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Page 1: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Investor Presentation

Page 2: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Important Disclosure

No representation or warranty, express or implied is made as to, and no reliance should be placed on, the fairness, accuracy,

completeness or correctness of such information or opinions contained herein. The information contained in this presentation is

only current as of its date. Certain statements made in this presentation may not be based on historical information or facts and

may be “forward looking statements”, including those relating to the Company’s general business plans and strategy, its future

financial condition and growth prospects, and future developments in its industry and its competitive and regulatory

environment. Actual results may differ materially from these forward-looking statements due to a number of factors, including

future changes or developments in the Company’s business, its competitive environment and political, economic, legal and social

conditions in India. This communication is for general information purpose only, without regard to specific objectives, financial

situations and needs of any particular person. This presentation does not constitute an offer or invitation to purchase or

subscribe for any shares in the Company and neither any part of it shall form the basis of or be relied upon in connection with

any contract or commitment whatsoever. The Company may alter, modify or otherwise change in any manner the content of this

presentation, without obligation to notify any person of such revision or changes. This presentation can not be copied and/or

disseminated in any manner.

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Page 3: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

…because passion drives perfection…

…and perfection drives

performance

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Page 4: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Outline

• Indian Healthcare opportunity at inflection point• Legacy problems, Recent transformation, Rising aspirational middle-class, Effect of health insurance and government

schemes driving demand for better healthcare

• Total opportunity size in Rs. 11.7 trillion, other industry data

• Shalby - A proxy for the huge opportunity of growth in the Indian Healthcare space• Profile and brief timeline, About the Promoters, Proven track-record of growth and expansion, Pioneer in joint

replacements in India, Well-poised for the next phase of expansion and growth

• Snapshot• No. of Hospitals, No. of Beds, FY18 Revenue/EBITDA/PAT (absolute and %), IPO, 10-Year CAGR Revenue, 10-Year CAGR

EBITDA

• What makes Shalby deliver a superior performance – our unique Business Model• Lowest Capex and Opex per bed due to optimal use of real-estate, in-house planning teams, fully-committed team of

doctors, focus on surgeries with higher ARPOB, Centralised procurement, Gradual ramp-up of operational bed capacity

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Page 5: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Outline

• Relevant and Low cost Expansion• Role of OPDs and SACE in identifying where to go, optimal capacity of ~200 bed capacity, catchment area, focus on

underpenetrated markets in India and continue with OPDs to expand reach into newer geographies

• Current Expansion in Progress: Nashik, Vadodara, Mumbai

• Case of Expansion & Specific Growth Drivers for Shalby• Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle – case study, Shalby’s leadership in

joint replacement, huge scope for organic growth and operating leverage, 5x growth on current infra possible without major

capex

• Developing similar expertise to capitalise on next growth cycles in other specialties

• Performance Review• Revenue mix, Operational parameters, maturity profile, profitability and B/Sheet snapshot

• Key developments during the period

• Strengths and Differentiators• Global leadership in Joint Replacement, Experienced promoters with hands-on involvement, strong brand, optimized

business model now being replicated, unleveraged Balance Sheet

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Page 6: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

is at an Inflection Point

1 Indian Healthcare

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Page 7: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

The Opportunity Set

Source: National Commission Population Frost & Sullivan analysis.

Population and Population Growth Rate of India

(Historical and Expected)

0%

20%

40%

60%

80%

100%

2014(E) 2016(E) 2018(E) 2020(E)

54+ years

35-54 years

20-34 years

0-19 years

1.27 billion 1.29 billion 1.32 billion 1.35 billion

CAGR (2014-2020)

0.9%

2.6%

1.6%

0.7%

-0.04%

100%=

68%

6%

13%

9% 4%

Healthcare Delivery-Hospitals Diagnostics

Pharma Medical Devices

Health Insurance

Spilt of Indian Healthcare Industry by Segments

Total market size (2016): INR 9.2 trillion

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Page 8: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

The Opportunity Size

Source: Frost & Sullivan analysis.

Indian Healthcare Delivery Industry size (2015-2020)

2015 2016(E) 2017(E) 2018(E) 2019(E) 2020(E)

5.46.2

7.3

8.5

10

11.7

Public Hospitals Private Hospitals

30%

70%

Spilt of Public and Private Hospitals in India

Private

Corporate

Hospitals

account to less

than 10% of the

total Private

Hospitals

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Page 9: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Legacy Issues of India Healthcare

• Always been an underdog due to lack of infrastructure and expenditure from the government

• In the private space, it was charitable trusts who contributed to healthcare, but even this has waned

from 1980s

• Tier II and Tier III towns are served by Nursing Homes – started by doctors themselves

• The burgeoning population of India poses a serious challenge to healthcare access

• And yet…

• …the Healthcare space in India is undergoing a paradigm shift

today…

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Page 10: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Conducive Government PoliciesDespite Challenges

Wide procedure penetration –

to Tier 2 and 3 cities

Swastha Bharat, Smriddha Bharat. Demographic

dividend realization impossible without proper

healthcare

Rashtriya Samaj Beema Yojana: 100 mln families

will get Rs 500,000 per year for their families to

cover secondary and tertiary hospital expenses

100% depreciation on capex incurred, MAT

credit can be availed for 15 years, all

healthcare education and training services

exempted from GST

State Policies include capital subsidy on purchase of

medical equipment, capital investment subsidy on

construction of tertiary-care hospitals and interest

subvention, along with several other benefit

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Page 11: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Recent transformation

• Private sector investment has been increasing due to change in mind-set and better returns on

investment

• Healthcare businesses can also be profitable as long the costs are affordable

• The advent of information technology has given a fillip to the healthcare business making it both

controllable and scalable

• Rising aspirational middle-class today is not averse to paying for quality healthcare services

• Impact of health insurance, government schemes and emergence of medical tourism - key drivers

of positive change

• Healthcare today in India is evolving to be a larger consumer

story than ever before

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Page 12: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

A proxy for growth in the Indian Healthcare space

Shalby Limited2

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Page 13: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Promoter

Dr. Vikram ShahChairman & Managing

Director

Qualifications

Academic Qualifications:

• MBBS

• MS (Orthopaedics)

Professional Qualifications

• AO Basic Course

(London)

• F.A.O.A.A (Switzerland)

• F.A.I.S.F (Germany)

Achievements

• Over two and a half decades of professional work experience

across UK, USA and India. Serving as Director, Department of Knee

Replacement at Shalby Hospitals since 1993

• Dr. Shah innovated zero ‘0’ Technique in 2011 and was awarded the

Double Helical Award 2017, for the innovation

Reduction of surgery time: 2.5 hours to 22 minutes

Reduction in patient stay: 15 days to 3 days

Drastic fall in infection rates due to minimum incision

• Invented the OS Needle, which is thick bore reverse cutting needle

used in attaching soft tissues to the bone. Before the invention of

the Needle, surgeons had to use complicated soft tissue

procedures that had a very high failure rate. The needle can be

attached with commonly available vicryl thread

• President of Indian Society of Hip & Knee Surgeons (ISHKS) for the

year 2010-11

• Part of joint international faculty for development of new joints by

Zimmer Inc., USA

• Receiver of several awards and accolades by reputed organizations

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Page 14: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Management Structure

CEO

CFO

Group GM –Finance & Accounts

Head -Commercials

Chief Information

Officer

Chief Human Resource Officer

Regional COO

Western India

CAO SG Unit CAO KrishnaCOO Surat

Cluster

CAO Surat

CAO Vapi

Regional COO North &

Central India

COO North Cluster

CAO Mohali

CAO Jaipur

COO Central Cluster

CAO Indore

CAO Jabalpur

VP ProjectsDirector

International Business

EA to CEO

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Page 15: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Our Journey so far…

1994

6

2007

228

2004

27

2015

907

2011

674

2017

2012

Started professional

practice with a 6-bed

facility

Operationalized First

Multispecialty Hospital of the

group Shalby SG

[Bed Capacity: 201]

Commissioned Shalby Jabalpur

[Bed Capacity: 233]

Commissioned Shalby Indore

[Bed Capacity: 243]

Acquired Shalby Mohali

[Bed Capacity: 145]

Revenue growth – 100

times in first 10 years

Incorporation of Company

Acquired Shalby Vapi

[Bed Capacity: 146]

Acquired Krishna Shalby

[Bed Capacity: 220]

Bed capacity grown 10 times

in 10 years – to 2012 beds

Commissioned:

Shalby Jaipur [Bed Capacity: 237]

Shalby Naroda [Bed Capacity: 267]

Shalby Surat [Bed Capacity: 243]

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Page 16: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Reach and Presence - Hospitals

Ahmedabad

SG – 201 beds

Krishna – 220 beds

Vijay – 27 beds

Vapi – 146

beds

Jabalpur – 233 bedsMohali – 145 beds

Indore – 243 beds

Hospital (operational)

Jaipur – 237 beds

Ahmedabad

(Naroda) – 267 beds

Surat – 243 beds

Nashik – 113 beds

Vadodara – 150 beds

Hospital (recently set up)

Hospital (upcoming)

Has a total bed capacity of 2,012 beds across 11 multi-specialty hospitals

Network of Hospitals in India with bed capacity

Mumbai – 50 beds,

to be increased to

150

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Page 17: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Reach and Presence - OPD and SACE

Has a network of 40 patient outreach centres and 7 SACEs in India

Network of Outpatient Clinics in India International Footprint Presence in Africa

Eldoret

Kisumu

Nairobi (1)

Dar es Salaam (2)

Nairobi (1)

Kenya

Rwanda

Tanzania

Ethiopia

UAE (2)

Presence in UAE

International footprint consists of 6 outpatient clinics and 1 SACE in

Africa, and 2 SACEs in UAE, 1 OPD each in Bangladesh and Cambodia

SACE

OPD Clinics

SACE

Outpatient clinics

SACE

Addis Ababa (1)

Rwanda (1)

Sudan

Sudan (1)

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Page 18: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

3 Shalby - a snapshot

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Page 19: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

11 Hospitals 55% Operating bed to total bed capacity

2,012 Total Installed Bed Capacity

1,100 Operational beds

48 Outpatient clinics

36% Bed Occupancy

31% 11 year CAGR Revenue

40% 11 year CAGR EBITDA

Double-digit return ratios against industry trend of single-digit

Consistently superior ROCE of mature hospitals

400+ Doctors & 3,500+ Support Staff

19

Current Scale of Operations

Page 20: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Best in class financials

• Best in class operational metrics despite lower operating bed/ bed capacity ratio and lower occupancy rates

• Based on current infra 5x Revenue and EBITDA growth possible without any major capex

Years represent Financial Years EBITDA calculated on total revenue FY 12 to FY 17 – Data as per restated consolidated financials

Growth achieved without any outside equity funding

Revenue CAGR – 31% for 11 years EBITDA CAGR – 40% for 11 years

Revenue EBITDA

149%

55%

38%29% 26%

36%

14%6% 5%

13% 19%194

482 745

1,030 1,332

1,685

2,298 2,617 2,776 2,927

3,305

3,923

FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

Growth (%) Revenue (in Mn)

11%

16%14% 14%

20%

26%

21%

25% 25%

20%

24% 24%

22 77 107 142

262

439 482

660 687

579

778

925

FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

Margin (%) EBITDA (in Mn)

Dip due to new units

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Page 21: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Best in class economic returns

• Double Digit return ratios against industry trend of single digit

362 203 259 345 481 844 1,041 1,461 1,835

2,508

7,615

2%

9%

17%

28%31%

18%

32%

17.0%20.0%

11%

6%

FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

RoE %

Shareholders' Equity (Rs in Mn) RoE (%)

362 354 330 309 428 1,104 1,257

2,496

4,003

5,420

6,870

15%

26%

51%

88%

66%

20%

36%

22%14% 14% 12%

FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY15 FY16 FY17 FY18

ROCE %

Net Block (Rs in Mn) ROCE (%)

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Page 22: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

is the key to our outperformance

Our Unique Business Model4

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Page 23: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Our Business Model – featuresOptimising Capex and Opex

• Lowest Capex and Opex per bed dueto optimal use of real-estate

• Equipment planning and utilitiesplanning

• In-house planning teams

• Focus on surgeries with higherARPOB, better margins and returnratios

• Centralised procurement

• Gradual ramp-up of bed capacity

• Fully owned or O&M on revenuesharing (no fixed rentals, no securitydeposit or MG)

Optimize capex

planning with

Inhouse projects

team

Utilities

planning

to optimize

capex

Better

utilization

of space [and

expensive real

estate]

Cost per bed ~

Rs. 4.5 millions

for fully owned

set-up. Lower for

leased premises

Operational

Efficiency due

to

better capex

planning

Low consumable

cost

Leveraging

economies of

scale through

centralized

procurement

EBITDA upwards

of 20% which is

higher than

industry average

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Page 24: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Our Business Models…

Fully ownedOperate and Manage [Revenue Sharing]

AcquisitionOperate SACE and Outpatient Clinics

Efficiency is paramount

No fixed rental

No security deposit

No minimum guarantee

Unique revenue sharing model

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Page 25: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Typical concept of 200 (±20%) bed capacity set-up

Facilities 10-15 kms away

Local and Natural Footfalls from 4-

5 kms radius helps to fill up ~70-80

beds

Balance ~70-80 beds – patients

come in the name of doctors

reducing thereby dependency on

star doctors thus controlling

doctor payout %

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Page 26: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

The Shalby Way

Strong record of consistently being EBITDA positive and ARPOB of ~Rs. 32,000/ day (amongst best in the industry)

Profits reinvested for growth - No dividend payouts

Growth until recently, financed only through internal accruals. In recent times debt used for aggressive expansion

Current turnover and EBITDA largely contributed by older units. Growth from newer units to begin now

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Page 27: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Expansion Strategy5

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Page 28: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Low Cost and Relevant Expansion

• Role of OPDs and SACE in identifying where to go

• Optimal capacity of ~200 bed capacity

• Focus on underpenetrated markets in India for hospitals

• Continue with OPDs to expand reach into newer geographies

• At Shalby, our market is ready before we begin!

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Page 29: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Expansion strategy across the country

Patients visit ourclinics across

India and abroad

We analyze patient trends andaccordingly decidewhere to expand

Simultaneously hire local doctors and train them at Ahmedabad who conduct OPDs in

and around that city

So we can startthe facility with

low brandingbudget but high

brand recall

Set-up outpatient

clinics where we have a strong

brand recall

Operating such Outpatient clinicsfor 15 years now

Rajasthan

Madhya Pradesh

Gujarat

Maharashtra

Punjab

Ahmedabad

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Page 30: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Expansion Plans in Progress

•Bed Capacity 113

•Capex – Rs 250 mnNashik

•Bed Capacity 150

•Capex – Rs 350 mnVadodara

•Bed Capacity 175

•Capex – Rs 1 bnMumbai

[Santa Cruz]

•Current bed capacity 50. Addition 100 beds

•Capex – Nil

Mumbai [Ghatkopar]

Investment Plans for Upcoming facilities

Total capex planned – Rs. 1.6 bn for addition of 538 beds @ Cost per bed – ~Rs. 3 mn

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Page 31: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Case for Expansion6

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Page 32: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Case study - the Cardiac growth story in India

Source: Industry reports

2014 ~ 2,00,000

surgeries and 8,00,000

angioplasties

2004 ~ 50,000 surgeries

1994 ~5000

surgeries

1984 ~500

surgeries

Facilities 10-15 kms away

CAGR – 29% in 30 years.

Currently growing @ 2-3%

Wide procedure penetration –

to Tier 2 and 3 cities

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Page 33: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Surgery Count CAGR @32% in 23 years

Knee Replacement - the big opportunity

2017~1,75,000 surgeries

2010~54,000 surgeries

2000~6000

surgeries

1994 ~300

surgeries

Last year, In United States ~0.8 mn knee

replacements in a population of

~300 mn

Asian population 15 times more

prone to Arthritis of knee

than their western counter

parts

India has a similar affording

population. Hence, direct potential to

grow to 8 lacs Knee

replacements

Hence huge potential for growth based

on incidence rates

Source: Industry reports

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Page 34: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Specific Growth Drivers for Shalby

Advantage Shalby

Shalby is pioneer in Joint

Replacements in the country, best

positioned to capitalize on it

Increasing focus on high-end

specialties like oncology and

organ transplants such as Liver,

Heart & Lungs, etc.

Huge scope for organic growth and operating

leverage, without any

significant capex

Emphasis on Processes &

Doctor Selection

Way forward to move to other

potential markets where the

demand supply gap is significant

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Page 35: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Q4 and Year Ended 31.03.2018

Performance Update7

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Page 36: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

11 Hospitals

2,012 Total Installed Bed Capacity

1,150 Operational beds

48 Outpatient clinics

Double-digit return ratios against industry

trend of single-digit

Consistently superior ROCE of mature hospitals

400+ Doctors & 3,500+ Support Staff

Snapshot

Ahmedabad

SG – 201 beds

Krishna – 220 beds

Vijay – 27 beds

Naroda – 267 beds

Vapi – 146 beds

Jabalpur – 233 beds

Mohali – 145 beds

Indore – 243 beds

Jaipur – 237 beds

Surat – 243 beds

Mumbai – 50 beds,

to be increased to

150

Reach & Presence

Hospital (operational)

Hospital (recently set up)

36

Page 37: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Key Developments of the Year

Wide procedure penetration

– to Tier 2 and 3 cities

Historically highest revenue

during the quarter & year

Successful conclusion of the IPO of INR 5,048

million and listing on the stock exchanges

Jaipur, Surat and Naroda units

operationalized in FY18

37

Page 38: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Financial Highlights Q4FY18

• Drop in EBITDA and margin by 16.4% and

7.3% respectively inter alia due to higher

advertisement spend for commissioning of

new units ,launch expenses for the same

174.20

145.42 20.75%

13.42%

Q4FY17 Q4FY18

Operational EBITDA (in millions)

EBITDA Margin

78.70

182.86

9.10%

16.50%

Q4FY17 Q4FY18

PAT (in millions) PAT Margin

• PAT grew by 132.4%

• PAT margin expanded by 7.4% due to

higher revenue and operating

leverage and normalization of taxes

• Total Revenue grew by 27.9%

38

868.15

1110.36

Q4FY17 Q4FY18

Total Revenue (in millions)

Page 39: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

2

(INR in million)

Operational Performance Synopsis

Note: The operational bed count of 1,150 considers 50 operational beds at Zynova-Shalby Hospital, Mumbai, for which no other operational parameters

are tracked

ParticularsQuarter Ended

31-03-18% of Revenue

Quarter Ended

31-03-17% of Revenue Growth

Total Revenue 1110.36 868.15 27.90%

Total EBITDA 172.09 15.50% 202.69 23.35% -15.1%

Bed Capacity (Nos.) 2,012 1,265 59.05%

Operational Beds (Nos.) 1,150 781 47.25%

Average Length of Stay 3.6 days 3.9 days N.A.

Occupancy (Beds) 396 253 56.52%

In-Patient Count (Nos.) 9,998 5,818 71.85%

Out patient Count (Nos.) 64,189 42,060 52.61%

ARPOB ( In Rs.) 30,625 36,941 -17.10%

Page 40: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

40

(INR in million)Financial Highlights Q4FY18

ParticularsQuarter Ended

31-03-18% of Revenue

Quarter Ended

31-03-17% of Revenue Growth Variation

Revenue from Operations 1,083.69 839.48 29.09%

Expenses

Materials & Consumables 264.44 24.40% 188.67 22.47% 40.16% 1.93%

Fees to Doctors and Consultants 300.13 27.70% 222.48 26.50% 34.90% 1.19%

Other Operative Expenses 111.81 10.32% 80.03 9.53% 39.71% 0.78%

Employee Costs 139.06 12.83% 99.5 11.85% 39.76% 0.98%

Administrative Expenses 122.83 11.33% 74.61 8.89% 64.63% 2.45%

Total Operational Expenses 938.27 86.58% 665.28 79.25% 41.03% 7.33%

Operational EBITDA 145.42 13.42% 174.20 20.75% -16.52% -7.33%

Other Income 26.67 28.67 -6.98%

Total EBITDA 172.09 202.87 -15.17%

Finance Cost -3.13 26.47 -111.82%

Depreciation & Amortization Expense 64.13 45.00 42.51%

Profit before tax (PBT) 111.09 131.22 -15.34%

Tax Expense -71.77 52.52 -236.65%

Profit after tax (PAT) 182.86 78.7 132.35%

Page 41: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

• Factors contributing to increase in profitability

a. Growth in Revenue of 29.1% over Q4FY17 inter alia contributed by price increase, occupancy growth of 56.5%, In-patient and

Out-Patient growth of 71.8% and 52.6% respectively

b. Normalization and restatement of deferred tax expense on first time implementation of Ind AS

• Factors responsible for dampening profitability growth

a. Reduction in ARPOB by 17.10% due to change to the specialty mix and geographical expansion, which has enabled de-risking

b. Increase in ‘Fees to Doctors and Consultants’ by 1.2% of Revenue

c. Increase in costs of ‘Materials & Consumables’ by 1.9% of Revenue on account of price cap on stents and knee implants

pursuant to NPPA orders during the year

d. Initial temporary operating losses of recently commissioned units

e. Increase in ‘Employees Cost’ of 1.0% of Revenue due to recruitment for new units

f. Increase in ‘Administrative Costs’ of 2.45% of Revenue due to higher ad spend for new units

g. Increase in ‘Other Operative Expenses’ by 0.8% of Revenue

h. Foreign exchange loss of Rs 16.8 million on buyers’ credit against import of medical equipment

41

Financial Highlights Q4FY18

Page 42: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Financial Highlights FY18

716.39

843.55

22.26% 21.88%

FY17 FY18

Operational EBITDA (in millions)

EBITDA Margin

303.62

440.15 9.24%

11.16%

FY17 FY18

PAT (in millions) PAT Margin

3284.29

3942.35

FY17 FY18

Total Revenue (in millions)

42

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48

(INR in million)

Operational Performance Synopsis

Note: The operational bed count of 1,150 considers 50 operational beds at Zynova-Shalby Hospital, Mumbai, for which no other operational parameters

are tracked

Particulars YTD Mar’18 % of Revenue YTD Mar’17 % of Revenue Growth

Total Revenue 3,942.35 3,284.29 20.04%

Total EBITDA 930.67 23.61% 782.43 23.82% 18.95%

Bed Capacity (Nos.) 2,012 1,265 59.05%

Operational Beds (Nos.) 1150 781 47.25%

Average Length of Stay 3.7 days 4.0 days N.A.

Occupancy (Beds) 335 271 23.62%

In-Patient Count (Nos.) 32,967 24,704 33.45%

Out patient Count (Nos.) 222,970 166,519 33.90%

ARPOB ( In Rs.) 31,564 32,671 -3.39%

Page 44: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

44

(INR in million)Financial Highlights FY18

Particular YTD Mar’18 % of Revenue YTD Mar’17 % of Revenue Growth Variation

Revenue from Operations 3,855.23 3,218.26 19.79%

Expenses

Materials & Consumables 947.71 24.58% 784.87 24.39% 20.75% 0.19%

Fees to Doctors and Consultants 898.06 23.29% 774.76 24.07% 15.91% -0.78%

Other Operative Expenses 398.38 10.33% 315.56 9.81% 26.25% 0.53%

Employee Costs 447.96 11.62% 376.89 11.71% 18.86% -0.09%

Administrative Expenses 319.57 8.29% 249.79 7.76% 27.94% 0.53%

Total Operational Expenses 3,011.68 78.12% 2,501.87 77.74% 20.38% 0.38%

Operational EBITDA 843.55 21.88% 716.39 22.26% 17.75% -0.38%

Other Income 87.12 66.04 31.93%

Total EBITDA 930.67 782.43 18.95%

Finance Cost 121.34 102.15 18.78%

Depreciation & Amortization Expense 224.32 160.08 40.13%

Profit before tax (PBT) 585.01 520.20 12.46%

Tax Expense 144.86 216.58 -33.11%

Profit after tax (PAT) 440.15 303.62 44.97%

Page 45: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

45

54.2%

10.8%

9.8%

6.1%

4.1%

15.0%

Specialty Mix

Arthroplasty General Medicine & Critical Care

Cardiac Sciences Other Ortho

Onco Sciences Others

60.3%21.0%

16.4%

2.3%

Payee Profile

Selfpay TPA Corp-Govt Corp-Private

Revenue Composition FY18

Page 46: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

60.3% 62.3% 59.5%51.2%

39.7% 37.7% 40.5%48.8%

FY15 FY16 FY17 FY18

Revenue Mix

Knee Replacement Others

30.44% 28.99% 24.39% 24.58%

24.90% 26.12%24.07% 23.29%

6.94% 7.85%9.81% 10.33%

7.20% 9.96%11.71% 11.62%

6.02%7.98%

7.76% 8.29%75.50%

80.89%77.74% 78.12%

FY15 FY16 FY17 FY18

Cost Structure

Administrative and Other Expenses Employee Benefit Expenses

Other Operative Costs Fees to Doctors and Consultants

Materials & Consumables

Revenue Composition & Cost Structure

46

Page 47: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

4 Year Trend

695

576

716

844 26.4%

20.1%

22.3%21.9%

FY15 FY16 FY17 FY18

Operational EBITDA (in millions)

EBITDA Margin

2,627 2,868

3,232 3,824

8.9% 9.2%

12.7%

18.3%

FY15 FY16 FY17 FY18

Revenue from Operations (in millions)

Revenue Growth YoY

Operational EBITDARevenue from Operations

47

Page 48: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

907

1,295 1,265

2,012

593

823 781

951

196 252 271 335

FY15 FY16 FY17 FY18

Bed Capacity Operational Occupied

39,904

34,173 32,671 31,564

4.03

4.14

3.99

3.70

FY15 FY16 FY17 FY18

ARPOB (in Rs / day) ALOS (Days)

4 Year TrendBed Count Split Operational Parameters

• ARPOB dropping is due to de-risking by way of expansion to newer geographies and increased multispecialty focus,

which has altered our specialty mix

• Decreasing ALOS is a positive sign as it means early discharge for the patients and increased bed turnover rate for us 48

Page 49: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Maturity

Stage

% of Operational

Revenue

% of Operational

Beds

Operational

Beds Occupancy ALOS (Days) Bed Capacity

5 years +

(SG; Vijay;

Krishna; Vapi)

2-5 years

(Jabalpur, Indore)

< 2 years

(Jaipur; Naroda;

Surat; Mohali)

Maturity Profile - FY Mar’18 (Annual Performance)

38% 476

59442%

89223%

22%

14%

30%

32%

418

335

347

3.94

3.58

3.26

38%

62%

49

Page 50: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

50

Balance Sheet Standalone(Rs. in Millions)

Statement of Audited Assets and Liabilities STANDALONE

As at As at

Particulars 31/03/2018 31/03/2017

EQUITY AND LIABILITIES

EQUITY

Equity share capital 1,080.10 874.09

Other equity 6,672.36 1,711.34

Total Equity 7,752.46 2,585.43

NON- CURRENT LIABILITIES

Financial liabilities

Borrowings 749.83 2,854.04

Other Financial Liabilities 46.23 22.47

Provisions 13.71 15.18

Deferred Tax Liabilities (Net) - -

Other Non-current Liabilities 128.41 88.77

TOTAL NON-CURRENT LIABILITIES 938.18 2,980.46

CURRENT LIABILITIES

Financial liabilities

Borrowings 157.16 229.72

Trade Payables 479.93 391.78

Other Financial Liabilities 445.30 577.81

Other Current liabilities 45.04 43.51

Provisions 6.06 7.51

Current tax liabilities 3.54 3.71

TOTAL CURRENT LIABILITIES 1,137.03 1,254.04

TOTAL LIABILITIES 2,075.21 4,234.50

TOTAL EQUITY AND LIABILITIES 9,827.67 6,819.93

(Rs. in Millions)Statement of Audited Assets and Liabilities STANDALONE

ParticularsAs at

31/03/2018As at

31/03/2017ASSETS

NON- CURRENT ASSETS

Property, plant and equipment 6,480.55 3,120.37

Capital work-in-progress 376.48 2,207.02

Goodwill 81.97 -

Intangible Assets - 1.61

Intangible assets under development 2.24 2.27

Financial Assets

Investments 9.10 94.10

Loans 77.70 -

Other Financial Assets 229.37 19.12

Deferred Tax assets 111.56 71.61

Other non current assets 74.79 363.69

Total Non-Current Assets 7,443.76 5,879.79

CURRENT ASSETS

Inventories 118.81 75.58

Financial assets

Investments 13.54 4.30

Trade Receivables 601.49 334.58

Cash and Cash Equivalents 108.83 115.82

Other Bank Balances 1,042.29 41.21

Loans - 86.07

Other Financial Assets 158.94 153.69

- -

Current tax asset 97.03 81.30

Other Current Assets 111.06 47.59

Assets classified as held for sale 131.92 -

54218 2,383.91 940.14

Total Assets 9,827.67 6,819.93

Page 51: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Shareholding Pattern

• Total Number of Shares: 108,009,770

Promoter79.41%

FIIs/ DIIs and Retail19.49%

FIIs – 6.28%DIIs – 6.28%

Retail – 6.93%

Trust 0.94%

Others0.16%

Promoter Group Public Trust Others

Shareholding as on 31st March 2018

51

Page 52: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Our Strengths and Differentiators

Experienced

promoters with

hands-on

involvement

Strong brand,

global

leadership in

Joint

Replacement

Optimized

Business Model

now being

replicated

Unleveraged

Balance Sheet

Even after the

IPO promoter

holding is ~80%

Professional

management

Strong emphasis

on governance

and compliance

Leadership and

succession plan

in place

52

Page 53: Investor Presentation - Best Multispecialty Hospital in India · •Knee Replacement - US vs India comparison, potential for 10 years, Cardio growth cycle –case study, Shalby’sleadership

Thank you

Opp. Karnavati Club, S G Road, Ahmedabad – 380015, Gujarat, India