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NAHC 28th Annual
Meeting and Exposition
               October 12, 2009
             Los Angeles, California

 Homecare Valuations in the Real World:
     Putting Theory into Practice

      Jack J. Eskenazi, Jr. , Managing Partner
           Healthcare Advisory Partners

       Brian Bruenderman, Director of Development
                    ResCare




                Healthcare Advisory Partners
                 Copyright 2009 All Rights
                         Reserved
Overview

•Concepts of Value
•Value Drivers
•Capitalization of Earnings
Method
•Case Studies


         Healthcare Advisory Partners
          Copyright 2009 All Rights
                  Reserved
Concepts of Value
•Market Capitalization
•Book Value
•Goodwill
•Enterprise Value




        Healthcare Advisory Partners
         Copyright 2009 All Rights
                 Reserved
Enterprise Value

•Comparables
•Buyers’ Perspective
•Sellers’ Perspective




         Healthcare Advisory Partners
          Copyright 2009 All Rights
                  Reserved
Value Drivers
•Determine Premium or
Discount

•Qualitative Value Drivers

•Quantitative Value Drivers


         Healthcare Advisory Partners
          Copyright 2009 All Rights
                  Reserved
Qualitative Value
       Drivers
•Business Mix
•Geography
•Management Depth




        Healthcare Advisory Partners
         Copyright 2009 All Rights
                 Reserved
Quantitative Value
      Drivers
•Size
•Trends
•Margins




           Healthcare Advisory Partners
            Copyright 2009 All Rights
                    Reserved
Financial Statements

•Transparent Financial Reporting
     GAAP
•Accrual Basis Financial Statements
•Break Out Direct and Administrative
Expenses




            Healthcare Advisory Partners
             Copyright 2009 All Rights
                     Reserved
Capitalization of
   Earnings Method
•Service Companies use
Income Approach
•Boil Complexity Down to
Single Number
•Enterprise Value is Expression
of Earning Power of Investment



          Healthcare Advisory Partners
           Copyright 2009 All Rights
                   Reserved
EBITDA
•Reproducible Cash Flow
•Reliable # for Any Buyer’s
Model
•Adjusted EBITDA




         Healthcare Advisory Partners
          Copyright 2009 All Rights
                  Reserved
Adjusted EBITDA

•Nonrecurring Expenses
•Owners’ Compensation
•Personal Expenses
•Add Backs & Subtractions



        Healthcare Advisory Partners
         Copyright 2009 All Rights
                 Reserved
No Magic Formula
•EBITDA Multiplier
•3-5x Adjusted EBITDA
•Transaction Structure
•Convention Due to Historical
Pattern: Not Prescriptive
•Typically between 1xGP and
1xRevs

          Healthcare Advisory Partners
           Copyright 2009 All Rights
                   Reserved
Real World Context

•Market Conditions
•Regulatory Environment
•Financing




        Healthcare Advisory Partners
         Copyright 2009 All Rights
                 Reserved
Formulas Must be Applied
    with Intelligence
 •Analyze within Context of
 Industry and Individual
 Benchmarks

 •Is Operation Reproducible?

 •Guideline – Not Prescriptive


           Healthcare Advisory Partners
            Copyright 2009 All Rights
                    Reserved
Case Study:
 Small Transactions
•Very Common but Formulas
Least Applicable

•Licensure
•Small but Viable
•The Overachiever


         Healthcare Advisory Partners
          Copyright 2009 All Rights
                  Reserved
Case Study:
Medium Transactions
•$2 - $15 Million
•Standard from which Formula
is Derived
•Formula is Most Applicable
•Premium
•Discount


          Healthcare Advisory Partners
           Copyright 2009 All Rights
                   Reserved
Case Study:
 Large Transactions
•$15-$25+ Million
•Platform Investment
•Size Premium May Exceed
5xEBITDA Ceiling
•Strategic Buyer
•Financial Buyer


         Healthcare Advisory Partners
          Copyright 2009 All Rights
                  Reserved
Case Study:
Largest Transactions

•Exceptional Cases
•Often Publicly Traded
•Often Exceed 5xEBITDA
•Apria/ResCare/Healthfield/Addus




            Healthcare Advisory Partners
             Copyright 2009 All Rights
                     Reserved
Conclusions
•Formulas Reflect Market
Parameters
•Formulas Must be Applied
Intelligently
•Market is Active and Robust
•Good Companies Available for
Premium
•Weaker Companies Available
for Discount
          Healthcare Advisory Partners
           Copyright 2009 All Rights
                   Reserved

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NAHC '09

  • 1. NAHC 28th Annual Meeting and Exposition October 12, 2009 Los Angeles, California Homecare Valuations in the Real World: Putting Theory into Practice Jack J. Eskenazi, Jr. , Managing Partner Healthcare Advisory Partners Brian Bruenderman, Director of Development ResCare Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 2. Overview •Concepts of Value •Value Drivers •Capitalization of Earnings Method •Case Studies Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 3. Concepts of Value •Market Capitalization •Book Value •Goodwill •Enterprise Value Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 4. Enterprise Value •Comparables •Buyers’ Perspective •Sellers’ Perspective Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 5. Value Drivers •Determine Premium or Discount •Qualitative Value Drivers •Quantitative Value Drivers Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 6. Qualitative Value Drivers •Business Mix •Geography •Management Depth Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 7. Quantitative Value Drivers •Size •Trends •Margins Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 8. Financial Statements •Transparent Financial Reporting GAAP •Accrual Basis Financial Statements •Break Out Direct and Administrative Expenses Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 9. Capitalization of Earnings Method •Service Companies use Income Approach •Boil Complexity Down to Single Number •Enterprise Value is Expression of Earning Power of Investment Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 10. EBITDA •Reproducible Cash Flow •Reliable # for Any Buyer’s Model •Adjusted EBITDA Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 11. Adjusted EBITDA •Nonrecurring Expenses •Owners’ Compensation •Personal Expenses •Add Backs & Subtractions Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 12. No Magic Formula •EBITDA Multiplier •3-5x Adjusted EBITDA •Transaction Structure •Convention Due to Historical Pattern: Not Prescriptive •Typically between 1xGP and 1xRevs Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 13. Real World Context •Market Conditions •Regulatory Environment •Financing Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 14. Formulas Must be Applied with Intelligence •Analyze within Context of Industry and Individual Benchmarks •Is Operation Reproducible? •Guideline – Not Prescriptive Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 15. Case Study: Small Transactions •Very Common but Formulas Least Applicable •Licensure •Small but Viable •The Overachiever Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 16. Case Study: Medium Transactions •$2 - $15 Million •Standard from which Formula is Derived •Formula is Most Applicable •Premium •Discount Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 17. Case Study: Large Transactions •$15-$25+ Million •Platform Investment •Size Premium May Exceed 5xEBITDA Ceiling •Strategic Buyer •Financial Buyer Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 18. Case Study: Largest Transactions •Exceptional Cases •Often Publicly Traded •Often Exceed 5xEBITDA •Apria/ResCare/Healthfield/Addus Healthcare Advisory Partners Copyright 2009 All Rights Reserved
  • 19. Conclusions •Formulas Reflect Market Parameters •Formulas Must be Applied Intelligently •Market is Active and Robust •Good Companies Available for Premium •Weaker Companies Available for Discount Healthcare Advisory Partners Copyright 2009 All Rights Reserved