The Health Care M&A Monthly

In the March 2006 issue:

Extendicare To Explore Strategic Alternatives
The Senior care operator Extendicare is exploring ways to harness the value in the company, including a sale of all or part of its business. Extendicare supports a valuation of just over $2 billion, but the sum of the parts may be worth more than the whole.
...
February’s M&A Market
A total of 60 mergers and acquisitions were announced in the health care industry during February. Nearly $3.4 billion was committed to this M&A activity. Several companies are contemplating strategic alternatives, suggesting an emerging seller’s market on the horizon.
...
In The Departments
Services
- Health Care Services
- Deal Summaries
- Additional Transactions
- Transaction Updates

Technology
- Health Care Technology
- Deal Summaries
Additional Transactions
- Transaction Updates

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Companies Mentioned in this issue:
March 2006

3i Group p13
A
ACON Laboratories p12
Adheris p8
AEW Capital Management p7
Aircast p12
American Medical Instruments Holdings p12
American Retirement Corporation p7
Amphora p4
Angiotech Pharmaceuticals p12
Arcadia Resources p3
Assisted Living Concepts p1
AxERx p11
B
Baxter International p12
Bear Stearns p13
Beech Street Corporation p8
betapharm Group p13
Beverly Enterprises p2
Biogen Idec p11
Bioniche Life Sciences p13
Bioniche Pharma Group p13
Blackstone Group p2
Brookdale Senior Living p7
C
CABG Medical p12
Caliper Life Sciences p11
Canadian Valley Medical Solutions p3
CardioVascular Hospitals of America p4
Carinopharm GmbH p11
Carlyle Group p3
Centre Partners p4
Cipla p13
Citigroup Corporate and Investment Banking p13
Cleveland Clinic p4
ClickFind p12
Concentra p8
Curlin Medical, LLC p12
Cypress Senior Living p7
D
DATATRAK p12
DaVita p4
Dialysis Corp. of America p4
dj Orthopedics p12
Dr. Reddy’s Laboratories p13
DSI Holding Company p4
Dynacq p3
E
Eisai Co., Ltd. p13
Elan Corp. p13
Emdeon Corp. p12
Essex Woodlands Health Ventures p12
Extendicare p1
Extendicare Health Services p1
F
Fidelity Investments p12
Formation Capital p2
Fresenius Medical Care p4
Fuji Photo Film Co., Ltd. p11
G
GlaxoSmithKline p13
Goldsmith Agio Helms p12
H
Health Grades p12
Health Management Associates p4
HFJ, LLC p8
Horizon Health Corp. p3
I
Inverness Medical Innovations p12
IonSpec Corporation p12
K
Kingswood Pines Hospital p3
KKR p2
L
Lehman Brothers p1
LifePoint Hospitals p4
LTC Properties p8
M
Meadow Wood p3
Memorial Hermann Healthcare System p8
Merrill Lynch Capital p8
Misys Healthcare Systems p11
Misys plc p11
Moog p12
MultiPlan p3
Myogen GmbH p11
Myogen, Inc. p11
N
National Renal Institutes p4
NovaMed p8
Novartis p13
O
OrthoLogic p11
P
PainCare Holdings p4
Payerpath p11
Perseus Proteomics p11
Pfizer p13
Pfizer Consumer Healthcare p13
Physicians Medical Centre of Baton Rouge, LLC p3
PLIVA Pharmaceuticals d.d. p13
Pliva Research Institute Ltd. p13
Preston Plaza Surgery Center p8
R
Ranbaxy Laboratories p13
Remedy Therapeutics p3
Renal Care Group p4
Rosemont Pharmaceuticals p13
Rothschild p13
RoundTable Healthcare Partners p12
RoundTable Healthcare Partners, LP p13
RS Investments p12
S
Sal. Oppenheim p13
sanofi-aventis p11
Savient Pharmaceuticals p13
Serono SA p13
Skilled Healthcare Group p2
Smith County Memorial Hospital p4
St. Francis Healthcare System p4
St. Francis Liliha p4
St. Francis West p4
Standard & Poor p8
Sumner Regional Health Systems p4
Sunwest Management p8
T
Tailwind Capital p12
Tandem Health p2
Tenet Healthcare Corp. p4
Texas Medical Center p8
The Institute for Rehabilitation and Research p8
U
Uso Racional p13
V
Varian p12
Ventiv Health p8
Vista Surgical Hospital p3
W
Wachovia Bank p12
Wachovia Securities p12
Walgreen Co. p3
Walgreens Home Care p3
Wockhardt p13
Wulfing Holding GmbH p11
X
Xenogen p11
 

Extendicare To Explore Strategic Alternatives - Possible $2 Billion Breakup and Sale of Extendicare May Help Jumpstart Skilled Nursing M&A Market in 2006

Email Editor

Two paragraphs into its otherwise routine fourth-quarter and year-end earnings report, Extendicare (NYSE: EXE) revealed that it had engaged Lehman Brothers to help it "provide value to shareholders," which, when decoded, means that the senior care provider is poised to pursue alternatives that could include the sale of part or all of the company.

Extendicare has grown to become one of the largest senior care providers in North America, with 439 skilled nursing and assisted living facilities. It generates annual revenue of about $1.7 billion, 75% of which comes from its U.S. operations, with the remainder coming from Canada.

The U.S. portion of the business, Extendicare Health Services, is one of the largest skilled nursing operators. With its $280 million acquisition of Texas-based Assisted Living Concepts, a deal that closed in January 2005, EXE also has a strong presence in the seniors housing side of the business. The Canadian side of operations includes skilled nursing and seniors housing with revenues of $325 million, as well as a home health business with revenue of nearly $110 million.

But despite its growth, looking around at the current market environment apparently persuaded insiders that they were sitting on a group of assets, the sum of whose parts might prove to be worth more than the whole. Investors readily agreed, sending the stock up 40% on the first day of the news. The price has risen a bit since, hitting a high of $21.48 per share.

Extendicare’s stock was stuck in the $2.00 to $4.00 per share range from mid-1999 to mid-2003, when it finally took off, climbing to a peak of $18.09 per share in 2005. In doing so, it managed to outperform the overall market in the past three years.

Some equity analysts at Canadian firms, buoyed by the recent news, have sharpened their pencils and calculated a breakup value for EXE in the range of $24 to $27 per share, or a roughly 25% premium its current price. At the current price, EXE boasts a market cap of $1.45 billion, to which net debt of about $650 million may be added, pushing the total value of the company just over the $2.0 billion mark.

To "maximize" shareholder value, the Canadian operations might be sold off to a Canadian buyer, perhaps a REIT, given the more liberal REIT regulations north of the border. The remaining U.S. operations could then go to another buyer with little interest in the Canadian side of the business, even after recent elections tilted the government more to the right and, theoretically, the United States.

Not enough is known about EXE’s home health business or the relevant payor sources to determine whether there could be a third buyer for that component. Finally, since the Assisted Living Concepts operations may not be fully integrated into the overall business, they could be spun out separately to take advantage of the high valuations in the assisted living market (see the forthcoming Senior Care Acquisition Report). With all these various combinations in the offing, bankers must be very, very happy.

Who, then, would the buyers be? Though possible, we think it unlikely that one of the major skilled nursing chains would want to buy Extendicare Health Services lock, stock and barrel. What seems most likely is that companies who have recently bid on such major portfolios as Beverly Enterprises (NYSE: BEV), Skilled Healthcare Group and Tandem Health, but who came up short, will want to have a run at Extendicare’s skilled nursing business. (They will likely buy it along with the assisted living business, which can then be spun off to help finance the deal.) The Blackstone Group, KKR and Formation Capital come foremost to mind, but there will be many others.

Despite the optimism of the Canadian analysts, it seems to us that any acquisition premium is already built into the now higher price of $21 per share. While the sum of the parts may ultimately be worth more than the whole, with two or three competing deals, one may risk bumping into and hurting the others before closing, so navigating the cross-currents will be key. Skilled nursing may also start receiving the attention showered on the seniors housing market.

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