healthcare services sector review: publicly-traded ... filehealthcare services sector review: public...
TRANSCRIPT
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Sources: ThomsonOne, Bloomberg
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($ in millions)
Healthcare Services Sector Review: Publicly-Traded Healthcare Services Summary
Number Aggr. Median TEV / Median Price /
of Equity Mkt. Median % Change LTM Multiples Earnings Ratio
Companies Value 3 mos. 12 mos. Revenue EBITDA 2016 2017
Acute Care Hospitals 5 $52,872 15.9% (9.8)% 1.0x 8.5x 17.3x 12.8x
Alternate Site 16 68,902 6.9 (7.8) 2.4 11.4 21.4 18.2
Assisted Living 1 3,430 13.4 (49.0) 2.0 11.9 7.4 6.7
Clinical Laboratories 4 29,658 14.2 (0.3) 2.5 10.2 14.5 13.9
CROs — Pharma Services 9 29,162 10.1 4.8 2.4 12.5 18.2 16.1
Distribution / Supply 8 107,989 3.2 (3.3) 0.6 10.0 15.1 14.4
E-Health 3 4,722 22.8 42.1 4.1 17.0 19.0 24.2
HCIT 18 47,995 3.1 (10.3) 3.6 13.5 23.5 20.8
HMO Medical — Diversified 4 237,003 9.1 8.1 0.9 9.0 14.6 13.3
HMO Medical — Government 3 17,473 (0.2) (0.0) 0.4 9.7 17.7 13.2
HMO Medical — National & Regional 3 27,641 16.8 6.9 0.4 9.9 18.6 17.8
Home Care / Hospice / Staffing 6 5,436 8.1 4.8 1.0 11.9 18.2 16.8
Long-Term Care 7 4,234 2.1 (35.7) 0.9 7.9 16.0 14.5
Other Services 7 5,530 4.8 (1.0) 1.5 9.9 16.3 13.9
Outsourced Services 11 14,583 (0.9) 11.3 0.9 10.2 16.8 15.7
Pharmacy Benefit Managers 2 156,412 3.3 (6.7) 0.7 10.0 14.4 13.1
Physician Practice Management 5 15,450 2.4 (28.2) 1.4 12.0 15.6 14.6
Total / Median (unweighted) 112 $828,491 6.9% (1.0)% 1.0x 10.2x 16.8x 14.5x
FY2016 FY2017
Value at % Change Price / Earnings Ratio
4/30/2016 3 mos. YTD 12 mos. 36 mos. 2016 2017
Dow Jones Industrial Average 17,773.64 8.1% 3.6% (1.4)% 20.9%
S&P 500 2,065.30 6.5 2.6 (2.0) 30.5 16.8x 15.8x
Nasdaq Composite 4,775.36 3.4 (2.6) (4.6) 44.7
Russell 2000 1,130.85 9.5 2.0 (7.9) 22.4 21.5 17.6
S&P 500 Healthcare Providers & Svs. 629.16 7.8 0.2 (1.3) 76.2
S&P 500 Healthcare Facilities 437.16 14.7 18.1 5.0 33.9
S&P 500 Managed Healthcare 1,207.54 9.9 5.4 8.4 111.5
Healthcare Services Composite 672.44 5.8% (7.6)% (9.6)% 27.1%
Number Aggr. Equity % of Total % of Aggr. Interest Rates
of Mkt. Value Number of Equity Mkt. Median Stock Price Performance
Companies ( millions) Companies Value 3 mos. YTD 12 mos. 36 mos.
>5bln 26 $702,514 23.2% 84.8% 8.3% 3.1% 2.1% 105.3%
1bln - 5bln 42 107,672 37.5 13.0 9.5 6.5 (0.2) 89.0
250mm - 1bln 27 16,768 24.1 2.0 3.3 5.9 (1.9) 99.2
<250mm 17 1,537 15.2 0.2 3.6 (39.7) (11.4) 16.3
Total / Median 112 $828,491 100.0% 100.0% 6.0% 4.5% (1.0)% 94.1%
Capitalization Profile
Market Indices
Sector
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Source: ThomsonOne
Healthcare Services Sector Review: Publicly-Traded Healthcare Services Summary
Median % Change - 3 Months
Performance of Market Indices for Latest 36 Months (%)
One Year Forward P/E for Latest 36 Months (x)
Outsourced Services
HMO Medical — Government
Long-Term Care
Physician Practice Management
HCIT
Distribution / Supply
Pharmacy Benefit Managers
Other Services
Alternate Site
Home Care / Hospice / Staffing
HMO Medical — Diversified
CROs — Pharma Services
Assisted Living
Clinical Laboratories
Acute Care Hospitals
HMO Medical — National & Regional
E-Health
(5.0)% 0.0% 5.0% 10.0% 15.0% 20.0% 25.0%
0
25
50
75
100
125
150
175
4/30/2013 8/31/2013 12/31/2013 4/30/2014 8/31/2014 12/31/2014 4/30/2015 8/31/2015 12/31/2015 4/30/2016
DJ Indu S&P 500 NASDAQ Russell 2000 Healthcare Services Composite
0
2
4
6
8
10
12
14
16
18
20
4/30/2013 8/31/2013 12/31/2013 4/30/2014 8/31/2014 12/31/2014 4/30/2015 8/31/2015 12/31/2015 4/30/2016
Healthcare Services Composite S&P 500
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Source: ThomsonOne
($ in millions, except per share data)
Healthcare Services Sector Review: Public Comps Stock Price Equity Total Last Twelve Forward
Company Name As Of 52-Week Market Enterprise Months (LTM) TEV / LTM TEV / EBITDA PE Ratio PEG
04/30/16 High Low Value Value (TEV) Revenue EBITDA EBIT Revenue EBITDA 2016 2017 2016 2017 2016
Acute Care Hospitals
COMMUNITY HEALTH SYSTEMS INC $15.70 $53.50 $10.59 $1,787 $19,311 $19,540 $2,730 $1,433 1.0x 7.1x 7.0x 6.7x 4.8x 4.4x 0.6x
HCA HOLDINGS INC 80.62 95.49 43.91 31,907 63,207 40,240 7,417 6,011 1.6 8.5 8.2 7.8 12.9 11.7 1.2
LIFEPOINT HEALTH INC 67.56 88.18 58.20 2,933 5,508 5,531 687 378 1.0 8.0 7.1 6.5 18.0 15.3 2.6
TENET HEALTHCARE CORP 31.69 60.93 21.39 3,145 19,832 18,989 2,109 1,479 1.0 9.4 8.1 7.6 17.3 12.8 1.1
UNIVERSAL HEALTH SERVICES INC 133.68 148.57 100.82 13,100 16,791 9,268 1,631 1,274 1.8 10.3 9.9 9.2 17.9 16.4 1.9
5Number of Companies: Mean: Total: $52,872 $124,648 $93,567 1.3x 8.7x 8.0x 7.6x 14.2x 12.1x 1.5x
Median: 1.0 8.5 8.1 7.6 17.3 12.8 1.2
Alternate Site
AAC HOLDINGS INC $20.59 $46.60 $14.36 $473 $594 $229 $42 $28 2.6x 14.0x 11.4x 9.3x 21.5x 18.2x 1.1x
ACADIA HEALTHCARE COMPANY 63.19 85.62 49.77 5,526 9,064 2,046 434 356 4.4 NM 14.2 12.4 22.2 18.5 1.1
ADEPTUS HEALTH INC 68.12 123.97 37.13 1,436 1,636 389 65 65 4.2 NM 14.4 10.5 25.9 17.7 0.3
ALLIANCE HEALTHCARE SERVICES INC 7.19 22.27 6.23 77 712 473 94 57 1.5 7.6 NA NA NA NA NA
AMSURG CORP 80.98 87.42 54.11 4,437 7,556 2,721 519 104 2.8 14.6 12.7 11.3 18.8 16.6 1.2
CIVITAS SOLUTIONS INC 20.04 30.23 15.19 744 1,357 1,392 152 76 1.0 9.0 8.5 7.9 27.5 20.1 2.7
CONCORD MEDICAL SERVICES HOLDINGS LTD 4.89 8.23 4.07 218 352 96 33 3 2.9 10.5 3.9 8.2 14.0 9.8 0.7
DAVITA HEALTHCARE PARTNERS INC 73.90 84.40 61.36 15,231 23,531 14,000 2,392 1,894 1.7 9.8 9.8 9.2 19.0 16.9 1.6
FRESENIUS MEDICAL CARE AG & CO KGAA 86.76 91.77 73.04 26,580 36,109 17,023 2,837 2,327 2.1 12.7 10.3 9.4 21.4 19.1 1.7
HEALTHSOUTH CORP 41.46 48.37 30.26 3,732 7,557 3,332 649 596 2.3 11.6 9.7 9.1 16.9 15.4 1.6
RADNET INC 5.05 8.87 4.66 239 883 833 119 41 1.1 7.4 6.5 6.2 17.8 13.8 1.8
SELECT MEDICAL HOLDINGS CORP 13.38 17.20 7.33 1,757 4,482 4,005 409 275 1.1 11.0 8.9 8.3 15.5 13.6 1.2
SURGICAL CARE AFFILIATES INC 48.35 49.90 27.88 1,933 3,151 1,089 261 196 2.9 7.8 NM NM 22.6 19.8 1.0
SURGERY PARTNERS INC 16.29 22.32 11.76 784 2,509 1,011 158 124 2.5 15.9 13.3 11.1 NM 18.4 NA
U.S. PHYSICAL THERAPY INC 49.86 56.37 42.59 623 696 337 46 47 2.1 15.2 13.0 12.2 25.4 23.2 1.8
VCA INC 62.97 64.98 44.00 5,113 6,019 2,197 435 369 2.7 13.8 12.9 11.8 22.1 19.7 1.6
16Number of Companies: Mean: Total: $68,902 $106,209 $51,019 2.4x 11.7x 10.5x 10.9x 20.8x 17.4x 1.4x
Median: 2.4 11.4 10.3 9.4 21.4 18.2 1.4
Assisted Living
BROOKDALE SENIOR LIVING INC $18.46 $38.60 $11.28 $3,430 $9,742 $4,966 $822 $56 2.0x 11.9x 10.5x 9.8x 7.4x 6.7x 0.6x
1Number of Companies: Mean: Total: $3,430 $9,742 $4,966 2.0x 11.9x 10.5x 9.8x 7.4x 6.7x 0.6x
Median: 2.0 11.9 10.5 9.8 7.4 6.7 0.6
Clinical Laboratories
LABORATORY CORPORATION OF AMERICA HOLDINGS$125.32 $128.84 $97.79 $12,794 $18,509 $9,029 $1,819 $1,520 2.1x 10.2x 9.6x 9.0x 14.3x 13.0x 1.4x
PSYCHEMEDICS CORP 14.41 16.30 7.76 78 81 27 3 1 3.0 NM NA NA 9.1 NA 0.5
QUEST DIAGNOSTICS INC 75.17 89.00 59.65 10,633 14,433 7,517 1,459 1,274 1.9 9.9 9.7 9.3 14.8 13.9 1.6
SONIC HEALTHCARE LTD 14.82 17.56 12.11 6,152 7,999 2,036 645 415 3.9 12.4 9.2 8.7 17.6 16.7 1.9
4Number of Companies: Mean: Total: $29,658 $41,022 $18,609 2.7x 10.8x 9.5x 9.0x 13.9x 14.5x 1.3x
Median: 2.5 10.2 9.6 9.0 14.5 13.9 1.5
CROs — Pharma Services
ALBANY MOLECULAR RESEARCH INC $15.05 $22.48 $13.71 $537 $874 $428 $81 $53 2.0x 10.8x 9.4x 8.5x 14.3x 12.3x 1.2x
CATALENT INC 29.53 34.41 18.92 3,677 5,434 1,813 412 329 3.0 13.3 13.1 11.9 18.2 16.2 2.7
CHARLES RIVER LABORATORIES INTERNATIONAL INC 79.27 82.40 59.99 3,734 4,511 1,398 341 265 3.2 13.2 11.4 10.2 18.2 16.0 1.4
ICON PLC 67.58 84.14 63.20 3,714 3,874 1,587 350 291 2.4 11.1 10.2 9.5 14.4 12.9 0.9
INC RESEARCH HOLDINGS INC 48.13 57.11 29.62 3,082 3,498 941 224 203 3.7 15.6 14.7 12.9 20.3 17.4 1.1
PAREXEL INTERNATIONAL CORP 61.10 76.17 56.00 3,280 3,641 2,165 331 250 1.7 11.0 10.1 9.1 16.5 14.2 1.0
INTERPACE DIAGNOSTICS GROUP INC 0.52 2.74 0.19 9 9 146 (14) (31) 0.1 NM NM NM NM NM NA
PRA HEALTH SCIENCES INC 47.45 51.35 28.28 2,873 3,651 1,416 263 227 2.6 13.9 12.9 11.5 19.7 16.9 1.4
QUINTILES TRANSNATIONAL HOLDINGS INC 69.07 80.45 55.01 8,254 9,971 4,414 839 680 2.3 11.9 11.2 10.2 18.3 16.4 1.6
9Number of Companies: Mean: Total: $29,162 $35,465 $14,308 2.3x 12.6x 11.6x 10.5x 17.5x 15.3x 1.4x
Median: 2.4 12.5 11.3 10.2 18.2 16.1 1.3
Distribution / Supply
ACETO CORP $22.43 $32.20 $18.03 $663 $722 $562 $79 $70 1.3x 9.1x 9.2x 7.9x 13.5x NA 0.7x
AMERISOURCEBERGEN CORP 85.10 116.28 80.50 19,184 22,707 142,238 2,202 1,939 0.2 10.3 9.6 8.8 14.3 12.7 1.0
CARDINAL HEALTH INC 78.46 91.23 74.73 25,839 29,177 117,709 3,024 2,862 0.2 9.6 9.0 8.3 14.2 12.8 1.1
HENRY SCHEIN INC 168.70 174.75 126.17 13,858 15,141 10,830 899 769 1.4 16.8 14.9 13.8 25.5 23.0 2.2
MCKESSON CORP 167.82 243.61 148.29 38,361 45,135 191,059 4,998 4,502 0.2 9.0 8.8 8.5 12.6 11.8 1.3
OWENS & MINOR INC 36.39 41.48 31.89 2,287 2,699 9,815 288 227 0.3 9.4 9.6 9.2 17.8 16.8 4.1
PATTERSON COMPANIES INC 43.35 53.07 38.51 4,296 5,443 5,398 456 386 1.0 11.9 11.9 11.3 16.7 15.0 1.7
VWR CORP 26.64 28.83 21.56 3,501 5,556 4,356 460 412 1.3 12.1 11.6 10.8 15.8 14.4 1.5
8Number of Companies: Mean: Total: $107,989 $126,580 $481,965 0.7x 11.0x 10.6x 9.8x 16.3x 15.2x 1.7x
Median: 0.6 10.0 9.6 9.0 15.1 14.4 1.4
4
Source: ThomsonOne
($ in millions, except per share data)
Healthcare Services Sector Review: Public Comps Stock Price Equity Total Last Twelve Forward
Company Name As Of 52-Week Market Enterprise Months (LTM) TEV / LTM TEV / EBITDA PE Ratio PEG
04/30/16 High Low Value Value (TEV) Revenue EBITDA EBIT Revenue EBITDA 2016 2017 2016 2017 2016
E-Health
EBIX INC $48.12 $49.92 $19.78 $1,619 $1,767 $271 $104 $91 6.5x 17.0x 15.5x 13.9x 19.0x 17.4x 1.9x
HEALTHSTREAM INC 22.62 32.41 17.80 718 567 222 33 17 2.6 17.0 14.9 12.1 NM NM NA
WEBMD HEALTH CORP 62.74 63.98 37.57 2,385 2,664 650 199 125 4.1 13.4 11.9 10.6 NM 31.1 NA
3Number of Companies: Mean: Total: $4,722 $4,999 $1,142 4.4x 15.8x 14.1x 12.2x 19.0x 24.2x 1.9x
Median: 4.1 17.0 14.9 12.1 19.0 24.2 1.9
HCIT
ACCRETIVE HEALTH INC $2.37 $5.95 $1.77 $262 $158 $117 ($118) ($127) 0.7x NM 22.4x 8.7x NM 25.5x NA
ALLSCRIPTS HEALTHCARE SOLUTIONS INC 13.40 15.78 11.47 2,505 3,025 1,400 254 152 2.2 11.9 11.1 9.9 23.1 19.6 1.4
ATHENAHEALTH INC 133.30 170.42 110.68 5,234 5,431 974 198 102 5.6 27.4 23.3 19.0 NM NM NA
CAREVIEW COMMUNICATIONS INC 0.24 0.40 0.20 33 70 5 (5) (5) 13.6 NM NA NA NA NA NA
CASTLIGHT HEALTH INC 3.60 10.36 2.54 545 425 81 (61) (78) 5.2 NM NM NM NM NM NA
CERNER CORP 56.14 75.00 49.59 18,969 19,061 4,595 1,530 1,075 4.1 12.5 11.2 10.1 23.9 20.8 1.7
COMPUTER PROGRAMS AND SYSTEMS INC 51.33 59.16 36.04 693 658 178 33 28 3.7 20.0 7.6 7.0 15.2 13.4 1.4
EVOLENT HEALTH INC 12.01 23.15 8.14 722 847 97 (32) (39) 8.7 NM NM NM NM NM NA
HMS HOLDINGS CORP 16.89 18.29 8.11 1,421 1,474 479 113 90 3.1 13.0 12.3 11.0 26.7 22.8 2.0
IMPRIVATA, INC. 12.12 21.63 9.00 306 255 123 (15) (16) 2.1 NM NM NM NM NM NA
IMS HEALTH HOLDINGS INC 26.64 33.52 22.36 8,784 12,573 3,039 898 706 4.1 14.0 13.3 12.3 16.9 15.2 1.7
INOVALON HOLDINGS INC 17.10 29.00 15.12 2,811 2,380 442 146 130 5.4 16.3 13.1 11.0 29.1 24.0 1.3
MEDIDATA SOLUTIONS INC 43.63 61.31 30.22 2,496 2,426 404 91 86 6.0 26.5 22.5 18.2 43.3 35.3 2.6
MEDICAL TRANSCRIPTION BILLING CORP 0.99 2.50 0.68 10 10 23 (1) (6) 0.4 NM 5.1 2.4 NM NM NA
NATIONAL RESEARCH CORP 36.51 38.22 27.54 891 855 105 32 26 8.2 26.5 24.8 NA 46.8 40.6 3.6
OMNICELL INC 31.86 40.80 25.06 1,143 1,061 542 94 75 2.0 11.3 9.1 7.9 20.3 17.5 1.2
QUALITY SYSTEMS INC 14.08 17.95 12.00 857 748 493 78 64 1.5 9.6 9.3 7.7 18.0 16.4 1.0
VOCERA COMMUNICATIONS INC 11.72 16.02 10.08 310 194 107 1 (4) 1.8 NM NM NM NM NM NA
18Number of Companies: Mean: Total: $47,995 $51,649 $13,238 4.3x 15.4x 13.2x 10.4x 26.3x 22.8x 1.8x
Median: 3.6 13.5 11.7 10.0 23.5 20.8 1.6
HMO Medical — Diversified
AETNA INC $112.27 $134.40 $92.42 $39,362 $47,032 $60,899 $5,418 $5,056 0.8x 8.7x 8.7x 8.1x 14.1x 12.8x 1.5x
CIGNA CORP 138.54 170.68 123.54 35,501 39,396 38,405 4,370 3,771 1.0 9.0 8.9 8.5 15.1 13.8 1.4
UNITEDHEALTH GROUP INC 131.68 135.11 95.00 125,124 160,384 165,878 13,019 11,341 1.0 12.3 10.9 9.9 16.7 14.7 1.1
ANTHEM INC 140.77 173.59 115.63 37,016 50,634 79,863 5,682 5,183 0.6 8.9 8.5 8.0 12.9 11.7 1.2
4Number of Companies: Mean: Total: $237,003 $297,447 $345,045 0.8x 9.7x 9.2x 8.6x 14.7x 13.3x 1.3x
Median: 0.9 9.0 8.8 8.3 14.6 13.3 1.3
HMO Medical — Government
CENTENE CORP $61.96 $83.00 $47.36 $10,563 $14,995 $24,582 $1,229 $821 0.6x 12.2x 6.9x 6.0x 14.8x 12.6x 0.8x
MOLINA HEALTHCARE INC 51.76 82.37 48.00 2,929 3,935 15,244 571 411 0.3 6.9 6.3 5.8 17.7 13.2 1.1
WELLCARE HEALTH PLANS INC 89.99 98.79 69.16 3,982 5,086 13,920 524 392 0.4 9.7 8.5 8.1 20.2 16.4 1.2
3Number of Companies: Mean: Total: $17,473 $24,015 $53,746 0.4x 10.9x 7.9x 7.2x 17.6x 14.1x 1.1x
Median: 0.4 9.7 8.5 7.7 17.7 13.2 1.1
HMO Medical — National & Regional
UNIVERSAL AMERICAN CORP $7.44 $11.16 $5.55 $610 $580 $1,623 $20 $7 0.4x NM 15.8x 10.9x NM 26.8x NA
HUMANA INC 177.07 219.79 155.24 26,387 29,507 54,216 2,522 2,370 0.5 11.7 9.6 9.1 20.0 17.8 1.3
TRIPLE-S MANAGEMENT CORP 26.04 27.70 17.34 645 669 2,903 82 65 0.2 8.2 9.0 8.2 17.2 15.1 1.7
3Number of Companies: Mean: Total: $27,641 $30,755 $58,742 0.4x 9.9x 11.5x 9.4x 18.6x 19.9x 1.5x
Median: 0.4 9.9 9.6 9.1 18.6 17.8 1.5
Home Care / Hospice / Staffing
ADDUS HOMECARE CORP $18.50 $38.08 $15.33 $212 $211 $349 $24 $18 0.6x 8.7x 7.2x 6.3x 14.4x 12.1x 1.0x
ALMOST FAMILY INC 42.01 50.48 34.08 432 548 557 46 37 1.0 12.0 10.3 9.6 16.3 15.1 1.4
AMEDISYS INC 51.49 54.29 26.05 1,721 1,795 1,315 110 73 1.4 16.4 14.5 12.1 29.6 23.9 0.4
BIOSCRIP INC 2.64 4.97 1.19 182 670 986 45 2 0.7 14.8 13.6 10.7 NM NM NA
CHEMED CORP 129.78 160.12 115.29 2,159 2,288 1,557 238 204 1.5 9.6 9.6 9.2 18.2 16.8 1.8
LHC GROUP INC 40.34 51.83 29.69 731 839 838 71 68 1.0 11.8 11.1 10.4 20.5 19.3 1.4
6Number of Companies: Mean: Total: $5,436 $6,350 $5,602 1.0x 12.2x 11.0x 9.7x 19.8x 17.5x 1.2x
Median: 1.0 11.9 10.7 10.0 18.2 16.8 1.4
5
Source: ThomsonOne
($ in millions, except per share data)
Healthcare Services Sector Review: Public Comps Stock Price Equity Total Last Twelve Forward
Company Name As Of 52-Week Market Enterprise Months (LTM) TEV / LTM TEV / EBITDA PE Ratio PEG
04/30/16 High Low Value Value (TEV) Revenue EBITDA EBIT Revenue EBITDA 2016 2017 2016 2017 2016
Long-Term Care
ADCARE HEALTH SYSTEMS INC $2.20 $4.10 $1.85 $44 $220 $18 $0 ($8) 12.0x NM NA NA NM NA NA
CAPITAL SENIOR LIVING CORP 20.06 26.45 14.58 601 1,340 422 76 19 3.2 17.7 14.9 13.2 NM NM NA
DIVERSICARE HEALTHCARE SERVICES INC 8.47 16.84 6.45 54 110 388 15 7 0.3 7.4 NA NA NA NA NA
FIVE STAR QUALITY CARE INC 2.44 5.07 2.00 121 190 1,378 35 1 0.1 5.4 5.9 4.9 NM NM NA
KINDRED HEALTHCARE INC 14.76 24.57 7.96 1,257 4,420 7,223 562 451 0.6 7.9 4.4 6.6 16.8 15.4 4.2
NATIONAL HEALTHCARE CORP 64.45 69.40 57.16 984 956 907 109 70 1.1 8.8 8.9 8.8 NA NA NA
ENSIGN GROUP INC 22.56 27.04 17.60 1,174 1,230 1,388 141 110 0.9 8.7 7.6 6.7 15.3 13.5 1.0
7Number of Companies: Mean: Total: $4,234 $8,466 $11,724 2.6x 9.2x 9.7x 8.2x 16.0x 14.5x 2.6x
Median: 0.9 7.9 8.1 7.3 16.0 14.5 2.6
Other Services
AIR METHODS CORP $36.98 $46.49 $32.81 $1,467 $2,173 $1,117 $292 $202 1.9x 7.4x 6.4x 5.9x 10.9x 9.9x 0.6x
ALERE INC 39.00 55.99 31.96 3,364 6,769 2,459 549 469 2.8 12.3 12.1 11.0 16.3 13.9 1.6
DIGIRAD CORP 5.83 6.92 3.50 114 95 78 10 2 1.2 9.5 5.5 5.2 18.8 17.7 1.2
CHINA CORD BLOOD CORP 6.24 7.69 4.61 456 163 106 48 46 1.5 3.4 3.8 3.2 29.4 NA 1.0
CRYO-CELL INTERNATIONAL INC 3.25 3.95 2.12 30 26 21 2 3 1.2 12.8 NA NA NA NA NA
HOOPER HOLMES INC 0.14 0.49 0.05 18 21 32 (6) (7) 0.7 NM NA NA NA NA NA
INFUSYSTEM HOLDINGS INC 3.60 3.75 2.22 81 116 72 17 9 1.6 6.7 NA NA 12.9 NA 0.6
7Number of Companies: Mean: Total: $5,530 $9,363 $3,886 1.6x 9.6x 6.9x 6.3x 17.7x 13.8x 1.0x
Median: 1.5 9.9 5.9 5.5 16.3 13.9 1.0
Outsourced Services
AMN HEALTHCARE SERVICES INC $35.51 $37.47 $21.24 $1,704 $1,849 $1,582 $173 $129 1.2x 10.7x 8.5x 7.6x 16.8x 14.8x 1.4x
CORVEL CORP 45.20 46.92 29.27 885 858 497 64 44 1.7 13.4 NA NA NA NA NA
CROSS COUNTRY HEALTHCARE INC 12.43 18.76 9.72 407 495 778 37 27 0.6 13.3 10.5 8.7 18.5 14.0 0.7
DIPLOMAT PHARMACY INC 30.29 52.33 22.41 1,997 2,090 3,725 115 81 0.6 18.1 17.5 14.5 NM 28.2 NA
HEALTHCARE SERVICES GROUP INC 37.85 38.49 29.42 2,739 2,637 1,466 101 94 1.8 NM 20.0 17.6 NM 30.7 NA
HEALTHWAYS INC 11.65 17.80 9.18 421 655 770 70 19 0.9 9.4 8.1 7.1 NM 29.6 NA
MAGELLAN HEALTH INC 70.46 73.00 45.40 1,745 1,409 4,655 196 76 0.3 7.2 5.7 5.1 25.7 18.8 NM
ON ASSIGNMENT INC 36.06 51.00 29.34 1,924 2,618 2,217 264 226 1.2 9.9 9.0 8.1 11.5 10.4 0.9
PHARMERICA CORP 23.64 36.96 19.79 727 1,131 2,026 133 89 0.6 8.5 8.5 7.7 11.8 10.4 1.8
ADVISORY BOARD CO 31.64 60.38 18.87 1,294 1,775 798 179 126 2.2 9.9 9.3 8.4 18.8 16.6 1.1
PROVIDENCE SERVICE CORP 49.84 56.92 39.08 741 1,033 1,801 98 103 0.6 10.5 8.3 6.9 16.1 13.0 1.1
11Number of Companies: Mean: Total: $14,583 $16,551 $20,316 1.1x 11.1x 10.6x 9.2x 17.0x 18.7x 1.2x
Median: 0.9 10.2 8.8 7.9 16.8 15.7 1.1
Pharmacy Benefit Managers
CVS HEALTH CORP $100.50 $113.65 $81.37 $109,775 $134,738 $159,969 $11,973 $9,454 0.8x 11.3x 10.2x 9.4x 17.3x 15.3x 1.2x
EXPRESS SCRIPTS HOLDING CO 73.73 94.61 65.55 46,637 61,465 101,644 6,972 6,626 0.6 8.8 8.4 8.3 11.6 10.9 0.7
2Number of Companies: Mean: Total: $156,412 $196,203 $261,613 0.7x 10.0x 9.3x 8.9x 14.4x 13.1x 1.0x
Median: 0.7 10.0 9.3 8.9 14.4 13.1 1.0
Physician Practice Management
BIRNER DENTAL MANAGEMENT SERVICES INC $9.50 $13.81 $8.63 $18 $28 $64 $4 ($1) 0.4x 7.7x NA NA NA NA NA
ENVISION HEALTHCARE HOLDINGS INC 22.63 45.95 18.31 4,234 7,076 5,753 614 530 1.2 11.5 9.8 8.8 15.6 13.6 1.1
EXAMWORKS GROUP INC 36.05 42.60 21.98 1,480 1,967 841 126 61 2.3 15.6 12.2 11.4 NM 43.8 NA
MEDNAX INC 71.29 86.09 61.40 6,632 8,022 2,893 671 646 2.8 12.0 11.7 10.7 17.2 15.7 1.2
TEAMHEALTH HOLDINGS INC 41.83 70.21 33.15 3,087 5,467 3,869 410 333 1.4 13.3 10.8 9.5 14.8 12.7 0.9
5Number of Companies: Mean: Total: $15,450 $22,559 $13,421 1.6x 12.0x 11.1x 10.1x 15.9x 21.4x 1.1x
Median: 1.4 12.0 11.3 10.1 15.6 14.6 1.1
6
Sources: Morgan Markets, Bloomberg
As of April 30, 2016
Debt Capital Markets Overview
6.75%
7.13%
8.05%
5.39%
High Yield Market Overview
High Yield New Issue Volume
High Yield Corporate Credit Yields
($ in billions)
April saw $32.4bln of High Yield issuance compared to $20.8bln in March
– Refinancing: 49.0% year to date vs. 43.4% in 2015
– Acquisition finance/LBO transactions: 26.0% year to date vs. 37.5% in 2015
Two Healthcare issuers hit the High Yield market in April after one last month
– Quorum Health priced $400mln of senior notes (Caa1 / CCC+) at 11.625% for the spin-off from Community
Health Systems
– Regionalcare Capella Healthcare priced $800mln of 1st Lien Notes (B1 / B) at 8.250% for the merger of
Regionalcare and Capella Healthcare
April saw a net inflow from mutual funds of approximately $1.4bln; 2016 year-to-date net inflows are +$9.7bln
The yield on the High Yield index fell from 10.44% on February 11th to 8.05% on April 31st
– Healthcare yields fell 27 bps from 7.02% to 6.75% during the month of April
$33.3
$20.8
$9.2 $10.1
$19.4
$9.1
$22.1
$4.3 $5.5 $9.4
$20.8
$32.4
$0.0
$10.0
$20.0
$30.0
$40.0
$50.0
$60.0
May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
10.00%
11.00%
Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16
HY - All BB B HY - Healthcare
7
Sources: Morgan Markets, Bloomberg
As of April 30, 2016
Debt Capital Markets Overview
105 bps
134 bps 139 bps
213 bps
173 bps
Investment Grade Market Overview
Investment Grade New Issue Volume
Investment Grade Corporate Credit Spreads
($ in billions)
April saw $103.7bln of issuance in the Investment Grade market versus $119.9bln in March
Two Investment Grade Healthcare issuers hit the market in April
Thermo Fisher issued $1.0bln (Baa3 / BBB) to fund the acquisition of Affymetrix
Ascension Health System issued $700mln (Aa2 / AA+) for general corporate purposes
In April, Investment Grade funds saw $6.3bln of net inflows; 2016 year-to-date net inflows total $5.8bln
Investment Grade spreads tightened during the month by 17 bps to 173 bps
– Investment Grade Healthcare spreads tightened by 11 bps, ending at 139 bps
– The 10-yr US Treasury yield ended the month higher at 1.83% versus 1.77% at the beginning of the month
$154.9
$97.2
$129.1
$48.6
$102.5 $104.5 $101.6
$54.0
$125.6
$102.0
$119.9
$103.7
$0.0
$20.0
$40.0
$60.0
$80.0
$100.0
$120.0
$140.0
$160.0
$180.0
May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16
50 bps
100 bps
150 bps
200 bps
250 bps
300 bps
350 bps
Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16
IG - Healthcare IG - All AA A BBB
Amount Rating
Date Issuer Ticker ($mm) Security Coupon Maturity Price Spread Moody's S&P Sector
25-Apr-16 Ascension Health System ASCHEA $700 Sr Unsec 394.500% 11/15/2046 100.000 +122 Aa2 AA+ Healthcare - Facilities & Services
Use of Proceeds: General Corporate Purposes
4-Apr-16 Thermo Fischer Scientific Inc TMO 1,000 Sr Unsec 300.000% 4/15/2023 99.512 +155 Baa3 BBB Life Science Equipment
Use of Proceeds: Acquisition of Affymetrix
22-Feb-16 Express Scripts Holding Co ESRX 500 Sr Unsec 3.300% 2/25/2021 99.790 +210 Baa2 BBB+ Healthcare - Facilities & Services
22-Feb-16 Express Scripts Holding Co ESRX 1,500 Sr Unsec 4.500% 2/25/2026 99.467 +280 Baa2 BBB+ Healthcare - Facilities & Services
Use of Proceeds: Refinancing existing notes
22-Feb-16 UnitedHealth Group UNH 750 Sr Unsec 1.700% 2/15/2019 99.963 +80 A3 A+ Healthcare - Managed Care
22-Feb-16 UnitedHealth Group UNH 750 Sr Unsec 2.125% 3/15/2021 99.695 +95 A3 A+ Healthcare - Managed Care
22-Feb-16 UnitedHealth Group UNH 1,000 Sr Unsec 3.100% 3/15/2026 99.921 +135 A3 A+ Healthcare - Managed Care
Use of Proceeds: Refinancing commercial paper borrowings
8
Recent High Yield Deals
Sources: Morgan Markets, Bloomberg
As of April 30, 2016
Recent Investment Grade Deals
Year-to-Date Debt Capital Markets Transactions
Amount Rating Issuance
Date Issuer Security ($MM) Moody's S&P Coupon Maturity Price Yield Spread Type Sector
22-Apr-16 Regionalcare Capella Healthcare 1st Lien Notes $800 B1 B 8.250% 1-May-23 100.000 8.250% 659 bp 144A Healthcare - Facilities & Services
Use of Proceeds: To finance the merger of RegionalCare Hospital Partners with Capella Healthcare
8-Apr-16 Quorum Health Sr. Notes 400 Caa1 CCC+ 11.625% 15-Apr-23 98.266 12.000% 1,053 bp 144A Healthcare - Facilities & Services
Use of Proceeds: Spin-off from Community Health Systems
28-Mar-16 Surgery Center Holdings Sr. Notes 400 Caa2 CCC+ 8.875% 15-Apr-21 100.000 8.875% 751 bp 144A Healthcare - Facilities & Services
Use of Proceeds: To repay second-lien term debt, repay the outstanding balance on their revolver and to fund general corporate purposes
4-Feb-16 Vizient Sr. Notes 600 Caa1 CCC+ 10.375% 1-Mar-24 100.000 10.375% 867 bp 144A Healthcare IT
Use of Proceeds: Acquisition of MedAssets’ Spend and Clinical Resource Management and Sg2 businesses
4-Feb-16 Acadia Healthcare Sr. Notes 390 B3 B 6.500% 1-Mar-24 100.000 6.500% 479 bp 144A Healthcare - Facilities & Services
Use of Proceeds: Acquisition of U.K.-based behavioral healthcare services provider Priory Group
28-Jan-16 Centene Corp Sr. Notes 1,400 Ba2 BB 5.625% 15-Feb-21 100.000 5.625% 423 bp 144A Managed Care
28-Jan-16 Centene Corp Sr. Notes 1,000 Ba2 BB 6.125% 15-Feb-24 100.000 6.125% 420 bp 144A Managed Care
Use of Proceeds: To fund the acquisition of Health Net
9
Source: Loan Connector
New Issue
Forward Calendar
None
Loan Market Update
Tranche LIBOR Upfront
Date Company Name Tranche Type Amount Deal Amount Maturity Date Spread Fee Moody's S&P Lead Arranger(s) Use of Proceeds Phase
28-Apr-16 EyeCare Services Partners Other Loan $61,000,000 $61,000,000 NA NA NA NR NR NXT Capital LLC General Purpose Completed
22-Apr-16 St. Lawrence Health Systems, Inc. Term Loan 6,500,000 6,500,000 22-Apr-23 NA NA NR NR NA General Purpose Completed
1-Apr-16 Trilogy Health Services Inc Revolver/Line >= 1 Yr. 60,000,000 60,000,000 21-Mar-21 400 NA NR NR Capital One Bank, Wells Fargo & Co General Purpose Completed
10
Sources: Morgan Markets, Bloomberg
As of April 30, 2016
Yield Curve Suggests Continued Low Rate Environment Forward LIBOR Rate
10-yr UST Yield Remains Near All-Time Lows % of Time the 10-yr UST was Below a Specific Yield (1962 – Present)
Current Interest Rate Environment
0.00%
0.50%
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
3 Mo 6 Mo 12 Mo 2 Yr 3 Yr 5 Yr 7 Yr 10 Yr 30 Yr
Forward Yield Curve - April 31 Yield Curve -March 31
Forward Yield Curve - Year End 2016
0.00%
0.25%
0.50%
0.75%
1.00%
1.25%
1.50%
1.75%
2.00%
May-16 Nov-16 May-17 Nov-17 May-18 Nov-18 May-19 Nov-19 May-20 Nov-20
1.00%
1.50%
2.00%
2.50%
3.00%
3.50%
4.00%
Apr-11 Oct-11 Apr-12 Oct-12 Apr-13 Oct-13 Apr-14 Oct-14 Apr-15 Oct-15 Apr-16
0.1%3.5%
7.2%10.7%
13.1%
19.3%
29.5%
36.5%
42.0%
49.1%
56.5%
62.8%
70.1%
77.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
1.5% 2.0% 2.5% 3.0% 3.5% 4.0% 4.5% 5.0% 5.5% 6.0% 6.5% 7.0% 7.5% 8.0%
15 28 14 8 6 13 10 0 0 4 2 7IPO Pricings
by Month
$0.0
$2.5
$5.0
$7.5
$10.0
May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
Dea
l Val
ue
Prior Period
Current Period
68 57 52 47 27 23 44 32 31 18 51 31FO Pricings
by Month
$0.0
$10.0
$20.0
$30.0
$40.0
May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
Dea
l Val
ue
Prior Period
Current Period
Follow-Ons LTM ($ in billions)
11
Sources: Capital IQ, Dealogic, Lipper
As of April 30, 2016
Initial Public Offerings LTM ($ in billions)
LTM Aftermarket Follow-On Performance (%) Relative IPO Aftermarket Performance
Equity Capital Markets: Deal Volume & Aftermarket Performance Trends
2-Year Avg. Proceeds 2-Year Avg. Proceeds
(10.0%)
(7.5%)
(5.0%)
(2.5%)
0.0%
2.5%
5.0%
7.5%
10.0%
12.5%
15.0%
17.5%
May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
1-Day 1-Week 1-Month
60
70
80
90
100
110
120
130
Apr-15 Jun-15 Aug-15 Oct-15 Dec-15 Feb-16 Apr-16
Renaissance IPO Index
Russell 2000 Index
NASDAQ Composite
12
Source: Dealogic
Healthcare Services Initial Public Offerings
Healthcare Services Follow-On Offering
Equity Capital Markets: Year-to-Date Healthcare Services Pricings
Healthcare Services Convertible Offerings
Healthcare Services IPO Backlog
None
Filing Pricing Deal Market Shares % Filing Offer Pricing % Change in Price
Date Date Issuer Ticker Value Cap Offered Secondary Range Price Range 1 Day 1 Week 1 Month Healthcare Sector
08/31/15 04/20/16American Renal Associates
Holdings IncARA $190.0 $654.0 8.625 0% 20.00 - 23.00 $22.00 In Range 20.5% 25.0% NA Healthcare Services
Mean $190.0 $654.0 8.625 20.5% 25.0% -
Median $190.0 $654.0 8.625 20.5% 25.0% -
Filing Expected Expected
Date Date Issuer Ticker Value Sector Issuer Description
4/22/16 TBA Performance Health Holdings Corp PHC $100.0 Healthcare Services Health and wellness company that offers pain management, fitness, therapy, and wellness products
Filing Pricing Deal Market Shares % Offer Discount to % Change in Price
Date Date Issuer Ticker Value Cap Offered Secondary Price Filing Last 1 Day 1 Week 1 Month Healthcare Sector
03/02/16 03/03/16 PRA Health Sciences Inc PRAH $214.0 $2,693.0 5.000 0% $42.70 4.4% 4.4% 2.9% 1.3% 3.0% Healthcare Services
01/05/16 01/06/16 Acadia Healthcare Co Inc ACHC 702.0 5,029.0 11.500 0% 61.00 (4.1%) (0.9%) 0.9% (4.7%) (3.3%) Healthcare Facilities
Mean $458.0 $3,861.0 8.250 0.2% 1.8% 1.9% (1.7%) (0.1%)
Median $458.0 $3,861.0 8.250 0.2% 1.8% 1.9% (1.7%) (0.1%)
Announcement Date Target(s) Buyer(s) Target Business DescriptionDeal Value
($mm)
04/27/16 ExamWorks Group, Inc. Leonard Green & Partners, L.P.Provides independent medical examinations, peer and bill reviews, Medicare
compliance, case management and other related services$1,981
04/26/16 Lifeguard Medical Solutions, LLC Allied 100, LLCDistributes automated external defibrillators and offer an online monitoring system, onsite
training programs and medical oversight servicesNA
04/26/16Healthsouth Rehabilitation Hospital Of
Beaumont LLCPost Acute Medical, LLC
Owns and operates a rehabilitation hospital that provides treatment for strokes,
amputations, arthritis, brain injuries and other injuriesNA
04/22/16 Dimensional Management Corporation Waud Capital Partners, L.L.C. Offers dental care services and operates 23 dental offices NA
04/21/16 Stat Read, LLC Teleradiology Specialists, PLLC Provides radiology report reading services under the name UrgentRad Radiology NA
04/19/16 Prospective Payment Specialists, Inc. Receivables Outsourcing, Inc.Provides compliance and revenue cycle services to teaching hospitals, regional medical
centers, and critical access hospitalsNA
04/19/16 Today's Options of New York, Inc. Molina Healthcare, Inc.Offers healthcare plans to its members in Central NY including Medicaid Managed Care,
Child Health Plus and health benefit exchange plans41
04/19/16 Avadyne Health, Inc. MTS Health Investors, LLCProvides outsourced revenue cycle management services and technology solutions to
hospital clientsNA
04/18/16 The Meadows of Wickenburg, Inc. Kohlberg & Company, L.L.C.Provides addiction and psychological trauma treatment services for conditions including
trauma, PTSD, alcohol addiction and more180
04/11/16 Sequence Therapy, LLC Advantis CorporationProvides pain management and physical therapy services and develops digital
application for healthcare providersNA
04/11/16ACSH Urgent Care of Virginia and ACSH
Primary Care of VirginiaUrgeMedical Group, Inc.
ACSH Urgent Care of Virginia, LLC and ACSH Primary Care of Virginia, LLC own and
operate urgent care centers1
04/11/16 Wunderlich, M.D., S.C. DuPage Medical Group, Ltd.Offers services for chronic medical conditions; evaluation of new illnesses, pre-surgical
clearance, surgery and prevention screeningsNA
04/08/16 Mountain View Medical Group, P.C. DaVita HealthCare Partners Inc. Operates as a multiple-physician medical practice group in the Pikes Peak region NA
04/08/16Autoclave Testing Supplies and Autoclave
Testing ServicesMesa Laboratories Inc.
Autoclave Testing Supplies, Inc. and Autoclave Testing Services, Inc. distribute dental
sterilizer testing productsNA
04/08/16 Aging Family Services, Inc. LifeLinks,LLCProvides professional geriatric care management services to older adults in Raleigh,
Durham, and Chapel HillNA
04/06/16 Evergreen Rehabilitation, LLC Encore Rehabilitation Services, LLCProvides physical, occupational, and speech therapy services to long-term care
communities and outpatient therapy centersNA
04/06/16 Legend Healthcare, LLC The Ensign Group, Inc.Offers nursing and rehabilitative care, restorative care, physician services coordination,
pharmacy services, social service and care planningNA
04/06/16 Prairie View Healthcare Community Welcov Healthcare, LLC Operates a 52-bed nursing facility providing transitional, long-term and memory care NA
04/05/16 Upper Valley ENT Premier HealthNet Offers ears, nose and throat treatment services NA
04/05/16 Forty seven Medical Office Facilities Physicians Realty Trust Forty seven Medical Office Facilities throughtout the United States 611
04/04/16 Moore Physical Therapy and FitnessProfessional Orthopedic and Sports
Physical Therapy, P.C.
Offers physical therapy services, MLS Laser Therapy, post-surgical recovery, and athletic
training, fitness, ergonomics and nutrition servicesNA
04/04/16Victory Park Nursing Home and Victoria
Retirement CommunityCareTrust REIT, Inc.
Victory Park Nursing Home and Victoria Retirement Community comprises nursing and
retirement facilitiesNA
04/04/16 Cedar Falls Health Care Center CareTrust REIT, Inc. Cedar Falls Health Care Center comprises an 82-bed skilled nursing facility 5
04/04/16Kindred Healthcare, Inc., 12 Long Term
Acute Care HospitalsCurahealth, LLC 12 Long Term Acute Care Hospitals 28
04/04/16 Children's Emergency Services, Inc. Team Health Holdings, Inc. Provides emergency healthcare services for Dayton Children's Hospital NA
04/04/16 North Florida Anesthesia Consultants, Inc. Sheridan Healthcare, Inc.Provides anesthetic services for surgery centers and physician offices in Jacksonville,
Florida and the surrounding areasNA
04/01/16 Physicians' Specialty Hospital, LLC Community Health Systems, Inc.Offers spine surgery, urology, podiatry, pain management, minimally invasive general
surgery, bariatric surgery and other surgery servicesNA
04/01/16 CryoGen Management Signet Interactive LLCOffers cryogenic services including careful preparation, cooling and long-term patient
care in liquid nitrogenNA
13
Source: Capital IQ
M&A Activity
April 2016 March 2016 January 2016 December 2015 November 2015 November 2015 September 2015
has acquired has acquired
has acquired has been acquired by
Follow-On Offering Follow-On Offering Senior Secured Credit Facilities Senior Secured Credit Facilities Senior Secured Credit Facilities
a portfolio company of $2,553,750,000
$401,625,000 $466,777,280 Senior Unsecured Notes $150,000,000
$545,000,000 Joint Lead Arranger, Joint Lead Arranger,
Left Bookrunner Exclusive Buy-Side Advisor Exclusive Buy-Side Advisor Co-Manager Co-Manager & Joint Bookrunner & Sole Bookrunner &
Administrative Agent Administrative Agent Administrative Agent
14
Select Transactions
For additional information on KeyBanc Capital Markets,
please contact any of the individuals listed below
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Healthcare Investment Banking Team
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Director
Healthcare
(216) 689-4535
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Vice President
Healthcare
(212) 476-7463
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Managing Director & Segment
Leader – Diversified Industries Group
(216) 689-4441
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Managing Director
Healthcare
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Managing Director
Healthcare
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Managing Director
Healthcare
(212) 476-7430
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