Fairness opinionsPhysician Groups2018

Envision Healthcare Holdings acquired by KKR: fairness opinion by J.P. Morgan and Evercore and Guggenheim Securities

Announced June 11, 2018 · One-step merger · All cash · DEFM14A filed August 13, 2018
Physician Groups Facility-Based Sponsor: Kohlberg Kravis Roberts & Co. L.P. (KKR); KKR Americas Fund XII L.P.
Enterprise value
$9.9B
EV / LTM EBITDA
10.0x
EBITDA $995M · 12% margin
EV / LTM revenue
1.16x
revenue $8.5B
DCF discount rate
8.0%–9.0%
Perpetuity growth

Deal terms

ConsiderationAll cash
Price per share$46.00
Premium5.4%
Premium basisclosing stock price of $43.64 on June 8, 2018, the last trading day prior to execution of the merger agreement
StructureOne-step merger
Termination fee$167M
Reverse termination fee$275M
Go-shopNone
Outside date

Implied value per share by method vs. $46.00 offer

Selected companies — FV / 2018E Adjusted EBITDA (J.P. Morgan) $30.25 – $46.25
Precedent transactions — FV / LTM Adjusted EBITDA (post-SBC) as of March 31, 2018 (J.P. Morgan) $33.00 – $57.25
Discounted cash flow (J.P. Morgan) $34.75 – $71.25
Selected companies — Enterprise Value / 2018E EBITDA (Management Projections) (Evercore) $35.37 – $51.31
Selected companies — Enterprise Value / 2018E EBITDA (Analysts' Consensus) (Evercore) $34.12 – $49.78
Precedent transactions — EV / LTM EBITDA (less SBC) as of March 31, 2018 (Evercore) $34.06 – $58.54
Discounted cash flow (Evercore) $34.26 – $80.16
DCF sensitivity analysis (reference only) - no acquisition/transaction expenses (Evercore) $36.95 – $74.38
DCF sensitivity analysis (reference only) - 33% terminal tax rate (Evercore) $27.77 – $68.96
Last 52-Week Trading Range (Evercore) $24.79 – $63.36
Equity Research Analyst Price Targets (Evercore) $38.00 – $51.00
Selected companies — Firm Value / 2018E Adjusted EBITDA (Guggenheim Securities) $30.25 – $46.25
Precedent transactions — Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) as of March 31, 2018 (Guggenheim Securities) $33.00 – $57.25
Discounted cash flow (Guggenheim Securities) $34.75 – $71.25
Illustrative DCF based on Wall Street Consensus Estimates (informational) (Guggenheim Securities) $34.75 – $51.25
Envision Stock Price Trading History (past year) (Guggenheim Securities) $24.79 – $63.36
Wall Street Equity Research Analyst Price Targets (Guggenheim Securities) $38.00 – $51.00

Ranges as disclosed in the banker’s summary of analyses; the red line marks the per-share consideration.

Opinion of J.P. Morgan to the target board

Delivered June 10, 2018 · Fee $32.0M, $3.0M on delivery of the opinion

Discounted cash flow assumptions

Discount rate8.0%–9.0%
Basisweighted average cost of capital of the Company
Terminal valuePerpetuity growth
Perpetuity growth1.0%–1.5%
Exit multiple
Projection period2018E-2022E
Projections usedManagement Case and Management Sensitivity Case (assumed equally likely)
Implied value per share$34.75–$71.25

Management Case: $48.50-$71.25 per share; Management Sensitivity Case: $34.75-$54.50 per share.

Selected public companies (3)

MEDNAX, Inc. (as of June 8, 2018) · MEDNAX, Inc. (as of November 15, 2017) · Surgery Partners, Inc. (as of June 8, 2018)

MultiplePeer lowPeer medianPeer highRange appliedImplied per share
FV / 2018E Adjusted EBITDA 8.0x–10.0x $30.25–$46.25

Selected precedent transactions (10)

DateTargetAcquirerMultiple
2017-05Medical Solutions L.L.C.TPG Growth
2016-10TeamHealth Holdings, Inc.The Blackstone Group L.P.
2016-06Envision Healthcare Holdings, Inc.AmSurg Corp.
2015-08IPC Healthcare, Inc.TeamHealth Holdings, Inc.
2015-05Virtual Radiologic CorporationMEDNAX, Inc.
2015-01VISTA Staffing Solutions, Inc.Envision Healthcare Holdings, Inc.
2014-05Sheridan Healthcare, Inc.AmSurg Corp.
2014-05Healogics Holding Corp.Clayton, Dubilier & Rice, LLC
2012-10CHG Healthcare Services, Inc.Leonard Green & Partners, L.P./Ares Management LLC
2011-02Emergency Medical Services CorporationClayton, Dubilier & Rice, LLC
MultipleLowMedianHighRange appliedImplied per share
FV / LTM Adjusted EBITDA (post-SBC) as of March 31, 2018 9.5x–13.0x $33.00–$57.25

Estimated fee of approximately $32.0 million, of which $3.0 million became payable upon delivery of the opinion and a substantial portion of which is contingent upon consummation of the merger. Aggregate fees received from the Company in prior two years ~$46.0 million; from KKR and affiliates ~$110.0 million.

Opinion of Evercore to the target board

Delivered June 10, 2018 · Fee $10.2M ($10.2M contingent on closing)

Discounted cash flow assumptions

Discount rate8.0%–9.0%
BasisEvercore's judgment of the estimated range of Envision's weighted average cost of capital
Terminal valuePerpetuity growth and exit multiple
Perpetuity growth1.0%–2.0%
Exit multiple9.0x–11.0x terminal value EV / 2022E EBITDA
Projection periodQ3 2018-2022
Projections usedManagement Case and Management Sensitivity Case (assumed equally likely)
Implied value per share$34.26–$80.16

Management Case - Perpetuity Growth: $48.34-$80.16; Management Case - LTM EBITDA Multiple: $47.00-$69.42; Management Sensitivity Case - Perpetuity Growth: $34.74-$62.15; Management Sensitivity Case - LTM EBITDA Multiple: $34.26-$53.80. Present values as of June 30, 2018.

Selected public companies (7)

MEDNAX, Inc. · Surgery Partners, Inc. · AMN Healthcare Services, Inc. · DaVita Inc. · Encompass Health Corporation · Fresenius Medical Care AG & Co. KGaA · Select Medical Holdings Corporation

MultiplePeer lowPeer medianPeer highRange appliedImplied per share
Enterprise Value / 2018E EBITDA (Management Projections)8.4x13.3x 8.5x–10.5x $35.37–$51.31
Enterprise Value / 2018E EBITDA (Analysts' Consensus)8.4x13.3x 8.5x–10.5x $34.12–$49.78

Selected precedent transactions (10)

DateTargetAcquirerMultiple
2017-05-08Medical Solutions L.L.C.TPG Growth10.1x EV/LTM EBITDA
2016-10-31TeamHealth Holdings, Inc.The Blackstone Group L.P.13.5x EV/LTM EBITDA
2016-06-17Envision Healthcare Holdings, Inc.AmSurg Corp.12.6x EV/LTM EBITDA
2015-08-04IPC Healthcare, Inc.TeamHealth Holdings, Inc.22.2x EV/LTM EBITDA
2015-05-12Virtual Radiologic CorporationMEDNAX, Inc.11.1x EV/LTM EBITDA
2015-01-19VISTA Staffing Solutions, Inc.Envision Healthcare Holdings, Inc.9.8x EV/LTM EBITDA
2014-05-29Sheridan Healthcare, Inc.AmSurg Corp.12.2x EV/LTM EBITDA
2014-05-21Healogics Holding Corp.Clayton, Dubilier & Rice, L.L.C.10.1x EV/LTM EBITDA
2012-10-22CHG Healthcare Services, Inc.Ares Management LLC; Leonard Green & Partners, L.P.12.6x EV/LTM EBITDA
2011-02-14Emergency Medical Services CorporationClayton, Dubilier & Rice, L.L.C.9.7x EV/LTM EBITDA
MultipleLowMedianHighRange appliedImplied per share
EV / LTM EBITDA (less SBC) as of March 31, 20189.7x12.4x22.2x 9.5x–13.0x $34.06–$58.54

Other analyses

AnalysisSummaryImplied per share
DCF sensitivity analysis (reference only) - no acquisition/transaction expensesPerpetuity growth method assuming no acquisitions and transaction expenses throughout projection period: Management Case $50.25-$74.38; Management Sensitivity Case $36.95-$56.85.$36.95–$74.38
DCF sensitivity analysis (reference only) - 33% terminal tax ratePerpetuity growth method assuming 33% tax rate during perpetuity period instead of 26%: Management Case $40.31-$68.96; Management Sensitivity Case $27.77-$52.40.$27.77–$68.96
Last 52-Week Trading RangeLow and high closing prices of Envision common stock during the twelve months ended June 8, 2018 ranged from $24.79 to $63.36. Reference only.$24.79–$63.36
Equity Research Analyst Price TargetsRange of selected equity analyst price targets as of June 8, 2018 was $38.00 to $51.00 per share. Reference only.$38.00–$51.00

Fee of approximately $10.2 million payable if the merger is consummated, of which $1 million was paid upon execution of the merger agreement. Separately, for general strategic advisory work, two quarterly retainer fees of $250,000 beginning October 6, 2017 and a $4.5 million fee for general strategic advisory services provided prior to June 30, 2018 (retainers creditable). Prior two years: ~$5 million fees from Envision; ~$32.5 million from KKR and affiliates.

Opinion of Guggenheim Securities to the target board

Delivered June 10, 2018 · Fee $10.2M ($10.2M contingent on closing)

Discounted cash flow assumptions

Discount rate8.0%–9.0%
Basisestimate of Envision's weighted average cost of capital
Terminal valuePerpetuity growth
Perpetuity growth1.0%–1.5%
Exit multiple
Projection period2018E-2022E
Projections usedManagement Case and Management Sensitivity Case
Implied value per share$34.75–$71.25

Management Case: $48.50-$71.25; Management Sensitivity Case: $34.75-$54.50. Terminal values cross-checked by reference to implied terminal year Adjusted EBITDA multiples.

Selected public companies (3)

MEDNAX, Inc. (as of June 8, 2018) · MEDNAX, Inc. (as of November 15, 2017) · Surgery Partners, Inc. (as of June 8, 2018)

MultiplePeer lowPeer medianPeer highRange appliedImplied per share
Firm Value / 2018E Adjusted EBITDA9.1x9.7x13.3x 8.0x–10.0x $30.25–$46.25

Selected precedent transactions (10)

DateTargetAcquirerMultiple
2017-05-08Medical Solutions L.L.C.TPG Growth10.1x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
2016-10-31TeamHealth Holdings, Inc.The Blackstone Group L.P.13.5x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
2016-06-17Envision Healthcare Holdings, Inc.AmSurg Corp.12.6x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
2015-08-04IPC Healthcare, Inc.TeamHealth Holdings, Inc.22.2x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
2015-05-12Virtual Radiologic CorporationMEDNAX, Inc.11.1x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
2015-01-19VISTA Staffing Solutions, IncEnvision Healthcare Holdings, Inc.9.8x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
2014-05-29Sheridan Healthcare, Inc.AmSurg Corp.12.2x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
2014-05-21Healogics Holding Corp.Clayton, Dubilier & Rice, LLC10.1x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
2012-10-22CHG Healthcare Services, Inc.Leonard Green & Partners, L.P./Ares Management LLC12.6x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
2011-02-14Emergency Medical Services CorporationClayton, Dubilier & Rice, LLC9.7x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC)
MultipleLowMedianHighRange appliedImplied per share
Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) as of March 31, 20189.7x12.4x22.2x 9.5x–13.0x $33.00–$57.25

Other analyses

AnalysisSummaryImplied per share
Illustrative DCF based on Wall Street Consensus Estimates (informational)Stand-alone DCF using Wall Street consensus estimates with the same discount rate range and terminal value methodology resulted in a reference range of $34.75-$51.25 per share.$34.75–$51.25
Envision Stock Price Trading History (past year)From June 8, 2017 to June 8, 2018, Envision common stock traded in a range of approximately $24.79-$63.36 per share.$24.79–$63.36
Wall Street Equity Research Analyst Price TargetsAnalyst price targets for Envision as of June 8, 2018 were $38.00-$51.00 per share.$38.00–$51.00
Recap of Implied Merger Financial Metrics / PremiaAt $46.00 per share: 5.4% premium to closing price of $43.64 (June 8, 2018); (27.4)% to past year high of $63.36; 85.6% to past year low of $24.79; 8.0% to $42.60 pre-Q3 2017 earnings release price (Oct 31, 2017). Implied FV/Adjusted EBITDA: 10.9x LTM (3/31/18) as reported; 10.0x 2018E Management Case; 10.0x 2018E Management Sensitivity Case; 10.2x 2018E Wall Street consensus; 8.6x 2019E Management Case; 9.0x 2019E Sensitivity Case; 9.3x 2019E consensus.

Cash transaction fee of approximately $10,210,103 payable upon consummation of the merger; Envision previously paid a cash consulting fee of $4,500,000. During the two years ended June 10, 2018, Guggenheim received ~$38 million from Envision and ~$9 million from KKR and affiliates for unrelated services.

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Management projections

Projection yearYear 1Year 2Year 3Year 4CAGR
Revenue$9.4B$10B$12B$13B11.6%
Revenue growth10.4%11.2%11.2%12.4%
EBITDA$1.2B$1.3B$1.5B$1.7B13.5%
EBITDA growth16.2%13.7%12.5%14.3%
EBITDA margin12%13%13%13%
Implied EV / EBITDA8.6x7.5x6.7x5.9x

Year-1 growth is against LTM at announcement ($8.5B revenue, $995M EBITDA); later years are year over year.

Management prepared two sets of five-year projections for fiscal years 2018-2022: the Management Case (prepared February 2018) and the Management Sensitivity Case (downside sensitivities reflecting lower same-contract rate/volume growth and incremental clinical labor costs). Management Case: revenue of $8,525.8 million in 2018 growing to $13,085.7 million in 2022, with Adjusted EBITDA of $994.5 million in 2018 growing to $1,689.6 million in 2022 and Adjusted EPS of $3.67 to $7.15; unlevered free cash flow declined from $88.6 million in 2018 to ($680.9) million in 2022. Management Sensitivity Case: revenue of $8,525.8 million (2018) to $12,550.6 million (2022), Adjusted EBITDA of $994.5 million to $1,478.7 million, Adjusted EPS of $3.67 to $5.84, and unlevered free cash flow of $88.6 million to ($843.5) million. All three financial advisors were instructed to treat the two cases as equally likely; the Sensitivity Case was not provided to bidders including KKR.

Process notes

Three financial advisors (J.P. Morgan, Evercore and Guggenheim Securities) each delivered fairness opinions to the Envision board on June 10, 2018; there was no special committee. J.P. Morgan and Guggenheim produced identical reference ranges for the DCF, precedent transactions and public trading multiples analyses. All three banks disclosed substantial prior fee relationships with KKR (J.P. Morgan ~$110 million, Evercore ~$32.5 million, Guggenheim ~$9 million over the prior two years), and Guggenheim had advised Envision on the sale of its AMR unit to a KKR portfolio company. KKR Americas Fund XII L.P. provided a limited guarantee capped at $280 million in the aggregate backing the $275 million parent termination fee. Firm value for Envision was increased by $240 million in respect of an estimated tax liability related to the AMR sale in the trading multiple analyses. The deal followed a publicly announced strategic alternatives review begun October 31, 2017.

Other Physician Groups fairness opinions

All Physician Groups opinions → · J.P. Morgan opinions · Evercore opinions · Guggenheim Securities opinions