Rating Rationale
June 28, 2019 | Mumbai
Apollo Hospitals International Limited
Ratings upgraded to 'CRISIL A-/Stable/CRISIL A2+'
 
Rating Action
Total Bank Loan Facilities Rated Rs.110 Crore
Long Term Rating CRISIL A-/Stable (Upgraded from 'CRISIL BBB/Stable')
Short Term Rating CRISIL A2+ (Upgraded from 'CRISIL A3+')
1 crore = 10 million
Refer to annexure for Details of Instruments & Bank Facilities
Detailed Rationale

CRISIL has upgraded its ratings on the bank facilities of Apollo Hospitals International Limited (AHIL) to 'CRISIL A-/Stable/CRISIL A2+' from 'CRISIL BBB/Stable/CRISIL A3+'.
 
The upgrade reflects the strong support from the parent Apollo Hospitals Enterprise Ltd (AHEL; 'CRISIL AA/FAA+/Stable/CRISIL A1+'), as reflected by its articulation to provide the requisite support to meet all debt obligation if AHIL is unable to do so and even if the other joint venture (JV) partner (Cadila Pharmaceuticals Ltd [Cadila]) does not extend support. The upgrade also factors in improvement in operating profitability of AHIL. Standalone operating margin improved from 11% in fiscal 2017 to 17% in fiscal 2019, driven by increased patient volume and lower administration expenses. The consolidated operating margin improved to a lesser extent, from 11% to 13.6%, because of losses at the newly formed subsidiary Apollo CVHF Ltd (Apollo CVHF).
 
The ratings continue to reflect the strong operational, management, and financial support AHIL receives from the promoters, the sustained improvement in its business risk profile with improving operating profitability, and its moderate financial risk profile with steady accretion of reserves. These strengths are partially offset by geographical concentration in revenue and exposure to risks related to stabilisation of operations of Apollo CVHF. AHIL also faces regulatory risks in the healthcare industry in India. Any change in the ownership pattern or in the support philosophy of AHEL towards AHIL will remain a key rating sensitivity factor.
 
Operating margin was adversely impacted in fiscal 2017 and the first half of fiscal 2018 by one-time factors such as demonetisation of high-value currency notes in November 2016, price control on stents and knee implants, expenses towards Joint Commission International (JCI) accreditation, and higher staff cost. The profitability improved significantly in fiscals 2018 and 2019, but remains moderate because of losses at Apollo CVHF and higher operating cost arising from implementation of the Goods and Service Tax (GST).

Analytical Approach

CRISIL has fully consolidated the business and financial risk profiles of AHIL with its subsidiary Apollo CVHF as the latter is majority held and controlled by AHIL. Also, CRISIL has moderately consolidated JV Apollo Amrish Oncology Services Pvt Ltd, considering it is jointly held and controlled by both AHIL and its partner.
 
CRISIL has also applied its parent notch-up framework to factor in the intensity of distress support available from AHEL.
 
Furthermore, CRISIL has treated AHIL's Rs 11 crore redeemable preference shares subscribed to by AHEL as neither debt nor equity because the shares are from the promoters, long-dated (with residual maturity of 10 years), and cumulative in nature.

Please refer Annexure - List of entities consolidated, which captures the list of entities considered and their analytical treatment of consolidation.

Key Rating Drivers & Detailed Description
Strengths:
* Strong operational, management, and financial support from the promoters, especially AHEL:
AHIL is a subsidiary of AHEL, and the parent has control over strategic and operational decisions and strong oversight over financial matters. AHIL benefits from the Apollo brand and patient referrals from AHEL's centres. The promoters of AHIL-AHEL and Cadila-have regularly provided funds through equity infusions and unsecured loans to fund cash losses and capital expenditure (capex). During fiscal 2018, AHIL received equity infusion of Rs 15 crore, which was invested in the new subsidiary Apollo CVHF, in addition to Rs 10 crore received in fiscal 2016. Need-based support from the promoters aids financial flexibility and is expected to continue over the medium term. Additionally, AHEL's strong articulation of support to AHIL when required and to meet all debt obligation supports the ratings.

* Sustained improvement in business risk profile with improving operating profitability:
Operating profitability improved in fiscals 2018 and 2019 on account of increased occupancy (64% in fiscal 2019 against 62% in fiscal 2018), higher outpatient volume (16% growth in fiscal 2019), and reduced administration expenses. The management has steadily enhanced its strengths in specialty streams by adding consultants and state-of-the-art equipment. The business risk profile also reflects the diversified patient profile and AHIL's focus on positioning itself as a specialised centre for cardiac sciences, neuro sciences, transplants, nephrology, orthopaedics (including total knee replacement and spine surgeries) and oncology. In keeping with this, AHIL formed an oncology-focused JV, Apollo Amrish Oncology Services Pvt Ltd, with Comprehensive Blood & Cancer Centre, in fiscal 2015 and a specialised cardiac centre through Apollo CVHF in fiscal 2017.
 
* Moderate financial risk
The financial risk profile weakened in fiscal 2017, but improved in the past two fiscals and remains moderate, with gross debt to EBITDA (earnings before interest, tax, depreciation, and amortisation) ratio of 2.49 times as on March 31, 2019 (3.27 times as on March 31, 2017) and gearing of 0.61 time (0.74 time). Debt protection metrics improved due to higher EBITDA. Interest coverage and net cash accrual to total debt ratios increased to 3.47 times and 0.21 time, respectively, in fiscal 2019, from 2.50 times and 0.08 time, respectively in fiscal 2017. The financial risk profile is expected to strengthen with steady accretion to reserves and low capex requirement in the near future.

Weaknesses:
* Revenue concentration in a single location
Although AHIL is focused on attracting patients from other cities and countries, its ability to tap potential customers is constrained by its single-location operations. Furthermore, the hospital is situated on the outskirts of Ahmedabad. Thus, despite being operational for over a decade, occupancy remains moderate at 60-65%. The hospital also remains vulnerable to increased competition from major hospitals in Ahmedabad. The image-sensitive nature of the healthcare industry aggravates the risk of revenue concentration.
 
* Moderate project implementation risk
AHIL has formed a JV (64:36), Apollo CVHF, with Advanced Cardio Vascular Care  Ltd, to set up an exclusive cardiac centre near SG Highway, Ahmedabad, at a cost of Rs 40 crore (funded through equity of Rs 25 crore and debt of Rs 15 crore). The JV commenced operations in January 2019 against the previous expectation of April 2018. Though project execution risk has reduced on account of completion of the project, AHIL faces risk related to stabilisation of operations at the new hospital, with occupancy likely to be low-to-moderate in the first few years, thereby impacting operating efficiency. Apollo CVHF reported a net loss of Rs 7.8 crore for fiscal 2019, which constrained AHIL's profitability for the fiscal.
Liquidity

Liquidity is aided by improved cash accruals (increased from Rs 5 crore in fiscal 2017 to Rs 14 crore in fiscal 2019), moderate bank limit utilization (average utilization of 47% during fiscal 2019) and adequate cash balance of Rs 9 crore against annual term loan repayment of Rs 12 crore for fiscal 2020 (Rs 12 crore in fiscal 2019). Further, AHEL's liquidity profile is supported by the funding support from the promoters, whenever required.

Outlook: Stable

CRISIL believes AHIL would post stable operating profits and comfortable debt protection metrics. AHIL would also continue to benefit from operational, financial, and managerial support from AHEL.
 
Upside scenario:
* Significant improvement in AHIL's operating profitability, capital structure, and debt protection metrics

Downside scenario:
* Weakening in financial risk profile of AHIL
* Change in the support philosophy of AHEL towards AHIL

About the Company

Incorporated in 1997, AHIL is an equal JV between AHEL and Cadila, providing healthcare services through its 323-bed multi-specialty hospital in Ahmedabad. It is a tertiary care hospital with focus on cardiac surgery, neurosurgery, orthopaedics, oncology, total knee replacement, and solid organ transplants.
 
During fiscal 2015, AHIL formed an equal JV with Amrish Oncology Services Pvt Ltd (owned by Dr Ravi Patel, an American citizen of Indian Origin and owner of brand CBCC, Comprehensie Blood & Cancer Care Center), named Apollo Amrish Oncology Services Pvt Ltd, specialising in oncology. Of the 323 beds at AHIL's Ahmedabad hospital, 57 are dedicated to the JV.
 
During fiscal 2017, AHIL formed a JV, Apollo CVHF, with Advanced Cardio Vascular Care Ltd (owned by Dr Sameer Dani, a leading cardiologist in Ahmedabad). The JV manages the recently commissioned (January 2019) 66-bed exclusive cardiac centre on SG Highway, Ahmedabad. AHIL holds 64% in Apollo CVHF.

Key Financial Indicators (Consolidated)
As on / for the period ended March 31   2019 2018
Revenue Rs crore 191 179
Profit after tax (PAT) Rs crore 4 4
PAT margin % 2.3 2.3
Adjusted Debt/Adjusted networth Times 0.61 0.60
Interest coverage Times 3.47 3.05

Any other information: Not applicable

Note on complexity levels of the rated instrument:
CRISIL complexity levels are assigned to various types of financial instruments. The CRISIL complexity levels are available on www.crisil.com/complexity-levels. Users are advised to refer to the CRISIL complexity levels for instruments that they consider for investment. Users may also call the Customer Service Helpdesk with queries on specific instruments.
Annexure - Details of Instrument(s)
ISIN Name of instrument Date of allotment Coupon
rate (%)
Maturity
date
Issue size
(Rs Cr)
Rating Assigned
with Outlook
NA Overdraft NA NA NA 18 CRISIL A2+
NA Term Loan 1 NA NA Jan-22 45 CRISIL A-/Stable
NA Term Loan 2 NA NA Mar-21 32 CRISIL A-/Stable
NA Term Loan 3 NA NA Dec-26 15 CRISIL A-/Stable
 
Annexure - List of entities consolidated
Name of the company Type of consolidation
Apollo CVHF Limited Full consolidation
Apollo Amrish Oncology Services Pvt. Ltd. Moderate consolidation
Annexure - Rating History for last 3 Years
  Current 2019 (History) 2018  2017  2016  Start of 2016
Instrument Type Outstanding Amount Rating Date Rating Date Rating Date Rating Date Rating Rating
Fund-based Bank Facilities  LT/ST  110.00  CRISIL A-/Stable/ CRISIL A2+      01-03-18  CRISIL BBB/Stable/ CRISIL A3+      28-12-16  CRISIL BBB/Stable/ CRISIL A3+  CRISIL BBB/Stable/ CRISIL A3+ 
            16-02-18  CRISIL BBB/Stable/ CRISIL A3+           
All amounts are in Rs.Cr.
Annexure - Details of various bank facilities
Current facilities Previous facilities
Facility Amount (Rs.Crore) Rating Facility Amount (Rs.Crore) Rating
Overdraft 18 CRISIL A2+ Overdraft 18 CRISIL A3+
Term Loan 92 CRISIL A-/Stable Term Loan 92 CRISIL BBB/Stable
Total 110 -- Total 110 --
Links to related criteria
CRISILs Approach to Financial Ratios
CRISILs Bank Loan Ratings - process, scale and default recognition
Rating criteria for manufaturing and service sector companies
CRISILs Criteria for Consolidation
CRISILs Criteria for rating short term debt

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