Healthcare & Life Sciences Industry Update August 2011 Member FINRA/SIPC
www.harriswilliams.com
What We’ve Been Reading August 2011 •
The biggest story from inside the Beltway over the last month was the battle and eventual deal to raise the U.S. debt ceiling to avoid an impending August 2nd default. The Budget Control Act of 2011 will raise the debt ceiling by $2.1-$2.4 trillion, while reducing spending by approximately $2.1 trillion over the next decade. In an interesting post-deal analysis, Michael Hiltzik of the Los Angeles Times notes that despite the protracted negotiations over a broad spectrum of cost-cutting measures, healthcare was not raised as a primary issue. Some have found this especially concerning, considering the outsized portion of the Federal Budget currently allocated to healthcare spending, which is forecast to rise in the coming years. A recent article in The Economist, entitled “Looking to Uncle Sam” makes this point and goes further to suggest that Centers for Medicare & Medicaid Services (CMS) actuaries may be underestimating future increases in Medicare and Medicaid spending.
•
One potential reason CMS actuaries may be underestimating the future costs of Medicare and Medicaid relates to healthcare reform’s effect on employee benefits, and specifically, the 2014 switch to subsidized exchange policies. A recent report by McKinsey & Company estimates that approximately 30% of employers will stop offering employersponsored insurance (ESI) when this switch is made, as opposed to the 7% estimated by the Congressional Budget Office. An ESI exodus of this magnitude could cause substantial strain on an already robust government healthcare budget. Read about the study here.
•
While the U.S. government struggles with the issue of how to limit healthcare costs in coming years, an Accountable Care Organization (ACO) success story has surfaced out of California. Duke Helfand, of the Los Angeles Times writes that over the past year the partnership of Blue Shield of California, Catholic Healthcare West, and Hill Physicians Medical Group effectively worked together to cut approximately $20 million in costs. These savings were largely attributable to shorter stays and a drop in readmission rates, which are also indicative of higher quality of care. While news of this successful ACO has encouraged proponents of this model, others caution that patient care must always be the top priority, as opposed to cost cutting. Read the article here.
•
One strategy that has been commonly employed by ACOs to reduce costs is the increased use of hospitalists to manage inpatient care. Hospitalists are the fastest-growing segment of the physician market, and there are now approximately 30,000 nationwide. A recentlyreported study by Yong-Fang Kuo and Dr. James S. Goodwin from the University of Texas Medical Branch in Galveston reveals that the utilization of these physicians may actually lead to increased costs, despite shorter length of stay for patients cared for by hospitalists. This reported increase is attributable to higher readmission rates and shifting of costs to other providers, such as nursing homes. While this data appears interesting, it should be noted that these statistics do not take into account quality of care, and therefore may not be indicative of actual value ascribable to hospitalist care. Read about the report here.
1
Equity Trading Overview August 2011 Key Trading Statistics (detail begins on page 6)
Number of Companies
Sector Clinical Laboratories Contract Pharma Manufacturing Contract Research Organizations Disease Management Emergency Services Health Care Staffing HMO - Medical Information Services Specialty Managed Care Specialty Pharmacy Management Dental Products Durable Medical Equipment Life Sciences Tools Medical Devices and Products Medical / Surgical / Dental Supplies Acute-Care Hospitals Assisted Living Diagnostic Imaging Dialysis Services Home Care / Hospice Long-Term Care Physician Practice Management Psychiatric Hospitals / Management Surgicenters / Rehabilitation
3 5 6 3 2 4 12 14 2 5 5 4 3 13 7 5 7 3 2 7 4 6 4 5
Payer, Provider, & Pharmacy Support Services Products & Devices Provider-Based Services HC&LS Composite Index
Average Enterprise Value
Change in Stock Price 3 mos. 12 mos.
Median TEV/ LTM Multiples Revenue EBITDA
Median TEV/ Forward Mulitples Revenue EBITDA
$8,150 618 1,906 1,830 473 759 12,521 2,055 2,467 7,879 22,293 2,384 14,412 33,828 8,684 7,142 1,489 2,740 20,670 1,036 723 809 2,596 2,337
(5.9%) (10.2%) (7.5%) (20.6%) (7.6%) (6.7%) (1.6%) 1.0% (10.6%) (2.9%) (10.4%) (6.9%) (15.5%) (7.6%) (9.0%) (15.8%) (19.8%) (10.6%) (3.6%) (22.4%) (11.5%) (6.6%) (9.4%) (5.3%)
16.6% 21.2% 10.4% 3.3% 40.7% 48.3% 62.0% 43.8% 5.5% 21.5% 28.3% 14.1% 23.8% 23.9% 27.0% 26.1% 50.1% 14.5% 41.1% 1.3% 40.1% 32.5% 30.9% 33.0%
1.7x 0.9x 1.4x 2.1x 1.6x 0.7x 0.4x 3.7x 1.0x 0.7x 2.5x 1.6x 2.6x 2.5x 0.2x 0.9x 1.7x 1.6x 2.1x 0.7x 0.6x 1.0x 0.4x 1.3x
8.1x 7.3x 10.5x 7.9x 8.4x 12.8x 5.9x 19.2x 6.8x 12.1x 12.1x 10.3x 9.3x 9.2x 8.7x 6.5x 10.8x 6.2x 10.7x 6.1x 6.0x 8.0x 4.4x 7.1x
1.7x 1.2x 1.4x 2.0x 1.6x 0.7x 0.4x 3.4x 0.9x 0.6x 2.4x 1.5x 2.5x 2.4x 0.2x 0.9x 1.4x 1.5x 2.0x 0.7x 0.6x 1.0x 0.5x 1.2x
8.2x 8.9x 9.4x 6.9x 8.6x 9.9x 5.9x 10.8x NA 9.7x 11.6x 7.3x 8.3x 8.3x 7.9x 6.3x 10.0x 6.0x 10.0x 6.0x 4.6x 7.5x 5.0x 7.1x
56
$3,866
(7.3%)
27.3%
1.4x
9.9x
1.4x
8.7x
32
$16,320
(9.9%)
23.4%
1.9x
9.9x
1.8x
8.7x
43
$4,394
(11.7%)
30.0%
1.1x
7.3x
1.1x
6.9x
131
$6,658
(9.5%)
27.5%
1.4x
8.9x
1.4x
8.0x
(5.2%)
17.3%
S&P 500
Public Company Sector Performance (12-month % change in stock price)
HMO - Medical Health Care Staffing Assisted Living
Dialysis Services Emergency Services Information Services Long-Term Care Surgicenters / Rehabilitation
Physician Practice Management Medical / Surgical / Dental Supplies Dental Products HC&LS Composite Index Specialty Pharmacy Management Life Sciences Tools
Psychiatric Hospitals / Management Medical Devices and Products Acute-Care Hospitals Contract Pharma Manufacturing S&P 500 Clinical Laboratories
Diagnostic Imaging Durable Medical Equipment Contract Research Organizations Specialty Managed Care Disease Management
Home Care / Hospice
(10.0%)
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
2
Equity Markets Overview August 2011 Healthcare and Life Sciences Industry Stock Performance
130 120 110 100 90 80 70 60
50 40 Aug-08
Dec-08
Apr-09
Aug-09
Dec-09
HW&Co. HCLS Index
Top 30 Equity Offerings (by proceeds)
Apr-10
Aug-10
S&P 500
Closing Date
Filing Date
Issuer
07/08/11
07/08/11
Merrimack Pharm(Atlantic)
07/13/11
07/13/11
ZELTIQ Aesthetics Inc
07/26/11
07/26/11
07/29/11
Dec-10
Apr-11
Aug-11
Dow Jones U.S. Health Care Index
Gross Proceeds ($mm)
Ticker
Transaction Type
MACK
IPO
$172.5
ZLTQ
IPO
115.0
Accuray Inc
ARAY
Convertible
100.0
07/29/11
Argos Therapeutics Inc
ARGS
IPO
86.3
07/29/11
07/29/11
AP Pharma Inc
APPA
Follow-On
74.3
07/28/11
07/14/11
Endocyte Inc
ECYT
Follow-On
71.2
07/13/11
06/07/11
Ventrus Biosciences Inc
VTUS
Follow-On
51.8
07/15/11
07/15/11
Provectus Pharmaceuticals Inc
PVCT
Follow-On
50.0
07/28/11
08/03/10
Horizon Pharma Inc
HZNP
IPO
49.5
07/28/11
05/27/11
BioSante Pharmaceuticals Inc
BPAX
Follow-On
48.0
07/11/11
07/11/11
Emmaus Holdings Inc
N/A
IPO
39.4
07/08/11
07/08/11
Derma Sciences Inc
DSCI
Follow-On
33.2
07/21/11
05/31/11
Pernix Therapeutics Hldg Inc
PTX
Follow-On
28.0
07/14/11
03/24/10
Delcath Systems Inc
DCTH
Follow-On
23.8
07/18/11
07/13/11
InSite Vision Inc
ISV
Follow-On
22.2
07/27/11
11/08/10
CytRx Corp
CYTR
Follow-On
20.0
07/26/11
07/26/11
Chelsea Therpeutics Intl Ltd
CHTP
Follow-On
19.8
07/22/11
07/22/11
Neurogesx Inc
NGSX
Follow-On
19.4
07/21/11
07/21/11
Celsion Corp
CLSN
Follow-On
18.5
07/20/11
07/20/11
Celsion Corp
CLSN
Follow-On
18.5
07/01/11
07/01/11
Novelos Therapeutics Inc
NVLT
Follow-On
17.3
07/19/11
05/02/11
NeoStem Inc
NBS
Follow-On
16.5
07/11/11
07/11/11
Emmaus Holdings Inc
N/A
Follow-On
10.7
07/19/11
07/19/11
BioLase Technology Inc
BLTI
Follow-On
7.5
07/07/11
06/30/11
Emisphere Technologies Inc
EMIS
Follow-On
7.5
07/05/11
06/24/11
TearLab Corp
TLB
Follow-On
7.0
07/28/11
07/28/11
TearLab Corp
TLB
Follow-On
6.9
07/01/11
07/01/11
Celsion Corp
CLSN
Follow-On
6.6
07/11/11
07/11/11
Next Fuel Inc
NXFI
Follow-On
6.3
07/06/11
07/06/11
Aradigm Corp
ARDM
Follow-On
4.8
3
M&A Overview August 2011 Quarterly M&A Activity
350
Top 10 Healthcare Deals
300 17
Number of Transactions__
Announced Healthcare & Life Sciences M&A
16 18
19
32
250
13 13
21
11 9
200
5
150 278 249
279 255
232
100
Announced
Target
7/29/2011 7/25/2011 7/21/2011 7/21/2011 7/18/2011 7/14/2011 7/12/2011 7/11/2011 7/8/2011 7/2/2011
Salar, Inc. Accelerated Rehabilitation Centers, Ltd. MedcoHealth Solutions Inc. Amira Pharmaceuticals, Inc. Align Networks Webmedx, Inc. Kinetic Concepts Inc. Multimodal T echnologies, Inc. Dermik Laboratories, Inc. Immucor Inc.
225
223
256
242
268
198
6
179
50
84
Number of Deals
$161.0
376
2.5x
1200 $350.5
1000
$300
800
$250 $194.1
600
$174.6
$150
$110.6
$118.0
400
$100 200
$50 $0 2008
Aggregate Deal Value
2009
2010
14.2x
12x
11.1x 1.5x
9x 7.7x 1.0x
6x 0.5x
3x
0.0x
2006
2011 YTD
2007
2009
TEV / LTM EBITDA
2010
2011 YTD
TEV / LTM Sales
PEG Investments and Exits
Number of Companies
120
3 16 8 25 30 53 10 10 4 23
100
Number of Investments'
Biotechnology Healthcare T echnology Healthcare Distributors Healthcare Equipment Healthcare Facilities Healthcare Services Healthcare Supplies Life Sciences T ools & Services Managed Healthcare Pharmaceuticals
2008
# of deals
PEG Investments by Segment (Last 3 Years) HC&LS Industry Segment
2.0x
12.8x
0x
0 2007
15x
15.2x
EV / LTM Revenue Multiple__
$389.4
EV / LTM EBITDA Multiple__
15.5x
2006
Announced Private Equity M&A Activity
18x
1400
$450
$200
11.07x
Median Healthcare and Life Sciences Transaction Multiples
Number of Transactions__
Aggregate Transaction Value ($ in billions)
$500
$350
1.77x
Strategic Acquirer
Announced Healthcare and Life Sciences Transactions
$400
Median Transaction Multiples TEV/Rev TEV/EBITDA
Note: Transactions based on publicly available information
3Q08 4Q08 1Q09 2Q09 3Q09 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 PEG Acquirer
T ranscend Services, Inc. OMERS Private Equity Express Scripts Inc. Bristol-Myers Squibb Company General Atlantic Nuance Communications, Inc. Apax Partners Worldwide LLP MedQuist Holdings Inc. Valeant International (Barbados) SRL T PG Capital
LTM Deal Statistics Aggregate Value ($bn)
0
Healthcare and Life Sciences M&A Trends
Buyer
18
113
95
94
80
79
80
71
69 60
58
60
50
49 40
70
62
42
40
40
40 31 25 23
23
2001
2002
27
20
0 2003
2004
2005
Number of Investments
2006
2007
2008
2009
Number of Exits
2010
2011 YTD
4
Debt Markets Overview August 2011 Quarterly Healthcare Loan Volume
Average Spread on Healthcare Loans L + 500
$24
Average Spread Over LIBOR__
Loan Volume by Quarter ($ in billions)___
Key Credit Statistics
$21 $18 $15 $12 $9 $6
L + 400
L + 300
L + 200
L + 100 $3 $0
L+0 2Q05 4Q05 2Q06 4Q06 2Q07 4Q07 2Q08 4Q08 2Q09 4Q09 2Q10 4Q10 2Q11 Pro Rata
2005
Credit Statistics
2008
2009
2010
1H 2011
Weighted-Average Institutional
L + 1000 2006
2007
2008
2009
2010
1H 2011
Average Spread Over LIBOR__
2005
EBITDA Multiple__
2007
Average Secondary Spread
6.0x
4.0x
2.0x
0.0x Debt/EBITDA
Recent Healthcare & Life Sciences Debt Offerings (by deal amount)
2006
Revolving Credit / Term Loan A
Institutional
Date Effective
Senior Debt/EBITDA EBITDA/Cash Interest EBITDA - Capex/Cash Interest
Borrower Name
Description
L + 800
L + 600
L + 400
L + 200
L+ 0
Rating
Spread
07/26/11
Royalty Pharma
Pharmaceutical preparations
USD 3,600,000,000
Deal Amount
Tranche Amount USD 2,750,000,000 Term Loan
Type
NR
275
07/26/11
Royalty Pharma
Pharmaceutical preparations
USD 3,600,000,000
USD 850,000,000 Term Loan
NR
300
07/25/11
Immucor Inc
Diagnostic substances
USD 1,100,000,000
USD 100,000,000 Revolver/Line >= 1 Yr.
NR
N/A
07/25/11
Immucor Inc
Diagnostic substances
USD 1,100,000,000
USD 600,000,000 Term Loan
NR
N/A
07/25/11
Immucor Inc
Diagnostic substances
USD 1,100,000,000
USD 400,000,000 Bridge Loan
NR
N/A
08/01/11
Capsugel, Capsugel Financeco SCA
Pharmaceutical preparations
USD 1,070,000,000
USD 150,000,000 Revolver/Line >= 1 Yr.
BB- / B1
N/A
08/01/11
Capsugel, Capsugel Financeco SCA
Pharmaceutical preparations
USD 1,070,000,000
USD 920,000,000 Term Loan
BB- / B1
450
07/02/11
CareFusion Corp
Surgical and medical instruments
USD 550,000,000
USD 550,000,000 Revolver/Line >= 1 Yr.
NR
162.5
07/01/11
Alkermes Inc
Pharmaceutical preparations
USD 450,000,000
USD 140,000,000 Term Loan
B / Caa1
800
07/01/11
Alkermes Inc
Pharmaceutical preparations
USD 450,000,000
USD 310,000,000 Term Loan B
BB / B1
525
07/29/11
Insight Pharmaceuticals Corp
Medicinals and botanicals
USD 420,000,000
USD 110,000,000 Term Loan
NR
N/A
07/29/11
Insight Pharmaceuticals Corp
Medicinals and botanicals
USD 420,000,000
NR
N/A
07/29/11
Insight Pharmaceuticals Corp
Medicinals and botanicals
USD 420,000,000
USD 290,000,000 Term Loan B
NR
N/A
07/09/11
Examworks Group Inc
Health and allied services
USD 262,500,000
USD 262,500,000 Revolver/Line >= 1 Yr.
NR
275
07/29/11
Amneal Pharmaceuticals LLC
Pharmaceutical preparations
USD 250,000,000
USD 180,000,000 Term Loan
NR
325
07/29/11
Amneal Pharmaceuticals LLC
Pharmaceutical preparations
USD 250,000,000
USD 70,000,000 Revolver/Line >= 1 Yr.
NR
325
07/29/11
Water Pik Inc
Dental equipment and supplies
USD 197,000,000
USD 20,000,000 Revolver/Line >= 1 Yr.
B / B2
N/A
07/29/11
Water Pik Inc
Dental equipment and supplies
USD 197,000,000
B / B2
N/A
07/21/11
MCCI Medical Group
Health and allied services
USD 155,000,000
NR
N/A
07/21/11
MCCI Medical Group
Health and allied services
USD 155,000,000
NR
N/A
07/15/11
Ensign Group Inc
Skilled nursing care facilities
USD 150,000,000
USD 75,000,000 Revolver/Line >= 1 Yr.
NR
250
07/15/11
Ensign Group Inc
Skilled nursing care facilities
USD 150,000,000
USD 75,000,000 Term Loan A
NR
250
07/11/11
DentalOne Partners Inc
Offices and clinics of dentists
USD 65,000,000
USD 17,000,000 Revolver/Line >= 1 Yr.
NR
500
07/11/11
DentalOne Partners Inc
Offices and clinics of dentists
USD 65,000,000
USD 48,000,000 Term Loan
NR
500
USD 20,000,000 Revolver/Line >= 1 Yr.
USD 177,000,000 Term Loan USD 15,000,000 Revolver/Line >= 1 Yr. USD 140,000,000 Term Loan B
5
Healthcare and Life Sciences Industry Update August 2011 Payer, Provider, & Pharmacy Support Services Company Name (Ticker) 7/29/2011 Clinical Laboratories Bio-Reference Laboratories Inc. Laboratory Corp. of America Holdings Quest Diagnostics Inc. Number of Companies
Contract Pharma Manufacturing Akorn, Inc. Cambrex Corporation. Integrated Biopharma Inc. Patheon Inc. West Pharmaceutical Services, Inc. Number of Companies
Contract Research Organizations Albany Molecular Research Inc. Charles River Laboratories International, Inc. Covance Inc. ICON plc PAREXEL International Corporation Pharmaceutical Product Development Inc. Number of Companies
3
5
6
Disease Management Alere Inc. Corac Group plc Healthways Inc. Number of Companies
3
Emergency Services Air Methods Corp. Eastland Medical Systems Limited Number of Companies
2
Health Care Staffing AMN Healthcare Services Inc. Cross Country Healthcare, Inc. On Assignment Inc. Team Health Holdings, Inc. Number of Companies
As of July 29, 2011
4
Stock Price % Change 3 mos. 12 mos.
$19.94 (20.9%) 90.76 (5.9%) 54.01 (4.2%) Median: (5.9%) Mean: (10.3%)
52 Week High Low
Equity Total Debt Mkt. Value
Cash and Equiv.
Total Ent. Value (TEV)
Lastest Twelve Months (LTM) Revenue EBITDA EBIT
LTM Period (3)
Lastest FYE Date (3)
Forward Estimate Revenue EBITDA
TEV/ LTM Multiples
EBIT
Revenue
(5)
EBITDA
TEV/ Fwd Multiples Revenue
EBITDA
(5.2%) 23.9% 16.6% 16.6% 11.8%
$25.99 100.94 61.21
$18.02 72.33 43.38 Total
$557 9,094 8,549 $18,200
$46 2,003 4,328
$21 195 994
$582 11,153 12,714 $8,150 $8,150
$508 5,344 7,413 $13,265
$72 1,226 1,536
$59 1,046 1,272
Apr-11 Jun-11 Jun-11
Oct-10 Dec-10 Dec-10
$555 5,571 7,498 $13,624
$72 1,318 1,551
$58 1,070 1,250
1.1x 2.1x 1.7x 1.7x 1.6x
8.1x 9.1x 8.1x 8.1x 8.4x
1.0x 2.0x 1.7x 1.7x 1.6x
8.0x 8.5x 8.2x 8.2x 8.2x
4.7% 91.4% (16.2%) 21.2% (62.8%) (20.0%) (10.2%) (13.4%) (7.1%) 22.3% (10.2%) 21.2% (18.3%) 20.3%
$7.62 6.78 0.28 2.94 47.96
$2.95 3.54 0.03 1.82 32.74 Total
$655 130 2 277 1,469 $2,533
$0 118 13 275 377
$46 35 1 39 95
$610 212 14 512 1,741 $618 $618
$91 232 41 687 1,152 $2,202
$20 46 (1) 98 182
$15 24 (2) 40 105
Mar-11 Mar-11 Mar-11 Apr-11 Jun-11
Dec-10 Dec-10 Jun-10 Oct-10 Dec-10
$114 239 NA 687 1,184 $2,225
$32 NA NA 76 196
$26 25 NA 33 116
6.7x 0.9x 0.3x 0.7x 1.5x 0.9x 2.0x
13.9x 4.6x NM 5.2x 9.3x 7.3x 8.3x
5.3x 0.9x NA 0.7x 1.5x 1.2x 2.1x
19.3x NA NA 6.7x 8.9x 8.9x 11.6x
$4.78 (2.2%) (27.0%) 39.55 (6.3%) 23.8% 57.25 (8.5%) 44.4% 22.33 (9.1%) (3.1%) 20.53 (26.0%) (1.9%) 28.83 (6.5%) 22.7% Median: (7.5%) 10.4% Mean: (9.8%) 9.8%
$7.10 42.84 63.86 26.22 27.91 32.91
$3.87 28.20 37.44 18.93 16.80 22.71 Total
$145 2,043 3,473 1,350 1,209 3,265 $11,484
$13 857 93 0 292 0
$10 159 368 192 119 350
$135 2,728 3,159 1,134 1,382 2,898 $1,906 $1,906
$206 1,127 2,108 920 1,405 1,545 $7,310
$6 255 305 106 171 294
($12) 164 203 71 108 229
Mar-11 Mar-11 Jun-11 Jun-11 Mar-11 Jun-11
Dec-10 Dec-10 Dec-10 Dec-10 Jun-10 Dec-10
$221 1,143 2,065 961 1,230 1,536 $7,156
$15 266 324 82 153 327
($3) 192 218 43 89 257
0.7x 2.4x 1.5x 1.2x 1.0x 1.9x 1.4x 1.4x
24.1x 10.7x 10.4x 10.7x 8.1x 9.3x 10.5x 12.2x
0.6x 2.4x 1.5x 1.2x 1.1x 1.9x 1.4x 1.5x
8.8x 10.2x 9.8x 13.8x 9.0x 8.9x 9.4x 10.1x
(20.6%) 3.4% (28.6%) (44.3%) (11.8%) 3.3% (20.6%) 3.3% (20.3%) (12.5%)
$41.18 0.56 17.62
$26.61 0.21 9.50 Total
$2,527 53 505 $3,085
$2,773 0 227
$319 34 4
$4,742 17 731 $1,830 $1,830
$2,267 1 698 $2,966
$458 (7) 135
$78 (7) 84
Jun-11 Dec-10 Jun-11
Dec-10 Dec-10 Dec-10
$2,362 2 690 $3,054
$614 (8) 119
$494 (11) 68
2.1x 15.5x 1.0x 2.1x 6.2x
10.0x NM 5.4x 7.7x 7.7x
2.0x 7.1x 1.1x 2.0x 3.4x
7.7x NM 6.1x 6.9x 6.9x
$70.10 3.7% 117.8% 0.03 (18.9%) (36.3%) Median: (7.6%) 40.7% Mean: (7.6%) 40.7%
$77.22 0.08
$30.81 0.02 Total
$886 16 $902
$100 1
$56 1
$930 17 $473 $473
$575 (1) $575
$111 (2)
$85 (2)
Mar-11 Dec-10
Dec-10 Jun-10
$593 NA $593
$108 NA
8.4x
$4.14 6.34 4.18 11.81 Total
$319 215 377 1,428 $2,339
$219 52 79 403
$562 255 440 1,781 $759 $759
$775 469 471 2,759 $4,474
$41 21 32 169
$948 507 571 1,691 $3,718
$64 24 45 180
$6.93 4.41 0.20 2.15 43.87 Median: Mean:
$29.49 0.21 14.93 Median: Mean:
$8.06 6.91 10.20 22.01 Median: Mean:
(6.6%) 24.2% (6.9%) (22.5%) (7.2%) 122.2% 10.7% 72.5% (6.7%) 48.3% (2.5%) 49.1%
$9.33 9.86 11.67 24.13
$4 10 16 49
$25 10 24 142
Mar-11 Mar-11 Mar-11 Mar-11
Dec-10 Dec-10 Dec-10 Dec-10
$81 NA NM
$42 12 37 151
1.6x 1.6x 1.6x
8.4x 8.4x
1.6x NA 1.6x 1.6x
8.6x NA 8.6x 8.6x
0.7x 0.5x 0.9x 0.6x 0.7x 0.7x
13.7x 11.9x 13.8x 10.5x 12.8x 12.5x
0.6x 0.5x 0.8x 1.1x 0.7x 0.7x
8.8x 10.6x 9.8x 9.9x 9.9x 9.8x
NM
6
Healthcare and Life Sciences Industry Update August 2011 Payer, Provider, & Pharmacy Support Services Company Name (Ticker) 7/29/2011
Stock Price % Change 3 mos. 12 mos.
52 Week High Low
Equity Total Debt Mkt. Value
Cash and Equiv.
HMO - Medical Commercial: Aetna Inc. CIGNA Corporation Coventry Health Care Inc. Health Net Inc. HealthSpring Inc. Humana Inc. Unitedhealth Group, Inc. WellPoint Inc. Number of Companies
Government: AMERIGROUP Corporation Centene Corp. Molina Healthcare Inc. WellCare Health Plans, Inc. Number of Companies
8
4
Total Ent. Value (TEV)
Lastest Twelve Months (LTM) Revenue EBITDA EBIT
LTM Period (3)
Lastest FYE Date (3)
Forward Estimate Revenue EBITDA
TEV/ LTM Multiples
EBIT
Revenue
(5)
EBITDA
TEV/ Fwd Multiples Revenue
EBITDA
$41.49 0.3% 50.9% 49.77 6.3% 62.5% 32.00 (0.8%) 69.8% 28.12 (15.6%) 19.8% 41.04 (1.1%) 113.0% 74.58 (2.0%) 61.5% 49.63 0.8% 63.0% 67.55 (12.0%) 35.4% Median: (1.0%) 62.0% Mean: (3.0%) 59.5%
$46.01 52.95 37.86 34.03 48.95 84.32 53.50 81.92
$26.42 30.06 18.28 23.05 17.17 45.66 29.94 48.61 Total
$15,472 13,466 4,743 2,545 2,780 12,559 53,771 24,363 $129,698
$4,090 3,228 1,818 399 388 1,956 11,131 9,660
$1,444 1,656 1,359 142 301 1,756 9,790 2,402
$18,117 15,038 4,916 2,801 2,868 12,758 55,127 32,323 $17,994 $17,994
$33,811 21,443 11,959 13,736 3,777 34,679 98,364 59,293 $277,061
$3,402 2,465 1,027 343 397 2,211 9,197 5,372
$2,951 2,250 912 308 357 1,935 8,439 4,752
Jun-11 Mar-11 Jun-11 Mar-11 Mar-11 Mar-11 Jun-11 Jun-11
Dec-10 Dec-10 Dec-10 Dec-10 Dec-10 Dec-10 Dec-10 Dec-10
$33,220 21,495 12,100 12,060 5,438 37,090 101,539 59,841 $282,782
$3,384 2,476 862 474 474 2,239 8,557 4,494
$2,976 2,139 729 445 420 2,017 7,612 3,965
0.5x 0.7x 0.4x 0.2x 0.8x 0.4x 0.6x 0.5x 0.5x 0.5x
5.3x 6.1x 4.8x 8.2x 7.2x 5.8x 6.0x 6.0x 6.0x 6.2x
0.5x 0.7x 0.4x 0.2x 0.5x 0.3x 0.5x 0.5x 0.5x 0.5x
5.4x 6.1x 5.7x 5.9x 6.1x 5.7x 6.4x 7.2x 6.0x 6.1x
$55.00 32.81 22.65 43.85 Median: Mean:
$75.74 39.35 29.03 55.75
$33.26 20.01 16.43 23.84 Total
$2,728 1,651 1,043 1,866 $7,289
$251 340 167 0
$602 492 464 1,233
$2,397 1,518 751 633 $1,325 $1,325
$6,060 4,845 4,407 5,559 $20,871
$471 236 186 209
$456 191 135 185
Jun-11 Jun-11 Jun-11 Mar-11
Dec-10 Dec-10 Dec-10 Dec-10
$6,282 5,238 4,649 5,921 $22,090
$421 254 179 301
$386 195 128 275
0.4x 0.3x 0.2x 0.1x 0.2x 0.2x
5.1x 6.4x 4.0x 3.0x 4.6x 4.6x
0.4x 0.3x 0.2x 0.1x 0.2x 0.2x
5.7x 6.0x 4.2x 2.1x 4.9x 4.5x
(4.0%) 4.6% 0.2% (20.5%) 2.3% 49.5% 0.2% 4.6% (0.5%) 11.2%
$8.95 8.65 36.89
$5.96 5.36 22.07 Total
$403 313 245 $960
$0 21 16
$44 30 3
$290 303 257 $283 $283
$115 161 66 $341
($8) 43 20
($25) 23 15
Mar-11 Mar-11 Mar-11
Dec-10 Dec-10 Dec-10
$148 182 75 $148
$34 52 NA
$22 34 NA
2.5x 1.9x 3.9x 2.5x 2.8x
NM 7.1x 13.0x 10.1x 10.1x
2.0x 1.7x 3.4x 2.0x 2.4x
8.7x 5.8x NA 7.2x 7.2x
35.25 (39.1%) (23.6%) Median: (39.1%) (23.6%) Mean: (39.1%) (23.6%)
58.55
31.66 Total
2,083 $2,083
800
1,065
1,818 $1,818 $1,818
576 $576
150
132
Jun-11
Dec-10
$588 $588
$201
$142
3.2x 3.2x 3.2x
12.1x 12.1x 12.1x
3.4x 3.4x 3.4x
10.6x 10.6x 10.6x
$18.15 (15.7%) 8.7% 58.79 27.2% 124.7% 66.49 10.7% 71.5% 73.45 25.0% 77.5% 75.60 (4.0%) 38.1% 12.67 (20.9%) (46.4%) 5.08 3.0% 56.8% 91.36 1.8% 65.5% 17.13 0.0% 0.0% 29.06 20.4% 94.0% Median: 2.4% 61.1% Mean: 4.8% 49.0%
$23.13 60.29 68.12 79.06 84.82 25.00 6.19 92.38 18.00 30.25
$16.42 25.18 36.22 40.00 50.58 12.31 2.46 52.90 16.64 13.69 Total
$3,453 2,057 11,224 813 2,136 743 428 2,674 1,199 309 $25,034
$449 0 115 0 0 968 196 0 700 0
$145 46 185 10 116 57 47 117 326 16
$3,757 1,952 10,656 788 2,019 1,653 619 2,548 1,831 278 $2,610 $2,610
$1,074 280 1,979 173 339 428 173 371 1,321 101 $6,241
$173 47 526 41 94 107 31 112 160 22
$97 35 399 39 75 41 13 104 110 20
Mar-11 Jun-11 Jul-11 Jun-11 Jun-11 Mar-11 Mar-11 Jun-11 Mar-11 Mar-11
Dec-10 Dec-10 Jan-11 Dec-10 Dec-10 Dec-10 Dec-10 Mar-11 Dec-10 Dec-10
$1,439 321 2,118 180 371 590 235 428 NA 128 $5,810
$359 68 673 42 110 185 57 146 NA 28
$303 35 461 43 85 51 43 129 NA 26
3.5x 7.0x 5.6x 4.5x 6.0x 3.9x 3.6x 7.2x 1.4x 2.7x 4.2x 4.5x
21.7x 41.2x 21.2x 19.2x 21.5x 15.4x 20.1x 25.1x 11.4x 12.7x 20.6x 20.9x
2.6x 6.1x 5.0x 4.4x 5.4x 2.8x 2.6x 5.9x NA 2.2x 4.4x 4.1x
10.5x 28.7x 15.8x 18.8x 18.4x 9.0x 10.9x 17.5x NA 9.8x 15.8x 15.5x
(19.5%) (9.4%) (21.0%) 0.1% (14.5%) (12.5%)
66.9% 60.9% 19.2% 79.1% 63.9% 56.5%
Information Services Data/Analytics: Accelrys Inc. eResearchTechnology, Inc. National Research Corp. Number of Companies
3
eHealth: WebMD Health Corp. Number of Companies
1
Hospital/Physician: Allscripts Healthcare Solutions, Inc. athenahealth, Inc. Cerner Corporation Computer Programs & Systems Inc. HMS Holdings Corp. MedAssets, Inc. Merge Healthcare Incorporated Quality Systems Inc. SXC Health Solutions, Corp. Transcend Services, Inc. Number of Companies
As of July 29, 2011
10
$7.27 6.37 36.43 Median: Mean:
7
Healthcare and Life Sciences Industry Update August 2011 Payer, Provider, & Pharmacy Support Services Company Name (Ticker) 7/29/2011 Specialty Managed Care Assurant Inc. CorVel Corporation Number of Companies
Specialty Pharmacy Management BioScrip Inc. Express Scripts Inc. Catalyst Health Solutions, Inc. Omnicare Inc. PharMerica Corporation Number of Companies
As of July 29, 2011
2
5
Stock Price % Change 3 mos. 12 mos.
52 Week High Low
Equity Total Debt Mkt. Value
Cash and Equiv.
Total Ent. Value (TEV)
Lastest Twelve Months (LTM) Revenue EBITDA EBIT
LTM Period (3)
Lastest FYE Date (3)
Forward Estimate Revenue EBITDA
TEV/ LTM Multiples
EBIT
Revenue
(5)
EBITDA
TEV/ Fwd Multiples Revenue
EBITDA
35.62 46.15 Median: Mean:
(10.3%) (10.9%) (10.6%) (10.6%)
(4.2%) 15.1% 5.5% 5.5%
41.90 54.19
33.43 35.74 Total
3,438 536 $3,974
972 0
940 12
4,410 524 $2,467 $2,467
8,319 381 $8,700
951 59
818 46
Jun-11 Mar-11
Dec-10 Mar-11
8,159 446 $8,604
NA NA
885 NA
0.5x 1.4x 1.0x 1.0x
4.6x 8.9x 6.8x 6.8x
0.5x 1.2x 0.9x 0.9x
NA NA NA NA
$7.18 54.26 65.53 30.50 12.77 Median: Mean:
55.7% (4.4%) 10.1% (2.9%) (3.0%) (2.9%) 11.1%
14.7% 21.5% 90.2% 23.9% (2.0%) 21.5% 29.7%
$7.85 60.89 67.58 33.01 14.75
$4.00 42.50 31.40 19.14 6.88 Total
$389 26,490 2,899 3,532 375 $33,685
$278 4,089 146 1,959 244
$0 766 183 451 12
$667 30,288 2,862 4,970 607 $7,879 $7,879
$1,743 45,002 4,054 6,244 1,920 $58,962
$55 2,541 162 621 75
$43 2,312 142 471 46
Mar-11 Jun-11 Mar-11 Jun-11 Mar-11
Dec-10 Dec-10 Dec-10 Dec-10 Dec-10
$1,783 45,655 5,149 6,137 2,118 $60,842
$69 2,849 192 604 81
$49 2,643 155 492 47
0.4x 0.7x 0.7x 0.8x 0.3x 0.7x 0.6x
12.1x 11.9x 17.7x 8.0x 8.1x 11.9x 11.6x
0.4x 0.7x 0.6x 0.8x 0.3x 0.6x 0.5x
9.7x 10.6x 14.9x 8.2x 7.5x 9.7x 10.2x
8
Healthcare and Life Sciences Industry Update August 2011 Products & Devices Company Name (Ticker) 7/29/2011 Dental Products 3M Co. Danaher Corp. DENTSPLY International Inc. Sirona Dental Systems Inc. Young Innovations Inc. Number of Companies
Durable Medical Equipment Hill-Rom Holdings, Inc. Invacare Corporation ResMed Inc. Steris Corp. Number of Companies
Life Sciences Tools Agilent Technologies Inc. Becton, Dickinson and Company Life Technologies Corporation Number of Companies
5
4
3
$87.14 49.11 37.89 50.58 28.98 Median: Mean:
Stock Price % Change 3 mos. 12 mos. (10.4%) (11.1%) 0.9% (11.4%) (6.6%) (10.4%) (7.7%)
52 Week High Low
Equity Total Debt Mkt. Value
Cash and Equiv.
Total Ent. Value (TEV)
Lastest Twelve Months (LTM) Revenue EBITDA EBIT
LTM Period (3)
Lastest FYE Date (3)
Forward Estimate Revenue EBITDA
TEV/ LTM Multiples
EBIT
Revenue
(5)
EBITDA
TEV/ Fwd Multiples Revenue
EBITDA
0.9% 28.3% 30.5% 67.3% 7.9% 28.3% 27.0%
$98.19 56.09 40.16 57.87 33.40
$78.40 35.24 27.76 29.55 24.06 Total
$61,829 33,668 5,355 2,820 232 $103,904
$5,600 6,573 951 389 0
$2,747 1,594 575 300 1
$62,905 39,755 5,666 2,905 231 $22,293 $22,293
$28,574 14,035 2,290 878 106 $45,882
$7,279 2,878 467 224 28
$6,110 2,446 398 148 24
Jun-11 Jul-11 Jun-11 Jun-11 Jun-11
Dec-10 Dec-10 Dec-10 Sep-10 Dec-10
$30,052 16,416 2,304 882 108 $49,762
$7,956 3,330 458 250 29
$6,722 2,776 389 195 25
2.2x 2.8x 2.5x 3.6x 2.2x 2.5x 2.7x
8.7x 13.6x 12.1x 14.0x 8.2x 12.1x 11.3x
2.1x 2.4x 2.5x 3.3x 2.1x 2.4x 2.5x
7.9x 11.9x 12.4x 11.6x 8.0x 11.6x 10.4x
$37.29 (17.2%) 29.98 (8.9%) 30.29 (5.0%) 34.99 (2.9%) Median: (6.9%) Mean: (8.5%)
16.5% 24.7% (5.3%) 11.6% 14.1% 11.9%
$48.80 34.52 35.90 38.00
$31.16 22.59 29.24 28.07 Total
$2,355 957 4,632 2,079 $10,023
$153 256 100 210
$235 33 672 193
$2,225 1,175 4,040 2,097 $2,384 $2,384
$1,558 1,784 1,243 1,337 $5,922
$299 136 336 251
$212 100 268 196
Jun-11 Jun-11 Jun-11 Jun-11
Sep-10 Dec-10 Jun-11 Mar-11
$1,584 1,810 1,426 1,393 $6,213
$321 NA 375 287
$205 NA 302 234
1.4x 0.7x 3.4x 1.7x 1.6x 1.8x
7.4x 8.6x 12.0x 14.9x 10.3x 10.7x
1.4x 0.6x 2.8x 1.5x 1.5x 1.6x
6.9x NA 10.8x 7.3x 7.3x 8.3x
$42.16 83.61 45.03 Median: Mean:
49.8% 23.8% 6.2% 23.8% 26.6%
$55.33 89.75 57.25
$26.68 66.87 42.40 Total
$14,674 18,290 8,050 $41,013
$2,153 2,725 2,739
$2,975 749 694
$13,860 19,151 10,224 $14,412 $14,412
$6,156 7,651 3,636 $17,444
$1,165 2,235 1,104
$911 1,739 694
Apr-11 Jun-11 Jun-11
Oct-10 Sep-10 Dec-10
$6,620 7,789 3,752 $18,161
$1,483 2,305 1,312
$1,282 1,775 1,086
2.3x 2.6x 2.8x 2.6x 2.5x
11.9x 8.7x 9.3x 9.3x 10.0x
2.1x 2.5x 2.7x 2.5x 2.4x
9.3x 8.3x 7.8x 8.3x 8.5x
$51.32 (1.4%) 33.05 (6.5%) 58.17 2.2% 7.16 (4.4%) 98.68 (7.6%) 21.01 (22.7%) 18.57 (15.7%) 51.12 (9.9%) 64.79 (1.4%) 36.05 (13.7%) 54.34 (7.9%) 60.09 0.2% 60.02 (8.0%) Median: (7.6%) Mean: (7.4%)
4.8% 24.3% 33.1% 27.9% 26.8% 23.9% 32.8% (1.0%) 12.0% (0.1%) 17.7% 33.6% 15.1% 23.9% 19.3%
$54.24 36.00 62.50 7.96 113.84 28.47 23.24 60.49 68.05 43.33 65.21 65.86 69.93
$45.07 24.65 42.47 5.04 75.88 13.01 13.76 49.51 56.99 30.80 42.74 41.74 46.27 Total
$79,766 903 33,179 10,942 8,550 699 4,857 8,428 177,599 38,247 21,102 23,030 11,521 $418,822
$18,830 0 4,400 4,201 901 506 1,470 1,760 17,830 9,835 1,021 4,027 1,147
$2,740 148 2,168 595 748 20 573 597 22,356 1,382 735 2,789 576
$92,184 830 35,624 14,989 8,539 1,198 5,736 9,586 168,562 45,654 19,448 25,694 11,723 $33,828 $33,828
$37,300 358 13,542 7,818 2,821 868 1,751 4,008 63,396 15,933 7,823 11,185 4,353 $171,156
$10,054 84 3,849 1,938 907 141 597 872 19,484 5,365 2,383 2,217 1,565
$7,176 60 3,172 1,155 794 116 298 634 16,480 4,561 1,935 1,439 1,216
Jun-11 Jun-11 Jun-11 Jun-11 Jun-11 Jun-11 Jun-11 Jun-11 Jul-11 Apr-11 Jun-11 Jul-11 Jun-11
Dec-10 Dec-10 Dec-10 Dec-10 Dec-10 Dec-10 Sep-10 Dec-10 Jan-11 Apr-11 Dec-10 Dec-10 Dec-10
$38,816 370 13,784 7,791 2,917 940 1,772 4,257 65,373 16,573 8,346 11,688 4,481 $177,108
$11,509 90 3,976 1,839 933 157 636 1,086 20,372 6,185 2,414 2,365 1,657
$8,915 68 3,287 1,103 829 125 540 868 17,193 5,267 1,986 2,130 1,287
2.5x 2.3x 2.6x 1.9x 3.0x 1.4x 3.3x 2.4x 2.7x 2.9x 2.5x 2.3x 2.7x 2.5x 2.5x
9.2x 10.5x 9.3x 7.6x 9.4x 8.8x 9.6x 10.5x 8.7x 8.5x 8.2x 11.6x 7.5x 9.2x 9.2x
2.4x 2.2x 2.6x 1.9x 2.9x 1.3x 3.2x 2.3x 2.6x 2.8x 2.3x 2.2x 2.6x 2.4x 2.4x
8.0x 9.2x 9.0x 8.2x 9.2x 7.6x 9.0x 8.8x 8.3x 7.4x 8.1x 10.9x 7.1x 8.3x 8.5x
$38.31 (5.7%) 43.76 0.2% 66.46 (9.0%) 81.12 (2.3%) 30.50 (11.5%) 30.84 (11.1%) 23.93 (16.8%) Median: (9.0%) Mean: (8.0%)
32.2% 35.4% 28.7% 27.0% 14.0% 18.3% 25.1% 27.0% 25.8%
$43.47 47.06 74.98 87.32 35.71 36.93 29.47
$27.09 29.69 50.97 57.81 25.68 24.88 18.30 Total
$10,496 15,342 6,131 19,980 1,945 3,699 1,283 $58,875
$1,362 2,502 443 3,989 212 531 219
$1,912 1,962 117 3,612 186 389 29
$9,857 15,799 6,955 20,853 1,998 3,841 1,483 $8,684 $8,684
$79,525 102,644 7,995 114,614 8,389 3,416 2,070 $318,654
$1,321 1,881 663 2,448 233 417 167
$1,215 1,567 555 2,012 201 376 135
Jun-11 Jun-11 Jun-11 Jun-11 Jun-11 Apr-11 Jul-11
Sep-10 Jun-11 Dec-10 Mar-11 Dec-10 Apr-11 Apr-11
$79,800 106,692 8,191 119,158 8,573 3,570 2,172 $328,156
$1,330 2,192 700 2,975 252 430 180
$1,225 1,797 588 2,487 218 386 147
0.1x 0.2x 0.9x 0.2x 0.2x 1.1x 0.7x 0.2x 0.5x
7.5x 8.7x 10.6x 8.5x 8.6x 9.2x 8.9x 8.7x 8.8x
0.1x 0.1x 0.8x 0.2x 0.2x 1.1x 0.7x 0.2x 0.5x
7.4x 7.2x 9.9x 7.0x 7.9x 8.9x 8.2x 7.9x 8.1x
(15.5%) (2.7%) (18.4%) (15.5%) (12.2%)
Medical Devices and Products Abbott Laboratories ArthroCare Corporation Baxter International Inc. Boston Scientific Corporation CR Bard Inc. Hanger Orthopedic Group Inc. Hologic Inc. Hospira Inc. Johnson & Johnson Medtronic, Inc. Stryker Corp. Thermo Fisher Scientific, Inc. Zimmer Holdings, Inc. Number of Companies
Medical / Surgical / Dental Supplies AmerisourceBergen Corporation Cardinal Health, Inc. Henry Schein Inc. McKesson Corporation Owens & Minor Inc. Patterson Companies Inc. PSS World Medical Inc. Number of Companies
As of July 29, 2011
13
7
9
Healthcare and Life Sciences Industry Update August 2011 Provider-Based Services Company Name (Ticker) 7/29/2011 Acute-Care Hospitals Community Health Systems, Inc. Health Management Associates Inc. Lifepoint Hospitals Inc. Tenet Healthcare Corp. Universal Health Services Inc. Number of Companies
Assisted Living Assisted Living Concepts Inc. Brookdale Senior Living Inc. Capital Senior Living Corp. Emeritus Corp. Five Star Quality Care Inc. Skilled Healthcare Group, Inc. Sunrise Senior Living Inc. Number of Companies
5
7
Diagnostic Imaging Alliance Healthcare Services, Inc. RadNet, Inc. Varian Medical Systems Inc. Number of Companies
3
Dialysis Services DaVita, Inc. Fresenius Medical Care AG & Co. KGAA Number of Companies
2
Home Care / Hospice Addus HomeCare Corp. Almost Family Inc. Amedisys Inc. Gentiva Health Services Inc. LHC Group, Inc. Lincare Holdings Inc. Chemed Corp. Number of Companies
Long-Term Care The Ensign Group, Inc. Kindred Healthcare Inc. National Healthcare Corp. Sun Healthcare Group, Inc. Number of Companies
As of July 29, 2011
7
4
Stock Price % Change 3 mos. 12 mos.
52 Week High Low
Equity Total Debt Mkt. Value
Cash and Equiv.
Total Ent. Value (TEV)
Lastest Twelve Months (LTM) Revenue EBITDA EBIT
LTM Period (3)
Lastest FYE Date (3)
Forward Estimate Revenue EBITDA
TEV/ LTM Multiples
EBIT
Revenue
(5)
EBITDA
TEV/ Fwd Multiples Revenue
EBITDA
$25.84 9.50 37.10 5.56 49.64 Median: Mean:
(15.9%) (14.2%) (15.8%) 37.7% (10.8%) 23.7% (19.8%) 26.1% (9.4%) 44.8% (15.8%) 26.1% (14.3%) 23.6%
$42.50 11.74 43.45 7.70 56.46
$22.33 6.13 29.73 3.92 30.51 Total
$2,428 2,405 1,929 2,722 4,848 $14,332
$8,852 2,985 1,584 4,090 3,753
$271 96 276 267 52
$11,526 5,159 3,258 6,940 8,829 $7,142 $7,142
$13,625 5,442 3,452 9,372 6,695 $38,586
$1,718 781 541 1,128 1,043
$1,133 522 367 728 781
Jun-11 Jun-11 Jun-11 Mar-11 Jun-11
Dec-10 Dec-10 Dec-10 Dec-10 Dec-10
$13,955 5,725 3,554 9,737 7,609 $40,580
$1,852 815 539 1,240 1,200
$1,179 549 376 841 870
0.8x 0.9x 0.9x 0.7x 1.3x 0.9x 1.0x
6.5x 6.6x 6.0x 6.2x 8.5x 6.5x 6.8x
0.8x 0.9x 0.9x 0.7x 1.2x 0.9x 0.9x
6.2x 6.3x 6.0x 5.6x 7.4x 6.2x 6.3x
$15.67 21.39 8.79 19.65 4.95 8.80 8.82 Median: Mean:
(13.1%) (1.9%) (21.5%) 50.1% (5.2%) 66.5% (19.8%) 11.8% (40.9%) 35.6% (27.4%) 262.1% (15.0%) 209.5% (19.8%) 50.1% (20.4%) 90.5%
$19.61 28.30 10.91 26.35 8.95 15.93 12.44
$13.08 12.66 4.87 15.20 3.50 2.30 2.18 Total
$363 2,609 242 870 235 335 506 $5,160
$114 2,464 174 2,028 66 508 155
$3 37 30 80 26 1 42
$469 5,036 386 2,820 238 842 624 $1,488 $1,488
$234 2,238 224 1,073 1,260 853 1,373 $7,256
$60 382 34 171 44 128 66
$37 91 20 68 27 103 36
Mar-11 Mar-11 Mar-11 Mar-11 Jun-11 Mar-11 Mar-11
Dec-10 Dec-10 Dec-10 Dec-10 Dec-10 Dec-10 Dec-10
$236 2,334 268 1,248 1,290 882 1,344 $7,602
$65 415 38 219 49 141 45
$42 123 NA 92 45 115 NA
2.0x 2.3x 1.7x 2.6x 0.2x 1.0x 0.5x 1.7x 1.5x
7.9x 13.2x 11.6x 16.7x 5.3x 6.5x 10.8x 10.8x 10.3x
2.0x 2.2x 1.4x 2.3x 0.2x 1.0x 0.5x 1.4x 1.4x
7.2x 12.1x 10.0x 12.9x 4.8x 6.0x 13.9x 10.0x 9.6x
$3.61 (18.3%) 3.75 2.5% 62.76 (10.6%) Median: (10.6%) Mean: (8.8%)
0.8% 84.7% 14.5% 14.5% 33.4%
$5.06 5.19 72.19
$3.27 1.80 51.01 Total
$192 140 7,355 $7,687
$651 523 18
$102 0 584
$753 663 6,805 $2,740 $2,740
$479 571 2,530 $3,579
$144 99 633
$40 44 581
Mar-11 Mar-11 Jul-11
Dec-10 Dec-10 Oct-10
$508 597 2,600 $3,705
$156 111 651
$43 48 600
1.6x 1.2x 2.7x 1.6x 1.8x
5.1x 6.2x 10.8x 6.2x 7.3x
1.5x 1.1x 2.6x 1.5x 1.7x
4.8x 6.0x 10.5x 6.0x 7.1x
$83.54 76.96 Median: Mean:
42.7% 39.5% 41.1% 41.1%
$89.76 80.19
$57.25 58.93 Total
$7,978 23,255 $31,233
$4,294 6,457
$1,006 620
$11,711 29,629 $20,670 $20,670
$6,494 12,208 $18,702
$1,221 2,453
$982 1,938
Mar-11 Mar-11
Dec-10 Dec-10
$6,782 13,048 $19,830
$1,319 2,665
$1,083 2,129
1.8x 2.4x 2.1x 2.1x
9.5x 11.9x 10.7x 10.7x
1.7x 2.3x 2.0x 2.0x
8.9x 11.1x 10.0x 10.0x
$6.21 40.76 38.87 29.21 31.69 31.79 72.25
$2.80 23.77 22.82 17.58 19.61 22.55 49.22 Total
$63 236 762 550 425 2,425 1,293 $5,755
$34 1 172 1,048 0 533 163
$1 55 149 92 0 134 60
$96 182 787 1,509 440 2,836 1,405 $1,036 $1,036
$274 338 1,586 1,609 652 1,721 1,321 $7,501
$16 52 206 223 96 449 163
$12 49 173 197 88 333 142
Mar-11 Mar-11 Mar-11 Mar-11 Mar-11 Jun-11 Jun-11
Dec-10 Dec-10 Dec-10 Dec-10 Dec-10 Dec-10 Dec-10
$276 342 1,584 1,891 667 1,799 1,368 $7,926
$16 47 186 245 83 454 189
$12 43 148 215 80 334 161
0.3x 0.5x 0.5x 0.9x 0.7x 1.6x 1.1x 0.7x 0.8x
6.1x 3.5x 3.8x 6.7x 4.6x 6.3x 8.6x 6.1x 5.7x
0.3x 0.5x 0.5x 0.8x 0.7x 1.6x 1.0x 0.7x 0.8x
6.0x 3.9x 4.2x 6.2x 5.3x 6.2x 7.4x 6.0x 5.6x
$34.85 28.99 53.08 15.01
$16.35 11.52 33.51 6.78 Total
$594 979 658 176 $2,406
$142 351 10 153
$51 19 34 86
$684 1,248 714 243 $723 $723
$678 4,462 722 1,920 $7,783
$99 228 99 133
$82 105 72 92
Mar-11 Mar-11 Mar-11 Mar-11
Dec-10 Dec-10 Dec-10 Dec-10
$764 5,422 789 1,957 $8,931
$117 372 97 110
$93 222 69 80
1.0x 0.3x 1.0x 0.1x 0.6x 0.6x
6.9x 5.5x 6.6x 1.8x 6.0x 5.2x
0.9x 0.2x 0.9x 0.1x 0.6x 0.5x
5.9x 3.4x 7.3x 2.2x 4.6x 4.7x
(5.2%) (2.1%) (3.6%) (3.6%)
$5.83 25.27 25.86 17.99 22.78 25.59 60.81 Median: Mean:
(2.7%) 9.4% (27.1%) (4.1%) (22.4%) 1.3% (35.8%) (12.7%) (23.1%) (0.3%) (18.6%) 7.4% (12.7%) 13.1% (22.4%) 1.3% (20.3%) 2.0%
$28.40 18.84 47.57 7.00 Median: Mean:
2.7% (25.3%) 2.4% (40.6%) (11.5%) (15.2%)
58.0% 42.8% 37.4% 0.0% 40.1% 34.6%
10
Healthcare and Life Sciences Industry Update August 2011 Provider-Based Services Company Name (Ticker) 7/29/2011
Stock Price % Change 3 mos. 12 mos.
52 Week High Low
Equity Total Debt Mkt. Value
Cash and Equiv.
Physician Practice Management Multispecialty / Primary Care: Continucare Corp. IPC The Hospitalist Company, Inc. Number of Companies
Specialty: Integramed America Inc. MEDNAX, Inc. Number of Companies
Dental: American Dental Partners, Inc. Birner Dental Management Services Inc. Number of Companies
Psychiatric Hospitals / Management Magellan Health Services Inc. Providence Service Corp. Universal Health Services Inc. Number of Companies
2
2
2
4
Total Ent. Value (TEV)
Lastest Twelve Months (LTM) Revenue EBITDA EBIT
LTM Period (3)
Lastest FYE Date (3)
Forward Estimate Revenue EBITDA
TEV/ LTM Multiples
EBIT
Revenue
(5)
EBITDA
TEV/ Fwd Multiples Revenue
EBITDA
$6.32 17.9% 45.18 (12.9%) Median: 2.5% Mean: 2.5%
65.9% 75.1% 70.5% 70.5%
$6.38 52.25
$3.25 22.66 Total
$383 742 $1,125
$0 0
$45 18
$339 717 $528 $528
$324 413 $737
$43 47
$39 44
Mar-11 Jun-11
Jun-10 Dec-10
$324 458 $783
$45 53
$42 49
1.0x 1.7x 1.4x 1.4x
7.9x 15.2x 11.6x 11.6x
1.0x 1.6x 1.3x 1.3x
7.5x 13.6x 10.6x 10.6x
$9.15 68.16 Median: Mean:
(9.2%) (3.9%) (6.6%) (6.6%)
10.8% 47.1% 28.9% 28.9%
$11.04 75.47
$7.95 44.83 Total
$108 3,273 $3,382
$14 177
$45 15
$76 3,421 $1,749 $1,749
$250 1,451 $1,701
$15 348
$8 326
Mar-11 Mar-11
Dec-10 Dec-10
$272 1,586 $1,859
$19 387
$10 363
0.3x 2.4x 1.3x 1.3x
5.0x 9.8x 7.4x 7.4x
0.3x 2.2x 1.2x 1.2x
4.1x 8.8x 6.5x 6.5x
$11.62 (11.9%) 20.90 4.8% Median: (3.6%) Mean: (3.6%)
1.0% 18.0% 9.5% 9.5%
$13.86 21.99
$10.05 16.13 Total
$179 39 $218
$87 4
$6 1
$260 42 $151 $151
$290 65 $355
$49 5
$26 3
Jun-11 Mar-11
Dec-10 Dec-10
$294 NA $294
$46 NA
$24 NA
0.9x 0.6x 0.8x 0.8x
5.3x 8.1x 6.7x 6.7x
0.9x NA 0.9x 0.9x
5.7x NA 5.7x 5.7x
$52.10 0.2% 30.9% 11.85 (19.6%) (15.0%) 49.64 (9.4%) 44.8% Median: (9.4%) 30.9% Mean: (9.6%) 20.2%
$56.76 18.27 56.46
$39.31 11.25 30.51 Total
$1,629 154 4,848 $6,631
$1 170 3,753
$155 58 52
$1,273 273 8,829 $2,594 $2,594
$2,891 887 6,695 $10,473
$289 64 1,043
$234 51 781
Jun-11 Mar-11 Jun-11
Dec-10 Dec-10 Dec-10
$2,818 915 7,609 $11,343
$257 57 1,200
$198 44 870
0.4x 0.3x 1.3x 0.4x 0.5x
4.4x 4.3x 8.5x 4.3x 4.3x
0.5x 0.3x 1.2x 0.5x 0.6x
5.0x 4.8x 7.4x 5.0x 5.7x
$25.43 (5.3%) 37.10 (10.8%) Median: (8.1%) Mean: (8.1%)
37.3% 23.7% 30.5% 30.5%
$28.00 43.45
$16.35 29.73 Total
$796 1,929 $2,725
$301 1,584
$38 276
$1,253 3,258 $2,255 $2,255
$734 3,452 $4,186
$261 541
$236 367
Jun-11 Jun-11
Dec-10 Dec-10
$772 3,554 $4,326
$269 539
$245 376
1.7x 0.9x 1.3x 1.3x
4.8x 6.0x 5.4x 5.4x
1.6x 0.9x 1.3x 1.3x
4.7x 6.0x 5.4x 5.4x
$24.40 (4.8%) 7.85 (12.0%) 24.08 (1.1%) Median: (4.8%) Mean: (6.0%)
35.9% 20.2% 33.0% 33.0% 29.7%
$28.50 9.66 26.23
$16.20 5.62 15.30 Total
$2,322 1,211 284 $3,818
$1,440 1,484 5
$141 15 11
$4,173 2,712 291 $2,392 $2,392
$2,085 2,499 218 $4,801
$457 328 41
$377 260 35
Jun-11 Mar-11 Mar-11
Dec-10 Dec-10 Dec-10
$2,066 2,719 233 $5,018
$457 382 37
$383 310 38
2.0x 1.1x 1.3x 1.3x 1.5x
8.9x 8.3x 7.1x 8.3x 8.1x
2.0x 1.0x 1.2x 1.2x 1.4x
9.1x 7.1x 7.8x 7.8x 8.0x
Surgicenters / Rehabilitation Surgery Centers: AmSurg Corp. Lifepoint Hospitals Inc. Number of Companies
Rehabilitation / Long Term Acute Care: HEALTHSOUTH Corp. Select Medical Holdings Corporation US Physical Therapy Inc. Number of Companies
As of July 29, 2011
2
3
11
M&A Detail August 2011
Announced U.S. Healthcare and Life Sciences M&A
Announced
Target
Seller
Buyer
7/29/2011
Arrow Medical Supply, Inc.
-
Spectrum Surgical Instruments Corp.
7/29/2011 7/29/2011 7/29/2011
Northwest Plant Breeding Company Augusta Laboratory, Inc. Salar, Inc.
Dow AgroSciences LLC US Clinical Laboratories, LLC Transcend Services, Inc. (NasdaqGS:TRCR)
7/29/2011 7/29/2011 7/28/2011 7/28/2011
Angelini Labopharm LLC HearUSA Inc., Substantially All Assets GeneWize Life Sciences, Inc. Tomball Regional Medical Center Provider Network Allied Healthcare International Inc. (NasdaqGS:AHCI) 20 Clinic Physical Therapy Group
Maryland Department of Business and Economic Development, Investment Arm Labopharm Inc. (TSX:DDS) HearUSA Inc. (OTCPK:HEAR.Q) GeneLink Inc. (OTCBB:GNLK) -
7/28/2011 7/27/2011 7/27/2011 7/27/2011
Octavian Advisors, LP -
Private Equity Involvement
-
-
-
No
$11.0
2.8x
-
9.2x
No No No
-
-
-
-
No No No No
$138.9
0.5x
7.9x
10.9x
No
US Physical Therapy Inc. (NasdaqGS:USPH) U.S. Healthworks, Inc. IntegraCare Home Health and Hospice Services, Inc. American Anesthesiology, Inc. Watson Pharmaceuticals, Inc. (NYSE:WPI) -
$16.5
1.3x
-
-
No
-
-
-
-
No No
-
-
-
-
No No
-
-
-
-
No
Decision Resources, Inc. Brooks Automation Inc. (NasdaqGS:BRKS) OMERS Private Equity Source Scientific, LLC LifeBridge Health, Inc.; Physiotherapy Associates, Inc. United Seating & Mobility, LLC Express Scripts Inc. (NasdaqGS:ESRX) China Nuvo Solar Energy, Inc. (OTCPK:CNUV) athenahealth, Inc. (NasdaqGS:ATHN)
$85.0
2.4x
-
-
No No Yes
-
-
-
-
Yes No No
$33,464.1
0.5x
11.1x
13.2x
No No
-
-
-
-
No
$36.0
-
-
-
No
$475.0
-
-
-
No
$42.5
4.2x
-
-
Yes
-
-
-
-
Yes No No
$178.9
4.6x
-
-
Yes
-
-
-
-
No No
$0.7
-
-
-
No No No No
-
-
-
-
No
$127.0
-
-
-
Yes
-
-
-
-
No
$148.0
-
-
-
No No
$275.0
-
-
-
Yes No
-
-
-
-
No
Angelini Group Siemens Hearing Instruments, Inc. Capsalus Corp. (OTCBB:WELL) Community Health Systems, Inc. (NYSE:CYH) Saga Group Ltd.
7/26/2011 7/25/2011 7/25/2011 7/25/2011
PharmaStrat Inc. Penrod Medical Equipment, LLC Nexus Biosystems, Inc.
First Physicians Capital Group, Inc. (OTCPK:FPCG) Telegraph Hill Partners
7/25/2011 7/25/2011 7/22/2011
Accelerated Rehabilitation Centers, Ltd. BIT MedTech operation Henning & Cole Therapy Associates, Ltd.
Gryphon Investors -
7/21/2011 7/21/2011
Central Kentucky Mobility, LLC MedcoHealth Solutions Inc. (NYSE:MHS)
-
7/21/2011
SurgLine, Inc.
-
7/21/2011
Proxsys, LLC
Clayton Associates, LLC
7/21/2011
Amira Pharmaceuticals, Inc.
7/20/2011
Icagen, Inc. (NasdaqGM:ICGN)
Prospect Venture Partners; Versant Ventures Goldman Sachs Group, Merchant Banking Division; Venrock
Bristol-Myers Squibb Company (NYSE:BMY) Pfizer Inc. (NYSE:PFE)
7/20/2011 7/20/2011 7/19/2011
Strata Decision Technology, LLC Bioptics, Inc. Community Medical Center Healthcare System
Fox Capital Fund -
Veronis Suhler Stevenson Faxitron X-ray LLC Geisinger Health System Foundation
7/19/2011
Allos Therapeutics, Inc. (NasdaqGS:ALTH)
AMAG Pharmaceuticals, Inc. (NasdaqGS:AMAG)
7/19/2011 7/19/2011
Lahey Clinic, Inc. Moses Taylor Health Care System, Inc.
Calvert Asset Management Company, Inc.; Warburg Pincus LLC; Perseus, L.L.C. Lahey Clinic Foundation Inc -
7/19/2011 7/19/2011 7/19/2011 7/19/2011
Estech, Cannulae Product Line ASG Medical Systems, LLC Kenwood Hospitalists LLC Titterington Veterinary Services, Inc.
Estech -
7/19/2011
Endoscopic Technologies, Inc.
7/18/2011
Endoscopic Technologies, Inc., Cannulae Product Line Victory Pharma, Inc.
Ampersand Capital Partners; Essex Woodlands Health Ventures
Shionogi Inc.
7/18/2011
TREK Diagnostic Systems, Inc.
Magellan Biosciences, Inc.
7/18/2011 7/18/2011
Rocket Careers, Inc. 15 Properties in US
7/18/2011 7/18/2011
Align Networks Vicept Therapeutics Incorporated
7/18/2011
AMHN, Inc (OTCBB:AMHN)
ING Real Estate Community Living Group (ASX:ILF) H.I.G. Capital Vivo Ventures, LLC; Sofinnova Ventures, Inc. -
Thermo Fisher Scientific, Inc. (NYSE:TMO) Bench International Search, Inc. Chartwell Seniors Housing REIT (TSX:CSH.UN) General Atlantic Allergan Inc. (NYSE:AGN)
Perrigo Co. (NasdaqGS:PRGO)
Enterprise Value Sales EBITDA EBIT
-
NorthWorks Occupational Health LLC Outreach Health Services, Inc, Medicare Services Business American Anesthesiology of Florida Perrigo Co., Portfolio of Generic Pharmaceutical Products Outpatient Surgery of Del Mar, LLC
7/26/2011 7/26/2011
Outreach Health Services, Inc.
Enterprise Value ($mm)
Northeast Health Systems, Inc. Community Health Systems, Inc. (NYSE:CYH) Sorin SpA (BIT:SRN) SYNEO, LLC Sound Physicians, Inc. Entest Biomedical, Inc. (OTCPK:ENTB) Sorin SpA (BIT:SRN)
vitaMedMD, LLC
12
M&A Detail August 2011
Announced U.S. Healthcare and Life Sciences M&A (Continued)
Announced
Target
Seller
Buyer
7/15/2011
North Florida Acute Care Specialists, LLC
-
7/14/2011
Webmedx, Inc.
Ferrer Freeman & Co.
7/14/2011
Coast To Coast Physicians Alliance, P.A.
-
7/14/2011 7/14/2011 7/14/2011 7/13/2011 7/13/2011
12 Healthcare Facilities AllerQuest LLC, Minor Determinant Mixture MetroPlex PartnerMD, PC Sunrise of Fox Chapel and Sunrise of Cranberry
7/13/2011 7/13/2011 7/12/2011 7/12/2011 7/12/2011
Amorcyte Inc. Tri Quality, Inc. Eastwind Surgical, LLC Healthnostics, Inc. (OTCPK:HNSS) Kinetic Concepts Inc. (NYSE:KCI)
7/11/2011
Multimodal Technologies, Inc.
AllerQuest, LLC L B Realty, Inc. Sunrise Senior Living Inc. (NYSE:SRZ) Novitas Capital; Colt Ventures MedBioWeb Corp. Goldman Sachs Group, Merchant Banking Division; Goldman Sachs Asset Management, L.P. -
7/11/2011
STEMTIDE Inc.
-
7/11/2011
Coral Blood Services, Inc.
The American National Red Cross
7/10/2011 7/10/2011
Nextwave Diagnostic Laboratories and Wilmington Pathology Laboratory Coral Blood Services, Inc., Blood Cell Collection Operation Assets Vetstreet BrightHeart Veterinary Centers
Neostem, Inc. (AMEX:NBS) Otto Bock HealthCare LLP Meridian Surgical Partners, LLC Apax Partners Worldwide LLP; CPP Investment Board; Public Sector Pension Investment Board MedQuist Holdings Inc. (NasdaqGM:MEDH) Inolife Technologies, Inc. (OTCPK:INOL) Solstas Lab Partners
7/8/2011
Dermik Laboratories, Inc.
MediMedia USA, Inc. LLR Partners Inc.; Caltius Capital Management Sanofi (ENXTPA:SAN)
Vicar Operating, Inc. VCA Antech Inc. (NasdaqGS:WOOF) Valeant International (Barbados) SRL
7/8/2011
Cadia Healthcare Group
Sabra Health Care REIT, Inc. (NasdaqGS:SBRA)
7/8/2011 7/7/2011
Broadmeadow Investment, Renaissance Healthcare and Capitol Healthcare and Pike Creek Healthcare Arrowhead Electronic Healthcare, LLC QN Diagnostics, LLC
7/7/2011
Wright Dental Care, LLC
QuantRX Biomedical Corporation (OTCPK:QTXB) -
7/7/2011 7/7/2011
Rehab Specialties Inc. PEAK Surgical, Inc.
7/7/2011
Salient Surgical Technologies, Inc.
7/6/2011 7/6/2011 7/6/2011
ACOM Medical Billing Primedoc Management Services, Inc. Portfolio of Six Assisted Living and Dementia Care Properties
7/6/2011 7/5/2011 7/4/2011
Cypress Heart, P.A. Healthcare Innovative Solutions, Inc. PhotoMedex, Inc. (NasdaqGM:PHMD)
7/4/2011 7/2/2011 7/1/2011 7/1/2011
Ansell Sandel Medical Solutions LLC Immucor Inc. (NasdaqGS:BLUD) South Jersey Heart Group, P.C. Bioscan, Inc., Analytic Instrumentation and Radiochemistry Equipment Business Zymetis, Inc.
7/11/2011
7/1/2011 7/1/2011 7/1/2011 7/1/2011 7/1/2011 7/1/2011 7/1/2011 7/1/2011
Kearsley Retirement Community Ethos Assisted Living, Two Kentucky Assisted Living Homes Olympus Endo Technology America Inc
Venrock; Western Technology Investment; Signet Healthcare Partners Affinity Capital Management; QuestMark Partners; RiverVest Venture Partners, LLC; Arnerich -
Perseus, L.L.C.; Clutterbuck Capital Management LLC Bioscan, Inc. Maryland Department of Business and Economic Development NewCourtland Elder Services Ethos Senior Living LLC
Village Ventures; BioVentures Investors, LLC ArthroCare, Parallax and Contour Product Lines ArthroCare Corporation (NasdaqGS:ARTC) Four Corners Regional Heart Institute, LLC and Pyramid Healthcare, Inc. Advanced Physical Therapy PC Cardinal Equity Partners
IPC The Hospitalist Company, Inc. (NasdaqGS:IPCM) Nuance Communications, Inc. (NasdaqGS:NUAN) IPC The Hospitalist Company, Inc. (NasdaqGS:IPCM) American Realty Capital V, LLC ALK-Abelló A/S (CPSE:ALK B) The Lovelady Center Markel Ventures Concordia Lutheran Ministries
Enterprise Value ($mm)
Enterprise Value Sales EBITDA EBIT
Private Equity Involvement
-
-
-
-
No
-
-
-
-
Yes
-
-
-
-
No
$257.5 -
-
-
-
No No No No No
$15.7 $2.6 $5,793.2
2.8x
9.1x
11.9x
Yes No No No Yes
$132.7
-
-
-
No
$0.1
-
-
-
No
-
-
-
-
No
$3.0
-
-
-
No
$146.0 $50.0
0.9x
-
-
No Yes
$425.0
1.8x
-
-
No
$97.5
1.7x
-
-
No
Bracket NuRx Pharmaceuticals, Inc (OTCPK:NUXP) Great Expressions Dental Centers, P.C. United Seating & Mobility, LLC Medtronic, Inc. (NYSE:MDT)
-
-
-
-
No No
-
-
-
-
No
-
-
-
-
No No
Medtronic, Inc. (NYSE:MDT)
-
-
-
-
No
$62.0
-
-
-
No No No
-
-
-
-
No Yes Yes
$13.5 $1,642.5 -
1.4x 4.9x -
11.1x -
12.6x -
No Yes No No
$2.1
-
-
-
No
Tryko Partners Senior Care, Inc.
$23.2
-
-
-
No No
Gyrus ACMI, Inc.
$60.0
-
-
-
No
NeuroTherm, Inc.
-
-
-
-
No
Mercy Regional Medical Center Clearview Capital, LLC ATI Holdings, LLC
-
-
-
-
No No Yes
ACOM Health, Inc. Eagle Hospital Physicians LLC Harrison Street Real Estate Capital, LLC; Bickford Senior Living Group, LLC Kansas Medical Center, L.L.C. Beacon Partners Inc. Radiancy, Inc. Ansell Ltd. (ASX:ANN) TPG Capital Lourdes Health System Eckert & Ziegler Strahlen & Medizintechnik AG (XTRA:EUZ) AE Biofuels, Inc. (OTCPK:AEBF)
13
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Managing Director
Managing Director
Managing Director
Managing Director
[email protected]
[email protected]
[email protected]
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+1 (804) 915-0110
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Director
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[email protected]
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