Index Rebal/Special Situations, Quiddity Advisors

Janaghan Jeyakumar, CFA

Index Rebal/Special Situations

Quiddity Advisors

Pan-Asia Catalysts/Events

Index Rebalance

<ul>
<li>In this insight, we take a look at the potential index changes for F100 and F250 in the run up to the June 2023 Rebalance.</li>
<li>Based on latest prices, there are no changes expected for F100 while there could be up to four changes in F250 between now and the June 2023 Rebalance</li>
<li>This includes the potential intra-review replacement of F250 member <a href="https://www.smartkarma.com/entities/al-noor-hospitals-group-plc" target="_blank" data-smartkarma-citation="entities:21813:1" rel="noopener">Mediclinic International (MDC LN)</a> in the F250 index.</li>
</ul>


In this insight, we take a look at the potential index changes for F100 and F250 in the run up to the June 2023 Rebalance.
Based on latest prices, there are no changes expected for F100 while there could be up to four changes in F250 between now and the June 2023 Rebalance
This includes the potential intra-review replacement of F250 member Mediclinic International (MDC LN) in the F250 index.


Quiddity Leaderboard for UK F100/​250 June 2023: Mediclinic Replacement Candidates Have High Impact

<ul>
<li>In this insight, we take a look at Quiddity's final predictions for index changes for UK's F100 and F250 indices for the March 2023 Rebalance.</li>
<li>The index changes are likely to be confirmed after market close today and there could be more intra-review changes later this month.</li>
<li>In this insight, we take a look at the recent price performance of names that can potentially be involved in index changes and our flow expectations for each name.</li>
</ul>


In this insight, we take a look at Quiddity's final predictions for index changes for UK's F100 and F250 indices for the March 2023 Rebalance.
The index changes are likely to be confirmed after market close today and there could be more intra-review changes later this month.
In this insight, we take a look at the recent price performance of names that can potentially be involved in index changes and our flow expectations for each name.


Quiddity Final Predictions for UK F100/250 March 2023 Regular Review & Other Intra-Review Changes

<ul>
<li>In this insight, we take a look at the names leading the race to become ADDs/DELs for the STOXX Europe 600 and EuroSTOXX Indices for the December 2022 Rebalance.</li>
<li>There could be five M&amp;A-related intra-review deletions between now and the end of the year.</li>
<li>There could be more index changes in the December 2022 Rebalance too. </li>
</ul>


In this insight, we take a look at the names leading the race to become ADDs/DELs for the STOXX Europe 600 and EuroSTOXX Indices for the December 2022 Rebalance.
There could be five M&amp;A-related intra-review deletions between now and the end of the year.
There could be more index changes in the December 2022 Rebalance too. 


STOXX Europe Quiddity Leaderboard Dec 22: Five Intra-Review Changes, Porsche Leading The Race

European Event-Driven Analyst

Jesus Rodriguez Aguilar

Event-Driven

<ul>
<li>After four prospective offers from a Remgro-led consortium, Mediclinic's Board is to recommend the latest one: 504p/share in cash, cum dividend. The PUSU deadline has been extended until 5 August.</li>
<li>The offer values Mediclinic at c. 10x EV/Fwd EBITDA, both above the median of comparables and the failed offer for Spire. At 35% premium, it seems reasonable, but not overly generous.</li>
<li>After four proposals, I doubt the consortium will increase its offer, and investors will be happy to part with the cash. Gross spread is 3.92%. Long MDC LN.</li>
</ul>


After four prospective offers from a Remgro-led consortium, Mediclinic's Board is to recommend the latest one: 504p/share in cash, cum dividend. The PUSU deadline has been extended until 5 August.
The offer values Mediclinic at c. 10x EV/Fwd EBITDA, both above the median of comparables and the failed offer for Spire. At 35% premium, it seems reasonable, but not overly generous.
After four proposals, I doubt the consortium will increase its offer, and investors will be happy to part with the cash. Gross spread is 3.92%. Long MDC LN.


On 26 May, <a href="https://www.smartkarma.com/entities/ramsay-health-care-ltd" target="_blank" data-smartkarma-citation="entities:673:1" rel="noopener">Ramsay Health Care (RHC AU)</a> signed an agreement to acquire <a href="https://www.smartkarma.com/entities/spire-healthcare-group-plc" target="_blank" data-smartkarma-citation="entities:22159:1" rel="noopener">Spire Healthcare (SPI LN)</a> from Mediclinic and others. Consideration is 240p, in cash, adjustable for any dividend or capital distribution at the discretion of the bidder. Mediclinic failed to acquire Spire (at a 25% higher price back then) and is tendering its 29.9% stake.
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Consideration represents 1.9x EV/Fwd Revenue, 10.5x EV/Fwd/EBITDA and 38.9x Fwd P/E. Past acquisitions in the sector have been carried out at a median 11.7x EV/EBITDA. Premium vs. prior trading session is 24.4%.
Ramsay wants to enlarge its UK footprint, and increase the NHS mix in the merged UK operations (thus diversification of revenue as it seems difficult to grow through private payers exclusively). Margins from treatment provided on behalf of NHS are not dissimilar to those from private practice. NHS will have to deal with an increase in the waiting lists due to the pandemic. There is some mention to synergies but those will not presumably come until 2023. There are some issues regarding Ramsay's leverage, although it may need to divest some UK assets anyway to obtain the green light from the CMA.
Spire has been obtaining a ROIC of 3.3% lately, below WACC, which I conservatively estimate at 8.5% in my DCF valuation, so the business is likely to have been destroying value over the last FYs. Scale and better management may be behind the acquisition.
</div>
On the day of the offer announcement, shares in Spire were up 52p, c. 27%, and closed at 245p, above Ramsay’s offer. Ramsay earlier closed down 0.7% on the Australian Stock Exchange. As I Finnish this Insight, Spire is trading at 247p. 
Considering the premium offered, and that Mediclinic will tender its stake, I think interloper risk is unlikely. 
As in the case of <a href="https://www.smartkarma.com/entities/udg-healthcare-plc" target="_blank" data-smartkarma-citation="entities:22193:1" rel="noopener">UDG Healthcare (UDG LN)</a> (see <a href="https://www.smartkarma.com/insights/cd-r-udg-healthcare-recommended-cash-offer" target="_blank" data-smartkarma-citation="insights:51370" rel="noopener">CD&amp;R/UDG Healthcare: Recommended Cash Offer</a> ), investors may want a premium over 24%, the shares are trading at 247p, c. 3% above the offer. Folks may have been using too high discount rates for UK listed healthcare, as there have been a number of bids lately in this sector (UDG, <a href="https://www.smartkarma.com/insights/carlyle-vectura-group-expectations-of-a-sweetened-bid" target="_blank" data-smartkarma-citation="insights:52066" rel="noopener">Carlyle/Vectura Group: Expectations of a Sweetened Bid</a>, Spire, among others).
Gross spread is a negative (2.9)%. Recommendation is long SPI LN, TP 256.5p (blended average of comps and DCF), 3.8% upside to current market levels and c. 7% above offer price. Downside risk is limited and expectations of a sweetened bid are high.

On 26 May, Ramsay Health Care (RHC AU) signed an agreement to acquire Spire Healthcare (SPI LN) from Mediclinic and others. Consideration is 240p, in cash, adjustable for any dividend or capital distribution at the discretion of the bidder. Mediclinic failed to acquire Spire (at a 25% higher price back then) and is tendering its 29.9% stake.

Consideration represents 1.9x EV/Fwd Revenue, 10.5x EV/Fwd/EBITDA and 38.9x Fwd P/E. Past acquisitions in the sector have been carried out at a median 11.7x EV/EBITDA. Premium vs. prior trading session is 24.4%.
Ramsay wants to enlarge its UK footprint, and increase the NHS mix in the merged UK operations (thus diversification of revenue as it seems difficult to grow through private payers exclusively). Margins from treatment provided on behalf of NHS are not dissimilar to those from private practice. NHS will have to deal with an increase in the waiting lists due to the pandemic. There is some mention to synergies but those will not presumably come until 2023. There are some issues regarding Ramsay's leverage, although it may need to divest some UK assets anyway to obtain the green light from the CMA.
Spire has been obtaining a ROIC of 3.3% lately, below WACC, which I conservatively estimate at 8.5% in my DCF valuation, so the business is likely to have been destroying value over the last FYs. Scale and better management may be behind the acquisition.

On the day of the offer announcement, shares in Spire were up 52p, c. 27%, and closed at 245p, above Ramsay’s offer. Ramsay earlier closed down 0.7% on the Australian Stock Exchange. As I Finnish this Insight, Spire is trading at 247p. 
Considering the premium offered, and that Mediclinic will tender its stake, I think interloper risk is unlikely. 
As in the case of UDG Healthcare (UDG LN) (see CD&amp;R/UDG Healthcare: Recommended Cash Offer ), investors may want a premium over 24%, the shares are trading at 247p, c. 3% above the offer. Folks may have been using too high discount rates for UK listed healthcare, as there have been a number of bids lately in this sector (UDG, Carlyle/Vectura Group: Expectations of a Sweetened Bid, Spire, among others).
Gross spread is a negative (2.9)%. Recommendation is long SPI LN, TP 256.5p (blended average of comps and DCF), 3.8% upside to current market levels and c. 7% above offer price. Downside risk is limited and expectations of a sweetened bid are high.

United Kingdom

Mediclinic International is a diversified international private healthcare services group with operations across Switzerland, Southern Africa (South Africa and Namibia), and the Middle East. The company specializes in providing acute care, specialist-oriented, and multi-disciplinary healthcare services, operating hospitals, subacute hospitals, mental health facilities, day clinics, and outpatient clinics. It was founded in 1983 and is headquartered in Stellenbosch, South Africa.

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Mediclinic International (MDC LN)

Quiddity Leaderboard for UK F100/250 June 2023: Mediclinic Replacement Candidates Have High Impact

The Top 15 F250 potential ADDs have decent impact and some of these names could become intra-review ADDs or regular ADDs between now and June 2023....

Janaghan Jeyakumar, CFA

Quiddity Final Predictions for UK F100/250 March 2023 Regular Review & Other Intra-Review Changes

I expect three changes in the regular review and two intra-review changes in March 2023 for the F250 index. I do not expect any changes for the...

Janaghan Jeyakumar, CFA

STOXX Europe Quiddity Leaderboard Dec 22: Five Intra-Review Changes, Porsche Leading The Race

I expect ~12 ADDs/DELs in total for the STOXX Europe 600 index before the end of the year including intra-review changes and regular review...

Janaghan Jeyakumar, CFA

Remgro/Mediclinic: Healthier Offer

In a nutshell, this deal may be about an opportunistic buy-and-hold acquisition by both Remgro (which will increase its stake by c. 5%) and MSC,...

Jesus Rodriguez Aguilar

Ramsay Health Care/Spire Healthcare

Investors may want a premium over 24%. Gross spread is (2.9)%. Long SPI LN, TP 256.5p (average of comps and DCF), c. 7% above offer. Limited...

Jesus Rodriguez Aguilar

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Quiddity Leaderboard for UK F100/​250 June 2023: Mediclinic Replacement Candidates Have High Impact

The Top 15 F250 potential ADDs have decent impact and some of these names could become intra-review ADDs or regular ADDs between now and June 2023....

Janaghan Jeyakumar, CFA

Quiddity Final Predictions for UK F100/250 March 2023 Regular Review & Other Intra-Review Changes

I expect three changes in the regular review and two intra-review changes in March 2023 for the F250 index. I do not expect any changes for the...

Janaghan Jeyakumar, CFA

STOXX Europe Quiddity Leaderboard Dec 22: Five Intra-Review Changes, Porsche Leading The Race

I expect ~12 ADDs/DELs in total for the STOXX Europe 600 index before the end of the year including intra-review changes and regular review...

Janaghan Jeyakumar, CFA

Remgro/Mediclinic: Healthier Offer

In a nutshell, this deal may be about an opportunistic buy-and-hold acquisition by both Remgro (which will increase its stake by c. 5%) and MSC,...

Jesus Rodriguez Aguilar

Ramsay Health Care/Spire Healthcare

Investors may want a premium over 24%. Gross spread is (2.9)%. Long SPI LN, TP 256.5p (average of comps and DCF), c. 7% above offer. Limited...

Jesus Rodriguez Aguilar

Quiddity Leaderboard for UK F100/250 June 2023: Mediclinic Replacement Candidates Have High Impact