Enter Presentation Title Heres2.q4cdn.com/987536832/files/doc_presentations/PGND... · 2015. 11....

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December 2015 INVESTOR PRESENTATION

Transcript of Enter Presentation Title Heres2.q4cdn.com/987536832/files/doc_presentations/PGND... · 2015. 11....

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December 2015

INVESTOR PRESENTATION

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SAFE HARBOR / DISCLAIMER

This presentation includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of

1995, which relate to future, not past, events and are subject to risks and uncertainties. The forward-looking statements,

which address the Company's expected business and financial performance and financial condition, among other matters,

contain words such as: “believe,” “could,” “opportunities,” “continue,” “expect,” “may,” “will,” or “would” and other words and

terms of similar meaning.

Forward-looking statements by their nature address matters that are, to different degrees, uncertain, such as statements

about expected income; earnings; revenues; and growth. Although the Company believes the expectations reflected in such

forward-looking statements are based upon reasonable assumptions, it can give no assurance that the expectations will be

attained or that any deviation will not be material. Readers are cautioned not to place undue reliance on these forward-

looking statements, which speak only as of the date on which they are made. Factors that could cause actual results to differ

materially from these forward-looking statements can be found in the Company's Registration Statement on Form S-1 and

the accompanying prospectus filed with the Securities and Exchange Commission on May 22, 2015. These or other

uncertainties may cause the Company’s actual future results to be materially different than those expressed in any forward-

looking statements. The Company undertakes no obligation to update or revise any forward-looking statements.

This presentation also contains estimates and other statistical data made by independent parties and by us relating to market

size and growth and other data about our industry. This data involves a number of assumptions and limitations, and you are

cautioned not to give undue weight to such estimates. In addition, projections, assumptions and estimates of our future

performance and the future performance of the markets in which we operate are necessarily subject to a high degree of

uncertainty and risk.

This presentation also contains non-GAAP financial measures. You can find a reconciliation of the non-GAAP financial

measures to the most directly comparable GAAP financial measures in the appendix to this presentation.

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INVESTMENT HIGHLIGHTS

Recognized Position of Leadership in a Large and Growing Market

Investing in Disruptive Solutions

Strong Financial Performance

A Leading Industry Platform Poised for Growth

Favorable Industry Dynamics

Proven Management Team

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EXPERIENCED MANAGEMENT TEAM

Patrick T. Ryan, Chief Executive Officer

30+ years of experience working with healthcare leaders

and providers

Previously served as CEO of The Broadlane Group,

PolyMedica Corporation (PLMD) and Physicians Dialysis

Patricia Riskind, Chief Client Experience Officer

25+ years of healthcare experience

Previously founded PatientImpact, acquired by Press

Ganey in 2009, and co-founded 3d Health

Joe Greskoviak, President, Chief Operating Officer

30+ years of healthcare experience

Previously served as President of MedAssets’ spend and

clinical resource management business (MDAS) and as

EVP and Chief Development Officer for The Broadlane

Group

Dr. James Merlino, President & Chief Medical Officer,

Consulting

17 years of experience

Practicing surgeon

Previously Chief Patient Experience Officer for The

Cleveland Clinic Health System

Dr. Thomas Lee, Chief Medical Officer

35 years of healthcare experience; practicing physician

Previously served as Network President for Partners

Healthcare System and CEO for Partners Community

Healthcare, Inc.

Board member of Geisinger Health System and NYP /

Weill Cornell Medical Center

Christina Dempsey, Chief Nursing Officer

30+ years of healthcare experience

Faculty for the Missouri State University Dept of Nursing

Previously VP at Patient Flow Technology and VP for

surgical and emergency services at Mercy St. John’s

Deirdre Mylod, Executive Director, The Institute for

Innovation and SVP, Research and Analytics, Press Ganey

19 years of healthcare experience

Launched the Institute for Innovation to reduce patient

suffering and improve patient engagement

Breht Feigh, Chief Financial Officer

25+ years of financial experience

Previously served as CFO of American Dental Partners

(ADPI)

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INHERENT

SUFFERING

Experienced even if

care is delivered

perfectly

GOAL

Alleviate this suffering

AVOIDABLE

SUFFERING

Caused by defects

in the approach

to deliver care

GOAL

Prevent this suffering

Design the Patient Experience to Reduce

Suffering

PRESS GANEY OVERVIEW

Mission To help healthcare organizations reduce suffering and improve clinical

quality, safety and the overall patient experience

History A pioneer and thought leader in the patient experience industry with 30

years of experience

Built Company on the simple premise that “the patient voice matters”

Strengths An industry leader in the approximately $3.7B patient experience

measurement and performance improvement solutions market

Viewed as a strategic partner to our clients

Represent healthcare providers across the continuum of care

Scale and Growth Multiple drivers of sustainable organic growth

Natural operating leverage

High revenue visibility

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PRESS GANEY PIONEERED THE INDUSTRY AND CONTINUES TO DRIVE INNOVATION TODAY

Unrivaled patient experience database

constitutes barrier to entry

Investment in innovation to address

dynamic industry demands

30 years of improving the patient

experience

1985: Established by Co-Founders

Dr. Irwin Press & Dr. Rod Ganey

Establish

Market

Industry

Growth Thought Leadership & Innovation

Evolve

the Model

1992: Government begins tying patient

experience metrics to reimbursement

2002: Develops online

client forum

2012: New

Management Team

2012: Morehead

Acquisition

2013:

Introduction

of Suffering

Framework

2009 - 2010: Four

Strategic Acquisitions:

Patient Flow

Technologies

PatientImpact

Data Advantage

Quality Indicator Project

1997: Press Ganey releases

One Million Patients

Have Spoken

2012: Institute for

Innovation

2013: Census Based

Surveying

2014: NDNQI

Acquisition

2014: DCS

Acquisition

2014: Compassionate

Connected Care

Over 300 C-Suite Visits

(2012-2014)

2006: CMS introduced

HCAHPS Program

2014: ACA

Implemented

2015: Transparency

Summit – 140 clients

2013: OTS

Acquisition

2014: NCC -

2500 clients

2015: Peds

Summit –

50+ clients

2015: HPI

Acquisition:

2015: NCC -

2900 clients

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Competitive Forces

30 Years Technology & Innovation Investment

Advanced Analytics & Insights

Thought Leadership

Advisory Strength

Client Relationships

PRESS GANEY’S ECONOMIC MOAT

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DRIVING CULTURAL AND OPERATIONAL PERFORMANCE

Scientific

Measurement • Scientifically rigorous

• Industry-leading

benchmarking database

• Robust data sets (CPT,

DRG, ICD-9)

• 105 million+ surveys

distributed in 2014

Advanced

Analytics • Integrated data insights

• High reliability analytics

• Sentiment analysis

• VBP modeling

• Quality measures

Intuitive

Reporting • Enterprise view

• Drill down to service,

unit, physician levels

• Targeted improvement

opportunities

Expert

Advisors • Nationwide advisory

support

• Access to subject matter

experts, PhDs

• Discrete consulting

engagements

Patient-Centered Solutions

Patient experience

improvement

Physician, nurse and

employee engagement

Nursing quality indicators

Patient reported outcome

measures

Core measures

Culture and engagement

Safety and high reliability

Compassionate Connected

Care

Patient Experience /

Engagement Solutions

Clinical & Quality

Outcomes

Consulting

Services

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300+ Client Facing Associates

72 Quota-Driven Sales Professionals ($18.5mm) (1)

120 Advisory Professionals ($12.4mm) (1)

144 Account Management Supporting Clients ($9.2mm) (1)

1000+ Press Ganey Total

Geographically-based model for majority of client base

INDUSTRY LEADING SALES AND CLIENT MANAGEMENT TEAMS

1. Includes salary, incentives, commissions, taxes and benefits.

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DISTINGUISHED CLIENT BASE Deep Customer Relationships with High Level of C-Suite Connectivity

~3% largest client

revenue

contribution(1)

~94% average

annual revenue

retention(2)

~8 years average

duration of hospital

client relationship

99% operational

effectiveness(3)

1. Represents year 2015.

2. Represents 2012 - 2014.

3. Operational effectiveness error rate calculated by dividing total errors in the collection, compilation and / or presentation of data by total requests for data.

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CASE STUDIES

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4.3

3.7 3.6

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Lowest Middle Best

Av

era

ge

Le

ng

th o

f S

tay

(D

ay

s)

Reliability Score Quintile Rank

Average Length of Stay by Patient

Experience Reliability Score Ranking (1)

1. Reliability and length of stay data derived from our 2013 HCAHPS all-facilities database and CMS Hospital Compare database.

Source: Based on MSPB (Medicare Spending per Beneficiary) 2012, HCAHPS.

Note: Hospital Compare 2012 and Billian’s 2012 data, N=2,655.

10.0%

14.8%

10.5%

2.8%

0%

4%

8%

12%

16%

20%

TopPerformers

BottomPerformers

~5% Over-

payment

for bottom

performers

HIGHLY RELEVANT SOLUTIONS Patient Experience Is Linked to Clinical & Financial Performance

Average Length of Stay Cost of Care and Operating Margin

Patient Experience is a Powerful Tool for Performance Improvement

Hospital Net Margin

CMS spending on 30 Days Readmission

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72

62 61

71 70 70 74

27

20 21

34

28

40

30

0

20

40

60

80

100

Nurse Responsive Physician Pain Medication Discharge Rate

Avera

ge N

ati

on

al P

erc

en

tile

Ran

k i

n P

ati

en

t E

xp

eri

en

ce

Top 20% of Employee Engagement Bottom 20% of Employee Engagement

National Percentile Rank Based on Employee Engagement Scores (1)

Employee Engagement Improves Patient Experience

1. Based on Engagement data from 52 projects, HCAHPS data from Jan-Dec 2013 hospital compare dataset.

HIGHLY RELEVANT SOLUTIONS Patient Experience Is Linked to Operational & Organizational Performance

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CASE STUDY: EMPLOYEE ENGAGEMENT

Use of employee engagement surveying since

2004, but scores were declining without actionable

improvement plan

Developed comprehensive engagement strategy,

implementing more of Press Ganey’s prescribed

approaches

By 2011, employee engagement at Carolinas

moved to the 93rd percentile from the 76th

percentile in 2010, and has since remained in the

top decile

Supported by our solutions, CHS observed

significant performance benefits including:

- Efficiency (patient discharges per employee)

improved 23% from 2009 through 2013

- Effectiveness (net patient revenue per

employee) improved 17% from 2009 through

2013

Workforce has produced both improved

productivity and contribution

23%

17%

Efficiency Effectiveness

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CASE STUDY: CENSUS BASED SURVEYING / TRANSPARENCY

In 2011, implemented Census Based Surveying,

increasing survey returns by 170% from 2010 to

2012

By end of 2012, went to full transparency via

University of Utah online physician review site,

driving increased accountability and resulting in

significant improvement according to the client

Physician ratings rose from 9% of providers in 90th

percentile in 2010 to 50%+ in 90th percentile in

2014 based on Press Ganey’s benchmarking

database

Additionally, improved from 3% of providers in 99th

percentile in 2010 to 26% in 99th percentile in 2014 9%

22%

27%

46%

50%+

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

2010 2011 2012 2013 2014

% of Total Providers

% of Providers at 90th Percentile or above

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INVESTING IN INNOVATION AND THOUGHT LEADERSHIP

29 Executive Council

members of Press

Ganey nonprofit

245+ Speaking

engagements

2,900 Attendees at annual

client conference

1,000+ Attendees at five

regional

symposiums

261,000+ Monthly user logins

for improvement

solutions

300+ Industry articles in

key trade

publications

26,000+ Participants in the

online community

3,000+ Custom analytic

reports generated

annually

250 Participants in CNO

Quarterly Best

Practices

Roundtable

Investing in Thought Leadership

Invested $20.4 mm Toward Technology Platform in 2014

~69% New Product Innovation, Additional Product Functionality and Business Growth

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GROWTH STRATEGY / TOTAL ADDRESSABLE MARKET

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VIRTUOUS CIRCLE OF GROWTH

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FAVORABLE INDUSTRY DYNAMICS

Healthcare Dynamics Market Response

Shift away from fee-for-service to value-based

models of care delivery

Narrow networks

Shift to Value-Based Healthcare

Rise of Consumerism in Healthcare

Expanding Government Regulation

Growth in U.S. Healthcare Spending

Manage population health / care coordination

Patient-centricity movement

Operational integration and advanced analytics

Demand for more comprehensive data

Transparency

Brand awareness / equity

Expanded CAHPS programs

Patient engagement critical for payment

Focus on performance and outcomes

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PQRS CAHPS

PERFORMANCE MANAGEMENT IS ESSENTIAL Expanding CAHPS Impact on Financial Performance

2%

Medical Practices 2+ EPs

Emergency Departments Anticipated ED CAHPS Implementation ED CAHPS Survey Development

Hospital Outpatient Departments, Ambulatory Surgery Centers

OAS CAHPS Implementation OAS CAHPS Survey Development

Pediatric Inpatient Hospitals Child HCAHPS Implementation

Inpatient Hospitals HCAHPS

Inpatient Psychiatric Facilities Inpatient Psychiatric CAHPS Survey Development Anticipated PY CAHPS

Implementation

Dialysis Centers ICH CAHPS

Hospice Providers Hospice CAHPS

Accountable Care Organizations ACO CAHPS for Pioneer & Shared Savings programs

Medical Practices 100+ EPs

Home Health Agencies HHCAHPS

PQRS CAHPS used within VBPM

PQRS CAHPS

Medical Practices 25+ EPs PQRS CAHPS

2015 2016 2017

Voluntary Required for

Payment

Penalty

PQRS CAHPS Anticipated MIPS

Anticipated MIPS

Anticipated MIPS

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TOTAL ADDRESSABLE MARKET

Total addressable market is

large and expanding as patient-

centric care becomes mission-

critical

Ample opportunity to grow in the

white space with new and

existing clients and in new

markets

Patient Experience Measurement and

Performance Improvement Solutions

Source: 2014 Stax analysis.

$3.7B

$6.0B

2014 2018

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HISTORY OF SUCCESSFUL ACQUISITIONS

Patient

Experience

Clinical

Consulting

Engagement

Disciplined acquisition strategy for acquiring capabilities in core and adjacent markets

2015 2014 2013 2012 2011 2010 2009

eSurvey technology

platform

Point of care

technology platform

Engagement survey

platform, benchmarks

Core measures

reporting platform and

expertise

Patient reported outcomes survey

Nurse engagement surveys,

benchmarks, insights

Throughput analysis and

process improvement Safety and reliability consulting

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HPI ACQUISITION EXPANDS PATIENT EXPERIENCE SOLUTIONS SUITE

Safety Directly Impacts the Patient Experience

- 440,000 Americans die from preventable hospital errors

- 3rd leading cause of death in the US

- 1 in 25 hospitalized patients develop a preventable hospital infection

- Seniors have a 25% chance of injury, harm or death from a preventable

hospital error

Patient injury/error related cost to hospitals ~ $2,013 per discharge

Improvement requires providers to understand the interdependency of

safety, quality and patient-centeredness

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HPI offers industry-leading safety and reliability consulting

‒ Founded 2006

‒ 20+ Consultants

‒ 700+ Hospital clients

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FINANCIAL REVIEW

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FINANCIAL OVERVIEW

Retention: 97% client retention / 94% revenue retention 3-year average 2012-2014

Visibility: average contract life for top 100 patient experience clients is 2.5 years

Duration: ~8 years average duration of hospital client relationship

Government: accelerant due to CAHPS mandates and Value Based Reimbursement

Census Based Survey: deeper, actionable insight

Engagement: linkages to patient experience and quality

Consulting: operational improvement

Cost of Revenue: greater percentage of insights from lower cost electronic surveys

Technology Improvements: redesign of platforms for collecting and sharing data

Sales Force: broader product offering

Working Capital: prepayment of services

Unlevered Free Cash Flow: 81% of EBITDA from 2012 to 9/2015

Balance Sheet: deleveraged and lower interest rates

Organic

Growth

Revenue

Predictability

Operating

Leverage

Cash Flow

Long Term Growth Targets

Revenue: 7-9% organic / 2-3% acquisition

Adjusted EBITDA: 13-15%

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$0

$50

$100

$150

$200

$250

$300

$350

2012 2013 2014 9 Mos'14

9 Mos'15

LTM9/15

Revenue

GROWTH TRACK RECORD

($ in millions)

$0

$25

$50

$75

$100

$125

2012 2013 2014 9 Mos'14

9 Mos'15

LTM9/15

Adjusted EBITDA

9 Months

+13%

9 Months

+16%

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THIRD QUARTER PERFORMANCE

$72

$81

$0

$25

$50

$75

$100

3Q14 3Q15

Revenue Adjusted EBITDA ($ in millions)

12.6% YoY Growth

11.6% Organic

1% Acquisition

$27

$31

$0

$10

$20

$30

$40

3Q14 3Q15

17% YoY Growth

Cost of revenue 41.6% → 40.9%

General & administrative 21.9% → 20.8%

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5.4x

4.6x

4.0x 3.8x

1.6x 1.5x

0.0x

1.0x

2.0x

3.0x

4.0x

5.0x

6.0x

2012 2013 2014 1Q15 2Q15 3Q15

Total Net Debt (2) / Adjusted EBITDA Ratio

CASH FLOW AND LEVERAGE

1. Unlevered free cash flow = adjusted EBITDA – capital expenditures.

2. Net debt = total debt – cash.

($ in millions)

$0

$10

$20

$30

$40

$50

$60

$70

$80

$90

2012 2013 2014 1Q15 2Q15 3Q15

Unlevered Free Cash Flow (1)

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INVESTMENT CONCLUSIONS

Recognized Position of Leadership in a Large and Growing Market

Investing in Disruptive Solutions

Strong Financial Performance

A Leading Industry Platform Poised for Growth

Favorable Industry Dynamics

Proven Management Team

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APPENDIX

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ADJUSTED EBITDA RECONCILIATION

1. Includes costs associated with modification of equity awards in connection with the liquidating distribution and IPO of $70,438 in May of 2015.

2. Write-off of unamortized deferred financing fees, loss on original issue discount and lender fees in connection with debt refinancings.

3. Non-cash property and equipment and intangible impairment charges related to the discontinuation of certain clinical solutions in 2013.

4. Management fees paid to Vestar.

5. Transaction costs incurred in connection with completed and potential acquisitions.

6. Non-recurring expense associated with executive separation agreements and targeted employee headcount reductions.

7. Primarily consists of professional fees incurred in connection with corporate strategic planning and technology consulting projects, as well as expenses and revenue credits related

to client retention due to the discontinuation of certain clinical solutions and software applications.

Fiscal Year ended December 31 Nine Months ended

September 30

Three Months ended

September 30

LTM ended

September 30

($ in thousands) 2012A 2013A 2014A 2014A 2015A 2014A 2015A 2014A 2015A

Net income (loss) $(7,391) $99 $15,583 $10,509 $(40,427) $4,776 $7,416 $10,516 $(35,353)

Interest expense 32,157 24,644 19,832 15,136 9,921 4,706 1,567 20,757 14,617

Income tax expense (benefit) (604) 5,926 13,196 9,185 1,254 4,174 2,614 9,543 5,265

Depreciation & amortization 27,202 32,468 35,102 25,825 30,624 8,779 10,528 34,785 39,901

EBITDA $51,364 $63,137 $83,713 $60,655 $1,372 $22,435 $22,125 $75,601 $24,430

Equity-based compensation(1) 14,256 9,787 8,034 7,565 81,466 2,658 6,469 10,511 81,935

Extinguishment of debt (2) 7,185 7,922 2,894 2,894 1,750 8 1,112 2,894 1,750

Non-cash impairment

charges (3) - 2,579 - - - - - 2,579 -

Management fee to related

party (4) 968 907 1,047 690 553 230 - 912 910

Acquisition expenses (5) 1,327 902 462 332 319 264 116 450 450

Severance (6) 2,797 625 1,084 - 705 - 705 625 1,789

Loss on disposal of property

& equipment - 274 1,719 1,595 (30) 504 1 1,595 94

Other non-comparable items (7)

1,465 2,159 3,606 1,830 1,246 360 382 3,071 3,021

Adjusted EBITDA $79,362 $88,292 $102,559 $75,561 $87,381 $26,459 $30,910 $98,238 $114,379

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UNLEVERED FREE CASH FLOW

Fiscal Year ended December 31 Quarter ended

($ in thousands) 2012A 2013A 2014A 3/31/15 6/30/15 9/30/15

Adjusted EBITDA $79,362 $88,292 $102,559 $27,340 $29,131 $30,910

Capital Expenditures (18,191) (17,230) (19,414) (9,185) (5,994) (5,721)

Unlevered Free Cash Flow $61,171 $71,062 $83,145 $18,155 $23,137 $25,189

Free Cash Flow Conversion (1) 77% 80% 81% 66% 79% 81%

1. Free Cash Flow Conversion defined as % of Adjusted EBITDA.

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CAPITALIZATION

As Reported

($ in thousands) 12/31/12 12/31/13 12/31/14 3/31/15 6/30/15 9/30/15

Cash $7,845 $32,635 $6,962 $12,162 $19,922 $23,793

Total Debt $438,188 $436,736 $419,296 $416,195 $193,979 $193,228

Net Debt $430,343 $404,101 $412,334 $404,033 $174,057 $169,435

LTM Adjusted EBITDA $79,362 $88,292 $102,559 $106,124 $109,926 $114,379

Total Net Leverage 5.4x 4.6x 4.0x 3.8x 1.6x 1.5x

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