Health C are M A News...Health Care M&A News 2 ISSN#: 2375-7612 Published monthly by: Irving Levin Associates, Inc. 268½ Main Avenue, Norwalk, CT …

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Health Care M&A News Inside the World of Health Care Mergers, Acquisitions & Finance Since 1948

VOLUME 24| ISSUE 5

I f you’ve attended any healthcare deal-making conference in the last few years, you’ve heard that telehealth is one of the hottest target sectors going, right up there with autism services and physician prac-

tices (dermatologists, ophthalmologists, dentists, you name it).

It’s caught in something of a perfect storm at the moment, as more states and regions implement laws to facilitate telehealth services. On the federal level, the Centers for Medicare and Medicaid Services on April 5, 2019 finalized policies that increase plan choices and benefits, including allowing Medicare Advantage plans to include additional telehealth benefits.

Private health insurers have been offering telehealth services to their members for some time but continue to up their offerings. Humana (NYSE: HUM) just announced a partnership with Doctor on Demand to

CROs Are Poised for More M&A ActionContract Research Organizations Are Back in Investors’ Sites

Contract research organizations (CROs), like contract development and manufacturing organizations (CDMOs), have been popular targets for private equity firms and strategic buyers for years.

Strong cash flow is a big attraction, as customers are primarily biotechnology, pharmaceutical and medical device companies. The scramble to discover drug candidates targeting cancer, neurological disorders and chronic diseases has spurred a lot of outsourcing of research and development, as well as mergers and acquisitions.

The deals seem to come in waves, and the healthcare market may be in for a tsunami this year.

In 2013, some 20 transactions for CRO/CDMO targets were announced, with some hefty price tags attached. Royal DSM paid $1.95 billion to buy

Telehealth: Answering the CallMaking Providers More Accessible Is on Everyone’s Checklist

Continued on page 2

Continued on page 7

Gotta Love CROsEvery other year, it seems, we see a wave of

deals for contract research organizations

(CROs). Signs are pointing to another wave

cresting in 2019..................................... Page 1

Telehealth Fits Many BudgetsTelehealth companies are gaining traction

with consumers, and physicians may follow.

Acquirers from all sectors are dialing up these

companies for their potential to add value to

other services......................................... Page 1

April M&A Nudges Higher It’s the start of a new quarter, one that industry

insiders expect will begin to ramp up deal

volume through the rest of the year... Page 22

Departments

ServicesHealth Care Services News ................. Page 3

Deal Summaries ................................ Page 12

Additional Transactions ................... Page 20

TechnologyHealth Care Technology News............. Page10

Deal Summaries .............................. Page 16

Additional Transactions ................... Page 21

MAY 2019

In This Issue

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Health Care M&A News

2 www.healthcaremanda.com

ISSN#: 2375-7612Published monthly by:

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Health Care M&A News Inside the World of Health Care Mergers, Acquisitions & Finance Since 1948

Patheon. Other big deals that didn’t disclose prices came from KKR & Co. (NYSE: KKR), which acquired both PRA International and ReSearch Pharmaceutical Services that year.

CRO deal volume rose a little in 2014 (27 deals), then ebbed in 2015 (11 deals). The tide began to rise again in 2016 (31 deals) and reached tidal-wave status in 2017, when 54 deals were announced. In that year, Patheon was sold again, this time to Thermo Fisher Scientific (NYSE: TMO) for $7.2 billion. The Carlyle Group (NASDAQ: CG) sold its majority interest in Pharmaceutical Product Development, LLC to Hellman & Friedman for $9.05 billion, but kept some equity in the game.

In 2018, the tide ebbed again, relatively speaking, with 43 deals announced, still the second most active.

We recently spoke with David Blume, co-founder and managing director at Edgemont Partners. The market is drawing a lot of attention from private equity firms that are competing aggressively for platforms with potential.

“Large private equity firms are coming down into the middle market,” he noted. “The largest global PE firms are competing with 100% equity offers.”

In the first four months of 2019, nine CRO deals are on the books. The latest—and largest—is Catalent, Inc.’s (NYSE: CTLT) $1.2 billion deal for Paragon Bioservices, a Baltimore, Maryland-based CRO backed by NewSpring Capital and Camden Partners. Paragon specializes in adeno-associated virus vectors, the most commonly used delivery system for gene therapy.

Catalent, with a market cap of $6.6 billion, offers development services, delivery technologies and supply solutions for drugs and biologics. Although Paragon will represent a small percentage of Catalent’s business in the near term, it is expected to transform Catalent’s business profile and accelerate its revenue and EBITDA growth over time. The gene therapy market is expected to have sustained growth of 25% in the medium term and Catalent expects Paragon will outpace this market growth for the foreseeable future.

The only other CRO deal in 2019 to disclose a price was Charles River Laboratories’ (NYSE: CRL) acquisition of the French non-clinical lab Citoxlab. Based in Evreux Cedex, France, the target specializes in regulated safety assessment services, non-regulated discovery services, and medical device testing. The deal cost Charles River $510 million, 13.8x EBITDA.

The acquisition strengthens Charles River’s services in general and specifically in specialty toxicology, preclinical medical device testing, non-regulated discovery solutions, and genomics research. The deal is expected to add $115-$130 million to Charles River’s 2019 revenue. On a trailing 12-month basis, Charles River generated revenue of $2.1 billion, EBITDA of $495 million, and net income of $135.4 million.

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HealthCareMandA 3

Two of the nine CRO deals reported this year had private equity firms as direct buyers. New York City-based Behrman Capital acquired Rockville, Maryland-based Emmes in March for an undisclosed price. Founded in 1977, Emmes is a CRO serving academic institutions, non-profits, foundations, pharmaceutical and biotech companies in over 60 different countries.

In January, Advent International acquired a majority interest in BioDuro, LLC from Bridgewest Group. BioDuro has operations in San Diego, California and Beijing and Shanghai, China. The CRO provides drug discovery services from the target identification stage through to IND filing with the Food and Drug Administration. As a result of the investment, BioDuro plans to expand, including a new research base in China and new preclinical discovery facilities in San Diego.

Edgemont’s auction processes in this market attract strong interest and multiple bidders, Blume said. There’s still plenty of inventory, too. “We have a record backlog now,” Blume told us. “We’re expecting a record year.” Watch out for the CRO tsunami.

HealtH Care ServiCeS NewS

Behavioral health Care

BayMark Health Services, a portfolio company of Webster Equity Partners, is still on the acquisition trail, even as it is reportedly prepping for a sales process.

In its first deal announced in 2019, BayMark targeted Recovery Services of New Mexico, based in Albu-querque. Recovery Services offers opioid treatment programs for patients around the state. It has three traditional opioid treatment programs, one office-based treatment program and a fifth location inside of Bernalillo County Metropolitan Detention Center.

BayMark provides medication-assisted treatment for opioid addiction and dependency to thousands of patients nationwide. It is the largest opioid treatment company in North America with 218 programs across 32 states and one Canadian province. Since August 2016, BayMark has announced 15 transactions, not one of which disclosed a price.

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In January, Webster engaged Goldman Sachs to advise on a sales process, according to Buyouts Insider. No word on how that’s going, but there are sure to be some interested parties kicking the tires.

Three other sponsored behavioral health care providers announced acquisitions in April, as they continue to build out regional platforms.

KKR’s (NYSE: KKR) Texas-based autism platform, Blue Sprig Pediatrics, acquired West Texas Autism Center, which operates two clinics in Abilene and San Angelo, Texas.

Virginia-based Pinnacle Treatment Centers, a portfolio company of Linden Capital Partners, acquired American Addiction Treatment Center, which includes three outpatient opioid treamtent programs based in Hayes, Newport News and Williamsburg, Virginia and one office-based opioid treatment program in Newport News.

And New Jersey-based Sprout Health Group, a portfolio company of Housatonic Partners since 2016, bought Endeavor House North, a drug treatment center in Kearny, New Jersey. Financial terms were not disclosed, naturally.

home health & hospiCe

Encompass Health Corp. (NYSE: EHC) announced it will acquire Alacare Home Health & Hospice for $217 million dollars. That purchase price was about 1.9x the target’s approximate 2018 revenue of $117 million.

Founded in 1970, Alacare provides home health, hospice and palliative care, physical rehabilitation, and specialty programs for dementia, cancer, stroke and heart patients. It has a large presence in Alabama, with 23 co-located home health and hospice agencies across the state.

The company provides facility- and home-based patient care through its 127 hospitals and 237 home health & hospice locations in 36 states. After the deal closes, Encompass Health will own 84 facilities nationwide. The combined platform will be among the 10 largest

hospice providers in the country based on Medicare reimbursement.

Two not-for-profit mergers in the hospice space have been announced in recent months, both taking place in North Carolina.

In early March, Hospice and Palliative Care of Greens-boro and Hospice and Palliative Care of Alamance-Caswell in Burlington announced their decision to merge. The Greensboro-based not-for-profit serves Guilford County and surrounding areas. It provides home-based hospice care, operates a 14-bed hospice facility and offers a community-based palliative care service.

The Burlington-based organization provides home health care, counseling for children and adults, and operates a 22-bed hospice home.

The two organizations currently serve more than 3,000 hospice patients annually. The combined organization will explore adopting a new name either before or after the merger becomes effective on September 30, 2019.

A month later, in April, Hospice of the Piedmont (High Point) and Hospice of Randolph County (Asheboro) announced their intent to merge, also on September 30.

Hospice of Randolph County provides in-home hospice care and operates the 16-bed Randolph Hospice House. It offers bereavement services and palliative care programming in Randolph, Guilford, Alamance, Davidson, Chatham, Montgomery and Moore counties.

Hospice of the Piedmont operates the 18-bed Hospice Home at High Point, as well as in-home hospice care. It serves Guilford, Randolph, Davidson and Forsyth counties. The two groups served more than 2,000 patients in 2018 across their combined eight-county service area.

hospitals

Verity Holdings LLC, a subsidiary of Verity Health System of California, Inc., was finally sold as part of

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VOLUME 24 | ISSUE 5

HealthCareMandA 5

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a Chapter 11 bankruptcy proceeding that began 2018. Privately held KPC Healthcare paid $610 million for three hospitals and a skilled nursing facility.

This sale includes St. Francis Medical Center (339 beds); St. Vincent Medical Center (320 beds); Seton Medical Center (279 beds) and the SNF, Seton Coastside.

physiCian mediCal Groups

Emergency Care Partners (ECP), backed by Varsity Healthcare Partners and Regal Healthcare Capital Partners, has acquired Ascension Emergency Physicians. The target provides outsourced emergency department management services to Our Lady of the Lake Ascension, formerly known as St. Elizabeth Hospital. Financial terms were not disclosed.

ECP provides emergency medicine and outsourced emergency department management services to hospital facilities across Louisiana, New York and Pennsylvania. ECP was initially formed through the joint recapitalization of Professional Emergency Medicine Management and Professional Emergency Physicians Associates.

The combined emergency medicine platform will service departmental operations at 20 hospitals, supported by a combined clinical workforce of 201 physicians and 223 mid-level providers, treating more than 710,000 emergency room visits annually. ECP’s physicians, including legacy physician partners, will continue to serve as meaningful shareholders in the combined company.

This is actually the second deal from ECP in 2019. In February, the company acquired Progressive Emergency Physicians, which also provides outsourced emergency department management services to care facilities across New York and Pennsylvania. Financial terms were not disclosed in this deal, either.

rehaBilitation

ClearSky Health, a new rehabilitation platform, is wasting no time on the acquisition front. The company, backed

by Blue Wolf Capital Partners LLC and Peloton Equity LLC, was created to develop and acquire inpatient rehabilitation facilities (IRFs) and related post-acute services companies.

In April, ClearSky announced its first acquisition, adding four inpatient rehabilitation facilities in Louisiana and Texas, formerly owned by Maxim Management Group, LLC. The specific facilities and price terms weren’t disclosed.

After only two announced deals last quarter in the Rehabilitation sector, it seems the sector is making a comeback. So far, nine deals in this sector have been announced in 2019 (yes, that’s a lot for this sector, lately).

The largest to date is Global Medical REIT Inc.’s (NYSE: GMRE) $94 million acquisition of four IRFs and U.S. Physical Therapy, Inc. (NYSE: USPH) $23.6 million purchase of an industrial injury prevention company.

other serviCes

AMN Healthcare Services, Inc. (NYSE: AHS), a healthcare solutions and staffing services company, has acquired Advanced Medical Personnel Services, Inc. for $200 million.

Advanced Medical Personnel specializes in placing therapists and nurses in contract positions across multiple settings including hospitals, schools, clinics, skilled nursing facilities and home health.

AMN purchased Advanced Medical for the company’s recently launched telehealth platform that delivers speech therapy to children in large school districts across the country.

Another telehealth company changed hands in early April, as Advantia Health, a physician practice focused on women’s health, acquired Pacify, a telehealth company. In January, Medici bought Chiron Health, a virtual healthcare company, for an undisclosed amount. (See other story on page 1.) □

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Telehealth Continued from page 1

launch a new virtual primary care model called On Hand, beginning in June 2019. Teladoc Health (NYSE: TDOC) in March launched a new service in Canada, called Teladoc Telemedicine Services.

For the record, telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine, as defined by the Health Resources Services Administration. While telemedicine refers specifically to remote clinical services, telehealth includes remote non-clinical services, such as provider training, administrative meetings and continuing medical education, in addition to clinical services. We do not include remote patient monitoring as part of the telehealth subsector, due to its more passive, data-collection aspect that does not require a physician’s exclusive attention.

Consumers are getting more comfortable with the telehealth concept, too. From 2016 to 2017, private insurance claims for services rendered via telehealth

(as a percentage of all medical claim lines) grew 53% nationally, more than any other venue of care studied by FAIR Health, which published its findings on April 1. Compared with telehealth’s 53% growth, national usage of urgent care centers increased 14%, of retail clinics, 7%, and of ambulatory surgery centers, 6%. Claims for emergency room visits decreased by 2% in that same period.

Adoption by physician practices is still low, however. A 2018 survey by the American Medical Association found just 15% of physicians worked in practices that offer telehealth services. Spending on telehealth services is pretty healthy, however. IBISWorld, an industry research firm, pegged the total market revenue at $2 billion in 2018.

reCent deals Spending on telehealth deals can’t be measured in the same way, primarily because the targets in this fragmented market are generally small and terms of the

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deals are kept private.

In the first four months of 2019, five acquisitions of telehealth targets have been announced, compared with 10 each in 2018 and 2017. The five deals we’ve seen in 2019 demonstrate telehealth’s appeal across sectors, as the acquirers include companies outside the digital health sector.

One example is AMN Healthcare Services (NYSE: AHS), which provides healthcare workforce solutions and staffing services to healthcare facilities. On April 30, the company agreed to pay $200 million to acquire privately held Advanced Medical Personnel, which specializes in placing therapists and nurses in contract positions across multiple settings such as hospitals, schools, clinics, skilled nursing facilities and home health. The attraction for AMN was Advanced Medical’s recently launched telehealth platform to serve the needs of children within large school districts with telehealth therapist consultations, in addition to on-site visits.

Also in April, Advantia Health paid an undisclosed price for Pacify. Advantia focuses on women’s health via its Woman’s Health Hub model, which physically and clinically integrates primary care, behavioral health and other common services into its OB-GYN practices to provide coordinated services to meet women’s needs.

Pacify developed a telehealth app that focuses on virtual perinatal care for new and expectant mothers. It connects them with consultants and registered nurses to complement in-person visits with OB-GYNs, pediatricians and other physicians.

Pacify works with more than 30 health plans, employers and public health agencies, including Medicaid managed care organizations and Women, Infants and Children (WIC) programs. This deal combines Advantia’s physical physician practices with Pacify’s virtual capabilities to provide on-demand, 24/7 virtual care for new mothers through the Pacify platform.

On April 1, California-based rehabilitation company Paradigm acquired Restore Rehabilitation, based in

Owings Mills, Maryland.

Paradigm treats injured workers through three divisions: catastrophic care management, complex care solutions, and specialty networks. Its specialties include nurse triage, transitional return to work, physician advisory services and complex pain management.

Restore Rehabilitation is a case management company that provides field coverage in 27 states and nationwide telehealth coverage. It will be integrated into Paradigm’s Complex Care Solutions division and will operate under the Paradigm name.

telehealth leaders

Teladoc is the publicly traded pure-play in the telehealth space, with a market cap of $4.4 billion. It went public in July 2015 with a share price of $19 and is currently trading around $61 per share.

Even before its IPO, the company was actively acquiring. In September 2013, Teladoc took over Consult A Doctor, a Miami, Florida-based telemedicine service and technology platform with a network of board-certified physicians in all 50 states. In May 2014, it acquired Dallas, Texas-based AmeriDoc, a telehealth platform.

In 2016, it paid approximately $153 million for HealthiestYou, a telehealth consumer engagement platform for the small- to mid-sized employer market. A year later, it acquired Best Doctors from Brown Brothers Harriman for $440 million and gained global reach through the target’s network of more than 50,000 medical experts worldwide. All are peer-rated in a Gallup-certifed poll as being in the top 5% of physicians in more than 450 medical specialties.

In March 2019, the company boosted its global presence with the acquisition of the French telehealth provider MedecinDirect, for an undisclosed sum. The deal combines Teladoc’s virtual care services with MedecinDirect’s consultation and prescription digital health solutions. The organization will become the French country unit of Teladoc Health.

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HealthCareMandA 9

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Other U.S. players include privately held InTouch Health, an enterprise telehealth platform that supports over 130 healthcare systems, 7,700 registered network users, and 1,780 care locations worldwide. In 2018, it surpassed 1,680,000 network sessions and is expected to manage more than 300,000 clinical sessions in 2019.

Last year InTouch made two deals. In January, it acquired TruClinic, which offers a secure, high definition video communication system and a suite of practice management products. In April it acquired Alpharetta, Georgia-based REACH Health, which provides enterprise telemedicine systems for multiple specialties and settings of care. The REACH 5.0 platform allows bedside clinicians to consult and collaborate with remote specialists. No financial terms were disclosed.

Private equity firms, which are storming many healthcare services sectors at the moment, have not piled into the telehealth sub-sector as heartily as they have other areas of digital health. Rest assured, interest is growing. Harbour Point Capital acquired InSight Telepyschiatry in November 2018, following Pharos Capital Group’s 2016 deal for FasPsych LLC. Other specialties like teleradiology are attracting medical device makers such as Royal Philips (NYSE: PHG). The company acquired Direct Radiology in March. You’ll be hearing a lot more about these services in the years to come.

HealtH Care teCHNology NewS

BioteChnoloGy

Ocugen, Inc. , a privately held cl inical-stage biopharmaceutical company, has acquired Histogenics Corporation (NASDAQ: HSGX). Although no financial terms were disclosed, the merged company will be publicly-traded, operating under the Ocugen name.

Ocugen discovers, develops and commercializes a pipeline of therapies that address rare and underserved eye diseases. Histogenics develops a restorative cell therapy technology platform. It has collaborated with Brigham and Women’s Hospital, Cornell University and other leading institutions to advance molecular biology

and proprietary materials sciences.

Perhaps a big factor driving Ocugen’s purchase is Histogenic’s pipeline in areas such as cell restorative therapy as well as its NeoCart platform, a Phase 3 investigational product that uses bio-engineering and cell processing for orthopedic use.

This is not the only deal to focus on cell therapies in the biotech world in April. Shanghai Fosun Pharmaceutical bought an exclusive license to develop, manufacture, and commercialize CTX and hRPC cell therapy programs in China from ReNeuron for $7.9 million and nearly $18.5 million in milestones.

mediCal deviCes

Only one deal in this sector revealed a price, among the four deals announced in April. That was the $167.5 million acquisition of AngioDynamics’ (NASDAQ: ANGO) Namic fluid management business, which includes a portfolio of manifolds, contrast management systems, closed fluid systems, guidewires, disposable transducers, and interventional accessories. It also includes a manufacturing facility in Glens Falls, New York.

The buyer, Medline Industries, Inc., makes and distributes medical supplies and clinical products globally.

Upon closing, AngioDynamics intends to use the net cash proceeds of approximately $160 million to pay down all outstanding debt. The cash balance of approximately $74 million will be used to support strategic investments in its existing portfolio.

pharmaCeutiCals

Misonix, Inc. (NASDAQ: MSON), an international surgical device manufacturer, has acquired the pharmaceutical company Solsys Medical, LLC. The target company markets TheraSkin, a cellular and tissue-based product for regenerative wound healing, especially for difficult-to-heal chronic wounds. TheraSkin has been applied

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VOLUME 24 | ISSUE 5

HealthCareMandA 11

to more than 100,000 wounds supported by multiple clinical studies.

The deal will cost Misonix a total of $117 million, comprised of $97 million in stock plus Solsys’ $20 million outstanding secured debt. As part of the deal, Misonix will issue 5.7 million new shares. Upon closing, it will own 64% of the company and Solsys unitholders will own 36%.

Misonix hopes to get a wider market reach out of this transaction, seizing on the opportunity to address the domestic wound biologics market, which is valued at approximately $700 million annually.

The combined company is expected to generate roughly $80 million in sales in 2020.

FSD Pharma Inc. (CSE: HUGE), a Canadian-based cann-abis company, has acquired Prismic Pharmaceuticals Inc., a specialty pharmaceutical company focused on novel non-addictive prescription drugs for the treatment of pain, inflammation and neurological disorder.

The transaction cost approximately $17.5 million, but FSD gains Prismic’s worldwide licensing rights to a patent-protected form of palmitoylethanolamide, which can increase the effectiveness while lowering the dosage amount for non-addictive prescription drugs. That lines up well with FSD’s cannabinoid product portfolio. It’s a step closer to FSD’s goal of creating a platform that advances research and development of FDA-approved applications of synthetic cannabinoids.

With Purdue Pharma and other pharmaceutical giants under public scrutiny for their role in the opioid crisis, it’s no surprise we’re seeing trends to move away from potential addictive prescription drugs. In March, Pacira Pharmaceuticals, Inc. (NASDAQ: PCRX), a specialty pharmaceutical company, bought MyoScience, Inc. for $120 million. Myoscience designed the iovera system, an FDA-approved non-opioid treatment to block pain and relieve the pain and symptoms associated with osteoarthritis of the knee. Perhaps in the second quarter, we’ll see more deals across the sectors looking to find alternatives to opioids. □

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Deal Summaries: Services Home Health & Hospice

TARGET LISTING ACQUIRER LISTING DATE PRICE Alacare Home Health & Hospice Private Encompass Health Corp. NYSE: EHC 4/1/2019 $217,000,000 Birmingham, Alabama Birmingham, Alabama

In Brief: Founded in 1970, Alacare provides home health, hospice and palliative care, physical rehabilitation, and specialty programs for dementia, cancer, stroke and heart patients. It owns and operates 23 co-located home health and hospice agencies across Alabama.

Deal Summaries: Services Hospitals

TARGET LISTING ACQUIRER LISTING DATE PRICE Verity Holdings, LLC Nonprofit KPC Healthcare, Inc. Private 4/17/2019 $610,000,000 Los Angeles, California Santa Ana, California

In Brief: Verity Holdings is a subsidiary of Verity Health System of California, Inc., which filed for Chapter 11 bankruptcy protection in 2018. This sale includes St. Francis Medical Center (339 beds); St. Vincent Medical Center (320 beds); Seton Medical Center (279 beds) and Seton Coastside, a skilled nursing facility.

Deal Summaries: Services Long-Term Care

TARGET LISTING ACQUIRER LISTING DATE PRICE Juniper Village at Cape Coral Private Regional owner/operator Private 4/1/2019 $6,275,000 Cape Coral, Florida

In Brief: Built in 1968 with a complete renovation in 1995, this assisted living community has 100 licensed beds in 80 units, with 44,240 square feet on 1.5 acres. Occupancy was 94% at the time of sale. It is located in a mixed-use area about 40 miles north of Naples.

Skilled nursing portfolio Private CareTrust REIT, Inc. NASDAQ: CTRE 4/2/2019 $211,000,000 Texas and Louisiana San Clemente, California

In Brief: This portfolio includes 1,734 total beds and units. There are seven SNFs and one SN/AL campus in Louisiana and three SNFs plus one CCRC in Texas. They were previously owned by BM Eagle Holdings, a joint venture controlled by BlueMountain Capital Management.

Vista Gardens Private Private equity group Private 4/2/2019 $22,800,000 Vista, California Colorado

In Brief: Built in 2011, this memory care community has 99 beds in 71 units, with 43,996 square feet on 4.51 acres. Occupancy is 88% based on beds, and rents averaged $5,940 per month. It was the only asset of the local owner, who is exiting the industry.

The Waters of White Hall Private Strawberry Fields REIT LLC Private 4/4/2019 $6,850,000 White Hall, Arkansas South Bend, Indiana

In Brief: Built in 2001, this skilled nursing facility has 120 dual-certified beds and approximately 45,000 square feet. Occupancy is relatively strong (between 101 and 106 patients), and is performing well.

Assisted living community Private Local owner/operator Private 4/4/2019 $6,500,000 Michigan Michigan

In Brief: Built in 1987 and recently receiving a significant renovation, this assisted living community has 50 units and 44,000 square feet. Located in southeast Michigan, it was over 90% occupied and operated at a 20.5% margin. The seller, a local owner, acquired the facility 11 years ago.

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Deal Summaries: Services Long-Term Care (cont’d)

TARGET LISTING ACQUIRER LISTING DATE PRICE Assisted living/MC community Private Local owner/operator Private 4/4/2019 $6,500,000 Ohio Ohio

In Brief: Featuring two buildings that were built in 2000 and 2013, this assisted living/memory care community has 35,500 square feet on 10 acres. It is located in rural northeast Ohio. It has strong cash flow and good occupancy. This was the seller’s only asset.

Skilled nursing facility Private Owner/operator Private 4/12/2019 $6,700,000 Newark, Ohio New Jersey

In Brief: This skilled nursing facility has 99 beds and 28,000 square feet, and was cash flowing well. It was built in 1972 with consistent updates through the years and added a rehab wing in 2015.

Care home Private Target Healthcare REIT LSE: THRL 4/15/2019 $9,000,000 Formby, United Kingdom Stirling, Unietd Kingdom

In Brief: Opened in late 2017, this care home has 40 units, all with private bathrooms. There are also large common areas and dining rooms. It was experiencing strong lease up in an affluent area with few care home options.

Aurora Village Apartments Private Afton Properties Private 4/19/2019 $8,650,000 Lancaster, California Los Angeles, California

In Brief: Located on a 3.4-acre campus near Antelope Valley Hospital, this affordable senior apartment community has 132 one- and two-bedroom units. It had been previously owned by Aurora Village LP since opening in 2004.

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Deal Summaries: Services Long-Term Care (cont’d)TARGET LISTING ACQUIRER LISTING DATE PRICE

4 skilled nursing facilities NYSE: MED Healthcare Partners LLC Private 4/22/2019 $28,500,000 Alabama, Georgia & Oklahoma RHE Lynnbrook, New York

In Brief: The portfolio includes Attalla Health & Rehab (182 beds) in Attalla, Alabama; Healthcare at College Park (100 beds) in College Park, Georgia; Quail Creek Nursing & Rehabilitation Center (118 beds) and Northwest Nursing Center (100 beds), both in Oklahoma City.

Maynooth Lodge Nursing Home Private Brindley Healthcare Private 4/28/2019 $11,240,000 Maynooth, Ireland Donegal, Ireland

In Brief: Built in October 2015, this care home has 79 beds. It is located in County Kildare, west of Dublin.

8 senior living properties NYSE: WELL Not disclosed Private 4/30/2019 $290,000,000 United States

In Brief: Previously owned by Welltower and triple-net leased to StoryPoint Senior Living, this portfolio includes eight senior living communities. They average more than 20 years old.

3 seniors housing communities Private Welltower Inc. NYSE: WELL 4/30/2019 $80,000,000 Various, New Jersey Toledo, Ohio

In Brief: The communities were triple-net leased to Chelsea Senior Living.

Seniors housing community Private Welltower Inc. NYSE: WELL 4/30/2019 $57,000,000 Michigan Toledo, Ohio

In Brief: StoryPoint Senior Living will take over management of the community under a RIDEA agreement.

Memory care community NYSE: WELL Not disclosed Private 4/30/2019 $9,000,000 United States

In Brief: This memory care community is operated by Senior Resource Group. Welltower owned a 47.5% interest in the community. The property was determined to be non-core by Welltower, prompting the sale, which closed in the first quarter.

Deal Summaries: Services Physician Medical GroupsTARGET LISTING ACQUIRER LISTING DATE PRICE

Access Dental and Lacosta Dental Private Surge Private Equity Private 4/18/2019 $30,000,000 Austin, Texas Dallas, Texas

In Brief: Access Dental has built a network of multi-specialty family dental practices throughout Texas. It operates four clinics in the Austin

area. Lacosta Dental, part of Access, operates five dental practices in Corpus Christi, Port Arthur and Beaumont.

Deal Summaries: Services RehabilitationTARGET LISTING ACQUIRER LISTING DATE PRICE

Injury prevention company Private U.S. Physical Therapy, Inc. NYSE: USPT 4/11/2019 $23,600,000 United States Houston, Texas

In Brief: The unidentified company specializes in delivering injury prevention and care, post-offer employment testing, functional capacity evaluations, and return-to-work services. It performs these services across a network in 45 states including onsite at 11 client locations.

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HealthCareMandA 15

Strategies to Respond E� ectively and Ethically to Today’s Growth ChallengesUpdated payer guidelines, new government regulations and compliance concerns, and ever-changing Google policies are challenging behavioral healthcare executives to continuously evolve their business practices. To provide senior executive and marketing leadership the practical education they need to accomplish their missions in today’s environment, we have carefully developed an engaging agenda for the third annual Treatment Center Executive & Marketing Retreat.

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Deal Summaries: Services Rehabilitation (cont’d)TARGET LISTING ACQUIRER LISTING DATE PRICE

Four IRFs Private Global Medical REIT Inc. NYSE: GMRE 4/18/2019 $94,000,000 Orlando, California Bethesda, Maryland

In Brief: CNL Healthcare Properties is selling the real estate assets of four inpatient rehabilitation facilities (IRFs). The portfolio is roughly 207,204 square feet and is expected to provide an annual rent total of $6.9 million. The average remaining lease term is roughly 8.3 years.

Deal Summaries: Services Other ServicesTARGET LISTING ACQUIRER LISTING DATE PRICE

Paragon Bioservices, Inc. Private Catalent, Inc. NYSE: CTLT 4/15/2019 $1,200,000,000 Baltimore, Maryland Somerset, New Jersey

In Brief: Paragon Bioservices is a contract research organization (CRO) specializing in adeno-associated virus vectors, the most commonly used delivery system for gene therapy. It is backed by NewSpring Capital and Camden Partners.

Nonclinical research business Private Laboratory Corp. of America NYSE: LH 4/17/2019 $485,000,000 East Millstone, New Jersey Burlington, North Carolina

In Brief: Envigo is selling its nonclinical research services business, which provides nonclinical drug development to the pharmaceutical and biopharmaceutical industries.

Advanced Medical Personnel Private AMN Healthcare Services NYSE: AHS 4/30/2019 $200,000,000 Dallas, Texas San Diego, California

In Brief: Advanced Medical Personnel Services specializes in placing therapists and nurses in contract positions across multiple settings including hospitals, schools, clinics, skilled nursing facilities and home health.

Deal Summaries: Technology BiotechnologyTARGET LISTING ACQUIRER LISTING DATE PRICE

IFM Tre Private Novartis AG NYSE: NVS 4/1/2019 $310,000,000 Boston, Massachusetts Basel, Switzerland

In Brief: IFM Therapeutics LLC is selling its subsidiary, IFM Tre, a biotech company focused on developing anti-inflammatory medicines targeting the NLRP3 inflammasome. Preclinical trials have shown that IFM Tre’s molecules can selectively suppress inflammation caused by the NLRP3 inflammasome without disturbing the rest of the immune system.

Royalties on five hematology assets Private XOMA Corporation NASDAQ: XOMA 4/8/2019 $6,000,000 Portland, Oregon Emeryville, California

In Brief: Aronora, Inc. is selling the rights to potential royalty payments and a portion of the potential milestone payments associated with five of its hematology assets.

License to cell therapy programs AIM: RENE Shanghai Fosun Pharmaceutical SHA: 600196 4/9/2019 $7,900,000 Bridgend, United Kingdom Shanghai, China

In Brief: ReNeuron is selling an exclusive license for the development, manufacture, and commercialization of the CTX and hRPC cell therapy programs in China. CTX cell therapies focus on stroke disabilities and hRPc focuses on retinal diseases. Fosun will fully fund the development of ReNeuron’s CTX and hRPC cell therapy programs in China, including clinical development and subsequent commercialization activities.

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Deal Summaries: Technology Biotechnology (cont’d)TARGET LISTING ACQUIRER LISTING DATE PRICE

Collaboration on FCX-007 NASDAQ: Castle Creek Pharmaceuticals Private 4/15/2019 $7,500,000 Exton, Pennsylvania FCSC Parsippany, New Jersey

In Brief: Fibrocell Science will collaborate with Castle Creek to develop and commercialize its lead gene therapy candidate, FCX-007, for the treatment of recessive dystrophic epidermolysis bullosa (RDEB), a rare, life-threatening genetic disorder diagnosed in infancy with no cure or treatment approved by the FDA.

Collaboration on NASH therapies Private Gilead Sciences, Inc. NASDAQ: GILD 4/16/2019 $15,000,000 South San Francisco, California Foster City, California

In Brief: Insitro will collaborate with Gilead to discover and develop therapies for patients with nonalcoholic steatohepatitis (NASH), a progressive liver disease that can lead to fibrosis, cirrhosis and liver cancer.

Global license to immunology Private Eli Lilly and Company NYSE: LLY 4/22/2019 $20,000,000 La Jolla, California Indianapolis, Indiana

In Brief: Avidity Biosciences, Inc. is providing its technology platform in a global licensing and research collaboration agreement. It includes the development and commercialization of potential new medicines in immunology and other select indications.

License to sacituzumab govitecan NASDAQ: Everest Medicines II Private 4/29/2019 $65,000,000 Morris Plains, New Jersey IMMU New York, New York

In Brief: Immunomedics has entered an exclusive license agreement to develop, register, and commercialize sacituzumab govitecan in greater China, South Korea and certain Southeast Asian countries. Sacituzumab govitecan is currently being evaluated in a multicenter Phase 2 study in patients with solid cancers.

Deal Summaries: Technology eHealthTARGET LISTING ACQUIRER LISTING DATE PRICE

Get Real Health Private Computer Programs & Systems NASDAQ: 4/24/2019 $11,000,000 Rockville, Maryland Mobile, Alabama CPSI

In Brief: Get Real Health provides a wide range of patient engagement and software tools for hospitals, physician practices, wellness companies, biotech and research companies, and health insurance companies.

OTTR Complete Transplant Private CareDx, Inc. NASDAQ: 4/25/2019 $16,000,000 Omaha, Nebraska Brisbane, California CDNA

In Brief: OTTR Complete Transplant Management provides organ transplant patient tracking software for over 200 programs at more than 60 transplant centers in the United States and Canada.

Deal Summaries: Technology Medical DevicesTARGET LISTING ACQUIRER LISTING DATE PRICE

Namic fluid management NASDAQ: Medline Industries, Inc. Private 4/17/2019 $167,500,000 Latham, New York ANGO Mundelein, Illinois

In Brief: AngioDynamics, Inc. is selling its Namic fluid management business, which includes a portfolio of manifolds, contrast management systems, closed fluid systems, guidewires, disposable transducers, and interventional accessories. It also includes a manufacturing facility in Glens Falls, New York.

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Deal Summaries: Technology PharmaceuticalsTARGET LISTING ACQUIRER LISTING DATE PRICE

Royalties on Emgality Private Royalty Pharma Private 4/1/2019 $260,000,000 Cambridge, Massachusetts New York, New York

In Brief: Arteaus Therapeutics is selling its royalty interest on future global net sales of Eli Lilly and Company’s (NYSE: LLY) Emgality (galcanezumab), an anti-CGRP antibody for the prevention of migraine headaches.

License to Nerlynx NASDAQ: Pierre Fabre S.A. Private 4/1/2019 $60,000,000 Los Angeles, California PBYI Lavaur, France

In Brief: Puma Biotechnology is selling an exclusive license to develop and commercialize Nerlynx in Europe and part of Africa. Nerlynx is for the extended adjuvant treatment of adult patients with early-stage hormone receptor-positive HER2-overexpressed/amplified breast cancer.

Global rights to two Eisai drugs Private Advanz Pharma Corp. TO: ADVZ 4/1/2019 $33,300,000 Woodcliff, New Jersey Mississauga, Ontario

In Brief: Eisai Inc. is selling the global rights to Salagen tablets (excluding Japan) and to Panretin gel. Salagen treats dry mouth conditions caused by radiotherapy for head and neck cancer, and Panretin treats cutaneous lesions in patients with AIDS-related Kaposi’s sarcoma.

Doc Generici Private Intermediate Capital Group Private 4/8/2019 $1,200,000,000 Milan, Italy London, United Kingdom

In Brief: CVC Capital Partners is selling Doc Generici, a generic drug manufacturer that provides drugs for the treatment of common medical conditions in areas including cardiovascular, neurological and gastrointestinal/metabolism. CVC acquired the company in 2016.

U.S. rights to Symproic Private BioDelivery Sciences NASDAQ: 4/10/2019 $20,000,000 Florham Park, New Jersey Raleigh, North Carolina BDSI

In Brief: Shionogi, Inc. is selling the commercial rights to Symproic for the U.S. and Puerto Rico. Symproic aims to treat opioid-induced constipation (OIC) in adults with chronic non-cancer pain. It currently is undergoing seven global Phase 3 trials.

Rights to two antibiotics in China NYSE: Eddingpharm Private 4/22/2019 $375,000,000 Indianapolis, Indiana LLY Hong Kong

In Brief: Eli Lilly and Company is selling the rights in China for two legacy antibiotic medicines, Ceclor and Vancocin, as well as a manufacturing facility in Suzhou, China that produces Ceclor.

Prismic Pharmaceuticals Inc. Private FSD Pharma Inc. CSE: HUGE 4/24/2019 $17,500,000 Scottsdale, Arizona Cobourg, Ontario

In Brief: Prismic is a specialty pharmaceutical company dedicated to addressing the opioid crisis by developing novel non-addictive prescription drugs for the treatment of pain, inflammation and neurological disorders.

Ramdev Chemical Private Ipca Laboratories NSE: IPCALAB 4/252019 $15,964,525 Mumbai, India Mumbai, India

In Brief: Ramdev Chemical manufactures and markets advanced drug intermediates, fine chemicals, custom synthesis molecules, and active pharmaceutical ingredients.

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VOLUME 24 | ISSUE 5

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Building Occupancy and Maximizing Value in Seniors HousingFEBRUARY

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APRILHome Health & Hospice: The Future of Healthcare Delivery?

MAYThe 55+ Active Adult Market: The New Frontier of Seniors Housing

JUNESkilled Nursing Market: Acquiring, Selling and Valuing

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Additional Transactions Services

SECTOR TARGET ACQUIRER DATE

BEHAVIORAL HEALTH CARE Privatklinik Friedenweiler clinic Principal Real Estate 4/9/2019 Endeavor House North Sprout Health Group 4/11/2019 West Texas Autism Center Blue Sprig Pediatrics, Inc. 4/16/2019 American Addiction Treatment programs Pinnacle Treatment Centers 4/19/2019 Recovery Services of New Mexico BayMark Health Services 4/30/2019

HOME HEALTH & HOSPICE Harmony Home Care BrightStar Care 4/1/2019 Careforce Home Care Workers Cooperative Nova Leap Health Corp. 4/2/2019 Legacy Hospice Choice Homecare of Texas, LLC 4/2/2019 Nursing Plus of Broward Jewish Family Home Care 4/2/2019 Hospice of Randolph County Hospice of the Piedmont 4/10/2019 DiaLibre Air Liquide 4/17/2019 In-Home Care VNA Perry Memorial Hospital 4/29/2019 Angels of Care Pediatric Home Health Varsity Healthcare Partners 4/30/2019

HOSPITALS Bakersfield Heart Hospital The Sanders Trust 4/9/2019 Jackson General Hospital West Virginia University Health 4/9/2019

LABS, MRI & DIALYSIS AutoGenomics Inc. Prescient Medicine Holdings Inc. 4/23/2019

LONG-TERM CARE Mountain Ridge Assisted Living Avamere Family of Companies 4/1/2019 Rosewood Care Center of Galesburg Regional owner/operator 4/1/2019 The Greens of LeRoy St. Ann’s Community 4/2/2019 Rockbrook Memory Care The Ensign Group, Inc. 4/2/2019 Phoenix Mountain Post Acute The Ensign Group, Inc. 4/2/2019 7 skilled nursing/assisted living facilities Skilled nursing owner 4/3/2019 Lakeside Assisted Living Ascend Partners, LLC 4/4/2019 10 senior living communities Hickory Senior Living 4/4/2019 Buffalo Community Healthcare Center The Grand Healthcare System 4/5/2019 3 care homes Country Court Care Group 4/8/2019 Waterton Plaza at Cowhorn Creek Partnership buyer 4/8/2019 The Springs at Carman Oaks & at Wilsonville The Springs Living 4/9/2019 5 skilled nursing facilities Owner/operator 4/9/2019 Senior apartment community Not disclosed 4/10/2019 2 skilled nursing facilities Blackadder Corporation 4/11/2019 Stepping Stones Korian 4/15/2019 The Fountains of Granite City & of Godfrey Triloma Seniors Housing 4/16/2019 6 senior apartment communities Preservation of Affordable Housing 4/17/2019 Skilled nursing facility New York investor 4/18/2019 Broomall Presbyterian Village Vintage Healthcare LLC 4/18/2019 Watercrest at Dominion & Isle at Watercrest Welltower Inc. 4/19/2019 Copper Hill Care Home Armighorn Capital Ltd. 4/24/2019 Insignia of Savannah Mainstay Senior Living 4/30/2019 Hilltop Lodge Not disclosed 4/30/2019 Parker Senior Living Private equity firm 4/30/2019 MANAGED CARE Century Healthcare, LLC Fringe Benefit Group 4/16/2019

PHYSICIAN MEDICAL GROUPS Southern Connecticut Dental Group 42 North Dental 4/1/2019 Southeast Gastro Gastro Health, LLC 4/2/2019 Capital Region Midwifery St. Peters Health Partners 4/3/2019 Dental Care Group G Square Healthcare Private Equity 4/8/2019 Sterling Surgical Center, LLC Catholic Health 4/11/2019 Carolinas Centers for Sight Eye Health America 4/11/2019

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HealthCareMandA 21

Additional Transactions Services (cont’d) SECTOR TARGET ACQUIRER DATE

PHYSICIAN MEDICAL GROUPS Ludwick Eye Center Omni Ophthalmic Management 4/15/2019 Ascension Emergency Physicians Emergency Care Partners 4/24/2019

REHABILITATION Restore Rehabilitation Paradigm 4/1/2019 ISDI Holdings, Inc. IMAC Holdings, Inc. 4/2/2019 4 IRFs in Louisiana and Texas ClearSky Health 4/29/2019

OTHER SERVICES Finger Lakes Clinical Evolution Research Group, LLC 4/1/2019 Little Spurs Pediatric Urgent Care Great Point Partners 4/3/2019 CV Staff Solutions THMED 4/15/2019 Comprehensive Pharmacy Services Frazier Healthcare Partners 4/16/2019 Covance Research Products business Envigo 4/17/2019 Orbis Clinical PharmaLogics Recruiting 4/24/2019 Ambulatory surgery center Montecito Medical Real Estate 4/26/2019 Symmetry Healthcare Solutions Aya Healthcare Inc. 4/26/2019 Sunrise Air Ambulance Guardian Flight 4/29/2019

Additional Transactions TechnologySECTOR TARGET ACQUIRER DATE

BIOTECHNOLOGY Histogenics Corporation Ocugen, Inc. 4/8/2019 Global license to PB1023 ImmunoForge 4/9/2019 Global rights to losmapimod Fulcrum Therapeutics 4/23/2019 License to MT-1303 Salix Pharmaceuticals 4/25/2019 Vortex Biosciences EMV Capital 4/25/2019 Zellkraftwerk GmbH Canopy Biosciences, LLC 4/29/2019

eHEALTH Pacify Advantia Health 4/4/2019 Valent Medical Solutions, Inc. Gemspring Capital 4/9/2019 Occupational Medical Consulting, LLC Wellness Workdays 4/10/2019 RealTime Clinic MYRX365 4/10/2019 Silversphere Sentrics 4/10/2019 Medusind Solutions, Inc. H.I.G. Capital 4/11/2019 IntelliSoft Group Symplr 4/16/2019 Wanda, Inc. EMV Capital 4/17/2019 Bernoulli Health Capsule Technologies, Inc. 4/30/2019

MEDICAL DEVICES Leaf Healthcare, Inc. Smith & Nephew plc 4/1/2019 Burpee MedSystems LLC Seisa Medical Inc. 4/4/2019 Alliqua Biomedical, Inc. Adynxx, Inc. 4/22/2019

PHARMACEUTICALS Creo Pharmaceuticals Ltd. Zentiva Group a.s. 4/1/2019 Rights to three prescription drugs Encore Dermatology Inc. 4/2/2019 Rokshaw Limited EMMAC Life Sciences 4/9/2019 ANDA portfolio Dr. Reddy’s Laboratories Ltd. 4/13/2019 Parvulet technology platform Adare Pharmaceuticals, Inc. 4/15/2019 Canamo y Fibras Naturales, S.L. Canopy Growth Corporation 4/16/2019 Genepharm MS Pharma 4/16/2019 Pharmy II Laboratory The Ethypharm Group 4/17/2019 Rising Pharmaceuticals, Inc. Rising Pharma Holdings, Inc. 4/22/2019 Evergreen Organix Cannabis One Holdings, Inc. 4/22/2019 Exclusive rights to Pliaglis in Europe Cantabria Labs 4/25/2019

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April Deal Volume Nudges HigherAfter a Very Slow First Quarter, M&A Activity Shows Signs of Growth

Everyone we’ve talked to in recent weeks agrees that the first quarter of 2019 was very slow, even slower than expected. So a slight uptick (+5%) in April’s

deal volume was a welcome sign of Spring.

May’s early activity is even stronger than April’s. but we know how quickly that can change. One example: President Trump returned to threatening more and higher tariffs on imported goods from China as trade talks appeared to bog down in the first week of May. The markets held up for a day, then sentiment turned pessimistic and we’re back to the uncertainty that prevailed at the end of 2018. And we know how much investors like uncertainty.

April 2019’s deal volume (132 deals) had a hard comp against last April’s 184 transactions, resulting in a 28% decline year over year. Every sector except Rehabilitation and Other Services posted losses against last year’s numbers. Even the Long-Term Care sector, which had a busy month in April 2019 (40 deals), slid 15% compared with the 47 deals reported in April 2018. We just can’t seem to catch a break this year.

Spending on deals, based on disclosed prices, wasn’t nearly as robust, with just $6.2 billion reported. Just two deals topped the $1 billion mark in April 2019, Catalent’s (NYSE: CTLT) acquisition of contract research organization Paragon Biosciences and CVC Capital Partners’ acquisition of Italian drug maker Doc Generici.

Deal Volume, April 2019 vs. March 2019 and April 2018

April 2019 Deals

March 2019 Deals

April 2018 Deals

Share of total Change Change

Services

Behavioral Health Care 5 4% 7 -29% 7 -29%

Home Health & Hospice 9 7% 7 29% 10 -10%

Hospitals 3 2% 7 -57% 7 -57%

Labs, MRI & Dialysis 1 1% 2 -50% 3 -67%

Long-Term Care 40 30% 35 14% 47 -15%

Managed Care 1 1% 4 -75% 2 -50%

Physician Medical Groups 9 7% 7 29% 26 -65%

Rehabilitation 5 4% 0 100% 3 67%

Other Services 12 9% 10 20% 10 20%

Services subtotal 85 64% 79 8% 115 -26%

Technology

Biotechnology 13 10% 7 86% 19 -32%

eHealth 11 8% 22 -50% 18 -39%

Medical Devices 4 3% 9 -56% 12 -67%

Pharmaceuticals 19 14% 9 111% 20 -5%

Technology subtotal 47 36% 47 0% 69 -32%

Grand total 132 100% 126 5% 184 -28%

Source: HealthCareMandA.com, May 2019

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HealthCareMandA 23

That helps explain the 75% plunge compared with March’s nearly $25 billion of spending, which was dominated by Centene Corp.’s (NYSE: CNC) $17.3 billion bid for WellCare Health Plans (NYSE: WCG). April 2019 slid even lower (-78%) compared with the year-earlier month, when $28.9 billion of spending was disclosed. That crazy month featured eight billion-dollar-plus transactions, the largest of which was Novartis’ (NYSE: NVS) $8.0 billion acquisition of AveXis Inc. (NASDAQ: AVXS) and Procter & Gamble’s (NYSE: PG) $4.2 billion deal for Merck KGaA’s consumer health business. We haven’t seen transactions like that (yet) in May, but there are a lot of companies shopping around, or being shopped. In the Managed Care sector, Magellan Health (NASDAQ: MGLN) is reportedly being pursued by UnitedHealth Group (NYSE: UNH). Magellan (market cap of $1.6 billion) is something of a specialty shop, with

behavioral health services and Medical health plans, as well as a pharmacy benefits management division. If that doesn’t work out Anthem (NYSE: ANTM) is considered a good fit, at least by Forbes.

Then there are rumors that the Centene/WellCare deal could be broken up by hedge fund investors Corvex Management and Sachem Health Capital Management. Although Centene’s CEO publicly stated he is sticking with the WellCare deal, Reuters reported on May 6 that Humana (NYSE: HUM) may be interested in Centene and its 8.6 million Medicaid members, without WellCare. No word from Humana on that one.

The usual raft of pharmaceutical deals are being floated, and surely several portfolio companies are being prepped for exits by their sponsors. The private equity wave may be about to crash this summer. Surf’s up? □

Dollar Volume, April 2019 vs. March 2019 and April 2018

April 2019 Deals

March 2019 Deals

April 2018 Deals

Share of total

Change Change

Services

Behavioral Health Care $0 0% $0 — $0 —

Home Health & Hospice $217,263,000 3% $0 — $1,420,370,000 -85%

Hospitals $610,000,000 10% $63,000,000 868% $0 —

Labs, MRI & Dialysis $0 0% $0 — $90,500,000 -100%

Long-Term Care $768,860,000 12% $512,050,000 50% $4,996,525,000 -85%

Managed Care $0 0% $17,439,386,930 -100% $0 —

Physician Medical Groups $30,000,000 0% $136,000,000 -78% $2,178,000,000 -99%

Rehabilitation $117,600,000 2% $0 — $0 —

Other Services $1,885,000,000 30% $2,608,398,300 -28% $30,000,000 6183%

Services subtotal $3,628,723,000 58% $20,758,835,230 -83% $8,715,395,000 -58%

Technology 0%

Biotechnology $431,400,000 7% $2,257,000,000 -81% $9,873,000,000 -96%

eHealth $27,000,000 0% $445,576,197 -94% $1,246,500,000 -98%

Medical Devices $167,500,000 3% $1,225,500,000 -86% $1,798,900,000 -91%

Pharmaceuticals $1,984,282,537 32% $235,000,001 744% $7,236,378,700 -73%

Technology subtotal $2,610,182,537 42% $4,163,076,198 -37% $20,154,778,700 -87%

Grand total $6,238,905,537 100% $24,921,911,428 -75% $28,870,173,700 -78%

Source: HealthCareMandA.com, May 2019

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THE HEALTH CARE SERVICES ACQUISITION REPORT25TH EDITION

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The 2019 Health Care Services Acquisition Report provides ESSENTIAL INFORMATION ON HEALTHCARE SERVICES DEALS THAT YOU WILL NOT FIND ANYWHERE ELSE. Order today, before your competition does.Sig

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The SeniorCare Investor $697/year (individual) or multi-user license, $1,997/year

Inside the world of senior care mergers, acquisitions, & finance. Stay up-to-date on the seniors housing industry with this award-winning monthly newsletter & weekly enewsletters.

The Senior Care Acquisition Reports $795 Bundle

sential market knowledge at your fingertips. These reports give you the hard-find data metrics and insightful analyses of all thF year’s senior care

ergers and acquisitions.

• The Seniors Housing Acquisition & Investment Report - $595/report• The Skilled Nursing Acquisition & Investment Report - $595/report

Multi-user license includes print, electronic PDFT and an Excel spreadsheet - $2,187

HEALTHCAREMANDA.COMHealthCareMandA.com $2,497/year or multi-user license, $4,997/year

xclusive access inside the Health Care M&A Market. With a monthly newsletter, weekly enewsletter, and quarterly reports, HealthCareMandA.com is devoted to health care M&A data for the serious analyst and investor in every sector.

e Health Care Services Acquisition Report $�95�SFQPSU

he industry source for mergers and acquisitions in healthcare services. Find exclusive M&A trends and expert analysis of eight health care services sectors.

hese reports includes charts, graphs, and key statistics.

Multi-user license includes an electronic PDF and an Excel spreadsheet - $2,187

Annual Webinar Pass$747/yearInteractive content direct from the leading experts in Health Care and Seniors Housing M&A.

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DEAL SEARCH ONLINEHealth Care M&A and Seniors Housing DatabaseExplore over 26,000 M&A transactions for market valuations and M&A comps. Research price, revenue, target, acquirer, price per bed and unit, income multiples when available, and much more.

Unlimited & Individual Sector Licenses Available

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* CORPORATE, MULTI-USE LICENSESAVAILABLE FOR ALL PRODUCTS

Go to www.levinassociates.com/products or call (203) 846-6800 to order.

To order by mail, select the products above, fill out the billing information, and send this form to:

Levin Associates 268 1/2 Main Avenue Norwalk, CT 06851

IRVING LE VIN ASSOCIATES (203) 846-6800 • [email protected] • www.levinassociates.com

Billing Information:

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SENIORS HOUSING AND HEALTH CARE M&A SINCE 1948Investment Opportunities to Grow Your Business

THE SENIORCARE INVESTORThe SeniorCare Investor $697/year (individual) or multi-user license, $1,997/year



Essential market knowledge at your fingertips. These reports give you the hard-to-find data metrics and insightful analyses of all thF year’s senior caremergers and acquisitions.




Exclusive access inside the Health Care M&A Market. With a monthly newsletter, weekly enewsletter, and quarterly reports, HealthCareMandA.com is devoted to health care M&A data for the serious analyst and investor in every sector.

The Health Care Services Acquisition Report $�95�SFQPSU

The industry source for mergers and acquisitions in healthcare services. Find exclusive M&A trends and expert analysis of eight health care services sectors. These reports includes charts, graphs, and key statistics.



Annual Webinar Pass $747/yearInteractive content direct from the leading experts in Health Care and Seniors Housing M&A.








Levin Associates 268 1/2 Main Avenue



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Name _________________________________________

Company ______________________________________

Email Address _________________________________

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THE SENIORCARE INVESTORThe SeniorCare Investor $697/year (individual) or multi-user license, $1,997/year



Essential market knowledge at your fingertips. These reports give you the hard-to-find data metrics and insightful analyses of all thF year’s senior caremergers and acquisitions.




Exclusive access inside the Health Care M&A Market. With a monthly newsletter, weekly enewsletter, and quarterly reports, HealthCareMandA.com is devoted to health care M&A data for the serious analyst and investor in every sector.

The Health Care Services Acquisition Report $�95�SFQPSU

The industry source for mergers and acquisitions in healthcare services. Find exclusive M&A trends and expert analysis of eight health care services sectors. These reports includes charts, graphs, and key statistics.















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THE SENIORCARE INVESTORThe SeniorCare Investor Newsletter $697/yearInside the world of senior care mergers, acquisitions, & finance. Stay up-to-date on the seniors housing industry with this award-winning monthly newsletter & weekly enewsletter.

Senior Care Acquisition Report, 23rd Edition $595/copyEssential market knowledge at your fingertips. This 250+ page report gives you the hard-to-find data metrics and insightful analyses of all this year’s senior care mergers and acquisitions.

HEALTHCAREMANDA.COMHealthCareMandA.com Newsletter $1,997/yearExclusive access inside the Health Care M&A Market. With a monthly newsletter, weekly enewsletter, and quarterly reports, HealthCareMandA.com is devoted to health care M&A data for the serious analyst and investor in every sector.

Health Care Services Acquisition Report, 24th Edition $595/copyThe industry source book of mergers and acquisitions in healthcare services. Find exclusive M&A trends and expert analysis of eight health care services sectors. 250+ page report includes charts, graphs, and key statistics.

Individual Sector ReportsSector reports also available in the following health care sectors: Hospitals, Not-for-Profit, Home Health Care & Hospice, and Physician Medical Groups.

Go to www.healthcaremanda.com/sector-reports/ for more information.






* CORPORATE, MULTI-USE LICENSES AVAILABLE FOR ALL PRODUCTS

Go to www.levinasscoiates.com/products or call (203) 846-6800 to order.






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Documents

Health C are M A News...Health Care M&A News 2 ISSN#: 2375-7612 Published monthly by: Irving Levin Associates, Inc. 268½ Main Avenue, Norwalk, CT …