sententia capital long achi

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Accretive Health. – Long Sententia Capital Management December 2014 ticker: ACHI mkt cap: $786m price: $8.10 intrinsic value: $11 Recommendation: Accretive Health is a buy at $8 with a base case of $11, representing 35% upside. We see a 1:4 risk to reward investment with further upside following a rerating on the completion of the financial restatement. Key Points: Why Undervalued? Financial restatement pending Recent NYSE Delisting Company Highlights Anticipated 10% FCF yield on restatement Sticky customer base with expanding margins RCM Industry leader Trading at 8.2x and 1.5x EBITDA and sales, compared to 12x peers and a 4x recent buyout Industry Trends Shallow 10% penetration of healthcare customers Increased complexity will lead to growing customer base to improve RCM efficiencies Catalyst Restatement expected midDec 2014 Uplisting within three months of becoming current Stock Information (as of December 2014) Price 8.10 $ Net Debt (228) 52 Week Low 9.82 $ Enterprise Value 558 52 Week High 6.92 $ % Insider Ownership 20.00% Shares Out 97.0 % Short Interest -- Market Cap 786 % Dividend Yield 0.0% Key Metrics 2009 2010 2011 LTM Restatement Income Stateme 2009 2010 2011 LTM Restatement Returns (%) NPR $12,000 $15,000 $22,000 $19,000 $18,000 ROIC 17.4% 5.8% 8.7% 8.2% 8.2% Revenue $510 $606 $826 $974 $300 ROA 14.1% 4.8% 8.0% 3.9% 3.9% growth -- 18.8% 36.3% 17.8% NA ROE 68.5% 8.8% 12.3% 6.5% 6.5% EBITDA $33 $45 $82 $74 $75 Multiples 2009 2010 2011 LTM Restatement margin 6.5% 7.4% 9.9% 7.6% 25.0% EV/EBITDA 12.0x 21.0x 18.0x 9.0x 8.0x Net Income $15 $13 $29 $17 $19 Valuation margin 2.9% 2.1% 3.5% 1.7% 6.0% Cases (2015) EBITDA EV/EBITDA Mkt Cap Price Balance Sheet 2009 2010 2011 LTM Restatement Low Case 65 9.0x 585 $8 Cash and Equi 44 156 197 220 228 High Case 80 13.0x 1,040 $13 Total Debt - - - - - Base Case 75 11.0x 825 $11 Debt/Equity NA NA NA NA NA Margin of Safety 25% Shares 37 71 97 97 97 Upside 34% BV per Share 0.48 $ 1.51 $ 2.35 $ 2.56 $ 2.56 $ Accretive Health, Inc. provides revenue cycle management services for hospitals and healthcare providers in the United States. It offers integrated revenue cycle management services that help healthcare providers to manage their revenue cycles. Accretive Health, Inc. serves multi-hospital systems, including faith-based or community healthcare systems, academic medical centers, independent ambulatory clinics, and physician practice groups.Accretive Health, Inc. was founded in 2003 and is headquartered in Chicago, Illinois.

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Accretive  Health.  –  Long  Sententia  Capital  Management              December  2014  ticker:  ACHI     mkt  cap:  $786m       price:  $8.10   intrinsic  value:  $11    

   Recommendation:  Accretive  Health  is  a  buy  at  $8  with  a  base  case  of  $11,  representing  35%  upside.  We  see  a  1:4  risk  to  reward  investment  with  further  upside  following  a  re-­‐rating  on  the  completion  of  the  financial  restatement.    Key  Points:  Why  Undervalued?  

-­‐ Financial  restatement  pending  -­‐ Recent  NYSE  Delisting  

 Company  Highlights  

-­‐ Anticipated  10%  FCF  yield  on  restatement  

-­‐ Sticky  customer  base  with  expanding  margins  

-­‐ RCM  Industry  leader    -­‐ Trading  at  8.2x  and  1.5x    EBITDA  

and  sales,  compared  to  12x  peers  and  a  4x  recent  buyout  

 Industry  Trends  

-­‐ Shallow  10%  penetration  of  healthcare  customers  

-­‐ Increased  complexity  will  lead  to  growing  customer  base  to  improve  RCM  efficiencies  

 Catalyst  

-­‐ Restatement  expected  mid-­‐Dec  2014  

-­‐ Uplisting  within  three  months  of  becoming  current      

Stock Information (as of December 2014)

Price 8.10$ Net Debt (228) 52 Week Low 9.82$ Enterprise Value 558 52 Week High 6.92$ % Insider Ownership 20.00%Shares Out 97.0 % Short Interest --Market Cap 786 % Dividend Yield 0.0%

Key Metrics 2009 2010 2011 LTM Restatement Income Statement 2009 2010 2011 LTM Restatement

Returns (%) NPR $12,000 $15,000 $22,000 $19,000 $18,000ROIC 17.4% 5.8% 8.7% 8.2% 8.2% Revenue $510 $606 $826 $974 $300ROA 14.1% 4.8% 8.0% 3.9% 3.9% growth -- 18.8% 36.3% 17.8% NAROE 68.5% 8.8% 12.3% 6.5% 6.5% EBITDA $33 $45 $82 $74 $75Multiples 2009 2010 2011 LTM Restatement margin 6.5% 7.4% 9.9% 7.6% 25.0%

EV/EBITDA 12.0x 21.0x 18.0x 9.0x 8.0x Net Income $15 $13 $29 $17 $19Valuation margin 2.9% 2.1% 3.5% 1.7% 6.0%

Cases (2015) EBITDAEV/EBITDA Mkt Cap Price Balance Sheet 2009 2010 2011 LTM Restatement

Low Case 65 9.0x 585 $8 Cash and Equi 44 156 197 220 228 High Case 80 13.0x 1,040 $13 Total Debt - - - - - Base Case 75 11.0x 825 $11 Debt/Equity NA NA NA NA NAMargin of Safety 25% Shares 37 71 97 97 97 Upside 34% BV per Share 0.48$ 1.51$ 2.35$ 2.56$ 2.56$

Accretive Health, Inc. provides revenue cycle management services for hospitals and healthcare providers in the United States. It offers integrated revenue cycle management services that help healthcare providers to manage their revenue cycles. Accretive Health, Inc. serves multi-hospital systems, including faith-based or community healthcare systems, academic medical centers, independent ambulatory clinics, and physician practice groups.Accretive Health, Inc. was founded in 2003 and is headquartered in Chicago, Illinois.

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

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Executive  Summary    Overview  Accretive  Health  is  a  Revenue  Cycle  Management  (RCM)  industry  leader  that  will  soon  be  re-­‐rated  as  they  restate  three  years  of  financials.  We  see  a  1:4  risk  to  reward  ratio  as  the  company  restates,  and  further  catalysts  as  the  company  uplists  and  management  builds  out  the  customer  base.        Summary  Accretive  Health  is  a  poster  company  for  things  that  have  gone  wrong.  Starting  in  2011,  on  the  back  of  losing  a  computer  that  contained  unencrypted  customer  data,  Accretive  lost  a  key  customer  and  business  relationships  in  Minnesota.  Soon  after,  in  2012,  Accretive  announced  that  all  of  its  past  SEC  financial  filings  (3  years  worth)  would  be  restated  through  an  audit.      Over  the  next  year,  the  company  replaced  its  CEO  and  executives.  This  past  March,  the  company  missed  its  restatement  timeline  and  delisted  from  the  NYSE.  Further,  three  weeks  after  the  delisting,  the  company  announced  that  its  replacement  CEO,  Steve  Shuckenbrock,  would  step  down  after  his  one-­‐year  commitment  ends  this  October.  All  told,  a  mess.    We  like  this  mess,  as  we  see  clear  signs  that  the  company  is  not  only  a  going  concern,  but  has  a  foundation  on  which  to  further  expand  as  the  industry  leader.  The  company  has  no  debt  and  a  quarter  of  its  market  cap  is  in  cash.  The  company  has  stated  that  the  audit  restatement  is  above  the  line  and  will  have  no  affect  on  cash  and  no  affect  on  cumulative  net  income  or  EBITDA.      Steve  Schulman,  a  proven  40-­‐year  veteran  of  the  healthcare  industry,  took  over  as  Chairman  of  the  Board  in  April,  providing  further  confidence  that  there  is  no  malfeasance  in  the  reports.  Steve  led  two  healthcare  companies  through  turnarounds,  selling  one.  The  CEO,  Dr.  Emad  Rizk,  was  announced  in  July.  He  comes  with  25  years  experience  and  is  recognized  as  a  renowned  healthcare  industry  expert.  He  comes  with  great  connections  in  industry  and  a  focused  attention  on  client  relationships,  culture  and  operational  excellence.      Post  restatement,  Accretive  is  near  8x  EV/EBITDA  and  a  projected  1.5x  sales.  Prior  to  the  restatement,  Accretive  traded  closer  to  12x  EBITDA  and  up  to  21x  EBITDA.  Competitors  trade  near  11x  EV/EBITD.  As  a  high  mark,  a  smaller  competitor  was  just  purchased  for  3.8x  revenue.  At  $8,  free  cash  flow  yield  is  closer  to  10%  as  their  contracts  have  matured.  We  anticipate  an  initial  re-­‐rating  and  further  upside  as  the  company  builds  out.      Potential  Catalyst  The  near  term  catalysts  is  the  restatement,  expected  mid-­‐December  2014.  A  future  catalysts  will  be  an  uplisting  back  into  the  NYSE.  Jumping  ahead,  Accretive  represents  a  great  candidate  for  a  buy-­‐out  as  stability  returns  to  the  company.    

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

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Table  of  Contents    

Variant  Perception  ...................................................................................................................................................  3  

Why  is  Accretive  Mispriced?  ...............................................................................................................................  3  

Valuations  ....................................................................................................................................................................  3  

Accretive  Health  ........................................................................................................................................................  5  

Industry  .....................................................................................................................................................................  12  

Keys  to  getting  the  investment  right  .............................................................................................................  13  

The  Bear  Case  ..........................................................................................................................................................  13  

Key  Risks  ...................................................................................................................................................................  13  

Moving  Forward  ....................................................................................................................................................  13  

Premortem  ...............................................................................................................................................................  14  

 

   

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

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Variant  Perception  Behavioral    Accretive  is  currently  in  a  dark  period,  literally  and  figuratively,  through  a  pending  restatement  and  investor  sentiment.  We  are  taking  a  long-­‐term  view  and  taking  advantage  of  this  period  by  investing  ahead  of  the  restatement.    

Why  is  Accretive  Mispriced?  Uncertainty  in  Financials,  Forced  selling    Uncertainty  in  Financials  Accretive  announced  in  February  2013  that  they  would  restate  their  financials  from  till  2010  till  2012.  This  caused  the  stock  to  drop  25%.  The  company  announced  that  although  the  revenues  would  be  impacted,  there  would  be  no  impact  to  cumulative  net  income  or  cash  flows.  Since  then,  there  has  been  no  indication  that  contracts  or  business  has  suffered  aside  from  the  Minnesota  clients  (discussed  below),  the  uncertainty  behind  the  restatement  has  continued  to  pressure  the  stock.      Forced  Selling  Due  to  Accretive’s  pending  restatement,  the  company  missed  the  New  York  Stock  Exchange’s  (NYSE)  extensions  to  become  current  on  their  filings  and  delisted  from  the  NYSE  in  March  2014.  The  stock  went  up  initially,  from  $8  to  $9.50,  but  settled  near  $7.50  as  we  feel  the  stock  came  under  the  forced  selling  from  indexes  and  ETFs.  Fidelity  owned  14%  of  Accretive  and  sold  between  April  and  June  of  this  year.      These  two  items  have  provided  the  opportunity  to  come  into  Accretive  at  an  attractive  price.    

Valuations  Revenue,  EV/EBITDA,  Free  Cash  Flow      For  our  valuations,  we’ve  attempted  to  come  at  this  through  a  few  different  avenues  as  the  financials  are  pending  release.  There  are  several  cases  and  a  wide  range  you  can  anticipate.      Revenue  A  big  portion  of  revenues  will  be  reclassified  as  expenses  on  the  restatement,  so  we  have  made  some  forecasts  on  what  we  can  expect.  Included  in  the  4-­‐5%  of  hospital  NPR  costs  were  employee  paychecks.  Accretive  classified  these  as  revenue  and  these  will  now  shift  to  expenses  on  the  restatement.  We  see  a  range  of  10%  to  40%  of  base  fees  remaining  as  revenue,  with  a  higher  probability  closer  to  25%.      

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

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The  below  table  uses  $760m  in  pre-­‐restatement  revenue,  which  was  estimated  against  $18b  in  NPR;  we  applied  80%  of  total  revenue  to  base  fees,  14%  for  incentive  and  6%  for  other;  we  add  in  cash  of  $228m.      The  1.5x  to  3x  multiple  is  used  to  show  the  range  of  valuations.  A  recent  competitor,  SPi  Healthcare,  was  purchased  by  Conifer  for  3.8x  Revenue.      

   

             

 EBITDA.    Accretive  had  10%  margins  in  2011.  EBITDA  will  not  change  materially  on  the  restatement,  so  we  use  the  same  measures  as  before.  Holding  this  constant,  we  can  estimate  EBITDA  of  $76m.  This  implies  8x  EV/EBITDA.  Accretive  has  traded  down  to  6x  during  its  restatement.  Prior  to  the  restatement  announcement,  Accretive  traded  down  to  9x  at  its  lowest  point.  It  traded  as  high  as  21x  and  more  normally  at  12x.  You  can  see  the  sensitivity  charts  below  for  estimated  EBITDA  and  multiple  ranges.      

   

   

Current'Mkt'Cap:'$810mRevenue Base Total 1.5x 2.0x 2.5x 3.0x

10% $61 $205 $536 $638 $741 $84320% $122 $266 $627 $760 $894 $1,02730% $184 $327 $719 $883 $1,047 $1,21040% $245 $389 $811 $1,005 $1,200 $1,394

8.0x 9.0x 10.0x 11.0x$65 $748 $813 $878 $943$70 $788 $858 $928 $998$75 $828 $903 $978 $1,053$80 $868 $948 $1,028 $1,108$85 $908 $993 $1,078 $1,163

97m 8.0x 9.0x 10.0x 11.0x$65 $7.7 $8.4 $9.1 $9.7$70 $8.1 $8.8 $9.6 $10.3$75 $8.5 $9.3 $10.1 $10.9$80 $8.9 $9.8 $10.6 $11.4$85 $9.4 $10.2 $11.1 $12.0

Current'Price:'$8.10Total 1.5x 2.0x 2.5x 3.0x

10% $205 $5.5 $6.6 $7.6 $8.720% $266 $6.5 $7.8 $9.2 $10.630% $327 $7.4 $9.1 $10.8 $12.540% $389 $8.4 $10.4 $12.4 $14.4

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

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Free  Cash  Flow  Conservatively,  we  see  cash  flow  yield  at  5%  ex  cash.  On  the  2013  company  update,  Accretive  stated  that  cash  grew  from  $177m  to  $220m  in  nine  months  of  2012.  This  is  +$43m.  Adding  back  $13m  ($20m  -­‐  $7m  tax)  from  restatement  and  restructure  costs,  and  removing  $36m  from  working  capital  (remaining  AR  from  Minnesota),  we  get  to  $26m,  or  $0.27  per  share.  This  is  near  5%  ex  cash.  Now,  we  expect  this  to  be  higher  as  there  are  a  greater  number  of  RCM  contracts  maturing,  4Q  has  historically  been  a  stronger  quarter,  and  Salem  Health  also  signed  in  2013.  With  that,  we  estimate  Accretive  is  closer  to  a  10%  FCF  yield.    

Accretive  Health  Highlights,  History,  Management    Highlights.    Expanding  Margins.  First,  to  be  comfortable  with  the  valuations  scenarios  we  have  to  first  understand  the  ramp  up  in  revenues  through  the  Revenue  Cycle  Management  (RCM)  segment,  which  made  up  95%  of  revenues.  (We  may  use  past  tense  for  the  revenues  as  they  are  pending  restatement,  but  we’ve  attempted  to  adjust  for  this  in  our  analysis.)      On  the  NPR  ramp  up,  you  can  see  the  increase  in  NPR  each  year  on  the  chart.  The  RCM  contracts  are  for  5  years  and  the  revenue  ramp  up  happens  from  two  areas,  with  both  ramping  up  as  the  contract  matures:  1)  cost  reduction  (base  fees)  and  2)  revenue  lift  (incentive  fees).      Base  Fee.    Each  hospital  is  estimated  to  spend  4-­‐5%  of  their  NPR  on  the  collection  effort.  Accretive  works  to  reduce  this  from  0  to  15-­‐30%  through  the  fifth  year,  reaching  a  peak  near  year  4.  Accretive  takes  70%  of  this  cost  savings.      Incentive  Fee.    Accretive  estimates  that  it  can  reduce  the  hospital’s  revenue  leakage,  which  will  increase  revenue  from  0  to  4-­‐6%  over  five  years.  Accretive  takes  25%  of  these  increases.      How  does  this  look  over  five  years?  Like  this:  <.  Starts  out  small  and  grows.  Here  is  a  sample  for  $1B.  There  are  a  lot  of  variables,  so  we  capped  cost  reduction  at  20%  and  reached  that  in  year  4  and  capped  revenue  increase  at  4%,  growing  it  1%  each  year.    

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

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Base# Incen0ve#

                     

 We  can  see  the  effect  on  EBITDA  margins  through  the  financials  as  they  grew  from  6.5%-­‐10%  from  2009  -­‐  2011.    Sticky  Customer  Base  RCM  contracts  are  normally  5  years.  We  get  a  rough  estimate  of  when  RCM  contracts  fall  off  and  roll  on  based  on  the  increase/decrease  in  NPR,  coupled  with  projected  NPR  Accretive  services  with  each  customer.      Here’s  a  look  at  the  NPR  adjustments  pieced  together.  You  can  see  the  year  of  each  increase  in  NPR  and  the  extent  of  the  contract  life.  You  may  notice  that  some  NPR  increases  taper  down.  This  is  the  affect  of  the  Minnesota  contracts  lost  in  2012.      Now,  if  you  hold  the  base  case  revenue  growth  we  took  from  the  first  step  and  overlay  this  onto  the  RCM  contracts  rolling  off  and  on,  you  see  the  below  growth  in  revenue  through  2014.    

 Again,  there  are  too  many  variables  with  the  first  step  so  we  are  looking  broadly  at  the  impact  of  the  NPR  increases  and  decreases.  As  the  contracts  mature,  they  create  greater  revenue  and  higher  margins.  So  even  though  we  had  a  decrease  of  $4b  in  NPR  since  2011,  we  can  expect  revenues  to  remain  flat  to  up  through  this  year.  The  last  NPR  metric  given  by  management  was  $18b  as  of  the  end  of  2013.      

$0#

$5,000#

$10,000#

$15,000#

$20,000#

$25,000#

2005# 2006# 2007# 2008# 2009# 2010# 2011# 2012# 2013#

Staggerd(RCM(Contracts(via(NPR(

2005# 2006# 2007# 2008# 2009# 2010# 2011# 2012# 2013#

!20.0%&

0.0%&

20.0%&

40.0%&

60.0%&

80.0%&

100.0%&

120.0%&

2008& 2009& 2010& 2011& 2012& 2013& 2014&

RCM$Rev$Growth$

RCM&Rev&Growth&

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

7  

Going  forward,  if  there  were  no  customers  added  this  year,  we  can  still  expect  growth  through  2015,  but  this  will  fall  sharply  moving  forward  unless  customers  re-­‐sign  or  Accretive  adds  more  contracts.  One  customer,  Beaumont,  is  expected  to  merge  with  two  other  health  systems,  Botsford  and  Oakwood.  Should  they  use  Accretive  services,  this  could  lead  to  a  $2.5b  increase  in  NPR  in  2015.  The  merger  has  been  announced  and  is  in  the  final  stages  of  completion.      History.    Minnesota  AG  Impact.  Accretive  has  been  on  a  roller  coaster  ride  from  its  high  of  $30  in  2011.  That  year,  an  employee’s  laptop  was  stolen,  containing  thousands  of  unencrypted  customer  details.  This  led  to  an  Attorney  General  (AG)  investigation  in  2012.  As  the  investigation  took  shape,  Accretive  was  accused  of  aggressive  collection  tactics  and  a  6  volume  report  was  released  in  2012.  Ultimately,  many  of  the  claims  were  unsubstantiated  and  the  case  was  settled  for  $2.6m  and  the  agreement  by  Accretive  to  not  conduct  business  in  Minnesota.  Accretive  lost  $1.7b  in  market  capita  through  this  time.      Accretive  suffered  headline  and  reputation  damage  but  other  than  the  Minnesota  customers,  they  did  not  lose  additional  ones  and  continued  to  build  out  their  customer  base.  The  company  purchased  stock  in  3Q2012  and  4Q2012,  1.1m  and  3.2m  shares  respectively.      You  can  see  the  impact  below.      

       

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Accre%ve'Stock'Price'(201022014)'

Accre:ve#Stock#Price#

Restatement##announced#for#mid(Dec#

Stolen#Laptop#

AG#Complaint#AG#alleges#HIPAA#viola:ons#

Fairview#drops#RCM#rela:onship#AG#releases#report#Fairview#drops#QTTC#rela:onship#

Next#chart#($1.7b#drop)##

Se5les,'no'wrongdoing'

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

8  

Restatement  Impact.  In  early  2013,  Accretive  announced  that  it  would  postpone  4Q  results  and  also  announced  that  it  would  restate  company  filings  back  till  2010.  In  the  midst  of  the  restatement  announcement,  Accretive  continued  to  add  customers.  Also  in  2013,  they  announced  that  Steve  Shuckenbrock  would  be  named  CEO  and  the  founder  and  current  CEO,  Mary  Tolan,  would  step  down.  Steve  was  to  serve  a  one  year  contract  with  an  option  to  extend.      Steve  announced  a  relocation  of  HQ  from  Chicago  to  Dallas  and  an  employee  reduction.  Accretive  provide  a  business  update  at  the  end  of  2013,  stating  that  cash  grew  and  the  restatement  would  continued  with  an  expected  March  2014  completion.  They  also  announced  that  Accretive  would  repurchase  $50m  of  stock  after  the  restatement.      March  arrived,  the  restatement  didn’t,  and  the  company  announced  that  it  would  be  delisted  from  the  NYSE.  At  the  same  time,  Accretive  announced  that  Steve  would  step  down  and  not  extend  past  October.  Additionally,  Steve  Shulman,  a  well  respected  Board  Director,  was  announced  as  Chairman.  On  the  back  of  Mr.  Shulman’s  experience  and  reputation,  we  had  further  confidence  that  there  was  no  malfeasance  in  the  restatements  and  it  was  simply  taking  longer  than  anticipated.      Accretive  announced  Dr.  Emad  Rizk  as  CEO  in  July  and  in  November  announced  that  the  restatement  is  expected  to  be  complete  by  mid-­‐December.      Below  is  the  snapshot  of  the  stock  movement.      

       

$6#$7#$8#$9#

$10#$11#$12#$13#$14#

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30,Nov,14#

Accre%ve'Stock'Price'(201222014)'

AccreCve#Stock#Price#

Postpones#4Q#results,#restatement##

New#customer,#Salem#Health#

Shuckenbrock,#CEO#

Bus.#Update#

DelisCng#noCce#

Dr.#Rizk,#CEO#

Restatement##announced#for#mid,Dec#

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

9  

Management    There  have  been  many  executive  changes.  In  addition  to  stability  through  Accretive’s  current  leadership,  there  will  be  increased  financial  stability  as  lingering  compensation/severance  packages  roll  off  as  well.      CEO    

   Accretive’s  C-­‐suite  is  on  its  third  rotation  this  year.  Mary  Tolan,  co-­‐founder  and  CEO  up  to  the  restatement,  resigned  in  2012.  Steve  Shuckenbrock,  a  former  DELL  executive,  came  in  on  a  one  year  commitment  to  replace  Mary.  There  were  positive  and  negatives  with  Steve’s  appointment,  mainly  surrounding  his  experience  in  software,  which  is  critical  in  RCM,  but  is  lacking  in  healthcare  industry  relationships.  During  Steve’s  short  tenure,  he  planned  to  move  some  headquarter  operations  from  Illinois  to  Texas.  This  move  didn’t  appeare  to  sit  well  with  some  key  executives.  Miles  McHugh,  the  Chief  Accounting  Officer,  is  an  example  as  he  resigned  shortly  after  the  announcement  with  the  8-­‐k  citing  the  move  as  the  reason.  Ultimately,  in  March  2014,  Steve  announced  his  intention  to  resign  in  October  2014,  which  would  be  the  end  of  his  year  commitment,  and  the  move  was  quietly  cancelled.    Dr.  Emad  Rizk  was  named  CEO  in  July.  He  brings  over  25  years  of  healthcare  experience,  most  recently  as  the  President  of  McKesson  Health  Solutions,  and  was  named  one  of  the  50  Most  Influential  Physician  Executive  in  the  United  States  by  Moder  Physician.  His  experience  and  relationships  will  serve  Accretive  well  as  he  brings  stability,  steadiness  and  vision  to  the  Company.      Dr.  Rizk  named  four  priorities  when  he  took  over:  1)  Finishing  the  restatement,  2)  Establish  a  company  wide  focus  on  consistent  execution  and  operational  excellence,  3)  Develop  market  focused  products  and  services  to  help  the  customers  adapt  to  the  evolution  of  the  health  care  markets,  and  4)  Implement  consistent  processes  and  controls  to  develop  an  industrial  strength  platform.  The  pending  restatement  in  mid-­‐December  will  be  his  first  tangible  step.      Here  is  Accretive’s  announcement  on  his  selection.  [emphases  added]  “The  Board  was  very  strategic  about  finding  the  right  person  to  become  our  new  CEO  –  Emad  is  that  person,”  said  Steve  Shulman,  chairman  of  Accretive  Health’s  Board  of  Directors.  “He  is  a  renowned  healthcare  industry  expert  who  brings  with  him  more  than  25  years  of  experience,  and  at  the  same  time  has  demonstrated  a  profound  ability  to  drive  growth  and  innovation.”    Since  2003,  Dr.  Rizk  has  served  as  president  of  McKesson  Health  Solutions,  a  division  of  McKesson  Corporation.  As  president  of  this  division,  he  built  a  world-­‐class  team  and  oversaw  significant  growth,  with  a  focus  on  helping  providers  and  payers  implement  new  delivery  and  financial  payment  processes  

CEO Starts Resigns Salary Ends Options NotesMary%Tolan Founder Apr013 $731 Oct014 DirectorShuckenbrock Jul013 Jul014 $595 Oct014 2,900%%%%%%%%%% DirectorDr.%Rizk Jul014 Current $750 2,700%%%%%%%%%% Director

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10  

as  the  healthcare  industry  transitions  from  volume-­‐  to  value-­‐based  care.  During  his  tenure,  he  built  an  organization  that  became  a  leader  in  the  healthcare  industry.    Prior  to  joining  McKesson,  Dr.  Rizk  served  as  senior  partner  and  global  director  of  Deloitte  Consulting,  prior  to  which  he  was  worldwide  medical  director  for  Monsanto  Corporation.  He  also  currently  serves  on  the  board  of  Accuray  Incorporated.  In  2013,  Dr.  Rizk  was  named  one  of  the  50  Most  Influential  Physician  Executives  in  the  United  States  by  Modern  Physician,  the  fifth  time  he  has  been  recognized  by  this  publication.  He  has  also  been  counted  among  the  Top  100  Most  Powerful  People  in  Healthcare  by  Modern  Healthcare;  and  named  one  of  the  nation’s  Top  25  Leaders  in  Disease  Management  by  Managed  Healthcare  Executive.    CFO    

   Peter  Csapo  has  16  years  of  experience  in  Healtcare  Industry  and  worked  with  Dr.  Rizk  at  McKesson.  He  was  announced  as  CFO  in  August  2014.      Below  is  the  announcement.  [emphasis  added]  “Peter  is  an  accomplished  leader  with  extensive  healthcare  experience  and  intimate  knowledge  of  hospital  and  payer  finance  and  operations,  all  of  which  we  will  leverage  as  we  move  forward,”  said  Dr.  Rizk.  “Peter  spent  a  great  deal  of  time  working  with  hospital  CEOs  and  CFOs  during  his  time  at  VHA,  and  I  know  he  is  the  ideal  person  to  help  us  enhance  our  financial  infrastructure  and  internal  operating  controls  as  Accretive  Health  moves  into  our  next  phase  of  growth  and  innovation.”    Since  2011,  Csapo  has  served  as  area  senior  vice  president  and  chief  financial  officer  for  VHA,  Inc.,  parent  company  of  Novation,  Provista  and  aptitude™,  where  he  provided  leadership  to  turn  around  the  company’s  financial  strategy  and  infrastructure,  and  modernize  information  technology  methodologies  to  align  with  and  support  VHA’s  new  business  model.    Prior  to  that,  Csapo  worked  at  McKesson  Health  Solutions  as  chief  financial  officer  and  vice  president,  customer  operations.  He  joined  McKesson  in  1998,  where  he  advanced  through  multiple  corporate  and  divisional  leadership  roles  during  his  13-­‐year  tenure.    Csapo  also  worked  at  Honeywell  International,  Inc.,  in  finance  and  enterprise  resource  planning  (ERP)  systems.  He  began  his  career  at  the  headquarters  of  Sears,  Roebuck  and  Co.  in  audit  and  SEC  financial  reporting.  Csapo  is  a  graduate  of  the  University  of  Wisconsin  at  Madison  and  received  his  Certified  Public  Accountant  certificate  from  the  state  of  Illinois.    “After  16  years  of  working  with  hospitals  and  health  plans,  I  look  forward  to  capitalizing  on  my  experience  to  evolve  Accretive  Health’s  financial  processes  and  systems  to  set  us  up  for  our  journey  to  sustained  growth  and  profitability,”  Csapo  said.    “Emad  and  I  made  a  great  team  when  we  worked  together  before,  and  it  will  be  a  privilege  to  have  the  opportunity  to  work  with  him  again  in  this  leadership  capacity.”      

CFO Starts Resigns Salary Ends Options NotesJohn%Staton Aug,13 Apr,14 33/month Oct,15 299 SeveranceSean%Orr Aug,13 Aug,14 $450 Aug,15 300 SVP,%restatementPeter%Csapo Aug,14 Current $470 470 Also%CAO

212.851.3488   ©  Sententia  Capital  Management,  LLC   [email protected]    

11  

CSO      

   David  Mason’s  announcement:  David  Mason  brings  more  than  30  years  of  healthcare  management  and  hospital  revenue  cycle  experience  to  Accretive  Health,  most  recently  as  senior  vice  president  and  general  manager  at  RelayHealth,  which  he  joined  in  2007.    While  there,  Mason  led  the  company’s  Financial  Solutions  division,  where  he  was  responsible  for  all  business  operations,  business  development,  strategic  planning,  product  management,  client  relationships  and  payer  services.    CAO    

   The  CAO  role  was  merged  with  the  CFO  roles  following  Thomas  Gibson’s  departure.      Board  of  Directors    The  Board  of  Directors  (BOD)  consists  of  13  directors.  There  are  three  classes,  staggering  the  elections.  From  the  breakout  below,  we  see  room  for  adjustments  on  the  director  positions  as  Accretive  continues  to  progress.      

     

CSO Starts Resigns Salary Ends Options NotesRichard(Kimball Apr/13 Aug/14 // 14/Aug 1000 ResignedDavid(Mason Aug/14 Current // 400

CAO Starts Resigns Salary Ends Options NotesMiles&McHugh Sep.13 Feb.14 .. May.14 No&relocationThomas&Gibson Jun.14 Nov.14 $285 Nov.14 Role&merges&with&CFO

# Name Joined Committee Notes Class1 Edgar'Bronfman Oct02006 Comp/Gov* Accenture'PE II020152 J.'Michael'Cline Aug02003 Comp/Gov Co0Founder I020143 Steven'Kaplan Jul02004 Audit/Comp*/Gov Morningstar II020154 Stanley'Logan Apr02011 Audit* Finance/Consulting III020135 Denis'Nayden Oct02003 Comp Oak'Hill'Capital I020146 Steve'Shulman* Apr02013 Chairman/Gov PE'Firm/Magellan I020147 Arthur'Spiegel Oct02003 Comp Private'Investor III020138 Mark'Wofsen Oct02003 Audit Oak'Hill'Capital III020139 Alex'Mandi Nov02013 Merger'experience10 Emad'Rizk Jul02014 CEO/President11 Stephen'Shuckenbrock Jul02013 Former'CEO12 Robert'Stanek Nov02013 Health'Care'Industry13 Mary'Tolan Aug02003 Co0Founder I02014

*Chairperson

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Steve  Shulman,  Chairman.    Former  CEO  of  Magellan  Health  Services.  Steve  led  Magellan  through  a  successful  turnaround  and  restructuring  out  of  bankruptcy  in  2002  through  2008.  He  also  led  Prudential  Healthcare,  from  1997  to  1999,  through  a  turnaround  and  ultimate  sell  of  the  company  to  Aetna.  Mr.  Shulman  currently  advises  Water  Street  Healthcare  Partners,  a  PE  firm.  His  experiences  and  expertise  will  serve  Accretive  well  as  they  transition  out  of  the  restatements.    

Industry    RCM  is  a  growing  industry  with  incoming  competitors.  Currently,  Tenet  Healthcare  and  HCA  are  two  strong  competitors  through  their  subsidiaries,  Conifer  and  Parallon.  Both  have  expanded  over  the  years.  UnitedHealth  has  Optum,  which  created  a  JV  called  Optum360  that  has  also  shown  growth.  Setting  aside  the  differentiating  services,  the  limiting  factor  for  the  main  competitors  is  that  they  are  subsidiaries  of  two  of  the  larges  for-­‐profit  hospital  chains  and  other  hospitals  are  not  likely  to  contract  with  direct  competitors.  On  the  right  is  chart  that  shows  the  top  5  non-­‐profit  hospital  systems.    For  services,  Accretive  works  to  set  themselves  apart  from  other  competitors.  The  main  differentiator  is  their  End-­‐to-­‐End  solution,  as  they  do  not  consider  themselves  a  consulting  firm,  a  pure  outsourcing  model,  or  a  software  provider,  but  a  comprehensive  operating  partner.      The  RCM  industry  has  an  estimated  10%  penetration  by  RCM  vendors,  implying  a  $20b  industry  for  hospitals.  The  physician  portion  is  estimated  at  $45b.  The  low  penetration  is  a  function  of  providers  doing  their  own  RCM.  However  the  complexity  is  increasing  and  this  outsourcing  can  quickly  ramp  up.  Some  reasons  for  the  increased  complexity:    

-­‐ ICD-­‐10:  New  coding  standard  requiring  large  system  and  talent  upgrades  -­‐ Increased  administrative  costs:  RCM  requires  additional  employees  to  manage  -­‐ ACA  affects:  Increased  financial  risks  due  to  higher  deductible  plans  -­‐ New  EMR  requirements  -­‐ Current  vendor  footprint  is  raising  the  bar  on  industry  reporting.  

 Dr.  Rizk  spoke  to  the  increasing  complexity  as  one  of  his  reason  for  joining  Accretive.  This  evolving  landscape  will  increase  the  attractiveness  of  Accretive’s  comprehensive  offerings  to  potential  customers.          

# Non%Profit+by+size Vendor1 Ascension Accretive2 Catholic/Health/Initiatives Confier3 Catholic/Health/East Accretive4 Adventist Cerner5 Dignity Optum

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Keys  to  getting  the  investment  right  Re-­‐rating,  Stabilization  in  Business    Re-­‐rating.  The  restatement  should  add  stability  to  the  stock.  The  keys  will  be  revenue,  margins  and  cash  flow.  We  anticipate  that  the  restatements  will  show  Accretive  as  an  attractive  company  with  steady  customers  and  maturing  contracts  reflected  in  its  margins  and  increased  cash  flows.    

The  Bear  Case  Damaged  Goods    Between  the  AG  investigation,  restatement,  cancelled  HQ  move,  and  delisting,  Accretive  has  undergone  some  second  guessing  by  potential  customers.  In  spite  of  this,  Accretive  has  continued  to  be  recognized  in  the  industry  and  has  added  new  customers.  With  new  management,  we  feel  that  their  reputation  will  continue  to  improve  as  they  exit  the  restatement.    

Key  Risks  Customer  Base    5  year  contracts  and  close  comprehensive  partnerships  with  customers  and  software  make  Accretive  a  very  sticky  vendor.  With  that  said,  there  the  industry  is  evolving  and  key  customers  moving  to  other  vendors  may  present  problems.  The  main  concern  is  Intermountain,  which  represents  20%  of  Accretive  revenue.  They  have  recently  partnered  with  Cerner  via  software  management  and  as  Cerner  has  expanded  their  RCM  services,  Intermountain  could  make  an  easier  transition  to  Cerner.  Their  contract  is  expected  to  be  up  for  renewal  at  the  end  of  2015  and  should  be  tracked.    

Moving  Forward    We  anticipate  the  following  milestones  as  Accretive  progresses,  which  may  act  as  further  catalysts.      Moving  Forward  

1) Financial  Restatement  (mid-­‐December  2014)  2) Investor  Awareness  via  roadshows  (Spring  2015)  3) Uplisting  (Spring  2015)  4) Management/BOD  adjustments  (2015)  

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Premortem  Financials,  Reputation  Impact    The  restatements  had  more  changes  than  we  anticipated,  leading  to  lower  valuations.      The  year  of  restatements  and  negative  news  affected  the  customer  base  more  than  expected.    

 

               Sententia  Capital  Management  Sententia  Capital  Management  is  a  value  investing  based  capital  management  firm.  The  firm  manages  a  long  centric,  concentrated,  market  and  capital  agnostic  equities  fund  with  an  opportunistic  mindset  to  manage  short-­‐medium  term  volatility  while  capitalizing  on  long-­‐term  appreciation.    We  believe  that  a  value-­‐based  approach  to  investing,  enhanced  by  the  use  of  derivatives  and  steeped  in  a  culture  of  patience  and  discipline,  is  the  most  effective  way  to  preserve  capital  in  the  short  term  and  to  grow  wealth  over  the  long-­‐  term.  We  perform  detailed  analytical  and  fundamental  work  prior  to  making  an  investment.  This  analysis  includes  detailed  financial  analysis,  industry  dynamics,  meetings  with  management  when  possible,  and  an  understanding  of  technical  factors  that  may  affect  the  prices  of  the  securities.  The  Fund  may  employ  derivative  applications.  We  will  seek  to  maximize  portfolio  liquidity  by  investing  in  securities  where  there  is  an  active  market.    Michael  Zapata,  Founder,  Portfolio  Manager  Mr.  Zapata  is  founder  and  general  partner  of  Sententia  Capital.  He  received  his  B.S.  from  Texas  A&M  University  and  was  commissioned  as  a  Naval  Officer  in  May  of  2001.  Throughout  his  time  in  the  Navy,  Michael  served  as  a  Navy  SEAL  officer  and  deployed  seven  times  during  the  Global  War  on  Terrorism.  Following  his  last  command  at  the  Naval  Special  Warfare  Development  Group,  Michael  transitioned  out  of  the  military  to  attend  Columbia  Business  School  in  2011.  There  he  was  accepted  into  the  The  Heilbrunn  Center  for  Graham  and  Dodd  Investing  and  earned  his  master’s  degree  with  a  focus  on  investment  management.  Upon  completion  of  his  MBA,  Michael  formed  Sententia  Capital  Management.