Investor Presentation July 2018 Senior management presenting - - PowerPoint PPT Presentation

Investor Presentation

July 2018

2

Prasanth Manghat CEO Hani Buttikhi CIO Senior management presenting Prashanth Shenoy CFO

2

Asjad Yahya Investor Relations

3

Agenda

3 1 2

Overview of the business Understanding the Saudi opportunity better

3

Transformational partnership with GOSI to form a new KSA healthcare champion

4

M&A: A vital part of the story

5

Financial outlook

6

A closer look at key assets

7

Appendix

4

NMC at a glance

4

Over 108,000 distribution SKUs

137 owned and managed facilities

(70 owned / 67 managed)

2017 Group revenues:

USD 1.6bn

Operations across

13 countries

Over 5.7 mn patients in 2017

1,919

licensed beds 2017 Group EBITDA:

USD 353mn 20%

2017 RoAE

FTSE 100

company

• c. £7bn market cap
• c. 2,000 doctors
• c. 18,000 staff

5

• Est. 1975

c.109,000 SKU’s

Five verticals built around centres of excellence

5

CENTRE OF EXCELLENCE

• Est. 1975

1,259 beds

• Est. 2015

106 beds & c.20k Cycles

• Est. 2015

554 beds

• Est. 2012

Over 1,000 beds

Cardiology Long-term Care

6

Future growth driven by a well-defined strategy

6

2015 Strategy Update 2015 Strategy Update 2017 Strategy Update 2017 Strategy Update

Capacity Build Capabilities Focus Geographic Expansion

Accelerate the establishment of Centres of Excellence in key specialties within existing hospitals Accelerate the establishment of Centres of Excellence in key specialties within existing hospitals Addition of new verticals focused on highly underserved segments in the UAE and wider GCC and further development of Centres of Excellence Establish a strategic presence outside the UAE with leading global medical institutions to enhance and expand technological know-how and medical expertise Establish a strategic presence outside the UAE with leading global medical institutions to enhance and expand technological know-how and medical expertise Increase participation in the growing UAE medical tourism industry and establish NMC as a destination of choice Increase participation in the growing UAE medical tourism industry and establish NMC as a destination of choice Grow NMC’s medical speciality offering and clinic network within the UAE and maximising operational synergies Grow NMC’s medical speciality offering and clinic network within the UAE and maximising operational synergies Increase NMC’s footprint in Saudi Arabia and the broader GCC via organic initiatives and acquisitions Increase NMC’s footprint in Saudi Arabia and the broader GCC via organic initiatives and acquisitions

NMC Health’s strategy is built on three key tenets

Expanding the healthcare business’ target market from the GCC to wider emerging markets Fertility to be developed as a global business taking advantage of substantial growth opportunities Rapid adoption and deployment of technological innovation via both organic initiatives and acquisitions

1 2 3

7

7

An expansive footprint: 137 facilities across 13 countries

8

Agenda

8 2 1

Understanding the Saudi opportunity better Overview of the business

3

Transformational partnership with GOSI to form a new KSA healthcare champion

4

M&A: A vital part of the story

5

Financial outlook

6

A closer look at key assets

7

Appendix

9

Attractive demographics working in NMC’s favour

9

33m pop’n

• 2% growth rate p.a., twice the global growth rate
• NMC has c. 1,200 licensed beds in UAE with a population base of 9-10mn. This implies

potential for 3,000-4,000 beds in KSA on simple comparison

• KSA faces an estimated shortage of 30,000 beds, requiring substantial investment
• Median age of 29 years
• Healthy outlook for various

medical segments NMC focuses

• n:
• Obstetrics and

Gynaecology; Paediatrics; Fertility (IVF) and Cosmetics

30% of the pop’n <19 yrs

• Beds shortage in KSA estimated

at 15,000

• 30% of existing, overall beds in

the system blocked by LT care patients

• Geriatrics continues to expand

at a rapid 7-8% CAGR

Considerable demand for LT care beds

• As with most GCC countries,

lifestyle disease is a major problem in KSA

• Almost 70% of the population is
• bese
• 30% of the population is

diabetic, or pre-diabetic

Prominence

• f lifestyle

disease

10

Re-Focus on private healthcare insurance roll-out a significant driver

10

Individuals under Private Insurance Mandate (15.2 mm)

Expats (c.10mm)

Insured Uninsured

CCHI expected to enforce insurance

• f uninsured

Saudis during 2018 Shift towards Saudization to enhance number of Saudis eligible for private insurance

2.3 2.8 9.3

12.1

0.8

3.1

Anticipated re-focusing on insurance roll-out will be a significant growth driver in Saudi Arabia

Saudi citizens (c. 5mm) Source: BUPA Arabia

11

Agenda

11 3 1

Transformational partnership with GOSI to form a new KSA healthcare champion Overview of the business

2

Understanding the Saudi opportunity better

4

M&A: A vital part of the story

5

Financial outlook

6

A closer look at key assets

7

Appendix

12

NMC and GOSI have entered a strategic partnership to create a new national healthcare champion in KSA

12 Formation of a new and unique national champion #2 private healthcare operator in KSA by beds capacity Strong platform with pan KSA presence Wide ranging yet well defined investment mandate Strong synergy potential to support sustainable value creation

1 2 3 4 5

13

Formation of a new national champion

13

JV to be capitalized through:

• NMC to transfer its KSA assets
• GOSI/ Hassana to transfer their stake in CARE at

c.SAR70 per share

• NMC to fully consolidate the JV’s financials and retain
• perational, Board and management control
• Transaction remains subject to regulatory approvals and

due-diligence

JV capitalization New structure

1

2

New JV

> 51% < 49% 38.9% majority

KSA Assets

New JV

38.9% 1

2

At SAR70 / share

KSA Assets

majority

14

Addition of CARE to the existing portfolio: substantial growth

• pportunity

14

Significant milestones achieved since inception which now includes 2 flagship hospitals

1967 Year incorporated USD46m 2017 EBITDA +7% 2013-17 EBITDA CAGR 2013 Year listed +10% 2013-17 Rev. CAGR USD380m Total assets USD667m Market cap.(1)

• c. 3,000

Total staff

Note: company information, Facstet. SAR to USD exchange rate: 0.2666 (1) As of 7 June, 2018 (closing share price: SAR55.8)

USD228m 2017 Revenue

1967 1991 2015

20% 2017 EBITDA margin 0.5x Leverage (2017 Net Debt/EBITDA) 10% 2017 Net profit margin RCH 330, CNH 495 Number of beds 2 Hospitals 1 Polyclinic 1 Mobile unit

15 664 788 825 998 1,020 1,328 1,489 c.1,850

Newly formed JV platform will be the second largest Saudi operator by bed capacity in KSA

15

Source: companies website, AlpenCapital GCC Healthcare industry report (March 2018) Notes: Market cap as of 6 June 2018 (1) Best estimate for the number of beds from publicly available sources which include the under construction Al-Habib Medical City, Al-Khobar Hospital and two hospitals in Jeddah (2) No of beds does not include announced Greenfield project in Al Khobar by NMC (3) Includes the under construction Mouwasat Hospital Al Khobar (220 beds) (4) Includes the expansion of Dallah Hospital Al-Nakheel by 150 beds and the development of Namar Hospital (400 beds)

KSA

KSA (1) (3) (4)

A combination of NMC’s KSA assets and CARE would immediately create one of the largest private healthcare providers by beds capacity

(2)

10(1) 7 3 6(2) 2(3) 5 5 2

# of beds capacity # of hospitals

Al Rashid Hospital Al Salam Medical Group Chronic Care Al Qadhi Specialty As Salama Hospital National Care Hospital Riyadh Care Hospital

Ha’il Najran Jeddah Riyadh Al Khobar

64 beds 330 beds 495 beds 140 beds 100 beds 140 beds 220 beds

NMC’s hospitals CARE’s hospitals

(2)

Beds capacity and number of hospitals Beds capacity and number of hospitals Strategic geographic positioning across KSA Strategic geographic positioning across KSA

16

NMC is now in a position to replicate their full continuum of care across Saudi Arabia

16

Tertiary Highly specialised Primary Care Multi-specialty UAE Establishing an integrated network across the full continuum of care

UAE UAE KSA KSA

17

Agenda

17 4 1

M&A: A vital part of the story Overview of the business

2

Understanding the Saudi opportunity better

3

Transformational partnership with GOSI to form a new KSA healthcare champion

5

Financial outlook

6

A closer look at key assets

7

Appendix

18

10.2x 7.6x 9.6x 12.6x 11.1x 8.5x 12.9x 12.4x 17.4x 19.9x 19.9x 23.2x 22.2x 21.0x 22.5x 33.9x Feb-15 Apr-15 Apr-15 Jun-15 Nov-15 Aug-16 Dec-16 Jan-18

Snapshot of key acquisitions

18 57% 14% 4% 36% 16% 30% 14% Price performance post-acquisition (+4 months) Price performance post-acquisition (+4 months) Significant medium-term returns to NMC shareholders from integration of acquisitions

Price movement (from pre-announcement closing price)

NMC undisturbed LTM EV/EBITDA (pre-acquisition)

LTM EV/EBITDA multiples paid: recent acquisitions (>USD25mn) LTM EV/EBITDA multiples paid: recent acquisitions (>USD25mn) Demonstrated discipline in identifying and executing immediately accretive acquisitions

Source: NMC, S&P Capital IQ

+24% on average

19

90 +30 +26 +140 +17 +220 +5 +26

Case study: Leveraging the long-term care acquisition

19

Evolution of long-term care beds Evolution of long-term care beds

Source: NMC, S&P Capital IQ

• Fully acquired ProVita in June 2015

for a total consideration of US$ 161m

• 90 beds at time of acquisition
• Added 35 beds organically
• Cross-asset pollination:
• Added 52 and 17 LT care

beds in NMC Royal and Al Zahra, respectively

• Dual benefit of enhancing

service offering and improving margin profile

• Entered the Saudi market by

targeting the highly under-served LT- care segment

• This route would not have

been possible without the ProVita license and expertise

• Increase in number of beds from 90

to 554 done at an incremental cost of

• nly c. US$ 40m
• No. of long-term care beds added to NMC network

90 120 146 286 303 523 528 554

• No. of LT care

beds at acquisition Organic expansion H2 2015 H1 2016 H2 2017 Royal Hospital additions As-Salama additions Al Zahra additions Chronic Care H1 2017

Total beds

Organic expansion Royal Hospital additions

20

Agenda

20 5 1

Financial outlook Overview of the business

2

Understanding the Saudi opportunity better

3

Transformational partnership with GOSI to form a new KSA healthcare champion

4

M&A: A vital part of the story

6

A closer look at key assets

7

Appendix

21

NMC’s strategy has delivered consistent long-term revenue and EBITDA growth

21

Revenue (US$m)

339 387 444 490 551 644 881 1,221 2009 2010 2011 2012 2013 2014 2015 2016 2017 CAGR FY09-17: 21.4% Growth

EBITDA (US$m)

42 56 71 80 93 103 150 246 2009 2010 2011 2012 2013 2014 2015 2016 2017 Growth Margin CAGR FY09-17: 30.5% 14.0% 14.8% 10.5% 12.4% 16.9% 36.8% 34.3% 25.0% 12.9% 16.7% 10.3% 46.7% 63.7% 12.4% 14.6% 15.9% 16.2% 16.9% 15.9% 17.1% 38.6% 20.2% 31.3% 44% 22.0% 353 1,603

22

Solid growth momentum seen in 2017 to continue in 2018

Key figures 2017 results overview 22

880.9 1,220.8 1,603.4 36.8% 38.6% 31.3%

0% 10% 20% 30% 40% 50% 300 600 900 1,200 1,500 1,800 2015 2016 2017

Revenue US$m and annual growth

Revenue Growth

150.3 246.1 353.4 17.1% 20.2% 22.0%

0% 5% 10% 15% 20% 25% 100 200 300 400 2015 2016 2017

EBITDA US$m and margin

EBITDA Margin

2018 outlook

• 2018E guidance:
• 22% YoY revenue growth
• EBITDA of around US$ 465m
• Strong cash conversion cycle sustained
• 79% of EBITDA converted into cash flow from
• perations in 2017
• Net debt-to-EBITDA projected at 2.7x at end-2018
• FY 2017 revenue reached US$ 1.6bn, up 31.3% YoY
• Healthcare business accounted for 70% of Group revenues

and 87% of Group EBITDA for the year

• EBITDA increased by 43.6% to US$ 353.4m
• EBITDA margin reached 22.0%, increase of 180bps YoY
• Adjusted net profit reached US$ 236.6m, up 43.2% YoY

23

Strong growth built within the system

Capex already incurred for upcoming beds* 23 Earnings uptrend to continue 25% EBITDA margin sustainable over long term Breakup of operational beds (2018E)

*: additional 210 beds under construction in KSA 537 679 1,365 1,675 2015 2016 2017 2018E

Operational beds Mature beds, 53% Beds in ramp-up phase, 47%

22% 25% 2017 2020/ 2021

Group EBITDA margin

1,221 1,603 1,956 246 353 465 2016 2017 2018E

Revenues (US$mn) EBITDA (US$mn)

24

Agenda

24 6 1

A closer look at key assets Overview of the business

2

Understanding the Saudi opportunity better

3

Transformational partnership with GOSI to form a new KSA healthcare champion

4

M&A: A vital part of the story

5

Financial outlook

7

Appendix

25

Multispecialty Vertical: The foundation of the healthcare business

25

Abu Dhabi Specialty: The original healthcare facility

US$575m

• Established in 1975 as a small pharmacy, with a clinic added in 1976
• 127-bed facility in the heart of Abu Dhabi island
• One of the largest top and bottom line contributors for NMC:
• 2017 revenues of over US$ 130m, serving over 1m patients p.a.
• Consistent EBITDA margin
• Sustaining 7-9% YoY revenue growth, despite maturity of the asset
• Increase in top line driven by:
• Annual price revisions
• Capacity expansions
• Introduction of more sophisticated specialisms

Al Ain Specialty: Key driver of intermediate growth

• Established in 2008, the facility is designed to cater to the greater

concentration of Emiratis within Al Ain’s population

• 125 licensed beds, 115 currently operational
• Al Ain Specialty has sustained over 20% revenue CAGR since its opening in

2008

• Al Ain Specialty’s top line growth is anticipated to moderate in the coming

years, but the facility will remain one of the key drivers of NMC’s revenue and EBITDA growth over the near to medium term

26

Multispecialty Vertical: Dubai assets primed to capitalize on mandatory insurance rollout

26

Dubai Specialty: Leveraging off mandatory insurance in Dubai

US$575m

• 116-bed facility established in 2004
• Positive impact of introduction of mandatory insurance in Dubai already

visible in the form of improving patient footfall

• Witnessing double digit revenue and patient growth in past 3 years
• Given that the final phase of the mandatory insurance roll-out was

completed in March 2017, a material improvement in operations is anticipated from 2018 onwards

• NMC owns the plot of land adjacent to Dubai Specialty Hospital, allowing for

doubling of capacity if sufficient patient demand is generated DIP Hospital: Catering to “New Dubai”

• Located in Dubai Investment Park, the 86-bed facility is the only hospital

catering to a catchment of over 300,000 patients

• Only hospital in Southern Dubai with inpatient facilities
• Services offered include sophisticated specialisms such as:
• Cardiology
• Critical care medicine
• Neurology and
• Neonatology
• Similar to the case for Dubai Specialty, the DIP Hospital is anticipated to be

a key beneficiary of the roll-out of mandatory insurance in Dubai

27

Multispecialty Vertical: Major growth drivers of the future

27

Al Zahra Hospital: Completing the ‘hub & spoke’ model in Sharjah

US$575m

• NMC announced the US$ 560m acquisition of Al Zahra Hospital in

December 2016

• Widely recognized as the highest quality private sector hospital in Sharjah,

with over 35 years of operational experience

• Licensed capacity of 156 beds
• 17 long-term care beds introduced at the hospital; to be managed by

ProVita

• Ability to increase total number of beds to 200 without significant

capex

• Serves as a hub for NMC’s existing network of outpatient facilities in Sharjah

that cater to 800,000 patients per annum

• Focus on under-utilized specialities, such as cardiology, expected to

substantially improve revenue generation and margin profile NMC Royal Hospital: Transformational impact on the healthcare portfolio

• Only private tertiary care hospital in UAE
• Licensed for 316 beds, with the potential to increase capacity to 400 beds
• Completed in late 2015, operational ramp-up progressing ahead of

expectations

• EBITDA breakeven achieved in less than 18 months versus original

guidance of 24 months

• A key beneficiary of the recent relaxation of regulations for Thiqa

cardholders, with Emiratis constituting over 40% of the patient base

• Expected to be primary top and bottom line growth driver for NMC from 2019
• nwards and likely to become largest contributor by 2022

28

Multispecialty Vertical: Establishing a foothold in the lucrative Saudi market

28

Al Qadhi Specialty Hospital: Only private tertiary care facility in Najran

US$575m

• Only tertiary care facility in Najran, serving a population of over 500k
• The transaction was sourced and completed by NMC’s own team
• Strong business relationship with the original owner translated into

an attractive deal for NMC Health

• The facility recently signed a contract with the Saudi Arabian Society of

Metabolic and Bariatric Surgery for referral of patients

• Bariatric surgery represents addition of a value-add service to the

facility

• NMC’s team played an instrumental role in the introduction of this

service, reflecting rapid integration with the acquired entity

• Land and building owned by previous owner
• Long-term lease signed
• Owner also owns adjacent land, allowing further expansion

Al Rashid Hospital: First private hospital in Ha’il

• Established in 1991, Al Rashid was the first private hospital in Ha’il
• Serving a population of over 500k
• Benefits from a strong reputation and better geographic positioning

than competitors

• Ha’il remains underserved in terms of healthcare services
• Al Rashid currently offers primary and secondary care services
• New specialities to be added following the acquisition
• Transaction completed at one of the lowest multiples paid by NMC to date
• Land and building acquired as part of the transaction, with empty

adjacent land allowing further expansion

29

Multispecialty Vertical: Greater focus on specialisms in larger cities in KSA

29

Al Salam Medical Group: Entry into the largest healthcare market in KSA

US$575m

• Established in 1985, Al Salam Medical Group owns a 100-bed hospital and

2 polyclinics in Riyadh

• Served over 900k patients in 2016
• Transaction completed at less than 7x 2018E EV/EBITDA multiple
• Hospital and clinics offer a range of specialties, including cardiology and

paediatrics

• NMC to add a number of specialized services after the acquisition, including

long-term care, cosmetics and IVF

• Availability of vacant land adjacent to existing facility offers opportunity for

further growth

30

Multispecialty Vertical: Building a leading position in the Omani private healthcare space

30

Atlas Healthcare: The first extension of vertical outside UAE

US$575m

• Private healthcare sector still at a nascent stage in Oman
• With 102 beds, NMC’s facilities account for a 20% market share in

the private healthcare space

• Mandatory healthcare insurance to be rolled out in Oman from 2018
• Two facilities acquired from Atlas Healthcare, located in Ruwi and Ghubra,

respectively

• Both facilities have been upgraded and rebranded
• Focus on expansion of medical staff (particularly doctors) and introduction of

specialities to support improvement of operational performance

31

Multispecialty Vertical: Reinforcing the cosmetics and aesthetics business

31

CosmeSurge: A leader in a high growth market segment

US$575m

• Largest group of cosmetic surgeons, dermatologists and dentists in the GCC
• Enhances NMC’s cosmetic services portfolio
• Cosmetic and aesthetic services added to invasive cosmetic

procedures and complex surgeries already offered by NMC

• Transaction completed at an attractive 2018E EV/EBITDA multiple of 10.6x
• NMC managing CosmeSurge since September 2017 under O&M contract,

providing considerable insight into the business pre-acquisition

• Wide number of revenue and cost synergies identified prior to the

transaction

• Key areas in this regard include: cross-referral of patients, reduced

capex requirement from leveraging NMC’s existing capacity and cost sharing of support services related to HR, IT and procurement

• CosmeSurge associated with attractive 31% EBITDA margin, with potential

for up to 400bps improvement on back of identified synergies

32

Maternity & Fertility Vertical: Second largest IVF player in the world

32

• NMC acquired 86.4% stake in Clinica Eugin for EUR 143mn in February

2015

• Ranked among top 3 fertility providers in Europe in terms of number of

cycles

• Clinica Eugin is a leading IVF centre of excellence, with world leading

technology and expertise

• Subsequent bolt-on acquisitions have expanded geographical and

knowledge base of the company

• Operating in Spain, Brazil, Columbia, Italy & Denmark
• Substantial knowledge transfer from Clinica Eugin to UAE, which is

transforming the IVF landscape in the country Clinica Eugin: The start of the capability focused stage of growth strategy

US$575m

Fakih IVF: The undisputed market leader in UAE

• Solidified foothold in UAE fertility market by acquiring 51% stake in Fakih

IVF for US$ 189m in November 2015

• Outstanding 49% minority acquired in 2018, with Fakih IVF now a

wholly owned subsidiary of NMC

• Over 40% market share in UAE with more than 4,000 IVF cycles performed

each year

• Aggressive expansion underway:
• First IVF clinic established in Oman in 2018
• KSA represents a major growth market. Entry planned during 2018

33

Maternity & Fertility Vertical: Targeting a highly underserved segment of the market

33

• First private mother and child hospital in Abu Dhabi
• The 106-bed facility opened in July 2014 with only outpatient services
• Inpatient services introduced in July 2015, starting with 60
• perational beds
• Brightpoint has consistently exceeded internal expectations and achieved

EBITDA breakeven earlier than original guidance provided by management

• Ability to cater to some of the most pronounced maternity-related

complications

• Premature births at as early as 24 weeks have been successfully

managed at NMC’s facilities Brightpoint Royal Women’s Hospital: A first for the private sector in UAE

US$575m

34

Long-Term & Home Care Vertical: A vital component of NMC’s integrated healthcare offering

34

• NMC fully acquired ProVita in June 2015 for a total consideration of US$

161m

• Only two long-term care providers currently operating in the UAE
• A highly underserved market, with the UAE government spending

substantial amounts on Emirati patients in long-term care abroad

• 30 patients shifted from abroad to ProVita facilities already
• Number of beds increased from 90 at time of acquisition to 194
• 52 LT care beds added at NMC Royal Hospital
• 17 LT care beds added at Al Zahra
• 86% bed occupancy as at end-2017

ProVita: Pioneer in UAE long-term care market

US$575m

Chronic Care : Foray into the attractive Saudi market

• NMC entered the Saudi healthcare market in August 2016 through 1)

acquisition of a 70% stake in Al Salama Hospital in Al Khobar and 2) investment in a start-up long-term care provider in Jeddah (Chronic Care)

• Chronic Care addresses the acute shortage of LT care beds in KSA
• Beds are made available to other healthcare operators on a “lease

plus” model to de-clog their ICU beds

• Retention payments made for usage of beds in the Jeddah facility

effectively remove receivables risk

35

35

• Over 40 years of experience has helped transform NMC Trading into one of

the top 3 distribution companies in the UAE

• Around 109,000 SKUs across several segments
• Exclusive wholesaler of mainly globally established and branded

healthcare products and equipment

• Additional distribution agreements, addition of agencies, customer tie-ups

and cost efficient operations contribute to driving performance

• Slower growth in the Distribution division, relative to the Healthcare business

resulting in declining contribution to top and bottom line

• High single digit revenue growth expected to sustain
• EBITDA margin stable around 9-10% mark

A high RoE business

US$575m

Distribution: Exclusive tie-ups drive growth

Segment contribution (2017)

Scientific 11.1% Homecare 0.2% Pharma 34.2% Education 4.6% Veterinary 0.4% FMCG 35.3% Food 14.2%

36

A snapshot of the business segments

• 1. Healthcare – Reported 2017 revenues up 41%, EBITDA up 31% to US$ 355.4m
• 2. Distribution – 2017 Revenues up 13%, SKU’s at 108.9k and EBITDA margin at 10.6%
• 3. Consolidated 2017 EBITDA at US$ 353.4m (+43.6% YoY), Net profit at US$ 209.2m (+38.2% YoY)1

36

880.9 1220.8 1,603.40 36.8% 38.6% 31.3% 0% 10% 20% 30% 40% 50% 300 600 900 1,200 1,500 1,800 2015 2016 2017 Revenue Growth Revenue US$m and annual growth Source: NMC 2017 results presentation 1. 2015-2017 EBITDA corresponds to Profit from Operations before Depreciation, Amortisation, Impairment and Transaction Costs in the NMC annual reports 517.1 823.3 1,161.6 55.7% 59.2% 41.1% 0% 20% 40% 60% 80% 500 1,000 1,500 2015 2016 2017 Revenue Growth Healthcare revenue US$m and YoY growth

150.3 246.1 353.4 85.8 151.4 209.2

100 200 300 400 2015 2016 2017 EBITDA Net profit EBITDA & Net profit US$m 393.4 431.9 486.8 16.1% 9.8% 12.7% 0% 5% 10% 15% 20% 200 400 600 2015 2016 2017 Revenue Growth Distribution revenue US$m and YoY growth 43.5 47.1 51.5 11.1% 10.9% 10.6% 8% 9% 10% 11% 10 20 30 40 50 60 2015 2016 2017 EBITDA EBITDA margin Distribution EBITDA US$m and margin 3,211 4,320 5,767 34.3% 34.5% 33.5% 33% 34% 35% 2,000 4,000 6,000 8,000 2015 2016 2017 Total patients Growth Patients (‘000) and YoY Growth 137.0 241.1 355.4 26.5% 29.3% 30.6% 0% 10% 20% 30% 40% 100 200 300 400 2015 2016 2017 EBITDA EBITDA margin Healthcare EBITDA US$m and margin 33.3% 29.5% 30.6% 20% 25% 30% 35% 2015 2016 2017 Net working capital as % of sales

Scientific 11.1% Homecare 0.2% Pharma 34.2% Education 4.6% Veterinary 0.4% FMCG 35.3% Food 14.2%

Segment contribution 2017

37

Key healthcare segment statistics

37

1,919 licensed beds

Healthcare verticals dominate revenue stream Revenue/patient rising as complexity increases Sharp increase in operating beds capacity

Healthcare verticals continue to grow faster than Distribution (2017)

NMC Royal largest hospital by bed capacity

137 176 190 20% 28% 8%

0% 5% 10% 15% 20% 25% 30% 50 100 150 200 2015 2016 2017 Rev per pat Growth

537 679 1,365 87% 26% 101%

0% 20% 40% 60% 80% 100% 120%

• 200

400 600 800 1,000 1,200 1,400 1,600 2015 2016 2017 Operational beds Growth

316 220 156 140 140 127 125 125 116 106 102 100 86 60 833.6 486.8 205.8 113.8 8.4 50.6% 29.5% 12.5% 6.9% 0.5%

0% 10% 20% 30% 40% 50% 60% 200 400 600 800 1,000 Multispecialty Distribution Maternity & Fertility LT & Homecare O&M Vertical revenues (US$mn) Share of revenues

38

Agenda

38 7 1

Appendix Overview of the business

2

Understanding the Saudi opportunity better

3

Transformational partnership with GOSI to form a new KSA healthcare champion

4

M&A: A vital part of the story

5

Financial outlook

6

A closer look at key assets

39

1 2 3 4 5 6 7 10 20 30 40 50 60 4.2% 3.5% 2.4% 1.5% 1.0% 0.8% 0.3% UAE GCC Africa Oceania Asia Americas Europe

50% 95% 2006 - Pre 2014 - Post

Attractive dynamics in the UAE healthcare market

39

• 1. Strong Macro Indicators – ratings agencies estimate UAE GDP growth in 2017e of ~2.3%

High historic population growth1 High GDP per Capita2 (US$ ‘000)

• 2. Growing demand, spending and lagging capacity
• 3. Mandatory healthcare insurance: Abu Dhabi in 2007, Dubai started in 2014 and Sharjah is expected to be next

Abu Dhabi Est. % of population covered AD insurance categories7 Healthcare expenditure per capita4 (US$) Beds/GDP per capita5 ('000)

Source: (1) IHS Connect data, 2008-15 population growth CAGR. (2) As at 2016, Oxford Economics, GDP per capital, real US$, constant prices (3) Latest statistics based on Dubai Statistics Center Dubai Statistics Center, Dubai Courts Department, Dubai Health Authority and Global Media Insight Source: (4) WHO, BMI as at 2016. (5) As at 2015, GDP per capita sourced from government offices of statistics or central banks; (6) Latest statistics from WHO, BMI HAAD Source: EIU, Booz & Co, IMF, HAAD, DHA, MOH, UAE Stats; (7) Abu Dhabi insurance categories based on 2016 HAAD payer members split

Medical staff/1,000 population6

66 52 46 42 41 36 21 17 Qatar US UK UAE Kuwait KSA Oman Germany

World Average: 1.2%

10,203 4,722 3,312 1,956 1,737 1,388 1,066 US UK Qatar UAE Kuwait KSA Germany France Germany US UK UAE Kuwait Bahrain KSA Oman Lebanon Egypt

UAE est. population by Emirate3 (‘m)

4.10 3.33 1.53 0.95 0.67 0.38 0.19 AD Dubai Sharjah RAK Ajman Fujairah UAQ

NMC focus

UAE population 4.1m 3.3m 2.5m Abu Dhabi Dubai Northern Emirates

Mostly insured Mostly insured Mostly uninsured

3.3 1.5 1.9 1.4 0.9 8.9 3.0 3.6 2.9 2.3 OECD UAE Dubai AD NE Physicians Nurses

OECD Avg.

45% 36% 19% Basic Enhanced Thiqa

40

Life-style diseases a major problem in UAE

• Non-communicable diseases responsible for largest

number of deaths among individuals below the age of 70 years in UAE

• Key concerns include cardiovascular, diabetes,

cancer and obesity

• WHO estimates 20% of UAE population has diabetes and

another 18% is at risk

• High genetic disorder incidence in UAE due to interfamily

marriages

• WHO estimates that, in 2012, average neo-natal

mortality rate was 5, while average mortality rate of babies under 5 years of age was 8 High incidence of life-style related diseases 40 Over 70% deaths due to non-communicable disease*

Source: WHO *: for population under 70 years of age

High prevalence of physical inactivity*

Source: WHO *: for population under 70 years of age

41

UAE has a weight problem

41 Over 60% of UAE male population is overweight Over 20% of UAE male population is obese… … while over 30% of female population is obese … as is the case for female population

Source: WHO