Envision Healthcare Holdings acquired by KKR: fairness opinion by J.P. Morgan and Evercore and Guggenheim Securities
Deal terms
Implied value per share by method vs. $46.00 offer
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
Discounted cash flow assumptions
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)
| Multiple | Peer low | Peer median | Peer high | Range applied | Implied per share |
|---|---|---|---|---|---|
| FV / 2018E Adjusted EBITDA | — | — | — | 8.0x–10.0x | $30.25–$46.25 |
Selected precedent transactions (10)
| Date | Target | Acquirer | Multiple |
|---|---|---|---|
| 2017-05 | Medical Solutions L.L.C. | TPG Growth | — |
| 2016-10 | TeamHealth Holdings, Inc. | The Blackstone Group L.P. | — |
| 2016-06 | Envision Healthcare Holdings, Inc. | AmSurg Corp. | — |
| 2015-08 | IPC Healthcare, Inc. | TeamHealth Holdings, Inc. | — |
| 2015-05 | Virtual Radiologic Corporation | MEDNAX, Inc. | — |
| 2015-01 | VISTA Staffing Solutions, Inc. | Envision Healthcare Holdings, Inc. | — |
| 2014-05 | Sheridan Healthcare, Inc. | AmSurg Corp. | — |
| 2014-05 | Healogics Holding Corp. | Clayton, Dubilier & Rice, LLC | — |
| 2012-10 | CHG Healthcare Services, Inc. | Leonard Green & Partners, L.P./Ares Management LLC | — |
| 2011-02 | Emergency Medical Services Corporation | Clayton, Dubilier & Rice, LLC | — |
| Multiple | Low | Median | High | Range applied | Implied 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
Discounted cash flow assumptions
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
| Multiple | Peer low | Peer median | Peer high | Range applied | Implied per share |
|---|---|---|---|---|---|
| Enterprise Value / 2018E EBITDA (Management Projections) | 8.4x | — | 13.3x | 8.5x–10.5x | $35.37–$51.31 |
| Enterprise Value / 2018E EBITDA (Analysts' Consensus) | 8.4x | — | 13.3x | 8.5x–10.5x | $34.12–$49.78 |
Selected precedent transactions (10)
| Date | Target | Acquirer | Multiple |
|---|---|---|---|
| 2017-05-08 | Medical Solutions L.L.C. | TPG Growth | 10.1x EV/LTM EBITDA |
| 2016-10-31 | TeamHealth Holdings, Inc. | The Blackstone Group L.P. | 13.5x EV/LTM EBITDA |
| 2016-06-17 | Envision Healthcare Holdings, Inc. | AmSurg Corp. | 12.6x EV/LTM EBITDA |
| 2015-08-04 | IPC Healthcare, Inc. | TeamHealth Holdings, Inc. | 22.2x EV/LTM EBITDA |
| 2015-05-12 | Virtual Radiologic Corporation | MEDNAX, Inc. | 11.1x EV/LTM EBITDA |
| 2015-01-19 | VISTA Staffing Solutions, Inc. | Envision Healthcare Holdings, Inc. | 9.8x EV/LTM EBITDA |
| 2014-05-29 | Sheridan Healthcare, Inc. | AmSurg Corp. | 12.2x EV/LTM EBITDA |
| 2014-05-21 | Healogics Holding Corp. | Clayton, Dubilier & Rice, L.L.C. | 10.1x EV/LTM EBITDA |
| 2012-10-22 | CHG Healthcare Services, Inc. | Ares Management LLC; Leonard Green & Partners, L.P. | 12.6x EV/LTM EBITDA |
| 2011-02-14 | Emergency Medical Services Corporation | Clayton, Dubilier & Rice, L.L.C. | 9.7x EV/LTM EBITDA |
| Multiple | Low | Median | High | Range applied | Implied per share |
|---|---|---|---|---|---|
| EV / LTM EBITDA (less SBC) as of March 31, 2018 | 9.7x | 12.4x | 22.2x | 9.5x–13.0x | $34.06–$58.54 |
Other analyses
| Analysis | Summary | Implied per share |
|---|---|---|
| DCF sensitivity analysis (reference only) - no acquisition/transaction expenses | Perpetuity 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 rate | Perpetuity 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 Range | Low 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 Targets | Range 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
Discounted cash flow assumptions
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)
| Multiple | Peer low | Peer median | Peer high | Range applied | Implied per share |
|---|---|---|---|---|---|
| Firm Value / 2018E Adjusted EBITDA | 9.1x | 9.7x | 13.3x | 8.0x–10.0x | $30.25–$46.25 |
Selected precedent transactions (10)
| Date | Target | Acquirer | Multiple |
|---|---|---|---|
| 2017-05-08 | Medical Solutions L.L.C. | TPG Growth | 10.1x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| 2016-10-31 | TeamHealth Holdings, Inc. | The Blackstone Group L.P. | 13.5x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| 2016-06-17 | Envision Healthcare Holdings, Inc. | AmSurg Corp. | 12.6x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| 2015-08-04 | IPC Healthcare, Inc. | TeamHealth Holdings, Inc. | 22.2x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| 2015-05-12 | Virtual Radiologic Corporation | MEDNAX, Inc. | 11.1x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| 2015-01-19 | VISTA Staffing Solutions, Inc | Envision Healthcare Holdings, Inc. | 9.8x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| 2014-05-29 | Sheridan Healthcare, Inc. | AmSurg Corp. | 12.2x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| 2014-05-21 | Healogics Holding Corp. | Clayton, Dubilier & Rice, LLC | 10.1x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| 2012-10-22 | CHG Healthcare Services, Inc. | Leonard Green & Partners, L.P./Ares Management LLC | 12.6x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| 2011-02-14 | Emergency Medical Services Corporation | Clayton, Dubilier & Rice, LLC | 9.7x Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) |
| Multiple | Low | Median | High | Range applied | Implied per share |
|---|---|---|---|---|---|
| Transaction Firm Value / LTM Adjusted EBITDA (post-SBC) as of March 31, 2018 | 9.7x | 12.4x | 22.2x | 9.5x–13.0x | $33.00–$57.25 |
Other analyses
| Analysis | Summary | Implied 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 Targets | Analyst 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 / Premia | At $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.
Management projections
| Projection year | Year 1 | Year 2 | Year 3 | Year 4 | CAGR |
|---|---|---|---|---|---|
| Revenue | $9.4B | $10B | $12B | $13B | 11.6% |
| Revenue growth | 10.4% | 11.2% | 11.2% | 12.4% | |
| EBITDA | $1.2B | $1.3B | $1.5B | $1.7B | 13.5% |
| EBITDA growth | 16.2% | 13.7% | 12.5% | 14.3% | |
| EBITDA margin | 12% | 13% | 13% | 13% | |
| Implied EV / EBITDA | 8.6x | 7.5x | 6.7x | 5.9x |
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
Other Physician Groups fairness opinions
- Network Medical Management / Apollo Medical Holdings 2016 · 9.5x EV/EBITDA
- Team Health Holdings / Blackstone 2016 · 11.5x EV/EBITDA
- Envision Healthcare Holdings / AmSurg 2016 · 11.2x EV/EBITDA
- USMD Holdings / WellMed Medical Management 2016 · 15.5x EV/EBITDA
- ExamWorks Group / Leonard Green & Partners 2016 · 11.5x EV/EBITDA
- Nutex Health / Clinigence Health 2021 · 10.0x EV/EBITDA
All Physician Groups opinions → · J.P. Morgan opinions · Evercore opinions · Guggenheim Securities opinions