Healthcare Products & Services Industry Update Q2 2017

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1 Healthcare Products & Services Industry Update Q2 2017

2 Q2 M&A TRANSACTION SUMMARY Q2 Deal Volume (1) Healthcare Products & Services M&A decreased slightly following increased transaction activity in Q The Healthcare Staffing sector was the most active M&A segment of the Healthcare Products & Services universe 300 Durable Medical Equipment, Clinical Laboratories, 3 Healthcare Staffing, 33 Emergency Services, Surgicenters/Rehabilitation, 3 Contract Pharma Manufacturing, 4 Home Care/Hospice, 7 Acute-Care Hospitals, 18 Medical Devices and Products, 16 0 Q Q Q Q Q Physician Practice Management, 8 Medical/Surgical/Dental Supplies, 9 Assisted Living/Long- Term Care Facilities, 11 Life Sciences Tools, 13 Q total Healthcare Products & Services M&A transaction volume was 174, representing a 0.6% increase over Q Footnote: (1) Defined as U.S. or Canadian targets that fall within our core Healthcare Products & Services coverage sectors or transactions completed by companies in BlackArch s public company coverage universe 2

3 NOTABLE M&A TRANSACTIONS MultiCare Health System, Inc. acquired Spokane Washington Hospital Company, LLC from Community Health Systems, Inc. for $425 million on June 30, Ashland LLC acquired Pharmachem Laboratories, Inc. for $660 million on May 17, This valuation implies a 10.5x EBITDA multiple. Spokane Washington Hospital Company June 2017 Spokane Washington Hospital Company, LLC is an acute care hospital in Spokane. May 2017 Pharmachem Laboratories, Inc. manufactures and distributes custom and branded nutritional and nutraceutical ingredients to natural and nutritionals, food and beverages, flavors and fragrances industries worldwide. Varex Imaging Corporation acquired the Medical Imaging business of PerkinElmer, Inc. from PerkinElmer Holdings, Inc. and other investors for $276 million on May 1, Allergan acquired ZELTIQ Aesthetics, Inc. from Aisling Capital LLC and other investors for $2.5 billion on April 28, This valuation implies a 7.4x revenue multiple. Medical Imaging Business of PerkinElmer May 2017 The acquired business develops, manufactures and sells digital detectors that are key components in medical and industrial X-ray imaging systems made by global OEM manufacturers. April 2017 ZELTIQ Aesthetics, Inc. is a medical technology company that develops non-invasive products for the selective reduction of fat. WellCare Health Plans, Inc. acquired Universal American Corp. from Deerfield Management Company and other investors for $600 million on April 28, Sartorius Aktiengesellschaft acquired Essen BioScience Inc. from SFW Capital Partners for $320 million on April 3, April 2017 Universal American Corp. provides health benefits to people covered by Medicare in the United States. April 2017 Essen BioScience Inc. develops and manufactures instruments, software, reagents and consumables for life science researchers worldwide. 3

4 HEALTHCARE PRODUCTS & SERVICES PERFORMANCE INDEX Public Company Trading Multiple Trend Analysis Y-o-Y Q-o-Q 12-Month Change (%) 60 Y-o-Y Q-o-Q Specialty Pharmacy Management Information Services 40 Surgicenters / Rehabilitation 20 Assisted Living / Long-Term Care Facilities 0 Home Care / Hospice Acute-Care Hospitals Clinical Laboratories Life Sciences Tools Medical / Surgical / Dental Supplies Physician Practice ManagementHealthcare Staffing Dialysis Services Dental Products -20 Psychiatric Hospitals / Management Contract Research Organizations Contract Pharma Manufacturing Durable Medical Equipment 3-Month Change (%) -40 Medical Devices and Products Diagnostic Imaging Centers -60 Y-o-Y Q-o-Q Y-o-Y Q-o-Q Note: Size of each data point corresponds to the relative size of each sub-sector s trading multiple 4

5 PUBLIC COMPANY TRADING MULTIPLE SNAPSHOT As of June 30, 2017 Sub-sector Median TEV/EBITDA Multiple Clinical Laboratories 12.2x Diagnostic Imaging Centers 8.4x Dialysis Services 9.8x Disease Management 15.4x Emergency Services NM 0.0x Information Services 17.2x Physician Practice Management 11.8x Specialty Pharmacy Management 8.3x Home Care / Hospice 15.0x Surgicenters / Rehabilitation 12.6x 5

6 PUBLIC COMPANY TRADING MULTIPLE SNAPSHOT As of June 30, 2017 Sub-sector Median TEV/EBITDA Multiple Assisted Living / Long-Term Care Facilities Psychiatric Hospitals / Management Acute-Care Hospitals 9.2x 9.2x 10.3x Healthcare Staffing 12.9x Medical Devices and Products Durable Medical Equipment 15.0x 16.0x Dental Products 17.6x Medical / Surgical / Dental Supplies 10.7x Contract Pharma Manufacturing 16.6x Contract Research Organizations 13.9x Life Sciences Tools 19.0x 6

7 COMPARABLE PUBLIC COMPANY ANALYSIS ($ in Millions Except Per Share Amounts) Outsourced Clinical Services Market Data LTM Financial and Performance Data (1) Valuation Multiples Price 52-Week Equity EBITDA 3 Yr. Revenue TEV/LTM: Company 6/30/2017 High Low Value TEV (2) Revenue EBITDA Margin CAGR % Revenue EBITDA Clinical Laboratories Laboratory Corporation of America Holdings $ $ $ $15,769 $21,340 $9,667 $1, % 18.2% 2.2x 11.5x Quest Diagnostics Incorporated ,210 18,773 7,588 1, % 1.8% 2.5x 13.0x Median 19.1% 10.0% 2.3x 12.2x Diagnostic Imaging Centers RadNet, Inc. $7.75 $7.98 $5.25 $366 $997 $909 $ % 9.0% 1.1x 8.4x Alternative Investment Trust (1) 0 0.0% NA NM NM Median 6.5% 9.0% 1.1x 8.4x Dialysis Services Fresenius Medical Care AG & Co. $96.44 $ $80.80 $29,539 $39,460 $19,570 $3, % 8.8% 2.0x 11.0x DaVita Inc ,602 21,086 15,014 2, % 7.0% 1.4x 8.6x Median 17.3% 7.9% 1.7x 9.8x Disease Management Alere Inc. $50.19 $50.32 $31.47 $4,385 $7,339 $651 NA NA 25.2% 11.3x NM Tivity Health, Inc NA NA 1,562 1, % (8.6%) 3.3x 15.4x Median 21.7% 8.3% 7.3x 15.4x Emergency Services Air Methods Corporation $0.00 NA NA NA NA $1,170 $ % 10.0% NM NM Median 24.5% 10.0% NM NM Sub-Sector Median 11.3x Enterprise Management Information Services Cerner Corporation $66.47 $69.28 $47.01 $21,964 $21,982 $4,827 $1, % 18.0% 4.6x 16.3x athenahealth, Inc ,599 5,784 1, % 19.7% 5.0x NM Allscripts Healthcare Solutions, Inc ,315 3,979 1, % 6.5% 2.4x 24.9x WebMD Health Corp. -- NA NA 2,128 2, % 8.7% 3.0x 11.6x Omnicell, Inc ,602 1, % 18.7% 2.6x NM HMS Holdings Corp ,552 1, % 2.0% 3.2x 17.0x Quality Systems, Inc ,079 1, % 4.6% 2.0x 17.3x Computer Programs and Systems, Inc % 8.7% 2.3x 20.6x Median 11.5% 8.7% 2.8x 17.2x Physician Practice Management MEDNAX, Inc. $60.37 $76.96 $53.80 $5,558 $7,408 $3,337 $ % 13.5% 2.2x 11.8x Median 18.8% 13.5% 2.2x 11.8x Specialty Pharmacy Management Express Scripts Holding Company $63.84 $80.02 $57.80 $37,891 $50,261 $100,276 $7, % (0.1%) 0.5x 7.0x PharMerica Corporation ,267 2, % 7.2% 0.6x 9.5x BioScrip, Inc % 1.3% 1.0x NM Median 6.0% 1.3% 0.6x 8.3x Sub-Sector Median 16.3x Footnotes: (1) LTM refers to the most recent twelve-month period for which data was available (2) Total enterprise value equals equity value plus minority interest, preferred stock and net debt; net debt equals total debt less cash and cash equivalents 7

8 COMPARABLE PUBLIC COMPANY ANALYSIS ($ in Millions Except Per Share Amounts) Specialized Services Market Data LTM Financial and Performance Data (1) Valuation Multiples Price 52-Week Equity EBITDA 3 Yr. Revenue TEV/LTM: Company 6/30/2017 High Low Value TEV (2) Revenue EBITDA Margin CAGR % Revenue EBITDA Home Care / Hospice Chemed Corporation $ $ $ $3,289 $3,389 $1,617 $ % 4.7% 2.1x 15.0x Amedisys, Inc ,118 2,163 1, % 6.9% 1.5x 20.5x LHC Group, Inc ,241 1, % 12.9% 1.4x 14.5x Almost Family, Inc , % 18.5% 1.4x 25.0x Addus HomeCare Corporation % 12.9% 1.1x 13.0x Median 8.1% 12.9% 1.4x 15.0x Surgicenters / Rehabilitation Envision Healthcare Corporation $62.67 $81.34 $53.12 $7,275 $13,722 $6,038 $ % 77.6% 2.3x 14.0x HealthSouth Corporation ,333 7,578 3, % 17.9% 2.0x 9.3x Select Medical Holdings Corporation ,038 5,342 4, % 12.8% 1.3x 11.3x U.S. Physical Therapy, Inc % 10.7% 2.3x 14.6x Median 16.1% 15.4% 2.1x 12.6x Assisted Living / Long-Term Care Facilities Brookdale Senior Living Inc. $14.71 $18.62 $10.65 $2,739 $7,847 $4,078 $ % 16.1% 1.9x 10.3x Kindred Healthcare, Inc ,359 7, % 13.4% 0.6x 9.3x Capital Senior Living Corporation , % 8.8% 3.1x 18.5x The Ensign Group, Inc ,104 1,334 1, % 22.4% 0.8x 11.0x National HealthCare Corporation ,066 1, % 4.5% 1.1x 10.2x Five Star Senior Living Inc , % 1.0% 0.1x 8.1x Median 8.8% 11.1% 0.9x 10.3x Psychiatric Hospitals / Management Universal Health Services, Inc. $ $ $99.72 $11,804 $15,715 $10,111 $1, % 9.9% 1.6x 9.2x Magellan Health, Inc ,729 2,083 5, % 12.2% 0.4x 8.6x The Providence Service Corporation , % 16.6% 0.4x 9.9x Median 4.6% 12.2% 0.4x 9.2x Acute-Care Hospitals HCA Healthcare, Inc. $87.20 $91.03 $67.00 $31,994 $64,373 $42,267 $8, % 6.1% 1.5x 7.8x Tenet Healthcare Corp ,944 19,684 19,324 2, % 10.7% 1.0x 9.5x Community Health Systems, Inc ,113 16,815 17,478 1, % 4.5% 1.0x 9.4x Universal Health Services, Inc ,804 15,715 10,111 1, % 9.9% 1.6x 9.2x LifePoint Health, Inc ,711 5,660 6, % 18.0% 0.9x 7.4x Median 11.9% 9.9% 1.0x 9.2x Healthcare Staffing On Assignment, Inc. $54.15 $55.15 $32.05 $2,860 $3,453 $2,530 $ % 14.5% 1.4x 13.1x Cross Country Healthcare, Inc % 23.1% 0.6x 12.7x Alta Natural Herbs & Supplements Ltd (0) (5.3%) 27.9% 1.2x NM Median 4.5% 23.1% 1.2x 12.9x Sub-Sector Median 10.3x Footnotes: (1) LTM refers to the most recent twelve-month period for which data was available (2) Total enterprise value equals equity value plus minority interest, preferred stock and net debt; net debt equals total debt less cash and cash equivalents 8

9 COMPARABLE PUBLIC COMPANY ANALYSIS ($ in Millions Except Per Share Amounts) Equipment and Supplies Market Data LTM Financial and Performance Data (1) Valuation Multiples Price 52-Week Equity EBITDA 3 Yr. Revenue TEV/LTM: Company 6/30/2017 High Low Value TEV (2) Revenue EBITDA Margin CAGR % Revenue EBITDA Medical Devices and Products Johnson & Johnson $ $ $ $356,367 $349,731 $72,174 $25, % 0.2% 4.8x 13.9x Medtronic plc , ,480 29,710 9, % 20.7% 4.7x 15.2x Abbott Laboratories ,351 99,742 23,607 5, % 6.3% 4.2x 19.4x Thermo Fisher Scientific Inc ,256 84,729 18,744 4, % 10.7% 4.5x 18.1x Stryker Corporation ,871 55,764 11,957 3, % 8.8% 4.7x 17.0x Boston Scientific Corporation ,960 43,318 8,714 2, % 6.8% 5.0x 18.7x Intuitive Surgical, Inc ,460 32,995 2,870 1, % 12.2% 11.5x 30.5x Baxter International Inc ,914 32,832 10,283 2, % (8.1%) 3.2x 14.7x C. R. Bard, Inc ,954 23,815 3,828 1, % 6.4% 6.2x 20.1x Hologic, Inc ,707 14,872 2,894 1, % 5.4% 5.1x 14.7x Varian Medical Systems, Inc ,485 9,330 3, % 2.9% 2.9x 14.5x Arabtec Holding PJSC ,172 1,592 2,244 (414) (18.4%) 9.6% 0.7x NM Hanger, Inc , % 3.7% 0.9x 13.5x Hargreaves Services Plc % (26.7%) 0.4x 10.1x Zemach Hammerman Ltd % 44.6% 0.8x 8.9x Median 25.0% # 6.4% 4.5x 15.0x Durable Medical Equipment ResMed Inc. $77.87 $79.44 $56.59 $11,043 $11,385 $2,067 $ % 9.9% 5.5x 20.0x Steris Plc ,929 8,136 2, % 15.9% 3.2x 15.6x Hill-Rom Holdings, Inc ,236 7,427 2, % 18.1% 2.7x 16.0x Invacare Corporation (14) (1.4%) (9.0%) 0.5x NM Median 18.7% 12.9% 2.9x 16.0x Dental Products 3M Company $ $ $ $124,339 $133,790 $30,533 $8, % (1.0%) 4.4x 15.7x DENTSPLY SIRONA Inc ,863 16,063 3, % 9.2% 4.2x 19.5x Median 24.7% 4.1% 4.3x 17.6x Medical / Surgical / Dental Supplies McKesson Corporation $ $ $ $34,793 $42,060 $199,851 $3, % 10.4% 0.2x 10.7x Cardinal Health, Inc ,613 28, ,976 3, % 12.6% 0.2x 9.4x AmerisourceBergen Corporation ,642 22, ,584 2, % 10.5% 0.1x 9.4x Henry Schein, Inc ,519 16,582 11,782 1, % 6.7% 1.4x 16.5x Varian Medical Systems, Inc ,485 9,330 3, % 2.9% 2.9x 14.5x Patterson Companies, Inc ,446 5,425 5, % 16.0% 1.0x 13.3x Owens & Minor, Inc ,970 2,407 9, % 0.8% 0.3x 10.5x Median 2.5% 10.4% 0.3x 10.7x Sub-Sector Median 15.0x Footnotes: (1) LTM refers to the most recent twelve-month period for which data was available (2) Total enterprise value equals equity value plus minority interest, preferred stock and net debt; net debt equals total debt less cash and cash equivalents 9

10 COMPARABLE PUBLIC COMPANY ANALYSIS ($ in Millions Except Per Share Amounts) Pharmaceutical and Life Sciences Market Data LTM Financial and Performance Data (1) Valuation Multiples Price 52-Week Equity EBITDA 3 Yr. Revenue TEV/LTM: Company 6/30/2017 High Low Value TEV (2) Revenue EBITDA Margin CAGR % Revenue EBITDA Contract Pharma Manufacturing West Pharmaceutical Services, Inc. $94.52 $99.91 $70.17 $6,952 $7,012 $1,544 $ % 3.3% 4.5x 22.1x Cambrex Corporation ,946 1, % 14.4% 3.6x 11.0x Median 26.5% 8.8% 4.1x 16.6x Contract Research Organizations Charles River Laboratories International $ $ $67.20 $4,819 $5,898 $1,772 $ % 14.7% 3.3x 13.9x ICON Public Limited Company ,259 5,288 1, % 6.8% 3.1x 13.4x PAREXEL International Corporation ,437 4,852 2, % 3.0% 2.3x 14.3x Albany Molecular Research, Inc. -- NA NA 923 1, % 38.7% 2.2x 20.9x Medpace Holdings, Inc ,182 1, % 0.0% 3.5x 12.2x Median 22.9% 6.8% 3.1x 13.9x Life Sciences Tools Becton, Dickinson and Company $ $ $ $44,359 $54,106 $12,158 $3, % 13.4% 4.5x 17.0x Agilent Technologies, Inc ,059 18,716 4, % (6.9%) 4.3x 19.0x PerkinElmer, Inc ,498 8,265 2, % (0.8%) 3.9x 20.2x Median 22.7% (0.8%) 4.3x 19.0x Sub-Sector Median 15.6x Footnotes: (1) LTM refers to the most recent twelve-month period for which data was available (2) Total enterprise value equals equity value plus minority interest, preferred stock and net debt; net debt equals total debt less cash and cash equivalents 10

11 HEALTHCARE PRODUCTS & SERVICES COVERAGE TEAM Kelly Katterhagen Managing Director Office: (704) Mobile: (704) BlackArchPartners.com Founder of BlackArch Partners and head of Healthcare Products & Services practice Completed over 60 middle-market M&A transactions and multi-year advisory engagements President of IOA Corp. advised privatelyheld businesses on equity maximization and liquidity planning Director at Bowles Hollowell Conner & Co. Officer at J.P. Morgan & Co. Ryan Jackson Vice President Office: (704) Mobile: (704) BlackArchPartners.com BlackArch Partners, Vice President Concentric Equity Partners, Associate Morgan Joseph & Co., Analyst M.B.A. from The University of Chicago Booth School of Business, with honors B.S. from University of North Carolina, with distinction M.B.A. from Harvard Business School and B.A. from Colgate University, magna cum laude BlackArch Partners, Associate M&T Bank, Officer LifeNet International, Co-Founder JOHNNY CONKLIN JULIE NEVELEFF CNL Financial Group Managing Director Analyst Jonathan O Connor Associate Office: (704) Mobile: (407) OConnor@ BlackArchPartners.com M.B.A. from University of Virginia s Darden School of Business B.S. in Finance from Southeastern University Office: (704) Mobile: (704) Conklin@BlackArchPartners.com Office: (704) Mobile: (301) Neveleff@BlackArchPartners.com 11

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