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1、Employer-Sponsored HealthcareQ1 2023TPAS AND BENEFITS SOLUTION PROVIDERS SECTOR SPOTLIGHTLarge and Growing Addressable Market2U.S.Health Insurance Market by Coverage TypeEmployer-SponsoredIndividualTraditional MedicareMedicare AdvantageMedicaid105M LivesEmployer Self-Funded55M LivesEmployer Fully Fu
2、ndedHealth Plan by Coverage TypeFully Insured Health Plan55M Lives Covered(35%)Employer purchases health insurance from a carrier;carrier assumes financial risk of providing healthcare for employers beneficiaries Carrier keeps any surplusLack of customizationLimited insight into cost driversNo rate,
3、access,or repricing controlLack of dedicated supportMisaligned incentivesSelf-Funded Health Plan105M Lives Covered(65%)Employer pays for claims incurred by beneficiaries and partners with TPA for claims administration,stop-loss,and value-add solutions,including data analytics and cost containmentEmp
4、loyer keeps surplusComplete visibility into each claim incurred and active management of costsNot tied to carriers rates,fees,or restrictionsOptions to address cost drivers through incentives and educational resourcesPlans customized to employers specific health benefit requirements and goalsEmploye
5、rs are increasingly moving toward self-funded health plans in order to reduce costs and retain surplus;the TAM will continue to increase,benefiting innovative TPAs prepared to capitalize on new SMB lives entering the marketSources:Kaiser Family Foundation Employer Health Benefits Annual Surveys;Wall
6、 Street research;(1)As of 03/27/2023 51%8%10%8%22%310M+Total Insured Population(1)Self-Funded Strategies PrevailingAs employers take more control over rising healthcare costs for their employeesincreasingly implementing self-funded strategiesthey will look to their TPAs for ROI-generating cost conta
7、inment strategies to minimize riskRecent changes in the U.S.healthcare system have created a favorable environment for alternative healthcare insurance optionsEmployers are frustrated with the escalating insurance premiums associated with fully insured coverageThe widespread adoption of self-funded
8、insurance strategies,especially by SMBs,has amplified the TAMLarge employer trends(5,000+employees)have caught on by SMEs capable of carrying stop-loss insurance(100+)Collectively,since 2001,the number of companies electing to self-insure has increased by 16 percentage pointsEstimated Workers Covere
9、d in Self-Funded Plans by Firm Size317%52%66%70%49%13%50%79%96%60%20%59%82%91%65%3-199200-9991,000-4,9995,000All Firms200120112022Sources:Kaiser Family Foundation Employer Health Benefits Annual Surveys;Wall Street research.Tailwinds Accelerating Self-Funded StrategiesUnsustainable healthcare cost t
10、rends,rising insurance premiums,and the potential for cost savings are driving the adoption of self-funded health plans.Fully Insured vs.Self-Funded Plan CostsHealthcare Cost Per CapitaAnnual Contributions for CoverageNon-Refundable PremiumStop-Loss InsuranceAdministrative CostsPotential SavingsActu
11、al ClaimsFully InsuredSelf-FundedRegulation and an aging and increasingly chronic population drive growth in healthcare spendingEmployer and employee contributions have continued to increase Self-funding provides employers with additional visibility into healthcare costs compared to fully insured pl
12、ans($in 000s)Healthcare costs are currently at all-time highs At$4.3 trillion today,healthcare spend represents 19%of GDP Spend is projected to grow to$6.8 trillion by 2030 Health benefits are a key component of attracting and retaining employees Continued increase in employer burden of employee hea
13、lthcare costs 4.8%CAGR in average employer premium over the past five years Self-funded plans provide greater price transparency,breaking down costs by component,and flexibility through customizable plans and solutions Opportunity to keep savings due to effective management of healthcare costs and r
14、educed utilizationUnsustainable Cost TrendsIncreasing Employer and Employee PremiumsIncreased Demand for Transparency4Sources:CMS;Kaiser Family Foundation Employer Health Benefits Annual Surveys7.08.09.010.011.012.013.020082009200001920202021$12,913$7,910$5,277$5,969
15、$12,865$16,253 20162021Employer ContributionEmployee Contribution$18,142$22,2214.1%CAGR2.5%CAGR4.8%CAGR(71%)(73%)TPA Value Proposition StrengtheningTPAs are an essential component of a self-funded strategy and are in use now more than everorchestrating innovative cost containment measures for the pa
16、yor and introducing difference-making advocacy services to members.The Benefits of Self-Funded Plan Administration BSPs are designed to contain costs;employers(and other self-funded groups)can avoid perennial premium increases attributable to commercial payors,which they pass on to their employeesBS
17、Ps furnish employers with full access to member claim data,allowing them to identify member cost drivers and design better cost management and member advocacy strategies within their plans to suit membersIn addition,as Transparency in Coverage proliferates,BSPs serve an essential compliance roleLive
18、s Covered in Self-Funded Plans by Firm Size,by YearRecessionBSPs weather economic cycles because of the value they deliver to self-funded clients;unlike typical vendors,this value proposition strengthens during an economic downturn because of the ROI generated513%15%17%13%10%10%13%13%12%12%15%16%13%
19、15%16%15%17%13%15%13%17%23%21%20%51%53%52%48%50%50%53%53%53%47%48%58%50%52%58%55%56%50%47%50%58%59%63%59%62%71%69%70%77%80%81%86%83%85%86%89%91%89%90%89%90%91%88%90%86%92%87%88%44%49%49%49%52%54%54%55%55%55%57%59%60%60%61%61%63%61%60%61%61%67%64%65%04200520062007200820092010201
20、0020202120223-199 Workers200-999 Workers 1,000 or More WorkersAll FirmsSources:Kaiser Family Foundation Employer Health Benefits Annual Surveys;Wall Street research.TPAs Effectively Orchestrating Innovative StrategiesThe employer market has long attempted various app
21、roaches to control healthcare costs.In order to see greater success in cost containment,newer,more sophisticated strategies are emergingthese are now a top priority for employers.Employers Demand Innovative Strategies to Combat Inflating Healthcare Costs6Helping members with chronic illnesses throug
22、h behavior change and routine adherenceDisease ManagementHistorical Approaches Have Failed to Effectively Reduce Employee Healthcare CostsEvaluation of the medical appropriateness of treatment,with the approval or denial of service or paymentUtilization ManagementPutting the bulk of the financial bu
23、rden on the member to be more mindful in their healthcare spendingHigh Deductible Health PlanPreventative employer programs aimed at reducing the risk of chronic illness through compensatory incentivesWellnessEnsuring the proper payment of claims,including medical bill reviewPayment IntegrityReplaci
24、ng contracted provider network rates with transparent and fair pricing based on reference benchmarksReference-Based PricingEnabling direct contractual relationships between providers and employers to drive cost savingsDirect ContractingRestricting a network to a smaller set of providers or PPO in ex
25、change for advantageous pricing or more stringent standardsNarrow NetworksPayment models focused on the quality of services provided,rather than just the quantityValue-Based ContractsPrescription drug plan management to optimize cost savings,medication adherence,and patient outcomesRx/Program Manage
26、mentForward-thinking benefits solution providers are essential centerpieces within the employer health marketconducting the most innovative,ROI-driving strategies to reduce costs for the payer and add value to the member Guidance toward compliance and adherenceRegulations Mandating Transparency Spur
27、 InnovationSources:National Pharmaceutical Council survey of 88 U.S.employers with 5,000 or more employees;Marsh McLennan;industry research.No Surprises ActTransparency in Coverage RuleAbility to contain costs and drive ROIResponsibility for reportingValue Proposition for Innovative Benefits Solutio
28、n ProvidersThe Transparency in Coverage rule(TIC)requires employer-provided group health plans to provide cost-sharing information to members such as:Negotiated rates for covered items and services between the plan and in-network providersHistorical payments and billed charges from out-of-network pr
29、ovidersIn-network rates and historical net prices for all covered prescription drugsTools for enrollees to receive personalized out-of-pocket cost estimates for careFor plan years beginning in 2023,an online tool must provide cost-share estimates for 500 shoppable services,expanding to all covered s
30、ervices in 2024The No Surprises Act(NSA)includes several different requirements specifically affecting employer-provided group health coverage:Prescription drug and healthcare spending reportingAn advanced explanation of benefits(EOB)requirementMedical/Rx identification card disclosure requirementsO
31、pportunity for consumers to appeal disputes over coverageThis ruling will likely result in employer-sponsored plans being burdened by increased medical costs The plan sponsor of a self-insured plan can delegate reporting responsibility to a TPA,creating further demand for specialty outsourced soluti
32、onsTrends Driving Increased Usage of BSPsGreater need for guidance on TICs impact on self-insured plansIncreased risk of severe non-compliance penaltiesDemand for innovative solutions promoting plan transparencyTech-driven solutions provide insights and tools to better manage costsAs transparency re
33、gulations stiffen,poorly capitalized competitors will be crowded out,catalyzing consolidation for carrier-owned TPA aggregators and increasing investment opportunities for employer-sponsored healthcare investorsAs regulators push for clarity around provider pricing,plan coverage,and balance billing
34、through the introduction and amendment of enacted legislation,the competitive moat for scaled TPAs and other benefits solution providers will continue to deepen.7Cost ContainmentHealth EngagementNavigation and TransparencyProvidersData AnalyticsSpecialty Benefit ManagementTPAs and Benefits Solution
35、Providers Services OfferedMedicalWorkers CompPension/RetirementBSPs deliver a suite of high-value front-and back-end services to groups employing a self-funded health insurance strategy.Plan DesignClaims AdministrationValue-Add SolutionsMarket Participants by TPA SubsegmentService OfferingConsumer-D
36、irected Benefits In addition to core plan design and administrative services,TPAs are increasingly offering ancillary value-add solutions to differentiate their capabilities and optimize wallet share from each client8Taft-Hartley CategoryServiceDescriptionASOIndependentPlan DesignBenefit DesignCusto
37、m plan design services to structure health insurance plansMember EnrollmentDistribution and collection of enrollment materials,EOB and initial member educationMember ServicePersonalized member assistance and engaged management via call center and digital toolsClaims AdminReporting and AnalyticsData
38、and insights into population health,utilization patterns,and ROIAncillary Benefits AdminAdministration of dental,vision,disability,life insurance,and other benefitsBack OfficeCustomized,white-labeled claims administration solutions,billing and operations supportValue-Add ServicesNetwork AccessPartne
39、rships with a variety of physician and health networks,including PPOsPBMCurated set of vendors to create and manage Rx plans to lower drug costsStop-Loss PlacementSecuring protection against large claims exceeding predefined limitsAdvocacy ProgramsGuidance toward the highest quality and most cost-ef
40、fective medical careRBP and OON ClaimsOut-of-network pricing based on established benchmarksPrevention and Health Engagement Improving outcomes through preventive care and health monitoringMedical Cost Management Solutions designed to lower the cost of care for chronic illnessesUnattached to a payor
41、,independent TPAs provide holistic solutions that combine creative and flexible in-house plan design,powerful claims administration capabilities,and a variety of best-in-class value-add services to meet individual clients needsEmployers are increasingly partnering with independent benefits solution
42、providers to design and implement custom self-funded strategies.Independent TPAs thrive on flexibility and personalized services custom-designed for the plan sponsors needs and can often provide more coverage,funding,and reimbursement optionsValue-add services meaningfully differentiate independent
43、TPAs by lowering costs and improving members experience through enhanced network access,precise cost containment strategies,and high-touch advocacy programs Flexibility and Variety Are Advantages of Independent TPAs9The market map below is representative of select,notable Benefits Solution Providers
44、 operating primarily in the U.S.Illustrative TPA Market MapCarrier-Owned TPAsIndependent TPAs10Carrier-Owned TPAs nowaccount for+50%of coveredlives,continue to beacquisitive(especially BCBSaffiliates),and offer steepdiscounts to retain existingand sign new membersIndependent TPAs aresetting pace wit
45、h flexibility,service,custom networks,and value-add owned andvended solutions to lowercosts and improvemembers experienceCollectively,TPAs and otherBenefits Solution Providershave attracted more privatecapital support than everbeforeInterest in TPA platformsand expansion via tuck-inM&A is at peak le
46、velCommercial PayorsBCBS AffiliatesFor more information,contact the leadership team on pg.19(+)Subsidiary of Provider/Health SystemApprox.$50M RevenueVariety of Value-Add SolutionsTPAs can differentiate through preferred relationships with integrated partners whose service capabilities provide a pat
47、hway to meeting a clients needs.Cost ContainmentHealth EngagementNavigation and TransparencyProvidersData AnalyticsSpecialty Benefit Management11For more information,contact the leadership team on pg.19The number of strategic acquirers pursuing add-ons and equity sponsors that desire a platform has
48、resulted in a ripe,seller-friendly market for growing,differentiated benefits solution providers.Fertile Buyer LandscapeSources:S&P Capital IQ,PitchBook,equity research,proprietary intelligence.Houlihan Lokey insights from multiple engagements inform real-time market intelligence from the most activ
49、e market participantsSponsor-Backed StrategicStrategicFinancial Sponsors12Currently Invested in a Platform:Currently Interested in a Platform:Select Precedent M&A Benefits Solution ProvidersYear202220222022202220222022212021Target:Acquirer:Target:Acquirer:Year202020202020202020
50、2020001713TEV/EBITDATEV/EBITDAFor more information,contact the leadership team on pg.19Source:Publicly available informationSelect Precedent M&A Value-Add SolutionsTarget:Acquirer:Target:Acquirer:Year20222022202220222022212021Year202202020202020
51、017201714TEV/EBITDATEV/EBITDAFor more information,contact the leadership team on pg.19Source:Publicly available informationHoulihan Lokey RoleCase Study#1:Allied Benefit SystemsHQChicago,ILEmployees375+LTM Revenue$100+LTM EBITDANDAllied Benefit Systems(Allied)is a national healthcare solu
52、tions company that supports healthy workplace cultures.Founded in 1980,Allied has grown to be one of the largest independent TPAs in the U.S.Allied provides customized benefits solutions,medical management,and cost control strategies to more than 9,000 small and medium-sized employersthe fastest gro
53、wing segment of the self-insured market.In addition,the company offers a broad array of network options,pharmacy solutions,and care management strategies to enable its customers to reduce costs and drive improved member satisfaction.The Houlihan Lokey deal team designed a quiet,custom sale process t
54、o maximize value while minimizing distraction.Houlihan Lokey maintained a highly competitive process through carefully targeted outreach while maintaining strict confidentiality throughout the entire process.In February 2021,following a brief pause in summer 2020 due to COVID-19,Allied completed a m
55、ajority recapitalization with Stone Point Capital.Stone Points reputation as a value-add sponsor,along with its TPA experience,complementary portfolio,and value proposition to Allied shareholders,served as competitive differentiators in the process.($in millions)TransactionMajority Recap.Company Pro
56、fileTransaction SnapshotClose DateNov.202015“We share managements enthusiasm regarding the partnershipWe believe that the group health TPA market is poised for consolidation,and the companys full suite of innovative cost containment solutions,designed to help clients combat rising healthcare costs,w
57、ill position the company for continued success.”Buyer Testimonial“We are thrilled to partner with Stone Point as we enter our next phase of growth.Stone Points network of relationships across the employee benefits brokerage and insurance ecosystems is second to none.”Client Testimonial Chuck Davis,C
58、EO,Stone Point Capital Mitch Wilneff,President,Allied Benefit SystemsHoulihan Lokey served as the exclusive financial advisor to Allied and assisted in initiating,structuring,and negotiating the transaction on its behalf.has been recapitalized bySellside AdvisorProject 59Case Study#2:Trustmark Healt
59、h BenefitsHQLake Forest,ILEmployees500+LTM Revenue$150+LTM EBITDANDTrustmark Health Benefits(Health Benefits)is a leading third-party administrator of self-funded,employer-sponsored health plans.Health Benefits designs,implements,and administers custom plans to manage costs through innovative soluti
60、ons,data transparency,and member-centric support.Health Benefits parent,Trustmark,through its operating divisions and subsidiaries,offers specialized expertise in voluntary benefits,self-funded health plan design and administration for smaller employers,and the delivery of wellness,fitness,recreatio
61、n,and injury prevention and treatment programs.Houlihan Lokey served as the exclusive financial advisor to Trustmark and assisted in initiating,structuring,and negotiating the transaction on its behalf.Houlihan Lokey also provided transaction advisory services.In October 2022,following a competitive
62、,multistage process comprising varying buyer types and transaction structures,Trustmark completed the sale of Health Benefits to Health Care Service Corporation(HCSC).In addition to favorable pricing and terms,HCSCs market reputation,cultural similarities to Trustmark,and retention of the existing m
63、anagement team served as competitive differentiators in the process.HCSC sweetened the deal by offering Trustmark incremental upside through a post-closing contingent consideration package and an ability to achieve it using HCSCs commercial capabilities.($in millions)Transaction100%SaleCompany Profi
64、leHoulihan Lokey RoleTransaction SnapshotClose DateOct.202216“With this acquisition,were making it easier for employers of all sizes to access our expansive provider networks,our data-driven insights,and coordinated approach to care that focuses on quality and value.”Buyer Testimonial“With this tran
65、saction,Health Benefits and its associates will be well positioned for future success Trustmark will focus on markets where we can grow in the future,deliver differentiated capabilities for our clients,and accelerate our efforts to become vastly more consequential in the markets we serve.”Client Tes
66、timonial Kevin Cassidy,President,National Accounts,HCSC Kevin Slawin,CEO,TrustmarkProject TranscendHoulihan Lokey is a leading global investment bank with expertise in mergers and acquisitions,capital markets,financial restructuring,and financial and valuation advisory.Our firm is the trusted adviso
67、r to more top decision-makers than any other independent global investment bank.We invite you to learn more about how our bankers can serve your needs:Our FirmLearn More About Corporate FinanceLearn More AboutFinancial RestructuringLearn More About Financial and Valuation AdvisoryLearn More AboutOur
68、 Industry CoverageKey Facts and FiguresOur Ranking by ServiceHoulihan Lokey Is a Global Firm No.1 Global M&A Advisor Under$1 BillionLeading Capital Markets AdvisorNo.1 Global M&A Fairness Opinion Advisor Over the Past 25 Years1,000+Annual Valuation EngagementsNo.1 Global Restructuring Advisor1,500+T
69、ransactions Completed Valued at More Than$3.0 Trillion CollectivelyCorporate FinanceFinancial RestructuringFinancial and Valuation AdvisoryAmericasAtlantaBostonChicagoDallasHoustonLos AngelesMiamiMinneapolisNew YorkSan FranciscoSo PauloWashington,D.C.Europe and Middle EastAmsterdamAntwerpDubaiFrankf
70、urtLondonMadridManchesterMilanMunichParisStockholmTel AvivZurichAsia-PacificBeijingFukuokaGurugramHo Chi Minh CityHong Kong SARMumbaiNagoyaOsakaShanghaiSingaporeSydneyTokyo2,000+CLIENTS SERVEDANNUALLY300+MANAGINGDIRECTORS(1)2,000TOTAL FINANCIALPROFESSIONALS37LOCATIONSWORLDWIDE$1.8BREVENUE(3)$6B+MARK
71、ET CAPITALIZATION(2)24Senior officers dedicated tothe sponsor community in the Americas and EuropeFully Integrated Financial Sponsor Coverage1,000+Sponsors covered,providingmarket insights and knowledge of buyer behavior700+Companies sold to financialsponsors since 2015(1)As of April 2023.Excludes c
72、orporate managing directors.(2)As of March 2023.(3)LTM ended December 31,2022.2022 Global Distressed Debt&BankruptcyRestructuring RankingsAdvisorDeals1Houlihan Lokey582PJT Partners Inc303Lazard294Rothschild&Co255Moelis&Co21Source:Refinitiv.1998 to 2022 Global M&A Fairness Advisory RankingsAdvisorDea
73、ls1Houlihan Lokey1,2322JP Morgan1,0303Duff&Phelps,A Kroll Business9384Morgan Stanley7255BofA Securities Inc710Source:Refinitiv.Announced or completed transactions.2022 M&A Advisory RankingsGlobal Transactions Under$1 BillionAdvisorDeals1Houlihan Lokey3812Rothschild&Co3693JP Morgan2174Lazard2065Goldm
74、an Sachs&Co203Source:Refinitiv.Excludes accounting firms and brokers.17Our Healthcare Industry GroupSelected Healthcare Industry Transactions200+Transactions Closed Since 2016,the Most of Any Firm93%Close Rate Within the Past Four YearsNo.1Global Healthcare Advisor for Deals Under$1BKey Facts and Fi
75、guresHoulihan Lokeys Healthcare Group has earned a reputation for providing superior service and achieving outstanding results in M&A advisory,capita raising,restructuring,and financial and valuation advisory services.We provide in-depth knowledge,proven transaction experience,and an exceptional lev
76、el of service to our clients.Learn More About Our Healthcare Industry CoverageIndustry Sector CoverageWe cover a broad array of sectors,with bankers dedicated to each of our primary coverage areas86%Transactions Closed in or AbovePitch Range100+Dedicated Healthcare Investment Bankers Global Medical
77、Technology Products and ServicesOral HealthPayor and Employer ServicesPharmacyPharmaceutical ServicesPhysician Practice ManagementPost-Acute/Senior HousingOutpatient ServicesBehavioralDistributionGlobal Healthcare TechnologyGlobal PharmaceuticalsHospital/Outpatient Clinical and Outsourced ServicesMa
78、naged Care/PayorsHealth Systems and HospitalsRetail Healthcarea portfolio company ofhas merged witha portfolio company ofSellside Advisorhas acquiredfrom Buyside Advisora portfolio company of has been acquired bySellside Advisora portfolio company ofhas completed the recapitalization withSellside Ad
79、visora portfolio company ofhas been acquired bySellside Advisora portfolio company ofhas been acquired bySellside Advisora portfolio company of has been acquired bya portfolio company of Sellside Advisora portfolio company of has merged witha portfolio company of with equity financing fromSellside A
80、dvisorApollo funds have partnered with and made a strategic investment inBuyside Advisora portfolio company ofhas been acquired by a fund managed by Blackrock,Inc.Sellside Advisor18a portfolio company ofhas been acquired bySellside Advisoran operating company investment ofhas been acquired bySellsid
81、e Advisorhas received strategic growth investment fromSellside AdvisorMark FrancisManaging DirectorGlobal Head of HealthcareMFrancisHL.comMike PisaniManaging DirectorCo-Head of Healthcare Services MPisaniHL.comLuiz GrecaManaging DirectorHead of HCITLuiz.GrecaHL.comContact UsPlease reach out to Trey
82、Marinello at 312.456.4777 to schedule a call to discuss insights on the sector or to explore how we can serve your business needsJ.J.BrownManaging DirectorJBrownHL.comTrey MarinelloManaging DirectorTMarinelloHL.comOur Employer-Sponsored Healthcare TeamEmployer-Sponsored Healthcare TeamSelected Secto
83、r Transactionsa portfolio company of has been acquired bySellside Advisor/Subsector CoverageSupporting Team Members Healthcare has been recapitalized bySellside AdvisorSupporting Team Members InsuranceArik RashkesManaging DirectorHead of InsuranceARashkesHL.comJuan GuzmanManaging DirectorJGuzmanHL.c
84、oma subsidiary ofhas been acquired bySellside Advisorhas formed a strategic partnership withto accelerate growth for Guardians subsidiarySellside Advisora portfolio company ofhas been acquired byCo-Advisorhas been acquired bySellside Advisor1 19a portfolio company ofhas been acquired bySellside Advi
85、sorMatthew CornishSenior Vice PresidentMCornishHL.comTombstones included herein represent transactions closed from 2015 forward.Benefits AdministrationCare and Benefits NavigationCost ContainmentPayment IntegrityPharmacy Benefits Mgmt.PPO and Specialty NetworksThird-Party AdministratorsValue-Based C
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