Rating Rationale
August 04, 2020 | Mumbai
Kailash Healthcare Limited
Rating outlook revised to 'Stable'; ratings reaffirmed
 
Rating Action
Total Bank Loan Facilities Rated Rs.166 Crore
Long Term Rating CRISIL BBB+/Stable (Outlook revised from 'Positive' and rating reaffirmed)
Short Term Rating CRISIL A2 (Reaffirmed)
1 crore = 10 million
Refer to annexure for Details of Instruments & Bank Facilities
Detailed Rationale

CRISIL has revised its outlook on the long-term bank facilities of Kailash Healthcare Limited (KHC; part of the Kailash group) to 'Stable' from 'Positive' and reaffirmed the 'CRISIL BBB+' rating, and has reaffirmed its 'CRISIL A2' rating on the company's short-term facility.
 
The outlook revision reflects the likely impact of Covid-19 and the nationwide lockdown to contain the pandemic on the group's business risk profile because of reduced footfall and deferment of elective surgeries. Though footfall started to increase in July 2020 and was almost 60-70% of the pre-pandemic level, the loss of revenue in the first quarter of fiscal 2021 and high proportion of fixed cost will result in lower revenue and operating margin for the fiscal. The Kailash group generated revenue of Rs 66.57 crore in the first quarter of fiscal 2021 as against Rs 90 crore in the year-ago period. Operating margin is expected to decline by 250-350 basis points in fiscal 2021. This will likely to result in a sharp drop in return on capital employed (RoCE).
 
CRISIL believes faster-than-expected return to normalcy may contain the impact on business performance. The group will benefit from its established position in the healthcare sector, steady ramp-up of operations in newly opened hospitals, and adequate net cash accrual to meet fixed debt obligation (cushion of 1.50 times) despite the expected decline in profitability and revenue.
 
The ratings continue to reflect the group's established presence in the healthcare sector backed by presence in multiple states, extensive experience of the promoters, and healthy financial risk profile. These strengths are partially offset by exposure to risks related to stabilisation and ramp-up of operations at new hospitals, large working capital requirement, and intense competition in the healthcare industry.

Analytical Approach

For arriving at the ratings, CRISIL has combined the business and financial risk profiles of KHC and Kailash Hospitals Ltd (KHL). This is because the entities, together referred to as the Kailash group, have considerable operational and financial linkages, are in the same business, and have a common brand. Furthermore, KHC holds 55.8% stake in KHL.

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

Key Rating Drivers & Detailed Description
Strengths:
* Established presence in the healthcare industry: The group has been offering multi-specialty tertiary healthcare services since 1995, and has one hospital each in Noida and Greater Noida in Uttar Pradesh and at Behror in Rajasthan, with 325, 250 and 250 beds, respectively. It set up three more hospitals, in Dehradun, Uttarakhand; Khurja, Uttar Pradesh; and at Sector 71 in Noida with 300, 110 and 200 beds, respectively, in the past five years. The hospital at Sector 71 commenced operations in January 2020. Revenue, though constrained by early stage of operations at the new hospitals, was Rs 382 crore in fiscal 2020. Revenue is expected to decline in fiscal 2021 because of the lockdown to contain Covid-19. However, with revival in demand, revenue should clock decent growth in fiscal 2022.
 
* Promoters' extensive experience: The key promoter, Dr Mahesh Kumar Sharma, has experience of over three decades, which will support the business risk profile. Dr Sharma obtained his Bachelor of Medicine, Bachelor of Surgery (MBBS) degree from the University College of Medical Sciences, and Diploma in Public Health and Hygiene (DPHH) from New Delhi (1984). Over the years, the promoters have set up hospitals in different cities and have successfully managed them.
 
* Healthy financial risk profile: Networth was Rs 124.18 crore as on March 31, 2020, driven by steady accretion to reserve. Total outside liabilities to tangible networth ratio, despite the ongoing capex, was comfortable at 2.25 times as on March 31, 2020, and is expected below 2 times over the medium term with repayment of term loan and sustained accretion to reserve. Interest coverage and net cash accrual to adjusted debt ratio were 4.2 times and 0.17 time, respectively, in fiscal 2020.
 
Weaknesses:
* Risks related to stabilisation and ramp-up in operations at new hospitals: The hospitals in Khurja and Sector-71, Noida (which began operations in January 2020), will take a couple of years to break even and cash flow from these projects will be negative in the interim. Furthermore, the revenue of the group depends largely on the older hospital in Noida, as the other hospitals are still under utilised.
 
* Exposure to intense competition in the healthcare industry: The group operates under the Kailash Hospitals brand. Although the hospitals are in diverse locations, they face intense competition from established players, such as Fortis Healthcare Ltd and Metro Specialty Hospital Pvt Ltd, especially given the image-sensitive nature of the healthcare industry. Revenue and profitability will remain constrained because of intense competition.
 
* Large working capital requirement: Working capital cycle has improved but remains large, with gross current assets at 84 days as on March 31, 2020 (88 days a year earlier), driven by receivables of 73 days (78 days). Moreover, receivables arising from tie-ups with Central Government Health Scheme (CGHS) and Ex-servicemen Contributory Health Scheme (ECHS) were stretched to 180-270 days, leading to higher dependence on bank lines.
Liquidity Adequate

Bank limit utilisation averaged 90.59% over the 11 months through June 2020 and the group plans to enhance working capital lines by around Rs 3 crore for meeting the working capital requirement of the hospital in Greater Noida. Timely sanction of limits will remain a key rating sensitivity factor. Promoters and related parties have extended funding support in the form of unsecured loans, which stood at Rs 4.83 crore as on March 31, 2020. Need-based fund support from the promoters should continue. The group is likely to generate net cash accrual of around Rs 24 crore, adequate to meet debt obligation of Rs 15.77 crore, in fiscal 2021. Unencumbered cash and bank balance was Rs 1.94 crore as on March 31, 2020.

Outlook: Stable

CRISIL believes the Kailash group will continue to benefit from the extensive experience of the promoters and its established market position.
 
Rating sensitivity factors
Upward factors:
* Improvement in working capital cycle or enhancement in bank lines leading to bank limit utilisation below 70%
* Fast ramp-up and breakeven at new hospitals, leading to more-than-expected revenue and profitability
* Sustenance of revenue and profitability in fiscal 2021

Downward factors:
* Steeper-than-expected decline in revenue or profitability, resulting in net cash accrual below Rs 20 crore
* Stretch in realisation of payments, leading to increase in working capital requirement and higher utilisation of bank lines
* Larger-than-expected, debt-funded capital expenditure, weakening key credit metrics

About the Group

KHC was set up in 1993 by Dr Sharma as Kailash Hospital & Research Centre Ltd, and got its present name in fiscal 2008. The company operates multi-specialty hospitals in Noida and Behror. The Noida facility is approved by the National Accreditation Board for Hospitals. The company manages two hospitals under an operations and maintenance contract: Deepak Memorial Hospital & Medical Research Centre in East Delhi and Shri Swami Bhooma Nand Dharmarth Chikatsalya Research Institute in Haridwar, Uttarakhand. The hospitals in Khurja and Dehradun have been operational since March 2016 and December 2016, respectively.
 
KHL, incorporated in 1999, operates a multi-specialty hospital in Greater Noida. It also runs Kailash Institute of Naturopathy, Ayurveda, and Yoga, which offers a wide range of specialty treatments. KHC holds 55.8% stake in KHL, Uma Medicare Ltd holds 6.5%, and the Garg family the remainder.

Key Financial Indicators - Standalone
Particulars Unit 2020 2019
Revenue Rs crore 308.12 269.79
Profit after tax (PAT) Rs crore 7.81 6.65
PAT margin % 2.54 2.38
Adjusted debt/adjusted networth Times 1.31 1.10
Interest coverage Times 3.44 3.47

Any other information: Not applicable

Note on complexity levels of the rated instrument:
CRISIL complexity levels are assigned to various types of financial instruments and are included (where applicable) in the Annexure -- Details of Instrument in this Rating Rationale. For more details on the CRISIL complexity levels, please visit www.crisil.com/complexity-levels.
Annexure - Details of Instrument(s)
ISIN Name of instrument Date of allotment Coupon
rate (%)
Maturity date Issue size
(Rs cr)
Complexity Level Rating assigned with outlook
NA Bank guarantee NA NA NA 2.0 NA CRISIL A2
NA Cash credit NA NA NA 35.0 NA CRISIL BBB+/Stable
NA Term loan NA NA Sept-2027 129.0 NA CRISIL BBB+/Stable

Annexure - List of entities consolidated
Names of Entities Consolidated Extent of Consolidation Rationale for Consolidation
Kailash Healthcare Ltd and Kailash Hospitals Ltd Full Operational and financial linkages, and common business and brand. Kailash Healthcare Ltd holds 55.8% stake in Kailash Hospitals Ltd.
Annexure - Rating History for last 3 Years
  Current 2020 (History) 2019  2018  2017  Start of 2017
Instrument Type Outstanding Amount Rating Date Rating Date Rating Date Rating Date Rating Rating
Fund-based Bank Facilities  LT/ST  164.00  CRISIL BBB+/Stable      06-11-19  CRISIL BBB+/Positive  29-08-18  CRISIL BBB+/Positive  06-03-17  CRISIL BBB+/Stable  CRISIL BBB+/Stable 
                07-03-18  CRISIL BBB+/Positive       
Non Fund-based Bank Facilities  LT/ST  2.00  CRISIL A2      06-11-19  CRISIL A2  29-08-18  CRISIL A2  06-03-17  CRISIL A2  CRISIL A2 
                07-03-18  CRISIL A2       
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
Bank Guarantee 2 CRISIL A2 Bank Guarantee 2 CRISIL A2
Cash Credit 35 CRISIL BBB+/Stable Cash Credit 35 CRISIL BBB+/Positive
Term Loan 129 CRISIL BBB+/Stable Term Loan 129 CRISIL BBB+/Positive
Total 166 -- Total 166 --
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
Rating Criteria for the Pharmaceutical Industry
CRISILs Bank Loan Ratings
CRISILs Criteria for Consolidation
CRISILs Criteria for rating short term debt
The Rating Process

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