Realized

Mentis, founded in 2006 and headquartered in Houston, Texas, is a leading provider of inpatient and outpatient postacute neuro-rehabilitative care to persons with an acquired brain injury ("ABI"). The Company utilizes an interdisciplinary clinical model with customized modified care plans that focus on each patient’s specific behavioral, clinical and social deficiencies. The Company’s comprehensive services include a combination of neuropsychological services, 24-hour rehabilitative nursing, cognitive rehabilitation, physical therapy, speech and language therapy, occupational / vocational rehabilitation, recreational therapy, group therapy, and physical medicine and rehabilitation management. Mentis allows patients that have suffered an ABI to re-enter their homes, community and/or workforce in a shorter period of time with meaningfully enhanced outcomes and greater independence.

Top Down Investment Thesis

Acquired brain injury includes both traumatic brain injuries ("TBI") (commonly caused by falls, auto accidents, workplace injuries, and assaults) as well as strokes, tumors or other conditions whereby the brain is damaged from a lack of oxygen. An estimated 2.4 million people in the U.S. sustain a TBI and another 795,000 sustain an acquired brain injury from non-traumatic causes each year. Currently more than 6.4 million individuals in the U.S. live with a lifelong disability as a result of TBI or stroke. Patients suffering from an ABI typically undergo a long and exhaustive care process that spans from the highest acuity setting down through lower levels of care and rehabilitation depending on the progress of each individual patient. The ultimate end-point for a patient, depending on their level of rehabilitation and independence, can span from a full recovery and independent living to a very limited recovery that requires life-long custodial care. This broad span of outcomes has very material cost ramifications as long-term custodial care can run millions of dollars depending on the age of the patient when they sustain their injury.

Excellere’s investment in Mentis is a result of the firm’s disciplined top down investment strategy, driven by several factors including i) an increased national awareness of brain injury, ii) the increased survival rate of those who have sustained a TBI due to medical advances, iii) higher incidences of stroke in a growing aging population, iv) cost pressures associated with increased healthcare spending shifting more patients to post-acute, lower cost settings, v) a strong and stable reimbursement outlook for neuro-rehabilitative care, vi) a niche market with a unique and complex patient and referral base making it very difficult for other rehabilitation facilities and new market participants to successfully treat ABI patients, and vii) Mentis' outcomes-driven clinical model offers a clear value proposition to each constituency the Company serves (patients, families, referents and payers) by allowing patients to re-enter their homes, community and/or workforce in a shorter period of time with greater independence.

Buy and Build Strategy

Post-acute neuro-rehabilitation is an underserved and highly fragmented market consisting mainly of smaller local and regional providers. Throughout its growth, Mentis has demonstrated an ability to establish new de novo facilities using a systematic approach to new market evaluation, referral source education, licensing, payer contracting and local recruiting. This proven ability to open new facilities in a fragmented marketplace, combined with the opportunity to expand geographic coverage through new referral and payer relationships, expanded service offerings and enhanced technology, creates an attractive buy-and-build opportunity. Mentis is actively seeking strategic add-on acquisitions of post-acute neuro rehabilitative care providers that will enable the Company to broaden its geographic footprint and deepen its presence in the market.

To the extent you are interested in learning more about Mentis, please contact Ryan Glaws at or Matt Halverson at to discuss the neurorehabilitation services sector further.

Realized

Founded in 2001, TrialCard Incorporated (“TrialCard” or the “Company”) provides specialized services that solve the market access challenges faced by the pharmaceutical industry. The Company offers customized solutions for clients that assist with prescription adherence and abandonment, sales force support, patient case management, reimbursement and clinical support, market share lift, product rescue, and loss of exclusivity challenges. TrialCard’s pharmaceutical manufacturer clients optimize revenue through a brand’s life cycle, while patients and providers benefit from better clinical outcomes and lower overall cost of care. TrialCard’s broad suite of services is enabled by the Company’s database of pharmacy-level transactions, data analytics capabilities, award-winning customer experience center, and proprietary program management processes; all of which enhance program efficacy and return on investment for its customers.

Top Down Investment Thesis

According to the New England Healthcare Institute, medication non-adherence is estimated to drive $290 billion in avoidable spending to the U.S. healthcare industry annually through unnecessary hospitalizations and additional medical risks. Seven percent of prescriptions are abandoned at the point of sale and between 33% and 50% of patients do not take their medications as prescribed. TrialCard’s portfolio of services helps drive patient access and adherence for pharmaceutical manufacturers, while simultaneously adding value across the healthcare delivery chain (i.e., pharmacies, patients and healthcare providers). One significant factor in non-adherence is the out-of-pocket cost burden on patients, thus co-pay programs and product vouchers have proven to be powerful tools in driving adherence. Patients are 2.3x more likely to refill physician prescribed medication when using TrialCard programs. Additionally, these programs generate actionable consumer insights while driving superior patient outcomes, which benefit physicians, patients and payers. Another significant cause of non-adherence is the complexities of specialty drugs relating to payer support, clinical coordination and drug administration. To address this issue, TrialCard’s specialty therapy hub provides assistance for patients in navigating the complex reimbursement challenges associated with specialty drug therapies such as prior authorization, benefits investigation and appeals processes. Through improving patient outcomes and lowering overall cost of care, increasing adherence generates benefits for all constituents in the healthcare system.

Buy and Build Strategy

The patient access and pharmaceutical adherence services industry is highly fragmented with a limited number of competitors providing a complete customer solution. TrialCard is well positioned to continue the expansion of its capabilities, customer relationships and technologies across the entire patient journey. The Company is pursuing strategic acquisition opportunities in the outsourced pharmaceutical support services industry, including the following existing and complementary capabilities: (i) specialty therapy hub services, (ii) tele-detailing, (iii) patient support / education, (iv) disease management, and (v) consulting and enhanced analytics.

To the extent you are interested in learning more about TrialCard, please contact Brad Cornell at or Mike Vieth at .

Realized

PhyMED is a leading provider of outsourced anesthesia, interventional pain management and other complementary services to hospitals, medical facilities and ambulatory surgery centers. Formed in 1994 and based in Tennessee, PhyMED is a top ten provider of anesthesia services in the United States.

Top Down Investment Thesis

Excellere’s investment in PhyMED is a result of a four year search for an anesthesia platform based on the firm’s disciplined top down investment strategy, driven by several factors including i) the non-discretionary nature of anesthesia services that carry a high degree of medical necessity as sedation is required for most surgical procedures, ii) a clear and deep value proposition to patients, surgeons, medical facilities and payers, and iii) the highly-fragmented nature of the industry.

The key customers for an outsourced provider of anesthesia services are the healthcare facilities, and more specifically the surgeons that anesthesiologists work with. For the medical facilities, a contracted or outsourced anesthesiology partner provides dedicated anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs), while reducing the need for internal resources dedicated to recruiting, credentialing, scheduling, billing, collections and compliance. For the surgeon and facility, there is significant value gained through access to a consistent staff of anesthesia professionals available in order to maximize the efficiency and throughput of the operating room, which is one of the most profitable areas of a hospital.

The U.S. anesthesia services industry is estimated at over $23.0 billion and growing at 4% per year, in line with growth in total surgical procedures and case reimbursement rate trends. The number of U.S. surgical procedures is projected to grow 29% from 2010 to 2020.

Buy and Build Strategy

The anesthesia services sector is highly fragmented and comprised of over 1,000 providers nationally. This fragmentation, combined with the opportunity to significantly enhance the value provided to its customers’ experiences and outcomes through the use of technology-driven solutions, suggests an immense opportunity to execute a customer-centric, buy-and-build strategy. Specific areas of focus within the outsourced anesthesia services sector include other compliance-focused anesthesia providers and complementary service lines such as interventional pain management and critical care coverage.

To the extent you are interested in learning more about PhyMED, please contact Matt Hicks at or Justin Unertl at to discuss the anesthesia services industry further.

Realized

AxelaCare, headquartered in Lenexa, Kansas, is a leading provider of home infusion therapy services, including Intravenous Immune Globulin (“IVIg”), Hemophilia and other traditional home infusion services, such as Intravenous Antibiotics and Total Parenteral Nutrition (“TPN”). The company, which was founded by a team of proven industry veterans, is experiencing rapid growth and currently operates three pharmacies serving patients in 25 states. AxelaCare’s full service approach includes hands-on clinical management of the patient intake process to ensure that patients are able to begin therapies in a timely and efficient manner. This combination of outstanding clinical and pharmacy services, along with AxelaCare’s culture of patient advocacy and support, significantly differentiates the company from other industry participants.

Top Down Investment Thesis

Excellere’s investment in AxelaCare is a result of the firm’s disciplined top down investment strategy. In 2008, Excellere targeted the specialty pharmacy sector (including home infusion) as an attractive buy-and-build opportunity and spent the subsequent two years carefully seeking a partnership with an industry leading management team who shared a vision to build a truly differentiated company.

AxelaCare competes within the specialty infusion sector of the specialty pharmacy industry. Specialty infusion services primarily involve the intravenous (i.e., directly into veins or muscles, or under the skin) administration of medications to treat a wide range of acute and chronic health conditions. Physicians, hospital discharge planners and case managers generally refer patients to specialty infusion providers to continue their therapies at home or in other non-acute settings.

The market for specialty infusion is approximately $10 billion and growing at approximately 8% to 12% annually. This significant organic growth is driven by numerous factors including: (i) favorable demographic trends, (ii) a growing pipeline of new pharmaceuticals and therapies that are appropriate for infusion, (iii) patient preference for home care (especially in cases of chronic diseases), (iv) lower costs as compared to treating chronic illnesses in a hospital setting, and (v) technological advancements that have made delivering complex therapies in the home safer and more prevalent. Approximately 70% of the drugs now under development in the biotech pipeline will require some degree of specialized, hands-on administration via injection or infusion.

Buy and Build Strategy

The specialty infusion sector is highly fragmented, with an estimated 700 to 1,000 home infusion providers in the United States. This fragmentation, combined with the industry’s strong organic growth, creates an attractive buy-and-build opportunity. AxelaCare is actively seeking strategic add-on acquisitions of home infusion providers that will enable the Company to broaden its geographic footprint and deepen its presence in the attractive home infusion market.

To the extent you are interested in learning more about AxelaCare, please contact Ryan Glaws and or Justin Unertl at .

Realized

MTS Medication Technologies (“MTS”) is a leading international provider of pharmaceutical adherence packaging solutions focused on the long term care, retail and nutraceutical markets. MTS designs, develops and manufactures proprietary pharmaceutical adherence packaging along with a complete line of highly specialized automated equipment to assist institutional pharmacies and long term care facilities with pharmaceutical dispensing, inventory management, and storage. MTS serves more than 8,000 customers in the United States, Canada, Europe, Australia, and the Middle East.

Top Down Investment Thesis

Pharmaceutical adherence packaging (i) increases patient compliance for their drug regimens; (ii) enables pharmacies to dispense drugs more efficiently/reliably and store/handle drugs properly; (iii) makes compliance easier for patients, who often must consume multiple drugs, multiple times per day to comply with their doctor’s prescribed regimen; (iv) provides physicians, through greater patient adherence, with the comfort that their prescriptions are being followed properly; and (v) reduces healthcare costs through fewer emergency room visits/deaths/hospital admissions related to non-adherence. Estimates indicate 28% of emergency room visits are related to the misuse of drugs; 70% of which are preventable and 24% of which result in hospital admissions. In addition, U.S. healthcare costs related to treating patients due to medication non-adherence is estimated to be $60-$100 billion annually (Healthcare Compliance Packaging Council).

Buy and Build Strategy

Partnering with Excellere to pursue a buy-and-build strategy, MTS is currently looking for acquisition opportunities that would enable the company to add more products and services to its existing customers, as well as increase its reach through new customers and distribution channels both domestically and internationally.

For more information regarding MTS please contact Matt Hicks at or Ryan Glaws at .

Realized

Advanced Pain Management (“APM”) is a Milwaukee-based, leading provider of interventional pain management services throughout Wisconsin. APM has the expertise to diagnose and treat a broad range of pain conditions, including pelvic, spine, neck, hip, cancer, diabetes, and obesity-related pain.

Top Down Investment Thesis

Chronic pain is estimated to cost the U.S. economy $90 to $100 billion per year. Costs continue growing due to increasing obesity, the aging population, and overall poor lifestyles. Interventional pain management (“IPM”) is a multidisciplinary approach for managing and eliminating pain and became more visible when it was granted a medical sub-specialty from the Centers for Medicare and Medicaid Services in 2003.

Interventional pain management develops customized plans, and uses minimally invasive outpatient procedures, such as nerve blocks, epidurals, and implants to help patients manage or eliminate pain. IPM is an attractive alternative to higher-risk heavy drug regimens that simply mask the pain or costly surgeries that require lengthy recovery and questionable long term outcomes. As a result, IPM offers an excellent value proposition to the patients, referring physicians, and payors

To learn more about Advanced Pain Management, please call David Kessenich at or Matt Hicks at .

Realized

MedExpress Urgent Care (“MedExpress”) is a leading provider of outpatient urgent care services. It currently operates urgent care centers in Pennsylvania, West Virginia, Colorado, and Florida. MedExpress delivers high-quality urgent care, including digital X-ray, laboratory work, EKGs, IV therapy, and minor surgery, and provides patients a greater level of convenience and flexibility than emergency rooms or primary care physicians. The clinics always have physicians onsite and are open daily to deliver flexible, efficient, and fast care.

Top Down Investment Thesis

Urgent care is an emerging model within the U.S. health care system. It is based on improved access to care delivered in a timely and cost effective manner. Many emergency departments have long wait times, and an antiquated primary care system leaves patients waiting days and sometimes weeks for an appointment. Urgent care provides a convenient and affordable health care solution for patients who need timely, high quality care. A typical urgent care center visit costs approximately 25 percent of a similar visit to a hospital emergency room. Because most visits to emergency departments are not for life threatening reasons, urgent care centers reduce healthcare costs significantly.

To learn more about MedExpress, please call David Kessenich at or Ryan Glaws at .