Packer16 Posted March 17, 2012 Share Posted March 17, 2012 Alliance Healthcare is an MRI/CAT scan and onoclogy outsources service provider for hospitals. This appears to be a growth story in a declining industry will comps who are selling at a premium but have much more risk. The MRI/CAT scan side of the business is mature some of the excess cash flow is being used to fund the growing oncology business. AIQ has long term contracts with hospitals versus the comps who do not. In addition, the hospital versus non hospital re-imbursement rates for MRI/CAT scan services is higher and AIQ does not have direct exposure to Medicare/Mediciaid and Health Plans like Radnet does. Oaktree Capital Management has been an investor at $3 to $4 per share. AIQ generates about $44 million in FCF with about $10 million of the cap-ex going to the growth oncology business. Next year about $20 million will go to oncology. The EBITDA has been declining voer the past 3 years but is expected to grow in 2012 as the oncology growth overcomes the decline in the MRI/CAT scan business. With a descretionary FCF of $54 million and a market cap of $79 million the total or descretionary FCF multiples are below 2x. On the latest conference call an investor stated that this is the lowest descretionary FCF multiple he has seen. AIQ does have 4.0x EBITDA of debt. However, other leasing and hospital firms have leverage ranging from 3.1x to 5.1x for hospitals and 4.2x for Radnet. At the present time AIQ pays 7.4% on its debt. Lets assume AIQ pays down the debt to 3.0x EBITDA over the next 4 to 5 years that would be $30 million per year (currently the debt amortizes at about $12 million per year). That leaves an addtional about $15 million in FCF assuming no growth and investment in the growing oncology business. If a portion (lets say 25% initially) of that is paid out as a dividend (similar to SALM) that provide a 5% yield with a growing underlying business. Packer Link to comment Share on other sites More sharing options...
beerbaron Posted March 17, 2012 Share Posted March 17, 2012 This is a highly levered bet, you seem to have plenty of those. Levered in term of debt and levered because of high fixed costs. The term loan is LIBOR+3.5%, there are also some mean term interests risks. Every time I see a company replace a fixed rate by a variable rate it makes me squeek a little bit ;) Can you sleep well with such risks? Is there some senior notes floating around? At 8.25% the debt might be a better play. BeerBaron Link to comment Share on other sites More sharing options...
Packer16 Posted March 17, 2012 Author Share Posted March 17, 2012 I think correctly utilized can be a plus take a look at banks/brokerage/ship leasing firms. Many of us seem to be comfortable with highly levered banks/brokerage/ship leasors (BAC, JEF, SSW) in part because the deposit/loan rates provide cheap financing to lever up the loan/security/ship portfolio. See TVL response for other aspects of leverage. The killer with debt is high debt levels and declining EBITDA and FCF, ala SPMD and DEXO. In those situations, it is a race against time (paying off the debt versus the FCF decline). You can get some insights by looking at bond rates and how other firms in the industry are priced and who else is invested in these firms. I am not sure that I would have been as intrested in AIQ unless Howard Marks was a large shareholder. Another aspect of these levered firms is you need management on your side and focused on debt reduction and some type of cash flow growth to a level where FCF can be returned to shareholders. One on the fence right now is FTR, which is priced cheap but might turn into a race against time. I am going to ask about this at the FFH dinner and it will be interesting to see Prem & Cos response. Packer Link to comment Share on other sites More sharing options...
Packer16 Posted April 13, 2012 Author Share Posted April 13, 2012 This is a Howard Marks special as he owns about 45% of AIQ's equity purchased from KKR at above $5 per share a few years ago. Alliance provides mobile MRI/CAT Scan equipment and facilities to hospitals on long-term contracts. About 80% of this type of revenue is on long-trem comntracts with hospitals (who can get preferential re-imbursement versus stand-alone centers). The other portion of revenue comes from a fast growing radiation oncology centers. Right now the firm sells at about 4.3x EBITDA and 1.4x FCF. The other major player in this space is Radnet who doesn't have an oncolgy business or LT contracts but sells for 5.2x EBITDA and 5.0x FCF. The management incentives and ownership are good (as you would expect with a Mark's controlled firm). This appears to be a cheap grower in a dull industry. The debt level is high but these guys are leasing the equipment to doctors and hospitals so debt is appropriate. If Alliance sells at Radnet's multiples it is a double at other hospital or radiology firm (6x EBITDA) it is a 5x play. Has anyone looked into this one? I do have to admit I would not be as interested without Marks controlling the firm. Packer Link to comment Share on other sites More sharing options...
PlanMaestro Posted April 13, 2012 Share Posted April 13, 2012 What was the reason for the big drop after the August earnings? This is a Howard Marks special as he owns about 45% of AIQ's equity purchased from KKR at above $5 per share a few years ago. Alliance provides mobile MRI/CAT Scan equipment and facilities to hospitals on long-term contracts. About 80% of this type of revenue is on long-trem comntracts with hospitals (who can get preferential re-imbursement versus stand-alone centers). The other portion of revenue comes from a fast growing radiation oncology centers. Right now the firm sells at about 4.3x EBITDA and 1.4x FCF. The other major player in this space is Radnet who doesn't have an oncolgy business or LT contracts but sells for 5.2x EBITDA and 5.0x FCF. The management incentives and ownership are good (as you would expect with a Mark's controlled firm). This appears to be a cheap grower in a dull industry. The debt level is high but these guys are leasing the equipment to doctors and hospitals so debt is appropriate. If Alliance sells at Radnet's multiples it is a double at other hospital or radiology firm (6x EBITDA) it is a 5x play. Has anyone looked into this one? I do have to admit I would not be as interested without Marks controlling the firm. Packer Link to comment Share on other sites More sharing options...
onyx1 Posted April 13, 2012 Share Posted April 13, 2012 This is a Howard Marks special as he owns about 45% of AIQ's equity purchased from KKR at above $5 per share a few years ago. Alliance provides mobile MRI/CAT Scan equipment and facilities to hospitals on long-term contracts. About 80% of this type of revenue is on long-trem comntracts with hospitals (who can get preferential re-imbursement versus stand-alone centers). The other portion of revenue comes from a fast growing radiation oncology centers. Right now the firm sells at about 4.3x EBITDA and 1.4x FCF. The other major player in this space is Radnet who doesn't have an oncolgy business or LT contracts but sells for 5.2x EBITDA and 5.0x FCF. The management incentives and ownership are good (as you would expect with a Mark's controlled firm). This appears to be a cheap grower in a dull industry. The debt level is high but these guys are leasing the equipment to doctors and hospitals so debt is appropriate. If Alliance sells at Radnet's multiples it is a double at other hospital or radiology firm (6x EBITDA) it is a 5x play. Has anyone looked into this one? I do have to admit I would not be as interested without Marks controlling the firm. Packer Holy leverage Batman! Do you know if Marks owns the debt too, or is he long just the common? Link to comment Share on other sites More sharing options...
Packer16 Posted April 13, 2012 Author Share Posted April 13, 2012 As far as I can tell only the common. Link to comment Share on other sites More sharing options...
Packer16 Posted April 13, 2012 Author Share Posted April 13, 2012 The big drop was a decline in FCF due to an increase in cap-ex for the new oncology units. Also a decline in CFO which caused the decline in FCF. This firm is also coming off a low investment period to a higher one and I think the market is having a hard time separating out the units due to lack of separate financials. They also had acquisition integration costs. The leasing aspect of the business is what got me comfortable with the debt levels. Packer Link to comment Share on other sites More sharing options...
CONeal Posted April 13, 2012 Share Posted April 13, 2012 Voting on a reverse split between 1:4 and 1:10 during the election. Link to comment Share on other sites More sharing options...
CONeal Posted April 13, 2012 Share Posted April 13, 2012 Wasn't Marks in the deal when they tried to take under XCO? The whole shady approach of that deal would make me 2nd guess investing along side anyone related to that deal. At 45%, if he wanted to take it private it will go private and he would determine the cost. The XCO failure http://blogs.wsj.com/deals/2011/07/13/dealpolitik-exco-shows-how-not-to-run-a-management-buyout/ Link to comment Share on other sites More sharing options...
Packer16 Posted April 13, 2012 Author Share Posted April 13, 2012 The reverse split is formality if AIQ has to switch to the NASDAQ because it's market cap is below $75 million for 30 days until March 2013. The take under is good info. Thx. Packers Link to comment Share on other sites More sharing options...
fenris Posted April 17, 2012 Share Posted April 17, 2012 I tried to wrap my head around this one but didn't get past these issues: - They have no pricing power in their imaging business - Despite investing in radiation oncology since 2008, that segment only contributed 15% of revenue in 2011 (and is expected to contribute 18% in 2012) - I have no visibility as to when their long term contracts expire and therefore can't estimate the real danger of pricing pressure They added this language in the FY2011 10-K (competition, last paragraph) "In recent years, we have seen an increase in direct sales by OEMs of systems to some of our clients. OEMs typically target our higher scan volume clients. These sales efforts by OEMs have resulted in an overcapacity of systems in the marketplace, especially for medical groups that add imaging capacity within their practice settings. This situation has caused an increase in the number of our higher scan volume clients deciding not to renew their contracts. We typically replace these higher volume scan clients with lower volume clients. Our MRI revenues decreased during the year ended December 31, 2011 compared to 2010. We believe that MRI revenues will continue to decline in future years. In all of our businesses, we may also experience greater competition in states that currently have certificate-of-need (“CON”) laws if those laws are repealed, thereby reducing barriers to entry in those states. " Where do you see the inflection point at which they can keep EBITDA stable without pouring all of the FCF into oncology? Have you looked into cash flow or EBITDA ROI for their oncology investments? Link to comment Share on other sites More sharing options...
Packer16 Posted April 17, 2012 Author Share Posted April 17, 2012 I think AIQ does have good pricing (compared to comps) but the pricing has declined since 2009 and is now at 2007 levels. They are providing the high-end scans (MRI and PET/CT) versus RDNT which provides these plus lower priced imagery. Since they get re-imbursed by hosptials they are effected indirectly by Medicare/Medicaid cuts. As to trends, the gap analysis provides the best insight. It was in a downward spiral until 2010 when it turned. In 2Q2011, it turned downward again but is declining at a lower rate in the latest Q. The first Q of negative results is when the stock dove. The ROIC for oncology is 13% and for imaging is 37%. However, the oncology numbers only include a partial year so the numbers may be higher then these numbers imply. The EBITDA is expected to stabilize in 2012 as the revenue gap is expected to decline. In addition, AIQ has a cost savings plan which should reduce costs by $20 to $25 million on an annualized over the next 2 years. They have a plan, good metrics and an incentivized management team to turn this around. We will see if they deliver. I have seen transactions in this space at higher than 6x EBITDA by hospital groups so there is interest from the hospital perspective, Clearly not a slam dunk. Packer Link to comment Share on other sites More sharing options...
fenris Posted April 22, 2012 Share Posted April 22, 2012 I agree that their pricing is better than comps (long-term contracts with hospitals vs direct billing, little medicare) but my point is that I have no visibility as to when the contracts are up for renewal. They experience pricing pressure upon renewal and I don't know when and to what extent that will hit their top line. What exactly do you mean by gap analysis? Actual result vs. prior QoQ/YoY? Isn't it more important to understand what will drive the gap rather than looking at the trend itself? As you said, it turned and then turned downward again. How do you get comfort they will not turn downward again? Do you know which one of Oaktree's funds is invested here? Link to comment Share on other sites More sharing options...
Packer16 Posted April 22, 2012 Author Share Posted April 22, 2012 Gap analysis is provided on a quartely basis and measures the decline of exsiting revenues from renewals. In terms of comfort with continued decline, this was discussed by management and a new investor on the last Q conf call. If you look at historical trends of prcing, it has increased until about 2009 timeframe and now is going down to 2007 levels. They also are planning on putting a number of thier mobile units out of service and optimising the routes of the remaining units. Management stated that they expect that the decline for imaging will taper off in the next 6 to 12 months and see the growth from oncology create a net positive EBITDA change over the TTM then. It is up to them at this point to execute. The market clearly is skeptical but if they can do this the stock will pop. I don't know which funds are invested but I do know they own the equity which they bought from KKR in 1997. Packer Link to comment Share on other sites More sharing options...
Packer16 Posted June 2, 2012 Author Share Posted June 2, 2012 AIQ had a good Q1 as the gap analysis turned positive. They also brought in a EVP from DaVita to run operations with the President & CEO stepping down. They announced the change before the relaese so I thought the release was going to be bad but it was better than I expected. This is another firm with a 1.0x 2011 FCF and 0.9x TTM FCF. Given the Oaktree backing and other transactions in the 6 -7 x EBITDA range, implying an upside of 7.3x, this may be the equivalent of a LEAP with no expiration. (Note: they will probably have a reverse split soon if the stock price does not bounce soon, so the price may decline further). Packer Link to comment Share on other sites More sharing options...
PlanMaestro Posted June 18, 2012 Share Posted June 18, 2012 Reading the 10K at the moment. Packer, do you have other material worth reading? Link to comment Share on other sites More sharing options...
Packer16 Posted June 19, 2012 Author Share Posted June 19, 2012 The 2 other sources I would look at are the AIQ website for an investor presentation and the largest comp's (Radnet) 10-K and investor presentation on their website. I don't know why it is going down as the last Qs results were not to bad. Unfortunately, I have reached my limit on this one before the price fell below a $1.00. If this plays out, it should be worth $7 to $9/share based upon a 7x EBITDA multiple. The weakness may be due to being dropped from the Russel 3000. Packer Link to comment Share on other sites More sharing options...
prunes Posted June 19, 2012 Share Posted June 19, 2012 I'm pretty ignorant about this type of business. With the MRI/CAT revenues declining as fast as they are, and with the oncology revenues still being a relatively small part of the total, how do you get comfortable with the total debt in place? How would one assess what the oncology revenues are going to look like in 2 or 3 years? Definitely cheap but I'm trying not to be seduced by the numbers. What % of your portfolio do you out into something like this? Link to comment Share on other sites More sharing options...
Packer16 Posted July 16, 2012 Author Share Posted July 16, 2012 In terms of debt, you can look at coverage which is close to 3.0x and leverage amount which is close to 4.0x. With these numbers it imples a B rating (the firm has a B+ corporate rating from S&P). The bonds are trading at a discount to B levels 14 to 15% YTM. This is based upon a concern of declining EBITDA but the firm has identified about $25 million in cost savings and with this will have an increasing EBITDA over the next year. In addition, these types of firms have bought out at mulitples in the 7x EBITDA range and hospitals (who are the major buyers, plans could also be appropriate buyers) have mulitples in the 6 to 7x range, so a purchase at a lower multiple is accertive. The fact that Oaktree has been involved in strategy at the corporate level (per the last conf call) provides me confidence that if this firm can make it, it will. Packer Link to comment Share on other sites More sharing options...
17thstcapital Posted August 7, 2012 Share Posted August 7, 2012 Good enough quarter here. Very nice rally in the stock in the last couple of weeks. Link to comment Share on other sites More sharing options...
Packer16 Posted November 4, 2012 Author Share Posted November 4, 2012 Nice quarter with debt paydown and sale leaseback. They appear to be trying to imitate DaVita in the radiology space. They are now at a CF multiple of 3.9x. The conf call provides some nice insights. Packer Link to comment Share on other sites More sharing options...
sampr01 Posted April 6, 2013 Share Posted April 6, 2013 Hi Packer What your thoughts on upcoming quarter.. Are concerned about "Discovery Group lowers stake in Alliance HealthCare to 5.9% from 7.0%". thanks Nice quarter with debt paydown and sale leaseback. They appear to be trying to imitate DaVita in the radiology space. They are now at a CF multiple of 3.9x. The conf call provides some nice insights. Packer Link to comment Share on other sites More sharing options...
Packer16 Posted April 6, 2013 Author Share Posted April 6, 2013 They appear to progressing in paying down their debt and their bonds now trade at premium to par. If I recall, I think Discovery Group is selling to another large shareholder. I am not concerned as they have investors to distribute too. If Oaktree sold, then I would be concerned. There is a also good article on Seeking Alpha about AIQ. Packer Link to comment Share on other sites More sharing options...
sampr01 Posted April 7, 2013 Share Posted April 7, 2013 Hi Packer Thanks for your insight. Do you have a time frame for this pick and you mentioned earlier that stock worth $7-$8. It is already at 8.32$ as of now or because reverse split?. Thanks They appear to progressing in paying down their debt and their bonds now trade at premium to par. If I recall, I think Discovery Group is selling to another large shareholder. I am not concerned as they have investors to distribute too. If Oaktree sold, then I would be concerned. There is a also good article on Seeking Alpha about AIQ. Packer Link to comment Share on other sites More sharing options...
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