GHC - Highlights June 2021 - eMarket Storage
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GHC – Highlights June 2021
An entrepreneurial history that began over 60 years ago
developed through organic and M&A growth projects
Aurelia
Casa di Cura Hospital and 3 new operating Rugani Hospital
Città di Roma the rooms at Villa expansion New
opens European Berica completed multi-specialist
Hospital constructed clinics
open for the New facility
Istituto Poliambulatorio Villa Fernanda
Hesperia Raffaele Dalla Rosa Prati begins
Hospital Garofalo created operations
expanded created
Garofalo Group Casa di Cura Villa Berica and Casa di Cura Acquisition of
Fides Medica and
established with Samadi Hesperia Rugani and Villa Poliambulatorio Dalla Rosa Prati, Ospedali Privati
51.05% of Casa di
the acquisition of acquired Hospital Von Siebenthal Riuniti, Centro Medico S. Biagio, Centro Medico
Cura Prof. Nobili
the Casa di Cura S. acquired acquired Università Castrense and Bimar, Aesculapio
Villa Garda acquired
Antonio da acquired
Padova in Rome Xray One Clinica
acquired S. Francesco
Geographical and sector CMSR Veneto Medica IPO on the MTA segment
acquired
diversification process acquired realized through capital
begins with the acquisition (incl. Sanimedica) increase and with demand ABB and
of the Eremo di Miazzina three times greater than access to
supply the STAR
segment
The 5 healthcare facilities in Rome (Casa di Cura S. Antonio da Padova, Casa di Cura Città di Roma, Aurelia Hospital, European Hospital and Samadi) are excluded from GHC perimeter
2GHC Group today: a leading operator in the private accredited
healthcare thanks to its business model based on geographical
and sectoral diversification
CMSR Veneto Medica Sanimedica
Altavilla Vicentina (VI) Vicenza and Altavilla Vicentina (VI)
GHC Group - Highlights
Villa Berica
Vicenza (VI) Centro Medico Uni. Castrense
Villa Garda 1 S. Giorgio di Nogaro (UD)
Garda (VR)
1 6 26 8
Xray One Clinica S. Francesco
Mantova (MN) 2 Verona (VR) Facilities Regions
8 6
Eremo di Miazzina Centro Medico S. Biagio, (+8 vs. IPO) (+2 vs. IPO)
Cambiasca and Gravellona Toce (VB) Portogruaro (VE)
Hesperia Hospital
Gruppo Fides Modena (MO)
1
Genova (GE)
Casa di Cura Prof. Nobili
Castiglione dei Pepoli (BO)
1,500 28.7k
Rugani Hospital
Monteriggioni (SI) 1
Poliambulatorio Dalla Rosa Prati Beds Admissions
Parma (PR)
(+250 vs. IPO) (+8.7k vs. IPO)
Ospedali Privati Riuniti
Bologna (BO)
Aesculapio
Villa Von Siebenthal San Felice sul Panaro (MO)
Genzano (RM) 1.6M 3,250
Outpatient Employees and self-
treatments employed professionals
(+0.6M vs. IPO) (+1,500 vs. IPO)
EE- 78%
Group facilities as of 31.12.2018 (reporting entities)
Rating ESG
# of facilities of GHC Group as of today Female
Facilities acquired in 2019, 2020 and 2021 (reporting entities) Standard Ethics
employees
Note: figures refer to 2020 including the contribution of Clinica S. Francesco acquired in April 2021
Investment Grade 3The healthcare sector in Italy: the ‘‘3As’’
High entry barriers make the healthcare sector hardly penetrable from new competitors
Authorization Accreditation Agreement
• Authorization to • Possession of the • Agreement which
operate structural, assigns to the
organisational and private accredited
technological facility a
requirements to production budget
provide services (‘cap’)
remunerated by
the National
Healthcare System
4Public healthcare spending not sufficient and among the lowest
based on international comparison
Stable and not cyclical public healthcare spending… …and among the lowest vs. other countries
%GDP 6.9% 6.9% 7.1% 7.0% 7.0% 6.9% 6.9% 6.8% 6.8% 6.8%
Public healthcare spending vs. GDP (comparison with G7)
30,0
117.7 119.1 120.3
111.3 112.8 114.0 112.9 114.3 114.6 115.9
14.4% 9.5% 9.4% 9.2% 7.6% 7.4% 6.8%
10,0
24,9 25,2 25,6 26,3
23,5 23,6 23,8 24,0 24,3 24,6
90,0
Average G7: 9.2%
70,0
87,8 89,2 90,2 88,9 90,0 90,0 91,0 92,4 93,4 93,9
50,0
30,0
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 UNITED
USA GERMANY FRANCE JAPAN CANADA ITALY
KINGDOM
Settore pubblico
Public spending
Settore privato accreditato
Private accredited spending
Public healthcare spending vs. GDP (comparison with EU countries)
• National Healthcare Service spending (“NHS”) was 9.2% 8.9% 8.5% 8.2% 8.0% 7.7% 6.8%
€120.3bn in 2019 (6.8% of the GDP), with a
moderate growth over the 2010-2019 period (CAGR
2010-2019: 0.9%) Average selection of EU countries: 8.2%
• Italy is characterized for being a parsimonious
system, with a per capita public healthcare spending
and spending as % of GDP among the lowest in
Europe
SWEDEN NORWAY DENMARK HOLLAND BELGIUM AUSTRIA ITALY
Source: OASI Report 2020 based on 2019 figures, Associazione Italiana Ospedaliera Privata (“AIOP”) 2020. Data related to G7 and EU countries (except Italy) are related to the year 5
2017Secular trends of ageing population and greater incidence of
chronic diseases
Chronic disease incidence
Italian population by age groups (€m)
(per 100 persons aged 75+ in 2015)
CAGR
60.8 60.7 60.3 ‘16-’30 57.5
65+ 13.4 14.1 16.5 +1.6% 43.4
15-64 39.1 38.7 36.8 (0.4%)
11.0
7.3 6.0 7.5
0-14 8.3 7.9 7.0 (1.2%)
Myocardial Arthrosis Kidney
2016 2020 2030
infarction disease
Italy EU
0-14 15-64 65+
• Demographic trend shows a progressive ageing of the population. In 2030 population over 65 is estimated to be ca. 27% of the total (vs.
22% of 2016)
• Aged 65+ people represent the most demanding group in terms of healthcare services
• At the same time, Italian population aged 75+ will suffer greater incidence of chronic diseases compared to the EU average
Source: OECD, Eurostat, “The 2018 Ageing Report”. Istat report 2017, “Anziani: Le condizioni di salute in Italia e nell’Unione Europea”.
6Composition of healthcare spending in Italy
OASI Report 2020 – latest figures available
€ bn
37.7 158.0
Private spending
(out of pocket)
26.3 120.3
▪ In 2019 total healthcare spending in Italy equal
Private
accredited to €158bn
spending Total national
93.9 healthcare
Public and ▪ This figure includes public spending (ca.
spending
private €120bn) and private spending (ca. €38bn)
accredited
Public healthcare
spending ▪ Public spending includes either public-to-
healthcare
spending public spending (ca. €94bn) and private
accredited spending (ca. €26bn)
78% 22% 100%
Key: GHC’s target market
Source: OASI Report 2020 based on 2019 figures, Associazione Italiana Ospedaliera Privata (“AIOP”) 2020 7Hospital sector: public vs. private accredited operators
Hospital sector acute care segment: expenditure vs. results
Average daily expense for admission and bed Index of complexity (2018)(1)
ca.2.6x ca.3x
€1,315
€1,150
Private accredited 1.37
€505
Public 1.23
€400
▪ Efficiencies even more significant considering the higher level
Average daily expense / admission Average daily expense / bed of complexity of the healthcare services provided by the
private accredited operators, as highlighted by the Index of
Public Private accredited
Complexity measure
Sources: AIOP Report 2020, Italian Ministry of Healthcare
Note: Figures refer to the acute care segment
(1) Index of complexity represents a sinthetic indicator of the level of complexity of the healthcare services provided. It is calculated as the average of the weights
attributed to each cluster of patients (through DRG’s), over the total number of admissions 8M&A discipline followed by GHC Group since IPO
M&A discipline - Highlights GHC distinctive features
Diagnostic centers: Revenues >5€M
Acute care facilities: Revenues >10€M
Experienced
Direct
and skilled
Non dilutive Op. EBITDA Margin (also in perspective) involvement of
M&A team
GHC CEO
High “cash conversion”
Privileged access Entrepreneurial
to key decision ‘‘cultural fit’’
Flexibility to evaluate ‘’case by case’’ opportunities makers with the Target
❑ Facility accredited with National Healthcare System
❑ Significant portion of private revenues
Lean
❑ Relevant potential synergies Proven rapidity
‘‘go / no go’’
of execution
❑ Favorable ownership structure(e.g. generational decision process
transition, etc.)
▪ Due Diligence process as ‘cognitive moment’’ of the
❑ Excellent reputation
Target
❑ Localization in virtuous regions and with favorable ▪ Often the Target are family-owned businesses subject to
regulatory framework generational turnover
9
Note: Op. EBITDA calculated as EBIT + D&A + provisions and write-offsHighly fragmented market subject to consolidation trends
Highly fragmented private accredited healthcare market
3% Acute care facilities
6%
5%
Specialised outpatient care
14%
15.8k 34%
Local residential care
Private accredited
healthcare facilities(1)
Local semi-residential care
Other local care
39%
Rehabilitation
Source: Italian Ministry of Health 2020
(1) Annuario statistico 2020 (figures refer to 2018), Ministry of HealthConstant delivery of the Build & Buy strategy continued in 2021
with the acquisition of Clinica S. Francesco of Verona
Revenues TARGET Normalized EBITDA(1) EBITDA Margin (%) EV / EBITDA (x)
@ 2018 @ 2019 @ 2018 @ 2019 @ 2018 @ 2019 @ 2018 @ 2019
€+0.6M +3.2% -1.3x
Dalla Rosa Prati
€15.0M €15.5M February 2019 €3.3M €3.9M 22.2% 25.4% 8.5x 7.2x
Enterprise Value: €27.8M
€+1.1M +4.1% -2.7x
Ospedali Privati Riuniti
€26.2M €26.5M May 2019 €4.0M €5.1M 15.3% 19.4% 12.5x 9.8x
Enterprise Value: €50.0M
€+1.9M +5.1% -2.6x
CMSB + BIM + CMUC
€19.0M €22.0M July and September 2019 €5.2M €7.1M 27.3% 32.4% 9.8x 7.2x
Enterprise Value: €51.2M
Aesculapio
€2.3M €2.3M September 2019 €0.3M €0.3M 14.1% 12.9% 6.5x 6.5x
Enterprise Value: €2.0M
XRay One - 2020
- €7.6M - €1.8M - 23.7% - 7.6x
Enterprise Value: €13.6M
S. Francesco - 2021
- €32.0M - €7.0M - 22.0% - 8.4x
Enterprise Value: €59.5M
TOTAL M&A
€105.9M €25.3M 23.9% 8.1x
Enterprise Value: €204.1M
Notes:
(1) Normalized EBITDA figures exclude one-off and non-recurring components and Holding costs. "CMSB + BIM + CMUC" means Centro Medico San Biagio, Bimar and Centro 11
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