Financial Analysis of National

Financial Analysis of National

Medical Center Group Dubai

School

Table of Contents

TOC o “1-3” h z u HYPERLINK l “_Toc410121773” Background PAGEREF _Toc410121773 h 4

HYPERLINK l “_Toc410121774” About HealthCare Industry in UAE PAGEREF _Toc410121774 h 4

HYPERLINK l “_Toc410121775” About NMC Group PAGEREF _Toc410121775 h 5

HYPERLINK l “_Toc410121776” NMC Top Pick in Sector PAGEREF _Toc410121776 h 5

HYPERLINK l “_Toc410121777” Details of DCF analysis PAGEREF _Toc410121777 h 6

HYPERLINK l “_Toc410121778” About the founder PAGEREF _Toc410121778 h 8

HYPERLINK l “_Toc410121779” SWOT Analysis PAGEREF _Toc410121779 h 9

HYPERLINK l “_Toc410121780” Financial Analysis PAGEREF _Toc410121780 h 11

HYPERLINK l “_Toc410121781” Ratio Analysis PAGEREF _Toc410121781 h 12

HYPERLINK l “_Toc410121782” Profitability Ratios PAGEREF _Toc410121782 h 14

HYPERLINK l “_Toc410121783” Asset Utilization Ratios PAGEREF _Toc410121783 h 14

HYPERLINK l “_Toc410121784” Liquidity Ratios PAGEREF _Toc410121784 h 15

HYPERLINK l “_Toc410121785” Debt Utilization Ratios PAGEREF _Toc410121785 h 16

HYPERLINK l “_Toc410121786” Summary PAGEREF _Toc410121786 h 17

HYPERLINK l “_Toc410121787” Company Source of Funds of Revenue PAGEREF _Toc410121787 h 18

HYPERLINK l “_Toc410121788” Gross Patient Service Revenue (GPSR). PAGEREF _Toc410121788 h 18

HYPERLINK l “_Toc410121789” Net Patient Service Revenue (NPSR). PAGEREF _Toc410121789 h 18

HYPERLINK l “_Toc410121790” Adjustments to GPSR revenue to calculate NPSR include: PAGEREF _Toc410121790 h 18

HYPERLINK l “_Toc410121791” Private Payers PAGEREF _Toc410121791 h 19

HYPERLINK l “_Toc410121792” Health Maintenance Organizations (HMOs) PAGEREF _Toc410121792 h 19

HYPERLINK l “_Toc410121793” Preferred Provider Organizations (PPOs) PAGEREF _Toc410121793 h 19

HYPERLINK l “_Toc410121794” Point of Service (POS) PAGEREF _Toc410121794 h 19

HYPERLINK l “_Toc410121795” Indemnity insurance PAGEREF _Toc410121795 h 19

HYPERLINK l “_Toc410121796” Uninsured PAGEREF _Toc410121796 h 20

HYPERLINK l “_Toc410121797” Other Operating Revenue PAGEREF _Toc410121797 h 20

HYPERLINK l “_Toc410121798” Investment Income PAGEREF _Toc410121798 h 21

HYPERLINK l “_Toc410121799” Unrestricted Donations PAGEREF _Toc410121799 h 21

HYPERLINK l “_Toc410121800” References PAGEREF _Toc410121800 h 22

HYPERLINK l “_Toc410121801” Appendix PAGEREF _Toc410121801 h 23

HYPERLINK l “_Toc410121802” Financial Summary PAGEREF _Toc410121802 h 23

HYPERLINK l “_Toc410121803” FY2013 Financial Highlights –A year on year comparison PAGEREF _Toc410121803 h 26

HYPERLINK l “_Toc410121804” FY2013 Business Highlights – A year on year comparison PAGEREF _Toc410121804 h 26

Background

About HealthCare Industry in UAEThe healthcare sector in the UAE is mainly managed by the government through the Ministry of Health (MoH) and the authorities Emirate. Each Emirate has its own health authority, like Dubai has DHA, (Dubai Health Authority), Abu Dhabi has HAAD. UAE government has tried to make UAE as the regional tourism hub. It is promoting medical tourism. UAE government has introduced compulsory health insurance, which has been followed by each emirates, in its own way. AS per Collins, after compulsory health insurance was introduced to Abu Dhabi, the revenues of most of the private hospitals doubled in subsequent years (Audit, 2014). In 2013, Dubai has also included the insurance plan in it system and has made it mandatory for everyone to have medical insurance

In UAE, there are total 88 hospitals, which include private and public sectors. These organizations provide various services related to healthcare industry. The total bed were 9176, by end of 2011. So, each hospital has on the average of 104 bed per hospital. Dubai & Abu Dhabi has 35 no. of hospital each, as per Colliers international 2013

The private sector contributes to 2/3rd of the total no. of hospitals.

About NMC GroupNMC is a healthcare group in the United Arab Emirates (UAE). Its headquarters are in Abu Dhabi, UAE’s NMC has branches capital in other emirates. Of UAE, which include Dubai, Sharjah & Al Ain. National Medical Company is listed on the London stock Exchange (LSE), since 2012. It is a part of the Foreign Trading Stock Exchange (FTSE).

NMC Healthcare group was created by H.E. Abdulla Humaid Al-Mazroei & B.R. Shetty, in 1975. It grew up and opened hospitals in Deira (1999) and Al Nadha (2004) in Dubai, in Al Ain (2008) & recently opened hospital in Sharjah, as well.

NMC has diversified into other lines of businesses, other than hospital & NMC. NMC has also ventured into pharmacies, hospitality (Foodland restaurant), financial services (UAE exchange is one of the prominent business), jewelry, education, advertisement, real estate, information technology & pharmaceuticals (NMC, 2014).

NMC is a very socially responsible company. This healthcare group is a sponsoring a cricket team, which has won many titles.

The NMC healthcare group is a composition of NMC Healthcare Division and NMC Distribution Division.

NMC Healthcare includes:

Abu Dhabi Specialty Hospital, Al Ain Specialty Hospital, Dubai Specialty Hospital, Dubai General Hospital, Sharjah Medical Centre, BR Medical Suites, NMC Day Surgery Centre in Mohammed Bin Zayed City & Third party hospital operations & management. In addition to this, NMC is adding new assets, medical facilities to the existing hospitals in Abu Dhabi & Dubai.

Segments

NMC distribution division includes wholesale of pharmaceutical goods, medical equipment, cosmetics, food and IT products and services.

NMC Top Pick in SectorNMC Health exchanges at an 18% and 8% rebate to EM social insurance peers on the premise of 2014e P/E and EV/EBITDA products, separately. While some markdown is supported because of the way that NMC’s plan of action incorporates an appropriation segment, which offers lower development and edges than the medicinal services part, we regardless view the valuation crevice as extreme. Our examination recommends a reasonable estimation of GBP 5.51/offer for the organization, 21% over the predominating business sector cost (Audit, 2014). Also, provided for its current system of three social insurance offices in Dubai (2 hospitals and one facility), alongside expected opening of an alternate clinic in Q2 14 (DIP Hospital), NMC is best situated among the recorded human services organizations to profit from the progressing take off of obligatory protection in Dubai. We along these lines feel that the organization offers the best esteem to speculators inside our social insurance scope and positions as our top pick in the part.

Details of DCF analysisOur DCF-based valuation of NMC has expanded to GBP 5.87/offer, 55% higher than our past evaluation of GBP 3.79/offer. Key elements driving the higher valuation are:

Fundamentally lower capital use of USD 293mn over our 5-year gauge period versus USD 419mn in our past model (use on various key ventures, for example, Brighpoint and DIP hospital is generally finish).

Our past model expected that NMC’s present 5-year contract to oversee Sheik Khalifa Hospital would not be restored upon fulfillment. Given the organization’s solid execution to date in working the office (NMC created Usd5.4mn from the agreement, meeting all its Kpis) and the predominating absence of supply of value healing facility administrators, we now feel that this suspicion is excessively moderate. Our amended model expect that the agreement will be replenished upon fulfillment (Colliers, 2014).

By moving the time of DCF investigation 1 year forward, Free Cash Flow in the most recent year of our unequivocal figure period (which structures the premise for Terminal Value) increments fundamentally from USD 102mn to Usd152mn. This is determined by a mix of 1) better usage at existing and new social insurance offices and 2) commitment from Third Party Management Services (administration of Sheik Khalifa Hospital), which was at one time rejected in our model.

We have brought down the expense of value from 12% to 11%, in accordance with that used for Al Noor. This reductions our WACC to 8.8% versus 9.2% in our last valuation.

About the founderB R Shetty is CEO & MD of the NMC Group of Companies & UAE Exchange. He is a trained pharmacist and he spotted an opportunity in the co acquired National Hospital, in Abu Dhabi. Today, this group has hospitals and NMC all across UAE and has patient base of more than one million, a year. Shetty has been awarded for Padmashree and Pravasi Bharatiya Samman. He is also the chairman of Abu Dhabi Indian School, AD, UAE. Shetty is involved in many philanthropic activities. He has investments in India as well, in medical institutions. He is founder member of the Indian Pharmaceutical Association in UAE. He is member of:

Advisory Board of Financial Sector),

Economic Department, Government of Dubai, UAE &

Pharmaceutical Committee, Dubai.

He is also the chairman of Abu Dhabi Indian School, AD, UAE. Shetty has been awarded for Padmashree and Pravasi Bharatiya Samman.

SWOT AnalysisSTRENGTHS: NMC has created competitive advantage through following those, its strengths include:

Market leader in healthcare plans segment: Special expertise, innovative service,

Market Capitalization Cost advantages, due to many branches,

Customer focused approach Cultural advantage, connected to Asians

Excellent reputation

Experienced staff

Latest Technology

International exposure

Diversification,

Easily accessible locations of the hospitals.

WEAKNESSES: NMC might need improvements in following:

Too much reliance on external funds

Targeting only Asians customers

Marketing gaps.

OPPORTUNITIES: Some significant trends exist in the market, which NMC can exploit, for its benefits, which include:

Some competitor’s leaving are market,

New & upgraded technology

Opening branches in neighboring gulf countries

Introduce new products to target specific segment of people: New market segment including Insurance business,

Diversification into niche market of commodity market, add new niche, or horizontal business.

THREATS: No one is immune to threats, NMC must consider these threats seriously, which includes:Competitor developing new product & service line,

New competitors like Americans, Canadian competitors are entering market and expanding,

Fast changing economic scenarios (economic shift), Changing Government regulations: new rules and regulations,

Change in insurance plans,

Competitors improved channels of distribution

Staff leaving for better prospects

Seasonality due to holidays, festivals Strengths

Financial AnalysisMost of the subsidiaries are 100% owned. The financial analysis of NMC Healthcare group include the above mentioned activities, together it is called ‘group’. NMC group follows IFRS, issued by IASB, for finalization and consolidation of its accounts. The functional currency is in UAE Dirhams, whereas the reporting currency is USD. The reporting period of financial statements in one year, i.e 1st Jan to 31st Dec (Colliers, 2014).

The primary economic environment influencing UAE and the effect of the local environment is limited to expenses incurred within the UK. The ability of the Company to meet its obligations and pay dividends to its shareholders is dependent on the economy of, and the operation of its subsidiaries in, the UAE.

Ratio AnalysisRatio Analysis

Year

S.No. Ratios 2009 2008

1 Gross Margin 33% 32%

2 Profit Margin 12% 12%

3 Operating Profit Margin 15% 19%

4 Return on Capital Employed 9% 8.30%

5 Return on Equity 19.30% 18%

6 Receivable Turnover Ratio 3.15 Times 2.70 Times

7 Average Collection Period 115 Days 133 Days

8 Fixed Asset Turnover Ratio 2.41 Times 2.42 Times

9 Total Asset Turnover Ratio 0.72 0.68

10 Current Asset Ratio 2.13 2

12 Quick Acid Test Ratio 1.91 1.72

13 Debt to Total Asset 52% 54%

14 Debt to Equity Ratio 110% 116.47%

15 Time Interest Earned 5.82 6.79

16 Inventory Conversion Period 94 days 80 days

17 Payable Deferral Period 76 days 76 days

18 Cash Conversion Cycle 133 days 137 days

To compare the position of the healthcare care group, am horizontal analysis has been done, which involved the evaluation of firm’

As NMC Health care is in related businesses i.e. related to the supply chain components of healthcare industry, the comparison is possible. The accounting principles followed are same, reporting dates are also same, even the functional/reporting currency is same.

Profitability RatiosThe company has been able to effectively generate and maintain the profitability of the company. The operations have been able to bring down the direct cost of the business, hence the profit from operations has gone up from 32% to 33%.

The company has been able to maintain a profit margin of 12%, year on year, this suggests that the company has been able to maintain the proportion of profit in sales steadily (Coyne & Hilsenrath, 2002).

The operating profit margins have gone down from 19% to 15%, which shows that the sales dollars which remains after the payment of all costs and expenses, except for interest and taxes.

The return on capital employed, has improved, from 8.30% to 9%, over the year.

The interesting fact to be understood here is that Cost of Capital is approximately 3% to 4% + EIBOR, approximately 7-8%. Hence the cost of capital is more or less equal to return on capital. The business has excel to improve it returns on capital employed, to cover up the short term, long term borrowings.

The responsibility of corporate governance is to take care of the interest of the shareholders of the company. The company has been able to generate better return to shareholders. The returns to shareholders have gone up. This means the market value of the share of NMC healthcare must have risen, after it got registered with FTSE, for fund raising, for its capital projects of starting new medical facilities in different parts of UAE.

Asset Utilization RatiosAlthough the receivable period has gone up, but the conversion cycles are too long. In the report, it is mentioned that funds are receivable from either government or insurance companies, which have long procedures, to release the payments. Even in some cases, company is doing impairment, to adjust the receivable, at the net realizable value. ‘An estimate of the collectible amount of trade accounts receivable is made when collection of the full amount is no longer probable. Amounts which are not significant, but which are past due, are assessed collectively and a provision applied according to the length of time past due, based on historical recovery rates.’ (as per the NMC 2014 A)

In the same lines, the receivable time has down own from last year, but this make the operating cycle, very long. Hence the company should try to reduce the receivable cycle. On evaluation the payable deferral period, it came out that payable cycles are shorter than receivable cycles.

There is a which ‘negative will harm the operating float’, cycle of the company. This will lead to drying up of working capital, in the company. This situation will lead to liquidity crunch, in years to come.

Inventory turnover time has gone up. It generally consist of the medicines sold at pharmacies, the medical equipment etc. the inventory turnover is slow.

The total cash conversion cycle is still positive, but it’s too long, the operating cycle, for a healthcare should not be longer than 3 months.

Ideally this is the time, during which the patient is diagnosed and treated. The company has to work on reducing its cash conversion cycle, for betterment of working capital management.

Liquidity RatiosThe short liquidity is quite strong at this point of time, the current asset are almost 2 times the current liability. This is a very healthy position (Thomas, 2009). To go deeper into liquidity issues, the conservative approach of establishing the financial health in short term, can be done by taking out inventory from the current assets, which states that current assets are still better of and cover the liability fully. The operating cycles have no shortage of liquidity.

But, as the company has raised funds through borrowing, and invested in inventory, the current assets and liabilities may go up. So, even after considering that, company has comfortable liquidity position.

Debt Utilization RatiosThe company is highly financial leveraged, more that 50% of its assets are financed with debts. But looking at the trend, it is visible that management is trying to reduce the part of debt.

Same way, the firm’s financial leverage can be established, it is very highly leveraged in comparison to the equity invested. This is due to the company going public in 2012. NMC healthcare raised funds through IPO and registered the company at FTSE, to finance its capital projects (NMC, 2014).SummaryThe cost of capital is almost equivalent to return on investment, the group has been able to maintain the cost of capital=return on capital. This means that governance of the group is aiming at reducing the cost of capital by generating, higher returns.

The operating cycle has to be shorten down by increasing the payable cycle and reducing the receivable cycle. The cash conversion h point of time. To improve the operating cycle the float ha to because operating cycle has be less than 3 months, as the cash get stuck between the receivable and payable cycle (Coyne & Hilsenrath, 2002).

The group has to work on it, the operating profit margins have gone down from 19% to 15%. The inventory turnover is also slow, which can leads stocks of medicines getting obsolete, reducing the profit margins. The group has to follow strict regime for working capital management, otherwise the current liabilities will be more than the current assets, which will have drastic effect on the cash /operation cycle.

As company has gone for IPO in the international market, the company has to look into its operation. The money raised from international market through raising shares is payable through dividends, although the share value has gone up. The group has to more stringently follow on its finances, as the company is highly leveraged through these debts.

The group should convert all the projects into cash cows soon, as the project cost should not go up. If they are unable to do so, the capital raised from market will become expensive.

Company Source of Funds of RevenueOperating revenue— earned by conveying patient consideration is the first and essential way that hospital profit. This income is hide their sorted in hospital fund terms as horrible and net

Gross Patient Service Revenue (GPSR).

The measure of cash that NMC would make on the off chance that they were forked over the required funds (that is, the non-discounted rate) for the consideration they convey (complete inpatient and outpatient incomes before derivations). On the other hand, hospital professional vide most patient consideration at short of what full charge and never really gather their terrible patient administration income (Dhabi, 2009).

Net Patient Service Revenue (NPSR).

The aggregate sum of cash the clinic really gathers in the wake of deducting philanthropy care and contractual changes.

Adjustments to GPSR revenue to calculate NPSR include:Free care (also known as charity care) represents administrations accommodated which installment was never expected and for which the patient is not sought after. Tolerant qualification with the expectation of complimentary consideration shifts by state and (here and there) by clinic and is by and large focused around monetary circumstance (salary and resources). NMC esteem free care at full charges on their budgetary proclamations, yet this does not reflect the genuine expense of giving the consideration. (Note: Free care varies from terrible obligation in that awful obligation speaks to administration charges for which a doctor’s facility anticipated that will gather yet winds up not getting paid. For more detail on awful obligation see Section III.) (Hajat, Harrison & Al Siksek, 2012)

Contractual are payment arrangements with organized payers.

Different payers pay different distinctive sums for indistinguishable administrations. Medicare, Medicaid, and private insurance agencies arrange installment courses of action that are focused around expenses, recorded healing facility charges, or other criteria. The value that these gatherings have the capacity arrange shifts (they don’t all pay the same marked down rate) as does the installment strategy.

Private PayersThe private health insurance framework stands parallel to the general population Medicare and Medicaid programs. These payers get a premium— normally from a business in the interest of workers, yet at times from different associations or people to pay for the medicinal services its members need. Private payers arrive in a mixture of sorts

Health Maintenance Organizations (HMOs)

Pay for inpatient hospital administrations by DRG, outlay, or marked down charges. They might likewise pay by arranged capitation rates, especially in an “incorporated conveyance framework” where doctor’s facilities and doctors contract together.

HMOs pay for outpatient hospital services in two common ways:

By capitation, where a supplier is paid a certain sum every patient for a foreordained set of administrations. Capitation installments are frequently depicted regarding “every part, every month (Hajat, Harrison & Al Siksek, 2012).

Preferred Provider Organizations (PPOs)

Pay hospital for inpatient and outpatient consideration focused around an arranged rebate of the clinic’s ordinary charges. Out-of-system consideration is normally paid for at the hospital’s charge rate.

Point of Service (POS)Associations are a crossover of Ppos and Hmos. Installment by a POS tackles diverse structures, contingent upon the particular POS plan. A few POS arrangements pay for administrations utilizing the marked down expense for-administration strategy and some utilization capitation. Out-of-system consideration is normally paid at the healing facility’s charge rate.

Indemnity insurance

Is the conventional type of protection? Under reimbursement protection, arrangements pay for inpatient and outpatient doctor’s facility consideration focused around the hospital’s charges. This strategy can be considered practically identical to different types of protection, for example, auto protection. Reimbursement contrasts from other private safety net providers that utilization the charge for-service technique, for example, PPOs and a few Hmos—in light of the fact that repayment insurance permits the patient to see any specialist or go to any clinic they wish. This flexibility of decision and relative absence of limitations has a tendency to pull in individuals with more prominent medicinal service’s needs, subsequently repayment arrangements are costly and have significantly expanded the copayment and deductible peculiarities of their profit arranges as of late. Thus, the quantity of individuals safeguarded by repayment arrangements is diminishing.

UninsuredThe individuals who don’t have an open or private payer speaking to them in the human services commercial center speak to themselves. These are the uninsured, who must discover the intends to fund their own particular consideration. Pay toward oneself Uninsured or pay toward oneself patients pay whatever charges the healing facility posts as their charge or cost. In 1996, payers toward oneself paid, on assert age, 87 percent more than what their consideration really cost. As a correlation, private safety net providers paid, generally speaking, 22 percent over the expense of their consideration. Pay toward oneself additionally means uninsured, such an extensive amount a clinic’s potential pay toward oneself income winds up as uncompensated consideration.

Other Operating RevenueHospital likewise profit by giving administrations that are continuous business exercises, yet that are not specifically identified with the clinic’s fundamental mission of conveying patient consideration. While these exercises acquire critical and persistent streams of stores, the cash coming about because of these administrations and exercises is called other working income. Some normal classifications that make up other working income include:

i. Cafeteria sales

ii. Gift shop sales

iii. Parking garage fees

iv. Space or equipment rentals

v. Research grants

While it is presumably evident how a doctor’s facility advantages monetarily from rentals, cafeteria, blessing shop, and stopping carport charges, financing from examination gifts merits somewhat more clarification. NMC are an important coliseum for investigating new medications, medicines, and methods, and outside offices store doctor’s facilities to perform such research. The primary associations that store medicinal exploration incorporate the National Institutes of Health and the Centers for Disease Control and Prevention, two national government organizations. Hospitals additionally get subsidizing from pharmaceutical organizations to test new medications and items. Cash from exploration stipends can be a noteworthy wellspring of stores for a doctor’s facility, especially on the off chance that it is an educating hospital.

Investment IncomeInvestment Income is turning into an undeniably critical route for NMC to profit. Classes of attractive securities incorporate shared subsidizes, stocks, and securities. Distinctive hospitals have diverse speculation systems: a few NMC put resources into stocks or other securities that give higher returns at more serious danger, while different doctor’s facilities put resources into more progressive settled rate return instruments, for example, securities and currency business sector reserves. It might be hard to get a feeling of the hospital’s ventures from their budgetary proclamations, in spite of the fact that the general blend of stocks, bonds, and trade are frequently unveiled in for money the references of the reviewed monetary articulations. Since speculation Income can be a “black box” on the grounds that you can’t tell what a clinic is contributing or what the level of danger included is, it is critical to get some information about its venture technique.

Unrestricted DonationsNMC regularly get money related endowments from people and organizations that wish to help the healing facility’s mission. At the point when these stores are not guided to a specific reason, they are considered as non-operating income (once more) for the doctor’s facility and recorded thusly on the Income articulation. Note that this income is not a steady or dependable wellspring of cash for a doctor’s facility (World Health Organization, 2010).

ReferencesAudit IT. (2014). Financial Analysis and Accounting Book of Reference. Available: HYPERLINK ” http://www.readyratios.com/reference/.” http://www.readyratios.com/reference/. Last accessed 12th Sept 2014.

Colliers. (2014). Healthcare and Education Services. Available:

HYPERLINK ” http://www.colliers.com/en-gb/unitedarabemirates/services/healthcar” http://www.colliers.com/en-gb/unitedarabemirates/services/healthcare.Last accessed 12th Sept 2014.

Coyne, J. S., & Hilsenrath, P. (2002). The World Health Report 2000: Can health care systems be compared using a single measure of performance?.American Journal of Public Health, 92(1), 30-33.

Dhabi, A. (2009). United Arab Emirates. Countries and Territories of the World, 444.

Hajat, C., Harrison, O., & Al Siksek, Z. (2012). Weqaya: a population-wide cardiovascular screening program in Abu Dhabi, United Arab Emirates.American journal of public health, 102(5), 909-914.

NMC. (2014). NMC Profile. Available: HYPERLINK “http://www.nmc.ae/.%20Last%20accessed%2012%20Sept%202014.” http://www.nmc.ae/. Last accessed 12 HYPERLINK “http://www.nmc.ae/.%20Last%20accessed%2012%20Sept%202014.” Sept 2014.

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Appendix

NMC Health Plc

FINANCIAL REPORT: Full year ended 31 December 2013

5842013970

London, 25 February 2014: NMC Health Plc (LSE:NMC) (‘NMC’),theleading integrated private sector healthcare operator in the United Arab Emirates, announces its results for the full year ended 31 December 2013.

Financial SummaryUS$m (unless stated) FY2013 FY2012 Growth

Group Revenue 550.9 490.1 12.4%

Gross profit 185.5 160.3 15.7%

Gross profit margin 33.7 32.7 +98bps

EBITDA 92.9 79.6 16.7%

EBITDA margin 16.9% 16.2% +62bps

Net profit 69.1 59.8 15.7%

Net profit margin 12.6 12.2 +36bps

Earnings per share (US$) 0.367 0.343 7.0%

Dividend per share (GBP pence) 4.4 4.1 7.3%

Normalized operating cash flow 85.1 35.3 141.2%

Total Capital Expenditure additions in the year 82.7 118.9 -30.5%

Capital Expenditure relating to four capital projects announced at IPO 72.2 82.3 -12.3%

Total cash 268.7 257.5 4.4%

Total debt 332.4 303.6 9.5%

Net debt 63.7 46.1 38.0%

Divisional performances Healthcare revenue 289.3 251.6 15.0%

Healthcare EBITDA 81.7 68.2 19.8%

Healthcare EBITDA margin 28.2 27.1 +113bps

Healthcare occupancy 64.7% 60.5% +420bps

Distribution revenue 300.2 271.1 10.7%

Distribution EBITDA 29.9 26.2 14.1%

Distribution EBITDA margin 10.0 9.7 +30bps

Notes:

Normalised operating cash flow is a non-IFRS line item and is equivalent to Net cash from operating activities.

Total cash is represented by bank deposits and bank balances and cash.

Total debt is a non-IFRS line item and includes short term and revolving working capital facilities required for the operation of the Distribution division but excludes accounts payables and accruals, amounts due to related parties, Employee end of service benefit and other payable.

Net Debt is a non-IF