SESSION M13: THE SENIOR LIVING UNIVERSE: NOT-FOR-PROFIT ... · • Many factors contributing to...

B.C. Ziegler and Company | Member of SIPC & FINRA

SESSION M13: THE SENIOR LIVING UNIVERSE: NOT-FOR-PROFIT & FOR PROFIT

PRESENTED BY

Tom MeyersManaging DirectorZiegler

May 22, 2017

DISCLOSURE LANGUAGE1. The information contained herein is intended to be general, factual, and educational in nature, and does not reflect any

assumptions, opinions, or views of B.C. Ziegler and Company (“Ziegler”) with respect to the recipient municipal entity’s or obligated person’s particular situation. Further,

a) Ziegler is not recommending an action to the municipal entity or obligated person; b) Ziegler is not acting as an advisor to the municipal entity or obligated person and does not owe a fiduciary duty pursuant

to Section 15B of the Exchange Act to the municipal entity or obligated person with respect to the information and material contained in this communication;

c) Ziegler is acting for its own interests; andd) The municipal entity or obligated person should discuss any information and material contained in this communication

with any and all internal or external advisors and experts that the municipal entity or obligated person deems appropriate before acting on this information or material.

2. B.C. Ziegler and Company (“Ziegler”) seeks to serve as an underwriter on a future transaction and not as a financial advisor or municipal advisor. The information provided is for discussion purposes only in anticipation of being engaged to serve as underwriter.

3

• SELECT SENIOR LIVING TRENDS FOR 2017

TOPIC 1

• NOT-FOR-PROFIT SENIOR LIVING GROWTH TRENDS AND SCOPE

TOPIC 2

• FOR-PROFIT COMPETITION, GROWTH TRENDS AND SCOPE

TOPIC 3

• SENIOR LIVING CAPITAL MARKETS

TOPIC 4

AGENDA

TOPIC 1: SELECT SENIOR LIVING TRENDS FOR 2017

DRIVERS FOR NFP SENIOR LIVING CONSOLIDATION

5

Complexities of Healthcare

Leadership Turnover

Ability to Attract Talent/Wrkforce Mgmt.

Competition

Reinvestment Requirements

Technology Demands

Financial Pressure

Hospital Consolidation Pressure

Diversify Service Lines

2016-2017

Source: Ziegler Investment BankingGrowth Capital Needs

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

100,000

2010 2015 2020 2025 2030 2035 2040 2045 2050

(In

Tho

usan

ds)

65 Years & Over 75 Years & Over 85 Years & Over 100 Years & Over

Source: U.S. Census Bureau National Population Projections (released 2008, based on Census 2000)

DEMOGRAPHICS DEFINE THE MARKET LOOKING TO THE FUTURE

6

We Are Here

Sophistication• Do you have the scale needed to compete in the local

healthcare marketplace?• What expertise do you have regarding the ACA and payment

reform (bundles, etc.)?• Are you technologically advanced with data analytics,

outcome-based reporting, etc.?

Partnerships• Are you able to compete and be a player in the new models

of care emerging as a result of the ACA?• Are you engaged in any joint ventures, post-acute networks

or bundled-payment agreements?

COMPLEXITIES OF HEALTHCARE

7

44.2%

51.9%

84.6%

86.5%

0% 20% 40% 60% 80% 100%

Increase in consumers w/ treatmentplans that skip skilled care altogether

Narrowing of networks from areahospitals, physician groups

Decreased length of stays in skilledcare

Patients with a higher level of acuitythan in years' past

Is your organization experiencing any of the following regarding your healthcare setting? (% Yes Responses)

8Source: Ziegler CFO Hotline, August 2016

ZIEGLER CFO HOTLINE: POST-ACUTE ACTIVITIES

SN REVENUE & PATIENT MIX

9Source: National Investment Center for the Seniors Housing & Care Industry | Skilled Nursing Data Report; data through June 2016

• Three hospital/senior living partners• Interlude™ Restorative Suites is a new, holistic model of

transitional care - upscale, soothing environment with superior, clinically-integrated care, in-patient rehabilitation, and guest-focused hospitality for the body and mind alike

INTERLUDE RESTORATIVE SUITESMINNESOTA

10

• SNF market is bifurcating into newer physical plants w/ ST Medicare rehab focus vs. older SNFs focusing on long-term Medicaid patients

THE CHANGING FACE OF FOR-PROFIT POST-ACUTE

11

PRESSURES IMPACTING SKILLED NURSING OCCUPANCYFIVE-YEAR LOW IN Q4 2016

Source: National Investment Center for the Seniors Housing & Care Industry | Skilled Nursing Data Report; data through December 31, 2016

81.8%

12

• Many factors contributing to challenges:– An aging population; retirements– Increase in minimum wages– Department of labor overtime ruling– Pressure on immigration rules– Growth among for-profits

• Many providers are working together, partnering with schools and universities

• Efforts to better understand work preferences, traits of the Millennials

• Not just your workforce…workforce of your partners (e.g. impact on construction costs)

13Source: Ziegler Investment Banking; Argentum

Will need to recruit 1.2

million direct care

staff by 2025

STAFFING: A COMPLEX ISSUE

14

15.6%

53.0%

0% 10% 20% 30% 40% 50% 60%

Limit admissions b/c of staffingshortages

Work w/ temp agencies to fill directcare staff vacancies

Has your organization had to…

Limit admissions b/c of staffing shortagesWork w/ temp agencies to fill direct care staff vacancies

Source: Ziegler CFO Hotline, June 2016

WORKFORCE: A STRATEGIC IMPERATIVE

• Largest multi-sites are adding corporate-level positions in response– Pushing some added costs down to affiliates

• Corporate areas of specialty being added by the LeadingAge Ziegler 150 in 2015 (in order of mentions)

1. Chief Clinical/Health Officer2. Chief Information/Technology Officer3. Chief Talent/HR Officer4. Business Development/Strategy Officer5. Chief Compliance Officer6. Philanthropy/Foundation Director

DISRUPTORS & CATALYSTS DEMAND GREATER SCALE AND SOPHISTICATION

15Source: 2016 LeadingAge Ziegler 150 (Preliminary data)

• Currently the primary mode of growth for residential settings among not-for-profit senior living providers

– Systems coming together

– Two smaller organizations joining to form larger

– Single-sites joining a system

16

UNIT GROWTH NOT JUST FROM BUILDING NEW UNITS, BUT ALSO FROM SYSTEM GROWTH

Spon

sors

hip

Tran

siti

ons

Affiliations

Acquisitions

Dispositions

2912

2234

52 55 60

36

1524

36

6380

91

0

20

40

60

80

100

2010 2011 2012 2013 2014 2015 2016

Total by # of Transactions & # of Communities

Transactions Market-Rate Communities

Note: Includes market-rate communities; excludes government subsidizedSource: Ziegler Investment Banking 12/31/16

NOT-FOR-PROFIT CHANGE OF OWNER/SPONSORAFFILIATIONS, DISPOSITIONS, ACQUISITIONS, CLOSURES

17

7 7 5 411 14

19

12

75 4

1118

36

0

5

10

15

20

25

30

35

40

2010 2011 2012 2013 2014 2015 2016

NFP to NFP Sponsorship Transitions Only

Transactions Market-Rate Communities

Note: Includes market-rate communities; excludes government subsidizedSource: Ziegler Investment Banking 12/31/16

NOT-FOR-PROFIT CHANGE OF OWNER/SPONSORAFFILIATIONS, DISPOSITIONS, ACQUISITIONS, CLOSURES

18

SELECT NFP LPC SPONSORSHIP TRANSITIONS: 2016/17

Source: Ziegler Investment Banking

Year Organization New Sponsor FP/NFP State

2017 Cadbury at Lewes Springpoint Senior Living NFP to NFP DE

2016 Franciscan Oaks Springpoint Senior Living FP to NFP NJ

2016 Rockhill Community & Lutheran Community at Telford NFP to NFP PA

2016 Bishop Spencer Place St. Luke’s Hospital NFP to NFP MO

2016 Westchester Meadows Bethel Methodist Home NFP to NFP NY

2016 LutheranCare Presbyterian Homes & Services NFP to NFP NY

2016 Episcopal Church Home Episcopal Retirement Services NFP to NFP KY

2016 Wesley Manor BHI Senior Living NFP to NFP IN

2016 Glacier Hills Trinity Senior Communities NFP to NFP MI

2016 Asbury Place Asbury Communities NFP to NFP TN

2016 Shenango Presbyterian Presbyterian SeniorCare NFP to NFP PA

2016 Birch Hill Terrace RiverWoods NFP to NFP NH

2016 Sacred Heart Village Nazareth Home NFP to NFP KY

2016 ABHOW & be.group Human Good NFP to NFP CA19

TOPIC 2: NOT-FOR-PROFIT SENIOR LIVING GROWTH TRENDS AND SCOPE

21Sources: Ziegler National CCRC Listing & Profile, LeadingAge, NIC MAP® Data and Analysis Service, The National Center for Health Statistics, Centers for Medicare and Medicaid Services

TODAY’S RETIREMENT OPTIONSA LOOK AT SENIORS HOUSING SUPPLY

• 1,961 communities 600,000 unitsLife Plan Communities

• 4,800 programs 289,400 participants/dayAdult Day Programs

• 4,000 agencies 1.34 mill discharged/yr.Hospice

• 15,600 homes 1,663,000 units Nursing Homes

• 1,100 communities 53,000 unitsFreestanding Memory Care

• 30,200 communities 1million residentsAssisted Living/ Residential Care

• 12,400 agencies 4.9 mill discharged/yr.Home Health

• 1,100 properties 184,000 unitsIL Housing 3%

15%

17%

22%

24%

26%

51%

80%

% NFP

TYPICAL LIFE PLAN COMMUNITY PROFILE

22

NFP: 80%FP: 20%

Single-sites: 38.1%Multi-Sites: 61.9%

Avg # of Units: 283

# Affiliated w/a Health System:

108

Source: Ziegler National CCRC Database

LPCs

23Source: 2016 LeadingAge Ziegler 150

• Represents the Largest 150 Not-for-Profit Sr Living Multi-site Providers

• Range from 18,527 market-rate units (National Senior Campuses) to 588 units (St. John’s Lutheran Ministries)

• Represents a total of 1,253 market-rate communities

2016 LEADINGAGE ZIEGLER 150

Accessible via Ziegler & LeadingAge websites

2016 LZ 150ANALYSIS OF THE DATA: SYSTEM HEADQUARTERSHEADQUARTERS’ LOCATIONS BY SIZE (TOTAL UNITS)

24Source: 2016 LeadingAge Ziegler 150 Publication (data as of 12/31/15)

588+ Units (Top 150)

3,250+ Units (Top 10)

1,970+ Units (Top 25)

1,350+ Units (Top 50)

780+ Units (Top 100)

Top 10Top 25Top 50Top 100Top 150

2016 LEADINGAGE ZIEGLER 150THE NATION'S LARGEST NOT-FOR-PROFIT MULTI-SITE SENIOR LIVING ORGANIZATIONS

RANKED BY TOTAL SENIOR LIVING UNITS

25Source: Preliminary 2016 LeadingAge Ziegler 100 Publication (data as of 12/31/15)

2016

Ran

k

2015

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System Name State Total ILU ALU NCB Total LPC IL AL NH1 1 National Senior Campuses MD 18,527 15,873 1,370 1,284 15 15 0 0 02 2 The Evangelical Lutheran Good Samaritan Society SD 17,822 5,013 2,286 10,523 168 69 8 8 833 3 ACTS Retirement Services, Inc. PA 7,933 5,591 901 1,441 21 21 0 0 04 4 Presbyterian Homes and Services MN 7,056 3,503 2,127 1,426 42 12 23 4 35 NR Benedictine Health MN 5,270 625 1,484 3,161 39 24 1 5 96 5 Covenant Retirement Communities IL 5,015 3,146 885 984 18 14 1 2 17 NR Ascension Senior Living MO 4,748 925 833 2,990 26 8 2 2 148 6 Retirement Housing Foundation CA 4,099 2,636 868 595 18 9 8 1 09 7 Lifespace Communities, Inc. IA 4,052 3,069 154 829 12 12 0 0 010 NR Trinity Senior Living Communities MI 3,745 1,184 633 1,928 20 5 4 1 1011 8 The Kendal Corporation PA 3,726 2,522 666 538 15 13 2 0 012 NR Presence Life Connections IL 3,558 1,021 369 2,168 21 6 1 0 1413 11 Presbyterian Senior Living PA 3,434 1,808 499 1,127 20 12 6 2 014 9 Lutheran Senior Services MO 3,326 1,614 709 1,003 11 8 0 1 215 12 Cornerstone Affiliates CA 3,318 1,984 646 688 12 12 0 0 016 10 Westminster Communities of Florida FL 3,254 2,027 476 751 9 9 0 0 017 14 Ohio Presbyterian Retirement Services OH 3,178 1,686 574 918 12 12 0 0 018 17 Asbury Communities MD 2,914 1,932 335 647 6 5 0 0 119 15 Pacific Retirement Services OR 2,856 2,116 333 407 9 8 1 0 020 16 Front Porch Communities and Services CA 2,782 1,873 369 540 10 5 5 0 021 18 Presbyterian Manors of Mid-America, Inc. KS 2,471 926 590 955 18 16 0 1 122 20 Masonic Villages of the Grand Lodge of Pennsylvania PA 2,434 1,496 254 684 5 3 1 0 123 19 Diakon Lutheran Social Ministries PA 2,419 919 529 971 9 9 0 0 024 21 Volunteers of America VA 2,404 531 723 1,150 25 4 3 9 925 13 Ecumen MN 2,393 290 1,477 626 36 0 4 24 8

Units(as of 12/31/15)

Communities(as of 12/31/15)




2016

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2015

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System Name State Total ILU ALU NCB Total LPC IL AL NH26 22 Christian Homes, Inc. MO 2,104 386 244 1,474 13 11 0 1 127 23 Shell Point FL 2,085 1,368 389 328 2 2 0 0 028 24 Willow Valley Communities PA 2,027 1,530 222 275 3 3 0 0 029 25 Springpoint Senior Living, Inc. NJ 1,967 1,429 271 267 6 6 0 0 030 26 Franciscan Communities, Inc. IL 1,946 733 438 775 8 4 1 3 031 27 Augustana Care MN 1,941 0 1,160 781 18 0 0 12 632 31 Otterbein Senior Lifestyle Choices OH 1,919 730 382 807 13 5 0 0 833 28 Concordia Lutheran Ministries PA 1,898 554 965 379 12 5 0 6 134 30 National Church Residences OH 1,860 779 539 542 12 5 2 4 135 29 Senior Quality Lifestyles Corporation TX 1,858 1,130 419 309 6 6 0 0 036 32 Christian Care Companies AZ 1,842 1,434 342 66 5 1 3 1 037 48 Greencroft Communities IN 1,779 635 534 610 8 7 1 0 038 36 Hebrew SeniorLife MA 1,764 659 159 946 4 2 1 0 139 NR ArchCare NY 1,738 1,337 59 342 5 1 4 0 040 33 Elim Care, Inc. MN 1,707 197 452 1,058 24 0 4 9 1141 34 Homewood Retirement Centers MD 1,694 965 278 451 5 4 1 0 042 35 Providence Life Services IL 1,603 665 360 578 8 3 2 1 243 65 Presbyterian SeniorCare PA 1,593 398 520 675 7 4 0 2 144 49 Bethesda Health Group, Inc. MO 1,588 708 18 862 10 0 6 0 445 38 The New Jewish Home fka Jewish Home Lifecare NY 1,585 24 0 1,561 4 0 1 0 346 40 Episcopal Senior Communities CA 1,572 1,076 120 376 6 6 0 0 047 42 Loretto NY 1,498 282 593 623 8 1 2 4 148 41 Magnolia Manor GA 1,483 339 335 809 8 2 4 1 149 43 Bethesda Senior Living Communities CO 1,482 155 1,327 0 17 0 2 15 050 NR Covenant Health MA 1,476 0 364 1,112 12 0 0 4 8






2016

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2015

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System Name State Total ILU ALU NCB Total LPC IL AL NH51 53 Lutheran Life Ministries IL 1,473 408 370 695 6 6 0 0 052 37 Buckner Retirement Services, Inc TX 1,468 845 267 356 7 5 2 0 053 45 Mississippi Methodist Senior Services, Inc. MS 1,452 778 354 320 12 2 8 0 254 46 WesleyLife IA 1,441 684 302 455 7 7 0 0 055 47 Holland Home MI 1,434 723 450 261 4 2 0 1 156 44 Presbyterian Homes IL 1,423 841 217 365 5 3 1 1 057 39 Eskaton CA 1,409 335 648 426 12 2 2 5 358 50 be.group CA 1,344 844 269 231 7 6 0 1 059 57 SantaFe Senior Living, Inc. FL 1,306 876 316 114 3 3 0 0 060 52 Baptist Village Communities OK 1,285 779 181 325 8 3 5 0 061 54 Masonicare CT 1,264 458 277 529 5 1 1 1 262 60 Friendship Senior Options IL 1,243 770 182 291 2 2 0 0 063 51 Wesley Enhanced Living PA 1,235 629 246 360 6 5 0 1 064 59 Phoebe - Devitt Homes PA 1,230 374 175 681 4 4 0 0 065 55 Lutheran Services Carolinas, Inc NC 1,230 244 254 732 9 1 1 1 666 58 Virginia United Methodist Homes, Inc. VA 1,227 514 435 278 7 6 0 1 067 74 United Church Homes, Inc. OH 1,227 310 193 724 9 5 1 0 368 61 American Baptist Homes of the Midwest MN 1,200 374 209 617 8 4 1 2 169 64 SpiriTrust Lutheran fka Lutheran Social Services of South Central Pennsylvania PA 1,191 554 303 334 6 6 0 0 070 62 Virginia Baptist Homes VA 1,179 741 221 217 4 4 0 0 071 98 BHI Senior Living, Inc. IN 1,179 257 601 321 4 4 0 0 072 63 Integrace MD 1,150 645 228 277 4 3 0 1 073 66 Heritage Communities fka United Methodist Memorial Home IN 1,124 263 513 348 3 3 0 0 074 67 Lutheran SeniorLife PA 1,106 472 192 442 7 2 5 0 075 70 Lutheran Homes of South Carolina SC 1,073 405 308 360 5 5 0 0 0






2016

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2015

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System Name State Total ILU ALU NCB Total LPC IL AL NH76 78 Northern California Presbyterian Homes and Services, Inc. CA 1,062 818 103 141 4 3 1 0 077 68 United Methodist Homes NY 1,055 366 263 426 4 3 0 1 078 85 Eventide MN 1,054 71 402 581 6 1 1 3 179 69 Walker Methodist MN 1,034 493 165 376 6 1 4 1 080 71 The United Methodist Homes of New Jersey NJ 1,026 88 686 252 5 1 0 4 081 72 Elant NY 995 148 144 703 6 1 0 1 482 73 Blue Skies of Texas TX 988 732 129 127 2 2 0 0 083 106 Methodist Retirement Communities TX 974 433 288 253 5 5 0 0 084 76 The Presbyterian Homes, Inc. NC 958 636 133 189 3 3 0 0 085 77 United Church Homes and Services NC 954 536 90 328 3 3 0 0 086 75 Presby's Inspired Life PA 940 474 206 260 4 2 0 1 187 79 The United Methodist Retirement Homes, Inc. NC 932 622 108 202 3 3 0 0 088 80 Menno Haven PA 920 531 177 212 3 2 1 0 089 NR Vista Prairie Communities MN 917 100 817 0 10 0 0 10 090 81 Liberty Lutheran Services PA 902 384 301 217 4 3 0 1 091 101 Morningside Ministries TX 890 385 182 323 3 3 0 0 092 82 VMP WI 889 447 205 237 2 2 0 0 093 83 Westminster Ingleside Retirement Communities DC 885 607 113 165 3 3 0 0 094 84 Oakwood Lutheran Senior Ministries WI 885 588 160 137 2 2 0 0 095 88 Presbyterian Communities of South Carolina SC 881 282 315 284 5 5 0 0 096 97 Cedar Community (Benevolent Corporation Cedar Community) WI 872 417 240 215 6 1 2 2 197 90 Christian Care Communities, Inc. KY 864 185 96 583 5 3 1 1 098 86 St. Ann's Community NY 863 246 75 542 2 2 0 0 099 87 Living Branches PA 850 461 246 143 3 2 0 1 0100 109 Sun Health Senior Living LLC AZ 844 637 61 146 3 3 0 0 0






2016

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2015

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System Name State Total ILU ALU NCB Total LPC IL AL NH101 89 Presbyterian Communities and Services TX 843 329 134 380 2 2 0 0 0102 91 Simpson Senior Services PA 839 494 153 192 3 3 0 0 0103 92 Goodwin House Incorporated VA 832 583 100 149 2 2 0 0 0104 56 Presbyterian Villages of Michigan MI 832 542 200 90 7 1 6 0 0105 93 Los Angeles Jewish Home CA 831 50 271 510 3 1 1 0 1106 95 Givens Estates NC 818 597 77 144 2 2 0 0 0107 94 Luthercare PA 811 474 126 211 3 2 0 0 1108 96 Heritage Ministries NY 808 253 122 433 9 1 3 2 3109 99 Western Home Communities IA 790 420 238 132 3 1 2 0 0110 100 The Ohio Masonic Home OH 781 338 249 194 3 2 1 0 0111 104 Sunnyside Presbyterian Home VA 779 500 129 150 3 3 0 0 0112 103 Lutheran Social Services of Michigan MI 770 294 120 356 5 1 2 0 2113 105 Life Enriching Communities OH 763 467 137 159 2 2 0 0 0114 115 Wesley Willows IL 749 488 170 91 2 1 1 0 0115 107 Garden Spot Village PA 747 542 86 119 2 1 0 0 1116 108 Christian Care Senior Living Communities TX 747 386 138 223 2 2 0 0 0117 110 Christian Living Ventures CO 744 414 152 178 3 3 0 0 0118 112 Landis Communities PA 743 491 149 103 3 1 1 1 0119 111 Mather LifeWays IL 741 624 46 71 3 2 1 0 0120 113 Wellspring Lutheran Services MI 736 128 224 384 10 1 3 2 4121 114 Luther Manor WI 732 366 156 210 2 1 0 1 0122 128 National Lutheran Communities & Services MD 713 417 120 176 3 2 0 1 0123 116 Lutheran Homes Society OH 702 142 171 389 5 2 1 0 2124 NR Methodist ElderCare Services OH 700 338 256 106 2 2 0 0 0125 NR Christian Village Communities OH 698 327 245 126 2 2 0 0 0






2016

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System Name State Total ILU ALU NCB Total LPC IL AL NH126 134 Sunset Manor, Inc. (Sunset Retirement Communities and Services) MI 698 304 225 169 4 2 0 1 1127 117 Saint Therese MN 698 300 76 322 3 2 0 1 0128 123 Messiah Lifeways PA 695 354 157 184 2 1 1 0 0129 118 Episcopal SeniorLife Communities NY 690 377 131 182 8 0 5 2 1130 119 Wesley Homes WA 688 453 87 148 2 2 0 0 0131 NR Christian Health Care Center NJ 681 297 92 292 2 1 1 0 0132 121 CRISTA Senior Ministries WA 680 382 131 167 2 1 1 0 0133 124 Lutheran Social Ministries of New Jersey, Inc. NJ 678 281 130 267 2 1 0 0 1134 126 Vincentian Collaborative Services PA 675 66 82 527 4 2 0 0 2135 127 Presbyterian Retirement Communities Northwest WA 668 474 132 62 4 3 1 0 0136 129 Maple Knoll Communities OH 667 369 91 207 2 2 0 0 0137 130 LifeStream Complete Senior Living AZ 661 357 144 160 5 1 2 0 2138 146 Albright Care Services PA 658 279 89 290 2 2 0 0 0139 120 St Andrew's Resources for Seniors MO 652 334 135 183 4 2 1 0 1140 132 LindenGrove, Inc. WI 650 189 461 9 0 0 5 4141 122 Masonic Homes of Kentucky, Inc. KY 638 248 147 243 3 1 1 0 1142 133 The Loomis Communities MA 634 426 74 134 4 3 1 0 0143 131 United Methodist Homes, Inc. CT 627 90 417 120 4 1 0 3 0144 137 Baptist Retirement Homes of North Carolina, Inc. NC 621 272 140 209 4 2 0 2 0145 136 Porter Hills MI 619 353 116 150 3 1 1 1 0146 125 Lutheran Life Villages IN 616 150 70 396 3 1 0 0 2147 138 Smith Senior Living IL 614 325 143 146 2 2 0 0 0148 NR Moorings Park FL 598 416 76 106 2 1 1 0 0149 135 Deaconess Abundant Life Communities MA 598 377 138 83 5 3 1 1 0150 141 St. John's Lutheran Ministries MT 588 145 257 186 5 4 1 0 0



31

$0

$200

$400

$600

$800

$1,000

$1,200

Total Revenue ($MM)

2016 LZ 150 “TOP 25” RATED SYSTEMSTOTAL REVENUE ($MM)

Note: Metrics calculated from each respective borrower’s most recent audited financials or covenant compliance certificates. Springpoint’s financials not available publicly.

32

$0

$50

$100

$150

$200

$250

$300

$350

$400

Total Revenue ($MM)

2016 LZ 150 “TOP 25” RATED SYSTEMSTOTAL REVENUE ($MM)

Note: Metrics calculated from each respective borrower’s most recent audited financials or covenant compliance certificates. Springpoint’s financials not available publicly.

Excludes Evangelical Lutheran Good Samaritan Society

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

55,000

60,000

1980 1985 1990 1995 2000 2005 2010 2015

Uni

ts

Year

ILU ALU NCB All Units

All other organizations pre-1980

2016 LZ 150GROWTH: GROWTH OF LARGEST 100 SYSTEMS, COMBINED UNIT MIXFROM 1980 (EXCLUDES EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY)

Partial histories used if complete data was unavailable


2016 LZ 150SYSTEM PRIMARY GEOGRAPHIC CLASSIFICATIONS

Source: 2016 LeadingAge Ziegler 150 Publication (Preliminary data) 34

National Across States

Bi- or Tri-state

Single State

State Region Metro Sub-metro

10.0%

3.3%

15.4%

28.7%

18.6%20.7%

3.3%

NFP SENIOR LIVING GROWTH & EVOLUTION IN 2017

35

NFP SL Growth

Expansions/Repositionings

New Community Locations

Sponsorship Transitions

HCBS Offerings

Joint Ventures


38.0%

71.5%

36.0%

76.5%

0.0% 20.0% 40.0% 60.0% 80.0% 100.0%

New community locations (affiliationsor development)

Expansion or repositioning of existingcommunity

Percentage of LZ 150 who plan to grow through…

2016 2015

GROWTH PLANS OVER THE NEXT TWO YEARS

36Source: 2015 & 2016 LeadingAge Ziegler 150 Publication s

NFP SUCCESS BEYOND RESIDENTIAL SETTINGS

37Source: 2016 LeadingAge Ziegler 150

70% of the LZ150 with HCBS are below $10 million annually in HCBS revenue

Age

Income

Services

THE POTENTIAL NOT-FOR-PROFIT FULL-SERVICE SENIOR LIVING MODEL

38

Market Rate IL – hospitality focus

Moderate Independent Living

Assisted Living

Memory Care

Skilled Nursing, post-acute

Skilled Nursing, Medicaid

Government Subsidized

Continuing Care at Home

Home Health

Home Care

Concierge

PACE

Hospice

Adult Day

Home Maintenance


Maximization of partnerships in the region

TOPIC 3: FOR-PROFIT COMPETITION, GROWTH TRENDS AND SCOPE

IN THE PIPELINE: SENIOR HOUSING CONSTRUCTION PROJECTS (5/18/17)

40

SENIOR HOUSING DEVELOPERS SET SIGHTS ON PHOENIX…land near Phoenix…$40 million community called Park at Copper Creek Independent Living…135-unit community… pool and grilling area …bistro, theater, fitness center, beauty salon and spa, crafts, game rooms, library, and private dining…

MORE SENIOR HOUSING TAKING SHAPE NEAR ATLANTA …close to Atlanta…mixed-use project would include new senior housing…retail space, a daycare, an elementary school, and apartments…

ASSISTED LIVING COMMUNITY PLANNED IN OHIO …StoryPoint…communities in Michigan and Ohio, seeks to build a new community with more than 200 independent living, assisted living, and memory care units,

SENIOR HOUSING PLANNED IN PHILLY…$147 million on a new community in Philadelphia. New Courtland Senior Services …build new housing and a care center for seniors.

WORKERS BREAK GROUND ON $27 MILLION SENIOR COMMUNITY IN GEORGIA …$27 million project…Savannah Quarters…10 acres…124 residents…spa and wellness center, farm-to-table dining, wine storage, a full-service salon…

MUSTANG CREEK ESTATES TO OPEN FIFTH DALLAS-AREA PROPERTY…$7.5 million assisted living and memory care community in Sachse, Texas…six homes that can house up to 16 seniors apiece…

SENIOR HOUSING COMING TOGETHER NEAR TEXAS A&M UNIVERSITY CAMPUS…159 senior living apartments…independent living, assisted living, and memory care units…14-acre wooded site…

DOMINION SENIOR LIVING BREAKS GROUND ON COMMUNITY IN SOUTH CAROLINA…$9.5 million senior living community…room for 60 seniors in assisted living and memory care apartments.

CENTRAL IOWA TO GET MORE ASSISTED LIVING AND MEMORY CARE UNITS…The Willows of Marshalltown…58 assisted living and memory care units…$13.3 million…expected to open in the summer of 2018.

SENIOR LIFESTYLE CORPORATION TO OPEN COMMUNITY IN OHIO…Mason, Ohio…The Sheridan at Mason…accepting reservations for 101 studio, one- and two-bedroom apartment homes, which include assisted living and memory care units…access to chef-prepared meals, a bistro…

SENIOR LIVING COMMUNITY TO HOST GRAND OPENING IN SOUTHERN LOUISIANA…ceremony to celebrate its grand opening…

RENOVATIONS WRAP UP AT WISCONSIN COMMUNITY Samaritas Senior Living, formerly Luther Manor, has finished its first round of renovations…added 19 new private rehabilitation rooms…more phases to go…entire project is slated to finish by summer of next year.

Pla

nn

edIn

Pro

gre

ssC

omp

lete

For-Profit

NFP

Govt.

FOR-PROFITS DOMINATE THE BROADER SECTOR AND ARE RAPIDLY GROWING

41Data Sources: Ziegler National CCRC Listing & Profile, LeadingAge, NIC MAP® Data and Analysis Service, The National Center for Health Statistics, Centers for Medicare and Medicaid Services

72%

25.5%

2.5%

42Source: NIC MAP® Data & Analysis Service, as of 3/31/17 © National Investment Center for the Seniors Housing & Care Industry | www.NICMAP.org

FOR-PROFIT DEVELOPMENT REMAINS STRONG

42

0

50

100

150

200

250

300

350

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Num

ber o

f Pro

pert

ies

With

Con

stru

ctio

n

Seniors Housing Construction by Profit Status; MAP314Q05 – 1Q17

Not-For-Profit

For-Profit

0%

2%

4%

6%

8%

10%

12%

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Construction vs. Inventory; MAP31Seniors Housing | 4Q05 – 1Q17

For-Profit Independent Living*

For-Profit Assisted Living*

Not-for-Profits

43

* Excludes not-for-profits and CCRCs

FOR-PROFIT GROWTH NOT JUST AL/MEMORY CARE INDEPENDENT LIVING COMING ON STRONG

Source: NIC MAP® Data & Analysis Service, as of 3/31/17 © National Investment Center for the Seniors Housing & Care Industry | www.NICMAP.org 43

44

NATIONAL OCCUPANCY IS GENERALLY HIGH

83%

85%

87%

89%

91%

93%

95%

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Seniors Housing Occupancy by Profit Status; MAP314Q05 – 1Q17

Not-For-Profit

For-Profit

Source: NIC MAP® Data & Analysis Service, as of 3/31/17 © National Investment Center for the Seniors Housing & Care Industry | www.NICMAP.org

LIFE PLAN COMMUNITIES EVEN BIGGER ADVANTAGE

83%

85%

87%

89%

91%

93%

95%

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

CCRC Occupancy by Profit Status; MAP314Q05 – 1Q17

Not-For-Profit

For-Profit

4.94%

Source: NIC MAP® Data & Analysis Service, as of 3/31/17 © National Investment Center for the Seniors Housing & Care Industry | www.NICMAP.org 45

46

LIFE PLAN COMMUNITIES BY STATENOT-FOR-PROFIT VS FOR-PROFIT

Not-For-ProfitFor-Profit

174

92

2015

13327

3011

CT: 28, 11

DC: 6, 1DE: 12, 6

10937

235

HI: 5, 2

71, 8

74

11318

6718

74, 10

80

MA: 31, 8

MD: 43, 6

74

417

643

5213

41

4, 0 6, 0

18, 0

65, 21

19, 2

NH: 19, 3VT: 2, 0

RI: 8, 5NJ: 39, 5

113

21 0

1

9427

0, 0

21, 5

31, 5

21, 5

15046

197,20

59,761

4116

495

Source: Ziegler Investment Banking as of 2/25/16

HCR ManorCare, Toledo, OH

• 63 Communities in 29 States– AZ, CA, CO, CT, DE, FL, GA,

IA, IN, KS, KY, MD, MI, MN, MO, NC, ND, NJ, NM, NV, OH, OK, PA, SC, SD, TX, VA, WA, WI

• 4,403 Total Units– 55+ Community– Independent Living– Assisted Living– Skilled Nursing– Memory Care

47

SENIOR LIVING SECTOR: FOR-PROFIT

www.hcr-manorcare.com

Source: Argentum 2016 Largest Senior Living Providers

48

SENIOR LIVING FP SECTOR:HCR MANORCARE

Source: www.hcr-manorcare.com

IndianaManorCare Health Services-Indy South, IndianapolisHeartland Hospice Serving Terre Haute & Surrounding CountiesManorCare Health Services-Prestwick, AvonHeartland Hospice Serving Central Indiana, IndianapolisManorCare Assisted Living of Summer Trace, CarmelManorCare Health Services of Summer Trace, CarmelManorCare Health Services-AndersonHeartland Home Health Care Serving Northeast Indiana, Fort WayneHeartland Hospice Serving Northeast Indiana, Fort WayneHeartland Hospice Serving North Central Indiana, Mishawaka

KentuckyHeartland Rehabilitation Services of KY-LondonHeartland Rehabilitation Services of KY-EdmontonHeartland Rehabilitation Services of KY-GlascowHeartland Rehabilitation Services of KY-BereaHeartland Rehabilitation Services of KY-Horse CaveHeartland Rehabilitation Services of KY-RichmondHeartland Rehabilitation Services of KY-MurrayArden Courts of LouisvilleHeartland of LouisvilleHeartland Rehabilitation Services of KY-PaducahHeartland Rehabilitation Services of KY-Alexandria

49



Ohio (cont’d)The Village at Westerville (Ret. Ctr.) Heartland of WestervilleHeatland Hospice Serving Central Ohio, ColumbusHeartland Home Health Care Serving Central Ohio,

ColumbusHeartland of DublinHeartland of Uptown WestervilleHeartland of UrbanaHeartland of MarysvilleHeartland of PiquaHeartland of CenterburgHeartland of GreenvilleHeartland of BellefontaineHeartland of MarionHeartland Home Health Care Serving Central Ohio,

MarionHeartland Hospice Serving Central Ohio, MarionHeartland of Indian Lake (Rehab Ctr). LakeviewManorCare Health Services-Belden Village, CantonHeartland of BucyrusHeartland Hospice Serving Northeast Ohio, AkronManorCare Health Services-BarbertonManorCare Health Services-AkronArden Courts of Bath, AkronHeartland of TwinsburgManorCare Health Services-Parma, ClevelandArden Courts of Parma, ClevelandHeartland Home Health Care Serving Northeast Ohio,

IndependenceHeartland Hospice Serving Northeast Ohio,

IndependenceHeartland Hospice Serving Northwest Ohio, FremontArden Courts of Chagrin FallsManorCare Health Services-North OlmstedArden Courts of Westlake

OhioHeatland of Riverview, South PointHeartland of PortsmouthHeartland Hospice Serving Southern Ohio, Oak HillHeartland Home Health Care Serving Southern Ohio,

LucasvilleHeartland Hospice Serving Southern Ohio, LucasvilleHeartland of JacksonArden Courts of Anderson Twp, CincinnatiHeartland of HillsboroHeartland of ChillicotheHeartland Hospice Serving Southwest Ohio, CincinnatiHeartland of MadeiraArden Courts of Kenwood, CincinnatiHeartland of MariettaHeartland of Mt. Airy, CincinnatiHeartland of Woodridge, FairfieldHeartland of Woodridge (1), FairfieldHeartland Hospice Serving Central Ohio, CirclevilleHeartland of Fairfield, PleasantvilleHeartland of CentervilleHeartland of MiamisburgHeartland of KetteringHeatland Hospice Serving Miami Valley, KetteringHeartland – Beavercreek, DaytonHeartland Rehabilitation Services of OH-Grove CityHeartland of EatonHartland of Victorian Village, ColumbusHeartland Rehabilitation Services of OH-ORS NewarkHeartland Home Health Care Serving Central Ohio,

NewarkHeartland of Lansing, BridgeportHeartland of Springfield, SpringfieldHeartland Rehabilitation Services of OH-New Albany,

Columbus

Ohio (Cont’d)ManorCare Health Services-Rocky River,

ClevelandManorCare Health Services-Mayfield HeightsManorCare Health Services-Euclid Beach, ClevelandHeartland of WatervilleManorCare Health Services-WilloughbyHeartland of MentorHeartland Rehabilitation Services of OH-PerrysburgHeartland of PerrysburgPerrysburg CommonsHeartland Health Care PerrysburgHeartland Rehabilitation Services of OH-Arrowhead,

MaumeeHeartland of WauseonHeartland Rehabilitation Services of OH-OregonHeartland of OregonHeartland Rehabilitation Services of OH-Westgate,

ToledoHeartland Hospice Serving Northwest Ohio, PerrysburgHeartland - Holly Glen, ToledoHeartland of ProMedica, SylvaniaHeartland Health Care Center-Canton (1), CantonHeartland Health Care Center-Canton, Canton

50



MinnesotaHeartland Hospice Serving Minnesota South, RochesterHeartland Home Health Care Serving Twin Cities, RosevilleHeartland Hospice Serving Twin Cities, RosevilleHeartland Hospice Serving Minnesota North, Sauk RapidsHeartland Hospice Serving Minnesota North, Brainerd

WisconsinManorCare Health Services-KenoshaHeartland Home Health Care Serving Southeastern Wisconsin, KenoshaHeartland Hospice Serving Southeastern Wisconsin, KenoshaHeartland Hospice Serving Southeastern Wisconsin, MilwaukeeHeartland Home Health Care Serving Southeastern Wisconsin, MilwaukeeManorCare Health Services-Pewaukee, WaukeshaHeartland Hospice Serving South Central Wisconsin, MadisonManorCare Health Services-PlattevilleHeartland Hospice Serving East Central Wisconsin, Fond du LacManorCare Health Services-Fond du LacManorCare Health Services-WaterlooManorCare Health Services-AppletonHeartland Hospice Serving Northeastern Wisconsin, DePereHeartland Home Health Care Serving Northeastern Wisconsin, DePereManorCare Health Services-East Green BayManorCare Health Services-West Green BayManorCare Health Services-ShawanoHeartland Hospice Serving Central Wisconsin, Stevens Point

IllinoisHeartland Hospice Serving Fairview HeightsHeartland Health Care Center-ChampaignHeartland Health Care Center-DecaturHeartland Health Care Center-PaxtonHeartland Health Care Center-NormalManorCare Health Services-KankakeeRiverview Senior Living Community, East PeoriaHeartland Health Care Center-Riverview, East PeoriaHeartland Health Care Center-PeoriaHeartland Hospice Serving Chicagoland South, FrankfortManorCare Health Services-South HollandArden Courts of South HollandManorCare Health Services-HomewoodArden Courts of Hazel CrestHeartland Health Care Center-MacombHeartland Health Care Center-HenryArdent Courts of Palos HeightsManorCare Health Services-Palos Heights EastManorCare Health Services-Palos Heights WestManorCare Health Services-Oak Lawn EastManorCare Health Services-Oak Lawn WestManorCare Health Services-HinsdaleManorCare Health Services-WestmontManorCare Health Services-NapervilleHeartland Hospice Serving Chicagoland Central, WestmontHeartland Health Care Center-GalesburgArden Courts of Glen EllynManorCare Health Services-WilmetteArdent Courts of GenevaArden Courts of Elk Grove, Elk Grove VillageManorCare Health Services-Elk Grove VillageArden Courts of NorthbrookManorCare Health Services-NorthbrookManorCare Health Services-Arlington HeightsManorCare Health Services-Rolling MeadowsManorCare Health Services-ElginHeartland Hospice Serving Chicagoland North, NorthbrookManorCare Health Services-LibertyvilleHeartland Hospice Serving Quad Cities, MolineHeartland Health Care Center-MolineHeartland Home Health Care Serving North Central Illinois &

Southern Wisconsin, Rockford

51



MichiganHeartland Rehabilitation Services of MI-Bedford, LambertvilleHeartland Health Care Center-Allen ParkHeartland Health Care Center-Three RiversHeartland Health Care Center-Ann ArborHeartland Hospice Serving Ann ArborHeartland Home Health Care Center-Ann ArborHeartland Health Care Center-Dearborn HeightsHeartland Health Care Center-JacksonHeartland Health Care Center-PlymouthHeartland Health Care Center-LivoniaHeartland Health Care Center-Grosse Pointe WoodsArden Courts of LivoniaHeartland Health Care Center-Livonia NEHeartland Hospice Serving Metropolitan Detroit, SouthfieldHeartland Home Health Care Serving Metropolitan Detroit, SouthfieldHeartland Hospice Serving Southwest Michigan, PortageArden Courts of Bingham FarmsArdent Courts of Sterling HeightsHeartland West BloomfieldMarvin & Betty Danto Health Care Center, West BloomfieldHeartland Health Care Center-Bloomfield HillsHeartland Health Care Center-Sterling HeightsHeartland Health Care Center-Battle CreekHeartland Health Care Center-KalamazooHeartland Health Care Center-Oakland, TroyHeartland Hospice Serving Greater Lansing and Jackson, MasonHeartland Home Health Care Serving Greater Lansing and Jackson, MasonHeartland Hospice Serving Central Eastern Michigan, LapeerHeartland Home Health Care Serving Central Eastern Michigan, FlintHeartland Hospice Serving Central Eastern Michigan, FlintHeartland Health Care Center-Briarwood, FlintFostrian Court Assisted Living, FlushingHeartland Health Care Center-Fostrian, FlushingHeartland of Holland

Michigan (cont’d)Heartland Health Care Center-IoniaHeartland Health Care Center-Crestview, WyomingHeartland Health Care Center-Grand RapidsHeartland Hospice Serving West Michigan, Grand RapidsHeartland Home Health Care Serving West Michigan, Grand RapidsHeartland Health Care Center-Greenview, Grand RapidsHeartland Health Care Center-SaginawHeartland Home Health Care Serving The Thumb, CaroHeartland Health Care Center-Knollview, MuskegonHeartland Health Care Center-Hampton, Bay CityHeartland Hospice Serving Northeastern Michigan, Bay CityHeartland Health Care Serving Northeastern Michigan, Bay CityHeartland Home Health Care Serving Northeastern Michigan, Bay CityHeartland Home Health Care Serving Central Michigan, Mt. PleasantHeartland Hospice Serving Central Michigan, Mt. PleasantHeartland Hospice Serving The Thumb, Bad AxeHeartland Hospice Serving West Michigan, FremontHeartland Health Care Center-WhitehallHeartland Hospice Serving Northern Michigan, West BranchHeartland Home Health Care Serving Northern Michigan, West BranchHeartland Hospice Serving Northern Michigan, CadillacHeartland Hospice Serving Northwestern Michigan, Traverse CityHeartland Home Health Care Serving Northwestern Michigan, CadillacManorCare Nursing & Rehabilitation Center, Kingsford

Brookdale Senior Living, Brentwood, TN(includes Emeritus Senior Living)

• 1,123 Communities in 47 States– All States except AK, DC, HI, SD


52


Source: www.brookdaleliving.com


KentuckyHorizon Bay, LouisvilleRichmond Place, LexingtonRichmond Place Rehab & Healthcare

Center, Lexington

OhioAmber Park, CincinnatiBrookdale Place At Finneytown, CincinnatiBrookdale Place At Kenwood, CincinnatiBrookdale Place At Oakwood, DaytonBrookdale Place Of Bath, AkronBrookdale Place Of EnglewoodBrookdale Place Of EnglewoodBrookdale Place Of WoosterChambrel At Montrose, AkronClare Bridge Of AustintownClare Bridge Of MonroeEmerald Crossings, DublinGrand Court DaytonGrand Court FindlayGrand Court SpringfieldHomewood At Richmond HeightsHomewood At Rockefeller Garden,

Cleveland HeightsSterling House Of AllianceSterling House Of BarbertonSterling House Of Beavercreek, DaytonSterling House Of Bowling GreenSterling House Of CantonSterling House Of Englewood. ClaytonSterling House Of Englewood. Clayton

Ohio (cont’d)Sterling House Of FairfieldSterling House Of FindlaySterling House Of GreenvilleSterling House Of LancasterSterling House Of MansfieldSterling House Of MarionSterling House Of MonroeSterling House of NewarkSterling House Of PiquaSterling House Of RichmondSterling House Of SalemSterling House Of Springdale,

CincinnatiSterling House Of SpringfieldSterling House Of TroySterling House Of UrbanaSterling House Of Washington

Township, DaytonSterling House Of WestervilleSterling House Of YoungstownThe Fairways, WickliffeTrillium Place, ColumbusWaterford DaytonWestlake Village, WestlakeWestlake Village Healthcare Center,

WestlakeWoodside Village Bedford

MichiganBrookdale Place Of Ann ArborBurcham Hills, East LansingClare Bridge Of Ann ArborClare Bridge Of Battle CreekClare Bridge Of Bay CityClare Bridge Of Delta, LansingClare Bridge Of Farmington Hills I & IIClare Bridge Of Grand Blanc, HollyClare Bridge Of Meridian, HaslettClare Bridge Of MidlandClare Bridge Of PortageClare Bridge Of SaginawFreedom Village At HollandGrand Court AdrianGrand Court Farmington HillsGrand Court NoviHeritage Of SouthfieldHomewood Village Genesee Valley,

FlintPark At Trowbridge, SouthfieldSterling House Of Battle CreekSterling House Of Bay CitySterling House Of DavisonSterling House Of Delta, LansingSterling House Of MidlandSterling House Of SaginawThe Inn At Freedom Village

Healthcare Center, HollandWynwood Of Grand Blanc, HollyWynwood Of MeridianWynwood of HaslettWynwood Of NorthvilleWynwood Of Portage

IndianaBerkshire Castleton, IndianapolisBrentwood At ElkhartBrentwood At HobartBrentwood At LaPorteBrookdale MerrillvilleBrookdale Place At Fall Creek, IndianapolisBrookdale Place At Willow Lake, IndianapolisBrookdale PortageBrookdale ValparaisoClare Bridge Of CarmelEastlake Terrace, ElkhartRobin Run Village, IndianapolisRobin Run Village Healthcare Center, IndianapolisSterling House Of BloomingtonSterling House of KokomoSterling House Of MarionSterling House Of RichmondSterling House Of South Bend

SENIOR LIVING FP SECTOR: BROOKDALE SENIOR LIVING

Source: www.brookdaleliving.com

Trilogy Health Services, Louisville, KY

• 88 Communities in 4 States– IN, KY, MI, OH


54


www.trilogyhs.com


IndianaForest Park Health Campus, RichmondMorrison Woods Health Campus, MuncieGlen Oaks Health Campus, New CastleSenior Living at Forest Ridge, New CastleSt. Andrews Health Campus, BatesvilleBethany Pointe Health Campus, AndersonThe Villas at Bethany Pointe, AndersonAspen Place Health Campus, GreensburgWellbrooke of WabashThe Villas at Springhurst, GreenfieldSpringhurst Health Campus, GreenfieldThe Villas at Ashford Place, ShelbyvilleAshford Place Health Campus, ShelbyvillePrairie Lakes Health Campus, NoblesvilleLakeland Rehabilitation and Healthcare

Center, MilfordClearvista Lake Health Campus, IndianapolisBlair Ridge Health Campus, PeruThe Villas at Blair Ridge, PeruThe Maples at Waterford Crossing, GoshenThe Villas at Waterford Place, KokomoWaterford Place Health Campus, KokomoWellbrooke of KokomoArlington Place Health Campus, IndianapolisWellbrooke of WestfieldWellbrooke of CarmelThornton Terrace Health Campus, HanoverGreenleaf Health Campus, EkkhartWoodBridge Health Campus, LogansportWellbrooke of AvonCovered Bridge Health Campus, SeymourHomewood Health Campus, LebanonHampton Oaks Health Campus, ScottsburgWellbrooke of South BendSt. Elizabeth Healthcare Center, Delphi

OhioThe Willows at WillardForest Glen Health Campus,

SpringfieldThe Villas at Forest Glen,

SpringfieldThe Oaks at NorthPointe,

ZanesvilleThe Oaks at Bethesda,

ZanesvilleThe Villas at BellevueThe Heritage, FindlayThe Willows at BellevueRichland Manor, BlufftonValley View Healthcare

Center, FremontBriar Hill Health Campus,

North BaltimoreSpringview Manor, LimaThe Villas at LeipsicThe Meadows of LeipsicHighland Oaks Health Center,

McConnelsvilleThe Meadows of KalidaGenoa Retirement Village, GenoaCypress Pointe Health Campus,

EnglewoodThe Lakes of Monclova, MaumeeThe Meadows of OttawaVillage Green Health Campus,

GreenvilleTriple Creek Retirement

Community, CincinnatiThe Villas at Triple Creek,

Cincinnati 55

SENIOR LIVING FP SECTOR: TRILOGY HEALTH SERVICESMichiganThe Oaks at Woodfield, Grand BlancRidgeCrest Health Campus, JacksonShelby Crossing Health Campus,

Shelby TownshipWestlake Health Campus, CommerceThe Willows at HowellThe Willows at OkemosThe Oaks at Northpointe Woods,

Battle CreekThe Willows at East LansingStonegate Health Campus, Lapeer

KentuckyCedar Ridge Health Campus, CynthianaThe Willows at Citation, LexingtonThe Willows at Hamburg, LexingtonForest Springs Health Campus, LouisvilleThe Villas at Forest Springs, LouisvilleWestport Place Health Campus, LouisvilleGlen Ridge Health Campus, LouisvilleFranciscan Health Care Center, LouisvillePark Terrace Health Campus, Louisville

Indiana (cont’d)White Oak Health Campus, MonticelloCreasy Springs Health Campus, LafayetteSt. Mary Healthcare Center, LafayetteThe Springs at LafayetteHearthstone Health Campus, BloomingtonCumberland Pointe Health Campus,

West LafayetteWellbrooke of CrawfordsvilleAutumn Woods Health Campus, New AlbanyThe Villas at Silvercrest, New AlbanyMill Pond Health Campus, GreencastleStonecroft Health Campus, BloomingtonThe Villages at Historic Silvercrest, New AlbanyOwen Valley Health Campus, SpencerStoneBridge Health Campus, BedfordAvalon Springs Health Campus, ValparaisoCedar Creek Health Campus, LowellSpring Mill Health Campus, MerrillvilleHarrison's Crossing Health Campus,

Terre HauteCobblestone Crossings Health Campus,

Terre HauteSt. Charles Health Campus, JasperThe Villas at St. Charles, JasperThe Villages at Oak Ridge, WashingtonThe Villas at Oak Ridge, WashingtonScenic Hills Care Center, FerdinandOakwood Health Campus, Tell CityThe Villas at Oakwood, Tell CityAmber Manor Care Center, PetersburgBridgePointe Health Campus, VincennesWoodmont Health Campus\, BoonvilleRiverOaks Health Campus, PrincetonSilver Oaks Health Campus, ColumbusRiver Pointe Health Campus, EvansvilleWest River Health Campus, Evansville

56

• Mainstreet Senior Living, Carmel, IN– 28 Communities in 7 states

• AR, IL, IN, KS, NY, PA, TX• 3,521 Total Units

– 55+ Community– Independent Living– Assisted Living– Skilled Nursing– Memory Care

• Future: 10 Communities in 4 States– 1 in Colorado– 6 in Indiana– 2 in Kansas– 1 in Texas

SENIOR LIVING FP SECTOR: MAINSTREET SENIOR LIVING

Sources: http://www.mainstreetinvestment.com/#welcome

American House Senior Living Communities, Bloomfield Hills, MI

• 38 Communities in 3 States– FL, IL, MI


57


www.americanhouse.com


58

SENIOR LIVING FP SECTOR: AMERICAN HOUSE

IllinoisAmerican House Cedarlake, Plainfield

Source: www.americanhouse.com

FloridaAmerican House Bonita Springs Senior Living, Bonita SpringsAmerican House Coconut Point, Bonita Springs

Michigan (cont’d)American House Milford Senior LivingAmerican House North Senior Living, FlintAmerican House Oakland Senior Living, PontiacAmerican House Petoskey Senior LivingAmerican House Riverview Senior LivingAmerican House Southfield Senior LivingAmerican House Southgate Senior LivingAmerican House Southland Senior Living, TaylorAmerican House Spring LakeAmerican House Sterling Heights Senior LivingAmerican House Sterling Meadows Senior Living, Sterling HeightsAmerican House Sterling Woods Senior Living, Sterling HeightsAmerican House Stone Senior Living, Rochester HillsAmerican House The Village Senior Living, Rochester HillsAmerican House Troy Senior LivingAmerican House West Bloomfield Senior LivingAmerican House Westland Hunter Senior LivingAmerican House Westland Joy Senior LivingAmerican House Westland Venoy Senior LivingRegent Street West Bloomfield

MichiganAmerican House Brownstown, Brownstown TwpAmerican House Carpenter Senior Living, YpsilantiAmerican House Charlevoix Senior Living, CharlevoixAmerican House Dearborn Heights Senior Living, Dearborn HeightsAmerican House East I Senior Living, RosevilleAmerican House East II Senior Living, RosevilleAmerican House Elmwood Senior Living, , Rochester HillsAmerican House Farmington Hills Senior Living, Farmington HillsAmerican House Grand Blanc Senior Living, Grand BlancAmerican House Grand Rapids Senior Living, Grand RapidsAmerican House Grosse Pointe at Cottage, Grosse Pointe FarmsAmerican House Hazel Park Senior Living, Hazel ParkAmerican House HollandAmerican House JenisonAmerican House KentwoodAmerican House Lakeside Senior Living, Clinton TownshipAmerican House Livonia Senior LivingAmerican House Lloyd’s Bayou, Spring LakeAmerican House Milford Senior Living

Singh Senior Living, West Bloomfield, MI

• 9 Communities in 3 States– MI, NC, VA


59


www.singhweb.com


60

SENIOR LIVING FP SECTOR: SINGH SENIOR LIVING

MichiganAdams Creek, Auburn HillsSummit Creek, CantonTurnbury Park, CantonWyndchase, CantonBriarcliff Village, Commerce TownshipMainCentre Apartments, NorthvilleBrownstones, NoviMainstreet Village, NoviShoreBrooke, NoviWexford Townhomes, NoviCiderMill Village, Rochester HillsNorthridge, Rochester HillsBrandywine, West BloomfieldAmberly, West Bloomfield

Source: www.singhweb.com

North CarolinaWaltonwood Cary Parkway, CaryWaltonwood Cotswold, CharlotteWaltonwood Providence, CharlotteWaltonwood Lake Boone, Raleigh

VirginiaWaltonwood Ashburn

Michigan (cont’d)Waltonwood at Carriage Park, CantonWaltonwood at Cherry Hill, CantonWaltonwood at Twelve Oaks, NoviWaltonwood at Main, Rochester HillsWaltonwood at University, Rochester HillsWaltonwood at Royal OakWaltonwood at Lakeside, Sterling Heights

TOPIC 4: SENIOR LIVING CAPITAL MARKETS

62

• Very few financings completed in the 12 months from July 2008 to July 2009• 2010 & 2009 volume focused on relieving pent-up demand created during the crisis

NOT-FOR-PROFIT SENIOR LIVING FINANCINGS

SOURCE: Thomson Financial Securities Data, as of 12/31/16, Ziegler Investment Banking, Volume & Other Bank Credit Estimates thru 12/31/16

$1,5

77

$1,4

90

$2,2

46

$2,5

06

$2,3

20

$2,2

93

$3,1

42

$3,5

24

$5,0

77

$4,9

82

$2,8

49

$2,8

60

$3,7

80

$3,1

60

$3,0

32

$4,1

38

$5,9

11

$7,3

94

$2,4

80

$1,8

01

$2,6

37

$1,1

48

$3,6

65

$2,7

95

$2,7

18

$3,8

02

$5,6

91

$475 $1

,066

$1,3

77

$1,4

35

$1,9

74

$2,5

43

$1,6

60

$1,5

00

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

(In

Mill

ions

)

Other Bank Credit Par Volume

Estimated Other/Bank Credit

HISTORICAL INTEREST RATES

1.001.502.002.503.003.504.004.505.005.506.006.507.007.508.008.509.009.50

10.0010.5011.0011.50

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Yield %

30-YR NRInstitutional

MMD 30-YR"AAA"

63

NR = Non-Rated

Senior Living Non-Rated Yields (1990 YTD - Weekly)

SOURCE: Ziegler Investment Banking, as of 5/12/17

30-Year NR Institutional

MMD 30-Year"AAA"

Minimum: 3.85% 1.95%Maximum: 10.75% 7.35%Average: 6.93% 4.81%Current: 5.26% 3.01%

0

5

10

15

20

25

30

35

40

1.95

2.05

2.15

2.25

2.35

2.45

2.55

2.65

2.75

2.85

2.95

3.05

3.15

3.25

3.35

3.45

3.55

3.65

3.75

3.85

3.95

4.05

4.15

4.25

4.35

4.45

4.55

4.65

4.75

4.85

4.95

5.05

5.15

5.25

5.35

5.45

5.55

5.65

5.75

5.85

5.95

6.05

6.15

6.25

6.35

6.45

6.55

6.65

6.75

6.85

6.95

7.05

Freq

uenc

y

30-yr "AAA" MMD

30-yr "AAA" MMD Histogram1990 - 2017 (Frequency "Weekly")

64

AAA MMD HISTORGRAMSTILL A UNIQUE MARKET OPPORTUNITY

4/21/17 MMD: 2.90%

Source: Thomson Financial Municipal Market Monitor, as of 4/21/17

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

1996-1997

1998-1999

2000-2001

2002-2003

2004-2005

2006-2007

2008 2009 2010 2011 2012 2013 2014 2015 2016

A Category BBB Category Unrated New Campus - Temp Debt New Campus - Perm Debt

65

BANK TRENDS (SENIOR LIVING)ANNUAL BANK CREDIT FEES

Letter of Credit Era Direct Purchase Era*

*Letter of Credit fees, if available, are 0.25%-0.50% higherSOURCE: Ziegler Investment Banking, as of 12/31/16

0

2

4

6

8

10

12

14

1996‐1997

1998‐1999

2000‐2001

2002‐2003

2004‐2005

2006‐2007

2008 2009 2010 2011 2012 2013 2014 2015 2016

Years

Direct Purchase A Category ‐ LOC BBB Category ‐ LOC NR Category ‐ LOC

66

BANK TRENDS (SENIOR LIVING)BANK CREDIT COMMITMENT PERIODS

Letter of Credit Era Direct Purchase Era

SOURCE: Ziegler Investment Banking, as of 12/31/16

20TH ANNUAL ZIEGLER SENIOR LIVING FINANCE + STRATEGY CONFERENCE

67

QUESTIONS & ANSWERS

1

69

ABOUT US• Ziegler is a privately-held investment bank, capital markets, wealth

management and alternative investments firm.

• A registered broker dealer with SIPC & FINRA

• Ziegler provides its clients with capital raising, strategic advisory services, equity & fixed-income trading, wealth management and research

• Founded in 1902, Ziegler specializes in the healthcare, senior living, educational and religious sectors as well as general municipal finance

*Investment banking services offered through B.C. Ziegler and Company. FHA mortgage banking services are provided through Ziegler Financing Corporation which is not a registered broker/dealer. Ziegler Financing Corporation and B.C. Ziegler and Company are affiliated and referral fees may be paid by either entity for services provided.

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