Rating Rationale
November 27, 2019 | Mumbai
Medanta Holdings Private Limited
Rating Reaffirmed
 
Rating Action
Total Bank Loan Facilities Rated Rs.500 Crore
Long Term Rating CRISIL BBB+/Positive (Reaffirmed)
1 crore = 10 million
Refer to annexure for Details of Instruments & Bank Facilities
Detailed Rationale

CRISIL has reaffirmed its rating on the long-term bank facility of Medanta Holdings Private Limited (MHPL) at 'CRISIL BBB+/Positive'.
 
The rating continues to draw support from the strong parentage of Global Health Pvt Ltd (GHPL; rated 'CRISIL A+/Positive') in the form of consolidation of operations and key functions, as well as management oversight. GHPL had acquired Dr Naresh Trehan's stake in MHPL in fiscal 2018 and additionally infused Rs 108 crore to fund its ongoing capital expenditure (capex).
 
MHPL commenced operations from November 2019 and the ratings reflect the benefits that MHPL likely to derive from the experience and track record of its parent in setting up and stabilising greenfield hospitals under its established brand, Medanta.
 
The ratings continue to benefit by the prudent funding mix, and tie-up of debt funding for the hospital at Lucknow with long maturity loans, which will help obviate liquidity pressures during the on-going stabilisation phase. The ratings also factor in the expected benefits likely to be made available to MHPL in the form of well-established systems and experienced hospital employees. Furthermore, the ratings presume that GHPL will ensure adequate funding is available to ensure debt servicing, until operations and cash generation stabilises at MHPL.
 
These strengths are partially offset by early stage of hospital project, and the impact of the expected initial losses on the financial risk profile over the medium term.

Analytical Approach

For arriving at the rating, CRISIL has factored in the business and financial support from parent, GHPL.

Key Rating Drivers & Detailed Description
Strengths:
* Experience and track record of founder promoter, Dr Naresh Trehan: MHPL is expected to benefit from the leadership of Dr Naresh Trehan, one of the leading cardiac surgeons in the country and the founder promoter of GHPL. Dr Trehan was instrumental in the establishment and subsequent management of the Escorts Heart Institute & Research Centre (Escorts) [New Delhi]. He spent 18 years at Escorts, developing healthcare delivery in India and research in cardiology. Dr Trehan also successfully commissioned GHPL's flagship, Medanta Medicity, the largest single-location hospital in the private sector in India. Furthermore, GHPL has diversified geographical presence through managed hospitals at Ranchi and Indore.
 
* Prudent funding mix with long maturity loans: MHPL is undertaking a capex of around Rs 800 crore for setting up of a hospital in Lucknow, which will be debt-funded by Rs 500 crore. Debt repayment is spread over a 10-year period and back-ended; therefore only interest needed to be serviced in the pre-operative period and until fiscal 2020. Furthermore, the debt repayments are structured in a way that the initial obligations are low.
 
Weaknesses:
* Exposure to demand risks related to the project: While MHPL commenced operations in November 2019, it is still exposed to demand risk associated with any large greenfield project. While CRISIL believes that the ramp up in occupancy at MHPL will be better than industry standards given the experience of the management, the unit will still make losses in initial years, till occupancy ramps up adequately. Though the hospital is expected to benefit from the brand reputation of Dr. Trehan in attracting patients, this remains to be demonstrated in the new location of Lucknow. Experienced doctors and staff from GHPL's flagship, Medanta, Gurgaon, are expected to be available to the Lucknow facility on a need basis, to help stabilise operations.
 
* Weak financial risk profile post-commissioning of project: Greenfield hospitals break-even at the operating profitability level in 3-4 years from commencement of operations. The initial phase normally witnesses losses as the occupancy rate improves gradually and the hospital develops operational efficiencies. Also, the losses could be substantial and are directly proportional to the scale of operations. Gestation losses combined with high debt levels during early stage of operations are expected to lead to weak debt protection metrics in the first 2-3 years. To offset this, bed capacity will be commissioned in phases, starting with 410 beds initially. Hospital building and other key infrastructure (excluding medical equipment and beds), however, has been completed for an overall capacity of 1000 beds.

Liquidity: Adequate
MHPL has adequate liquidity. The company has commenced operations from November 2019, and is likely to record negative cash accruals during the initial years of operations due to the gestation phase of operations. Its long-term debt repayments however remain nominal due to long tenure and back-ended nature of the repayments. In addition, the flexibility to meet obligations is enhanced with the maintenance of the 'Debt Service Reserve Account' as per the loan agreement (wherein the upcoming quarter's principal and upcoming month's interest will be maintained as a fixed deposit). While there was a minor delay of 4-5 days in the repayment of Rs 12.5 lacs term loan instalment during October 2019 on account of operational issues, the company had sufficient liquidity available to service the repayment. Furthermore, parent GHPL is expected to ensure adequate funding is available to ensure debt servicing, until operations and cash generation stabilises.
Outlook: Positive

CRISIL believes MHPL will benefit from its management's established track record of stabilising operations at greenfield hospitals as planned, consolidation of operations and key functions, as well as adequate oversight from parent, GHPL.

Rating Sensitivity factors
Upward Factors
* Stabilisation and quick ramp up of operations leading to healthy revenue growth and EBITDA break-even.
* Prudent funding of expansion plans such that gearing improves to below 1 time.

Downward Factors
* Delay in stabilisation and ramping up of operations leading to higher than expected losses; EBITDA loss of more than Rs. 30 crore.
* Lower than expected cash generation and higher debt drawdown leading to deterioration of credit metrics; gearing of more than 2 time.
* Change in stance of parent regarding operational and financial support extended to MHPL.

The rating will also be sensitive to the credit risk profile of GHPL.

About the Company

MHPL was set up in 2015 by eminent cardiac surgeon, Dr Naresh Trehan. The company, which became a 100% subsidiary of GHPL in fiscal 2018, is constructing a 1000-bed hospital in Lucknow at a total cost of around Rs 800 crore. The hospital has commenced operations from November 2019 with a total bed capacity of 410 beds.

About the Parent
GHPL was established in 2004 by Dr Trehan who, along with his associates, holds majority stake in the company. The balance is divided between Anant Investments (The Carlyle group ) and Dunearn Investments (Mauritius) Pte Ltd (Temasek Singapore Pte).

Medanta, a world-class super-specialty tertiary-care hospital at Gurugram, commenced operations in November 2009, and has a capacity of 1250 beds and 40 operation theatres, besides state-of-the-art diagnostic and laboratory facilities. In fiscal 2015, GHPL entered into an arrangement to manage a 136 bed-hospital at Indore (Madhya Pradesh) and 174 bed-hospital at Ranchi (Jharkhand) on a leased basis. The company's bed count stood at 1560 as on March 31, 2019, and its management plans to almost double bed capacity by fiscal 2022, through greenfield and brownfield expansions. Besides the 1000 bed hospital at Lucknow, GHPL is also planning to set up greenfield hospitals at Patna (Bihar) and at Noida (Uttar Pradesh); all these hospitals will be under the brand, 'Medanta'.

Key Financial Indicators
As on/for the period ended March 31 Unit 2019 2018
Revenue Rs crore N.M N.M
Profit After Tax (PAT) Rs crore N.M N.M
PAT margin % N.M N.M
Adjusted debt/adjusted networth Times N.M N.M
Interest coverage Times N.M N.M
N.M - Not meaningful

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 Long Term Bank Facility NA NA 31-Dec-2026 500 CRISIL BBB+/Positive
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  500.00  CRISIL BBB+/Positive      28-08-18  CRISIL BBB+/Positive  25-05-17  CRISIL BBB+/Positive  10-03-16  CRISIL BBB+/Positive  -- 
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
Long Term Bank Facility 500 CRISIL BBB+/Positive Long Term Bank Facility 500 CRISIL BBB+/Positive
Total 500 -- Total 500 --
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
Criteria for Notching up Stand Alone Ratings of Companies based on Group Support

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