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This presentation may not be copied, published, distributed or transmitted. The presentation has been prepared solely by the company. Any reference in this presentation to Fortis Healthcare Limited shall mean, collectively, the Company and its subsidiaries. This presentation has been prepared for informational purposes only. This presentation does not constitute a prospectus, offering circular or offering memorandum and is not an offer or invitation to buy or sell any securities, nor shall part, or all, of this presentation form the basis of, or be relied on in connection with, any contract or investment decision in relation to any securities. Furthermore, this presentation is not and should not be construed as an offer or a solicitation of an offer to buy securities of the company for sale in the United States, India or any other jurisdiction. Securities may not be offered or sold in the United States absent registration or an exemption from registration. Any public offering in the United States may be made only by means of an offering document that may be obtained from the Company and that will contain detailed information about the Company and its management, as well as financial statements. Any offer or sale of securities in a given jurisdiction is subject to the applicable laws of that jurisdiction. This presentation contains forward-looking statements based on the currently held beliefs and assumptions of the management of the Company, which are expressed in good faith and, in their opinion, reasonable. Forward-looking statements involve known and unknown risks, uncertainties and other factors, which may cause the actual results, financial condition, performance, or achievements of the Company or industry results, to differ materially from the results, financial condition, performance or achievements expressed or implied by such forwardlooking statements. Given these risks, uncertainties and other factors, recipients of this presentation are cautioned not to place undue reliance on these forward-looking statements. The Company assumes no responsibility to publicly amend, modify or revise any forward-looking statements, on the basis of any subsequent development, information or events, or otherwise. Unless otherwise stated in this presentation, the information contained herein is based on management information and estimates. The information contained herein is subject to change without notice and past performance is not indicative of future results. The Company may alter, modify or otherwise change in any manner the content of this presentation, without obligation to notify any person of such revision or changes. By attending this presentation you acknowledge that you will be solely responsible for your own assessment of the market and the market position of the Company and that you will conduct your own analysis and be solely responsible for forming your own view of the potential future performance of the business of the Company. Neither the delivery of this presentation nor any further discussions of the Company with any of the recipients shall, under any circumstances, create any implication that there has been no change in the affairs of the Company since that date.
Agenda
B. Company Overview
C. Recent Developments
D. Financials
Demographic changes, improving income levels, changing lifestyles, and rising insurance penetration etc
will result in a rise in discretionary spending on healthcare Accessible, reliable and affordable healthcare continues to be a challenge Opportunity in healthcare being significantly leveraged by private healthcare providers Expected to generate employment opportunities for
US$bn 26 19 17 2008 20 2010 25
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4.3%
4.1%
3.7%
6% 1%
US
France
Canada
UK
Japan
China
India
Thailand
Disease burden
Beds
Doctors
Nurses
139
7 11 20
8 12 20 28
8 14 20 29
9 15 21 28 27 2017E 30 - 44 years
11
16 23 26 25 2021E 45 - 59 years
72
27
39
34
32
31
30
24
22 9
35 32 29 2012E
Japan
France
UK
CanadaSingapore
US
China
Brazil Thailand
India
2001 0 - 14 years
2007
15 - 29 years
72.1
90%
80%
Lifestyle Diseases
45.0
70%
Asthma
60%
50%
40%
Acute Diseases
2008
2018E
30%
20%
10%
49.4 39.0
0% 2001 2012E
Lifestyle diseases are set to assume a greater share of the healthcare market Lifestyle diseases such as cardiac diseases require hospitalization and are more expensive to treat hence increasing the in-patient revenues
Source: CII-McKinsey, CRISIL Research
2008
2018E
Potential to contribute US$ 1.2 2.4 billion additional revenue for up-market tertiary care hospitals by 2012, and will account for 3 5% of total healthcare market
Heart Valve Replacement Bone Marrow Transplant Liver Transplant Knee Replacement Hip Replacement
Key Drivers For The Growth Quality healthcare at fraction of the cost Availability of skilled doctors & hospitals Good reputation of Indian doctors Upsurge of lifestyle diseases
Issues Inadequate healthcare infrastructure Unstructured medico legal jurisdiction Indians hospitals standards below par against the global benchmarks of care Lack of accredited hospitals and follow up care
Health Insurance
Growing Share Of Urban Middle Class Households
100% 80% 60% 40% 20% 0% 2001-02 <US$ 2,100 2006-07E US$ 2,100 - 12,800 2010-11E >US$ 12,800 52.5% 42.3% 3.3% 5.2% 7.0%
6,207
44.2%
CAGR: 32%
52.5%
58.6%
34.5%
1,000 0
494
713
2006
2007
2008
2009
2015E
Health insurance market in India is expected to grow at a CAGR of 32% to reach a market size of US$ 6.21bn by FY15
One of the fastest growing free economy Ranked 4th largest economy in the world in terms of purchasing power parity Higher service mix, increasing urbanization
Overall penetration at 2%. Growth driven by: a) increasing awareness, b) soaring healthcare costs and c) demographic profile of the people
Agenda
B. Company Overview
C. Recent Developments
D. Financials
Globally respected healthcare organization known for Clinical excellence and Distinctive Patient care
Achieved by
Talented people
Efficient systems
Foundation of 10
Trust
Incorporated in 1996, Fortis is second largest healthcare chain in India built on a focused organic and inorganic strategy Has 53* healthcare delivery facilities
30 operating hospitals,
Listed on Indian stock exchanges with a market capitalization of c.USD1.3bn (Feb 2011) Received international accreditation from reputed bodies such as JCI and NABH / NABL along with quality certifications (ISO 9001 / 14001) Acquired 10 hospitals from Wockhardt Hospitals in 2009 and gained pan India presence and had recently acquired a ~25.3% stake in Parkway Holdings (Southeast Asias leading healthcare service provider with a network of 20** hospitals with more than 3,400 beds throughout Asia) and has chosen to exit considering higher valuations
Took a significant step in establishing Fortis as a Global Healthcare Brand by its attempt to acquire Parkway Holdings Ltd Asias finest healthcare provider, but exited considering high valuations of the asset
Listed on BSE and NSE with a market cap of USD543mn Starts hospital at Jaipur
11
Strong IT system
Brand
Differential Model Doctor engagement, Deep penetration Strategy, Pan India presence
Key Differentiators
12
Organisational Chart
Managing Director
HeadInformation Technology
Chief Sales
* The business is bifurcated into three regions headed by Regional Directors (RDs) for respective regions.
13
Driving Efficiencies
Branding & Marketing Conveying Value Proposition
Operating Efficiency ARPOB, Occupancy, ALOS Gross Margins, EBIDTA Bed to Nurse ratio Supply Chain Management Best practice benchmarking DSO/ Inventory Days Surgical : Non Surgical Shared Service Centres FOS, MOS, Patient Satisfaction Index Capital Efficiency Optimize Capex Cheap Finance Model of Growth Outsourcing Off Balance Sheet Turn key/ PPP/ Leased Premises Technology Management : COE
Processes
IT System, Protocols, SOPs, Governance, Trust and Transparency , Integration Capability, Project Execution People Motivated, Trained and Engaged Staff: Service Excellence, Academics & Research, HR Processes
14
Fortis Shalimar Bagh (2010) Jessa Ram (2003) Vasant Kunj (2006) Delhi Heart Institute and Research Centre (2010) Fortis Gurgaon Yashoda Hospital, Ghaziabad (2006) Escorts-Delhi (2006) Kalra Hospital, Delhi (2010) GNRC, Guwahati (2009) Fortis Hospital, Sarat Bose Road, Kolkata (2009) Fortis Hospital, Rashbehari Avenue, Kolkata (2009) Fortis Hospital, Anandpur, Kolkata (2009)
Raigarh (2010)
Raipur (2006) Birla Institute MRC, Gwalior (2006) Fortis Hospital, Gwalior
Category Greenfield
No. of Hospitals 5
Brownfield
Managed HCC's Projects Total
14
11 16 7* 53
1795
993 71 0 3709
2285
1743 71 2129 8162
Not included in above map are international hospitals/ projects * Expansion of beds at Mulund hospital is a project, but does not add a new hospital to the total number of hospitals. Although, the beds considered as part of capacity in Project stage
15
A Doctor by Profession, Dr Nazareth completed his post graduation in Pathology from University of Mumbai and practiced clinical medicine for 11 years. He completed his MBA (Finance) and Diploma in Computer Programming and switched over to Hospital Management 12 years ago and has been instrumental in the significant growth of Fortis Hospitals (erstwhile Wockhardt Hospitals).
A chartered accountant by profession, Mr. Sareen holds a Bachelors degree in Commerce with Honors from the Punjab University
He has over 22 years of experience in the healthcare industry and over seven years of experience in management and finance functions
He is a gold medalist from the Indian Institute of Technology, New Delhi and holds a Bachelor of Technology degree in chemical engineering He was a Commonwealth Scholar at the Senior Management Program at the Manchester Business School in 1995 He has over nine years of experience in the healthcare industry and over three decades of management experience
16
4x
400
Cash Breakeven
28%
Revenues
300
EBITDA Breakeven
23%
16%
17%
200
x
31% 33% 36%
23% 30%
100
50%
0
CAPEX
(16%)
30%
Occupancy
85%
(100)
ROCE = 26% ROE = 20%
Year 1 Direct
Year 2 Personnel
Year 4 EBIDTA
Year 5
17
Focus on ARPOB
Surgical vs. Non Surgical
Medical Program
Total Revenue
Pricing
Specialties Chosen
Occupied Beds
Patient Turnover
Volumes
Bed Utilization
No. of Procedures
18
Fortis has Achieved Growth Both through Successful Acquisitions and Value Added Services
Ramp up at an acquired facility Fortis Malar, Chennai Extracting value from M&A: Escorts Delhi
` Cr.
64.1 61.2 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 FY07 FY08 FY09 EBITDA FY10 9MFY11 14.0 4.1 17.9 9.4 4.2 1.1 8.8 33.2
89% CAGR
8.6
12.8
12.7
13.2
18.1
Q4 FY09
Q1 FY10
Q2 FY10
Q3 FY10
EBITDA
Q4 FY10
Operating Revenue
Operating Revenue
Average FY2007 Monthly Revenue ` 18.3 Cr. 2,082 330 90% 7 Days 10%
2008
2010
ARPOB
` 0.67 Cr.
` 1.21 Cr.
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Executive counsel taking call on key hospital discussions Code of Ethics; Whistle blower policy
20
Agenda
B. Company Overview
C. Recent Developments
D. Financials
21
Wockhardt Acquisition
Leading healthcare providers with 17 super speciality hospitals in metros and tier-II cities Provide super speciality care in Cardiac, Neuro, Ortho, Minimal Access Surgery and Women Care Through the deal, Fortis added: 1,902 beds to capacity for ~US$ 190mn 10 hospitals in 3 cities Mumbai (2), Kolkata (3) & Bengaluru (5) Talent pool of c. 50 doctors and c.1300 paramedics Financially attractive at 9.5x EBITDA and Cost per bed at US$0.12mn Nursing colleges (450 candidates) 2 JCI accredited hospitals 2 new hospitals at Yeshwantpur, Bengaluru (120 beds) and Anandpur, Kolkata (414 beds) - to be operational in next 10-12 months. Kolkata facility operationalised in Sept 2010 The combined network to provide one of the largest Cardiac, Ortho and Neuro healthcare
Kolkata
BG Road, Bengaluru
Mulund, Mumbai
services
22
Recent Deals
O&M agreement with O.P. Jindal Hospital, Raigarh, Chhattisgarh 100 bed multi-speciality secondary care hospital Located within the campus of Jindal Steel & Power Limited
Reverse O&M agreement with Vivekanand Hospital Moradabad, Uttar Pradesh 150 bed multi-speciality secondary care hospital Located in Moradabad, North Eastern UP, the hospital was set up under a Trust in 1985. Constructed over a 6.3 acre land with a built up area of 198,000 sq ft Premises also house a Nursing College and a Nursing School
O&M agreement with East Coast Hospital in Pondicherry 100 bedded facility with a plan to expand it to a 250 bed facility To be operational by Q1FY12
23
1.
Gurgaon
450**
11 Acres, Owned
Q2 FY12
325
2.
Ludhiana 2
75
Q4 FY 12
20
3.
Kangra
100
Q1 FY12
24
4.
Ludhiana 1
200
Q4 FY12
50
5.
Ahmedabad
200
Q1 FY13
50
6. 7.
Q2 FY13 Q3 FY12
72 18 559
24
Agenda
B. Company Overview
C. Recent Developments
D. Financials
25
1,600 1,400
1,318 1,214
290
1,200
CAGR: 72%
1,000 800
225
772 649
113 1,067
567
42
308
12 525 548
81
6 75 FY05
296
FY06
FY07 Owned
FY08
FY09 Managed
FY10
9MFY11
26
Growth Driven by Steadily Increasing Occupancy Rates Leading to Improving Operating Parameters
Occupancy
80% 74% 70% 63% 60% 50% 40% FY08 FY09 FY10 H1FY11 68% 75%
4.30
4.20
4.10
4.10
FY08
FY09
FY10
H1FY11
FY08
FY09
FY10
H1FY11
27
Significant Increase in No. of Procedures with a Focus on Key Specialty Areas (Cardiac, Neuro, etc.)
Cardiac
40,000
Ortho
39,651
3,662 8,000
7,083 5,016
4,553 2,872 2,530
29,475
30,000 20,000 10,000 0 2,802 15,206 6,011 5,456 FY09 CTVS & Pediatrics PTCA CAG 8,214 6,924 20,851
+35%
+41%
FY10
Neuro
4,000 3,040 3,000 2,000 1,000 0 FY09 FY10 50,000
Dialysis
46,993
+125%
+61%
1,352
28
Ortho
37,169
3,095
8,000
27,137
2,552 14,210 7,500 5,666 4,709 9MFY2010 CTVS & Pediatrics PTCA 7,214 19,360
+37%
Neuro
4,000 3,000 1,895 2,000 20,000 1,000 0 9MFY2010 9MFY2011
*The data shown above is on Network Hospitals excluding the numbers of Clinique Darne - Mauritius
Dialysis
3,718 50,000
41,754 32,861
+96%
40,000 30,000
+27%
29
Particulars Operating Revenue Other Income # Total Income Direct Costs Employee Costs Other Costs EBITDA Finance Costs Depreciation & Amortization PAT
FY10 937.9 50.1 988.1 262.7 195.0 339.8 190.6 57.3 59.9 69.5
2.61
0.92
#Other income includes Foreign Currency translation gains, interest income and miscellaneous income
30
34.5
53.9
8.4%
14.5%
77.0
153
6.9%
14.3%
18.0
95.0
* Other Income constitutes mainly interest income from deployment of surplus funds
31
*Increase in other costs is primarily due to doctor engagement model at newly acquired hospitals **EPS calculated on reported consolidate net profit of Rs 95 Cr during 9MFY11
32
80 69.9 70
78.0
18%
19%
60
14%
55.8
19%
17%
40
35.9
30
22%
26%
25%
20
30%
17.3
21.4 16.7
14%
19%
27%
20%
Malar
Jaipur Q3 FY11
BG Road*
Mulund*
CG Road*
33
10%
7%
10
18% 18%
22%
14%
26%
14%
98
90 114 4,615
953
34
Summing Up
Healthcare Sector poised to grow
Healthcare Sector Growth led by Lifestyle Diseases and Insurance Penetration Government recognizes the need to partner with Private Sector Healthcare expenditure estimated to be 6% of GDP by 2012 & employ around 9 million people
One of the largest private healthcare delivery player in India Aggressively grown from 1 hospital in 2001 to a network of 53* hospitals in 2011 with ~ 8,000* beds Fortis Healthcare Leadership in Cardiac, Neurology and Orthopedics Evolved the Business Model and high level of Brand Equity Proven ability to acquire, integrate and turn around Providing attractive value propositions to various segments of market
* Estimated number of hospitals and beds is including hospitals under projects stage
35
THANK YOU
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