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December
2007 issue


Aussies Buying Seniors Housing--
Two Large Acquisitions Show The Trend of Foreign Buying

The seniors housing acquisition market remains timid, but two large transactions by Australia-based buyers has given the mood in the market a little boost just before the holidays.
...
Ensign Group Prices Weak IPO--
Pricing Is Severely Cut Amid Market Weakness and Turmoil

During a very difficult period in the market, The Ensign Group was able to get its IPO priced, but at terms much lower than they expected.
...
Assisted Living Market
In addition to the two portfolio purchases by Australian companies, Assisted Living Concepts is buying a group of leased facilities, plus we report on six one-off sales around the country.
...

Skilled Nursing Market
Buyers are watching what may happen to Medicare reimbursement, but any potential change is not stopping the small deals from going through.
...
Market Updates

The Carlyle Group had hoped to get its purchase of Manor Care completed by year-end, but West Virginia and the SEIU may change those plans. Meanwhile, development problems at Sunrise Senior Living may be having an impact on buyer interest, as we hear no news about the sale of the company.
...

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Companies Mentioned in this issue:

December 2007

A
Advocat p2
AEW Capital Management p8
Agemark Acquisition, LLC p12
Assisted Living Concepts p3, p9
Atria Senior Living p17
Augustana Care Corporation p11
B
Benchmark Assisted Living p8
Brookdale Senior Living p3
C
Capital Funding Group p10
Capital Health Group p10
Capital Senior Living p16
CB Richard Ellis p8
Community Care Management Services p13
Cook Inlet Housing Authority p13
D
D.A. Davidson & Co. p2
Doley Securities p17
Donley County Hospital Board p13
E
Emeritus Assisted Living p2
Ensign Group p2
F
Fannie Mae p6
FKP Property Group p4
G
G. Avery Enterprises p10
GE Financial Services p19
Green Park Financial p9
Greenfield Partners p8
Greystone Financial Group p6
Grosvenor Investment Management US Inc. p8
H
Hartford Group p11
Heller Financial p19
Heritage Green p4
HJ Sims Investments LLC p9
J
Johnson Controls p17
K
Kuwait Finance House p8
L
Landmark Realty Capital p12
Love Funding p19
M
Macquarie Group Limited p4
MainStreet Capital Partners p11
Manor Care p14
Marcus & Millichap p12
Mercury Real Estate Advisors p16
Merrill Lynch & Co. p19
Merrill Lynch Capital p19
Miller’s Merry Manor p11
P
Principal Senior Living Group p4
Providence Health System p13
R
RainDance HealthCare Group p12
Red Mortgage Capital p19
Regent Senior Living Communities p11
Rich Healthcare, LLC p12
S
Saratoga Partners p3
SEIU p14
Senior Living Investment Brokerage p10
Skilled Healthcare Group p2
Stamford Health System p13
Stifel, Nicolaus & Company p2
Sun Healthcare p12
Sunrise Senior Living p6, p15
T
The Carlyle Group p14
The GPT Group p8
The Rainmaker Group of Companies p17
V
Veritas InCare, LLC p10
W
West Creek Capital p16
West Virginia Health Care Authority p14

Ensign Group Prices Weak IPO--
Pricing Is Severely Cut Amid Market Weakness and Turmoil

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Since August, the capital markets have had quite the rollercoaster ride. One day the Dow Jones Industrial Average is up 300 points, the next day down 200 points, then up 150 points. Investors are reacting to any latest news that may impact what the Federal Reserve will do with interest rates, how the economy will react to oil price increases, what the fallout will be with the mortgage meltdown and whether we will have a consumer-led downturn at best, or a recession at worse.

The truth of the matter is that investors really don’t have a clue. One day it is euphoria, the next day the world as we know it is coming to an end. The only thing that stays constant is Wall Street bonuses, even though the risk managers fell asleep at the wheel and cost their firms a few billion here, a few billion there. Did they really think that borrowing short and investing long was going to be profitable forever? No, but then they don’t have to pay back those bonuses either.

So this was the environment The Ensign Group (NASDAQ: ENSG) found itself in during the past two months as management huddled with the lead underwriters for its IPO, D.A. Davidson & Co. and Stifel, Nicolaus & Company. Following in the footsteps of Skilled Healthcare Group (NYSE: SKH), which went public last May, we assume ENSG thought there was a small window between the time when some calm appeared in the market six weeks after the August meltdown and the traditional Holiday break when everyone is beginning to close the books for the year. They didn’t realize, apparently, how small that window was going to be, and it looks like it caught them while it was closing.

Just a month before the actual pricing, the company filed its disclosure with the SEC that it planned to sell 4.0 million shares at a range between $20.00 and $22.00 per share. But just a few weeks later the range dropped to $18.00 to $20.00 per share. That can happen, especially in a market as jittery as this, when no one knows if the Dow is going to drop another 1,000 points or not….next week. When the IPO was finally priced on November 8, it came with a $16.00 offering price, or nearly 24% below the mid-point of the original range. In the world of IPOs, that can be called a disaster, but at least it closed the month at a slight premium.

We don’t understand why it had to take such a large haircut when other skilled nursing companies were faring reasonable well. Three of the six other publicly traded SNF companies advanced in November, while two dropped less than 3% in value and one by 7%. But Ensign was punished, and by more than 20 lashes in a Saudi public square; either that, or D.A. Davidson, the sole book-running manager, was reading the wrong tea leaves, to put it mildly. Let’s just say this deal is not going to win them much future IPO business in the senior care sector, although they could make the argument that they did, after all, get it done. And they did exercise the underwriter’s over-allotment option for an additional 600,000 shares. Yes, but…

At its current price, Ensign’s market capitalization is just under $350 million, or a third less than Skilled Healthcare, ranking it as the second-smallest publicly traded skilled nursing company, only larger than Advocat (NASDAQ: AVCA). Size doesn’t always matter, but it is important to investors, and others, and ENSG’s public float is just $75 million, which isn’t going to excite anyone. Last month we mentioned that its financial performance in the first six months of this year was underwhelming, posting a slight decline in operating income on a 17% increase in revenues compared with the first six months of 2006. Or perhaps it’s the fact that the company’s EBITDAR margin dipped by 220 basis points in that same time period, or maybe that they own less than 38% of their facilities. Whatever the reason, management can’t be happy that they ended up with $20 million less than they had expected two months ago, and while it won’t kill them, it means less money for acquisitions and growth. Speaking of acquisitions, from March 2006 through March 2007, Ensign was on a buying spree, acquiring a little more than one nursing facility per month, on average, in 14 separate deals. Now that the IPO is done, we expect management will focus on growth again and put its new funds to use.

Some may blame the November meltdown of the assisted and independent living stocks, which dropped by an average of 13% in the month. Emeritus Assisted Living (AMEX: ESC) led the way with a 24% plunge, followed by Assisted Living Concepts (NYSE: ALC), which lost 22% of its value in November and hit a new low of $6.49 per share. The reality is that these stocks should have no impact on a skilled nursing facility company’s valuation during an IPO, but as silly as it sounds, there are still investors who group all of the seniors housing and care stocks together despite the reimbursement, regulatory and asset quality differences.

The big drop in Emeritus’ value was blamed on the distribution by its major investor, Saratoga Partners, of 937,500 shares to their investors, most of which was probably then sold. This should not come as a surprise to ESC shareholders, as Saratoga has stayed with Emeritus through thick and thin, mostly thin, over the years and should be compensated for their perseverance. And what looked like a dog of an investment for too many years ended up being profitable. There was also some speculation that when Brookdale Senior Living (NYSE: BKD) was dropping in value, Emeritus was forced to decline to keep their relative values in parity. The trading volume in Emeritus is so light, and the holdings so concentrated, that we don’t believe this was the cause for the drop.

We have to believe that both Brookdale and Assisted Living Concepts have been selling off because of occupancy concerns related to the housing market (BKD) and the private pay/Medicaid swap census issues at ALC. The company has been trying to reduce its Medicaid census and replace them with private pay residents. While ALC had a record number of private pay move-ins during the third quarter, it also had a record number of private pay move-outs in the same period, so the company did not see the private pay census growth it was expecting. Management believes many of the private pay residents who moved out had the original intent of converting to the Medicaid program, and when this option was removed, they went elsewhere. Despite these problems, private pay revenues as a percent of total revenues increased in the third quarter to 86.2% from 84.4% in the second quarter. Still, the company has a ways to go to convince investors that its strategy will work.

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Since 1948, Irving Levin Associates, Inc. has been the leading source of information and investment research on mergers and acquisitions in the Behavioral Health Care, Biotech, e-Health, Home Health Care, Hospitals, Laboratories, MRI and Dialysis, Long Term Care, Managed Care, Medical Devices, Pharmaceuticals, Physician Medical Groups, Rehabilitation and other health care markets.

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