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Private Lender PresentationNYSE American: HLTH|NEO Exchange: HLTH
March 2018
Corporate Presentation
1
This presentation contains forward-looking information (within the meaning of applicable securities laws) relating to the
business of Nobilis Health Corp. (the "Company") and the environment in which it operates. Forward-looking information
may include statements regarding the objectives, business strategies to achieve those objectives, expected financial results,
economic or market conditions, industry specific information, and the outlook of or involving the Company and its
business. Such forward looking information or statements are typically identified by words such as "believe", "anticipate",
"expect", "intend", "plan", "will", "may" and other similar expressions.
Forward-looking information, including any financial outlooks, is provided for the purpose of providing information about
management's expectations and plans about the future and may not be appropriate for other purposes. Forward-looking
information herein is based on various assumptions and expectations that the Company believes are reasonable in the
circumstances. No assurance can be given that these assumptions and expectations will prove to be correct and the
forward-looking information, including the financial outlooks included in this Presentation, should not be unduly relied
upon. Those assumptions and expectations are based on information currently available to the Company, including the
historic performance of the Company's business. Such assumptions include anticipated financial performance, current
business, industry and economic trends, and business prospects and are subject to the risks and uncertainties which are
discussed in the Company's regulatory filings available on the Company's web site at www.NobilisHealth.com or at
www.sec.gov. Any forward-looking statements that we make are based on assumptions as of today, and we undertake no
obligation to update them.
The Company’s management has approved the financial outlooks contained in this presentation.
FORWARD-LOOKING INFORMATION
2
LOCATIONS
• 11 markets across 5 states
• 5 surgical hospitals
• 12 ASCs
• 15 multi-specialty clinics
• 34 partner facilities
STRATEGY
• Optimized case mix and payor mix across the portfolio
• Higher acuity procedures leading to higher levels of
reimbursements
• Focus on minimally invasive procedures
• Compelling value proposition for physicians,
patients, and payors
• Low Cap-Ex requirements
• Scalable platform enables nationwide growth
COMPANY OVERVIEW
DIRECT-TO-PATIENT MARKETING MODEL
• Branded procedures drive additional surgical volume to nationwide
network of facilities
• Capitalizes on growing trend of consumerism in healthcare
• Drives organic growth
$300 million in Revenue & $41 million in Adjusted EBITDA, FY 2017 3
UNIQUE MARKETING MODEL
• Multiple marketing channels drive organic volume growth
• Proprietary technology platform targets prospective patients
• Strong value proposition: Superior patient experience that expands physicians’ practices
ATTRACTIVE FINANCIAL PROFILE
PATIENT-CENTRIC VALUE PROPOSITION
FAVORABLE PAYOR AND PROCEDURE MIX
ATTRACTIVE INDUSTRY FUNDAMENTALS
EXPERIENCED MANAGEMENT TEAM
• Low leverage
• Low capital expenditure requirements
• Stable cash balance
• Unique marketing model increases case volume and provides superior patient experience
• Offers optimal surgical environments that result in better overall quality of care
• Offers ancillary services that lead to better efficiency and outcomes
• Marketing segment targets higher acuity cases resulting in a highly attractive case mix
• Procedure diversification increases the stability of the revenue base
• Minimal government payor claims reduces risk of Medicare/Medicaid rate changes
• 66% of all surgeries are outpatient with >50% performed in ASCs vs. 32% in 2005
• Lower cost, high quality outpatient setting; trend toward increased consumerism in healthcare
• Abundance of desirable acquisition opportunities due to fragmented market
• Strong management team with healthcare and M&A experience
• Seasoned Ops team leads to financial and operational efficiencies
• Strong in-house and outside legal team to safely navigate complex healthcare space
INVESTMENT HIGHLIGHTS
4
UNIQUE PATIENT ACQUISITION MODEL
• Acquires patients from physician partners
• Physicians often form partnerships with inequitable
percentages:
• Productive doctors resent less productive doctors
• Management Co. only manages and does not drive patients
to centers
• Must rely on physician partners to grow their practices to then
bring more patients
• No vertical integration
Traditional Model The Nobilis Health Model
• Nobilis Health owns and manages its
facilities
• Drive patient flow to our facilities
• Control the patient experience through an
expanding continuum of care:
• Patient acquisition
• Primary care
• Ancillaries
• Surgeries
• Post-Op
Nobilis Health
Clinically
Integrated Network
Physician
Partners
Direct to Consumer
Marketing
Joint Marketing
with Physicians
Nobilis Health
Employed Primary
Care Physicians
Physician
Partners
(Minority Ownership)
5
• Ownership is just one of several alignment
opportunities between physicians and
Nobilis Health
• Acquire patients through:
• Direct to Consumer Marketing
• Employment of Primary Care
Physicians
• Clinically Integrated Network
• Joint Marketing with Physicians
• Physician Partners (Minority
Ownership)
BUSINESS OVERVIEW
6
Bariatrics
19% General Surgery
5%
GI
1%
Obstetrics &
Gynecology
3%
Orthopedic Surgery
11%
Otolaryngology
5%
Pain
26%
Podiatry
3%
Plastic & Reconstructive
10%
Spine
12%
Vascular
5%
2017 Case Mix 2017 Payor Mix
BCBS TX
17%
BCBS Other
12%
Aetna
11%
Cigna
8%
UHC
18%
Commercial
10%
Self Pay
14%
Workman
Compensation
3%
Medicare
6%
Other
1%
*Note: Measured as a percent of case volumes
BUSINESS OVERVIEW
7
Case Volume Revenue Per Case
8,740
17,814
19,941
18,757
0
5,000
10,000
15,000
20,000
25,000
2014 2015 2016 2017
CaseVolume
$9,611
$12,867
$14,329
$15,979
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
$18,000
2014 2015 2016 2017
RevenueperCase
* Note: Based on the Company’s average 2017 revenue per case figure of $15,979, the impact of Hurricane
Harvey in the Houston market led to an estimated loss of volume within the range of 950—1,250 cases in 2017.
*
Private Lender Presentation
INDUSTRY OVERVIEW
8
AMBULATORY SURGICAL CENTERS (ASCs)
• Outpatient only
• > 5,500 ASCs nation-wide
• 75%+ owned by independent
physician groups
• Full-service hospital
• Inpatient and outpatient
• > 5,700 hospitals nation-wide
• 60%+ not-for-profit
SPECIALTY SURGICAL HOSPITALS (SSHs)
• Typically outpatient focused
• Inpatient and outpatient
• ~300 SSHs nation-wide
SURGICAL SETTING BACKGROUND
TRADITIONAL HOSPITALS
NOBILIS HEALTH
9
INDUSTRY GROWTH
• Efficient cost structures
• Increased government focus on healthcare
• Aging population
• Despite recent consolidation activity, the ASC
industry remains highly fragmented
• Industry revenues expected to grow 7.5% as the
population ages and the newly insured access
care, reaching $40 billion annually
• The eight largest ASC owner/operators comprise
~22% of the overall market
• > 50% of outpatient surgeries performed in ASC
setting vs. 32% in 2005
GROWTH OF THE ASC INDUSTRY
Projected ASC Industry Revenue
Independent operators, hospitals, & small chains comprise 78% of ASCs in the U.S.
($ in billions)
$16 $17
$19 $20 $21 $22 $23
$25
$27
$30
$32
$34 $36
$38
$40
$0
$5
$10
$15
$20
$25
$30
$35
$40
$45
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015E
2016E
2017E
2018E
2019E
2020E
Source: CSM, Equity Research, IBIS healthcare expenditures estimates, Becker’s.
10
THE SPINE SHIFT
• Spine procedures shifting from inpatient to outpatient
• Key spine procedures have stronger tailwinds due to demographics and improvements in technology
• ~31 million Americans suffer from chronic back pain
• ~600,000 Americans undergo spine surgery every year
INPATIENT SPINE DISCHARGES 2014 - 2019
SHIFT TO OUTPATIENT
OUTPATIENT SPINE DISCHARGES 2014 - 2019
Note: Growth rate data reflects U.S. market.
Source: Wall Street Research.
Advanced Imaging 13%
Arthrocentesis / Injections
5%
Rehab & Chiropractic
14%
Standard Imaging
13%
E&MVisits
17%
FusionSurgery
Spinal Decom. / Laminec.
Vertebral Augmentation
23%
27%
25%17%
-9%
-5%
-2%
2%
-11%
Nobilis Health
Key Procedures
Lumbar / Thoracic Fusion
CervicalFusion
No Procedure and
Diagnostics
Spinal Decompression/
Laminectomy
Vertebral Augmentation
Procedures
Revision Spinal Procedure
11
Private Lender Presentation
GROWTH STRATEGY
12
MARKETING EXPERTISE DRIVES ORGANIC GROWTH
• Multiple marketing channels drive volume growth
at hospitals, ASCs, ancillary service lines, and clinics
• Bundled payment capabilities
• Strategically adding new marketing brands to portfolio
• Branded referral program, 360 Concierge
SERVICE LINES AND SPECIALTIES
• Continue optimizing case mix to maximize revenue
potential
• Increase the volume of high acuity procedures that
benefit from higher levels of reimbursement
• Identify and develop additional service lines
appropriate for outpatient environment
GROWTH STRATEGY
ACQUISITION OPPORTUNITIES
• Highly fragmented market with many ideal acquisition targets
• Focus on targets that allow Nobilis Health to cross-sell
service lines and leverage marketing capabilities
• Pursuing in-network targets that are amenable to Nobilis Health
marketing platform and allow the Company to leverage
existing infrastructure
• Acquisition strategy includes facilities and clinical practices
1
3
2
4 OPERATIONAL LEVERAGE
• Focus on driving cost reductions throughout system
• Identify and achieve greater economies of scale as Nobilis Health
continues acquiring new businesses and expanding
its platform
• Experienced leadership team with decades of healthcare
experience
• Clinically integrated network for contracting and care
coordination
13
14
Nobilis Brands
Lead Generation Concierge Service
 Inside sales team and IT platform
to maximize patient experience
 9 brands marketed directly to
patients via omni-channel
marketing strategy
Patient Tracking Conversion to Surgical Patient
 Patient education, medical
review, insurance verification,
and surgical scheduling
 Patient follow-up, experience
surveys, and referrals
• Marketing and technology platform that targets prospective
patients
• Unique value proposition to physicians; superior patient
experience
• Generates higher acuity cases vs. traditional referral model
• Scalable revenue driver
• In-house marketing team works one-on-one with physicians to
develop and distribute customized marketing plans
• Helps to expand physicians’ practices, while also driving
additional volume to facilities
• High average ROI
Direct-to-Consumer Marketing Physician Sales
High-Touch Marketing Model
UNIQUE PATIENT ACQUISITION STRATEGY
NEUROMONITORING
• Specialties: spine, neuro, orthopedic, Cardiovascular,
and ENT surgery
• 5 states with 54 different facilities (Nobilis & Non-
Nobilis)
ANESTHESIA
• Specialties: spine, bariatrics, ENT, orthopedic, plastic,
and general surgery
• All Nobilis Health facilities
• Helps recruit partner physicians
FIRST ASSIST
• Specialties: spine, bariatrics, ENT, orthopedic, plastic,
and general surgery
• Higher trained providers with Nobilis Health
PHYSICAL THERAPY
• Launched April 2017 as a hospital outpatient department of
Plano Surgical Hospital
• Provides patients and physicians with a partner within Nobilis
Health’s continuum of care
ANCILLARY SERVICES
15
BENEFITS
• Continuity of care for patients
• Improves patient outcomes
• Increases patient and physician satisfaction
• Helps recruit top physicians
• Maximizes revenue by capturing additional revenue streams per patient
DEVELOPMENT
• Nobilis Health actively seeks potential M&A targets in the ancillary
services space
• Focus on acquisitions with revenue potential system wide
• Increased capabilities position Nobilis Health to execute alternative
payment methodologies for payors
PATIENT CENTRIC STRATEGY
• Efficient use of capital and operating resources
• Treat same level of demand with less capacity then stand alone facilities
• Results in increased productivity, lower staffing requirements and reduced
operating and unit costs
• Concertis is Nobilis Health’s Clinically Integrated Network (CIN) of
healthcare providers, ancillary providers, and facilities that
improves the patient experience across the continuum of care
• The CIN captures referrals from primary care physicians to
coordinate patient care with Nobilis Health ancillary providers,
surgeons and facilities
• 360 Concierge and the physician portal, divisions of Concertis,
allow providers the ability to monitor patient care as they move
through the Nobilis Health continuum of care
• Launched in May of 2017, the 360 Concierge platform has
generated over 1,000 referrals and approximately of $2.3M in
referral-driven procedure revenue in 2017
• The platform currently enrolls over 100 referring physicians across
Nobilis’ three core markets
• Align with physicians through employment, bundled payment
products, 360 Concierge, and other financial and clinical products
CONCERTIS STRATEGY
PRIMARY CARE PRACTICES
• Less expensive to acquire than specialists
• Allows Nobilis Health to control patient experience
across the
continuum of care
• Feeds volume into bundled payment and 360
Concierge
• Achieves clinical integration
• Brings physicians into our narrow network
• Nobilis Health’s care navigators are trained health
care professionals who serve as patient concierges,
guiding patients through the entire episode of care
from diagnosis to post-surgical care
16
Private Lender Presentation
FINANCIAL OVERVIEW
17
FINANCIAL PERFORMANCE
18
TOTAL REVENUE & ADJUSTED EBITDA
*2018 Guidance providedon March 8, 2018
Revenue: $345M-$355M
Adj. EBITDA: $57M-$62M
Revenue
Adj.EBITDA
$31
$84
$229
$286 $300
$345-
$355
$3
$11
$40
$34 $41
$57-$62
$0
$10
$20
$30
$40
$50
$60
$70
$0
$50
$100
$150
$200
$250
$300
$350
$400
2013 2014 2015 2016 2017 2018E
Total Revenue Total Adjusted EBITDA
2013-2017 Revenue CAGR 76%
2013-2017 Adjusted EBITDA CAGR 92%
(Millions)
ORGANIC vs. ACQUISITION GROWTH
$0
$50
$100
$150
$200
$250
$300
$350
2013 2014 2015 2016 2017
TotalRevenue
Total Organic Revenue
Total Acquired Revenue
Total Rev: $31mm
YoY Growth: $10mm
Total Rev: $84mm
YoY Growth: $53mm
Total Rev: $229mm
YoY Growth: $145mm
Total Rev: $286mm
YoY Growth: $57mm
19
YEAR-OVER-YEAR ORGANIC GROWTH
Total Rev: $300mm
YoY Growth: $14mm
(Millions)
20
KEY METRICS
Cash from Operations of $26.4 million at December 31, 2017, compared with $1.6 million at December 31, 2016
STOCK SNAPSHOT (03/21/18) FINANCIAL SNAPSHOT (12/31/2017)
Symbol (NYSE American) HLTH
Share Price $1.65
Market Cap $129M
Shares Outstanding 78.2M
Float 57M
Insider Ownership 27%
EV/Revenue (2018E) 0.65x
EV/ EBITDA (2018E) 3.82x
Cash $22.5M
Accounts Receivable $144.5M
Net Income $3.8M
Fully Diluted EPS $0.05
Total Debt $120.9M
Net Debt $98.4M
Leverage Ratio 2.5x
* Net income impacted by $6.0 million deferred tax asset adjustment
21
FINANCIAL STATEMENT HIGHLIGHTS
INCOME STATEMENT
STATEMENT OF CASH FLOWS
BALANCE SHEET
As of 12/31/2017
(Millions)
Cash $22.5
Total Assets $431.0
Total Debt $120.9
Total Liabilities $216.3
Net Cash Provided by Operating Activities $26.4
Net Cash Used For Investing Activities $(67.4)
Net Cash Provided by Financing Activities $39.0
Total Revenue $299.7
Operating Expenses
Salaries and Benefits
Drugs and Supplies
General and Administrative
Bad Debt (recovery) Exp
Depreciation and Amortization
Total Operating Expenses
Corporate Expenses
Salaries and Benefits
General and Administrative
Legal
Depreciation
Total Corporate Expenses
$63.8
$48.9
$124.0
$2.4
$11.3
$250.4
$11.7
$12.8
$2.1
$0.4
$27.0
Net Income $3.8
Adjusted EBITDA $41.4
* Net income impacted by $6.0 million deferred tax asset adjustment
Private Lender Presentation
APPENDIX
22
HARRY FLEMING
Chief Executive Officer & Chairman of the Board
• Joined Nobilis Health in 2010
• Previously served as CFO, President and Executive Chairman of Nobilis
• Earned an MBA from Boston College, a J.D. from the University of Houston, and a B.A. from the
University of St. Thomas
• Joined Nobilis Health in 2010
• Previously served as Chief Operating Officer & Chief Business Development Officer at Nobilis
• Founder & CEO of Diagnostic and Interventional Spine Centers
• Doctorate from Texas Chiropractic College
• Joined Nobilis Health in 2017
• Previously served as Divisional CFO for St. Jude Medical’s America division
• Licensed CPA
• Earned an MBA from the University of Texas at Austin
• Joined Nobilis Health in 2014
• 15 years of healthcare sales and business development
• Previously held successful sales leadership positions at Intuitive Surgical, Medtronic, and Pfizer
• Earned a B.A. from Rhodes College
• Joined Nobilis Health in 2016
• Partner at Baker Donelson, specializing in health law and served as a Director of Legal Services
at Houston Methodist Hospital System
• Earned a J.D. from the University of Houston and B.A. cum laude from Rice University
MANAGEMENT TEAM
KENNETH EFIRD
President
DAVID YOUNG
Chief Financial Officer
PATRICK YODER
Chief Revenue Officer
MARISSA ARREOLA
Chief Strategy Officer / President, Concertis
23
MARCOS RODRIGUEZ
Chief Accounting Officer
• Joined Nobilis Health in 2016
• Began his career at Deloitte & Touche LLP and served five years as Director at Opportune LLP
• 19 years of financial & accounting reporting, external and internal audits, and SEC regulations
• Earned a B.S. from Louisiana State University and is a licensed CPA
• Joined Nobilis Health in 2017
• 20 years of operational and managerial experience in the healthcare industry
• VP of Continuous Improvement for United Surgical Partners International/ Tenet Healthcare
(“USPI”) and CEO of Memorial Hermann Surgical Hospital Kingwood, in Houston, Texas
• M.S. in Healthcare Management-Emergency Services from University of Maryland
• Joined Nobilis Health in 2015
• Previously served as CFO at Northstar Healthcare LLC and Nobilis Health
• 20 years of financial and accounting reporting in the healthcare industry
• Earned an M.B.A. from Texas Woman’s University and a B.S. from Sacred Heart University
• Joined Nobilis Health in 2017
• Previously served as Director of Marketing for Travelocity and Director of Online Marketing at
Hotels.com
• Earned a J.D. from University of Tennessee College of Law and a B.S. from Vanderbilt University
• Joined Nobilis Health in 2014
• 10 years of finance & accounting experience in the healthcare industry, including HCA & Tenet
• Earned an M.B.A. from University of Texas – San Antonio and a B.S. from New York University
MANAGEMENT TEAM
MARC CELIA
EVP of Operations
KENNETH KLEIN
CFO of Operations
PHIL AYRES
VP of Marketing
BRANDON MORENO
VP of Finance
24
TEXAS (DALLAS AND HOUSTON) EQUITY
First Surgical Hospital -------------------------------------------------------------------------- 51%
Hermann Drive Surgical Hospital ---------------------------------------------------------- 54.75%
Plano Surgical Hospital ----------------------------------------------------------------------- 100%
Hospital for Surgical Excellence of Oak Bend-------------------------------------------- 50.1%
ARIZONA (SCOTTSDALE)
Scottsdale Liberty Hospital ------------------------------------------------------------------ 75%
NOBILIS HEALTH FACILITIES
Hospitals
25
TEXAS (DALLAS, HOUSTON, AND EL PASO) EQUITY
First Street Surgical Center (HOPD) ------------------------------------------------------- 51%
Kirby Surgical Center -------------------------------------------------------------------------- 25%
Medical Park Drive Specialty Center (HOPD) -------------------------------------------- 51%
Elite Center for Minimally Invasive Surgery (HOPD) ----------------------------------- 50.1%
Houston Metro Orthopedic & Spine Surgery Center (HOPD) ----------------------- 50.1%
Elite Sinus Spine & Ortho (HOPD) ---------------------------------------------------------- 50.1%
Mountain West Surgery Center (HOPD) -------------------------------------------------- 100%
Uptown Surgery Center (HOPD) ---------------------------------------------------------- 100%
ARIZONA (PHOENIX, SCOTTSDALE, AND TUCSON)
Northstar Healthcare Surgery Center – Scottsdale -------------------------------------- 100%
Chandler Surgery Center ---------------------------------------------------------------------- 100%
Oracle Surgery Center -------------------------------------------------------------------------- 100%
Phoenix Surgery Center ------------------------------------------------------------------------ 100%
NOBILIS HEALTH FACILITIES
ASCs
26
TEXAS (DALLAS, HOUSTON, ROUND ROCK, SAN ANTONIO) EQUITY
Hamilton Vein Sugar Land Clinic ------------------------------------------------------------- 100%
Hamilton Vein Woodlands Clinic ------------------------------------------------------------ 100%
Hamilton Vein Clear Lake Clinic -------------------------------------------------------------- 100%
Hamilton Vein Katy Clinic ---------------------------------------------------------------------- 100%
Hamilton Vein Stone Oak Clinic --------------------------------------------------------------- 100%
Hamilton Vein Round Rock Clinic ------------------------------------------------------------- 100%
Piney Point Women’s Center (HOPD) ------------------------------------------------------- 51%
P5 Performance (HOPD) ------------------------------------------------------------------------ 100%
ARIZONA (CHANDLER, GLENDALE, PHOENIX, SCOTTSDALE, AND TUCSON)
Arizona Vein & Vascular Chandler Clinic ---------------------------------------------------- 100%
Arizona Vein & Vascular Oracle Clinic ------------------------------------------------------- 100%
Arizona Vein & Vascular Phoenix Clinic ----------------------------------------------------- 100%
Arizona Vein & Vascular Surprise Clinic ---------------------------------------------------- 100%
DeRosa Medical Clinic – Glendale ----------------------------------------------------------- 100%
DeRosa Medical Clinic – Chandler ----------------------------------------------------------- 100%
DeRosa Medical Clinic – Scottsdale ---------------------------------------------------------- 100%
NOBILIS HEALTH FACILITIES
Clinics
27
NOBILIS HEALTH BRANDS
North American Spine
The flagship brand, North American Spine
offers innovative, minimally invasive back and
neck surgeries and enjoys a solid track record of
superior outcomes. The minimally invasive,
laser spine procedures enjoy high recognition in
their markets and the aging population
encourages strong natural growth.
Clarity Vein & Vascular
Clarity Vein and Vascular provides minimally
invasive surgical treatment of painful and/or
unsightly vascular conditions ranging from the
relatively benign, like varicose or spider veins,
to the dangerous, like deep vein thrombosis or
peripheral artery disease.
Hamilton Vein Center
Hamilton Vein and Vascular is a full-service
clinical practice with multiple Texas locations
and an impressive record of successful
treatments. Adept at cosmetic procedures for
conditions like spider and varicose veins, the
practice also excels at diagnosing and treating
potentially harmful underlying conditions.
Migraine Treatment Centers of America
Migraine Treatment Centers of America is the
exclusive provider of the Omega™ Procedure, a
non-pharmaceutical surgical implant for the
relief of chronic migraine pain. Increasing
awareness of neurostimulation techniques,
vocal support from past patients, and favorable
insurance policies position the brand as very
high growth.
Arizona Vein & Vascular Center
Arizona Vein and Vascular is a mature practice
in the Phoenix/Scottsdale area that, like Clarity
Vein and Vascular, provides minimally invasive
treatment of venous conditions and disorders
from the unsightly to the dangerous.
MIRI Women’s Health
MIRI Women’s Health focuses on minimally
invasive surgeries for gynecological conditions
and offers second opinions for those seeking an
alternative to traditional hysterectomies.
Evolve
Evolve, a bariatric surgery brand, benefits from
increasing medical consensus on the health
benefits of bariatric surgery over conventional
diet and exercise for the significantly or morbidly
obese. Nationally rising rates of obesity and more
farsighted, preventive insurance policies poise
the brand for strong growth.
Onward Orthopedics
Onward Orthopedics treats non-spine joint
issues for patients of all ages and types. The
brand benefits from partner physicians with
solid histories of high-profile sports clients, and
can provide referrals to the North American
Spine and NueStep brands.
NueStep
NueStep focuses on the minimally invasive
relief of foot and ankle pain due to nerve
entrapment and a variety of other podiatric
issues. The brand’s success is a result of
educational marketing campaigns designed to
correct a historical under-appreciation of foot
pain and therapeutic modes used to address it.
28
Private Lender Presentation
NYSE American: HLTH|NEO:HLTH
29

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Nobilis health corporate presentation march 3.23.18 final[2]

  • 1. Private Lender PresentationNYSE American: HLTH|NEO Exchange: HLTH March 2018 Corporate Presentation 1
  • 2. This presentation contains forward-looking information (within the meaning of applicable securities laws) relating to the business of Nobilis Health Corp. (the "Company") and the environment in which it operates. Forward-looking information may include statements regarding the objectives, business strategies to achieve those objectives, expected financial results, economic or market conditions, industry specific information, and the outlook of or involving the Company and its business. Such forward looking information or statements are typically identified by words such as "believe", "anticipate", "expect", "intend", "plan", "will", "may" and other similar expressions. Forward-looking information, including any financial outlooks, is provided for the purpose of providing information about management's expectations and plans about the future and may not be appropriate for other purposes. Forward-looking information herein is based on various assumptions and expectations that the Company believes are reasonable in the circumstances. No assurance can be given that these assumptions and expectations will prove to be correct and the forward-looking information, including the financial outlooks included in this Presentation, should not be unduly relied upon. Those assumptions and expectations are based on information currently available to the Company, including the historic performance of the Company's business. Such assumptions include anticipated financial performance, current business, industry and economic trends, and business prospects and are subject to the risks and uncertainties which are discussed in the Company's regulatory filings available on the Company's web site at www.NobilisHealth.com or at www.sec.gov. Any forward-looking statements that we make are based on assumptions as of today, and we undertake no obligation to update them. The Company’s management has approved the financial outlooks contained in this presentation. FORWARD-LOOKING INFORMATION 2
  • 3. LOCATIONS • 11 markets across 5 states • 5 surgical hospitals • 12 ASCs • 15 multi-specialty clinics • 34 partner facilities STRATEGY • Optimized case mix and payor mix across the portfolio • Higher acuity procedures leading to higher levels of reimbursements • Focus on minimally invasive procedures • Compelling value proposition for physicians, patients, and payors • Low Cap-Ex requirements • Scalable platform enables nationwide growth COMPANY OVERVIEW DIRECT-TO-PATIENT MARKETING MODEL • Branded procedures drive additional surgical volume to nationwide network of facilities • Capitalizes on growing trend of consumerism in healthcare • Drives organic growth $300 million in Revenue & $41 million in Adjusted EBITDA, FY 2017 3
  • 4. UNIQUE MARKETING MODEL • Multiple marketing channels drive organic volume growth • Proprietary technology platform targets prospective patients • Strong value proposition: Superior patient experience that expands physicians’ practices ATTRACTIVE FINANCIAL PROFILE PATIENT-CENTRIC VALUE PROPOSITION FAVORABLE PAYOR AND PROCEDURE MIX ATTRACTIVE INDUSTRY FUNDAMENTALS EXPERIENCED MANAGEMENT TEAM • Low leverage • Low capital expenditure requirements • Stable cash balance • Unique marketing model increases case volume and provides superior patient experience • Offers optimal surgical environments that result in better overall quality of care • Offers ancillary services that lead to better efficiency and outcomes • Marketing segment targets higher acuity cases resulting in a highly attractive case mix • Procedure diversification increases the stability of the revenue base • Minimal government payor claims reduces risk of Medicare/Medicaid rate changes • 66% of all surgeries are outpatient with >50% performed in ASCs vs. 32% in 2005 • Lower cost, high quality outpatient setting; trend toward increased consumerism in healthcare • Abundance of desirable acquisition opportunities due to fragmented market • Strong management team with healthcare and M&A experience • Seasoned Ops team leads to financial and operational efficiencies • Strong in-house and outside legal team to safely navigate complex healthcare space INVESTMENT HIGHLIGHTS 4
  • 5. UNIQUE PATIENT ACQUISITION MODEL • Acquires patients from physician partners • Physicians often form partnerships with inequitable percentages: • Productive doctors resent less productive doctors • Management Co. only manages and does not drive patients to centers • Must rely on physician partners to grow their practices to then bring more patients • No vertical integration Traditional Model The Nobilis Health Model • Nobilis Health owns and manages its facilities • Drive patient flow to our facilities • Control the patient experience through an expanding continuum of care: • Patient acquisition • Primary care • Ancillaries • Surgeries • Post-Op Nobilis Health Clinically Integrated Network Physician Partners Direct to Consumer Marketing Joint Marketing with Physicians Nobilis Health Employed Primary Care Physicians Physician Partners (Minority Ownership) 5 • Ownership is just one of several alignment opportunities between physicians and Nobilis Health • Acquire patients through: • Direct to Consumer Marketing • Employment of Primary Care Physicians • Clinically Integrated Network • Joint Marketing with Physicians • Physician Partners (Minority Ownership)
  • 6. BUSINESS OVERVIEW 6 Bariatrics 19% General Surgery 5% GI 1% Obstetrics & Gynecology 3% Orthopedic Surgery 11% Otolaryngology 5% Pain 26% Podiatry 3% Plastic & Reconstructive 10% Spine 12% Vascular 5% 2017 Case Mix 2017 Payor Mix BCBS TX 17% BCBS Other 12% Aetna 11% Cigna 8% UHC 18% Commercial 10% Self Pay 14% Workman Compensation 3% Medicare 6% Other 1% *Note: Measured as a percent of case volumes
  • 7. BUSINESS OVERVIEW 7 Case Volume Revenue Per Case 8,740 17,814 19,941 18,757 0 5,000 10,000 15,000 20,000 25,000 2014 2015 2016 2017 CaseVolume $9,611 $12,867 $14,329 $15,979 $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 $16,000 $18,000 2014 2015 2016 2017 RevenueperCase * Note: Based on the Company’s average 2017 revenue per case figure of $15,979, the impact of Hurricane Harvey in the Houston market led to an estimated loss of volume within the range of 950—1,250 cases in 2017. *
  • 9. AMBULATORY SURGICAL CENTERS (ASCs) • Outpatient only • > 5,500 ASCs nation-wide • 75%+ owned by independent physician groups • Full-service hospital • Inpatient and outpatient • > 5,700 hospitals nation-wide • 60%+ not-for-profit SPECIALTY SURGICAL HOSPITALS (SSHs) • Typically outpatient focused • Inpatient and outpatient • ~300 SSHs nation-wide SURGICAL SETTING BACKGROUND TRADITIONAL HOSPITALS NOBILIS HEALTH 9
  • 10. INDUSTRY GROWTH • Efficient cost structures • Increased government focus on healthcare • Aging population • Despite recent consolidation activity, the ASC industry remains highly fragmented • Industry revenues expected to grow 7.5% as the population ages and the newly insured access care, reaching $40 billion annually • The eight largest ASC owner/operators comprise ~22% of the overall market • > 50% of outpatient surgeries performed in ASC setting vs. 32% in 2005 GROWTH OF THE ASC INDUSTRY Projected ASC Industry Revenue Independent operators, hospitals, & small chains comprise 78% of ASCs in the U.S. ($ in billions) $16 $17 $19 $20 $21 $22 $23 $25 $27 $30 $32 $34 $36 $38 $40 $0 $5 $10 $15 $20 $25 $30 $35 $40 $45 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015E 2016E 2017E 2018E 2019E 2020E Source: CSM, Equity Research, IBIS healthcare expenditures estimates, Becker’s. 10
  • 11. THE SPINE SHIFT • Spine procedures shifting from inpatient to outpatient • Key spine procedures have stronger tailwinds due to demographics and improvements in technology • ~31 million Americans suffer from chronic back pain • ~600,000 Americans undergo spine surgery every year INPATIENT SPINE DISCHARGES 2014 - 2019 SHIFT TO OUTPATIENT OUTPATIENT SPINE DISCHARGES 2014 - 2019 Note: Growth rate data reflects U.S. market. Source: Wall Street Research. Advanced Imaging 13% Arthrocentesis / Injections 5% Rehab & Chiropractic 14% Standard Imaging 13% E&MVisits 17% FusionSurgery Spinal Decom. / Laminec. Vertebral Augmentation 23% 27% 25%17% -9% -5% -2% 2% -11% Nobilis Health Key Procedures Lumbar / Thoracic Fusion CervicalFusion No Procedure and Diagnostics Spinal Decompression/ Laminectomy Vertebral Augmentation Procedures Revision Spinal Procedure 11
  • 13. MARKETING EXPERTISE DRIVES ORGANIC GROWTH • Multiple marketing channels drive volume growth at hospitals, ASCs, ancillary service lines, and clinics • Bundled payment capabilities • Strategically adding new marketing brands to portfolio • Branded referral program, 360 Concierge SERVICE LINES AND SPECIALTIES • Continue optimizing case mix to maximize revenue potential • Increase the volume of high acuity procedures that benefit from higher levels of reimbursement • Identify and develop additional service lines appropriate for outpatient environment GROWTH STRATEGY ACQUISITION OPPORTUNITIES • Highly fragmented market with many ideal acquisition targets • Focus on targets that allow Nobilis Health to cross-sell service lines and leverage marketing capabilities • Pursuing in-network targets that are amenable to Nobilis Health marketing platform and allow the Company to leverage existing infrastructure • Acquisition strategy includes facilities and clinical practices 1 3 2 4 OPERATIONAL LEVERAGE • Focus on driving cost reductions throughout system • Identify and achieve greater economies of scale as Nobilis Health continues acquiring new businesses and expanding its platform • Experienced leadership team with decades of healthcare experience • Clinically integrated network for contracting and care coordination 13
  • 14. 14 Nobilis Brands Lead Generation Concierge Service  Inside sales team and IT platform to maximize patient experience  9 brands marketed directly to patients via omni-channel marketing strategy Patient Tracking Conversion to Surgical Patient  Patient education, medical review, insurance verification, and surgical scheduling  Patient follow-up, experience surveys, and referrals • Marketing and technology platform that targets prospective patients • Unique value proposition to physicians; superior patient experience • Generates higher acuity cases vs. traditional referral model • Scalable revenue driver • In-house marketing team works one-on-one with physicians to develop and distribute customized marketing plans • Helps to expand physicians’ practices, while also driving additional volume to facilities • High average ROI Direct-to-Consumer Marketing Physician Sales High-Touch Marketing Model UNIQUE PATIENT ACQUISITION STRATEGY
  • 15. NEUROMONITORING • Specialties: spine, neuro, orthopedic, Cardiovascular, and ENT surgery • 5 states with 54 different facilities (Nobilis & Non- Nobilis) ANESTHESIA • Specialties: spine, bariatrics, ENT, orthopedic, plastic, and general surgery • All Nobilis Health facilities • Helps recruit partner physicians FIRST ASSIST • Specialties: spine, bariatrics, ENT, orthopedic, plastic, and general surgery • Higher trained providers with Nobilis Health PHYSICAL THERAPY • Launched April 2017 as a hospital outpatient department of Plano Surgical Hospital • Provides patients and physicians with a partner within Nobilis Health’s continuum of care ANCILLARY SERVICES 15 BENEFITS • Continuity of care for patients • Improves patient outcomes • Increases patient and physician satisfaction • Helps recruit top physicians • Maximizes revenue by capturing additional revenue streams per patient DEVELOPMENT • Nobilis Health actively seeks potential M&A targets in the ancillary services space • Focus on acquisitions with revenue potential system wide • Increased capabilities position Nobilis Health to execute alternative payment methodologies for payors PATIENT CENTRIC STRATEGY • Efficient use of capital and operating resources • Treat same level of demand with less capacity then stand alone facilities • Results in increased productivity, lower staffing requirements and reduced operating and unit costs
  • 16. • Concertis is Nobilis Health’s Clinically Integrated Network (CIN) of healthcare providers, ancillary providers, and facilities that improves the patient experience across the continuum of care • The CIN captures referrals from primary care physicians to coordinate patient care with Nobilis Health ancillary providers, surgeons and facilities • 360 Concierge and the physician portal, divisions of Concertis, allow providers the ability to monitor patient care as they move through the Nobilis Health continuum of care • Launched in May of 2017, the 360 Concierge platform has generated over 1,000 referrals and approximately of $2.3M in referral-driven procedure revenue in 2017 • The platform currently enrolls over 100 referring physicians across Nobilis’ three core markets • Align with physicians through employment, bundled payment products, 360 Concierge, and other financial and clinical products CONCERTIS STRATEGY PRIMARY CARE PRACTICES • Less expensive to acquire than specialists • Allows Nobilis Health to control patient experience across the continuum of care • Feeds volume into bundled payment and 360 Concierge • Achieves clinical integration • Brings physicians into our narrow network • Nobilis Health’s care navigators are trained health care professionals who serve as patient concierges, guiding patients through the entire episode of care from diagnosis to post-surgical care 16
  • 18. FINANCIAL PERFORMANCE 18 TOTAL REVENUE & ADJUSTED EBITDA *2018 Guidance providedon March 8, 2018 Revenue: $345M-$355M Adj. EBITDA: $57M-$62M Revenue Adj.EBITDA $31 $84 $229 $286 $300 $345- $355 $3 $11 $40 $34 $41 $57-$62 $0 $10 $20 $30 $40 $50 $60 $70 $0 $50 $100 $150 $200 $250 $300 $350 $400 2013 2014 2015 2016 2017 2018E Total Revenue Total Adjusted EBITDA 2013-2017 Revenue CAGR 76% 2013-2017 Adjusted EBITDA CAGR 92% (Millions)
  • 19. ORGANIC vs. ACQUISITION GROWTH $0 $50 $100 $150 $200 $250 $300 $350 2013 2014 2015 2016 2017 TotalRevenue Total Organic Revenue Total Acquired Revenue Total Rev: $31mm YoY Growth: $10mm Total Rev: $84mm YoY Growth: $53mm Total Rev: $229mm YoY Growth: $145mm Total Rev: $286mm YoY Growth: $57mm 19 YEAR-OVER-YEAR ORGANIC GROWTH Total Rev: $300mm YoY Growth: $14mm (Millions)
  • 20. 20 KEY METRICS Cash from Operations of $26.4 million at December 31, 2017, compared with $1.6 million at December 31, 2016 STOCK SNAPSHOT (03/21/18) FINANCIAL SNAPSHOT (12/31/2017) Symbol (NYSE American) HLTH Share Price $1.65 Market Cap $129M Shares Outstanding 78.2M Float 57M Insider Ownership 27% EV/Revenue (2018E) 0.65x EV/ EBITDA (2018E) 3.82x Cash $22.5M Accounts Receivable $144.5M Net Income $3.8M Fully Diluted EPS $0.05 Total Debt $120.9M Net Debt $98.4M Leverage Ratio 2.5x * Net income impacted by $6.0 million deferred tax asset adjustment
  • 21. 21 FINANCIAL STATEMENT HIGHLIGHTS INCOME STATEMENT STATEMENT OF CASH FLOWS BALANCE SHEET As of 12/31/2017 (Millions) Cash $22.5 Total Assets $431.0 Total Debt $120.9 Total Liabilities $216.3 Net Cash Provided by Operating Activities $26.4 Net Cash Used For Investing Activities $(67.4) Net Cash Provided by Financing Activities $39.0 Total Revenue $299.7 Operating Expenses Salaries and Benefits Drugs and Supplies General and Administrative Bad Debt (recovery) Exp Depreciation and Amortization Total Operating Expenses Corporate Expenses Salaries and Benefits General and Administrative Legal Depreciation Total Corporate Expenses $63.8 $48.9 $124.0 $2.4 $11.3 $250.4 $11.7 $12.8 $2.1 $0.4 $27.0 Net Income $3.8 Adjusted EBITDA $41.4 * Net income impacted by $6.0 million deferred tax asset adjustment
  • 23. HARRY FLEMING Chief Executive Officer & Chairman of the Board • Joined Nobilis Health in 2010 • Previously served as CFO, President and Executive Chairman of Nobilis • Earned an MBA from Boston College, a J.D. from the University of Houston, and a B.A. from the University of St. Thomas • Joined Nobilis Health in 2010 • Previously served as Chief Operating Officer & Chief Business Development Officer at Nobilis • Founder & CEO of Diagnostic and Interventional Spine Centers • Doctorate from Texas Chiropractic College • Joined Nobilis Health in 2017 • Previously served as Divisional CFO for St. Jude Medical’s America division • Licensed CPA • Earned an MBA from the University of Texas at Austin • Joined Nobilis Health in 2014 • 15 years of healthcare sales and business development • Previously held successful sales leadership positions at Intuitive Surgical, Medtronic, and Pfizer • Earned a B.A. from Rhodes College • Joined Nobilis Health in 2016 • Partner at Baker Donelson, specializing in health law and served as a Director of Legal Services at Houston Methodist Hospital System • Earned a J.D. from the University of Houston and B.A. cum laude from Rice University MANAGEMENT TEAM KENNETH EFIRD President DAVID YOUNG Chief Financial Officer PATRICK YODER Chief Revenue Officer MARISSA ARREOLA Chief Strategy Officer / President, Concertis 23
  • 24. MARCOS RODRIGUEZ Chief Accounting Officer • Joined Nobilis Health in 2016 • Began his career at Deloitte & Touche LLP and served five years as Director at Opportune LLP • 19 years of financial & accounting reporting, external and internal audits, and SEC regulations • Earned a B.S. from Louisiana State University and is a licensed CPA • Joined Nobilis Health in 2017 • 20 years of operational and managerial experience in the healthcare industry • VP of Continuous Improvement for United Surgical Partners International/ Tenet Healthcare (“USPI”) and CEO of Memorial Hermann Surgical Hospital Kingwood, in Houston, Texas • M.S. in Healthcare Management-Emergency Services from University of Maryland • Joined Nobilis Health in 2015 • Previously served as CFO at Northstar Healthcare LLC and Nobilis Health • 20 years of financial and accounting reporting in the healthcare industry • Earned an M.B.A. from Texas Woman’s University and a B.S. from Sacred Heart University • Joined Nobilis Health in 2017 • Previously served as Director of Marketing for Travelocity and Director of Online Marketing at Hotels.com • Earned a J.D. from University of Tennessee College of Law and a B.S. from Vanderbilt University • Joined Nobilis Health in 2014 • 10 years of finance & accounting experience in the healthcare industry, including HCA & Tenet • Earned an M.B.A. from University of Texas – San Antonio and a B.S. from New York University MANAGEMENT TEAM MARC CELIA EVP of Operations KENNETH KLEIN CFO of Operations PHIL AYRES VP of Marketing BRANDON MORENO VP of Finance 24
  • 25. TEXAS (DALLAS AND HOUSTON) EQUITY First Surgical Hospital -------------------------------------------------------------------------- 51% Hermann Drive Surgical Hospital ---------------------------------------------------------- 54.75% Plano Surgical Hospital ----------------------------------------------------------------------- 100% Hospital for Surgical Excellence of Oak Bend-------------------------------------------- 50.1% ARIZONA (SCOTTSDALE) Scottsdale Liberty Hospital ------------------------------------------------------------------ 75% NOBILIS HEALTH FACILITIES Hospitals 25
  • 26. TEXAS (DALLAS, HOUSTON, AND EL PASO) EQUITY First Street Surgical Center (HOPD) ------------------------------------------------------- 51% Kirby Surgical Center -------------------------------------------------------------------------- 25% Medical Park Drive Specialty Center (HOPD) -------------------------------------------- 51% Elite Center for Minimally Invasive Surgery (HOPD) ----------------------------------- 50.1% Houston Metro Orthopedic & Spine Surgery Center (HOPD) ----------------------- 50.1% Elite Sinus Spine & Ortho (HOPD) ---------------------------------------------------------- 50.1% Mountain West Surgery Center (HOPD) -------------------------------------------------- 100% Uptown Surgery Center (HOPD) ---------------------------------------------------------- 100% ARIZONA (PHOENIX, SCOTTSDALE, AND TUCSON) Northstar Healthcare Surgery Center – Scottsdale -------------------------------------- 100% Chandler Surgery Center ---------------------------------------------------------------------- 100% Oracle Surgery Center -------------------------------------------------------------------------- 100% Phoenix Surgery Center ------------------------------------------------------------------------ 100% NOBILIS HEALTH FACILITIES ASCs 26
  • 27. TEXAS (DALLAS, HOUSTON, ROUND ROCK, SAN ANTONIO) EQUITY Hamilton Vein Sugar Land Clinic ------------------------------------------------------------- 100% Hamilton Vein Woodlands Clinic ------------------------------------------------------------ 100% Hamilton Vein Clear Lake Clinic -------------------------------------------------------------- 100% Hamilton Vein Katy Clinic ---------------------------------------------------------------------- 100% Hamilton Vein Stone Oak Clinic --------------------------------------------------------------- 100% Hamilton Vein Round Rock Clinic ------------------------------------------------------------- 100% Piney Point Women’s Center (HOPD) ------------------------------------------------------- 51% P5 Performance (HOPD) ------------------------------------------------------------------------ 100% ARIZONA (CHANDLER, GLENDALE, PHOENIX, SCOTTSDALE, AND TUCSON) Arizona Vein & Vascular Chandler Clinic ---------------------------------------------------- 100% Arizona Vein & Vascular Oracle Clinic ------------------------------------------------------- 100% Arizona Vein & Vascular Phoenix Clinic ----------------------------------------------------- 100% Arizona Vein & Vascular Surprise Clinic ---------------------------------------------------- 100% DeRosa Medical Clinic – Glendale ----------------------------------------------------------- 100% DeRosa Medical Clinic – Chandler ----------------------------------------------------------- 100% DeRosa Medical Clinic – Scottsdale ---------------------------------------------------------- 100% NOBILIS HEALTH FACILITIES Clinics 27
  • 28. NOBILIS HEALTH BRANDS North American Spine The flagship brand, North American Spine offers innovative, minimally invasive back and neck surgeries and enjoys a solid track record of superior outcomes. The minimally invasive, laser spine procedures enjoy high recognition in their markets and the aging population encourages strong natural growth. Clarity Vein & Vascular Clarity Vein and Vascular provides minimally invasive surgical treatment of painful and/or unsightly vascular conditions ranging from the relatively benign, like varicose or spider veins, to the dangerous, like deep vein thrombosis or peripheral artery disease. Hamilton Vein Center Hamilton Vein and Vascular is a full-service clinical practice with multiple Texas locations and an impressive record of successful treatments. Adept at cosmetic procedures for conditions like spider and varicose veins, the practice also excels at diagnosing and treating potentially harmful underlying conditions. Migraine Treatment Centers of America Migraine Treatment Centers of America is the exclusive provider of the Omega™ Procedure, a non-pharmaceutical surgical implant for the relief of chronic migraine pain. Increasing awareness of neurostimulation techniques, vocal support from past patients, and favorable insurance policies position the brand as very high growth. Arizona Vein & Vascular Center Arizona Vein and Vascular is a mature practice in the Phoenix/Scottsdale area that, like Clarity Vein and Vascular, provides minimally invasive treatment of venous conditions and disorders from the unsightly to the dangerous. MIRI Women’s Health MIRI Women’s Health focuses on minimally invasive surgeries for gynecological conditions and offers second opinions for those seeking an alternative to traditional hysterectomies. Evolve Evolve, a bariatric surgery brand, benefits from increasing medical consensus on the health benefits of bariatric surgery over conventional diet and exercise for the significantly or morbidly obese. Nationally rising rates of obesity and more farsighted, preventive insurance policies poise the brand for strong growth. Onward Orthopedics Onward Orthopedics treats non-spine joint issues for patients of all ages and types. The brand benefits from partner physicians with solid histories of high-profile sports clients, and can provide referrals to the North American Spine and NueStep brands. NueStep NueStep focuses on the minimally invasive relief of foot and ankle pain due to nerve entrapment and a variety of other podiatric issues. The brand’s success is a result of educational marketing campaigns designed to correct a historical under-appreciation of foot pain and therapeutic modes used to address it. 28
  • 29. Private Lender Presentation NYSE American: HLTH|NEO:HLTH 29