Aurelia Healthcare — Appendices
Supporting appendices underpinning the Aurelia Healthcare business plan — the detailed financial assumptions schedule, the construction programme and technical specifications, the management-team profiles, the regulatory and legal framework, the ESG impact-measurement framework and the glossary.
Section 13 · Business Plan
Appendices
Supporting appendices underpinning the Aurelia Healthcare business plan — the detailed financial assumptions schedule, the construction programme and technical specifications, the management-team profiles, the regulatory and legal framework, the ESG impact-measurement framework and the glossary.
Appendices
Appendix A — Detailed Financial Assumptions Schedule
A.1 Macroeconomic Assumptions
| Assumption | Value | Source / Rationale |
|---|---|---|
| Long-run ZAR/USD exchange rate | ZAR 18.50 / USD | SARB 5-year average; Reuters consensus |
| SA CPI inflation (long-run) | 4.5% p.a. | SARB target band midpoint |
| SA medical inflation | 6.5% p.a. (CPI + 200bps) | BHF Council for Medical Schemes 5-yr trend |
| SA real GDP growth (long-run) | 1.8% p.a. | Treasury MTBPS 2025; IMF Article IV |
| SA corporate tax rate | 27.0% | SA Revenue Service current rate |
| Discount rate (Equity WACC) | 14.5% | CAPM: rf 9% + β1.0 × ERP 5.5% — South Africa |
| Discount rate (Debt) | 7.0% | SOFR + 350bps blended cost of senior debt |
| Healthcare CAPEX inflation | 5.5% p.a. | Construction PPI healthcare sub-index |
| Personnel cost inflation | 6.0% p.a. | SA bargaining council healthcare settlements |
A.2 Operational Assumptions
| Assumption | Phase I JHB | Phase II Avg | Stabilized |
|---|---|---|---|
| Total beds | 420 | 150 (per facility) | 870 (group) |
| Theatres | 18 | 8 (per facility) | 51 (group) |
| Construction period (months) | 24 | 20 | — |
| Pre-opening period (months) | 6 | 4 | — |
| Bed occupancy at maturity | 78% | 72% | 76% |
| Average length of stay (days) | 4.5 | 4.2 | 4.4 |
| Theatre utilisation | 82% | 76% | 80% |
| Capex per bed (USD) | 345k | 320k | 335k |
| Headcount per bed | 8.2 | 7.5 | 8.0 |
A.3 Revenue Assumptions (Year 1 baseline, USD)
| Service Line | Avg Revenue / Case | Cases at Maturity | % of Group Revenue |
|---|---|---|---|
| Cardiac surgery & cath lab | 28,400 | 5,800 | 20% |
| Oncology (medical & radiation) | 18,200 | 7,200 | 18% |
| Trauma & emergency surgery | 12,600 | 8,800 | 15% |
| Renal (dialysis + transplant) | 4,800 | 14,500 | 12% |
| Women & Children (maternity, paeds) | 6,200 | 12,000 | 10% |
| Diagnostics (MRI, CT, lab) | 420 | 180,000 | 8% |
| Outpatient consultations | 180 | 450,000 | 8% |
| Other surgical (orthopaedic, general) | 11,200 | 6,500 | 9% |
Appendix B — Construction Programme & Technical Specifications
B.1 Phase I — Aurelia Medical City Johannesburg
The flagship Phase I facility is designed as a 420-bed quaternary
care hospital occupying a 12-hectare site in Sandton North, with road
and air-ambulance access via N1 highway and Lanseria. The architectural
design is led by an international JCI-experienced healthcare design
practice, with engineering by a tier-1 South African EPC contractor
(selected via competitive tender) under a fixed-price design-build
contract with liquidated damages.
| Element | Specification |
|---|---|
| Site area | 12 hectares (28 acres) |
| Gross built-up area | 78,000 m² |
| Bed count | 420 (380 acute + 40 ICU/HDU) |
| Operating theatres | 18 (incl. 2 hybrid OR with imaging) |
| Cath labs | 4 |
| Dialysis stations | 60 |
| Radiotherapy bunkers | 4 (2× LINAC, 2× brachytherapy) |
| Imaging suite | 3T MRI ×2, 256-slice CT ×2, PET-CT, 4× US, 6× X-ray |
| Helipad | Yes — 24/7 operational |
| Parking | 2,800 bays (visitors, staff, ambulance) |
| Energy systems | 3 MW solar PV + 2 MWh BESS + 5 MW backup generators + grid |
| Water systems | 7-day on-site storage + greywater recycling + rainwater harvesting |
| HVAC | 100% fresh-air HEPA filtration in clinical areas; negative-pressure isolation rooms (8) |
| Total construction budget | USD 145M (incl. 8% contingency) |
| Construction period | 24 months from financial close |
B.2 Sustainability & Resilience Standards
All Phase I and Phase II facilities are designed to achieve Green
Star SA — Healthcare 5-Star rating from the Green Building Council South
Africa, equivalent to LEED Gold. Specific resilience standards
include:
- Renewable energy: On-site solar PV provides ~35%
of base load; battery storage covers full critical-load operation for 4
hours during grid outages; total Eskom-independence target by Year
7 - Water security: 7-day on-site storage; municipal
connection redundancy; greywater recycling reduces consumption by
40% - Waste management: Segregated medical-waste
streams; on-site sterile waste processing; 70% landfill diversion
target - Climate resilience: Designed to 1-in-100-year
storm events; raised site levels; storm-water attenuation
Appendix C — Management Team Profiles
Detailed curriculum vitae for the senior leadership team are provided
in the supplementary information memorandum (available under NDA). The
summary below indicates the experience profile of each role:
C.1 Group Chief Executive Officer
25+ years of healthcare leadership experience, including 10 years as
CEO of a top-3 South African private hospital group. Medical doctor
(MBChB, University of Cape Town) with MBA (London Business School).
Former independent non-executive director of two JSE-listed healthcare
companies. Track record of leading two greenfield hospital developments
to commercial operation, both delivered on time and within 5% of budget.
Founding shareholder in three private healthcare ventures, two of which
achieved successful trade-sale exits.
C.2 Group Chief Financial Officer
20+ years of financial leadership in healthcare, with prior CFO roles
at a JSE-listed hospital group and a DFI-funded pan-African operator.
CA(SA) and CFA charterholder. Led successful debut Eurobond issuance,
two equity capital raises, and structuring of senior-debt facilities
exceeding USD 800M cumulative. Deep relationships with development
financiers (AfDB, IFC, Proparco, FMO, DEG) and the JSE.
C.3 Group Chief Operating Officer
20+ years of hospital operations, beginning as a registered nurse and
progressing through hospital General Manager and Regional Director
roles. MBA (UCT GSB) with healthcare specialization. Six Sigma Master
Black Belt. Led operational integration of 12 acquired facilities at
prior employer, delivering 320bps EBITDA margin improvement within 36
months.
C.4 Group Chief Medical Officer
25+ years as a specialist physician (FCS(SA) Cardio-Thoracic
Surgery), with senior academic appointment as Associate Professor at a
leading South African medical school. Past President of a national
specialist society. MBA (Wits Business School). Clinical Director at a
JCI-accredited tertiary hospital for 6 years. Author of 80+
peer-reviewed publications. Brings extensive specialist-clinician
network and clinical-governance expertise.
Appendix D — Regulatory & Legal Framework
D.1 Key Regulatory Approvals & Licences
| Approval / Licence | Issuing Authority | Status |
|---|---|---|
| National Health Act Section 36 — Certificate of Need (private hospital) | National DoH / Provincial DoH | Targeted M+8 from FC |
| National Health Act — facility licence | National DoH | Targeted M+18 from FC |
| Council for Medical Schemes designated service provider status | Council for Medical Schemes | Application post-licensing |
| Health Professions Council of SA (HPCSA) practice numbers | HPCSA | Per-practitioner; rolling |
| South African Nursing Council registrations | SANC | Per-practitioner; rolling |
| Medicines Control Council pharmacy licence | SAHPRA | Targeted M+18 from FC |
| Radiation safety licence (radiotherapy / nuclear medicine) | Department of Health (Radiation Control) | Targeted M+22 from FC |
| Environmental Authorisation (NEMA) | Provincial DEDEAT | Pre-construction; in progress |
| Building Plan approval | Local Municipality | Pre-construction; in progress |
| Occupational Health & Safety compliance certificate | Department of Labour | Pre-occupation; standard |
| JCI accreditation | Joint Commission International | Targeted Y3 of operations |
| Green Star SA Healthcare 5-Star rating | GBCSA | Targeted at occupation |
D.2 Corporate Structure
The transaction is structured through a holding-company /
operating-company architecture compliant with South African Reserve Bank
exchange-control regulations and tax-efficient under the SA-Mauritius
and SA-Netherlands DTAAs:
- Aurelia Healthcare Holdings (Mauritius) —
ultimate parent; capital-pooling and dividend-reception vehicle; holds
100% of SA HoldCo - Aurelia Healthcare Holdings (Pty) Ltd (RSA) — SA
holding company; signs senior facility; intermediate dividend
conduit - Aurelia Hospital JHB (Pty) Ltd — Phase I OpCo;
owns Johannesburg facility - Aurelia Hospital CPT / DBN / PTA (Pty) Ltd —
Phase II OpCos (3 sister entities) - Aurelia Ambulatory Networks (Pty) Ltd — Phase
III platform; outpatient & dialysis - Aurelia Properties (Pty) Ltd — PropCo; owns and
leases facility real estate to OpCos under triple-net lease — supports
future REIT carve-out
Appendix E — ESG Impact Measurement Framework
Aurelia’s ESG framework aligns with AfDB’s 2P+2D operating principles
(Power, Productivity, Diversity, Development), the IFC Operating
Principles for Impact Management, and the UN Sustainable Development
Goals — particularly SDG 3 (Good Health), SDG 5 (Gender Equality), SDG 8
(Decent Work), SDG 10 (Reduced Inequalities), and SDG 13 (Climate
Action). The framework is operationalised through 24 quantitative KPIs
reported quarterly to the Board, of which the principal indicators are
summarised below:
| ESG KPI | Y1 Target | Y5 Target | Y10 Target |
|---|---|---|---|
| Patient interactions p.a. | 180,000 | 850,000 | 1,800,000 |
| Underserved & subsidised cases (% of total) | 8% | 12% | 15% |
| Local procurement (% of total spend) | 60% | 72% | 80% |
| Renewable energy (% of total consumption) | 15% | 38% | 55% |
| Water re-use rate (%) | 15% | 28% | 40% |
| Female representation in workforce (%) | 62% | 65% | 68% |
| Female representation in leadership (%) | 40% | 45% | 50% |
| B-BBEE level (RSA) | Level 4 | Level 2 | Level 1 |
| Total jobs created (direct + indirect) | 720 | 4,200 | 6,200 |
| Specialist doctors trained / accredited | 85 | 420 | 780 |
Appendix F — Glossary of Key Terms
| Term | Definition |
|---|---|
| AfDB | African Development Bank — multilateral development financial institution headquartered in Abidjan |
| ALOS | Average Length of Stay — average days an inpatient occupies a hospital bed per admission |
| B-BBEE | Broad-Based Black Economic Empowerment — South African transformation legislation and scoring framework |
| BHF | Board of Healthcare Funders — representative body of South African medical schemes |
| CFADS | Cash Flow Available for Debt Service — operating cash flow after working capital and tax, before debt service |
| CMS | Council for Medical Schemes — South African medical-aid regulator |
| DFI | Development Finance Institution — public-sector lender supporting development outcomes (e.g., AfDB, IFC, Proparco) |
| DSCR | Debt Service Coverage Ratio — CFADS divided by debt service obligations (interest + principal) |
| EBITDA | Earnings Before Interest, Tax, Depreciation, and Amortization — proxy for operating cash earnings |
| EMR | Electronic Medical Record — digital patient health record system |
| EV | Enterprise Value — equity value plus net debt; the total value of an operating business |
| FC | Financial Close — date all conditions precedent to debt drawdown are satisfied |
| HMI | Health Market Inquiry — South African Competition Commission inquiry into private healthcare market |
| IRR | Internal Rate of Return — annualised effective compounded return rate that makes NPV zero |
| JCI | Joint Commission International — global accreditor of hospital quality and patient safety |
| JSE | Johannesburg Stock Exchange — South Africa’s primary securities exchange |
| MOIC | Multiple on Invested Capital — gross-of-fees multiple of equity capital returned at exit |
| NDoH | National Department of Health (South Africa) |
| NHI | National Health Insurance — South African universal-health-coverage policy framework |
| POPIA | Protection of Personal Information Act — South African data privacy legislation |
| SAHPRA | South African Health Products Regulatory Authority — successor to MCC; regulates medicines and devices |
| SOFR | Secured Overnight Financing Rate — USD floating-rate benchmark; successor to USD LIBOR |
| WACC | Weighted Average Cost of Capital — blended after-tax cost of debt and equity |
Confidential — this business plan is provided to prospective investors and lenders for evaluation purposes only and may not be reproduced or distributed without the written consent of Aurelia Healthcare Holdings (Pty) Ltd.