Spa Securities share it's view about the Initial Public Offering of HCG Enterprises that opens on 16th March 2016 and closes on 18th March 2016

1. 1
HEALTHCARE
Healthcare Global
Recommendation: SUBSCRIBE
March 15, 2016 IPO - Note
HealthCare Global Enterprises (HCG) is a provider of speciality healthcare, focused on cancer and fertility. Under the 'HCG' brand,
it operates the largest cancer care network in India with a chain of 14 comprehensive cancer centres, including a centre of
excellence in Bengaluru, three freestanding diagnostic centres and one day care chemotherapy centre. HCG network is spread
across 13 cities and towns across eight states in India with 912 operational beds, which included ICU beds and day-care beds. In
FY15 its cancer segment had 37458 new patients registration followed by average occupancy of 53.5%. HCG has acquired 50.1%
equity interest in BACC Healthcare in 2013 which operates fertility centres under the 'Milann' brand. HCG now operates four
Milann fertility centres in Bengaluru. Its revenue and EBIDTA has grown at CAGR of 25.1% and 34.6% between FY12-15.
Issue Snapshot
Issue Open: 16-Mar-16
Issue Close: 18-Mar-16
Price Band INR 205-218
Issue Size INR 6109 - 6496 mn
Market Cap INR 17441-18547 mn
Particulars
OFS Issue Size (No. of shares) 18.20 mn Equity shares
Fresh Issue 11.60 mn Equity shares
QIBs 75% of Net Issue
Non-institutional 15% of Net Issue
Retail 10% of Net Issue
Capital Structure
Pre Issue Equity INR 1270 mn
Post Issue Equity INR 1386 mn
Bid Lot 65
Minimum Bid Amount @205 INR 13325
Minimum Bid Amount @218 INR 14170
Shareholding Pattern (%) Pre Issue (%) Post issue (%)
Promoters 28.8 25.1
Others 71.2 74.9
Particulars
Face value INR 10.0
FY15 EV/EBIDTA* 27.4
FY16E EV/EBIDTA (annualised)* 23.8
Investment Rationale
Largest cancer care provider in India
The HCG network is the largest provider of cancer care in India in
terms of the total number of private cancer treatment centres licensed
by the AERB. HCG operates 18 HCG cancer centres, including 14
comprehensive cancer centres, three freestanding diagnostic centres
and 1 day care chemotherapy centre in India as of Dec 2015. Its network
is spread across 13 cities and towns across eight states in India.
Provides high quality cancer care at a competitive price
HCG's relationships with medical technology vendors, pharma and
biotechnology companies helps drive introduction of the latest
technology advances. For instance, HCG is amongst the first
healthcare providers in India to standardize molecular diagnostics
technologies, including 128 slice PET-CT scans in the diagnosis
and staging of cancer. It has also successfully introduced high
intensity flattening filter free mode radiotherapy, stereotactic radio
surgery and robotic radio surgery. The five year survival rate for
breast cancer patients at HCG network is comparable to U.S.
benchmarks. The scale of operations and relationships with
vendors of specialized medical equipment provides competitive
advantage in sourcing and financing of medical equipment.
Entry into high potential fertility business
Fertility treatment is an emerging segment of the domestic
healthcare industry which is relatively underdeveloped and
fragmented. There are ~2.7cr couples suffering from infertility in
India, which could reach between 2.9 cr and 3.2 cr by 2020 and place.
Of 2.7 cr infertile couples, less than 3lakh currently seek fertility
treatment, owing to a lack of awareness and access as well as high
cost of the same. HCG has acquired 50.1% stake in BACC Healthcare
which operates four Milann fertility centres in Bengaluru. In H1FY16
and FY15, Milann fertility centres registered 5575 and 8027 new
patients and performed 679 and 1111 IVF procedures respectively.
Cancer cases in India
The prevalence of cancer in India is estimated at 39 lakh people
in 2015, with 11 lakh new cancer cases reported during the year.
However, real incidence of cancer could be 1.5-2 times higher than
the reported incidence or an estimated 16-22 lakh new cancer
cases in 2015. The under-diagnosis of cancer is represented in the
relatively late stage of presentation of cancer cases in India relative
to China, UK and US. Data between 2009-11 shows that only 43% of
breast cancer cases were diagnosed at early stages (stage I or
stage II) in India while it is 62% in the US and 72% in China.
Outlook and Valuation
HCG has emerged as one of the largest cancer care service providers
in India. Indian healthcare industry is likely to grow at a CAGR of
17.0% to reach INR 280 bn by 2020 driven by population growth,
rising income levels, and increase in lifestyle-related diseases.
HCG is likely to grow ahead of industry as it is well placed to
capture increasing opportunities in the industry backed by strong
brand recognition, high quality along with affordable pricing, past
track record and experienced management. HCG's expansion, which
is on the verge of completion would bring strong growth matrix for
the company while recently added new centres (mostly in 2012)
would see strong operating leverage. At the issue price band of
INR 218, the stock is available at EV/EBIDTA of 23.8x based on
FY16E annualised earnings. Its nearest comparable like Apollo
Hospitals and Narayana Hrudayalaya are trading at EV/EBIDTA of
25.7x and 34.2x respectively based on FY16E earnings. We
recommend investors to SUBSCRIBE the issue.
Objects of the issue
Offer For Sale (OFS)
Thecompanywillnotreceiveany proceedsfrom OFS(INR3731-3968mn)
Fresh Issue
Proceeds (INR 1500 mn) to be used for :-
Purchase of medical equipment INR 422 mn
Investment in IT software, services and hardware INR 302 mn
Pre-payment of debt INR 1470 mn
General corporate purposes* INR 335 mn
*Upper band

2. 2
HEALTHCARE
Investment Rationale
Largest cancer care provider in India
HCG network is the largest provider of cancer care in India in
terms of the total number of private cancer treatment centres
licensed by the AERB as of May 31, 2015. (Source: Government of
India, Atomic Energy Regulatory Board). HCG operates 18 HCG
cancer centres, including 14 comprehensive cancer centres, three
freestanding diagnostic centres and 1 day care chemotherapy
centre in India as of Dec 2015. The company began the expansion
of network in 2006 and has since added 11 comprehensive cancer
centres along with diagnostic and day care chemotherapy centres.
HCG network is spread across 13 cities and towns across eight
states in India. The extensive cancer network supports provision
of cancer care beyond metropolitan cities to patients throughout
India. The company has a strong reputation within the medical
community due to deployment of advanced technologies,
successful clinical outcomes and the extensive clinical experience
of its specialist physicians.
Particulars FY13 FY10 FV1S H1FY16
Comprehensivecancercentres 14 15 15 14
Newpatientregistrations 28,546 34,344 37,458 18,079
Patientstreatedwithradiationtherapy 10,225 11,131 12,647 6,163
PET-CT procedures 17,750 21,040 23,988 12,253
Chemotherapyregistrations 40,052 43,988 48,360 25,453
Surgeries 7,333 8,454 8,707 4,630
Numberofavailableoperationalbeds 746 829 875 912
AOR (%) 57.6 54.2 53.5 51.6
ALOS (days) 3.42 3.15 3.00 2.90
ARPOB (Rs/day) 19,034 21,850 24,647 26,685
ExistingcancercentresinIndia:- FacilitiesandServices
Locationofthe Commencementof Numberof Numberof Numberof Numberof
Laboratorycomprehensive Operation available RT Operation PETCT
cancercentre (CY) operationalbeds LINACs theatres scanners
Bengaluru-DoubleRoad 1989 92 1 4 –
Shimoga 2003 60 1 3 –
Bengaluru-KalingaRaoRoad 2006 234 3 1 2
Bengaluru-MSRamaiahNagar 2007 22 1 7 1
Nasik 2007 – 1 – 1
Delhi 2007 70 1 2 1
Hubli 2008 57 1 2 1
Ranchi 2008 54 1 2 –
Cuttack 2008 116 1 2 1
Vijaywada 2009 30 2 1 –
Chennai 2012 35 1 – –
Ongole 2012 19 1 2 –
Ahmedabad 2012 78 1 5 –
Tiruchirappalli 2014 35 1 – –
Provides high quality cancer care at a competitive price
HCG's relationships with medical technology vendors, pharma
and biotechnology companies along with R&D involvement helps
drive introduction of the latest technology advances. For instance,
HCG is amongst the first healthcare providers in India to
standardize molecular diagnostics technologies, including
genomic testing and molecular imaging, including 128 slice PET-
CT scans in the diagnosis and staging of cancer, as well as to
introduce high intensity flattening filter free mode radiotherapy,
stereotactic radio surgery and robotic radio surgery. The five year
survival rate for breast cancer patients at HCG network is
comparable to U.S. benchmarks. (Source: Delivering World-Class
Health Care, Affordably, published on Harvard Business Review,
dated November 2013). Moreover, the scale of operations and
relationships with vendors of specialized medical equipment
provides competitive advantage in sourcing and financing of
medical equipment.
ProposedcancercentresinIndia
Locationofthe Numberof Numberof Numberof Numberof
Laboratorycomprehensive operational RT Operation PET-CT
cancercentre beds LINACs theatres Scanners
Nagpur 115 1 4 1
Mumbai–Borivali 105 1 5 1
Kochi 100 1 3 1
Delhi 95 1 1 _
Kanpur 90 1 3 1
Baroda 60 1 4 1
Vishakhapatnam 88 1 _ 1
Gulbarga 85 1 3 _
Jaipur 60 1 2 1
Kolkata 50 1 2 _
Bhavnagar 35 1 3 _
Mumbai-Cooperage 32 1 2 1
Entry into high potential fertility business
Fertility treatment is an emerging segment of the domestic
healthcare industry which is relatively underdeveloped and
fragmented. There are an estimated 2.7cr couples suffering from
infertility in India, which could increase to between 2.9cr and
3.2cr by 2020 due to demographic, lifestyle and the presence of
various clinical risk factors among the population. Of the
estimated 2.7cr infertile couples, less than 3lakh currently seek
fertility treatment, owing to a lack of awareness and access to
fertility treatment, as well as high cost of the same. Nonetheless,
the number of IVF cycles performed in India has increased from
7,000 in 2001 to 1lakh in 2015. The number of IVF cycles performed
in India is forecast to increase to 2.6lakh by 2020, representing a
21% CAGR. Company acquired 50.1% stake in BACC Healthcare
which operates four Milann fertility centres in Bengaluru. Given
the large untapped potential, we believe there is significant growth
opportunity in the fertility segment. Moreover, the industry
fragmentation creates an opportunity to leverage the expertise of
HCG brand into a speciality healthcare brand as also to build and
establish Milann brand across India. The Milann fertility centres
provide comprehensive reproductive medicine services, including
assisted reproduction, gynecological endoscopy and fertility
preservation. In H1 FY16 and FY15, Milann fertility centres
registered 5575 and 8027 new patients and performed 679 and
1111 IVF procedures, respectively.

3. 3
HEALTHCARE
Cancer prevalence and incidence in India: an overview
The prevalence of cancer in India is estimated at 39lakh people in
2015, with 11lakh new cancer cases reported during the year.
However, the real incidence of cancer in India could be significantly
higher than the reported figure; data from large randomized
screening trials suggests real incidence of
cancer could be 1.5-2 times higher than the reported incidence or
an estimated 16-22lakh new cancer cases in 2015. Albeit even at
this level, the age adjusted cancer incidence per 100,000 people
in India is significantly lower than that for United States and
China. The gap between reported and real cancer incidence is
primarily attributed to under-diagnosis of cancer in India. The
under-diagnosis of cancer is represented in the relatively late
stage of presentation of cancer cases in India relative to China,
UK and US. Indeed data collected between 2009 and 2011 show
that only 43% of breast cancer cases were diagnosed at early
stages (stage I or stage II) in India while it is 62% in the US and
72% in China. Lack of cancer awareness and low participation in
screening programs are key factors for the relatively late stage of
the disease presentation and consequently low reported cancer
incidences in India. For instance, less than 1% of women in India
aged between 40-69 years participated in recommended breast
screening mammograms once in 24 months, as compared to 30%
in China and 65% in US in 2014.
Strong management backed by strong team
Several key members of the top management team including the
CEO and COO have been with HCG for over 5 years. Dr Kamini Rao
is a pioneer in the field of fertility treatment, with over 25 years of
experience in the field. The core team comprises of 400 specialist
physicians including 219 oncologists, 23 radiologists, 16
pathologists and 142 other specialist physicians. The fertility
business comprises of 27 fertility specialists, 18 of whom were
pursuing their post-graduate fellowships at Milann fertility
centres and 22 other specialist physicians.
Outlook and Valuation
HCG has emerged as one of the largest cancer care service providers
in India. Indian healthcare industry is likely to grow at a CAGR of
17.0% to reach INR 280 bn by 2020 driven by population growth,
rising income levels, and increase in lifestyle-related diseases.
HCG is likely to grow ahead of industry as it is well placed to
capture increasing opportunities in the industry backed by strong
brand recognition, high quality along with affordable pricing, past
trackrecordandexperiencedmanagement.HCG'sexpansion,which
is on the verge of completion would bring strong growth matrix for
the company while recently added new centres (mostly in 2012)
would see strong operating leverage. At the issue price band of INR
218, the stock is available at EV/EBIDTA of 23.8x based on FY16E
annualised earnings. Its nearest comparable like Apollo Hospitals
and Narayana Hrudayalaya are trading at EV/EBIDTA of 25.7x and
34.2x respectively based on FY16E earnings. We recommend
investors to SUBSCRIBE the issue.
Peer comparison
FY15 EBIDTA (%) FY16E
Company
CMP Mcap
Revenue 3-Yr CAGR EBIDTA APAT 3-Yr CAGR FY15 FY14 FY13 EPS P/E EV/EBIDTA
(INR) (INR Bn)
Healthcare Global* 218 18.5 5194 25.13% 717 6 NA 13.80 8.37 13.66 NA NA 23.8
Narayana Hrudayalaya 292 59.6 13639 21.01% 1328 (88) NA 9.74 11.20 9.93 1 292.0 34.2
Apollo Hospital 1406 195.6 51785 37.30% 7200 3222 47.03% 13.90 15.34 16.14 24 59.3 25.7
*AnnualisedEPS

4. 4
HEALTHCARE
Financials
Income Statement
Y/E (INR mn) FY12 FY13 FY14 FY15
Net Sales 2666 3383 4513 5194
Growth 24.09% 26.91% 33.41% 15.08%
Cost of Goods Sold 811 1035 1334 1460
Employee Cost 422 535 768 815
Other Optg. Exps. 1021 1351 2034 2202
Total Optg. Exps. 2254 2921 4136 4477
EBIDTA (excl OI) 412 462 378 717
Growth 8.90% 12.10% -18.28% 89.73%
EBITDA Margin 15.47% 13.66% 8.37% 13.80%
Dep./Amortization 238 296 362 398
EBIT 175 167 16 319
EBIT Margin 6.55% 4.92% 0.35% 6.13%
Interest Expense 240 292 322 342
Other Income 36 24 40 48
Exceptionals
EBT (29) (101) (267) 24
Tax Expenses 2 7 54 (17)
PAT (31) (109) (320) 41
Minority Interest 2 (4) 36 36
Adjustment to PAT 0 (4) (7) (1)
APAT (33) (101) (348) 6
Growth -150.68% 203.59% 243.59% LP
APAT Margin -1.25% -3.00% -7.72% 0.12%
Balance Sheet
Y/E (INR mn) FY12 FY13 FY14 FY15
Share Capital 593 675 688 708
Reserves and Surplus 1520 2159 1949 2087
Total Networth 2112 2834 2638 2795
Minority Interest 82 126 183 253
Secured 1557 2281 1466 1896
Unsecured 612 799 1455 1591
Total Debt 2169 3080 2921 3487
Deferred Tax Liability 16 15 12 5
Other Liabilities 130 163 41 36
Sources of Funds 4509 6217 5796 6576
Net Block 3923 5085 5115 5285
CWIP 0 0 109 422
Investments 2 606 23 1
Current Assets 839 944 1096 1220
Current Liabilities 553 873 1091 1186
Net Current Assets 286 71 5 34
Deferred Tax Assets 18 11 2 59
Other Assets 281 444 541 775
Application of Funds 4509 6217 5796 6576
Cash Flow
Y/E (INR mn) FY12 FY13 FY14 FY15
EBT (29) (101) (267) 24
Less: Other Income/Exceptionals (36) (24) (40) (48)
Add:Depreciation 238 296 362 405
Add: Interest paid 240 292 322 342
Direct taxes paid (4) (5) (47) (36)
Change in Working Capital (162) 155 214 (14)
Cash Flow from operations (a) 319 659 624 770
Change in Fixed Assets (1457) (940) (290) (539)
Change in CWIP 0 0 (109) (314)
Change in Investments 8 (604) 583 22
Cash Flow from Investing (b) (1449) (1544) 184 (831)
Change in Equity 433 800 150 100
Debt Raised/(Repaid) 830 911 (158) 565
Dividend paid 0 0 0 0
Interest paid (240) (292) (322) (342)
Cash Flow from Financing (c ) 1024 1419 (331) 323
Net Change in Cash (a+b+c) (106) 534 478 263
Opening Cash 58 166 107 255
Closing Cash 166 107 255 270
Key Ratios
Y/E FY12 FY13 FY14 FY15
Per Share Data (INR)
EPS -0.5 -1.6 -4.6 0.1
CEPS 3.4 2.7 0.6 6.2
BVPS 35.64 42.28 38.57 39.82
Return Ratios (%)
RoACE 4.93% 3.22% 1.00% 5.84%
RoANW -1.47% -3.83% -12.14% 1.48%
Liquidity Ratios
Net Debt/Equity 0.95 1.05 1.01 1.15
Interest Coverage Ratio 0.88 0.65 0.17 1.07
Current Ratio 0.61 0.61 0.67 0.7
Quick Ratio 1.39 0.97 0.9 0.91
Efficiency Ratios
Asset Turnover Ratio 0.77 0.68 0.82 0.94
Inventory Days 9.68 10.76 9.69 10.23
Debtor Days 58.97 64.93 42.75 44.84
Creditor Days 49.67 56.88 57.05 58.52
Valuation Ratios
P/BV(x)* 6.12 5.16 5.65 5.47
P/CEPS (x)* 64.12 80.74 363.33 35.16
EV/Net Sales (x)* 7.85 6.19 4.64 4.03
EV/EBIDTA(x)* 46.64 43.05 50.12 27.35
*Upper band

5. 5
HEALTHCARE
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