#1NH Narayana Health Health for all. All for health. Date of submission: 14th February 2024 To, The Secretary Listing Department BSE Limited Department of Corporate Services Phiroze Jeejeebhoy Towers, Dalal Street, Mumbai - 400 001 Scrip Code 539551 Dear Sir/Madam, To, The Secretary Listing Department National Stock Exchange of India Limited Exchange Plaza, Bandra Kurla Complex Mumbai - 400 051 Scrip Code- NH Sub: Investor Presentation for the quarter ended December 31, 2023 With reference to the subject, please find attached the Investor Presentation for the quarter ended December 31, 2023. Kindly take the above information on record. Thanking you Yours faithfully For Narayana Hrudayalaya Limited Sridh Digitally signed ar s by Sridhar s Date: 2024.02.14 19:47:25 +05'30' Sridhar S. Group Company Secretary, Legal & Compliance Officer Encl. as above Narayana Hrudayalaya Limited CIN: L85110KA2000PLC027497 Registered Office: 258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore 560099 Corporate Office: 261/A, 2nd Floor, Bommasandra Industrial Area, Anekal Taluk, Bangalore 560099 Tel +91 80 7122 2636 | Fax +91 80 2783 2648 | Email: [email protected] | www.narayanahealth.org Appointments 186-0208-0208#2Narayana Health "Narayana Health Earnings Update Q3 FY24#3Index Topic Narayana Health at a Glance Q3 FY24 Highlights Capex Slide No. 04 05 12 12 NHIC 13 Digital Transformation Initiatives 14 Narayana Health ESG Vision - "Health For All" 15 Shareholding Pattern 16 2#4Our Footprint Kakriyal, Jammu Jaipur Ahmedabad Mumbai Shimoga Delhi NCR As on 1st January 2024 Jamshedpur Raipur Kolkata Bengaluru Mysore Guwahati South Hospitals 5| Heart centres - 3 | Clinics - 11 - Operational beds - 1920 (Hospitals) - 241 (Heart centres) East Hospitals - 7 | Clinics - 4| Dialysis centre - 1 Operational beds - 1,865 North Hospitals 4 | Clinics - 1 - Operational beds: 1,159 West Hospitals - 2 Operational beds - 351 3#5Narayana Health - At Glance Facility Details Owned Operated Hospitals (1) No. of Facilities Operational Beds 18 5,295 Heart Centres 000 000 6,042 Capacity Beds 4.7 mn(2) Average Effective Capital Cost per Operational Bed 3 241 100+ + Clinics and Dialysis Center 17 0 Cayman Islands 1 110 Healthcare Facilities 39 5,646 (1) Owns the P&L responsibility (2) Based on (Gross Block for Fixed Assets (adjusted for non-cash government grant provision impact, non-cash financial lease impact for Dharamshila unit, non-cash EPCG license impact )+ Capital Work in Progress (CWIP))/Number of operational beds as of December 31st 2023 but excluding Managed Hospitals and Cayman facility Clinical Specialty & Sub-Specialty 19,002 Full-time Employees & Associates including doctors 4,193 Doctors 4#6Key Highlights - Operational & Financial Performance (Q3 FY24) Z Clinical & Operational SRCC, Mumbai - Survivor of High-risk clinical condition: 11-year-old presented with super refractory status epilepticus which has an expected mortality of 50% & expected disability of 80% was treated with Novel High dose Phenobarb therapy for 3 weeks. The patient recovered without any disability. Department of Orthopaedics and Trauma has started Hand Upper Limb Services & Elbow Arthroscopy during this Quarter in Mazumdar Shaw Medical Centre (MSMC), Bengaluru Mazumdar Shaw Medical Centre (MSMC), Bengaluru has successfully performed following procedures during the quarter: • 27 Solid Organ Transplants, 44 BMTs & 91 Robotic Procedures. IM Financial Performance • • • 2 very rare renal transplants of patients with Nephrocalcinosis - a genetic disorder. Trans-Hepatic Cholangioscopy, first ever reported case in India. 100 complex trauma cases, 66 Robotic Ortho procedures. Consolidated operating revenues of INR 12,036 mn in Q3 FY24, an increase of 6.7% YoY and decrease of 7.8% QoQ Consolidated EBITDA of INR 2,968 mn in Q3 FY24 translating into EBITDA margin of 24.7% and consolidated PAT of INR 1,881 mn at a PAT margin of 15.6% Consolidated Total Borrowings less Cash, Bank Balance and Current Investments was - INR 251 mn (Net Cash) as on 31st December, 2023 i.e., net debt to equity ratio of - 0.01 (out of which, debt worth US$ 61 mn is foreign currency denominated) (1) As per the accounting treatment for leases per IND AS 116 effective 1st April 2019 which resulted in INR 176 mn increase in EBITDA for Q3 FY24 (2) As per the accounting treatment for leases per IND AS 116 effective 1st April 2019 which resulted in INR 5 mn increase in PAT for Q3 FY24 5#7Revenue Mix - India (Q3 FY24) Operating Revenues (INR mn) 9,098 5.4% YoY 9,590 Q3 FY23 Q3 FY24 Specialty-Profile (4,7) 16% 5% 34% 8% 9% 14% 15% Cardiac Sciences Oncology Neuro Sciences Gastro Sciences Renal Sciences Orthopaedics Others (1) NH owns on freehold basis and operates with the P&L responsibility (2) NH operates the hospitals on rental/revenue sharing basis and owns the P&L responsibility (3) Includes managed hospital, clinics, heart centres, dialysis centres etc (4) As percentage of operating revenue, excluding NHIC Business Mix(7) 27% O 70% 2% 1% ■■Owned Hospitals (1) (2) ■Operated Hospitals (3) ■Other Anciliary Businesses Cluster-Wise (6,7) Payor-Profile (4,7) 8% Heart Centres 21% 28% 43% 16% 5% 35% 10% 9% 25% Domestic Walk-in patients Insured Patients (5) Schemes (5) International patients Bangalore Kolkata Western ■Southern Peripheral Eastern Peripheral ■Northern (5) Insured Patients include Insurance-covered patients, corporate patients (including public sector undertakings); Schemes include CGHS, ESIS, other state government schemes (6) Calculated on operating revenue of owned/operated hospitals, heart centres and other ancillary business (7) Percentages might not add up to 100% due to rounding off 6#8Operational Review - India Average Revenue Per Patient (IP & OP) (1,2) INR '000 OP IP 4.0 116.5 ALOS Days 123.0 4.2 Q3 FY23 Q3 FY24 Patient Footfalls (IP & OP) (1,3) '000 OP IP 582 57 Q3 FY23 604 57 Q3 FY24 (1) OP figures include day-care business but does not include Vaccine footfalls (2) ARPOB for the period Q3 FY24 was INR 14.1 mn as against INR 12.8 mn in Q3 FY 23. (3) Footfalls for IP correspond to Discharges (4) Includes critical care and step-down care beds 4.5 4.4 Q3 FY23 ICU Occupied Bed Days(4) '000 Q3 FY24 88 93 Q3 FY23 Q3 FY24 Excludes Managed Hospitals 7#9Regional Split - India (Q3 FY24) This considers owned/operated hospitals in India (excl. Jammu (¹)) Bangalore Southern Peripheral Kolkata Eastern Peripheral Western Northern Regions NICS MSMC HSR • Mysore Shimoga • RTIICS • Jamshedpur • • Barasat • Guwahati Mumbai Ahmedabad Gurugram NMH Raipur New Delhi Jaipur • NSH % of Hospital Operating Revenues 38% 6% 27% 11% 5% 13% YoY Revenue -3% 9% 10% Growth 7% 15% 8% YOY Hospital -3% -12% Discharges 5% 3% 4% 5% Growth ARPOB (INR mn) 17.4 11.5 14.0 10.8 12.0 16.3 (1) Jammu facility reported operational revenues of INR 304 mn and EBITDA of INR 7.3 mn in Q3 FY 24 80#10- Profitability Snapshot – India Hospitals (Q3 FY24) EBITDA and EBITDA Margin INR 'mn Cost Structure % of Operating Revenues Rental Revenue Share (6) 2.7% 2.8% Excludes NHIC, NHIL, Jammu & ATHMA 12.0% (1) 12.4% (1) 19.4% 19.2% (5) 18.3% 17.7% (5) (3) (3) -(1) 1,665 23.7% 22.8% (1) 1,794 Q3 FY23 Q3 FY24 (4) 28.0% 29.0% (4) Q3 FY23 Doctors and Nurses Other Expenses Q3 FY24 Consumable Expenses I Other Manpower Cost (1) Denotes EBITDA for entire India hospitals business excluding NHIC, NHIL, Jammu & ATHMA. EBITDA for Q3 FY24 including NHIC, NHIL, Jammu & ATHMA stood at INR 1,716 mn (17.9%). (2) Q3 FY23 numbers is also adjusted for Jammu, ATHMA and MSRNH (discontinued). (3) EBITDA for NHIC and NHIL stood at -INR 85.1 mn for Q3 FY24. (3) Consumable Expenses = Purchase of medical consumables, drugs and surgical equipment net of changes in inventories of medical consumables, drugs and surgical equipment (4) Doctors and Nurses = Employee benefits + Professional fees to doctors (5) Other Expenses = Overhead expenses + All other expenses (6) Effect of IND AS benefits is not considered 9#11Operational Review - Cayman Islands Average Revenue Per Patient (IP & OP) (1,2) US$ '000 OP 40.7 IP Discharges 30.7 1.1 1.2 Q3 FY23 Q3 FY24 620 492 Q3 FY23 Q3 FY24 (1) OP figures include day-care business of HCCI and EICL (2) ARPOB for the period Q3 FY 24 was USD 2.1 mn as compared to USD 2.2 mn in Q3 FY 23. (3) Operating revenues include HCCI and EICL entities. Operating Revenues (3) US$ mn Out-Patients (1) 30.6 28.2 Q3 FY23 Q3 FY24 9,558 7,647 Q3 FY23 Q3 FY24 10#12Consolidated Financial Performance Figures in INR mn, unless stated otherwise Profit and Loss Statement (1,3) Key Balance Sheet Items(1) Particulars (INR mn) Q3 FY24 9M FY24 Particulars 31st December 2023 Total Operating Revenue 12,036 37,423 Shareholder Equity Consumption 2,442 8,004 26,899 Doctors Expenses 2,185 6,504 Total Borrowings Employee (Excluding Doctors) Expenses 10,162 2,542 7,549 Other Admin Expenses 2,078 6,788 Lease Liability 1,717 Total Expenses 9,247 28,846 Other Income 179 Net Block + CWIP (2) 514 25,892 EBITDA 2,968 9,091 Goodwill Depreciation and Amortization 632 1773 1,178 Finance Costs 251 689 Right to Use Assets 1,802 Share of (loss)/profit of equity accounted investees Net Receivables 4,777 PBT 2,086 Tax Expense 205 6,629 641 Current Investments 5,804 PAT Total Comprehensive Income 1,881 1,870 5,988 6,082 Cash and Bank Balance 4,557 - As on December 31st, 2023, the Total Borrowings less Cash, Bank Balance and Current Investments was (INR 251 mn) – Net Cash representing a net debt to equity ratio of (0.01) (out of which, debt worth US$ 61 mn is foreign currency denominated) (1) Figures might not equal the reported numbers due to rounding off (2) Net Block includes non-cash government grant impact of INR 1,098 mn, non-cash financial lease impact of INR 630 mn and non-cash EPCG license impact of INR 132 mn (3) As per the accounting treatment for leases per IND AS 116 effective 1st April 2019 which resulted in INR 136 mn increase in depreciation, INR 36 mn increase in finance cost resulting in increase of INR 5 mn in PAT for Q3 FY 24 on pre-IND AS 116 basis 11#13Capex Strategy INR Mn 2,000 1,361 1,500 FY23 FY24 2,570 1,391 Radiation Oncology Center, Block A exterior work Block A interiors, NICU, PICU, Single Rooms, Medical Equipment 1,310 2,901 452 5,902 3,017 1,978 Refurbishment of OPD areas, Cathlab, Private and Semi-Private Rooms Day-Care beds, BMT Unit, Radiology equipment, Surgical Robot Infrastructure Reconfiguration, Replacement Medical Equipment Linac, CT, Orthopedic & Surgical Robots, Single Rooms FY23 ACTUALS FY24 YTD FY24 PROJECTED Cayman Brownfield/Capacity Addition I Replacement/Maintenance ■Greenfield/Inorganic Acquisition of Sparsh Health City unit, New Clinics New Clinics, Land for Expansion 12#14NHIC: Snapshot Program running since September 2022 at select Bengaluru locations дода 7 心回 42,749 As on 31st December 2023 Q3 FY24 Points of Presence Patient Transactions ار آها *53.7 Mn Q3 FY24 Revenue Current focus on Bengaluru We will learn and adjust model and expand geographical presence subsequently 13#15• Digital Transformation Initiatives 目 Impact | New Products Impact | Mobile Apps Initiatives | Business athmâ Reach athma • 26K+ orders processed through Athma radiology system 4 NH units onboarded namah 83 nursing hours saved with Digital Handover Process in the first month at HCCI India launch in Feb'24 • "Narayana Health 1.4 Million cumulative installs Patient Self-Check in launched in HCCI • athmâ An 8% QoQ increase in throughput while simultaneously cutting TAT by 3.3% across NH Labs Qaadi 000 • • athma 7 new sites onboarded on Athma SaaS Aggregate SaaS bed-count stands at 630 2,500 Surgeon hours saved annually with digital OT Notes 22% OPD Paper reduction in one quarter • 75% EMR Adoption in OPD across the group In Progress 3 Multi-Speciality hospitals ⚫ 11 Diagnostic Laboratories 14#16NH ESG Vision - "Health For All" 289 + A Healthy Planet Actuals 9M (T- Target 9M) By being conscious about impact on the environment, prioritizing consumption efficiency and resource optimization ✓ 30% Renewable energy mix by 2030 25% (T 26%) ☑ Carbon Neutral By 2040 A Healthy Society Ongoing 100% Waste-water recycling by 2030 1.3 KL Water Per occupied bed (T 1.3) Optimized Waste management processes 1.6 Kgs Per occupied bed (T 1.56) By improving access to care, digitising patient safety & experience and building the workforce for tomorrow 25,000+ Doctors, nurses, and paramedical trained by 2030 1310 (T 1300) 4000+ Underprivileged academically bright students, aspiring to become doctors by 2030 663 (T 450) A Healthy Institution- + Touching lives of 20,000+ Govt. school children through cleanliness and hunger Feeding program by 2030. 5428 (T 2475) By fostering a culture of innovation & strong governance Industry leader In clinical Governance On Plan Ongoing 100% NABH & enterprise level JCI certified hospitals by 2025 Ahead of Plan 5000+ Decreasing disparities in access to care 5000 BMTS by 2030 5000 Heart Procedures for Children every year with Treatment Cost Waiver 3248 (T 3975) 1000+ Publications Greater than 1000 publications in Peer Reviewed Indexed Journals (in the 5 years ending Calendar Year 2025). 143 Publications YTD (T 150) D 50% less Paper use across patients by 2025 from 2023 5,60,000+ hours Person hours invested in Associate Development Programs, including upskilling by 2030 2.93 L Person Hours of training (T 2.87 L) Best in Class risk management Robust Risk Management Process On Plan Ongoing 6.3 Pages/ Patient YTD (T 5) Digitization For enhancing patient safety & experience On Plan Ongoing Cyber resilience Zero Trust Architecture by 2025 On Plan Ongoing 15#17Fils 11.5% Others 13.8% Shareholding Pattern As on 31st December 2023(1) Dlls 10.2% ESOP Trust 0.6% Promoter Group 63.9% (1) Percentages might not add up to 100% due to rounding off Total Number of Shares 204,360,804 Key Dlls Axis Asset Management ICICI Prudential Life Insurance Nippon Life India Asset Management Unifi Capital DSP Asset Management Key Flls Wellington Asset Management Vanguard Index Fund Mirae Asset Management Simcah Partners Franklin Templeton Asset Management 16#18Disclaimer and Contact Details No representation or warranty, express or implied is made as to, and no reliance should be placed on, the fairness, accuracy, completeness or correctness of such information or opinions contained herein. The information contained in this presentation is only current as of its date. Certain statements made in this presentation may not be based on historical information or facts and may be "forward looking statements", including those relating to the Company's general business plans and strategy, its future financial condition and growth prospects, and future developments in its industry and its competitive and regulatory environment. Actual results may differ materially from these forward-looking statements due to a number of factors, including future changes or developments in the Company's business, its competitive environment and political, economic, legal and social conditions in India. This communication is for general information purpose only, without regard to specific objectives, financial situations and needs of any particular person. This presentation does not constitute an offer or invitation to purchase or subscribe for any shares in the Company and neither any part of it shall form the basis of or be relied upon in connection with any contract or commitment whatsoever. The Company may alter, modify or otherwise change in any manner the content of this presentation, without obligation to notify any person of such revision or changes. This presentation can not be copied and/or disseminated in any manner. For further Information, please contact: Mr. Nishant Singh Vice President - Finance, Investor Relations, M&A +91 8369353821 [email protected] Mr. Vivek Agarwal Senior Manager - Investor Relations, M&A +91 9510756827 [email protected] [email protected] www.narayanahealth.org 17#19Take Care