Investor Presentation September 2018

Transcription

1 Investor Presentation September 208

2 MLP Care: The # Private Hospital Group in Turkey 3 Hospitals; More than the #2 and #3 Competitors Combined Beds; 2x the size of 2 nd Largest Competitor 7 Cities Staff Doctors Addresses All Price Segments in the Turkish Market 3 JCI Accredited Hospitals 3 Centers of Excellence Revenues: 2.6 billion TL EBITDA: 409 million TL Revenues Adjusted EBITDA figure 2

3 Content. Recent Developments Regulatory changes, operational and financial updates 2. Why Invest in MLP Care? Operates in the Attractive Turkish Healthcare Market Clear Leader in Private Healthcare Provision Strong Brand Recognition and Unique Business Model Addressing All Price Points Clinical Excellence and World Class Service Offering Superior Financial Performance Outstanding Platform for Further Growth 3. Appendix Historical Financial Statements Cost Breakdown Cash Flow Generation Capital, Shareholder Structure* & Subsidiaries Key Historic Milestones 3

4 . Recent Developments Regulatory Changes Positive effects of the amendment of SUT prices Operational Updates Two new openings: Pendik and Mersin were completed on budget and schedule Medical tourism and top-up continued to post high growth Financial Updates Revenue and comparable EBITDA growth were 8% and 25% in H 208, respectively despite the global headwinds and early presidential elections All revenue segments posted strong growth in H 208 FX Exposure was mitigated by hedging 4

5 Bone Marrow Transplant Chemotherapy Radiotherapy Stent By-Pass Invasive Procedures Angio A-type surgeries Regulatory Changes SUT price amendments have positive impact on our numbers Complex surgeries in private sector 48% 36% 9% 7% 6% 5% 4% 4% As of July 5, 208, Healthcare Applications Comminuque of the Social Security Institution («SUT») prices are amended. The prices of inpatient procedures especially more complex procedures were increased up to 225%. The prices of laboratory and radiological procedures were reduced by around 5%. Provision of Healthcare Services (205) The expected impact of the price amendments on the private sector will be mainly on the complex procedures in the inpatient segment. 82% 69% 66% 47% 8% 3% 34% 53% Doctors' Consultations Inpatient Stays All Surgeries Complex Surgeries² Private Public¹ Turkish Ministry of Health 2 A type surgeries e.g., organ transplants, 204 numbers due to data availability 5

6 Operational Update Two new hospitals added to our hospital network Pendik Mersin Location İstanbul Mersin Opening Date March 208 May 208 Key Statistics 62,000 m2 35,000 m2 New hospitals were opened on budget and schedule The ramp up of the hospitals is in accordance with the plan 6

7 Operational Update Medical tourism and top-up continued to post high growth 3% 63% Medical Tourism 9% Other 8% SSI 30% (%) Revenue from PMI, Top-up & Contracted Institutions grew by 6x in the last five years Top-up Insurance continue to lead the growth (96% growth in H 208) 35% PMI, Top-up & Contracted Institutions 20% Self-pay 33% Medical Tourism growing 63% y-o-y SSI Insurance allows for a wide addressable market (c.98% of the total population) Share of self pay continues to increase in total (204: 27%) 8% Revenue Breakdown by Payor Type H 208 Source: Turkish Reinsurers and Insurers Association. Calculated as MLP Care s revenue from private medical insurance (excluding contracted institutions revenue) divided by the total payment made by insurers to healthcare providers. 7 Denotes growth/decrease vs. the same period of the last year

8 % by Department Volume & Price (TLm) Operational Update Medical tourism revenue grew above 60% in H % % 5 25 Diversified and Balanced Geography: Europe 40% Middle East and Africa 30% Former CIS and the rest 30% % Strong marketing through offices / affiliations in 5 countries with Medical Park and in 7 countries with Liv brands H 207 Volume Price H 208 FX based pricing adding to EBITDA growth c. 72% of total collected in cash 2% 2% 8% 7% 7% 7% 5% 5% 3% 3% Denotes growth vs. the same period of the last year ¹ Includes price and FX growth 8

9 Operational Update MLP Care benefits from the fast growth of Top-up Insurance Market # of People With Insurance (PMI and Top-up) in Turkey 000s CAGR ( ) Growth (H 207-H 208) 2,24 2,28 2,678 2, % 2,478 2,927 8.% % % 2,50 2,47 2,273 2,026 (.9%),96 2,45 9.4% H 207 H 208 PMI Top-up Insurance The number of people with Top-up insurance was up by 5% in H 208. MLP Care s revenue from Top-up segment grew by 96% in H

10 Financial Update Comparable Adj. EBITDA grew by 25% Revenue (TLm) Adj. EBITDA¹ (TLm) 7.7% 9.4% 24.9% 7.3%, % Q2 208 H 208 Q2 208 H 208 H () EBITDA has been adjusted for TFRS adjustments that have no cash impact on relevant period and one-off income/expense figures. (2) Comparable EBITDA without the negative EBITDA of new hospital openings in 208 including Mersin and Pendik has been adjusted for TFRS adjustments that have no cash impact on relevant period and one-off income/expense figures. Denotes growth vs. the same period of the last year 0

11 Financial Update All revenue segments posted strong growth in H 208 Domestic Patient Revenues 3.4% Medical Tourism Revenues 63.5% Ancillary Business 30.6%.4% 589, % % 65 9 Q2 208 H 208 Q2 208 H 208 Q2 208 H 208 Growth Continued in H 208 Inpatient revenues grew 9.9% in H 208 (Q2 208: 8.0%) Outpatient revenues grew 9.0% in H 208 (Q2 208: 6.8%) Continued to attract Foreign Patients in H 208 Share of revenue from Europe in total Medical Tourism: 40% Middle East & Africa: 30% Former CIS and the rest: 30% Generating higher revenues Higher laboratory revenues Enhanced revenues from managed hospitals Denotes growth vs. the same period of the last year

12 Financial Update Domestic hospital business revenue up 3.4% Outpatient Revenues (TLm) 9.0% 34.9%.8% (66) H 207 Volume Price H Inpatient Revenues (TLm) 9.9% 2.9% 6.8% H 207 Volume Price H 208 Average Revenue Per Visit (ARPV) Average Revenue Per Protocol (ARPP) H 207 H 208 0,25 0,2 0,5 0, 0,05 0 2,036 2,095,895 2, H 207 H 208 Outpatient and Inpatient revenues made up 40% and 60% of total Domestic Hospital Business Revenues in H 208. Denotes growth/decrease vs. the same period of the last year 22

13 Financial Update Adj. EBITDA improves on the back of smart cost management and savings Cost of Service and G&A Expenses as a % of Revenues Adj. EBITDA Margin 6.8% 7.0% 6.9% 6.6% 4.% 4.7% 7.4% 7.7% 8.7% 8.9% 22.6% 22.7% 23.4% 22.3% Material costs as a % of revenue declined, helped by the patient mix impact and decline in share of laboratory services business revenues (with higher material costs) Doctor costs as a % of revenue were slightly higher due to new hospital openings Personnel costs as a % of revenue were slightly higher due to new hospital openings Rent expenses as a % of revenue slightly increased due to FX impact (c.39% of rent expenses are FX based) and new hospital openings H 207 H 208 Material Doctor Personnel Rent Outsourced Other 3

14 Financial Update FX exposure mitigated by hedging FX BASED NET DEBT (in EUR m) NET DEBT 204 Before Hedging After Hedging Percentage 45% 55% Local Currency Hard Currency 29% 7% Local Currency Hard Currency 207 Q 208 H 208 (Before Hedging) H 208 (After Hedging) Nominal TL957m TL957m Net Debt / Adj. EBITDA x2. x2. EUR 35.6m of the total EUR98.7m loan (total principal and interest payments) for the period was hedged using cross currency swap transaction 4

15 Financial Update After the hedging transaction w/o the impact of non-cash FX losses, net income is fully hedged against FX changes TLm H 208 Hard Currency Hard Currency as % of Total Revenues After Hedging Transaction Domestic Hospital Revenue, Foreign Medical Tourism % 9% Ancillary Total revenues, % 9% Material (328) (33) (2%) (2%) Doctor (334) Personnel (278) Rent (3) (45) (3%) (3%) All other exp. (67) (24) (2%) (2%) Total costs (,220) (02) (7%) (7%) EBITDA % 2% Amortisation (90) Extraordinary income / (expense), net (5) Finance expenses, net of interest income (89) (26) (2%) (%) Non cash - FX gain / (loss), net (0) (0) (7%) (6%) Income / (expense), net before tax (54) (2) (8%) (5%) Taxation income / (expense), net Net Profit / (loss), net (8) (2) (8%) (5%) Net Profit / (loss), net -w/o Non cash FX gain / (loss) 02 (2) (0%) % 5

16 Financial Update Intelligent capex spending during strong headwinds Maintenance Capex (TLm) Total Capex (TLm) Operating Cash Flow / EBITDA 2.8% 2.9% 200,0 2.7%.4% 27.0% 92.% ,0 00, ,0 H 207 H 208 % of Revenue - H 207 H 208 % of Revenue H 207 H 208 % of EBITDA 6

17 2. Why Invest in MLP Care? Operates in the Attractive Turkish Healthcare Market 2 Clear Leader in Private Hospital Provision 3 Strong Brand Recognition and Unique Business Model 4 Clinical Excellence and World Class Service Offering 5 Superior Historical Financial Performance 6 Outstanding Platform for Further Growth 7

18 Operates in the Attractive Turkish Healthcare Market Turkey is an attractive healthcare market with a growing elderly population and level of affluence, with significant scope for expansion compared to OECD players Turkish Healthcare Spending to Providers (TLbn) Growth in Aging Turkish Population (millions) Growing Levels of Affluence in Turkey CAGR % 4% 2% 0% 0% 0% Income Bracket Distribution (%) High (>$50k) Upper Mid ($25-50k) Mid ($5-25k) Lower Mid ($0-5k) Low (<$0k) 9% 5% 24% 3% 27% 24% 7% 3% 24% 7% CAGR 9% 5% 0% (3)% (4)% Significant Scope For Expansion Compared to OECD 2 Peers Healthcare Spending Per Capita ($ 000) Healthcare Spending % of GDP Hospital Beds Per Capita ( 000) % 9.2% 2.7 MoH Goal: Turkey OECD Median² Turkey OECD Median² Turkey OECD Median² Source: IMS Health, Euromonitor International, OECD, Espicom Business Intelligence, MoH Statistics 205 (published in Dec-206), Turkish Statistical Institute, TOBB Report Denotes hospitals only excluding pharmaceutical, medical equipment, dental and other. 2 Denotes the Organization for Economic Cooperation and Development including 35 member countries: USA, Sweden, Switzerland, France, Germany, Austria, New Zealand, Netherlands, Denmark, Belgium, Canada, Japan, Norway, Finland, Portugal, Australia, Italy, Slovenia, UK, Spain, Iceland, Greece, Slovakia, Israel, Chile, Ireland, Czech Republic, Hungary, Luxembourg, Lithuania, Estonia, Poland, Mexico, Latvia and Turkey : 27,77 beds in Turkey. 8

19 Operates in the Attractive Turkish Healthcare Market Private operators have increased their market share, by increasing capacity and by focusing on procedures with higher complexity. Private players now account for 22% of beds, but provide 53% of complex surgeries. Number of Hospital Beds ( 000) Number of Inpatient Visits (m) % % CAGR 2% % 0 75% 3 69% CAGR 5% 4% 3% 22% 9% 25% 3% 9% Private Public Private Public¹ Provision of Healthcare Services (205) 82% 69% 66% 47% 8% 3% 34% 53% Doctors' Consultations Inpatient Stays All Surgeries Complex Surgeries² Private Public¹ Source: Ministry of Health, Health Statistics Yearbook 203, 205, TOBB report; Public includes Ministry of Health and University hospitals; 2 A type surgeries e.g., organ transplants, 204 numbers due to data availability 9

20 Operates in the Attractive Turkish Healthcare Market Supportive government policies have underpinned the expansion of private hospital groups Healthcare system and key participants Universal Healthcare Coverage with Patient Choice Regulation Funding Service Patients Government MoH Treasury SSI Private Insurance Self-Pay MoH University Hospitals Private Healthcare Institutions Universal healthcare coverage (UHI) Healthcare reforms initiated in 2004 Primary care free of charge for all citizens 98% population coverage by UHI Regulator Monitors quality at all public and private hospitals System favours patient choice Ministry of Health (MoH) Payor Social Security Institute (SSI) Owns and operates public hospitals Controls the number of licences in the sector Main provider of financing to the healthcare sector Monitors usage statistics across private and public hospitals Healthcare expenditure in private providers by payor type (TLbn) Private Public (SSI + MoH) 0 57% 43% 2009A Source: OECD reviews of health systems, Turkey 2008, Turkstat, TOBB report 9 42% 58% 205A CAGR TOBB report; 2 SUT prices = SSI tariffs; 3 200%+ on all services (except a few specified services); 4 Based on number of policies sold 3% 7% 9% Services provided by both public and contracted private hospitals with SSI being the key payor Private hospitals are able to charge higher rates than public hospitals, with some payment required from SSI patients SSI reimburses private hospitals using SUT prices 2. Price adjustment made in July 208 in favor of complex treatments which was stable since Private hospitals have the right to charge +200% 3 over and above SUT prices 2 Top-up insurance (since 204) Cheaper form of PMI to cover SSI patients co-pay costs Can only be used at hospitals that signed a contract with SSI Top-up PMI is the fastest growing segment of the health insurance market with CAGR of >9% 4 Patients choice Partial SSI reimbursements Co-pay up to 200% above SUT prices 2 Attractive funding structures increasing accessibility 20

21 <mm mm- 2mm 2mm 5mm >5mm Pop.¹ 2 Clear Leader in Private Hospital Provision MLP Care is the largest multi-specialty hospital group in Turkey and the only private player with a truly nationwide network National and local leader with a network covering the greatest number of cities 40% of beds located in the attractive Istanbul market MLP Care has the highest number of beds in nearly every city in which they are present MLP Care network (# of hospitals and locations) 2 Kocaeli Bursa Çanakkale İstanbul 0 İzmir Uşak Antalya Ereğli 2 Ankara 2 2 Samsun Mersin Tokat Ordu Trabzon 2 Elazığ Gaziantep Batman Source: Source: Latest information from company websites, Company Analysis, Turkstat (population estimates 206) Turkstat, 206 population; 2 Latest information from company websites Bed concentration in İstanbul: MLP: 40% Acibadem: 67% Memorial: 34% Medicana: 42% Location (in order of population) 2 İstanbul 0 2,532 9, Ankara İzmir Bursa Mersin Antalya Adana Konya Gaziantep Kocaeli Diyarbakır Kayseri Samsun Bodrum (Muğla) Eskişehir Trabzon Ordu Sivas Tokat Ereğli (Zonguldak) Elazığ Batman Çanakkale Uşak Total 3 5, ,27,796,680 2

22 Premium 2 Clear Leader in Private Hospital Provision MoH is investing in the PPP program, but large private players do not expect to see an impact in the near / mid term Highly illustrative schematic of the Turkish Healthcare Sector PPP success factors Top end of the Private Hospital market City hospitals are mega health complexes requiring operational excellence to ensure financial sustainability and top quality PPP will likely attract patients from public hospitals and less competitive, smaller private hospital operators Private Hospital market Public and Private Hospital market Public Hospital market Operational excellence Healthcare personnel Right governance system needs to be in place MoH needs to staff city hospitals with the right quantity and quality of medical staff Some public hospitals may need to be closed and staff re-located Re-location of medical staff may pose some risk due to remote location of city hospitals Private hospital s target population is significantly different from what the PPP hospitals are expected to attract Emergence of large PPP hospitals can accelerate consolidation in the industry, resulting in smaller hospitals having just license value As such, MLP Care is expected to be minimally impacted by the MoH s PPP initiative High service quality MoH needs to ensure patient demand through high quality service Significant increase in travel time, especially for outpatient or unplanned visits may hinder demand ¹ Ministry of Health, Health statistics yearbook 205, as of

23 Premium 3 Strong Brand Recognition and Unique Business Model Addressing Multiple Price Points Three concepts targeting three different price points with consistently outstanding medical service quality Concept Overview and Positioning 3 Total Hospitals in Portfolio Relative Average Price per Payor Type 3 Premium segment 5 Premium mass segment 22 Upper mass segment Number of hospitals including a particular concept Note: Three acquired hospitals (Ereğli, Avcılar and Çanakkale) are operated under the name of Anadolu Hastanesi, instead of Medical Park ¹ Inpatient numbers 23

24 3 Strong Brand Recognition and Unique Business Model Addressing Multiple Price Points Double Digit Growth in Majority of Payor Types 40% 3% 66% Medical Tourism 7% PMI, Top-up & Contracted Institutions 7% Other 7% SSI 35% 6% SSI Insurance provides Access to the majority of Turkey s population Revenue from PMI grew by 6x in the last five years Revenue from Top-up Insurance grew by more than 2x in 207 Self-pay 33% Medical Tourism growing from a small and sustainable base 8% 207 Revenue Breakdown by Payor Type Source: Turkish Reinsurers and Insurers Association. Calculated as MLP Care s revenue from private medical insurance (excluding contracted institutions revenue) divided by the total payment made by insurers to healthcare providers. 24 Denotes growth/decrease vs. the same period of the last year

25 4 Clinical Excellence and World Class Service Offering MLP Care benefits from a Virtuous Circle of best-in-class service, infrastructure and academic affiliations JCI accreditation The Gold Standard in Healthcare Globally SRC The Global standard for quality surgical care University affiliations Bahçelievler Göztepe İzmir Colorectal Surgery Robotic Surgery World s st st outside the US Metabolic and Bariatric Surgery 00% success rate Enable us to maintain flexibility in our doctor portfolio Attract Turkey s most skilled and experienced doctors 603 academicians working as physicians at MLP Care hospitals 3,000 scientific activities and publications in the last two years Highly diversified full service offering (No medical department comprises >9% of total sales) Da Vinci Robotic Surgery Gamma Knife Denotes Surgical Review Corporation. 25

26 Bone Marrow Transplant Chemotherapy Radiotherapy Stent By-Pass Invasive Procedures Angio A-type surgeries 4 Clinical Excellence and World Class Service Offering Top tier talent and patients are attracted to MLP Care s unrivalled reputation, resulting in a steadily growing market share Key points of attraction Top tier physicians choose MLP Care for: Strong and reliable brand Leading market share State-of-the-art infrastructure University affiliations Vast exposure to complex cases Ability to attract and retain top-tier physicians Proven track record of physicians recruitment Eyl # Share of academicians CAGR % 99% and drive patient in-flows to grow market share in Turkey MLP Care share in beds MLP Care share in inpatients MLP Care share in complex surgeries % 2 5% 48% 36% 9% 7% Complex surgeries in private sector 6% 5% 4% 4% 2% 2 4% MLP share in private beds MLP share in total beds MLP share in inpatients in the private sector MLP share in total inpatients Source: Turkish Ministry of Health. Data as of Assumes growth in beds based on 7.2% private beds CAGR and.9% total beds CAGR applied to 205 MoH figures. 26

27 5 Superior Historical Financial Performance EBITDA Growth > Net Sales > CPI (Consumer Price Index) Net Sales (TLm) %9 CAGR EBITDA (TLm) %25 CAGR % 3% 2% 3% 7% 9% 9% 9% 2% Net Sales Growth EBITDA Growth CPI (Consumer Price Index) 27

28 6 Outstanding Platform for Further Growth Quick and successful ramp up in greenfields as well as acquisitions with typical range of 2-8 months to EBITDA-neutral hospitals Example of Greenfield Batıkent (Oct-204) Total Investment TL50m Total Beds at Opening 0 Covered Area (sqm) 22,500 Example of Acquisition Yıldızlı (Sep-204) Total Investment Cost TL23m Total Capex TL8m Total Costs TL3m Total Beds 07 Covered Area (sqm) 2,000 Sales TL 000s 3,252 44,408 6,863 8,332 35,024 42,987 Contribution Margin (%) (63)% ()% 7% (0)% 5% 9% 0,780 8,348 Hospital Contribution per year in TL 000s,90 (2,057) 204 (359) 205 (807) Period open for: 3 Months 5 Months 27 Months 4 Months 6 Months 28 Months 28

29 M&A Greenfield 6 Outstanding Platform for Further Growth Proven track record of greenfield expansions and M&A Total Hospitals At Year End MLP Care has added on average c.400 beds p.a. through greenfield projects since 204 Multiple opportunities identified for expanding bed capacity in the near term Acquired 6 hospitals (of which 2 in İstanbul) Opened one managed university hospital in İstanbul 2 New Hospitals being opened in Mersin and İstanbul Bed expansion in Goztepe Two potential hospital openings / acquisitions MLP Care actively seeks out new opportunities in acquiring existing private hospitals E 209E 2020E 0 of 3 hospitals acquired Multiple targets identified and in consideration Remaining private hospitals 496 Vast amount of potential targets 88% 2% Top 4 private players 69 Total Beds Added to Portfolio Opened 2 greenfield hospitals in Ankara Opened 2 greenfield hospitals in İstanbul and Kocaeli Opened one managed university hospital in İstanbul and one greenfield hospital in Samsun Two greenfield hospital developments under construction E 209E 2020E Total private hospitals = 565 Cumulative Total Beds 3,380 4,054 4,622 5,330 5,900+ 6,330 6,830 Acquisitions Greenfields Expansions Pipeline Note: Bed counts based on licensed capacity average. 29

30 Medical tourism Self-Pay 6 Outstanding Platform for Further Growth MLP Care has several avenues to continue its growth trajectory Top line growth via the favourable insurance scheme 2 Growth through revenue diversification MLP Care has increased its market share in PMI (private medical insurance) (including Top-up Insurance) over the years, growing its revenue from PMI by 3x from 204 to 207 Top-up insurance is the fastest growing portion of the PMI market as MLP Care has been a pioneer in the Top-up insurance High Growth of MLP Care in the PMI (including Top-up Insurance) market MLP Care market share in the PMI market 7% 9% 2% 3% Self-Pay share of total pay in MLP Care revenues has up from c. 27% in 204 to c. 33% in 207 Driven by increased share of Istanbul Hospitals in total revenue Increased offerings for elective procedures Expended premium Outstanding medical quality in line with OECD countries Comparatively affordable with c % in estimated savings compared to US treatment costs Top-up Insurance s total policies sold grew by x in 204 and 207 Total # of policies sold ( 000s) Visitors to Turkey with health / medical related purpose ( 000s) MLP Care Medical Tourism Revenue (TLm) HI 207 HI 208 Source: TOBB Report; Insurance Association of Turkey; Medical tourism association; TURKSTAT, Departing Visitors by Purpose of Visit, Calculated as: MLP revenue from private medical insurance (excluding contracted institutions revenue) divided by the total payment made by insurers to healthcare providers 30

31 3. Appendix Historical Financial Statements Cost Breakdown Cash Flow Generation Capital, Shareholder Structure* & Subsidiaries Key Historic Milestones 3

32 Historical Balance Sheet TLm Dec 3 Dec 3 June 30 Cash and cash equivalents Trade receivables Inventory Short term other assets Current assets,06,6,404 Fixed assets,73,220,290 Deferred tax assets Long term other assets Non-current assets,420,560,706 Total Assets 2,435 2,72 3,0 Trade payables Short term other liabilities Short term financial liabilities (incl. leases) Current liabilities,03,26,380 Long term other liabilities Deferred tax liabilities Long term financial liabilities (incl. leases) 962, Non-current liabilities,39,355,059 Shareholders' equity Non-controlling interest Total liabilities & equity 2,435 2,72 3,0 32

33 Historical P&L Statements TLm FY 206 FY 207 H 207 H 208 Revenue 2,60 2,576,248,470 Cost of service (-) (,854) (2,7) (,055) (,23) Gross profit General administration expenses (-) (27) (25) (83) (23) Other income from operations Other expenses from operations (-) (69) (358) (58) (6) Operating income Finance expenses (-) (87) (25) (9) (0) Net foreign exchange (loss)/gain (85) (68) (5) (0) Net profit / (loss) before tax (62) (7) (28) (54) Tax income / (expense) from operations Net profit / (loss) (49) (33) (20) (8) 33

34 Reconciliation from Reported EBITDA to Adjusted EBITDA TLm H 207 H 208 Net profit / (loss) (49) (33) (20) (8) Tax income from operations (4) (38) (8) (46) Depreciation and amortization of tangible and intangible fixed assets including noncash provisions related to assets such as goodwill Total interest expenses, net of interest income and gain on financial derivatives (Income)/ expenses from investment operations 0 (0) (0) Reported EBITDA Net one-off (gains) / losses (47) 9 7 Non-cash GAAP provision expenses Adjusted EBITDA

35 Cost Breakdown Adjusted EBITDA Margin 4.5% 5.9% 8.7% 8.% 4.3% 4.2% 7.0% 7.3% 20.2% 8.6% 23.% 22.9% Material: Slight increase due to change in the revenue mix Doctor: Flat as doctor cost is ca. 95% variable Personnel: Decline on the back of operational leverage Rent: New hospital openings and FX impact 22.4% 22.9% Material Doctor Personnel Rent Outsourced Medical Service Purch. Other 35

36 Cash Flow Generation Maintenance Capex (TLm) Capex of New Hospitals (TLm) Free Cash Flow (TLm) % % 2.6% %2.6 63% 73% % of Sales Remained flat as a percentage of revenues at 2.6% Continued new hospital investments Strong free cash flow generation maintained x% FCF / EBITDA Includes expenditure on assets acquired through finance lease. 36

37 Capital, Shareholder Structure* & Subsidiaries *Shareholding structure after public offering (excluding the 6,827k shares purchased by shareholders from publicly traded portion) Lightyear Healthcare B.V. (Amsterdam, Holland) Hujori Financieringen B.V. (Amsterdam, Holland) Sancak İnşaat Turizm Nakliyat ve Dış. Tic. A.Ş (Istanbul, Turkey) Usta Group Elbaşı Group (Founders) Muharrem Usta İzzet Usta Saliha Usta Adem Elbaşı Nurgül Dürüstkan Elbaşı Free Float 30.69% 3.98% 5.35% 4.97% 35.0% MLP Sağlık Hizmetleri A.Ş. Tarsus Bursa VM Istanbul Fatih Ankara MP Ordu Trabzon Yıldızlı Antalya Trabzon Karadeniz Istanbul Bahçelievler Elazığ İstanbul Göztepe Uşak Istanbul Ulus Mersin Istanbul Pendik 57% 56.00% 58.84% 75% Arkaz Sağlık İşletmeleri A.Ş. Özel Silivri Arkaz Sağlık Hizmetleri Ltd. Şti. Silivri Avcılar Ereğli Çanakkale Özel Samsun Medikal Tıp Merkezi ve Sağlık Hizmetleri Ticaret Ltd. Şti. Sentez Sağlık Hizmetleri A.Ş. Batman Gaziantep İzmir Samsun Medikal Grup Özel Sağlık Hizmetleri A.Ş. Samsun Samsun Liv Temar Tokat Manyetik Rezonans Sağlık Hizmetleri ve Turizm A.Ş. Tokat 57% 80% 75% MS Sağlık Hizmetleri Ticaret A.Ş. Ankara Liv Mediplaza Sağlık Hizmetleri Ticaret A.Ş. İzmit Gebze 00% 00% Artımed Medikal Sanayi ve Ticaret Ltd. Şti. Kuzey Medikal Pazarlama İnşaat Taşımacılık San. Tic. Ltd. Şti. Ankara 00% BTN Asistans Sağlık Hizmetleri A.Ş. 2st Century Anatolian 00% of voting rights Foundation 00% of voting rights BTN Sigorta Aracılık Hizmetleri A.Ş. 80% 99.90% Allied Sigorta Aracılık Hizmetleri A.Ş. 00% 00% BTR Sağlık Hizmetleri A.Ş. 00% İstanbul Meditime Sağlık Hizmetleri Ticaret Ltd. Şti. Endmed Endüstri Medikal Malz. Cih. San. Tic. Ltd. Şti. and Kuzey Medikal Paz. İnş. Taş. San.ve Tic. Ltd. Şti. Partnership 00% Sotte Temizlik Yemek Medikal Turizm İnşaat San. ve Tic. A.Ş. 5% MA Group Sağlık ve Danışmanlık Hizmetleri Ticaret A.Ş. Catering Service Hospital Operators Laboratory Services Other Dormant Company Insurance Services Share Ownership Control Authority Hospital 37

38 Key Historic Milestones Founders Dr. Muharrem Usta and Adem Elbaşı opened the first hospital in Istanbul Dr. Usta, Adem Elbaşı and Sancak Group co-founded MLP Sağlık Hizmetleri A.Ş. ( MLP Care ) Carlyle acquired 40% stake in MLP Care and sold successfully in hospitals opened in Samsun and Ordu 3 hospitals opened in İzmir, Gebze and Tarsus hospital opened in İstanbul TPEF acquired 53.35% stake in MLP Care hospital opened in Samsun university hospital opened in İstanbul 2 MPARK Stocks starting to trade at BIST in February hospital opened in Istanbul # Hospitals hospital opened in Bursa hospital opened in İstanbul 3 hospitals acquired in Elazığ, Batman and Tokat 3 hospitals opened in Istanbul, Antalya and Gaziantep hospital acquired in Uşak 6 hospitals acquired in İstanbul, Trabzon, Çanakkale and Zonguldak 2 hospitals opened in Ankara 2 hospitals opened in Kocaeli and İstanbul. university hospital opened in İstanbul 2 hospitals opened in İstanbul and Mersin Managed hospital 38

39 Disclaimer This presentation may contain certain forward-looking statements concerning MLP Care s future performance and should be considered as good faith estimates made by the Company. These forward-looking statements reflect management expectations and are based upon currently available data. Actual results are subject to future events and uncertainties, which could materially impact the MLP Care s actual performance. IR Contact Dr. Deniz Can Yücel Head of Investor Relations T (Ext: 48) E deniz.yucel@mlpcare.com 39