3. LOCATIONS
ā¢ 10 markets across 5 states
ā¢ 5 surgical hospitals
ā¢ 13 ASCs
ā¢ 13 multi-specialty clinics
ā¢ 36 partner facilities
STRATEGY
ā¢ Optimized case mix and payor mix across the portfolio
ā¢ Higher acuity procedures leading to higher levels of
reimbursements
ā¢ Focus on minimally invasive procedures
ā¢ Compelling value proposition for physicians,
patients, and payors
ā¢ Low Cap-Ex requirements
ā¢ Scalable platform enables nationwide growth
COMPANY OVERVIEW
DIRECT-TO-PATIENT MARKETING MODEL
ā¢ Branded procedures drive additional surgical volume to nation-wide
network of facilities
ā¢ Capitalizes on growing trend of āconsumerismā in healthcare
ā¢ Drives organic growth
$315 million in revenue & $40 million in Adjusted EBITDA, LTM September 2017
Markets with Nobilis owned facilities
Markets with Nobilis partner facilities
3
4. UNIQUE MARKETING MODEL
ā¢ Multiple marketing channels drive organic volume growth
ā¢ Proprietary technology platform targets prospective patients
ā¢ Strong value proposition: Superior patient experience that expands physiciansā practices
ATTRACTIVE FINANCIAL PROFILE
PATIENT-CENTRIC VALUE PROPOSITION
FAVORABLE PAYOR AND PROCEDURE MIX
ATTRACTIVE INDUSTRY FUNDAMENTALS
EXPERIENCED MANAGEMENT TEAM
ā¢ Low leverage
ā¢ Low capital expenditure requirements
ā¢ Stable cash balance
ā¢ Unique marketing model increases case volume and provides superior patient experience
ā¢ Offers optimal surgical environments that result in better overall quality of care
ā¢ Offers ancillary services that lead to better efficiency and outcomes
ā¢ Marketing segment targets higher acuity cases resulting in a highly attractive case mix
ā¢ Procedure diversification increases the stability of the revenue base
ā¢ Minimal government payor claims reduces risk of Medicare/Medicaid rate changes
ā¢ 66% of all surgeries are outpatient with >50% performed in ASCs vs. 32% in 2005
ā¢ Lower cost, high quality outpatient setting; trend toward increased consumerism in healthcare
ā¢ Abundance of desirable acquisition opportunities due to fragmented market
ā¢ Strong management team with M&A and healthcare experience
ā¢ Seasoned Ops team leads to financial and operational efficiencies
ā¢ Strong in-house and outside legal team to safely navigate complex healthcare space
INVESTMENT HIGHLIGHTS
4
5. UNIQUE PATIENT ACQUISITION MODEL
ā¢ Acquires patients from physician partners who are not
obligated to bring cases to their facility
ā¢ Physicians often form partnerships with inequitable
percentages:
ā¢ Productive doctors resent less productive doctors
ā¢ Management Co. only manages and does not drive patients
to centers
ā¢ No growth drivers ā must rely on physician partners to grow
their practices to then bring more patients
ā¢ No vertical integration
Traditional Model The Nobilis Model
ā¢ Acquire patients through:
ā¢ Marketing programs
ā¢ Network of primary care
physician partners
ā¢ Physician employees
ā¢ Ownership is just one of several
alignment opportunities between
physicians and Nobilis
ā¢ Nobilis owns and manages its facilities
Nobilis Health
Network / Clinically
Integrated Network
Physician
Partners
Direct to Consumer
Marketing
Joint Marketing
with Physicians
Nobilis Health
Employed Primary
Care Physicians
ā¢ Drive patient flow to our facilities
ā¢ Control the patient experience through an
expanding continuum of care:
ā¢ Patient acquisition
ā¢ Primary care
ā¢ Ancillaries
ā¢ Surgeries
ā¢ Post-Op
Physician
Partners
(Minority Ownership)
5
6. FAVORABLE CASE MIX FAVORABLE PAYOR MIX
Note: Unless otherwise dated, figures are based on the LTM period ended 9/30/2017, pro forma for the full year impact of the AZ Vein acquisition.
Note 2: Case mix based on number of cases; payor mix based on revenue.
ENT
4%
General Surgery
4%
Ortho
7%
Pain
26%
Spine
18%
Bariatrics
19%
Vein/Vascular
4%
Podiatrist
2%
GI
1%
Plastic
Surgery
10%
GYN
3%
Migraine
2%
AETNA
22%
BCBS
16%
CIGNA
9%
UHC
33%
Other
Commercial
10%
Self Pay
6%
WC
3%
Medicare
1%
NOBILIS BUSINESS OVERVIEW
6
āTargeting Higher Acuity Casesā āMinimal Government Payor Claimsā
12. MARKETING EXPERTISE DRIVES ORGANIC GROWTH
ā¢ Multiple marketing channels drive volume growth
at hospitals, ASCs, and ancillary service lines
ā¢ Bundled payment capabilities
ā¢ Strategically adding new marketing brands to portfolio
ā¢ Branded referral program, 360 Concierge
SERVICE LINES AND SPECIALTIES
ā¢ Continue optimizing case mix to maximize revenue
potential
ā¢ Increase the volume of high acuity procedures that
benefit from higher levels of reimbursement
ā¢ Identify and develop additional service lines
appropriate for outpatient environment
GROWTH STRATEGY
ACQUISITION OPPORTUNITIES
ā¢ Highly fragmented market with many ideal acquisition targets
ā¢ Focus on targets that allow Nobilis Health to cross-sell
service lines and leverage marketing capabilities
ā¢ Pursuing in-network targets that are amenable to Nobilis Health
marketing platform and allow the Company to leverage
existing infrastructure
ā¢ Acquisition strategy includes facilities and clinical practices
1
3
2
4 OPERATIONAL LEVERAGE
ā¢ Focus on driving cost reductions throughout system
ā¢ Identify and achieve greater economies of scale as Nobilis
continues acquiring new businesses and expanding
its platform
ā¢ Experienced leadership team with decades of healthcare
experience
ā¢ Clinically integrated network for contracting and care
coordination
12
14. HIGH TOUCH MARKETING MODEL
Lead Generation
Direct-to-Patient Engagement Points
ā¢ Digital
ā¢ Traditional (TV, Radio)
ā¢ Email & Content
ā¢ Real-Time Fulfillment
Concierge Service
Inside Sales Team + IT Platform
ā¢ Dedicated Patient Coordinators
ā¢ Multi-touch, Full Service Process
ā¢ Proprietary Software Solutions
ā¢ CRM
Conversion to Surgical Patient
Patient Process Management
ā¢ Patient Education
ā¢ Imaging Review by Medical Team
ā¢ Insurance Verification & Explanation
ā¢ Surgery Clearance Management
ā¢ Surgery Scheduling/Coordination
Patient Tracking
Patient Experience Follow Up/Facilitate Research
ā¢ Post Operative Follow-up Contact
ā¢ Patient Experience Surveys & Testimonial
ā¢ Referral Request
ā¢ 360 Concierge Tracking Through-out Continuum
of Care
ā¢ Promotes Succinct Treatment Algorithm which
Results in Improved Patient Outcomes and Lower
Healthcare Costs
14
16. BENEFITS
ā¢ Continuity of care for patients
ā¢ Helps recruit top physicians
ā¢ Increases patient and physician satisfaction
ā¢ Improves patient outcomes
ā¢ Accretive to earnings
ANCILLARY SERVICES
DEVELOPMENT
ā¢ Nobilis actively seeks potential M&A targets in the
ancillary services space
ā¢ Focus on acquisitions with revenue potential system
wide
ā¢ Increased capabilities position Nobilis to execute
alternative payment methodologies for payors
PATIENT CENTRIC STRATEGY
ā¢ Achieve economies of scale
ā¢ Make efficient use of capital and operating resources
ā¢ Treat same level of demand with less capacity then
stand alone facilities
ā¢ Results in increased productivity, lower staffing
requirements and reduced operating and unit costs
FINANCIAL CONTRIBUTION
ā¢ 2016 revenue of $20.4 million compared to $2.3
million in 2015
ā¢ Maximizes revenue by capturing additional revenue
streams per patient
16
17. ā¢ Concertis is Nobilis Healthās Clinically Integrated Network (CIN) of
healthcare providers, ancillary providers, and facilities that
improves the patient experience across the continuum of care
ā¢ The CIN captures referrals from primary care physicians to
coordinate patient care with Nobilis Health ancillary providers, surgeons
and facilities
ā¢ 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
ā¢ As of September, we have over 100 providers in the 360 Concierge
system across our three major markets, which has resulted in over 1,000
referrals to the Nobilis Health system
ā¢ Align with physicians through employment, bundled payment
products, 360 Concierge, and other financial and clinical products
CONCERTIS STRATEGY
PRIMARY CARE PRACTICES
ā¢ Less expensive to acquire than specialists
ā¢ Allows Nobilis Health to control patient experience across the
continuum of care
ā¢ Feeds volume into bundled payment and 360 Concierge
ā¢ Achieves clinical integration
ā¢ Bring physicians into our narrow network
ā¢ Our 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
17
19. ā¢ 4 ASCs & Surgical Hospitals in Houston Metro Area
ā¢ $49.0M LTM 9/30/17 Revenue
ā¢ $30.3M LTM 9/30/17 Adjusted EBITDA
ā¢ 76 Physician Partners
ā¢ 86 Referring Physicians
COMBINED REGIONAL LEADER
This image cannot currently
be displayed.
ā¢ 14 ASCs & Surgical Hospitals
ā¢ 5 ASCs & Surgical Hospitals in Houston Metro Area
ā¢ $314.8M LTM 9/30/17 Revenue (1)
ā¢ $39.6M LTM 9/30/17 Adjusted EBITDA (1)
ā¢ 41 Physician Partners
ā¢ 490 Referring Physicians
(1) Pro forma for the full year impact of the AZ Vein acquisition.
(2) Includes $2 million of estimated cost synergies resulting from the consolidation of one Elite and one Nobilis ASC currently colocated at the same address.
ASCs &
Surgical Hospitals
ASCs, Surgical
Hospitals & Clinics in
Houston Metro
LTM 9/30/17
Revenue
LTM 9/30/17
Adjusted EBITDA
(Net NCI)
Physician
Partners
Referring
Physicians
19
20. CASE MIX
PAYOR MIX
19,325
29,126
30,978 30,701
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
2014 2015 2016 LTM
6/30/17
Cases
CASE VOLUME & REVENUE PER CASE
IN-NETWORK CASE MIX
Pain
27%
Spine
15%
Ortho
14%
Bariatrics
14%
ENT
9%
Plastic
7%
Podiatrist
4%
Other
11%
UHC 29%
Aetna 23%
BCBS TX
12%
BCBS 6%
Other
Commercial
12%
Cigna 11%
Self
4%
Worker's Comp 2%
Medicare 0.6%
Out-of-
Network
54%
In-Network
46%
$7,380
$9,634
$11,432
$12,344
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
2014 2015 2016 LTM
6/30/17
Rev. Per Case
PRO FORMA POST ACQUISTION
Note: All figures unless otherwise stated are based on LTM 6/30/2017 pro forma for the full year impact of the AZ Vein acquisition.
20
27. 27
FINANCIAL STATEMENT HIGHLIGHTS
INCOME STATEMENT
STATEMENT OF CASH FLOWS
BALANCE SHEET
As of 9/30/2017
(Millions)
Cash $34.1
Total Assets $317.1
Total Debt $75.7
Total Liabilities $159.1
Net Cash Provided by Operating Activities $27.9
Net Cash Used For Investing Activities $(13.3)
Net Cash Used For Financing Activities $(5.0)
Total Revenue $64.7
Operating Expenses
Salaries and Benefits
Drugs and Supplies
General and Administrative
Depreciation and Amortization
Total Operating Expenses
Corporate Expenses
Salaries and Benefits
General and Administrative
Legal
Depreciation
Total Corporate Expenses
$15.7
$10.4
$27.6
$2.7
$56.4
$2.9
$3.3
$0.7
$0.1
$7.0
Net Income $1.0
Adjusted EBITDA $6.7
29. HARRY FLEMING
Chief Executive Officer & Chairman of the Board
ā¢ Joined Nobilis in 2010
ā¢ Previously served as CFO, President and Executive Chairman of Nobilis
ā¢ Earned an MBA from Boston College, a J.D. from the University of Houston, and a B.A. from the
University of St. Thomas
ā¢ Joined Nobilis in 2010
ā¢ Previously served as Chief Operating Officer & Chief Business Development Officer at Nobilis
ā¢ Founder & CEO of Diagnostic and Interventional Spine Centers
ā¢ Doctorate from Texas Chiropractic College
ā¢ Joined Nobilis in 2017
ā¢ Previously served as Divisional CFO for St. Jude Medicalās America division
ā¢ Licensed CPA
ā¢ Earned an MBA from the University of Texas at Austin
ā¢ Joined Nobilis in 2014
ā¢ 15 years of healthcare sales and business development
ā¢ Previously held successful sales leadership positions at Intuitive Surgical, Medtronic, and Pfizer
ā¢ Earned a B.A. from Rhodes College
ā¢ Joined Nobilis in 2016
ā¢ Partner at Baker Donelson, specializing in health law and served as a Director of Legal Services
at Houston Methodist Hospital System
ā¢ 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
29
30. MARCOS RODRIGUEZ
Chief Accounting Officer
ā¢ Joined Nobilis in 2016
ā¢ Began his career at Deloitte & Touche LLP and served five years as Director at Opportune LLP
ā¢ 19 years of financial & accounting reporting, external and internal audits, and SEC regulations
ā¢ Earned a B.S. from Louisiana State University and is a licensed CPA
ā¢ Joined Nobilis in 2017
ā¢ 20 years of operational and managerial experience in the healthcare industry
ā¢ VP of Continuous Improvement for United Surgical Partners International/ Tenet Healthcare
(āUSPIā) and CEO of Memorial Hermann Surgical Hospital Kingwood, in Houston, Texas
ā¢ M.S. in Healthcare Management-Emergency Services from University of Maryland
ā¢ Joined Nobilis in 2015
ā¢ Previously served as CFO at Northstar Healthcare LLC and Nobilis Health
ā¢ 20 years of financial and accounting reporting in the healthcare industry
ā¢ Earned an M.B.A. from Texas Womanās University and a B.S. from Sacred Heart University
ā¢ Joined Nobilis in 2017
ā¢ Previously served as Director of Marketing for Travelocity and Director of Online Marketing at
Hotels.com
ā¢ Earned a J.D. from University of Tennessee College of Law and a B.S. from Vanderbilt University
ā¢ Joined Nobilis in 2014
ā¢ 10 years of finance & accounting experience in the healthcare industry, including HCA & Tenet
ā¢ Earned an M.B.A. from University of Texas ā 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
30
32. TEXAS (DALLAS, HOUSTON, AND EL PASO) EQUITY
First Nobilis 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 Ortho & 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 ā Scottsdale -------------------------------------- 100%
Chandler Surgery Center ---------------------------------------------------------------------- 100%
Oracle Surgery Center -------------------------------------------------------------------------- 100%
Phoenix Surgery Center ------------------------------------------------------------------------ 100%
Surprise Surgery Center ------------------------------------------------------------------------ 100%
NOBILIS FACILITIES
ASCs
32
33. 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%
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 ā Glendale ----------------------------------------------------------- 100%
DeRosa Medical Clinic ā Chandler ----------------------------------------------------------- 100%
DeRosa Medical Clinic ā Scottsdale ---------------------------------------------------------- 100%
NOBILIS FACILITIES
Clinics
33
34. NOBILIS FACILITIES
34
FACILITY NAME FACILITY DETAILS SPECIALTIES
PLANO SURGICAL HOSPITAL ā¢ 26 Inpatient Beds ā¢ Bariatrics
ā¢ 6 ORs ā¢ Spine
ā¢ 2 Procedure Rooms ā¢ Plastic Surgery
ā¢ Orthopedics
ā¢ General Surgery
ā¢ Pain Management
KIRBY SURGICAL CENTER ā¢ 4 ORs ā¢ Orthopedics
ā¢ 1 Procedure Room ā¢ General Surgery
ā¢ Pain
ā¢ ENT
HERMANN DRIVE SURGICAL HOSPITAL ā¢ 22 Beds ā¢ Bariatrics
ā¢ 18 Private Rooms ā¢ Spine
ā¢ 6 ORs ā¢ Plastic Surgery
ā¢ 2 Procedure Rooms ā¢ Orthopedics
ā¢ General Surgery
FIRST STREET SURGICAL HOSPITAL ā¢ 4 ORs ā¢ Bariatrics
ā¢ 1 Procedure Room ā¢ Spine
HOPDs of First Surgical Hospital: ā¢ Plastic Surgery
First Street Surgery Center ā¢ 4 ORs ā¢ Orthopedics
Medical Park Specialty Center ā¢ 1 OR ā¢ General Surgery
ā¢ Pain Management
ATRIUM MEDICAL CENTER ā¢ Bariatrics
ā¢ Spine
HOPDs of Atrium Medical Centre: ā¢ Plastic Surgery
Uptown Surgery Center ā¢ 2 ORs ā¢ Orthopedics
ā¢ General Surgery
ā¢ Pain Management
35. NOBILIS FACILITIES
35
FACILITY NAME FACILITY DETAILS SPECIALTIES
NORTHSTAR HEALTHCARE SURGERY CENTER - SCOTTSDALE ā¢ 4 ORs ā¢ Plastic Surgery
ā¢ 1 Procedure Room ā¢ Orthopedics
ā¢ General Surgery
ā¢ Pain management
ā¢ Bariatrics
ā¢ Podiatry
SCOTTSDALE LIBERTY HOSPITAL ā¢ 12 Inpatient Beds ā¢ Spine
ā¢ 2 ORs ā¢ Orthopedic Surgery
ā¢ 1 Procedure Room ā¢ General Surgery
ā¢ Podiatry
ā¢ Bariatrics
ā¢ Migraine
ā¢ Vascular
ARIZONA VEIN & VASCULAR CENTER ā¢ 4 Clinics ā¢ Vascular
ā¢ 4 ASCs
ā¢ 15 ORs
HAMILTON VEIN CENTER ā¢ 6 Clinics ā¢ Vascular
ā¢ 20 Radiofrequency Ablations (RFAs)
DEROSA MEDICAL ā¢ 3 Clinics ā¢ Health & Wellness
ā¢ 9 Providers ā¢ Weight Loss
ā¢ Chronic Health Condition Management
MESA HILLS SPECIALTY HOSPITAL
HOPDs of Mesa Hills Specialty Hospital:
Mountain West Surgery Center ā¢ 2 ORs
ā¢ 2 Procedure Rooms
ā¢ Spine
ā¢ Orthopedic Surgery
ā¢ General Surgery
ā¢ Podiatry
ā¢ Bariatrics
ā¢ Migraine
ā¢ Plastic Surgery
36. NOBILIS FACILITIES
36
FACILITY NAME FACILITY DETAILS SPECIALTIES
ELITE CENTER FOR MINIMALLY INVASIVE SURGERY (āTRAVISā) ā¢ 4 ORs ā¢ Orthopedic
ā¢ 2 Treatment Rooms ā¢ ENT
ā¢ 1 Private Rooms - Overnight ā¢ Pain
ā¢ Podiatry
ā¢ GI
HOUSTON METRO ORTHO & SPINE SURGERY CENTER (āMETROā) ā¢ 3 ORs ā¢ ENT
ā¢ 2 Treatment Rooms ā¢ Orthopedic
ā¢ 2 Private Rooms - Overnight ā¢ Pain
ā¢ Spine
ELITE SPINE SINUS & ORTHO (āRIVER OAKSā) ā¢ 22 Beds ā¢ Pain
ā¢ 18 Private rooms ā¢ Orthopedic
ā¢ 6 ORs ā¢ Podiatry
ā¢ 2 Procedure Rooms ā¢ Oculoplastic
ā¢ Plastic Surgery
ā¢ Ophthalmology
ā¢ Spine
ā¢ ENT
HOSPITAL FOR SURGICAL EXCELLENCE OF OAK BEND ā¢ 4 ORs ā¢ Pain
ā¢ 1 Treatment Room ā¢ Orthopedic
ā¢ 6 Inpatient Rooms ā¢ Podiatry
ā¢ GI
ā¢ Spine
ā¢ ENT
ā¢ Urology
38. Personalized treatment & access to multi-disciplinary medical staff & physicians
Goal: Self-source business and maximize ROI
Sales & Marketing
1
Direct to Consumer
(DTC)
Lead Generation
ConciergeService
Conversion to Surgical
Patient
Patient Experience
Follow Up
Successful Patient Outcomes
Sales Outreach to
Referral Community
Physician Referral to
Nobilis Brand
Leverage concierge
service for enhanced
patient experience
3
360 Concierge
Sales Outreach
to Physicians
Physician & Patient
Conversion
Nobilis Facility
CaseAcquisition
2
Physician
Recruitment
Patient and Physician
Satisfaction
SALES AND MARKETING STRATEGY
Our Unique
Approach
38