Healthcare Providers & Facilities

Transcription

1 Healthcare Providers & Facilities M A R K E T M O N I T O R F A L L

2 Contents INDUSTRY UPDATE 3 PUBLIC STOCK PERFORMANCE & VALUATIONS 4 RECENT INDUSTRY M&A TRANSACTIONS 9 EQUITY-RELATED CAPITAL RAISES 12 MOSS ADAMS CAPITAL OVERVIEW 15 SELECTED MOSS ADAMS CAPITAL TRANSACTIONS 17 CONTACT INFORMATION 18 2

3 Industry Update Consolidation Continues as Providers Seek Operating Scale & Efficiencies Biggest challenge facing providers remains implementing the Affordable Care Act (ACA) Operating expenses have risen as hospitals seek to understand and comply with new and required regulatory changes. Outpatient volumes increase and inpatient volumes decline as pressure to cut costs are causing providers to shift one-day (inpatient) admissions to outpatient care. Unfortunately, outpatient service is lower margin business than inpatient service. The majority of new plans/patients are covered by issuers with lower reimbursement rates and many hospitals are losing money on these patients. There is increasing pressure to prepare for value-based payment systems. Under these new payment systems, such as accountable care organizations (ACO s), health systems are paid for the value they create for their patients rather than for the volume of services they provide. Increasing transparency into provider costs and quality are leading consumers to reassess their primary care provider. As a result, the need for healthcare systems to consolidate and/or affiliate continues. Pressures mount on hospitals and hospital systems to consolidate, as a way to increase scale and operating efficiencies. Independent and standalone hospitals are having an increasingly difficult time remaining competitive, and profitable. Clinics continue to lose market share, which has led to both vertical and horizontal integration: Providers have looked to vertical integration (hospitals acquiring like hospitals) in order to pool resources, cut costs due to increased scale, and improve bargaining power amongst payors. Providers have also looked to horizontal integration (acquiring additional services) in order to become a true healthcare system and improve the quality of service and care provided for consumers. Consolidation has taken many forms, including affiliation through acquisition, membership substitution, joint venture, or clinic affiliations. However, consolidation volume has declined slightly from recent 2012/13 highs, as providers focus on cutting costs with their existing operations. Hospital consolidation is expected to remain elevated for at least the next five years. Sources: Accenture, Wall Street Journal, Company 10-Q filings, Moss Adams Capital analysis. 3

4 Market Performance HC Providers / Facilities Valuations Rebound with Favorable Growth Expectations EV/EBITDA multiples have rebounded from a 2Q decline with the Senior/Assisted Living industry niche leading the pack, at 16.9x, followed closely by Healthcare Distributors, at 13.9x. The Home Health and Healthcare Services indices are trading in-line with the S&P 500 Index, while Acute Care and Postacute Care continue to lag behind the broader market, trading at 9.6x and 9.0x EBITDA, respectively. Healthcare Providers & Facilities vs S&P The outlook for the overall industry group remains positive, with the revenue growth rate for five of the six industry niches expected to outpace the S&P 500 over the next 12 months. Expectations for the Acute Care Hospitals industry niche continues to be the most promising of the group, with 21.7% revenue growth expected over the next 12 months. Next 12 Months: Estimated Sales Growth 20.0x Senior / Assisted Living 35% 18.0x 16.0x 14.0x 12.0x 10.0x 8.0x 6.0x 4.0x 16.9x Healthcare Distributors 13.9x Home Care / Home Health / Hospice 10.9x S&P x Healthcare Services 10.2x Acute Care Hospitals 9.6x Post-Acute Care / Rehab 9.0x 30% 25% 20% 15% 10% 5% 0% Acute Care Hospitals 21.7% Post-acute Care/Rehab 7.4% Senior/ Assisted Living 17.6% Homecare/Home Health/Hospice 12.0% Healthcare Services 9.9% Healthcare Distributors 3.2% S&P % Note: The Healthcare Providers & Facilities indices are composed of the public companies included on pages Estimated growth is based on the median estimates of Wall Street analysts. Source: S&P Capital IQ. 4

5 Market Performance Healthcare Providers & Facilities Recent Stock Market Performance Over the past three years, only one of the six Healthcare Providers & Facilities industry niches has underperformed the S&P 500. Healthcare Services posted a gain of 32.3% vs. a 53.7% gain of the broader S&P 500. The remaining five industry niches, Acute Care Hospitals, Healthcare Distributors, Senior/Assisted Living, Home/Hospice Care, and Post- Acute Care/Rehab, have outperformed the S&P 500, posting gains of 175.5%, 98.0%, 91.4% 84.0%, and 83.5% respectively. 3-Year Indexed Stock Price Performance 175% Acute Care Hospitals 175.5% Healthcare Distributors 98.0% 125% Senior / Assisted Living 91.4% 75% Home Care / Home Health / Hospice 84.0% 25% Post-Acute Care / Rehab 83.5% S&P % -25% Healthcare Services 32.3% Note: The Healthcare Providers & Facilities indices are composed of the public companies included on pages Source: S&P Capital IQ. 5

6 Acute Care Hospitals & Post-Acute Care / Rehab: Valuation Metrics ($US in millions, except per share amounts) Company Name Acute Care Hospitals 10/31/14 TTM Data NTM Est. Growth EV Multiple Share Price 52 Week High - Low Market Cap Enterprise Value Sales EBITDA EBITDA Margin Sales EBITDA HCA Holdings, Inc. $71.25 $ $43.20 $30,807 $60,293 $35,354 $6, % 7.5% 8.2% 1.7x 8.7x 1.6x 8.1x Universal Health Services Inc ,581 13,876 7,557 1, % 18.4% 11.3% 1.8x 10.0x 1.6x 9.0x Community Health Systems, Inc ,534 23,770 15,509 1, % 30.7% 56.9% 1.5x 12.0x 1.2x 7.6x Tenet Healthcare Corp ,704 17,227 14,261 1, % 25.0% 35.5% 1.2x 10.9x 1.0x 8.0x Lifepoint Hospitals Inc ,216 5,119 3, % 17.9% 24.8% 1.3x 9.8x 1.1x 7.9x Acadia Healthcare Company, Inc ,189 3, % 50.4% 64.6% 4.4x 22.2x 2.9x 13.5x TTM Sales TTM EBITDA NTM Sales NTM EBITDA Median $15,551 $10,909 $1, % 21.7% 30.1% 1.6x 10.4x 1.4x 8.1x Average $20,621 $12,896 $2, % 25.0% 33.5% 2.0x 12.3x 1.5x 9.0x Post-acute Care/Rehab HEALTHSOUTH Corp. $39.60 $ $29.82 $3,474 $5,079 $2,303 $ % 7.4% 4.9% 2.2x 8.8x 2.1x 8.4x Select Medical Holdings Corporation ,662 3,310 2, % 5.3% 6.2% 1.1x 9.3x 1.1x 8.7x Kindred Healthcare Inc ,340 2,781 5, % 3.7% 40.2% 0.6x 9.9x 0.5x 7.1x National Healthcare Corp % 9.2% (100.0%) 1.0x 7.7x 0.9x NA US Physical Therapy Inc % 11.6% (6.3%) 1.9x 11.1x 1.7x 11.8x Median $2,781 $2,303 $ % 7.4% 4.9% 1.1x 9.3x 1.1x 8.6x Average $2,509 $2,278 $ % 7.4% (11.0%) 1.4x 9.4x 1.3x 9.0x Note: Not meaningful (NM) if EV/Revenue is greater than 5x, or EV/EBITDA is greater than 20x. NA if denominator is 0, for percentages and multiples, or if estimates are not available. NTM figures are based on the median estimate of Wall St. analysts. Source: S&P Capital IQ. 6

7 Senior / Assisted Living & Home Care / Hospice: Valuation Metrics ($US in millions, except per share amounts) Company Name Senior/Assisted Living 10/31/14 TTM Data NTM Est. Growth EV Multiple Share 52 Week Market Enterprise EBITDA TTM TTM NTM Price High - Low Cap Value Sales EBITDA Margin Sales EBITDA Sales EBITDA Sales NTM EBITDA Brookdale Senior Living Inc. $32.94 $ $26.11 $5,698 $8,208 $2,604 $ % 88.5% 92.1% 3.2x 18.3x 1.7x 9.5x Capital Senior Living Corp , % 14.2% 47.2% 3.4x 22.7x 3.0x 15.4x Skilled Healthcare Group, Inc % 1.6% 17.7% 0.8x 10.1x 0.8x 8.6x Five Star Quality Care Inc , % 21.1% 25.8% 0.2x 5.9x 0.2x 4.7x Median $940 $959 $ % 17.6% 36.5% 2.0x 14.2x 1.2x 9.1x Average $2,579 $1,219 $ % 31.3% 45.7% 1.9x 14.3x 1.4x 9.6x Homecare/Home Health/Hospice Chemed Corp. $ $ $64.16 $1,772 $1,880 $1,408 $ % 5.2% 16.3% 1.3x 10.2x 1.3x 8.8x The Ensign Group, Inc % 12.0% (9.0%) 0.8x 6.4x 0.7x 7.0x Gentiva Health Services Inc ,776 1, % 7.1% 40.9% 0.9x 12.5x 0.9x 8.9x Amedisys Inc , % 1.4% 111.8% 0.7x 24.1x 0.7x 11.4x LHC Group, Inc % 14.4% 10.9% 0.7x 9.0x 0.6x 8.1x Addus HomeCare Corporation % 13.9% 38.6% 0.6x 9.9x 0.6x 7.1x Almost Family Inc % 16.7% 92.7% 0.7x 17.3x 0.6x 9.0x Median $757 $956 $54 7.6% 12.0% 38.6% 0.7x 10.2x 0.7x 8.8x Average $891 $975 $82 7.8% 10.1% 43.2% 0.8x 12.8x 0.8x 8.6x Note: Not meaningful (NM) if EV/Revenue is greater than 5x, or EV/EBITDA is greater than 20x. NA if denominator is 0, for percentages and multiples, or if estimates are not available. NTM figures are based on the median estimate of Wall St. analysts. Source: S&P Capital IQ. 7

8 Healthcare Services & Distributors: Valuation Metrics ($US in millions, except per share amounts) Company Name Healthcare Services 10/31/14 TTM Data NTM Est. Growth EV Multiple Share Price 52 Week High - Low Market Cap Enterprise Value Sales EBITDA EBITDA Margin Sales EBITDA Quest Diagnostics Inc. $62.58 $ $50.46 $9,037 $12,707 $7,308 $1, % (100.0%) (100.0%) 1.7x 8.7x NA NA Laboratory Corp. of America Holdings ,757 11,128 5,846 1, % 2.6% 4.8% 1.9x 9.8x 1.9x 9.4x Team Health Holdings, Inc ,330 4,525 2, % 12.8% 25.1% 1.8x 16.9x 1.6x 13.5x IPC The Hospitalist Company, Inc % 9.9% 7.7% 1.3x 12.0x 1.1x 11.1x Healthways Inc % 11.7% 177.8% 1.1x 24.1x 1.0x 8.7x TTM Sales TTM EBITDA NTM Sales NTM EBITDA Median $4,525 $2,545 $ % 9.9% 7.7% 1.7x 12.0x 1.4x 10.2x Average $5,998 $3,414 $ % (12.6%) 23.1% 1.6x 14.3x 1.4x 10.7x Healthcare Distributors McKesson Corporation $ $ $ $45,949 $53,648 $149,428 $3, % 17.4% 50.3% 0.4x 16.0x 0.3x 10.6x Cardinal Health, Inc ,732 26,650 91,084 2, % 0.9% 13.1% 0.3x 11.2x 0.3x 9.9x AmerisourceBergen Corporation ,363 17, ,449 1, % 9.3% 55.9% 0.2x 15.3x 0.1x 9.8x Henry Schein, Inc ,888 10,976 9, % 6.4% 9.6% 1.1x 13.3x 1.0x 12.2x Patterson Companies, Inc ,219 4,604 4, % 2.4% 7.1% 1.1x 11.5x 1.1x 10.7x Owens & Minor Inc ,118 2,232 9, % 3.2% 16.4% 0.2x 9.4x 0.2x 8.1x MWI Veterinary Supply, Inc ,976 2,016 2, % 13.1% 13.0% 0.7x 15.9x 0.6x 14.1x PharMerica Corporation ,066 1, % 2.0% 19.3% 0.6x 9.5x 0.6x 8.0x Chindex International Inc % (100.0%) (100.0%) 0.0x 0.0x NA NA Median $4,604 $9,151 $ % 3.2% 13.1% 0.4x 11.5x 0.4x 10.3x Average $13,235 $42,339 $ % (5.0%) 9.4% 0.5x 11.4x 0.5x 10.4x Note: Not meaningful (NM) if EV/Revenue is greater than 5x, or EV/EBITDA is greater than 20x. NA if denominator is 0, for percentages and multiples, or if estimates are not available. NTM figures are based on the median estimate of Wall St. analysts. Source: S&P Capital IQ. 8

9 Number of Announced Transactions Overview of Selected HC Providers M&A Transactions Kindred Healthcare Inc. (NYSE:KND) acquires Gentiva Health Services (Nasdaq:GTIV) October 9, 2014 On October 9, 2014, Kindred Healthcare Inc. (NYSE:KND), a provider of acute-care services in the U.S., agreed to acquire Gentiva Health Services (Nasdaq:GTIV), a provider of health and home hospice services, for $720 million in cash and stock. Kindred s $720 million offer equates to $19.50 per share and represents a 17% premium to Gentiva s closing price at the date of announcement. This also represents a 50% boost of Kindred s initial $13 per share offer it made 5-months ago. Gentiva has downsized its operations in recent quarters amid tougher reimbursement from Medicare and Medicaid. The combination will allow the combined companies to improve scale and operating efficiency, as about 70% of combined revenues will come from government programs. The combined company will be based in Louisville, Ky, and will be the nation s largest provider of long-term, acute-care hospitals; inpatient rehabilitation facilities; and hospice and homehealth services with annual revenue of $7.1 billion. Providers & Facilities Mid-Market M&A* Steris Corporation (NYSE:STE) agrees to buy Synergy Health Plc (LON:SYR) October 13, 2014 Steris Corporation (NYSE:STE), an Ohio-based maker of hospital sterilization products, agreed to buy Synergy Health Plc (LON:SYR), a U.K. based provider specializing in outsourced services to the healthcare industry for $1.9 billion in cash and stock. The deal valued Synergy at pounds per share, a 39% premium to the company s stock price at the date of announcement. Steris said it will shift its domicile to the U.K. in a move that will cut its tax rate. The company joins a growing list of U.S. companies that are trying to cut their tax rate by moving their headquarters overseas. As part of the acquisition, Steris will form a new U.K. based company, which is expected to have a tax rate of 25% vs. the company s current 31.3% tax rate. The deal is part of a larger cost cutting initiative for Steris and is expected to help the company cut costs by $30 million or more annually. Sources: Company press releases, S&P Capital IQ YTD* YTD* * YTD figures represent total year-to-date M&A as of October 23, 2013 & Middle market M&A includes transactions with EV < $500mm, and transactions with undisclosed EV. 9

10 Recent Healthcare Providers & Facilities M&A Transactions $ in millions Transaction Announced Acquirer/Investor Target Target Description Value 10/22/14 DaVita HealthCare Parnters (a) Colorado Springs Health Partners, P.C. Operates medical centers offering healthcare services in the Pikes Peak region /20/14 MEDNAX, Inc. Houston Perinatal Associates, P.A. Owns and operates Perinatal Clinic, a high-risk pregnancy medical group /20/14 IPC The Hospitalist Company, Inc. Comprehensive Health Solutions, P.C. Provides medical care to residents in long-term and acute-care rehabilitation facilities /17/14 Altamont Capital Partners; Kingfish Group Legacy ER First Response, LLC Operates multiple hybrid emergency room & urgent care clinics /14/14 Fresenius Medical Care AG & Co. KGAA National Cardiovascular Partners, LP Manages the development of outpatient cardiac cath labs /13/14 PIVOT Physical Therapy Activcare, Inc. Operates an acute care hospital /08/14 Galen Hospital Alaska, Inc Alaska Medicare Clinic, Inc. Professional sports care and rehabilitation /06/14 Grove Hill Medical Center Connecticut Multispecialty Group, P.C. Outpatient healthcare clinic /06/ E. Commercial Blvd LLC Ft. Lauderdale Health & Rehabilitation Center Inc. Operates healthcare centers that provide healthcare services to patients. $ /06/14 Wellspan Health Philhaven Hospital Skilled nursing center providing rehab, respite, hospice and Alzheimer's care /03/14 Sinfonia Family Services of Virginia, Inc. Family & Community Support Systems, LLC Provides mental care services /01/14 Pyramid Healthcare, Inc. TODAY, Inc. Provides behavioral health, physical health, wellness, and substance abuse treatment /30/14 St. Andrews Acquisitions, Inc. Integrated Development Services, Inc. Operates behavioral health rehabilitation centers /29/14 Civitas Solutions, Inc. Mass Adult Day Health Alliance Operates a mental health clinic /26/14 Wilson Senior Care, Inc. Loris Extended Care Center (nka:loris Rehab and Nursing Center, LLC) A group of adult day health facilities /25/14 Pacifica Companies, LLC Autumn Years Newport Mesa, LLC Owns and operates a nursing facility that provides short-term and long-term care /24/14 Meridian Health System, Inc. Raritan Bay Medical Center Operates an assisted memory care living facility /17/14 Harmony Veterinary Clinic Cresco Veterinary Clinic Non-profit health care organization /16/14 University of Pittsburgh Medical Center, Endowment Arm Jameson Health System, Inc. Offers veterinary products and services for small and large animals /16/14 Norton Healthcare, Inc. Clark Memorial Hospital Operates a community healthcare system in Pennsylvania /24/14 Decision Point Center, Inc. Carleton Recovery Center, L.L.C. Operates as a hospital in Southern Indiana /16/14 ACSH Urgent Care Holdings, LLC Mid-South Urgent Care, Inc. Operates drug abuse and alcohol addiction rehabilitation centers in Arizona. $1.5 09/16/14 Investment Property Associates, LLC Retirement Community Specialists, Inc. Owns and operates urgent care centers /12/14 Advocate Health Care, Inc. NorthShore University HealthSystem Operates hospitals and medical offices /11/14 Elements Behavioral Health, Inc. Copac, Inc Operates as an alcohol and drug treatment center. -- Sources: S&P Capital IQ. (a) Public Companies in bold. 10

11 Notable Healthcare Providers & Facilities M&A Transactions $ in millions Transaction Announced Acquirer/Investor Target Target Description Value Metric 10/13/14 Steris Corp. (a) Synergy Health plc Outsourced sterilization services for hospitals. $2, x Rev; 12.9x EBITDA 10/09/14 Kindred Healthcare Inc. Gentiva Health Services Inc. Provides home health, hospice, and community care services. $1, x Rev; 12.7x EBITDA 10/05/14 Becton Dickinson CareFusion Provides healthcare services to hospitals. $11, x Rev; 13.8x EBITDA 09/26/14 Universal Health Services Inc. Cygnet Health Care Limited Provides mental health and social care services. $ x Rev; 8.8x EBITDA 09/18/14 Providence Service Corp. Community Care Health Network, Inc. Provides medical assessment solutions for Medicare health plans in the U.S. $ x Rev; 9.2x EBITDA 05/21/14 Clayton, Dubilier & Rice, Inc. Healogics, Inc. Operates 600 hospital outpatient wound care centers across the country. $ x Rev 02/20/14 Brookdale Senior Living Inc. Emeritus Corp. Operates senior living communities. $5, x Rev; 15.6x EBITDA 02/17/14 TPG Capital Chindex International Inc. Provides healthcare services. $ x Rev; 37.2x EBITDA 02/13/14 PhotoMedex, Inc. LCA-Vision Inc. Provides fixed-site laser vision correction services. $ x Rev 12/30/13 Banner Health Casa Grande Community Hospital Community healthcare system. $ x Rev 12/12/13 Centene Corp. U.S. Medical Management Provides home health care services. $ x Rev 11/05/13 National Health Industries, Inc. SunCrest Healthcare, Inc. Provides home health care services. $ x Rev 11/04/13 Kindred Healthcare Inc. Senior Home Care, Inc. Provides home health care services. $ x Rev 10/09/13 QuadMed, LLC Novia CareClinics, LLC Creates and manages employer sponsored on-site clinics. $ x Rev 09/30/13 Physicians Realty L.P. Crescent City Surgical Centre, L.L.C Operates a hospital. $ x Rev 09/19/13 Gentiva Health Services Inc. Harden Healthcare, LLC Owns and operates senior care facilities. $ x Rev 11/12/13 Senior Living Residences, LLC Standish Village Operates as a retirement community. $ x Rev; 14.3x EBITDA 07/29/13 Community Health Systems, Inc. Health Management Associates Inc. Operates general acute care hospitals and other health care facilities. $7, x Rev; 8.7x EBITDA 07/23/13 DLP Healthcare, LLC Wilson Medical Center, Inc. Provides healthcare services. $ x Rev 07/17/13 Almost Family Inc. Indiana HomeCare Network LLC Provides home health care services for patients. $ x Rev M&A Transactions in the table above include those with EV above $5 million and reported metrics. Sources: S&P Capital IQ. (a) Public companies in bold. Deal Revenue EBITDA Size Multiple Multiple Transactions Represented High $11, x 37.2x Median $ x 12.9x Low $ x 8.7x Mean $1, x 14.8x 11

12 Number of Transactions Overview of Selected HC Providers Capital Raises 21 st Century Oncology (Fort Meyers, FL) September 26, 2014 Providers Mid-Market Capital Raises* Canada Pension Plan Investment Board (CPPIB) made a $325 million investment in 21 st Century Oncology, a portfolio company of Vestar Capital Partners. The capital infusion will help 21 st Century pay off significant debts and provide them with long-term working capital. Vestar Capital and 21 st Century will retain a majority stake in the firm st Century Oncology operates and manages radiation treatment centers in the U.S and Latin America. The company is a leading provider of advanced radiation therapy and other Integrated Cancer Care services to cancer patients. The company operates 185 treatment centers, including 150 centers located in 16 U.S. states. Doctor on Demand (San Francisco, CA) August 6, 2014 Doctor on Demand, a start-up that facilitates quick video consultations with physicians, closed a $21 million Series A round led by Venrock, Shasta Ventures, and angel investor Richard Branson Doctor on Demand uses a HIPAA-secure network and synchronous video chat to connect patients with doctors. The technology allows users to access a physician from a smartphone or desktop in under three minutes. The physicians will treat colds, coughs, allergies and infections, amongst other ailments Sound Inpatient Physicians Inc. (Tacoma, WA) July 2, 2014 On July 2 nd, Fresenius Medical Care AG & Co. KGaA (FMC), a German company specializing in dialysis, invested $600 million in Sound Inpatient Physicians (Sound), a U.S. based healthcare service provider. The deal will allow existing investor, TowerBrook Capital Partners, to partially exit its initial investment in Sound. FMC will become a majority stakeholder as part of the recapitalization of Sound. The transaction comes as FMC aims to widen its services to medical fields related to kidney failure and to drive revenue growth. Sound works with more than 1,000 physician partners providing care in over 100 hospitals and post-acute care centers across the U.S. Sources: Company press releases, S&P Capital IQ YTD* YTD* * YTD figures represent total year-to-date capital raises as of October 23, 2013 & Middle market Public Offerings & Capital Raises includes transactions with < $500mm, and transactions with undisclosed values. 12

13 Healthcare Providers Public Company Equity Offerings $ in millions Transaction Date Company Funding Type Target Description Value 10/02/14 American Addiction Centers, Inc. IPO Provides behavioral healthcare services. $ /24/14 Envision Healthcare Holdings Inc. Follow-on Equity Offering Offers an array of healthcare related services to consumers and hospitals. $ /16/14 Civitas Solutions, Inc. Follow-on Equity Offering A national network of local health and human services providers. $ /09/14 Brookdale Senior Living Inc. Follow-on Equity Offering Owns and operates senior living communities. $ /10/14 Envision Healthcare Holdings Inc. Follow-on Equity Offering Offers an array of healthcare related services to consumers and hospitals. $1, /26/14 AmSurg Corp. Follow-on Equity Offering Operates outpatient surgery centers. $ /24/14 Adeptus Health Inc. IPO Operates a network of independent emergency rooms in the U.S. $ /19/14 Kindred Healthcare Clinics Follow-on Equity Offering Operator of transitional care hospitals. $ /11/14 Arcadia Healthcare Co. Inc. Follow-on Equity Offering Operates behavioral health treatment facilities. $ /27/14 Brookdale Senior Living Inc. Follow-on Equity Offering Owns and operates senior living communities. $ /19/14 HCA Holdings, Inc. Follow-on Equity Offering Provides health care services. $ /28/14 AdCare Health Systems Inc. PIPE Owns and manages skilled nursing facilities and assisted living facilities. $6.5 09/04/13 Surgical Care Affiliates, Inc. IPO Owns and operates multi-specialty ASCs and surgical hospitals. $ /13/13 BioScrip Inc. Follow-on Equity Offering Provides home care services and pharmacy benefit management services. $ /26/13 Orion HealthCorp Inc. PIPE Offers medical billing, coding, collection, and financial and practice management services. $ /16/13 BioScrip Inc. Follow-on Equity Offering Provides home care services and pharmacy benefit management services. $ /15/13 American Addiction Centers, Inc. PIPE Provides behavioral healthcare services. $6.5 03/11/13 Emeritus Corp. Follow-on Equity Offering Operates senior living communities. $ /11/13 HCA Holdings, Inc. Follow-on Equity Offering Provides health care services. $1, /10/12 HCA Holdings, Inc. Follow-on Equity Offering Provides health care services. $1,056.0 U.S. Public equity offerings of at least $5 million the last three years. Sources: S&P Capital IQ and PitchBook Data Inc. 13

14 Healthcare Providers Private Company Capital Raises $ in millions Transaction Announced Company Funding Type Target Description Value 09/26/14 21st Century Oncology (ICC) Growth Capital/Private Equity Operator of radiation therapy centers. $ /25/14 Vera Whole Health Venture Capital Provider of primary care, acute care, and health coaching via on or near-site clinics. $5.0 09/19/14 Fresenius Vascular Care Pensacola Venture Capital Provider of vascular care services. $8.9 09/04/14 Activate Healthcare Growth Capital/Private Equity Provider of on-site healthcare services to the employees of medium-sized enterprises. $5.6 08/06/14 Doctor on Demand Venture Capital Provider of medical care to people via video chat with a real, licensed physician. $ /29/14 QoL meds Growth Capital/Private Equity Operator of behavioral-health specialty pharmacies. $ /18/14 NextCare Inc. Growth Capital/Private Equity Provider of urgent care and walk in clinics. $ /02/14 Aspire Health Venture Capital Provider of an outpatient care clinics. $5.5 07/02/14 Sound Inpatient Physicians Growth Capital/Private Equity Provider of inpatient physician services in hospitals throughout the U.S. $ /23/14 IASIS Healthcare Holdings, Inc. Growth Capital/Private Equity Operates as a general partner and owns and operates hospitals. $5.2 05/15/14 Crown Bioscience Venture Capital Operator of a biology contract research organization. $ /14/14 One Medical Group Venture Capital Provider of primary care physician services for employers. $ /12/14 Urgent Team Holdings, Inc. Venture Capital Operates urgent care centers. $5.3 05/08/14 Counsyl Venture Capital Provides genetic screenings to determine inherited risk for diseases. $ /02/14 JourneyPure LLC Venture Capital Focuses on developing and operating addiction treatment centers. $7.0 04/30/14 ConvenientMD LLC Venture Capital Provides urgent care centers. $8.0 04/23/14 RegionalCare Hospital Partners Growth Capital/Private Equity Provider of healthcare services in non-urban markets. $ /08/14 Galichia Heart Hospital, LLC Growth Capital/Private Equity Provides heart care, surgical care, and emergency services. $8.5 04/03/14 Pure Life Renal Growth Capital/Private Equity Provider of kidney dialysis centers. $ /18/14 AbilTo Venture Capital Provider of a platform for fixed-duration programs on behavioral health. $6.0 Equity capital raises of $5 million for U.S. private companies in the last six months. Sources: S&P Capital IQ and PitchBook Data Inc. 14

15 Moss Adams / Moss Adams Capital Firm Overview Moss Adams Capital LLC Full service investment bank and strategic advisor Dedicated industry specialties Mergers and acquisitions; sell-side and buy-side Recapitalizations and institutional capital raises Key Attributes Middle market experts: independent, thoughtful client-centered advice Direct and constant senior level attention Deep and longstanding relationships with debt and equity capital providers and corporate investors/buyers Industry specific knowledge enhanced by proprietary access and insight from the Moss Adams LLP client base Moss Adams LLP Fully integrated accounting, tax and business advisory firm 100+ years old Dominant in the western US 2,000 employees, in 22 offices 16,000 nationwide mid market clients Consulting and Tax Services include financial due diligence, valuation advisory, international tax planning and compliance, transaction structuring and IT consulting and integration Approximately 2,000 Healthcare Clients U.S. and International Presence Affiliates in 80+ countries globally 15

16 Global Reach Direct international relationships Moss Adams Capital has a strategic alliance with Mazars Corporate Finance, an international investment bank with 25 offices, to identify cross-border strategic buyers and private equity investors. As a founding member of Praxity, AISBL, a global alliance of independent accounting firms, Moss Adams provides access to trusted expertise in 80+ countries worldwide. North America United States, Canada Europe Austria, Belgium, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Hungary, Ireland, Italy, Jersey, Latvia, Lithuania, Luxembourg, Malta, Monaco, Netherlands, Norway, Poland, Portugal, Romania, Russia, Slovakia, Spain, Sweden, Switzerland, Turkey, United Kingdom, Ukraine Asia China, Indonesia, Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand, Vietnam Latin America and Caribbean Argentina, Brazil, Cayman islands, Chile, Colombia, Mexico, Puerto Rico, Uruguay, Venezuela Middle East and Indian Subcontinent India, Israel, Lebanon, Pakistan, United Arab Emirates Africa Algeria, Angola, Benin, Botswana, Cameroon, Cape Verde, Djibouti, Egypt, Ghana, Ivory Coast, Lesotho, Madagascar, Mauritius, Morocco, Senegal, South Africa, Tunisia, Zambia Australasia Australia, New Zealand 16

17 Selected Healthcare Related Transactions 17

18 Contact Us Healthcare Providers & Facilities: Wiley P. Kitchell Managing Director (206) Third Avenue Suite 2800 Seattle, Washington Harman K. Wales Managing Director 2040 Main St Suite 900 Irvine, California Richard M. Anderson Managing Director Burr J. Dalton Director Tyler Dale Vice President Geoffrey B. Haydon Vice President 18