Andalusia Holding Company
Group Overview
Table of content • Executive Summary • About Andalusia • Business units - Saudi Arabia Business Units - Andalusia Saudi Arabia operation unit’s financial performance - Egypt Business Units - Andalusia Egypt operation unit’s financial performance • Andalusia Group without Expansion: • Andalusia Group Expansion • Andalusia Group after Expansion
This document is confidential & prepared by
Andalusia Al Shalalat Clinics
Andalusia Al Shalalat Hospital
Andalusia Al Maadi Hospital
Specialized Clinic 51
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Andalusia Smouha Hospital
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Executive Summary Andalusia is one of the leading regional players in the healthcare provision space in the Middle East. With a network of general hospitals, specialized medical centers, and polyclinics across Egypt and Saudi Arabia. Over more than 32 years of history, Andalusia has responded to the rapid change in the healthcare industry with strong leading innovative products and services provided to physicians and other professionals, patients and their families and to our customers. We have built our portfolio under a structure based on product and service expertise as well as innovative technology We have continually re-invented ourselves and our products to better serve our customers, opting to lead the change in our region rather wait for change and react to it. Our embrace of the latest technology and our deep know-how of the healthcare industry have enabled us to provide the innovative products in healthcare while emphasizing both the "health" and the "care" in healthcare. This clear and dynamic strategy was and still is the main driver of our growth and prosperity. Our portfolio optimizes the overall activities in the healthcare industry to create a synergistic bundle of products and services. That’s why Andalusia covers three major categories at various stages of the value chain: • Producers (product manufacturers). • Purchasers (group purchasing organizations and wholesalers /distributors). • Healthcare providers (hospital systems and integrated delivery networks).
Andalusia Group Portfolio Overview Andalusia Group for Medical Services was founded in 1984 by the entrepreneur Dr. Darweesh Zagzoug as a single hospital in Jeddah, Saudi Arabia; and grown over 32 years to own and manage several healthcare facilities in both Saudi and Egypt. The second generation family owner Dr. Hazem Zagzoug, the current CEO has made it possible for a renowned financial institution like the IFC to join forces to serve more than 8 million patients in the last 10 years with amicable quality, and creating 2000 new jobs. We are proud of our origin, our progress, as well as our partners.
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Andalusia Business Units Our business activities currently encompass two very distinct markets; the Egyptian & the Saudi Arabian healthcare markets. Our upcoming expansions are targeted towards the MENA & GCC areas.
Saudi Arabia Business Units The Saudi market is generally the largest market in the Middle East due to its considerable spending power and its hyper-competitive nature. Its healthcare market in particular is characterized by providing the highest quality services among the entire Arab world. Our current business units in Saudi Arabia are all in Jeddah, with a plan to expand all over the KSA
Andalusia Hai Elgamaa Hospital Being in operation since early 1984, HJH is considered as a flagship to the healthcare providers in Jeddah, KSA. Started with a capacity of 83 beds and 28 outpatient clinics, it has been and remains fully equipped with the most sophisticated medical equipment, while all procedures and processes are operated under the supervision of a highly qualified medical staff. The MRQP accreditation body has recently accredited HJH, and it was certified to be among the leading hospitals in applying quality measures in the healthcare sector allover Jeddah. During recent years, HJH Capacity increased to be 105 Beds and 60 outpatient clinics, while always emphasizing on maintaining the balance between the cutting edge medical services and the affordable prices, exerting consistent and ongoing efforts to build trustworthy long term relationships with our customers. As a result, the hospital witnessed a rapid growth over the last years in terms of revenue & customer force as the number of outpatient's visits to HJH has reached 272,000 patients, while the inpatients number has reached 14,150 patients. On 2015 only.
Andalusia Dental Center-Al Makaronah JDC has started to operate in 1989, and it has been recognized as a pioneer specialized dental center in Jeddah. With 22 specialized clinics, the center offers a wide range of services including the following specializations; pedodontics, oral surgery, endodontic, restorative, orthodontics, and general practice. All clinics are armed with up-to-the-minute dental equipment and have a fully furnished operating theatre for children’s treatment under general anesthesia. JDC constantly invests in new equipment, materials, and techniques to ensure the best possible care for its patients.
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Andalusia Polyclinics - Fawaz Fawaz Polyclinics were established in 2005 to fulďŹ ll the needs of Prince Fawaz region in Jeddah. The Andalusia Polyclinics are composed of 20 clinics, covering all medical specialties in addition to the top quality radiology & laboratory services, which is available around the clock. Andalusia Polyclinics is best known for its renowned medical sta and for placing a high emphasis on applying the international quality standards of ambulatory care.
Andalusia Dental Center-Le Chateau Le Chateau Dental Center was established in 2009, it was another breakthrough business unit of the Andalusia Arabian Holding Company. With the growing demand for dental services by numerous clients all over the metropolitan city; Jeddah, Andalusia Dental Center Le Chateau was conceptualized to reach out to more clients and fulfill all their dental needs, with its 12 Dental clinics, it combines the most sophisticated and innovative dental services with a highly competent professionals and skilled staff. All served by state of the art facilities.
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Andalusia Saudi Arabia Operation Unit’s Financial Performance: • 2015 Saudi Units Beds and patients : 2015
Andalusia
Andalusia Andalusia Andalusia Andalusia
Hai El Gamaa Jeddah Dental La-Chateau Clinic Center
Fawaz Saudi Arabia Polyclinics
84
Beds
84
ICU/CCU
22
22
Total Beds
106
106
OR
5
5
OP Clinics
60
Inpatients
14,150
Outpatients
272,000
12
22
20
114 14,150
19,300
62,000
54,000
407,300
• Saudi Units Revenue and Revenue Growth: • Without any Extensions in the last 5 years, the Saudi operational units achieved %74 growth during last powerful 5 years which means %15 increase yearly.
Historical
Forcast
$150 15% $100 30%
8%
8%
16%
15%
15%
15%
15%
Thousands
$50
07
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$0
$37.6
$48.9
$52.6
$56.7
$65.6
$75.1
$86.0
$98.5
$112.8
$129.2
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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• Andalusia Saudi Arabia EBITDA & EBITDA Margin : • According to the efficient cost management policy applied by Andalusia group management, Saudi Units achieved a solid 94% growth during last significant 5 years, which means the increase is around 18.8% yearly, in addition to the EBITDA Margin that reached 16% last year and expected to be 18% yearly by the end of 2016 according to our target policy.
Historical
Forcast
$25 $20 18%
$15 16%
$10
18%
18%
18%
12%
13%
13%
$5.5
$6.5
$6.7
$7.0
$10.6
$13.5
$15.5
$17.7
$20.3
$23.2
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
15% Thousands
18%
$5 $0
• Andalusia Saudi Arabia Net Profit & Net Profit Margin : • Saudi units achieved net profit margin yearly from 11% - 13%. And Net profit as amount increased by 80% within 5 years about 16% per year.
Historical
Forcast
$20 13%
$15
Thousands
$10 $5 $0
11%
13%
13%
13%
13%
13%
11%
11%
$4.7
$5.6
$5.7
$6.2
$8.5
$9.8
$11.2
$12.8
$14.7
$16.8
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
12%
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Egypt Business Units With over 90 million people, Egypt is one of the most populated nations in the MENA region. With a yearly increase of about 2% in population, Egypt is struggling to provide adequate healthcare. Despite many notable achievements in the last few decades, the Egyptian healthcare service industry is still considerably under development. Egypt has a diversified and segmented healthcare system, with several different public & private providers & financing agents, and from our experience, there is a real necessity for high quality healthcare services in Egypt. Our presence in the Egyptian market is focused in Cairo & Alexandria; the largest cities of Egypt with the highest demand for the healthcare services.
Andalusia Hospital - Alshallalat (ASH) ASH, which was established in 2004, is currently one of the largest medical institution that provide unique and specialized medical services in the Northern region of Egypt. Its medical services are blended with outstanding hotel accommodation ranging from «first class» up to “royal suite» accommodation. ASH has a total of 105 Beds 23 of them are the ICU and CCU, where the ICU of ASH is regarded the most reputable ICU in the northern area of Egypt as it has the most professional medical staff and it provides the highest quality, evidence –based medical care. ASH has 5 operating theatres fully equipped with state-of-the – art medical equipment. It has as well 23 outpatient clinics covering all medical specialties and subspecialties and fulfilling all the demands of its trusting customers. Recently, a technologically advanced Cath-lab has been introduced. It performs wide range of procedures with top quality and with individualized approach for each patient. ASH employs around 1340 people.
Andalusia Hospital – Maadi (AMH) Acquired in 2009, and after its soft renovation and the improvements made by Andalusia, the hospital is becoming one of the distinguished general hospitals in Maadi Cairo. It has a total of 70 beds and 5 operation theatres. It has built a reputation for high quality open heart surgeries and cardiac catheters, where a whole floor is dedicated for this type of surgeries. AMH employs more than 885 people, including 23 exclusive physicians & 263 nurses.
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Andalusia Hospital – Smouha (ASMH) Repeating the Successful story of acquisition done with Andalusia Hospital – Maadi, Andalusia has gone through the complete acquisition of the british Hospital in Alexandria to be a new franchise of Andalusia and has been named Andalusia Hospital – Smouha. The hospital ran on Feb 2012. SMH employs more than 790 staff, including 130 part-timers.
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Andalusia Egypt operation unit’s financial performance: • 2015 Egypt Units Beds & Patients : 2015
Andalusia Alshallalat
Andalusia Maadi
Andalusia Smouha
Andalusia Egypt
Beds
82
44
46
172
ICU/CCU
23
26
15
64
Total Beds
105
70
61
236
OR
5
5
4
14
OP Clinics
23
15
10
48
Inpatients
8,330
5,533
4,100
17,963
Outpatients
124,271
104,204
43,477
271,952
• Andalusia Egypt Revenue and the Revenue Growth : • In the last couple of months of the financial year 2012, Andalusia group expanded the operating units in Egypt by adding the new entity “Andalusia Smouha hospital’’ which started partially during first year, the revenue growth erosion because of the systematic FOREX risk in that year, but the financial year 2014 came to cover the deficit of 2013 with huge growth to Egypt units in addition to achieving Break-even point by the end of 2014.
Historical
Forcast
$100 15%
$80 $60 33%
Thousands
$40
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21%
0%
10%
15%
15%
15%
15%
$20 $0
$23.7
$31.4
$31.5
$38.1
$41.9
$48
$54.9
$62.9
$72
$82.4
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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• Historical EBITDA & EBITDA Margin : • Capitalizing of the pre-opening expenses in 2012 financial statement- not the operational effect, led to the decrease of EBITDA in 2012 to %15 instead of the regular %20-%18, and it is expected to be stabilizing back at %19 during next year without any expansions to Egypt operation units.
Historical
Forcast
$20 19% 19%
$15
Thousands
$10
20%
18%
18%
19%
19%
19%
21%
15%
$5.1
$4.9
$6.4
$6.9
$7.4
$9.1
$10.4
$11.9
$13.7
$15.7
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
$5 $0
• Historical Net Profit & Net Profit Margin : • It was natural that the net profits is affected during the financial year 2012 with Andalusia smouha hospital new expansion and stabilize with growth only %5 but from next year we move again to the standardized policy determined by Andalusia Group management.
Historical
Forcast
$10 12%
$8 $6
11%
11%
12%
12%
12%
12%
11%
Thousands
$4
10%
$2 $0
5%
$2.3
$1.7
$3.5
$4.3
$4.6
$5.8
$6.6
$7.5
$8.6
$9.9
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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Andalusia Group without Expansion: • 2015 Group Units Beds and patients :
2015
Saudi Arabia
Andalusia
Andalusia Egypt
Andalusia Group
Beds
84
172
256
ICU/CCU
22
64
86
Total Beds
106
236
342
OR
5
14
19
OP Clinics
114
48
162
Inpatients
14,150
17,963
32,113
Outpatients
407,300
271,952
679,252
• Revenue & Revenue Growth :
• Without any expansion for the whole group during next 5 year and according to our current market share from Egypt and Saudi Arabia markets that increase yearly through our quality that determined before over 32 years , andalusia group will keep the growth %15 yearly ( Taking into considerations the systematic FOREX risk ) .
Historical
Forcast
$250 15%
$200
15%
$150
5%
31%
13%
15%
15%
14%
13%
Thousands
$100
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$50 $0
$61
$80
$84
$95
$108
$123
$141
$161
$185
$212
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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• EBITDA & EBITDA Margin : • After extracting the management Fees for the strategy team and head office that serve the operation units for the following:
Head Office Service Reasearch and Development
ERP System specific for Andalusia
PMS to Measue and Develop Lapors
Market Events and Campaign
• EBITDA & EBITDA Margin : • Group Units Achieved growth during last historical 5 years 97% which means the Percentage increase / years about 19.5% .
Historical
Forcast
$40
17%
$35 $30
17%
$25
17% 15%
$20
Thousands
$15 $10 $5 $0
17%
17%
12%
13%
11%
11%
$8
$8
$9
$11
$16
$21
$24
$27
$31
$36
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
• Net Profit & Net Profit Margin :
The effect of our expansion during 2012 decrease the net profit but restore again to %6 after covering the whole risk points.
Historical
Forcast
$16 7%
$14 $12 7%
$10 $8
Thousands
$2 $0
7%
6%
$6 $4
7%
7%
4%
3%
4%
2%
$2
$1
$3
$3
$6
$9
$10
$11
$13
$15
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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Andalusia Jeddah New Hospital • Andalusia New Hospital Beds : • Andalusia Jeddah New Hospital Project is to build a world class health care facility located in a prime location within north of Jeddah. • The Facility is to be managed and operated by Andalusia Group for Medical Services. • Project is composed of a General Hospital, Specialized Units and Clinics. • General hospital that encompasses 100 census beds, 20 Clinics and 10 ER Beds spread over 6 floors. • Hospital building on Land Area 2,800 Sq. Mt and built up area 10,080 Sq. Mt.
100 Beds General Hospital
Specialized Centers
Medical Lab & Imaging Physiotherapy unit Dialysis General & Specialized Surgery Cancer Treatment
Cardiac Catheter ICU Unit Orthopedic Endoscopy unit Obstetrics and Gynecology
Kidney Center Dental Neonatal ICU Plastic Surgery IVF Center
• Andalusia New Hospital Investment Cost :
Total Investment Cost Breackdown The total investment cost is expected to be spent over twelve months and the project will be financed through debt to equity which is envisioned to be 90:10, with equity self-financed by the Andalusia Group Fresh Equity. The breakdown for the new hospital investment cost is divided as follows:
$ 0,800 Licenses
$ 1,333
$ 0,533
Furniture
Cars
$ 1,333
Medical Beds
$ 5,333
Medical Equipment
$ 5,227
Building
Land
$ 7,479
Working Capital
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$ 10,752
• Andalusia New Hospital Revenue : • The Project’s main source of revenue will be the general hospital. The Project’s sales are expected to achieve an average growth rate of %22 during the first ten years of operations. Sales Revenue Gross Profit
200 $21
150
$31
$44
$59
$75
$88
2018
2019
2020
2021
2022
$1
$8
$13
$21
$25
$101 $112 $29
$32
2023
2024
$124 $136 $35
$39
2025
2026
$151 $43
100
Thousands
50 0 (50
2027
2017 $3
•Andalusia New Hospital EBITDA : • EBITDA will Achieve %1.5 by the end of fourth year and is expected to reach to %14 by the end of the fifth year.
25 20 15
14%
10 5
Thousands
0 (5) (10)
2017 $(9)
(41%)
14%
13%
14%
14%
14%
14%
0%
7%
$10
$12
$14
$16
$18
$20
$22
2019
2020
2021
2022
2023
2024
2025
2026
2027
$2
2018 $(6)
(18%)
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Andalusia Jeddah New Hospital • Andalusia New Hospital Net Profit : • Net Profit margin will Achieve 1.5% by the end of fourth year that’s Meaning the Break Even point will achieve from fourth year and is expected to reach to 11% by the end of the seventh year .
20 15 9%
10 5 0 Thousands
(5)
2017
2018
2019
$(11)
$(8)
$(3)
(10) (15)
(27)%
10%
10%
11%
11%
11%
11%
2%
$7
$9
$10
$12
$14
$15
$17
2020
2021
2022
2023
2024
2025
2026
2027
$1
(7)%
(54)%
• Andalusia New hospital WC &PPE :
• The operating working capital will be negative during first 5 years and will achieve the working capital breakeven point by the fifth year. 30
$27 $23
20
$22
$22
$21
$20
$20
$20
$21 $18
10
(20)
17
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$23
$21
$21
$22
2025
2026
2027
$9
0 (10)
$22
$2 $(2)
$(5) $(9)
2017
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2018
$(12)
$(11)
2019
2020
2021
2022
2023
2024
• Andalusia New Hospital Finance Structure: • According to the financial structure that is targeted by Andalusia, 90% debt to10% fresh equity, the total equity will be negative during first 6 years because the retained losses from the early operational years but it will be stabilized before the Financial year 2024 and will continuously grow to achieve huge growth after 10 years of operations at financial year 2027.
FY (2027) Capital Structure (100%) = $ 72 M Equity (90%) = $ 65 M
Debt (10%)= $7M
80
Equity Debt
60 40
$30
$30
$65 $48 $30
$33 $28
$27
$25
$22
20
$20
$16
$13
$7
2025
2026
2027
67%
78%
90%
22%
10%
2026
2027
$19
0% (20) (40)
$7 $(3) $(8)
2017
$(170
$(19)
$(19)
2018
2019
2020
227%
293%
295%
400% 300% 200%
$(12)
2021
2022
112% 75%
0%
25% (38%) (193%) (195%)
2017
2018
50% 50%
33%
(12%)
(127%)
(200%) (300%)
2024
177%
138%
100%
(100%)
2023
2019
2020
(77%)
2021
2022
2023
2024
2025
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Andalusia Group after Expansion: • Andalusia group after expansion: 2017
Saudi Arabia
Andalusia
Andalusia Egypt
New Hospital
Andalusia
Andalusia Group
Beds
84
172
80
341
ICU/CCU
22
64
20
106
Total Beds
106
236
100
437
OR
5
14
10
24
OP Clinics
114
48
20
182
Inpatients
17,200
21,800
5,835
44,835
Outpatients
493,000
330,000
51,000
874,000
• Revenue & Revenue Growth : • Here’s the revenue performance after adding the new hospital to the group, growth for the revenues will move from 15% for the first year to reach 28% on the fourth year.
Historical
Forcast
$300 $250 14%
$200 $150
31%
5%
13%
32%
18%
19%
18%
13%
Thousands
$100
19
|
$50 $0
$61
$80
$84
$95
$108
$123
$162
$192
$229
$270
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
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• EBITDA & EBITDA Margin : • The new project will bear the fixed cost from the first 3 years (EBITDA, BEP) and the revenue will cover the whole fixed and variables cost from the fourth year.
Historical
Forcast
$50 15%
$40 14%
$30
Thousands
$20 $10 $0
11%
17% 15%
9%
13%
11%
11%
12%
$8
$8
$9
$11
$16
$21
$15
$22
$32
$40
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
• Net Profit & Net Profit Margin : • Our management expect to achieve losses during first operational year 2017 and it will be fully covered from the group retained earnings but the net profit will be back again from 2nd operational year 2018.
Historical
Forcast
$20
6% 4%
$15 $10
Thousands
$5 $0 $(5)
6%
9%
2%
4% 4%
2%
3%
$2
$1
$3
$3
$6
$9
$1
$3
$10
$16
2011
2012
2013
2014
2015
2016
2017 1%
2018
2019
2020
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Value creation 1- Exclusive doctors: i. The first healthcare provider in Egypt that adopted the concept of Exclusive Doctors. 2- Efficient, High-quality and safe healthcare: i. Received ISO 9001: 2008 certification in 2009 & Has been recertified in 2012. 3- Unique patient and family experience: i. 5 stars hospitality standards. ii. Customer services departments. iii. Call center. iv. Expert practitioners from healthcare professionals to chefs, cooks, room & guest services team, valet service, architects and designers. 4- Advanced business intelligence and Integrated information technology: i. Advanced Enterprise Solution. ii. Advanced Planning & Monitoring system.
Services Excellence Cardiology Dental Vascular
Andalusia Hospital Hai El Gamaa (HJH) Lab & Rad
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Cosmetology
Pediatrics
Plastic Surgery Orthopedic
Cardiology Dental Vascular
Cosmetology
Andalusia Hospital Alshallalat (ASH) Lab & Rad
Plastic Surgery Orthopedic
Pediatrics
Cardiology Pediatric OBE & GYN
Andalusia Hospital Smouha (SMH)
ICU & PICU GIT
Lab & Rad
Cardiology Lab & Rad ICU
Andalusia Hospital Maadi (AMH)
General Surgery Orthopedic
GIT
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Villa 39 Khalili El Khayat St., Kafr Abdo, Egypt. Tel.: +2 03 5457280