1 Insights and Research Investment Highlight October 2014 n Investment Highlight Industry Market Size Circa $80b total 1 Returns 2 Assets Characteristics Sector Snapshot n Total Return Average 5 years to Jun 13: 10.5% p.a Total Return: 11.6% p.a. 9.5% income, and 2.1% growth Hospitals (public, private and PPP) Specialist Day Surgeries inc operating rooms, specialist consultants, diagnostic imaging & pathology services Medical Centres Anciliary Assets inc ambulance services, medical research and educational facilities, and medical labs Average Lease Length: 3 Hospitals: 10 to 20+ years Medical Centre: 5+ years Average Vacancy Rate: 2% 4 Long-term industry fundamentals are positive: Growing population: by 2030, Aus population will have expanded by 27% 5 Aging population: n population aged 65+ will grow by circa 70% over the next 15 years 6 Technology advancement: major advances in medical technology are considered as a significant driver of increased healthcare expenditures Health expenditure is largely a mandatory not discretionary spend Per capita total health expenditure 7 - US: US$8,608 - AUS: US$5,939 - NZ: US$3,666 - UK: US$3,609 Aus expenditure growth rate: 5.3% p.a. over the last 10 years Overview real estate has one of the highest returns and lowest volatilities as a real estate investment asset class in. The asset class is typically less cyclical than other real estate classes, providing attractive risk-adjusted returns for investors. real estate characteristically long leases and low vacancy rate are a key attraction, providing investors with relatively secure income compared with other real estate sectors. While average lease term for core commercial real estate sectors is circa 6 years, healthcare assets typically have year leases. Furthermore, the average vacancy rate for healthcare real estate is only circa 2%. In addition, the sector stands to benefit from the long-term drivers of the healthcare industry. The healthcare expenditure is largely a mandatory, not discretionary spend, and demand for healthcare services continues to grow due to an ageing population, increased life expectancy and advances in medical technology, providing further opportunity in the sector. Unlike the US, UK and Europe, the healthcare real estate sector is widely unsecuritised in with only circa $1.4b securitised out of an estimated $80b of assets 8. There is increasing appetite for healthcare real estate sale and leaseback opportunities in. This brings an opportunity to secure quality assets from public or private operators with strong leases and yield. Investment Environment Highly un-securitised in : IPD REIT Index was only c.$1.4b FUM in Dec There is circa $78b of remaining assets un-securitised in
2 n Assets real estate assets are very diverse: examples include hospitals, specialist clinics, medical centres, diagnostic and pathology services and hospital service providers. Due to the lack of institutional developers in this sector, operators often develop their own facilities, and maintain this capital on their balance sheets. This starkly differs from the successful model employed in the US and UK, whereby operators seek real estate capital partners to provide and manage their facilities. Asset Class Tertiary Example Assets Hospitals: are privately owned and provide a range of services including acute care, rehabilitation and psychiatric. Public Hospitals: are operated by, or on behalf of, state and territory governments with funding assistance from the federal government. These facilities provide a range of general hospital services that include acute care, rehabilitation and psychiatric services. Public- Partnership (PPP) Hospitals: are public hospitals which are funded and operated through a partnership of government and one or more private sector companies. The services provided by these facilities are similar to those of public or private hospitals. Specialist Facility: provides specialist services such as psychiatric, mental, skin, and cancer treatments. Historic Returns The annual yield for the n healthcare real estate is between 7.5% and 10.5%, depending on the sub-sector. This suggests the spread between yields and the bond rate is circa bp, indicating a high margin compared to the rest of the world. Sector Returns (Annualised Return %, 1 year, 2 years and 3 years to Jun 13) 25% 20% 15% Sector Total Income Capital Return Return Return 1 year to Jun 13 Hospitals 12.3% 10.2% 2.1% Medical Centres 9.8% 8.9% 0.9% All RE 11.6% 9.5% 2.1% 3 year to Jun 13 Hospitals 10.8% 9.3% 1.5% Medical Centres 11% 8.9% 2.1% All RE 10.8% 9.2% 1.6% 5 year to Jun 13 Hospitals 11.4% 9.4% 2% Medical Centres 8.6% 8.7% -0.1% All RE 10.5% 9.1% 1.4% Over the last 5 years, hospitals has outperformed medical centres: the 5 year annualised returns to June 2013 are 11.4% and 8.6% for hospitals and medical centres respectively. In the year ending June 2013, hospitals returned 12.3%, outperforming medical centres which returned 9.8%. Total Return (Annualised Return %, quarterly periods, Jun 06 to Jun 13) Secondary Primary Ancillary Aged Care : include establishments that provide long-term nursing care to low and high care residents. These facilities are regulated and partly funded by government (up to circa 80%). Day Surgeries: that do not require an overnight hospital stay, and often include outsourced public services Diagnostic : such as imaging and pathology services Medical Centers Medical research and educational facilities Specialist laundries and hygiene services Medical Laboratories 10% 5% 0% -5% -10% Jun-06 Jun-07 Jun-08 Jun-09 Jun-10 Jun-11 Jun-12 Jun-13 All Property RE The healthcare real estate sector is less volatile relative to other sectors: the annualised average returns moved between 7 and 15% over the past 7 years, which is relatively steady compared to other real estate sectors, particularly considering this period included the 2008 financial crisis.
3 Average Annual Return n Insights and Research Relative Performance In FY2013, by delivering a total return of 11.6%, the n healthcare real estate sector outperformed the All (Composite) Index by 250bps. This comprised 9.4% of yield and 2.2% of capital growth. The closest real estate sectors are Office and Industrial, with annualised returns of 9.4% and 9.3%, respectively. Existing Funds The asset class is widely un-securitised. There are high barrier to entry as assets are considered illiquid, require a long term investment horizon, and high capital requirements for entry. However, a number of REITs already provide investors with the opportunity to access this sector in and New Zealand. Relative Performance (Average Annual Return %, for the year ending Jun 2013) 14% 12% 10% 8% 6% 4% 2% 0% -2% -4% 12% 10% 8% 6% 4% 2% 9.1% 9.4% 8.8% 9.3% 6.3% Capital Return Income Return Total Return Composite Retail Hotel Office Industrial 11.6% 0% 0% 2% 4% 6% 8% 10% 12% Annual Volatility The healthcare real estate sector has a low correlation with other real estate sectors, making it a desirable addition to a diversified real estate portfolio. Indeed, while the health sector secured positive returns of more than 5% throughout the GFC period, total real estate returns plunged to negative values in the same period. The performance data of real estate sectors in over the past 7 years show that healthcare real estate assets deliver the lowest risk and highest return when compared to other real estate sectors. Average annualised return and annual volatility for healthcare has been 11.6% and 2%, respectively. This positions healthcare real estate sector as the most attractive sector for investment. Risk Return Analysis (Return v Volatility, 7 years ending Jun 13) Listed Unlisted Total Aus/NZ Other Trust Generation REIT (ASX: GHC) Arena REIT (ASX: ARF) Vital Trust (NZX:VHP) Unity Investments Japara (ASX: JHC) Description n healthcare REIT, managed by APN Group Limited (APN). Owns a portfolio of 12 properties, including hospitals, medical centres, laboratories, and a medical office building. FUM: $324.9m n REIT consisted of two stapled trusts: Arena REIT No. 1 (Childcare Fund) and Arena. REIT No. 2 (HealthCare Trust). Portfolio of 7 multi-disciplinary primary care medical centres located around Sydney, and in Queensland. FUM: $331.8m NZ listed healthcare REIT. Invests in high-quality health and medical-related properties in New Zealand and. FUM: NZ$616m n unlisted healthcare real estate investment trust. The REIT has a diversified tenant base currently comprising hospital, medical and aged care operators. FUM: $560.5m FUM: A$1.8b Japara is the result of a recent restructuring which combined the former operator Japara Holdings and the wholesale Japara Trust. The Trust owned the freehold title to 29 of Japara s 35 aged care facilities At Japara s IPO, the company owned $781.2m in assets.
4 n Insights and Research Industry Demand Drivers The healthcare real estate performance is driven mainly by long-term demand drivers in the healthcare industry, and the fact that health expenditure is largely a mandatory, nondiscretionary spend. In other words, the economy is not the key demand driver for the healthcare sector. This is different from other sectors such as Retail, Industrial, Office and Hotel, which are sensitive to consumer or business sentiments, industrial production and retail demands. Therefore, healthcare real estate is classified as a non-cyclical and defensive sector. The size of the broader health sector in is about 9.3% of GDP at $130.3b, and the level of the health care expenditure has grown at 5.3% p.a. on a compounding basis over the last 10 years. The key industry demand drivers for the health sector is a growing and ageing population, and advancements in medical technology. Key Risks Investors have exposure to two general types of risks; real estate specific risks, and industry specific risks. specific risks Operator lease risk: risk of tenant default or non-renewal of any of the leases is significant as generally the tenant is one operator. The operators are sophisticated tenants and not easily replaced. Changes in federal and state government policy may impact the n health sector, and the ability of healthcare tenants to pay rent. However, the sector has increased its focus on private sector funding. This mitigates the risk of public sector funding withdrawals significantly. Industry specific risks The level of competition between hospital operators and other service providers, and the ability of hospital operators to maintain appropriate levels of cost control may impact the performance of operators generally. Growing population: by 2030, s population will have expanded by 27%, meaning another 6.2 million people will live in. According to the Council of, this increase means that an extra 125,000 retirement facilities and 24,000 more hospital beds will be needed. Ageing population: The n population aged 65 years and above will grow by circa 70% over the next 15 years. As ages, demand for healthcare services will increase. According to the n Bureau of Statistics (ABS), persons 65 years of age and older spend 4 times more on healthcare than the overall mean. Government legislation requires operators to be licensed. If a hospital s operating license were revoked, the hospital would not be permitted to continue operating. The majority of private hospital revenue is derived from health funds. The contractual terms negotiated with health funds will impact the profitability of the hospital operators, including the operators ability to meet future cost increases within the business. Advancements in medical technology: recent decades have brought about major advances in medical technology. This is considered a significant driver of increased healthcare expenditure as it means the range of conditions that can be treated will increase. Furthermore, the age range of patients who can be treated will also increase.
5 n Recent Transactions A number of recent transactions indicate that institutional investor interest in the sector is increasing: Regis (September 2014, prospective IPO) As the second-biggest aged care operator in, and riding off Japara s recent IPO success, Regis is raising $485m from its IPO at a final price of $3.65 per share. It was multiple times oversubscribed, with a positive response from retail and institutional investors. Regis IPO is expected to result in a $1.1b market capitalisation. Japara (August 2014, Acquisition) The newly listed company has signed contracts to acquire the Whelan Care Portfolio in South for $39.5m. Settlement is anticipated to be in October this year. The portfolio consists of four aged care facilities, which will increase Japara s aged care portfolio by 258 beds and 41 serviced apartments. Estia Health (August 2014, Prospective acquisition) The company is close to making its fourth acquisition in the aged care sector: a 1,000-bed operator. The acquisition, if successful, would take Estia Health s enterprise value to above $1b. The company is also exploring an IPO with an ASX listing in late 2014 or early Estia is currently owned by Quadrant Equity. Royal North Shore, RBS PPP (August 2014, Divestment) Goldman Sachs has been advising RBS over the last 12 months on its options to divest its debt and equity stakes in Sydney s Royal North Shore Hospital after a $1.1b redevelopment, undertaken as a PPP with the NSW government. Both local and international investors have expressed interest, including AMP Capital and UK s John Laing. Generation REIT (August 2014, Acquisition & Development) GHC recently acquired a medical office building (55 Little Edward Street, Brisbane) for $46m (initial yield 8%, WALE 7.36 years, occupancy 100%). Health-related tenants represent 75%, with two anchor tenants being the Queensland Eye Hospital (Cura Day Hospitals Group), and the Queensland Fertility Group (Virtus Health). Additionally, the Fund entered into a MoU with St John of God Health Care to develop a $120m private hospital at Casey, in Melbourne, the second phase of a three phase development. Vital Property Trust (August 2014, Acquisition) The Trust finalised the acquisition of the the Marian Centre Psychiatric Hospital in Perth this August. The hospital is a 31-bed stand-alone private hospital in a well-established medical precinct. It was acquired for $13.5m (initial yield 8.5%). Vital plans to undertake a $10.8m redevelopment and expansion of the hospital, which is forecast to be completed within 12 months. n Unity Property Trust (July 2014, Acquisition) The Trust acquired the Brisbane Waters Hospital on the NSW Central Coast for $16.18m. The property is a two-level, 78-bed general hospital (WALE 22.5 years, forecast yield 9.27%). Healthscope (July 2014, IPO) At $3.6b, Healthscope s IPO was the biggest listing in since The company s share price has continued to increase from the initial price of $2.10. Equity owners TPG and the Carlyle Group will still hold 38% of Healthscope s stock for up to 3 years. Japara (April 2014, IPO) Aged care firm, Japara listed on the ASX late April, after receiving funding commitments above the planned size of the offering. The IPO valued Japara at more than $500m. The company is the result of a restructure that merged the Japara Trust (wholesale health care real estate trust) with the operations arm of the company. Japara is the first pure-play aged-care operator to list on the ASX. Arena REIT (ARF) (December 2013, Merger) ARF moved into the healthcare space by stapling the Sydney Trust (SHCT) with the existing Arena Investments in December It inherited SHCT s existing portfolio of 6 multi-discplinary medical centres, valued at $54.7m. The anchor tenant of the medical centres is Primary Health Care. n Unity Property Trust (November 2013, Acquisition) The Trust acquired a medical technology facility in the medical precinct in Sydney s north shore, for $38.5m (forecast yield 9.8%). The anchor tenant is a leading global prosthetics and medical equipment manufacturer (Stryker). Generation REIT (GHC) (April 2013, Acquisition) Established in 2006 with an exclusive focus on healthcare real estate, the Fund acquired Westmead Rehabilitiation Hospital in NSW this April, for $20m (yield 9%, WALE 25 years, occupancy 100%). Later in September, the GHC invested in a secured debt interest position assocated with Waratah Hospital at $7.1m.
6 n Recent PPP Agreements Public- Partnerships (PPP) are a funding and operating partnership for the development of public hospitals that involve private sector companies. This model is the current preferred model for new public hospital development in. New Royal Adelaide Hospital (NRAH) (Completion 2016) In early 2011, the South n Government awarded the contract to finance, design, maintain, and to provide nonclinical services at the New Royal Adelaide Hospital to the SA Health Partnership (SAHP) consortium. The Consortium includes Leighton Contractors, Hansen Yuncken and Spotless. SAHP will provide nonclinical support services over a 35 year period after the hospital opens in The public sector will continue to be responsible for clinical services and patient care. Sunshine Coast Public University Hospital (SCUH) (Completion 2016) The SCUH is being delivered through a PPP contract with Exemplar Health, a consortium comprising a builder, a facilities manager, equity providers, and an asset manager. Following the project s completion, Exemplar health will continue to maintain the facility, by offering support services such as pest control, carparking and security, in a similar arrangement to the New Royal Adelaide Hospital. The Royal Children s Hospital (RCH) (April 2014) The new $3.74b Victorian RCH has been delivered as a PPP under the State Government's Partnerships Victoria model. The public sector (RCH) will continue to operate the hospital, while the private sector (Children's Health Partnership) will finance, design, construct and maintain the new hospital building. The Children's Health Partnership consortium comprises an equity holder, a builder and a facilities manager. Gold Coast University Hospital (September 2013) Lend Lease partnered with Queensland Health to deliver the new $1.76b Gold Coast University Hospital. With 750 beds, this hospital will provide new and expanded health services and forms part of the integrated Health and Knowledge Precinct planned for Southport in Queensland. This PPP was for the delivery of the asset only. Key Operators Operator Operator Status Owner Type of Assets Key Assets in Primary Ramsay Sonic Healtcare IPN Healthscope Primary (ASX: PRY, Market Cap: $2.4b) Ramsay (ASX: RHC, Market Cap: $9.26b) Sonic (ASX: SHL, Market Cap: $7.16b) Sonic Healtcare (ASX: SHL) TPG and Carlyle Group ( Equity firms) (ASX: HSO, Market Cap: $3.98b) Medical Centres, Pathology & Diagnostic Imaging Centres & PPP Hospitals, Day Surgery, Medical Centres & Rehab. Hospitals Pathology & Diagnostic Imaging Centres, and Ancillary (Food and Water Testing Labs) Medical Centres & Specialist (Skin Cancer) Centres Hospitals, Medical Centres, Specialist Centres & Day Surgery, Rehabiliation Hospitals 87 Medical Centres and Pathalogy Labs 782 Collection Centres 161 Diagnostic Imaging sites 44 Hospitals 3 PPP Hospitals 6 Day Surgeries 9 Clinics 17 Pathology & Radiology Centres 3 Labs 140 Medical Centres 20 Specialist (Skin Cancer) Centres 35 Hospitals 46 Medical Centres 18 Specialist (Skin Cancer) Centres 1 Day Surgery
7 n Insights and Research Operator Operator Status Owner Type of Assets Key Assets in Japara Japara (ASX: JHC, Market Cap: $614.3m) Aged care facilities, retirement complexes (including serviced apartments, Dementia and Alzheimer care facilities 35 aged care facilities 4 retirement complexes Regis ly held Aged care facilities 45 aged care facilities Bupa Care Aged care facilities, retirement Services Bupa Group 62 aged care homes homes Epworth HealthCare St John of God Health Care Catholic Catholic Health Adventist HealthCare St Vincent s Health Mater Health Service Not for Profit () Epworth Foundation St John of God Health Care Hospitals & Specialist Centres Hospitals, Home Nusrsing & Pathology Centres Catholic Church Hospitals and Aged Care Catholic Health Seventh-day Adventist Church St Vincent s Health (SVHA) Public & Hospitals Hospitals, Pathology & Diagnostic Imaging Centres, Day Surgery and Pharmacy Public & Hospitals, Medical Centres and Aged Care Sisters of Mercy Public & Hospitals 9 Hospitals 3 Specialist Centres 14 Hospitals 2 Pathology Centres 1 Hospital 2 Aged Care 21 Public Hospitals 54 hospitals 2 Hospitals 1 Day Surgery 2 Pathology & Radiology Centres 6 Public Hospitals 8 Hospitals 1 Medical Centre 3 Public Hospitals 4 Hospitals Sources: 1 Emerge Capital market research, IPD Research, n Unity Investments and Jones Lang Lasalle Research, n Unity Investments and Jones Lang Lasalle Research, Bureau of Statistics, Bureau of Statistic, World Health Organization, IPD Research, 2013 Contact Tim Frogley Emerge Capital Tel Director 3 Hickson Road Sydney Emerge Capital Group and/or its affiliates ( Emerge Capital ) are not making a recommendation or providing advice as to the benefits and or risks of many the investment. Emerge Capital are merely a conduit of information with no such recommendation or opinion attached. Before entering into a transaction, investors should determine the suitability of any investment with regard to their particular circumstances and independently (in consultation with their professional advisors) examine the special risks (maximum loss, currency risk, etc.) and the legal, regulatory, credit, tax, and accounting consequences. This document does not make any recommendation or disclose all related risks. No assurance can be given that any investment objective will be achieved or that investors will receive a return on their capital. Risks include the loss of some or all of the investor s investment. This document is issued by Emerge Capital, solely for information purposes and for the recipient s sole use. It does not constitute an offer or invitation to enter into any type of financial transaction. In receiving payments by third parties Emerge Capital s interests may be adverse to those of investors and such payments can affect the investor s return. Historical returns and financial market scenarios are no guarantee of current or future performance. Emerge Capital does not make any representation as to the accuracy or completeness of this document and assumes no liability for losses arising from the use hereof. This document may not be reproduced, in part or in full, without the written consent of Emerge Capital. Copyright 2010 Emerge Capital Group and/or its affiliates. All rights reserved.