical Gas 4,865,175 5,514,075 6,215,702 7,582,154 7,938,380 8,835,346 9,794,826 10,828,165 Consultants fees 213,257,9 87 263,374,4 41 343,420,74 6 418,056,02 4 498,971,44 5 554,011,06 6 647,110,16 9 729,550,41 4 231,751,5 52 283,450,0 48 365,141,99 1 443,272,22 2 524,609,15 5 581,540,75 8 676,596,24 6 761,081,84 7 Power & energy

Gas expenses for hospitals 4,265,632 4,478,914 4,702,859 4,938,002 5,184,902 5,444,147 5,716,355 6,002,173 Hospitals electricity 3,656,256 3,839,069 4,031,022 4,232,573 4,444,202 4,666,412 4,899,733 5,144,719

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7,921,888 8,317,982 8,733,882 9,170,576 9,629,104 10,110,560 10,616,088 11,146,892 Other direct expenses Laundry expenses 324,345 367,605 414,380 505,477 529,225 589,023 652,988 721,878 Linen for hospital &

patient 810,863 919,013 1,035,950 1,263,692 1,323,063 1,472,558 1,632,471 1,804,694 Security Services 4,590,000 4,819,500 5,060,475 5,313,499 5,579,174 5,858,132 6,151,039 6,458,591 5,725,208 6,106,118 6,510,805 7,082,668 7,431,462 7,919,713 8,436,498 8,985,163 Hospitals supplies Reagent Cost 40,593,75 8 48,712,50 9 58,455,011 70,146,013 84,175,216 92,592,737 101,852,01 1 112,037,21 2 Consumables 50,496,71 7 60,596,00 2 72,715,143 87,258,113 104,709,67 6 115,180,61 4 126,698,64 6 139,368,48 1 Medicine 53,913,60 0 68,428,80 0 82,114,560 101,088,00 0 105,131,52 0 117,573,12 0 127,526,40 0 146,188,80 0 Outsourced Test Expenses 1,800,000 1,890,000 1,984,500 2,083,725 2,187,911 2,297,307 2,412,172 2,532,781 146,804,0 75 179,627,3 11 215,269,21 4 260,575,85 1 296,204,32 3 327,643,77 8 358,489,22 9 400,127,27 4

Direct operating cost

392,202,7 22 477,501,4 59 595,655,89 2 720,101,31 7 837,874,04 5 927,214,80 9 1,054,138,0 61 1,181,341,1 76 Gross Profit 436,843,8 15 506,473,9 10 610,978,77 6 740,600,68 3 854,351,40 0 932,309,93 3 1,035,228,2 76 1,138,221,3 27 GP % 53 51 51 51 50 50 50 49 General Admin Expenses Salary and Allowances 182,993,2 00 213,873,3 03 276,777,21 5 304,454,93 7 334,900,43 0 368,390,47 3 405,229,52 0 445,752,47 3 Training & development 36,598,64 0 38,428,57 2 1,921,429 2,017,500 2,118,375 2,224,294 2,335,508 2,452,284 Traveling and Conveyance 1,829,932 1,921,429 2,017,500 2,118,375 2,224,294 2,335,508 2,452,284 2,574,898 Ambulance and Car

Expenses 1,200,000 1,260,000 1,323,000 1,389,150 1,458,608 1,531,538 1,608,115 1,688,521 Entertainment 600,000 630,000 661,500 694,575 729,304 765,769 804,057 844,260 Legal and audit fees

1,000,000 1,050,000 1,102,500 1,157,625 1,215,506 1,276,282 1,340,096 1,407,100 Repair & maintenance

500,000 550,000 605,000 5,000,000 5,500,000 6,050,000 6,655,000 7,320,500 Printing & stationery

2,400,000 2,520,000 2,646,000 2,778,300 2,917,215 3,063,076 3,216,230 3,377,041 Communication 3,000,000 3,150,000 3,307,500 3,472,875 3,646,519 3,828,845 4,020,287 4,221,301 Insurance premium 1,800,000 1,890,000 1,984,500 2,083,725 2,187,911 2,297,307 2,412,172 2,532,781 Marketing Expenses 30,000,00 0 24,000,00 0 19,200,000 15,360,000 20,000,000 20,000,000 20,000,000 20,000,000 Other admin expenses

2,500,000 2,625,000 2,756,250 2,894,063 3,038,766 3,190,704 3,350,239 3,517,751 264,421,7 72 291,898,3 03 314,302,39 4 343,421,12 4 379,936,92 7 414,953,79 5 453,423,50 8 495,688,91 0 EBITD 172,422,0 43 214,575,6 07 296,676,38 2 397,179,55 9 474,414,47 3 517,356,13 8 581,804,76 7 642,532,41 7 EBITD % 21 22 25 27 28 28 28 28 Depreciation 173,419,1 97 177,494,1 97 181,569,19 7 185,644,19 7 183,825,44 7 180,325,44 7 183,325,44 7 186,325,44 7 Financing charges 75,623,15 4 71,174,99 7 49,392,967 47,012,324 42,046,710 34,432,526 27,099,263 11,102,749 EBT (76,620,3 08) (34,093,5 87) 65,714,218 164,523,03 8 248,542,31 6 302,598,16 5 371,380,05 7 445,104,22 1 Other Income 9,249,600 9,676,080 10,123,164 10,591,868 11,083,258 11,598,453 12,138,629 12,705,018 Income [email protected]% 0 0 0 0 0 86,404,070 105,467,63 9 125,897,54 1 Earnings After Tax(EAT) (67,370,7 08) (24,417,5 07) 75,837,382 175,114,90 6 259,625,57 4 227,792,54 8 278,051,04 7 331,911,69 8

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Summary of Projected Revenue Calculation

2013 2014 2015 2016 2017 2018 2019 2020

Segment Taka Taka Taka Taka Taka Taka Taka Taka

Registration 11,232,000 7,128,000 5,132,160 4,212,000 4,380,480 2,939,328 2,125,440 2,436,480 Consultation 112,320,000 171,072,000 222,393,600 294,840,000 328,536,000 391,910,400 478,224,000 578,664,000 Bed Charges 64,790,900 73,678,100 84,843,800 112,579,200 101,142,800 115,042,050 123,059,000 127,790,950 Surgery 138,740,044 166,487,757 199,785,013 239,741,721 287,689,770 316,458,599 348,104,311 382,914,595 Procedure 113,743,544 136,492,252 163,790,703 196,548,843 235,858,612 259,444,473 285,388,920 313,927,812 Lab Medicine 159,091,000 190,909,200 229,091,040 274,909,248 329,891,098 362,880,207 399,168,228 439,085,051 Diagnistic and Imaging 111,534,050 133,840,860 160,609,032 192,730,838 231,277,006 254,404,707 279,845,177 307,829,695 Pharmacy 67,392,000 85,536,000 102,643,200 126,360,000 131,414,400 146,966,400 159,408,000 182,736,000 778,843,537 965,144,169 1,168,288,548 1,441,921,850 1,650,190,165 1,850,046,164 2,075,323,077 2,335,384,583

Hospital revenues can be classified mainly into 8(eight) broad categories, such as Registration, Consultation, Bed Charges, Surgery, Procedures, Lab Medicine, Diagnostic and Imaging and from sale of medicine. The segment wise percentage of sales in the years 2013 has been estimated to be @ 1%,14%,8%,18%,15%20%,14% and 9% respectively. The net revenue of Taka 778,843,537 has been calculated for the year 2013 on the basis of daily average sales of Taka 2,500,000.In reality hospital projects grow rapidly in the initial years provided there is excellent customer service with quality control in every aspects of operational activity. Basis industry trend we have projected year to year growth to be @ of 22% till 2016 while it is @ 12% in the next following years till 2018.

Revenue from Registration:

Registration Revenue

Description 2013 2014 2015 2016 2017 2018 2019 2020

Taka Taka Taka Taka Taka Taka Taka Taka

Count 224,640 285,120 342,144 421,200 438,048 489,888 531,360 609,120 Ratio to Consultations 50.00 25.00 15.00 10.00 5.00 3.00 2.00 2.00 Capacity Utilized 112,320 71,280 51,322 42,120 21,902 14,697 10,627 12,182 Revenue Per Count 100 100 100 100 200 200 200 200 Registration 11,232,00 0 7,128,00 0 5,132,160 4,212,000 4,380,48 0 2,939,32 8 2,125,44 0 2,436,48 0

Registration fee per patient for the initial 4 years has been proposed @ Taka 100.00 and Taka 200 for the following years till 2020.This is one time payment for a patient for the life time. The number of patient will get registered in the years 2013,2014,2015,2016,2017,2018,2019 and 2020 to be 112,320, 71,280,51,322,42,120,21,902,14,637,10,627 and 2,182 respectively. Only new patient visiting the

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hospital will require to be registered along with the hospital system and all patient history will be maintained in the systems basis this unique ID number for easy identification and complete medical record. Since the repeat patient will not require to be registered the revenue might not increase year to year unless new patient comes in to the hospital.

Consultation Revenue:

CONSULTATION REVENUE

2013 2014 2015 2016 2017 2018 2019 2020

Taka Taka Taka Taka Taka Taka Taka Taka

Consultants 52 60 66 75 78 81 82 94 Consultation slots Per day/consultant 30 30 30 30 30 30 30 30

Week days per week

6 6 6 6 6 6 6 6

Month/ Year Weeks/ Year

48 48 48 48 48 48 48 48 Capacity Count 449,280 518,400 570,240 648,000 673,920 699,840 708,480 812,160 Capacity Utilized Count 224,640 285,120 342,144 421,200 438,048 489,888 531,360 609,120 Percentage Utilized 50.00% 55.00% 60.00% 65.00% 65.00% 70.00% 75.00% 75.00% Revenue Per Count 500 600 650 700 750 800 900 950 Consultation 112,320,000 171,072,000 222,393,600 294,840,000 328,536,000 391,910,400 478,224,000 578,664,000

There will be both full and part time consultants in the hospital between two shifts. Full time consultants will start their clinic at 9.00 am and continue till 5.00pm while the part time consultants will start their clinic from 5.30 pm and continue till 11.30 pm.A total of 52 consultants (in 2013) both full and part time basis will be in the OPD clinic who will do both OPD and IPD services for their own patient simultaneously. Every consultant will be allowed a standard of 30 slots a day and will work for 48 weeks in a year on 6 working day/week basis. For consultation fees calculation purpose

we have calculated 50% capacity utilization in the 1st year while this is 55%,60%,65%,65%,70%,75%

and75% in the years 2014,2015,2016,2017,2018,2019 and 2020 respectively. Consultation fee per visit has been assumed to be Taka 500 in the year 2013 and Taka 600 in 2014,Taka 650 in 2015,Taka 700 in 2016,Taka 750 in 2017,Taka 800 in 2018,Taka 900 in 2019 and Taka 950 in 2020.Basis above assumptions revenue have been projected for Taka 112,320,000 in 2013 ,Taka171,072,000 in 2014,Taka 222,333,600 in 2015,Taka 234,840,000 in 2016,Taka 328,536,000 in 2017,Taka 391,910,400 in 2018,taka 478,224,000 in 2019 and Taka 578,664,000.

Bed Revenue:

BED REVENUE PROJECTIONS

2013 2014 2015 2016 2017 2018 2019 2020

Revenue Revenue Revenue Revenue Revenue Revenue Revenue Revenue