Ambu Business Plan 2020

BUSINESS PLAN 2019 - 2025

Nikas Christos Emergency Help CEO & Founder

EMS is viewed as one doorway to the healthcare system. Over the next five years, to further integrate Emergency Medical Services into a transformed healthcare system will be needed.

Particular areas that will be strengthened in the timeframe include the communication system and appropriate designation of hospital specialty canters for critical conditions including trauma, STEMI and stroke. Continued improvement and depth of both EMS and trauma data systems will inform future decision and directions for service delivery. Finally, the continued “professionalism” of the EMS workforce, via the use of national standards of practice is necessary to the full integration of EMS with the rest of the health care system.

ABOUT CHRISTOS NIKAS Christos Nikas was born to Athens, Greece in 1979. After graduating from Athens economical university, Christos has became Board Certified in Emergency Medicine Paramedic. He served as Medical Director of the Ambulance emergency department at private Hospital’s for over six years. The presence of paramedics on ground ambulances and the advanced skills they brought to the pre-hospital environment surely saved lives and developed a higher level of EMS services. In 2007 his created the first ambulance company, gaining strong partnerships and relationships of trust. He has worked for over fifteen (15) years in the field of medical transportations, telemedicine and insurance companies. Ηis beliefs and his philosophy of innovation, gave him the impetus to create new products and solutions not only in the tourism market but also in the insurance industry and EMS services.

“Emergency medical services (EMS) of the future will be community-based health management that is fully integrated with the overall health care system. It will have the ability to identify and modify illness and injury risks, provide acute illness and injury care and follow-up, and contribute to treatment of chronic conditions and community health monitoring. This new entity will be developed from redistribution of existing health care resources and will be integrated with other health care providers, public health, and public safety agencies. It will improve community health and result in more appropriate use of acute health care resources.

EMS will remain the emergency medical safety net.”

Chris Nikas

Healthcare in Greece

Executive Summary On 20th August 2018, Greece completed its stability program and concluded a period of 8 years of recession. During these years three economic adjustment programs (EAPs) were signed between Greece and its lenders, aiming at the stabilization of the Greek economy, enhancement of the economy’s productive capacity and export competitiveness. The impact of the measures taken was significant as Greece lost a quarter, in value terms, of its gross domestic product (GDP) while unemployment rose to approximately 30%.

Healthcare spending, after reaching its peak in 2009, decreased by approx. 40% during the period 2009-2016, in line with a drop of more than 60% in pharmaceutical spending.

On 20th August 2018, Greece completed its stability program and concluded a period of 8 years of recession. During these years three economic adjustment programs (EAPs) were signed between Greece and its lenders, aiming at the stabilization of the Greek economy, enhancement of the economy’s productive capacity and export competitiveness. The impact of the measures taken was significant as Greece lost a quarter, in value terms, of its gross domestic product (GDP) while unemployment rose to approximately 30%.

Following a considerable growth until 2009, Net Sales of Private Hospitals have been since declining, with the exception of 2012. The decline is at large attributed to the introduction of Rebates and Clawback mechanism in 2013.

The aforementioned, accompanied with intense competition and sharply climbing costs, appear to have initiated a process of consolidation in the healthcare sector. Pharmaceutical companies’ liquidity was also impacted by the Rebates and Clawbacks mechanism, the value of which increased by approx. 300% between 2012 and 2016.

The healthcare and pharmaceutical sectors were heavily affected by the austerity measures taken. Prior to the crisis, Greek healthcare system suffered from various inefficiencies, such as (a) centralized decision making, (b) lack of referral system and effective gatekeeping mechanisms, (c) absence of health technology assessment system, (d) non optimal allocation of economic resources. The measures taken were mostly focused on rationalizing the expenses and efforts were taken to modernize the healthcare system.

The decline in healthcare and pharmaceutical spending, along with the measures taken by the government to control the costs, trimmed the profit margin for all the market participants, including hospitals and pharmaceutical companies.

For the first time since the beginning of the crisis, healthcare spending grew by an average annual increase of 1.2% between 2014 and 2016. In the same period Pharmaceutical spending stabilized, following an average annual drop of 0.9%

Macro Environment & Healthcare Expenditure A sign of recovery The Greek economy demonstrates signs of recovery after years of recession Exit from the 3rd Economic Adjustment Program The Eurogroup agreement on 22nd June paved the way for the successful conclusion of the financial assistance program, smoothing out the return of Greece to market financing after 8 years.

Greece achieved a budget surplus before interest and other one-time payments equal to 4.19% of its gross domestic product in 2017, more than twice the target set for a 1.75% of GDP surplus. The Greek economy is set to maintain growth in 2018/19 and recovery is expected to strengthen as investment rebounds and consumption grows further.

The performance in specific industries (mainly tourism) has supported the GDP growth, coupled by an increase in public consumption and reduction in unemployment rate. The signs of recovery are expected to continue in the coming years.

‌however the gap in healthcare spending levels is still wide, with Greece lagging behind other EU countries, including countries in South Europe who were also affected by the crisis between 2009-2016.

Macro Environment & Healthcare Expenditure ΙΙ Healthcare spending

Healthcare spending is showing first signs of recovery with an average annual increase of 1.2% between 2014 and 2016.

Normalized Evolution of Healthcare Expenditure (2009=100)

Pharma spending

Pharmaceutical spending, after 7 years where it dropped cumulatively by 62%, has finally stabilized at the levels of approximately €2b. per year.

Healthcare Expenditure Cumulative Changes in EU countries (2009-2016)

Source: Eurostat, Hellenic Statistical Authority, OECD, Deloitte analysis

Healthcare in Greece

Healthcare Infrastructure

Healthcare spending had been on a downtrend from 2009 to 2016 (reaching €14.4b, down from ~ €23b), mainly due to the contraction in Government and Social Security coverage. As a consequence, households in Greece spent more money on healthcare (from 6.4% in 2011 to 7.4% in 2016) compared to other EU countries, mainly through out of pocket payments.

Healthcare expenditure - per capita

There is a gap in terms of per capita healthcare spending, between Greece and other European countries. In Greece, per capita spending for healthcare in 2016 was 53% less than France and 30% less than Spain.

Health expenditure in USD PPP* per capita, Group of Countries, 2016

Healthcare expenditure - households

Households in Greece, from 2012 onwards, have been increasing their spending in healthcare comparing to the other needs they develop. The peak was in 2015, when health expenditure reached 7.5% of households’ spending.

Health expenditure as % of total expenditure of households in Greece

Source: ELSTAT,IOBE 2017

Source: OECD *PPP: Purchasing Power Parity

Healthcare Infrastructure Healthcare Financing schemes - Comparative

Governmental spending is the main source of financing in the EU, where most healthcare systems are Beveridge (NHS type) systems or mixed systems. In Greece though, the corresponding percentage is considerably lower than in the other countries, while out-of-pocket share is much higher.

Healthcare Financing schemes - Greece Public expenditure in 2015 covered almost 60% of the total expenditure while private expenditure reached approximately 41% of the total financing.

As % per country, 2016

GG: General Government and Social Security, OoP: Out of Pocket, PI: Private Insurance, CAGR: Compound Annual Growth Rate Source: Elstat for Greece (2016 Data), OECD for the rest

Healthcare Infrastructure In 2016, there were 280 private and public hospitals operating ~45,300 beds in Greece. Signs of consolidation in the private sector continue, as the number of hospitals has been reduced by ~7% while the number of beds has been reduced by ~8% during the period 2012-2016.

Number of Inpatient Beds per Region

Number of Hospitals per Region

Competitive Landscape In 2016, the Greek Private Healthcare Providers’ sector was estimated at ~€1.5b., which may be further broken down into ~€0.9b for General Hospitals, ~€0.4b Diagnostic Centers and ~€0.2b for Maternity Hospitals in Attica region. In 2016, for the first time since 2012, the net sales of Private Healthcare Providers increased compared to the year before (+2.5% compared to 2015).

Evolution of Net Sales of Private Companies

After a considerable growth with a CAGR of +12.5% between 2003-2009, Net Sales of Private Healthcare Providers have been declining, with the exemption of 2012. In 2013, revenues saw a significant drop which was largely attributed to the introduction of rebate and clawback mechanism. In 2016, the industry’s Net Sales demonstrated an increase for the first time after four years. It is also noteworthy that similar to the healthcare overall expenditure, Net Sales remain relative stable since 2013.

Addressable Market

In 2016, out of a total healthcare expenditure of €14.7b, ~€1b is attributed to Private Healthcare Providers operating in Attica, which may be further broken down into €0.8b for General Hospitals & Diagnostic Centers and ~€0.2b for Maternity Clinics.

Source: National Statistical Authority, ICAP Group, Published Financial Statements, Deloitte Analysis Balance refers to Retailers (e.g. pharmacies & medical device suppliers) and Others (e.g. Private Practices & Ambulatory Services)

Competitive Landscape Market Concentration In 2016, the top 8 private healthcare providers in terms of net sales represented approximately ~66% of total Net Revenue and 44% of total inpatient beds of all General Hospitals in Greece. Three providers accounted for almost 52% of the general private clinic market share in 2016, two providers accounted for ~58% of the Maternity Clinics share and three providers for 35% of Diagnostic Centers.

Private Healthcare Providers' Market Share (in %, 2016)

Source from page 7-17:https://www2.deloitte.com/gr/en.html

Regulatory Changes Healthcare

In the last years, the Greek Healthcare system is going through a large scale transformation. This includes the development of a roll-out plan for health units, as well as revision of the service package and contractual agreements for health units, piloting of integrated health and social services for first time in selected areas and addressing informal payments. The healthcare reforms were designed in a way to control the public spending which was higher compared to other EU countries and to strengthen capacity for universal coverage, a Phase 2 (SCUC2) action. Government’s plan is to cover the rising unmet need through (a) modernization of healthcare sector, (b) rationalization of expenses and (c) Primary Care driven (gatekeeping) model of care.

Primary Care Reform (2017) Healthcare Reforms The newest Primary Care Plan, aims to rationalize firstSecondary Care Reform – Requested by the contact primary care services and create a secondlenders, with the aim to provide a new legal tier ambulatory infrastructure framework for the operations of the Private Clinics, specifying a threshold of beds for the authorization of establishment of private clinics Diagnostic Related Group (DRG) Reform (2019) – Introduction of DRG system to be piloted in 18 public hospitals. This will move Greece to Activity Based Funding and will provide transparency to the expenses and effective reimbursement (Price per DRG = Cost Weight x Base Rate x Adjustment Factor)

Technology Reforms Price List Observatory – Collects and analyses tenders and technical specifications published by hospitals EOPYY Digital Transformation – The national healthcare provider started its digital transformation journey

Healthcare in Greece

EMERGENCY MEDICAL SERVICES AND THEIR MODELS

E.M.S

EMERGENCY MEDICAL SERVICES AND THEIR MODELS

Introduction There is an increasing demand for Emergency Medical Services (EMS) around the world. To respond to this growing demand, the EMS communities require adaptable and sustainable model systems that encompass unified standards of practice, training and results with minimum risk.

Millions of patients with simple or complicated conditions or injuries seek pre-hospital care around the world.

EMTs with knowledge of Basic Life Support (BLS), Intermediate Life Support (ILS) or Advanced Life Support (ALS) or First Responders, as they are generally called in the United States, provide rapid assessments and treatment of the sick and injured prior to transporting them to a hospital or clinic for further evaluation.

Considerable knowledge, skill, and judgment are required to provide quality ambulatory emergency medical services. High quality emergency medical services and first responders are important part of any health care system. Many studies of prehospital services place greater emphasis on human factors, efficiency and continuous refinement of standards of practice.

Worldwide Emergency Medical Services are divided into two main models: (1) the German-Franco Model, in which an ambulance is staffed by physicians, and (2) the Anglo American Model, where ambulances are staffed with EMTs trained in BLS, ILS or ALS. In both models, effort is made to use modern techniques, tools and technologies to reduce medical uncertainties so as to attain the highest possible quality of patient-centric pre-hospital care.

Many countries around the world are using these ideas to support and improve their pre- 2 hospital services and emergency medicine. Oftentimes, in most countries, compromises are made in order to provide efficient pre-hospital services while staying within budgets and the capacity of existing infrastructure.

Individual countries also have different environmental performance and public health issues to contend with. The lack of trained pre-hospital providers, modern equipment and ambulance vehicles for example, also account for the challenges and short comings to provide quality emergency medical services. For many countries, the Anglo-American and Franco-German models are the guiding framework for their emergency medical services and continuing advancement in providing quality emergency medicine. Several significant factors, such as the improvement of EMS access, telemedicine and greater availability of pre-hospital services in rural areas, have resulted from the use of the EMS models.

EMS SYSTEMS AROUND THE WORLD

Introduction

When national and international doctors and emergency personnel arrive at medical emergencies or disaster scenes, they are often confronted with changing demands and safety threats created 4 by environmental changes, uncertain emergency scenarios and medical challenges.

EMS providers are expected to render effective life-saving evaluation, intervention, stabilization and treatment that are consistent with existing standards and codes.

Emergency personnel must be properly trained and equipped with suitable equipment, tools and communication systems to ensure that the highest quality of care, safety and reliability are attained before, during and after a medical emergency event Many countries have embraced modified versions of the Franco-German and Anglo-America EMS models to improve their prehospital care.

There are continued innovations to improve the models so as to address the many challenges facing pre-hospital providers (see the references

Europe geographically, is a peninsula. It’s the second smallest continent worldwide, with an area of 10,790,000 km2 . Its population is the third largest containing more than 700,000,000 humans. This is fewer amounts of people than what China holds alone. Europe has been developing economically and culturally since the Paleolithic Era. It is interesting with the line of history how far the Europe’s EMS models have developed. The European EMS models are known to incorporate modern tools, techniques and technologies such as telemedicine, electronic health records, pharmaceutical tracking systems and online communication into prehospital care or emergency medicine (see [42-43, 45-60]). This section examines the EMS systems in the following countries in Europe, Germany, Greece, Lithuania, Portugal, and United Kingdom.

E.M.S

There is a growing realization worldwide that nations will face major challenges to protect their citizens from an increasing number of health threats initiated by man-made or natural emergencies and disasters.

E.M.S

EMS SYSTEMS Greece

After Greece achieved independence from the Ottoman Empire in 1829, it gradually began adding nearby islands and territories. Today Greece is bordered by the Aegean Sea, Ionian Sea, Mediterranean Sea, Albania and Turkey, with a total area of 129 thousand km2 . Figure 13 highlights Greece in green to show its location in southern Europe.

The GDP of Greece was at $341.2 billion in 2008. In the same year, its population consisted of 11.2 million people. In 2009, a Greek citizen has a life expectancy of 80 years at birth. There were also 6.17 physicians per 1,000 people in that year in Greece.

The types of ambulance cars are used for emergency transport and also for comfort. The EMS in Greece is known as Ethniko Kentro Amesis Boitheias (EKAB), which is completely funded by the government. Greek emergency medical services are free for all citizens due to funding from the Greek National Health Care System EMS began in Greece with the creation of a first aid station in 1915 in Athens. This first aid station was funded by the Savior charity. The Hellenic Red Cross created a three more first aid stations between 1932 and 1988. These first aid stations were each equipped with 24 ambulances. Four more ambulance equipped first aid stations were created by the Social Insurance Institute in 1965. By 1975, Athens General Hospital founded the Center for Emergency Care.

Eventually, resources from the Red Cross and Social Insurance Institute were merged into the Center for Emergency Care in 1986. This process also established ‘166’ as the national telephone number for EMS in Greece. In 1987, the National Center for Emergency Care (Ethniko Kentro Amesis Boitheias) was created by the Greek government under the Ministry of Health with the purpose of handling Greece’s EMS

Today, Greek EMS is handled by the National Center for Emergency Care (EKAB). EMS in managed via 12 EKAB stations in the major Greek cities. EKAB substations operate under the authority of an EKAB station in order to serve a larger area. Dedicated communications and dispatch centers, physicians, EMTs and emergency medical equipment are at each station. EKAB stations coordinate with health care centers and hospitals in their respective regions for ambulance dispatch. These local health care centers and hospitals have their own equipment and personnel. The Greek dispatch process for Emergency Medical Services is shown in Figure

EMS SYSTEMS Greece

Greece has two types of land ambulances: basic ambulances, and Mobile Intensive Care Units (MICU).

Basic ambulances are equipped with first aid equipment, intravenous access kits, oxygen, simple airway equipment and suction. MICUs are equipped with advanced airway equipment, fluids, intravenous access equipment, manual defibrillators, pulse oximeters, drugs and ventilators. Some Greek cities also have motorcycles staffed with a paramedic and (optionally) a physician.

In Greece, there are two levels of EMTs: basic EMTs and advanced EMTs. Basic EMTs attend 1000 hours of training on topics such as assessing the critically ill, basic airway management, basic life support, cardiopulmonary resuscitation, immobilization of fractures, safe transportation, triage and treatment and wound management. Advanced EMTs attend 1400 hours of training, 800 hours of which is spent on theory and 600 hours of which is spent on workshops and practical training. Advanced EMTs learn about advanced life support, anatomy, common emergencies, disaster management, ECG-monitoring and manual defibrillation, infectious diseases, intravenous access techniques, pharmacology, physiology, and treatment protocols in addition to subjects covered by basic EMT training (

Private hospital ambulance authorization is provided by legislation only in: Clinics, Diagnostic Centers, Rehabilitation Centers, Hemodialysis Units to serve only his / her patient to and from the clinic.

This number of licenses is limited and depends on the size of the clinic and the number of beds it has.

It is forbidden to serve traffic incidents or to make transfers from public hospitals to the patient's home.

It is also forbidden to travel from ports or airports, even coverings in various sporting events.

E.M.S

Emergency Medical Services in Greece are accessed via either the ‘112’ or ‘166’ telephone. After calling the number, the caller is connected to a dispatcher which handles phone calls. In smaller cities, this dispatcher will also communicate with ambulances over radio. In large cities, separate dispatchers handle radio communication.

All dispatchers are trained EMTs with additional training for dispatch.

This gap is covered by private insurance companies where they have no limitation on the number of ambulance permits and have the same rights as the EKAB The assistance companies in Greece who have the right for ambulance license are: Interamerican, INTERSALONIKA, Mondial, Europ Assistance, mapfre, Interpartner assistance, Express service.

The number of ambulances in the EKAB in Greece is 408 and is divided into shifts and sectors. The number of private ambulances licensed in Greece is 245 and is at least 10 years old.

In the last year, illegal activity has been observed by private clinic ambulances, as they carry out incidents beyond their rights and licensing. This is because there is a great need for an ambulance service and this gap is not covered by insurance companies

However, the Health Inspectors' constantly checks and several offenders have been brought to the Prosecutor.

Our Business

Plan

Executive Summary

Emergency Medical Services (E.M.S.) with air/ground ambulancetransport can provide high standards of services, focused on building partnerships to bring quality medical specialty services directly into hospitals, clinics, private practices and other entities through AI, digital and telehealth technology.

We aim to improve patient care and outcomes, and to increase market share for both healthcare providers and the digitaltelehealth service providers they partner with.

New Greek legislation (L 4430/2016) allows private companies to operate with air medical transport, EMS services are now possible, and providing these services insurance companies will offer new medical packages, hospitals and clinics faster digital patient cover, increasing their healthy profit margins.

This opens a wide range of opportunity for emergency medical service (EMS) operators. Emergency Medical Care can be offered in a wide range of situations such as rescue missions, high altitude sports and in all emergency conditions. There are 5 key categories of EMS which cover all areas of a medical emergency. These include:

Executive Summary – Interfaces (ground ambulance)

Emergency Help established in the Ambulance Emergency Medical Services Operational network, the company operates a modern fleet of digitally equipped ambulances and is capable to support the needs of medical treatment and post medical support, air-ambulance, telemedicine, repatriation.

We aim at the creation of a powerful network that will provide high quality Health Services. We invest on the development of our team, our facilities and our innovative technology. Through professionalism and team work we promote all those values that are necessary for a modern, complete and advanced Health Services Network.

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Interfaces - These types of services are required when patients need to be moved from a residence to a medical care center or from an accident to an emergency medical center. Transporting a patient from or to a medical center requires a reliable and fully equipped medical ambulatory service, in major urban areas and across many regions in the country. Our company will fill this gap and provide a fully functional interface service to patients who are in need. We will also operate as a licensee of Europ Assistance, one of the largest and most recognized emergency medical care providers globally.

On-site Medical Services Insurance Companies Tour Operator Airports

Our main role is to respond to emergency calls, providing medical care to patients across the Greece, 24-hours a day, 365 days a year. Other services we offer include providing pre-arranged patient transport and finding hospital beds.

Futures

Step 1: 24 ambulances (central Greece and islands) Step 2: 39 ambulances (central Greece and islands)

Step 3: 65 ambulances (central Greece and islands)

Executive Summary – Aeromedical Service (Airplane/Helicopter )

We provides air medical transports for critically ill and injured patients across Greece and the rest of Europe. Patients receive an ICU-level of care from our highly skilled nurses and paramedics. Our experienced pilots fly patients aboard our medically equipped helicopters and airplanes We are committed to provide the highest level of service with safety and efficiency.

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Aeromedical Service - Airplane/Helicopter transportation of patients to specialized and emergency medical centers, for medical services by authorized doctors and specialists, to be provided by the company.

Our aircraft will be fitted with all the medical equipment needed and specified under EASA EMS regulation and compliant to HCAA requirements and manuals, and manned with trained flight health specialists qualified to provide the necessary medical assistance to the patient during the flight.

On landing the patient will be transported by ambulance to the nearest hospital, other care facility or residence, or if-need-be for repatriation to the nearest airport.

Air ambulance services and H.E.M.S. – Helicopter Emergency Medical Services - will be unique in the areas where we will operate. Currently, these services are carried out only by the Army, Search and Rescue (SAR) teams for the NCEH (EKAB).

We have 36 years of experience building strong industry relationships and serving our clients with private aircraft charter, aircraft management, emergency medical services and tourism services. What sets us apart is our broad reach across many private aviation sectors. Our in depth knowledge of the industry and a breadth of professional contacts, allows us to offer the most competitive rates and services in the market.

DESIGNATIONS Air Operator Certificate AOC Aerial Work Certificate Part 145 EMS-HEMS Step 1: 2 Helicopter EMS

Futures

Step 2: 3 Helicopter EMS & 1 EMS TURBOPROP AIRPLANE

Step 3: 3 Helicopter EMS & 1 EMS TURBOPROP AIRPLANE & 1 JET EMS AIRPLANE

Executive Summary – Nursing Assistance and Home Care

Emergency Nurse Assistance is a specialty staffing company employing RNs and other healthcare professionals for travel assignments at homes, hotels, hospitals and other medical facilities across the Europ. Managed by an industry-experienced, hands-on team of professionals, we are focused on delivering winwin solutions to the insurance companies, providers and medical facilities we serve.

Wherever there is a need for personal care, nursing assistants (NA), or nurses’ aides, are there. Nursing assistants work in nursing homes, home care, assisted living, Hospice, hospitals, community based long-term care, correctional institutions, and other longterm care settings.

 Nursing Assistance and Home Care – We deploy our trained and experienced Registered Nurses (RNs), Nursing Assistants (NAs) and Rescuers to provide Emergency Medical Care Services and Home Care Services. They will be stationed primarily in our telemedicine stations, emergency rescue operations (air or road), for home care and in other long-term care settings. Our paramedical staff will operate our telemedicine services, medical examining, and health care service.

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Medical & Nurse Home Care Services Medical & Nurse Travel Assistance Hotel Medical & Nurse Assistance Escort Commercial Flights Air ambulance Crew Ambulance & HEMS Crew Vital Telemedicine Maritime Telemedicine 24/7 personal consultant and support 24/7 Medical & Nurse Call On-site Medical Services

Executive Summary – Telemedicine

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Digital Health and Telemedicine - These services provided by our company will be handled by a team of specialized doctors, trained medical nurses, trained rescue members, and doctors who are certified health care professionals by the Greek Medical Control Board (National Emergency Aid Centre, National Instant Aid). We will establish telemedical health stations and kiosks in local communities, where patients can come to the station to measure vital functions such as pressure, and oximetry, diabetes, cardiovascular, etc., We plan to logistically maintain their personal health record, which will be tracked in our local stations and according to the need be able to talk a health professional through a telemedical video conference for additional services. This telemedicine service will also be provided at the patient’s residence with portable equipment and Wi-Fi link with doctors.

Telemedicine comprises a multitude of healthcare services targeted to diseases and conditions as well as personal health services in support of well-being and prevention. Furthermore, telemedicine is - like wider eHealth - a timely reflection of the ubiquitous digitalization of all sectors of society. Telestroke services can be used as a meaningful example of telemedicine services. By using methods of teleneurology, a patient suffering from acute vascular blockage (with the risk of an imminentfull vascular stroke) may receive local treatment under remote supervision preventing most of the stroke symptoms.

This telemedicine service contributes to making medical treatment faster and more efficient.

Vision

Mission Create a renowned EMS brand in Greece that stands for professional, ethical and high-quality service that holds patients care as their utmost responsibility.

Measuring project milestones The Company will look at major milestones and check they still fall on the same dates as originally agreed. If there is any slippage it will be worked out, so as to minimize the impact this will have on our overall deliverable timescales. At the end of each project phase we will review our quality standards and work out any poor project management practices and the derivable.

We fully intend to have regular quality reviews, so as to evaluate whether what we are doing meets the standards set out in our quality plans. Best find out now before the project goes too far, as it might be too late to do anything about it then.

Project management success is often determined by whether or not the original timeline is kept, so we plan to continually our progress. We will update our schedule regularly at least weekly. The schedule evaluation will be done more formally at the end of each stage or phase, or as part of a monthly report to senior stakeholder group or Project Board.

Client – Patient Base There is a growing call to shift from a “break-fix” reactive model to a more proactive and predictive one. But as our health care systems are highly focused on acute care and curative medicine, going beyond low-hanging fruit fixes to incorporate prevention of all levels into our systems’ culture, incentive schemes, funding models, and organization will require a systemic change.

The major driving force for this market is increasing age population, rising cost of healthcare, rising prevalence of chronic diseases.

Technological innovations and advancements fuel the market growth. With major market constraints in developing and underdeveloped nations which lack sufficient resources for the telemedicine market.

High technological costs, lack of physician support, and poor cases of implementation are also constraints.

We aim to approach our client/patient care market on a wholesale and on an individual basis. Large clients will be the Insurance and Re-Insurance companies, Hospitals and medical centers, doctors’ companies and care facilities.

Other large scale clients are factories, construction companies, municipal districts, school districts and the tourism sector. Major call centers that call out for emergency transports are also a target market. On an individual basis, our client base will be approached from a digital platform and a planned insurance broker facility.

Location and Facilities

The company will initially operate from the following areas in Greece:       

Attica The Peloponnese Central Greece Central Macedonia Crete Ionian Islands South Aegean

Services Introduction An Emergency Medical Service (EMS) system must encompass a spectrum of care, with dedicated prehospital and in-hospital medical facilities. It has to be organized in such a way as to include all necessary services—such as triage accurate initial assessment, prompt resuscitation, efficient management of emergency cases, and transport to definitive care.

The global economic downturn has had a direct effect on the health sector and poses additional threats to the healthcare system. Greece is one of the hardest-hit countries. Nowadays, primary care suffers major shortages in crucial equipment, unmet health needs, and ineffective central coordination.

Patients are also facing economic limitations that lead to difficulties in using healthcare services.

The multi-factorial problem of in-hospital EMS overcrowding is also evident and has been linked with potentially poorer clinical outcomes.

Furthermore, the ongoing refugee crisis challenges the national EMS. Adoption of a triage scale, expansion of the primary care network, and an effective primary– hospital continuum of care are urgently needed in Greece to provide comprehensive, culturally competent, and high-quality health care.

Services – Ambulance services Introduction

The company will provide both Basic and Advanced Life Support ambulance service. Run types will be inter-hospital transfers, emergency and non-emergency responses, discharges from hospitals, ground transport for aviation, outpatient visits and standby services for special events and clients.

Emergency Response: It will work as a primary mutual aid emergency response agency among others, for local communities, individuals, companies, athletic facilities and (air)-ports. It can also be utilized by neighboring municipalities and communities for mutual aid response during times of need.

Special Operations Team: The company will form a Special Operations Team (SOT) in response to the growing need for highly trained emergency medical personnel who can play versatile roles.

SOT personnel can always be on duty within a local community/district and additional manpower can be called in through alert system, 24/7, in case of emergency beacon.

Advanced Life Support (ALS) Transports: The company will offer acute medical transports between hospitals, trauma centers and special care units for patients who require advanced monitoring. Registered nurses and a certified medical practitioner will always be with ambulances as support during emergency cases or during critical care transportation.

Nursing staff will work closely with physician to perform appropriate treatment modalities during the transport.

Services – Ambulance services

Basic Life Support Transports: The overall commitment of any emergency medical services company is the provision of aftercare transports.

The company will provide non-emergency transportation from hospitals, health care facilities, and residences.

Basic Life Support (BLS) ambulances will be staffed by two certified emergency medical technicians who will maintain quality care during transport.

Patients who require transports will be assessed at the initiation of transportation and closely monitored until the trip is completed.

Standby for Special Events: Our ground ambulance service will also be used as Special Event Medical Services (SEMS) and Standby Ambulance Services. We will serve events like marathon, street festivals, sporting events, or concerts. In situ clients, such as yacht marinas, malls, cinema complexes, etc. could also be served. Registered nurses and doctors will be at venue with ambulances.

Services – HEMS &

The company will provide air medical transportation to patients in Greece and within its operational range. Intra-region air ambulance transportation with highly specialized care is our prime focus. Our service will be in line to emergency air medical transportation, and search &rescue. We will provide bedside-to-bedside facilities and our crews will be with the patient from the initial pick up and stay with them until the final arrival at their destination. Each air medical transport will have minimum of a twoperson crew that consists of a critical care trained flight nurse and a flight paramedic.

Air Medical Transportation: The company will engage experienced and certified doctors and nurses while transporting patients from one location to another.

Aircraft/Helicopters/chartered flights will be equipped with top-of-the-range medical apparatus. The patient will be transported on a modern adjustable Life Port stretcher with appropriate medical equipment. This technology allows the transfer of artificial pulmonary ventilation of an adult or child patient in a very controlled mode.

Search & Rescue: The Company aims to make an agreement with the Hellenic Coast Guard to provide search and rescue support. The Hellenic Coast Guard is responsible for resolving any emergency situation in Greek sea, port, and coastal areas. Search & rescue operation will be activated as soon as the Hellenic Coast Guard alarms us about any emergency. Our company will respond to any emergency as per the agreed levels of service offerings and within pre-defined timelines. Our crews are trained in search and rescue work. We will help to locate and/or rescue sailors from stricken yachts, fishermen swept from rocks, ill or injured crew from passing freight ships, missing and crashed light aircraft and lost hikers.

We will use helicopters/ airplanes for search and rescue operations, depending on the location. Our service will also be effective at night because of our night vision goggle capability.

Air ambulance services

Services - AI, digital

medical and telemedicine Remote Vitals Monitoring: Synchronization of remote smart devices with electronic health record (EHR) and portal for monitoring patient health.

• Collection of vitals or tracking of patient’s health remotely in real-time.

• Maintenance of comprehensive statistical data to understand patient health over time.

We will provide digital medical and telemedicine as part of our preventive and primary care services programme. We will have our digitally equipped with telemedicine stations around local districts and communities, where a medical examination room will be. Patients will be able to talk to a doctor via the station, who will assess patient’s state of health, evaluate test results, write a prescription and recommend accordingly. A Patient can access this service also from their home, office, business area etc.

Our telemedicine platform and call center are staffed by actively practicing emergency medicine specialists who deliver better consultation using modern tools and resources to patients. Telemedicine programme will help to provide ondemand doctors, customized care plans, and will bring healthcare to local communities. The service will include the following features:

Data Security: Patient information will never be stored on third party servers.

•Only authorized personnel will be given access to patient documents and health records.

•Recordings will be stored in authorized electronic medical record (EMR) so they remain confidential.

•The patient will have access to personal EMR. E-Prescription Integration: •Doctors can write prescriptions for patients on the call, just as they would in the office.

•Patients can select from participating pharmacies while still on call.

Session Recording: Doctors will have the ability to record sessions with patients for health records to improve future care.

•Record sessions for patient records or as a complement to patient notes.

•Transcripts will be available in real time for further analysis and stored in EMR.

We can leverage new technologies to make our health care system more proactive, preventive and patient-centered. Acute care, home care, prevention are the new business model that will allow for this systemic shift. From nutrition and exercise, e-health apps and telemedicine to predictive testing we will allocate our resources in the most sustainable and effective way between different levels of prevention.

As many patients face obstacles that make it difficult for them to commit the necessary time and resources to visit their health care provider on a regular basis, digital and telemedicine reduces the burden on patients by eliminating time away from work, childcare concerns, and travel time and costs. Telemedicine and e-health requires certain technologies to connect physician and patient via a secure, high-resolution video for a remote visit, share medical images, send text messages or online chats in real-time, and submit prescriptions to the patient’s pharmacy. Our telemedicine and digital e-health platform will hold the following features: Store-and-forward Technology: Our “store-and-forward” feature gives access patients and physicians to share medical data, images, and patient histories in a secure way.

EMR Integration: Our platform will have direct integration with the patient’s electronic medical record (EMR), so that patient histories are readily available, having records among both in-person, and a flawless remote visit.

Real-time Video Conferencing: This allows physicians to connect with their patients or other providers through secure, 2-way video. Real-time video is the best substitute for an in-person visit, since it allows the provider and patient to interact face-to-face and provides more visual data than a consultation over the phone.

Chat Function: A chat function is alternative medium of talk between patients and physicians in real-time. ePrescribe: Healthcare providers will be enabled to submit prescriptions electronically to pharmacies. No need to clarify a script when the pharmacy can’t decipher a provider’s handwriting.

Services - AI, digital medical and telemedicine

Mobile and Wearable Medical Devices: Patient’s medical condition will be captured through medical devices and the data will be sent to medical professionals at another location through our platform. We will use sophisticated devices to make them easy to carry and easy to use. Some of devices are as follows: Devices

Pulse Oximetry

EKG Digital stethoscope Otoscope Dermatoscope Blood pressure cuff Glucometer Ultrasound

Usage Measures the oxygen level in patients’ blood and their heart rate Records the electrical activity of the heart Listen heart and lung sounds in the body Examine the nasal and aural passages Observe the skin diseases Measure blood pressure Measure glucose in blood Make an image of a person's internal body structures

Reporting and Analytics: The telemedicine platform can report regarding how many remote visits a physician has done, how many different patients have been seen, the most common reason for the visit, how satisfied patients were with their visits, what type of medication was prescribed, costs relating to medications, etc.

Medical device integration: The telemedicine digital platform will connect and communicate directly with mobile and wearable medical devices. Thus the platform will track patient medical data and then share it with physician remotely.

Integrated Billing: The platform will integrate billing system.

This will help physicians to charge and collect payment from patients for a remote visit and even file a claim.

Services - Specialized Medical Assistance

The company will provide emergency medical support to expats, business travelers, groups, and individuals through an independent network of emergency medical personnel.

Our Emergency Medical Response Service (EMS) is available 24/7/365 and is manned by medical professionals. In the event of a medical emergency, trained nurses and rescue members will assess each situation and dispatch the most appropriate medical response transportation via air or by road.

Our doctors, registered nurses, and rescue members will provide the following key services: •Medical advice •Management support for medical evacuation •Medical treatment •Home Care nursing services following an accident •Event status evaluation •Free blood collection and blood transfer if needed

Services - Insurance Products

The company will offer insurance products designed for individuals and their family in any unexpected circumstances. The company will act as a one stop solution in an emergency, to take the patient to hospital/ paramedic centers through ground ambulance or transporting victim from one place to another by air ambulance, or providing anyone the medical expertise at remote place. Our solutions will take care of following benefits: •Obtaining complete and correct patient demographic and insurance information for every trip.

•Sending claims to the correct responsible party the first time, every time, and within a few days of transport.

•Confirmation of prior authorization and check deductibles to reduce manual workloads and expedite clean claims processing.

Our various forms of insurance packages will be as following:

Features

Package – 1

Package – 2

Package – 3

Access to Medical Files in Emergency Help

√

√

√

24-Hour Security Hotline

√

√

√

GPS Tracking Incident or Accident Position

√

√

√

Hospital Allowance

√

√

√

Vital Signs Tele Recording

√

√

√

Immediate Road Assistance Response (IRAR)

√

√

√

Remote Evacuation

√

√

√

Medical Instructions in Case of Illness

√

√

√

√

√

√

−

√

√

−

√

√

−

√

√

−

√

√

−

√

√

Medical Follow-Up

−

−

√

Homecare Services

−

−

√

−

−

√

−

−

√

GPS Tracking and Instruction to Nearest Pharmacy Location for Assistance Video Call in Case of Illness or Emergency

24 Hour Medical Assistance through Telemedicine or eHealth app Refund of the Return Travel Costs if the Trip is Canceled Terror Protection: Cancellation / Protection During Terrorist Attack in the Resort Area Translation of Medical Findings and Therapeutic Measures

Replacement of the Cancellation Fee if the Trip does not Start Vision Care and Hearing Aids

Healthcare in Greece

EKAB (Statistics and problems)

EMS SYSTEMS Greece – EKAB (Statistics and problems) The National Emergency Aid Centre was established in 1985 by Law Regulation 1579/1985 for the purpose of sending specialized personnel to the location of an emergency event and providing immediate assistance and relocating people to the nearest healthcare establishments (hospitals, health centers).

The National Emergency Aid Center receives more than 5,000 calls from the residents of Basin daily, 160,000 calls per month, almost 2 million calls per year. Αbout 30% of these calls refers to a request of medical transportation to a public hospital.

The remaining 70% of calls to National Emergency Aid Center are mainly refers on information about either on duty hospitals or on which hospital their relatives have been transferred to. Also, many people ask for hospital phone numbers, but also general "encyclopedic" information about symptoms or illnesses or first aid instructions, etc.

ELEMENTS According to the Operations Center data, in about one and a half minutes at least one Medical Transportation of patient with ground ambulance is being carried out in Athens ! Everyday, the ambulances of National Emergency Aid Center cross the streets of Attica, making about 1,000 transportations.

25% of the Medical Transportations relate to chronic incidents (for example hαemodialysis) or secondary (for example planned transportation of a patient from a hospital to a hospital or hospital discharges). The rest of the transportations are urgent, but in fact they are not always ... urgent.

600,000

requests per year for transfer to a public hospital

1.400.000

per year the phone calls for information

1 medical evacuation every 1.5 minutes 25% of medical evacuation relate to chronic incidents https://www.aftodioikisi.gr/ipourgeia/trelainoun-to-ekav-5-000-kliseis-tin-imerakiria-zitise-asthenoforo-epeidi-tin-xtipise-to-papoutsi/

EMS SYSTEMS Greece – EKAB (Statistics and problems) EMS SYSTEMS Greece – EKAB (Statistics and problems)

At least one hour, four out of ten patients facing an urgent health problem in Attica have to wait for the ambulance. The traffic of Athens, the paradoxical hospital on-call system and the uninterrupted rescue of other rescuers have resulted in the EKAB of Attica not having improved its services to the patient despite its reinforcement with a new fleet, a digital coordination center and staff.

According to the data presented at yesterday's event on January 14th, the EKAB of Attica serves an average of 21,000 emergency evacuations per month. In the two-month period November December 2018, only 12% of the emergency cases the ambulance reached the patient in less than 15 minutes. From 16 to 20 minutes, the ambulance arrived at 8.7% of the incidents, from 21 to 30 minutes, 17.9% of the patients waited, while in 40.3% of the incidents the waiting for the ambulance exceeded 60 minutes.

In Attica there are only 60 emergency ambulances in the morning (58 in the afternoon and 30 in the night), while at least 100 ambulances should be used to cover the population properly.

Although recently the EKAB of Attica was reinforced with new ambulances with a donation from the Stavros Niarchos Foundation, the number of "active" rescuers is small if one considers that ten rescuers per ambulance are needed to cover all shifts and holidays. And here is the problem of staff movements. It is indicative that out of 1,045 rescuers in Athens, fewer than half (47%) are attempting in the "streets" of the Basin.

34.892 emergencies incidents in Athens

6,89% 11 to 15 minutes 5,13% up to 10 minutes

ΕΚΑΒ Ambulance response time

28,57% 16 to 30 minutes

21,12% 31 to 1 hour

40,29% Over 1 hour

Number of ambulances and ambulance ICU units for emergencies in Attica 60 ambulances in the morning shift

http://www.kathimerini.gr/1004816/article/epikairothta/ellada/perimenontas-to-as8enoforo

58 ambulances in the afternoon shift

30 - 31 ambulances on a night shift

EMS SYSTEMS Greece – EKAB (Statistics and problems)

It is also worth mentioning that our 23,336 fellow citizens have been transported by EKAB ambulances. in 2018. From these: Hospital Discharges: 2,332, Emergencies: 15,978, Transportation at outpatient clinics: 2,061, Medical transportation from hospital to hospital (chronic incidents): 171, Other medical transportation of chronic incidents: 2,794. Thus, 68% of the transportation refers to emergency situations.

The medical transportations of 2018 per department A total of 23.208 were the medical transportations from Thrace’s EKAB in the departments of Evros, Rodopis, Xanthi according to the research of “Χ”, based on the elements of Thraces EKAB. This figure refers to 11.677 medical transportations at Evro, 4.766 at Rodopi and 6.765 at Xanthi.

More specifically, in the first quarter of 2018, the National Emergency Assistance Center in Thrace provided first aid and made 5,791 civilians to ambulances and mobile units at local hospitals and health centers. Detailed: Evros 2.900, Rodopi 1.185, Xanthi 1.706.

In the second quarter of 2018, first aid was given and 5,846 of medical transportation via ground ambulances and mobile units were dispatched at the local Hospitals and Health Centers in Thrace. Further details: Evros 2.972, Rodopi 1.194, Xanthi 1.680.

In the third quarter of 2018 , first aid was given and 5.592 of medical transportation via ground ambulances and mobile units were dispatched at the local Hospitals and Health Centers in Thrace . More details: Evros 2.863, Rodopi 1.072, Xanthi 1.657.

In the fourth and last quarter of 2018, first aid was given and 5.979 of medical transportation via ground ambulances and mobile units were dispatched at the local Hospitals and Health Centers in Thrace. Further details: Evros 2.942, Rodopi 1.315, Xanthi 1.722.. https://www.evros24.gr/ekav-thrakis-paron-me-23-208-diakomides/

EMS SYSTEMS Greece – EKAB (Statistics and problems)

Recording and analysis of incidents managed by the EKAB took place in Thessaloniki.

45 incident management parameters were analyzed, which included data on the circumstances of the incident, ease of communication and rescue interventions.

More than 1000 incidents were analyzed as a sample, all from Thessaloniki, and in particular from the 5 ambulances bases of the EKAB. The majority of incidents, (64%) were recorded in the afternoon and night shift, ie from 3 noon until 7 the following morning.

The study finds serious problems in the geographical distribution of the EKAB's strength, which does not correspond to either the distribution of the incidents or their volume.

For example, in the center of Thessaloniki - where the largest volume of incidents is recorded - there is no ambulance base, while the Evosmos area is incomplete.

The need for upgrading navigation features of the service is recorded: 152 incidents were transmitted as urgent, but they were not, and of the 313 cases sent as non-urgent, 16 emerged urgently and 3 over-urgent!

36% of cases were received without or with little help, ie patients who could board the ambulance by walking and did not need a stretcher.

Of the approximately 1,000 cases investigated, 365 - that is, 37% involved patients who had to be transported with a chair from the point of the call - often from a high-rise apartment building - to the ambulance.

EMS SYSTEMS Greece – EKAB (Statistics and problems)

The statistics of ΕΚΑΒ Tirnavos base movement prove its great contribution to the citizens of the Municipality of Tirnavos.

More specifically, in November 2016, the EKAB Base of Tirnavos made 32 shifts and dealt with 40 incidents and in December made 32 shifts and 58 incidents. Furthermore, in January 2017, 37 shifts took place and 56 incidents were dealt with, while 37 shifts took place in February 2017 and 67 incidents were dealt with.

These data show that the EKAB Base of Tyrnavos is not a paper structure, but in the last few months it offers the highest levels of medical transportations from the Health Center of Tirnavos to the health structures of Larissa. If someone can think that since 1995 until about October 2016 there was no transportation from the Health Center of Tyrnavos, it is perceived how important and positive development is the installation of the EKAB Tirnavos ambulance base.

https://ekabitikanews.blogspot.com/2017/04/blog-post_7.html

EMS SYSTEMS Greece – EKAB (Statistics and problems)

The sample of the study was all the incidents handed over by the General Hospital of Corinth during the year 2014. In total, 678 transprtatuions were recorded. As regards the frequency of transportations, July (12.8%) and August (9.3%) showed the highest incidence. In comparison to the clinics that performed the transportation, the recording showed that the highest percentage was obtained from the cardiology clinic (29.5%) and the surgical emergency department (TEP) (21.4%). The cause of transportation remains unknown or not reported for the 57.8% of the incidents, while 42% of the listed transportationS show high rates of coronary transfusion (19.9%). A high percentage (23.3%) of transportations are reported by men transported by the surgical of TEP, with a reported traffic accident, while a low rate of transportations (0.9%) occurs in orthopedic cases in men and refers to the transfer of special cases to a tertiary hospital.

The results of the study demonstrate the needs and capabilities of a particular hospital and could be compared to other adjacent prefectures so that a more rational management of the existing health structures to emerge, for the benefit of the citizens and with the purpose of optimal provision of health care.

http://journal-ene.gr/%CE%BF%CE%B9-%CE%B1%CE%BD%CE%B1%CE%B3%CE%BA%CE%B5%CF%82%CE%B1%CE%BD%CE%B1%CF%80%CF%84%CF%85%CE%BE%CE%B7%CF%82-%CE%B4%CE%BF%CE%BC%CF%89%CE%BD%CF%86%CF%81%CE%BF%CE%BD%CF%84%CE%B9/

EMS SYSTEMS Greece – EKAB (Statistics and problems)

Evritania: Transfers to Karpenissi with mules, bulldozers and agricultural vehicles ...

Evritania: Transfers to Karpenissi with mules, bulldozers and agricultural vehicles ...

The transportations – emphasized that- last for six hours and despite the commitment of the EKAB and the Minister of State administration, the problem has not been solved.

"Which patient with severe heart disease will survive? Which patient with a serious infection will survive? And which patient from a traffic accident? ", Wonder about all these the Bureau of POEDIN. The area has many visitors due to natural beauty, but especially in winter the road network is inaccessible.

Decommissioned During the recent visit of the EKAB administration, the residents showed the three-years out of order ambulance of the Center in Granitsa.

Revealing is the answer given to their requests by the EKAB administration: "Due to the limited staff of the EKAB of Karpenisi, which is responsible for the area for urgent pre-hospital care outside the city of Karpenissi and other areas of the prefecture, with the well-known geographic specificities, it is impossible under the present circumstances to place ambulances in western Evrytania for meet needs ".

Staff According to the administration,EKABS main concern is to strengthen the Karpenisi Sector through the recruitment of new staff and the strengthening of Health Centers with doctors and ambulance crews. https://www.iatronet.gr/eidiseis-nea/perithalpsi-asfalisi/news/42542/evrytania-diakomides-pros-to-karpenisi-me-moylaria-mpoylntozes-kai-agrotika-aftokinita.html

Market Research

Greece: Age distribution from 2007 to 2017

This statistic depicts the age distribution of Greece from 2007 to 2017. In 2017, about 14.21 percent of the Greek population fell into the 0-14 year category, 65.39 percent into the 15-64 age group and 20.4 percent were over 65 years of age.

Greece: Median age of the population from 1950 to 2050 (in years)

The statistic depicts the median age in Greece from 1950 to 2050. The median age of a population is an index that divides the population into two equal groups: half of the population is older than the median age and the other half younger. In 2015, the median age of Greece's population was 43.3 years.

Employment of nurses and

Crete

Number of nurses and midwives per 1,000 inhabitants

2,0

North Aegean Peloponnese

1,4

West Greece

West Macedonia

Peloponnese West Greece Continent West Macedonia East Macedonia

4,3

2,3 2,7

4,8

3,6

2,6

East Macedonia

North Aegean

2,5

2,2

Continent

Crete

3,5

3,1

3,9

Composition of employment by region

5,40% 1,50% 1,20%

3,30% 2,00% 5,00% 1,30% 4,30% 6,60% 1,90% 4,70%

43,70%

19,10%

midwives in Greece per region

Greece has the lowest number of nurses and midwives per 1,000 inhabitants (3.5 nurses and midwives)

The tragic subsistence of the NHS. Of the 44,900 organic positions of NHS hospitals, 29,000 are covered, while actual needs are estimated to be three times higher.

80.000

74.300

70.000 60.000 50.000 40.000 30.000 20.000

44.900 29.000

10.000 0

http://www.kathimerini.gr/911500/article/epikairothta/ellada/se-apognwsh-oi-noshleytes

Market Research We have undertaken a detailed market research to understand the scope of Emergency Medical Services in Greece.

The market research is focused on demographics, high-income districts in Greece, accidents and fatalities, tourist arrivals in different regions, and infectious disease frequency. Research on accidents was done in respect of road accidents, naval accidents, and accidents occurring at the workplace.

The research is divided into five sections: Air Medical Transportation data in Greece, region specific research, historical data analysis for different accidents, tourist arrivals, analysis of high income regions and finally, inferences.

5.1 Air Medical Transportation Data in Greece Key Figures from the National Center of Immediate Help (EKAB)

Ionian islands

•2.000-2.500 air medical transfers/year out of 15.531 missions in the last 10 years

Crete

Argosaronik os Cyclades

•14.794 (35.22%) originated at Cyclades •3.509 (24.40%) originated at Dodecanese •3.254 (22.5%) originated at the rest of Aegean •1.479 (10.2%) originated at Ionian islands •634 (4.3%) originated at Crete •346 (2.5%) originated at Argosaronikos i. Absolute indication for air ambulance 16% ii. Relative Indication 32.8% iii. 6.2% without any medical necessity or indication

rest of Aegean Dodecanese

Market Research 5.2 Region specific findings of attributes Population (%) REGION OF KRITI REGION OF SOUTHERN EGEO REGION OF NORTHERN EGEO

6% 3% 2%

REGION OF ATTIKI

35%

REGION OF PELOPONNISSOS

5%

REGION OF WESTERN GREECE REGION OF IONIAN ISLANDS

6% 2%

REGION OF CENTRAL GREECE

5%

REGION OF THESSALIA REGION OF IPIROS REGION OF WESTERN MAKEDONIA

7% 3% 3%

REGION OF CENTRAL MAKEDONIA

17%

REGION OF EASTERN MAKEDONIA

6%

Figure-1: Resident Population by Region, 2018 (estimated) Figure-1 shows the estimated resident population of Greece in 2018, by its region.

Figure-2: Number of Infectious Diseases Reported in Regions, 2016 Figure-2 shows different types of infectious diseases that were reported in 2016 in different regions.

Accidents at Work Πελοπόν-νησος (Peloponnisos)

Στερεά Ελλάδα (Central Greece)

Δυτική Ελλάδα (West Greece) Ιόνια νησιά (Ionian Islands)

Θεσσαλία (Thessaly) Thessalia

Ήπειρός (Ipeiros)

Δυτική Μακεδονία (West Macedonia)

Κεντρική Μακεδονία (Central Macedonia)

Ανατολική Μακεδονία & Θράκη (East … Κρήτη (Crete)

Νότιο Αιγαίο (Southern Aegean Sea) Βόρειο Αιγαίο (North Aegean) Aττική (Attica)

170

Figure-3: Accidents Occurred at Workplace by Regions, 2015

303

91

246

184

Figure-3 shows accidents that were recorded at workplace in different regions of Greece in 2015. It is observed that regions with higher population reported higher number of infectious diseases and more accidents. Regions with higher population also record higher number of accidents and higher number of diseases.

102

151 175 155

87

806 441

1548

5.3 Historical data analysis 5.3.1

Accidents Data

Figure-4: Road Traffic Accidents, 2010 - 2017

1,800

20,000

1,600

18,000 16,000

1,400

14,000

1,200

12,000

1,000

10,000

800

8,000

600

6,000

400

4,000

200 0

2,000 2010

2011 Dead

2012

2013

Heavy Injuries

2014

2015

2016

2017

Slightly injured (measured in right axis)

0

*Slightly injured is measured in the right axis of the graph Figure-5: Road Accident Fatalities, 2010 – 2017

5.3 Historical data analysis 5.3.1 Accidents Data

Market Research

Figures 4 to 10 show data on road traffic accidents and naval accidents. Findings are as follows: Figure-4 shows road accidents decrease overtime. Fatalities from road accidents are also falling in Greece as shown in figure-5. This is a positive sign and shows that the steps taken by the Government towards ensuring safety are yielding some results. Nevertheless the numbers still remain high and it will need professional EMS services to respond to any emergency situations immediately.

Naval accidents are continuously falling, according to data shown in figure-6. But 83% of the merchant ship accidents in 2017 occurred in Greek waters (figure-7). This data points to the fact that merchant ship accidents are still high and calls for more steps from the Government and the owners to make their operations safe. EMS services will play an important role in responding to any emergency situations arising in merchant ships operating in the Greek shipping lanes.

Crews were injured mostly while they were on board, and passengers were injured mostly when they were in port areas (figure-8). Severity of accident was also higher in port areas (figure-9).

Market Research

5.3 5.3.2

Historical data analysis Tourists Arrival Data

2,000,000 1,800,000 1,600,000 1,400,000 1,200,000 1,000,000 800,000 600,000 400,000 200,000 0

2015

2016

Figure-10: Tourists Arrival on Various Locations in 2015 and 2016 (January-June)

5.3

Market Research

Historical data analysis

5.3.2

Tourists Arrival Data

Locations Athens

Aktion

Zakynthos Heraklion

Thessaloniki Corfu

Patras Chios

West Macedonia

West Greece

Thessaly

Southern Aegean Sea

Peloponnese

North Aegean

Ă?peiros

Ionian Islands

East Macedonia & Thrace

Central Macedonia

Crete

Attica

Figure-11: Relative Prosperity of Regions, 2015 Prosperous region as measured in terms of per capita GDP of people in those regions. In figure-11, regions above the zero line are relatively more prosperous than others.

High High

High

Igoumenitsa

Central Greece

-4,000

High

North Aegean

Promachonas

-2,000

Crete Central Macedonia Ionian Islands

Skiathos

6,000

0

High

Low

High

Other stations

2,000

Ionian Islands

Epirus

South Aegean

8,000

4,000

High

Rhodes

Chania

10,000

Attica

South Aegean

Santorini

5.4 Prosperous Regions

Tourist Arrival Intensity

Kos

Mytilini

Table-A: Location-Region Mapping

Region

Evzonon Kakkavias Crystallopigi

North Aegean

South Aegean Crete

Central Macedonia Epirus

Peloponnese

North Aegean Central Macedonia Epirus Western Macedonia

High Low

High

High Low Low High

High Low

Low Low Low

EMS services will be provided in those areas where tourist arrivals are high.

Market Research

• In the first section we found there is a strong positive relation between population numbers, accidents in the workplace, and infectious diseases frequency.

• Port & marine areas have a higher frequency of accidents and therefore will have more requirements of emergency medical services.

• There are regions in the country where income is higher than other regions.

These variabilities and other factors in those regions indicate where air/ground ambulance services are affordable.

5.5 Chart Inferences

      

Ionian

Islands

Central

Greece

       

Low population Spread of infectious disease is low Accident rate at workplace is low Major airports Major seaports Tourist arrivals high High income region

Residence of moderate number of population Spread of infectious disease is high Accident rate at workplace is moderate Surrounded by sea and land; also has islands Mountainous land area Several medium size seaports Tourist arrivals low Relatively high prosperous region

The table near shows demography, disease spread, accident, tourist arrival etc. statuses of our target market.

Crete

       

Residence of moderate number of population Spread of infectious disease is moderate Accident rate at workplace is high An island Major seaports Major airports Tourist arrivals high High income region

Market Research

Central

Macedonia

Attica

        

      

Residence of large population Spread of infectious disease is high Accident rate at workplace is high Surrounded by sea and land Major seaports exist Tourist arrivals high Low income region

Urban area with high density population Spread of infectious disease is high Accident rate at workplace is high Surrounded by sea and land; also has islands Mostly urban districts with suburban area Major seaports exist Location of major airport Tourist arrivals are high Most prosperous region of the country.

South

Aegean

     

Low population Spread of infectious disease is low Accident rate at workplace is moderate Seaports localized Tourist arrivals high High income region

Marketing Strategy

S W

− − − − − −

− − − − −

Strong technology infrastructure that will help to scale-up operations quickly.

Tie-ups with leading service providers will help to deliver services efficiently.

Wide range of evacuation and medical emergency services that includes interfaces (ground ambulance), telemedicine, air ambulance and insurance products.

We operate as a licensee of Europ Assistance, one of the largest and most recognized emergency medical care providers globally.

Experienced Management team with depth of experience in all areas of Emergency Medical Services.

Multi location footprint across the country that will enable insurance companies or individual clients to avail our services across different locations.

The company is in a CAPEX cycle and it is forecasted that the business turnover will increase.

However, due to any unforeseen events, the expected revenues may not accrue which can cause downturn cycles.

Since there are multiple business lines the CAPEX cycle can be longer than anticipated. Therefore adequate funding to run the business effectively is required.

The business of Emergency Services is always under regulatory observations. If we fall short of regulatory benchmarks it may put the business under sanctions.

Our team is experienced in the business but there are multiple areas of business. Since some of these businesses are cyclical, there are chances that a particular business line may not do very well during any given Financial Year.

Maintaining operational metrics is a key to a successful Emergency Management Services (EMS) Business. Given the tough environments and time pressure within which the team will operate, there are chances that operational parameters may slightly fall below expectations. However, since we have a well-defined process in place, the chances of falling behind operational parameters will be less.

SWOT Analysis

O T

−The tourism industry in Greece is seeing an uptrend. Both domestic tourists and international tourists visit the country. Tourism is an important segment of our target market because of our tie-ups with Insurance companies.

Tourists availing insurance packages from our clients will be availing our services whenever there is a requirement. −The business is trying to establish digital eHealth stations with telemedicine capabilities in local communities, with the objective to give easy access of healthcare to people. Company will setup these telemedicine stations in franchise model. Successful implementation of franchisees will penetrate the local healthcare market very fast. −Our networks respond to, stabilize, and transport trauma patients involved in situations, such as automobile accidents, injuries from falls, and violence. Emergency medical service is such a job where health care provider’s performance gets better every time with experience. “Learning by doing” helps our medical assistants acquire skills. We provide space to our medical staffs to learn from practical scenarios. This gives them the opportunity to acquire great deal of experience which in turn helps us to give better services to patients.

−As emergency medical service is all about providing medical services at right time, it is necessary to have skilled medical assistants within network. A medical staff working for many years within a system will consistently improve their performance. Attrition of experienced personnel is a threat to our business model. −Our model is franchise based. We will scale our business through franchisees. We assumed we will start franchising a year after starting operations. Since, this business is highly capital intensive and if we were unable to start the franchise model we will be unable to open telemedicine health care stations by investing more money. This will affect our scale of operations and revenue directly. −In 2017, 30.5 million tourists arrived in Greece. Our revenue depends on tourists and therefore any recession in Europe or globally will affect us negatively.

Marketing Strategy

Marketing methodology

Google AdWords Strategy objective: We will use Google AdWords as one of our digital marketing channel. AdWords will bring us in front of the targeted base, when someone searches for terms related to our product or service, or when they're on a website with content related to our business.

Execution strategy: Several phrases based on our products & services will be placed to generate relevant key words. The most relevant keywords that will be added to the plan based on these three factors, ďƒ˜ Average Monthly searches - keywords with min. 1000 monthly searches will be taken. ďƒ˜ Competition - will look for low competition keywords for good return on investment and increase chances of high ranking. The low competitive keywords may not generate much traffic as high competition keywords, but will improve conversions. ďƒ˜ Suggested Bid - the bid for optimal click through rate.

After running the campaign, we will track whether the words have its prominence for longer amount of time or not; Click-through-rate is high or not, and average position of our ad in pages while anyone searching words or phrases related to our product & services.

The most significant findings are the follows: 1. Advertising accounts for about 39% of short and medium-term sales. In television advertising 33% of these sales are attributed, the highest percentage of any other viewing channel. Comparatively, the 22% came from Internet search engines, the 12% from internet display, affiliate Marketing 10%, printed promotion 8%, radio advertising 3% and 1% outdoor advertising.

2. TV viewing has enhanced direct response to other advertising channels as well.

Television advertising accounted the 31% of the sales that came from the phone, the 35% of sales that came directly from the point of sale and the 32% of sales came from online marketing channels.

3. TV viewing has also boosted the indirect response of customers to online viewing channels. More specifically, television advertising produced 32% of sales through online search engines, the 30% of sales through display and the 20% of sales from affiliate marketing.

Marketing methodology

Television Advertising

Strategy objective: First and foremost, objective of our marketing activities is to promote our product and services to a large number of people at shortest time. No other strategies except television advertising can make this possible. We are not just concerned about our product & services sales through TV advertising; we will use this campaign to create brand, to make people aware of our product, as well as it will act as our sales channel.

The most significant findings are the follows: 1. Advertising accounts for about 39% of short and mediumterm sales. In television advertising 33% of these sales are attributed, the highest percentage of any other viewing channel. Comparatively, the 22% came from Internet search engines, the 12% from internet display, affiliate Marketing 10%, printed promotion 8%, radio advertising 3% and 1% outdoor advertising.

2. TV viewing has enhanced direct response to other advertising channels as well. Television advertising accounted the 31% of the sales that came from the phone, the 35% of sales that came directly from the point of sale and the 32% of sales came from online marketing channels.

3. TV viewing has also boosted the indirect response of customers to online viewing channels. More specifically, television advertising produced 32% of sales through online search engines, the 30% of sales through display and the 20% of sales from affiliate marketing.

Marketing Strategy

Execution strategy:

ďƒ˜ Each advertisement will be 10-30 seconds long to spread the message clearly and effectively. ďƒ˜ Initially we will advertise on a regional scale in respect of our operational market. Later we will promote our services nationwide. This will consume less cash at the early stage. ďƒ˜ The campaign will run 5-6 times at the 6-10 pm slot during October to March.

Frequency will be 2-3 times during April to June and will be 8-9 times during high season of July to September.

Advertising expenditure in Greece from 2008 to 2015, by medium (in million euro)

Marketing Strategy

Marketing methodology

Radio Advertising Strategy objective: We will use radio advertising solely for our emergency services. Repetitive messages through radio campaign will give a greater penetration. When people will have need of basic life support or advanced life support or immediate evacuation, they will call at our helpline number to ask for support.

Execution strategy:  Campaign will air about our emergency medical services like basic life support, advanced life support, air evacuation etc. with focus on our helpline number.  Messages will be of 10-30 seconds.  We will run regional specific campaign.  We will choose from either one or two radio stations from the most popular ones.  Ads will be placed in equal slots between morning peak, evening peak and non-peak.

The larger audiences in Attica Radio stations: 3 REAL FM (20 spots), MELODY (20 spots), SKAI (20 spots) Cost: 2.400,00 € Total spots: 60 impressions Spots duration: 20 sec Average cost per spot: 40.00 € Schedule: 2 weeks (Monday-Friday)

Region Athena Evia Thessaloniki Crete Dodecanese Rhodes Chania Hellas Evros Peloponnesus Agrinio Thessaly Ionian Islands Northern Greece

Number of stations

TRANSMISSIONS SPOT

DAYS

5

183

7

2 3 3 5 4 2 5 43 5 5 2 4 3

49 105 74 210 187 21 171 187 179 116 91 84 56

7 7 7 7 7 3 7 1 7 7 7 7 7

DURATION SPOT 20" 20" 20" 20" 20" 20" 20" 20" 20" 20" 20" 20" 20" 20"

cost 444,00 € 785,60 € 1.200,40 € 712,80 € 885,00 € 218,00 € 1.431,20 € 864,84 € 466,33 € 691,20 € 516,80 € 477,27 € 279,20 € 1.058,00 €

More than 57% of Athens residents listen to various radio stations daily We select combined radio programs to optimize the promotion of your products to targeted groups of people at an economical cost. we have prepared over 30 different program combinations to have effective advertising penetration into the consumer community that we are most interested in.

Social Media Advertising

Facebook, Twitter and LinkedIn Ads Strategy objective: We will use this type of ads to promote our product and services to individuals personally. This campaign will be target audience centric. Our objective is to maximize conversions from our target audience.

Execution strategy:  Location - we will start our campaign for the Attica region first.

Then we will spread our campaign to Central Greece, Central Macedonia, Crete, the Ionian Islands, the South Aegean, Western Greece, and Western Macedonia accordingly. The campaign will execute to local customers first.  Age Group and Gender - Our target age group is 18-65 years.

Both men and women are part of the target audience.  Language - Ads will be viewed in Greek and English.  Targeted Customers - The target customers will be chosen from behavior, and interests.  Placement - In placement edit placement will be chosen so that people can look at the products from any device. The platforms chosen are Facebook, Instagram, Audience Network, Twitter and LinkedIn.

True View in-stream ads Strategy objective: In-stream ads will deliver our message through digital platforms to our target audience in a classic TV-like format. The ads will run on videos served on YouTube or on a collection of sites and apps in the Google Display Network (GDN). These ads will also run on YouTube videos that are embedded on other sites or apps. Ads can also appear on Android and iOS YouTube apps, m.youtube.com (on iPad and Android), and on connected smart TVs. Execution strategy:  Videos will be of 15-30 seconds and contain same content as of TV advertising.  Viewers can choose to skip the video ad after 5 seconds. If they choose not to skip the video ad, YouTube will broadcast the full ad video.  Click on videos will redirect viewers to our website.

Marketing Strategy

Social Media Advertising Search Engine Optimization (SEO):

Daily internet usage rate in Greece by age group

Strategy objective: Our objective is to place our website 55in first page of Google or any other search engines results when a search is related to our product and services. This will be done by search engine optimization. 45-54 SEO will uplift our site and also bring it to the top of the search engine results according to its relevance in 35-44 respect of the search.

Need of SEO campaign:  If a site appears higher up in the results, it gets more traffic to their pages, and so potentially more business.  The first position on Google search results on desktop had a 34.36% click through rate and 31.35% on mobile search according to Advanced Web Ranking 2015.  65% of smartphone users agree that when conducting a search on their smartphones, they look for the most relevant information regardless of the company providing the information.  51% of smartphone users have discovered a new company or product when conducting a search on their smartphone.  Google gets over 100 billion searches a month and on average its first page result contains 1890 words. Word Stream published in 2016 that search queries are four words or longer.

68,00% 77,00% 89,00%

25-34

93,00%

16-24

89,00% 0%

70% 60% 50% 40% 30% 20% 10% 0%

20%

40%

60%

80%

100%

Internet usage frequency among individuals in Greece

66%

57%

9% once a week (including every day)

Daily

At least once a week (But not every day)

3% Less than once a week

General Information • The total population of Greece is nearly 11 million people • Official language is Greek (99%) • Other languages: English and French (1%) • Ethnic groups: Greek 93%, other (foreign citizens) 7%

Marketing Strategy

Social Media Usage Active social media users – 5.30 million (+10% since last year) – 49% of the population Active mobile social users – 4.40 million (+16% since last year) – 40% of the population

The number of active Facebook users is 5.30 million.

• Female profiles – 47% • Male profiles – 53%

Market Research

Market Research

Market Research

The media market in Greece is characterised by low trust and low use of traditional media (including a weak newspaper market) alongside some of the highest use of social media and digital-born outlets in our study.

TOP BRANDS % WEEKLY USAGE (ONLINE)

TOP BRANDS % WEEKLY USAGE (TV, RADIO AND PRINT)

Financial Forecast Revenue assumptions:  The company will operate in a two thronged direction, one is central operations and the other is regional operations.  Ambulance operations, air ambulance operations, home care, nurse app. scheduling, and medical evacuations will be operated centrally. These are currently the company's direct revenue streams along with revenue from brand value charges to franchisee and eHealth app. services to car rental companies and the auto market. We will actively pursue to sign contractual agreements with health insurance companies, travel insurance companies, communities and parishes, corporations, event agencies etc.. Services such as eHealth digital and telemedicine, primary healthcare and home care, ambulance etc. will be delivered through our company's eHealth facilities and franchisee network stations.  The company will initially establish in Greece 10 eHealth stations and a network of 20 franchise eHealth stations.

These stations will be segregated into three levels according to population density of urban areas. The company owned stations will be located in 5 highly density urban areas, 3 in medium, and 2 in low dense areas. Our initial franchise network will operate 6 stations in high density areas, 7 in each medium and low dense area.  We plan to open eHealth stations in Athens, Piraeus, Peristeri, Thessaloniki, Patras, Larissa, Marousi, Heraklion, Chania, and Rhodes within December 2019 to start the franchise model in short time.  Company will earn revenue from its own stations and 20% commission from franchisee stations.

 Company’s brand value will be charged 30,000€ to franchisees.  Ambulance service revenue stream o Tier-1 stations will have highest usage of the ambulance services. o Tier-2 stations will have 70% and o Tier-3 stations will have 36% usage of ambulance services compared to Tier-1 stations. o Patients that will be served exclude contractual agreement numbers. o Each ambulance transportation, will cost from 40€ + 24% VAT to users.  EMS – Health Insurance, Auto Insurance, Re-Insurance and Travel Insurance companies contractual agreement revenue stream o Initially, we derive an approximate number of yearly contracts in Greece as follows, o Based on published data, in 2017 the Greek market was worth €1.9 billion in life insurance premiums. About 16% went to health insurance premiums (except hospital coverage), so about €300million was spent in health insurance premiums. o The average health insurance premium in other OECD countries was 213€. Greeks privately insured pay less than 2/3 of the average European on health care on average approximately €140 pp. spent on health insurance premium. o The local market has about 2 million health insurance contracts. We aim to capture 5-10% of the market for our services directly through health insurance companies and travel insurance companies or directly through re-insurance. o The premium for our services for a 10k cover agreement will be charged from 3€pp.

Revenue assumptions:

Air ambulance medical evacuation o Will also be available for individuals for repatriation, medical evacuation, transfers, etc. Evacuations cost 25,000€+ depending on the circumstances i.e. deductibles, etc./per individual contract.

Emergency Medical Services o We intent to actively pursue EMS contracts with Cities/Municipalities/Government, local parishes, sports venues, malls, ports and airports, large corporations and other, for a minimum cover of at least 500 persons initially y-o-y for these types of services. The company is charging an annual premium fee of €55 for each person in this type of contract.

Medical and Nurse Home Care Services - revenue stream: o Tier-1 stations will have the highest number of patients who will avail home care services. o Tier-2 stations will have 70% and o Tier-3 stations will have 56% of patients in respect of Tier-1 stations. o The service will be monthly and will be charged min. 75€ per month to each patient according to the needs.

 Nurse Registration revenue stream o Registered nurses can subscribe to the Emergency Help app either on a yearly basis or by month. We aim to register one-third of total nurses on a yearly plan and for the rest to subscribe per month. o We aim to cover 80% of nurses on a yearly or monthly plan for the Emergency Help app. o Yearly subscription is 30€ and monthly subscription is 5€.

Financial Forecast

7.1 Assumptions

 Payment from Insurance Cos., from its insured member revenue stream o These revenues will be generated from cases who avail Emergency Help’s services and insecure of other insurance companies. o Tier-1 stations will have highest number of emergency cases. o Tier-2 stations will have 70% and o Tier-3 stations will have 56% of cases in respect of Tier-1 stations. o Insurance companies will be charged 180€ per case for availing emergency medical services.  eHealth, digital Health and Telemedicine service revenue stream o As mentioned above, around 2 million people buy health insurance in Greece. We are aiming to provide eHealthtelemedicine services to an additional 2% of these covered excluding other contracts. o Tier-1 stations will have highest number of patients. Tier-2 stations will have 70% and Tier-3 stations will have 56% patients in respect of Tier-1 stations. o Patients will be charged min. 30€ for these services.

 Construction workstation ambulance service revenue streamo Each contract is for one quarter. o Tier-1 stations will get highest number of contract. o Tier-2 stations will have 70% and o Tier-3 stations will have 66% contract in respect of Tier-1 stations. o One contract will be charged 7,000€ for one quarter.

Rent-a-Car Emergency app revenue streamo The ‘Rent-a-Car’ app will be activated at €5 for 6 days and 20€/mo. o We assume that users will activate the app 60% time during October to March, 40% time during April to June, 90% time during July and August, and 80% time during September. Cost assumptions: o 2 helicopters in 2018, 4 helicopters in 2019, 5 helicopters in 2020, and 5 helicopters in 2021 on lease. o Marketing expense is assumed at 5%, 6%, 7%, and 8% of total revenue of company in 2019, 2020, and 2021 respectively. o Company’s owned eHealth, digital and telemedicine stations will pay rent, phone & internet, utilities, fuel cost, and other medical and nonmedical expenses. o Each eHealth, telemedicine station will have a dedicated ambulance and at least 3 drivers, 3 rescue member, and 3 nurses to cover its operational needs. The cost required to acquire and establish each station, is around 90,000€. We aim for 24/7 operational mode. Ambulances, telemedicine equipment, and technical equipment are depreciated at 20% rate. Loan interest rates are calculated at 6% for 20 years.

Financial Forecast

7.2 Funding Sources

Market Conditions

Market Conditions

Greece after many years of financial crisis and IMF memorandums is still in a very precarious financial situation due to an excessive public debt, high taxation, capital controls, and public sector inefficiencies. This explosive mix has kept serious investors from investing in a meaningful way in projects, with the exception of foreign funds that have invested in the health and tourism sectors, and generally in real estate. In 2017 the EIF – European Investment Fund – capitalized 9 venture capital schemes channeling more than €300m with other private investment entities to support Greek SMEs. Many EU programmes are also available for SME financing such as COSME, InnovFin and H2020. Currently the country seems to be going into an extended campaign period for general, local and EP elections in 2018 or early 2019. This undoubtedly creates opportunities and risks for the company to place on the table a new business proposal with such a wide scope of operations.

Our companies (air ambulance and ambulance) have been operating for many of years, so there is proof of record. Both companies have been funding their operations from own capital. However ENA – Emergency Nurse Assistance is a new nonprofit, and it will be challenging to finance. We have been in contact with independently managed funds in Europe and elsewhere, to capitalize on an abundant supply of capital for edgy projects, so as to scale up, and we are also approaching the EquiFund and private equity and venture capital ecosystem. The ENAplus Market of the Athens Stock Exchange is certainly an equity option, as well as the possibility of a change of Headquarters’ to another EU country, where taxes and the general finance environment will be more positive. Certainly the call centers can be relocated; aviation has a wider areal scope than strictly Greece and home care and telehealth are areas of marketing and development with a wider geographical potential. On the other hand R&D is two areas that due to their favorable tax status in Greece can be the area where we can expand and invest in Greece, particularly in the area of InsurTech and Blockchain for the EMR sectors. Ambulances will be purchased through a bank loan and air assets with long term leasing. Real estate will also be through lease/buyback schemes. The diagram that follows indicates where opportunities and challenges lie.

7.3 Financial Highlights by Year Forecasts by Year The company achieves positive operating income from 2019.

45.000.000 €

REVENUES

40.000.000 €

Expenses

35.000.000 € 30.000.000 € 25.000.000 € 20.000.000 € 15.000.000 € 10.000.000 € 5.000.000 € - €

2019

2020

2021

2022

2023

Ambulance REVENUES new ow ned (new purchase) 2nd hand ow ned (new purchase) total (new purchase) Total new ow ned ambulances Total 2nd hand ow ned ambulances Total Number of ow ned ambulances

14.000.000 € 12.000.000 €

AV serv ed per day per ambulance Grow th in contract Number of transportations serv ed per day Number of transportations serv ed per month (22 Per contract charges (in €)

10.000.000 €

Revenues (in €)

8.000.000 €

COST OF SALES cruw cost (per abulance per day) crue cost total fuel & maintenance cost (per abulance per day) fuel cost total other costs (per abulance per day) other costs total ambulance usage related Expenses (in €)

6.000.000 € 4.000.000 € 2.000.000 € - €

2019

2020

REVENUES

DEPRECIATION

2021

2022

COST OF SALES

GROSS MARGIN

2023

DEPRECI ATI ON new ow ned ambulances per year new ow ned ambulances Total Cost new ow ned ambulances per year Ambulance needed per year Cost 2nd hand per ambulances Total Cost 2nd hand ambulances per year DEPRECI ATI ON % per year Final DEPRECI ATI ON cost ow ned ambulances per total

GROSS MARGIN

2017

1

2018

1 1 0 1 5 0 5 140 45 €

75.600 2017

120 43.200 45 16.200 30 10.800 70.200

1 2 3

9 12 18

2020

2021

2022

2023

2 2

20 22

15 37

13 50

10 60

10 70

5 1 10 280 45 €

7,00 1 101 4.312 50 €

7,00

7,50

8,00

8,00

207 7.252 58 €

326 10.500 62 €

440 13.440 65 €

520 15.680 68 €

151.200 2018

2019

120 0 45 0 30 0 -

45000

2.587.200 2019

120 583.200 45 272.700 45 218.160 1.074.060 74.000

53.000

5.047.392 2020

120 1.274.400 50 531.000 42 446.040 2.251.440 74.000

7.812.000 2021

120 1.879.200 55 861.300 40 626.400 3.366.900 74.000

10.483.200 2022

120 2.376.000 55 1.089.000 40 792.000 4.257.000 74.000

12.794.880 2023

120 2.808.000 55 1.287.000 40 936.000 5.031.000 74.000

20 15 13 10 10 29.000 € 29.000 € 29.000 € 29.000 € 29.000 € 580.000 € 435.000 € 377.000 € 290.000 € 290.000 € 70% 60%+(30% from 2019) 50%+(40% from 2020) 100%+(25% from 2021) 100%+(25% from 2021) 406.000 € 435.000 € 362.500 € 384.250 € 384.250 € 406.000 € 435.000 € 362.500 € 384.250 € 384.250 €

1.107.140 €

2.360.952 €

4.082.600 €

5.841.950 €

7.379.630 €

NURSE 1.800.000 €

Revenue

N.Registered Nurses Growth annual Fee Revenue from annual Registration Monthly Fee Revenue from Monthly Registration

1.600.000 € 1.400.000 € 1.200.000 € 1.000.000 € 800.000 €

revenue per nurse case insidents / nurse/ day Days of work (2/3month) Revenue from homecare services

600.000 € 400.000 € 200.000 € - €

Total Revenue

2019

2020

Total Revenue

2021

2022

nurse related Expenses (in €) GROSS MARGIN

2023

COST OF SALES % expenses nurse related Expenses (in €)

GROSS MARGIN

JAN FEB MAR

APR

MAY

50 62,5 25% 25% 30,00 € 30,00 € 1.500,00 € 1.875,00 € 5,00 € 2,00 € 2,00 € 1 1 20 20 2.000,00 € 2.500,00 €

2019

2020

2021

2022

2023

298 25% 30,00 € 8.940,70 €

298 25% 30,00 € 8.941 €

1788 10% 30 € 53.640 €

3833 10% 30 € 114.990 €

6442 5% 30 € 193.260 €

9518 5% 30 € 285.540 €

2,00 € 2,00 € 2,00 € 2,00 € 2,00 € 2,00 € 2,00 € 1 1 1 1 1 1 1 20 20 20 20 20 20 20 3.125,00 € 3.906,25 € 4.882,81 € 6.103,52 € 7.629,39 € 9.536,74 € 11.920,93 €

2,00 € 1 20 51.605 €

2,00 € 1 20 309.628 €

2,00 € 1,5 20 437.042 €

2,00 € 1,5 20 865.365 €

2,50 € 2 20 1.420.663 €

15% 82.805 €

15% 158.794 €

15% 255.930 €

JUN

JUL

AUG

SEP

OCT

NOV

78 98 122 153 191 238 25% 25% 25% 25% 25% 25% 30,00 € 30,00 € 30,00 € 30,00 € 30,00 € 30,00 € 2.343,75 € 2.929,69 € 3.662,11 € 4.577,64 € 5.722,05 € 7.152,56 €

DEC

60.545 €

363.268 €

15% 9.082 €

15% 54.490 €

51.464 €

308.778 €

552.032 € 1.058.625 € 1.706.203 €

469.227 €

899.831 € 1.450.272 €

STATIONS - Telemedicine

4.500.000 €

REVENUES

Total Number of stations clients Served per station per day clients pay per Visit (services pack 1) Revenue from monthly visits monthly Revenue from municipalities per station (services pack 2) Total Revenue from municipalities

4.000.000 € 3.500.000 € 3.000.000 € 2.500.000 € 2.000.000 € 1.500.000 € 1.000.000 € 500.000 € - €

2019

2020

Total Revenue

GROSS MARGIN

2021

2022

Total Cost

2023

JAN

FEB

MAR 1

APR

2 5 15 € 3.300,00 € 1.500 € 3.000 €

Total Revenue

6.300 €

COST OF SALES nurse cost (per station per day) number of nurses per station nurse cost total per month rent cost (per station per month) rent cost total other costs (per station per month) other costs total

35,00 € 2 4.200 € 800 € 1.600 € 300 € 600,00 €

Total Cost

GROSS MARGIN

MAY

JUN

JUL

AUG

SEP

OCT

NOV

DEC

4 6 12 16 18 20 22 24 7 7 7 7 7 7 7 7 15 € 15 € 15 € 15 € 15 € 15 € 15 € 15 € 9.240,00 € 13.860,00 € 27.720,00 € 36.960,00 € 41.580,00 € 46.200,00 € 50.820,00 € 55.440,00 € 1.500 €

1.500 €

1.500 €

1.500 €

1.500 €

1.500 €

1.500 €

1.500 €

6.000 €

9.000 €

18.000 €

24.000 €

27.000 €

30.000 €

33.000 €

36.000 €

15.240 €

22.860 €

45.720 €

60.960 €

68.580 €

76.200 €

83.820 €

91.440 €

35,00 € 2 8.400 € 800 € 3.200 € 300 € 1.200,00 €

35,00 € 2 12.600 € 800 € 4.800 € 300 € 1.800,00 €

35,00 € 2 25.200 € 800 € 9.600 € 300 € 3.600,00 €

35,00 € 2 33.600 € 800 € 12.800 € 300 € 4.800,00 €

35,00 € 2 37.800 € 800 € 14.400 € 300 € 5.400,00 €

35,00 € 2 42.000 € 800 € 16.000 € 300 € 6.000,00 €

35,00 € 2 46.200 € 800 € 17.600 € 300 € 6.600,00 €

35,00 € 2 50.400 € 800 € 19.200 € 300 € 7.200,00 €

2019

2020

2021

2022

2023

24

36

48

60

75

15,00 € 285.120 €

15 € 966.240 €

15 € 1.514.700 €

15 € 2.158.200 €

15 € 2.663.100 €

186.000 €

549.000 €

765.000 €

981.000 €

1210500

471.120 € 1.515.240 € 2.279.700 € 3.139.200 € 3.873.600 €

260.400 €

768600

1071000

1373400

1694700

99.200 €

292646

407774

522902

645230

37.200 €

109.646 €

152.774 €

195.902 €

241.730 €

396.800 € 1.170.892 € 1.631.548 € 2.092.204 € 2.581.660 € 74.320 €

344.348 €

648.152 € 1.046.996 € 1.291.940 €

App + Tracker

REVENUES

GROSS MARGIN

N.Users / insurers Growth Annual Fee per client (insurance alert App)

1.000.000 € 900.000 €

Revenue from annual Registration

800.000 €

February

March

April

2

-

-

-

-

commission from sales Rev enue from trackers

500.000 € 400.000 €

Revenue (in €)

300.000 €

30.000 300 65 2%

Revenue from trackers sales

600.000 €

May

15.000

Annual tracker Sales tracker per price penetration & Grow th

700.000 €

19.500 € -

-

-

-

-

-

-

-

50%

50%

50%

50%

8% 1.560

30.000

COST OF SALES

200.000 €

%fee

100.000 €

app related Expenses (in €)

- €

January

fee cup

2019

2020

2021

2022

2023

GROSS MARGIN

0,75 -

0,75 -

0,75 -

0,75 -

50%

0,75

11.250

1

June

July

15.000 2% 2

30.000 300 65 2%

19.500 €

8% 1.560

30.000

August

15.000 2% 2

30.000 300 65 2%

19.500 €

8% 1.560

30.000

15.000 2% 2

30.000 450 65 3%

29.250 €

8% 2.340

30.000

September

15.000 2% 2

30.000 450 65 3%

29.250 €

8% 2.340

30.000

October

15.000 2% 2

30.000 450 65 3%

29.250 €

8% 2.340

30.000

November

15.000 2% 2

30.000 600 65 4%

39.000 €

8% 3.120

30.000

December

15.000 2%

2019 120.000 20%

2

30.000 600 65 4%

39.000 €

8% 3.120

30.000

2020

0,75

11.250

50%

0,75

11.250

50%

0,75

11.250

50%

0,75

11.250

50%

0,75

11.250

50%

0,75

11.250

50%

0,75

11.250

150.000 25%

2

2022

195.000 30%

2

2023

273.000 40%

2

409.500 50%

2

2

240.000

300.000

390.000

546.000

819.000

3.450 65 3%

21.000 60 7%

35.100 55 9%

54.600 50 10%

90.090 50 11%

224.250

8% 17.940

257.940 2019

50%

2021

1.260.000

8% 840

300.840 2020

50%

0,75

1.930.500

8% 1.404

391.404 2021

50%

0,75

2.730.000

8% 2.184

548.184 2022

50%

0,75

4.504.500

8% 3.604

822.604 2023

50%

0,75

50%

0,75

90.000

112.500

146.250

204.750

307.125

167.940

188.340

245.154

343.434

515.479

HEMS 20.000.000 €

OVERHEAD… Manuals

18.000.000 € 16.000.000 € 14.000.000 € 12.000.000 €

Depreciation costs

10.000.000 € 8.000.000 € 6.000.000 € 4.000.000 € 2.000.000 € - € -2.000.000 €

2019

INCOME

2020

HEMS costs

2021

2022

PROFIT/LOSS

2023

Personnel: AOC & PART 145 AOC AOC AOC AOC AOC

AOC-CAMO

AOC

PART 145 MO

PART 145 MO

AOC & PART 145

AOC PART 145 MO PART 145 MO Medical Internal Training

Manuals:

1 1 1 1 1 1

Monthly Cost (€) 2.000 € 1.800 € 1.000 € 1.000 € 1.800 € 1.000 €

1

1.500 €

personel number Accountable Manager CM Manager Safety Manager (deputy of CM) Security Manager Flight Ops Manager Training Manager

CAMO Manager

Ground Ops Manager

Quality Manager

1

Maintenance Manager

Planner (deputy of CAMO)

Pilots (7) CRS (2) Mechanic-Ground Assistant Personnel x 2 Medical Personnel, Doctors & Medevac Technical Crew Members Annual & Six Month Total for Personnel: AOC SPO MOE HEMS AOC/HEMS

1

1

1

5 2 2 1

1.500 €

1.800 €

1.800 €

1.000 €

3.000 € 2.000 € 1.200 € 15.000 €

Maintenance cost for Manuals

HEMS Helicopter (BELL 429) [Lease-to-Purchase Agreement] HEMS Helicopter (BELL 412) [Dry lease in Agreement] AirAmbulance Helicopter (BELL 355) [Dry lease in Agreement] HEMS Helicopter (BELL 407) [Dry lease in Agreement] EMS Turboprop (King Air C-90) [Purchase] EMS Jet (Cessna Citation XLS) [Purchase] Operational Site-Base (Hangar & Area Formation) Equipment-Special Tools-Flight and Technical Data Means of Ground Transportation & General Expenses

Repatriation out side [countries]:

Yearly Cost (€)

Yearly Cost (€)

Yearly Cost (€)

Yearly Cost (€)

24.000 € 21.600 € 12.000 € 12.000 € 21.600 € 12.000 €

30.000 € 30.000 € 12.000 € 12.000 € 30.000 € 12.000 €

30.000 € 30.000 € 12.000 € 12.000 € 30.000 € 12.000 €

30.000 € 30.000 € 12.000 € 12.000 € 30.000 € 12.000 €

30.000 € 30.000 € 12.000 € 12.000 € 30.000 € 12.000 €

18.000 €

18.000 €

21.600 €

21.600 €

12.000 €

18.000 €

30.000 €

30.000 €

18.000 €

24.000 €

24.000 €

30.000 €

30.000 €

18.000 €

612.000 € 72.000 € 28.800 € 180.000 € 100.000 € 1.244.800 €

612.000 € 72.000 € 28.800 € 180.000 € 100.000 € 1.244.800 €

42.800 € 24.650 € 12.350 € 11.730 € 12.500 € 104.030 €

12.500 € 12.500 €

12.500 € 12.500 €

12.500 € 12.500 €

12.500 € 12.500 €

800.000 € 600.000 € 180.000 €

800.000 € 450.000 € 170.000 €

1.200.000 €

800.000 € 450.000 € 160.000 € 280.000 € 100.000 € 1.750.000 € 200.000 € 70.000 € 50.000 € 3.860.000 € 5.117.300 €

800.000 € 450.000 € 150.000 € 280.000 € 1.200.000 € 85.000 € 100.000 € 45.000 € 50.000 € 3.160.000 € 4.417.300 €

190.000 €

3€ 10 € 20 € 6.500 € 20.000 €

18.000 €

30.000 €

30.000 €

24.000 €

24.000 €

504.000 € 72.000 € 28.800 € 180.000 € 100.000 € 1.136.800 €

2

Income 220.000 € 50.000 € 100.000 € 25 € 8€

30.000 €

30.000 €

24.000 €

24.000 €

396.000 € 72.000 € 28.800 € 180.000 € 100.000 € 1.028.800 €

2.500.000 €

1 1 1

24.000 €

24.000 €

180.000 € 48.000 € 28.800 € 180.000 € 100.000 € 731.200 €

3

Total Cost per Year Insurances Contracts: Tour Operators Contracts: Municipalities-Government Contracts: Repatriation in side [islants]:

Yearly Cost (€)

300.000 € 150.000 € 80.000 € 3.220.000 € 4.055.230 €

300.000 € 120.000 € 70.000 € 3.270.000 € 4.311.300 €

100.000 € 1.800.000 € 300.000 € 95.000 € 60.000 € 3.775.000 € 4.924.300 €

550.000 € 500.000 € 2.000.000 € 162.500 € 160.000 €

1.000.000 € 1.190.000 € 3.960.000 € 286.000 € 240.000 €

1.750.000 € 2.100.000 € 4.800.000 € 487.500 € 360.000 €

2.150.000 € 3.000.000 € 6.750.000 € 669.500 € 480.000 €

2.800.000 € 4.296.000 € 8.400.000 € 988.000 € 720.000 €

3.372.500 €

6.676.000 €

9.497.500 €

13.049.500 €

17.204.000 €

All Structure HEMS REVENUES

45.000.000 €

20.000.000 € 18.000.000 € 16.000.000 € 14.000.000 € 12.000.000 € 10.000.000 € 8.000.000 € 6.000.000 € 4.000.000 € 2.000.000 € - €

40.000.000 € 35.000.000 € 30.000.000 € 25.000.000 €

2019

2020

depreciation costs

2021

2022

2023

AMBULANCE

20.000.000 €

REVENUES

15.000.000 €

Expenses

depreciation costs

14.000.000 €

10.000.000 €

12.000.000 € 10.000.000 €

5.000.000 € - €

Expenses

8.000.000 € 6.000.000 €

2019

REVENUES

2020 Expenses

2021

2022

PROFIT/LOSS

2023

4.000.000 € 2.000.000 € - €

2019

2020

2021

2022

2023

EMERGENCY HELP 5Y P&L REVENUES AMBULANCES

HEMS

HEALTH STATI ONS

NURSE NETWORK APPS

Rev enue (in €) COST OF SALES

AMBULANCES

HEALTH STATI ONS NURSE NETWORK APPS

Expenses (in €) OVERHEAD COSTS

AMBULANCE operat ional cost s HEMS operat ional cost s market ing expenses Management cost

total Ov erhead costs (in €) Ambulance depreciation costs HEMS & Base depreciation costs Total total Expenses + depreciation costs

2019

2020

2.587.200

29%

t axes

NET RESULT

5.047.392

2022

7.812.000

2023

10.483.200

12.794.880

4.100.000 €

6.500.000 €

9.710.000 €

12.790.000 €

18.800.000 €

60.545 257.940

363.268 400.800

552.032 544.440

1.058.625 764.400

1.706.203 1.179.360

471.120

7.476.805 2019

1.074.060

396.800

51.464 90.000

1.612.324

90.698 731.200 € 373.840 474.660

1.515.240

13.826.700 2020

2.251.440

2.279.700

20.898.172 2021

3.366.900

3.139.200

28.235.425 2022

4.257.000

1.170.892

1.631.548

2.092.204

3.843.610

5.613.925

7.453.785

308.778 112.500

111.907 1.028.800 € 691.335 507.886

469.227 146.250

131.171 1.136.800 € 1.044.909 543.438

899.831 204.750

147.806 1.244.800 € 1.411.771 581.479

3.873.600

38.354.043 2023

5.031.000

2.581.660

1.450.272 307.125

9.370.057

166.377 1.244.800 € 1.917.702 622.182

1.670.398

2.339.928

2.856.318

3.385.856

3.951.061

290.000 3.220.000 € 3.510.000 €

392.600 3.270.000 € 3.662.600 €

517.000 3.775.000 € 4.292.000 €

641.400 3.860.000 € 4.501.400 €

772.200 3.160.000 € 3.932.200 €

6.792.722

9.846.138

12.762.243

15.341.041

17.253.318

9% PROFIT/LOSS

2021

684.084 198.384

485.699

29% 3.980.562 1.154.363

2.826.199

39% 8.135.929 2.359.419

5.776.509

46% 12.894.384 3.739.371

9.155.013

55% 21.100.724 6.119.210

14.981.514

Risk & Mitigation Strategies

8.1.Air-ambulance risks There are several risks that air ambulance operators may face. Time, planning challenges and environmental factors are associated with air ambulance transportation during emergency situations and these factors can make the operations inherently risky.

Time Pressure: The condition of a patient, and the time factor to get that patient to a specialized medical facility, is the major reason for an air ambulance to be tasked to support a medical emergency. This time pressure requires pre-flight planning and mission preparation. The time pressure can turn things into incomplete planning or wrong decisions during emergencies.

Environmental Factors: A significant proportion of emergency medical services (EMS) take place at night and often in poor weather. The crew is always prepared to carry out the mission despite of the environmental and geographic conditions.

Approximately a quarter of all air ambulance EMS accidents are weather related. Accidents occur because of reduced visibility and instrument meteorological conditions (IMC).

Inaccurate or out of date weather forecasts aggravate the risk.

CFIT: Controlled flight into terrain (CFIT) is a significant challenge. That is the case particularly in the takeoff or landing phases of flight, as well as collision with objects.

Communications: Communications problems with air traffic control (ATC) or a lack of communications due to remote locations and terrain can increase the risk.

The Air Medical Physician Association (AMPA) report also stated that air ambulance accidents occurred more often when flight crews were enroute to pick up a patient than at any other time during flight.

8.2 Risks related to ground ambulance Ensuring continuity of service : During an emergency, EMS services have to complete evacuation at a fast pace.

Capacity to operate becomes limited due to shortage of resources, huge number of casualties and so on.

Frustrations and misunderstandings engendered in such situations and can lead to violence against the service providers or against the organization running the service.

Elongated hospital turnaround times : Reducing hospital turnaround times is an ongoing battle for ambulances in emergency situations. The problem becomes acute during periods of hospital overcrowding. As a result ambulances may not reach patients in a timely manner and end up with increasing the criticality of the emergency situation further.

Staff safety: While patients are clearly at risk and there is turmoil situation, staffs may endanger themselves into lack of safety. Staffs are exposed to violence and aggression and can lead to staff absences due to injury and increased levels of stress.

Another major risk to the safety of patients is staff fatigue.

This is because of prolonged on-call periods; staffs are working additional hours before and/or after periods of duty. Consequence is poor decision making by staffs and exhausted from working long hours.

8.3 Risks related to healthcare professionals Misdiagnosis: Misdiagnosis is a significant risk with potential personal harm to patients in emergency situations. Premature closure often occurs in cases where clinicians are under pressure to reach a diagnosis so that treatment can begin as fast as possible. For example, in busy emergency department, clinicians do diagnosis that they feel more comfortable to manage.

Safety issues: Violence occurs in emergency departments when patients experience mistreatment. Family members or friends of patient become frustrated or angry about the care provided to their near ones. Health professionals should be trained on de-escalation strategies and should know what to do when they perceive that an interaction with a patient or family member has the potential to escalate to violence.

Use of Nurse Practitioners and Physicians Assistants: The use of nurse practitioners (NPs) and physician assistants (PAs) is on the rise. The professionals are involved in managing the care of complex patients. However, their skill set, specialty and training may vary widely. Risk may occur if the scope of practice laws in states where the EMS organization offers services are not aligned with practice parameters accordingly.

Recommendations

Operations •The company is providing emergency medical service and we recommend four key operations to cover all areas of medical emergency. These operations are ground ambulance service, air ambulance service, eHealth & telemedicine service, and home care and nursing assistance.

•According to the nature of business the company must set localized operations of ground ambulance, eHealth & telemedicine service, and nursing assistance.

•The company has planned to establish 30 telemedicine stations to localize its operations. It opts for franchisee model to achieve the number and scale the business fast. But before going to franchisee model the company must setup 10 telemedicine stations of its own to create the brand value of the company.

•We recommend that company must set up its own eHealth & telemedicine stations in three different types of urban environments based on population density. 5 will be in highly dense cities, 3 will be in medium and 2 will be in low dense cities. The logic behind this strategy is to accrue the large percentage of revenue and profit from populous cities by the company’s own operations.

Target Market •Attica, Central Greece, Central Macedonia, Crete, and Western Greece are more prone to accidents at workplace, and spread of infectious diseases. These regions are also inhabited by high to moderate population.

•Road accidents are decreasing overtime in Greece and fatalities from road accidents are also falling.

But on contradictory note port & marine areas are experiencing higher frequency of accidents. −83% merchant ship accidents took place in Greek sea in 2017. −Crews were injured mostly while they were on board and passengers were injured mostly when they were in port areas. −Severity of accident was higher in port areas.

•Greece is growing in double digits its tourism market in places like Attica, Central Macedonia, Crete, the Ionian Islands, and South Aegean.

•According to our analysis we found that Attica, Central Greece, Crete, the Ionian Islands, Southern Aegean are relatively the higher income regions in Greece.

We recommend Attica, Central Greece, Central Macedonia, Crete, Ionian Islands, and South Aegean to establish emergency medical services first. These regions have high prospect if we consider factors like population, accidents and fatalities, disease spread, income parity, and tourist arrivals. After establishing successful operations in these regions the company must set operations in the Peloponnese and Western Macedonia.

Promotion •We propose a mix of online-offline marketing strategy as we have planned for a fast and scalable model. In offline marketing we recommend for TV advertising, radio advertising, and digital billboard advertising. In online marketing the company must follow Google Adwords, digital display, social media advertising, TrueView in-stream ads, and Search Engine Optimization (SEO).

•Advertisement will be region specific and promotion frequency will be changed as per requirement to burn less cash.

•The company must spend at least 5%, 6%, 7%, and 8% of total revenue for promotional activity in 2018, 2019, 2020, and 2021 respectively.

Financing •In our projected financial gross profit increases year-on-year.

The company has the potential to increase its revenue over its cost of sales year after year.

•The business requires heavy cash deployment in initial years. The company’s operating income increases despite of cash deployment and becomes positive in the fourth year.

•Net profit is negative in our forecasted period because of high depreciation. If the depreciation rate becomes half, the net profit would have been positive in fourth year.

•Net cash flow from operations becomes positive in fourth year and the business will start to generate inflow of cash from fourth year onwards.

We recommend to having cash at end of each period equal to next six months operating expense. Total € 7million capital infusion is required to run the business in its first stage. € 5million is required in the first year and € 2million is required second year. No need of capital injection is required thereafter with the existing state of business; funding will be required for further strategic initiatives. € 5million is split into debt and equity. It is recommended to accrue € 2million as in debt and € 3million through equity to maintain debt-equity ratio less than 100%. More than 100% debtequity ratio may not be viable.

Conclusion

The Business Plan has been created taking into consideration all aspects of the business. We have mapped the service lines to the market demand and derived our financial forecast based upon the ground realities. The financial forecasts show a yo-y growth in revenue. This is a positive sign for the company. The business is built on strong fundamental grounds and has a footprint across the country. This will enable it to scale-up quickly and generate substantial returns for all stakeholders.

The above analysis for cost and income is a complete 5 year estimation economic plan and it provides information for the AOC-SPO-HEMS operations in accordance with the present economic and political situation in Hellas-Greece.

As stated above some of the initial costs has already depreciated and absorbed by the group since the companies has already started the procedures for the achievement of the group’s vision and scope. This Operational Business Plan is studied, composed and evaluated by Christos Nikas and Konstantinos Belesiotis for The Group.

Dear Sirs, We would like to take the opportunity to thank you for your time in examining our proposal for establishing a Hellenic Emergency Medical Services Network.

Our group has been studying the EMS market in Hellas for the past 20 years and has already established many contacts within the government agencies and the medical industry, flying till today and serve the needs for medical transport and support with air-ambulance flights. We strongly believe that this business plan provides information on how we intend to establish a market for our product as well as deliver the product which we propose to offer.

Statistically one helicopter can be used to service a population of 1 million people. Indicative for the above statistic is that in the United States HEMS network serving a population of 5 million people would receive two calls at the same time approximately once in 5 years. In this proposal we have purposely kept the service area short as well as limiting the number of subscribers we will allow so as to make the chances of this happening negligible.

Having experience in the aviation and EMS industry we can understand what an important service we are offering to the people and the excellent public relations and advertising this service can generate.

We are committed to running a profitable group of companies and with over 20 years in business we shall not sacrifice safety or make promises which we cannot support.

By examining the attached information and business plan I think you will agree that the EMS industry in Hellas holds the potential for a multi-million euro market. We strongly believe that the population of Hellas through government programs in combination with the insurance companies and the tour operators will rise the value of this product and embrace this service from the first day of operation as it is a complete benefit they cannot turn down. Thank you for your time and interest.

Sincerely, For The Group

CHRISTOS NIKAS - FOUNDER CEO

KOSTAS BELESIOTIS - FOUNDER Ground Ops Manager-Helicopter Engineer