Kovai Medical Center & Hospital Ltd Management Discussions.


The year passed by has witnessed one of the biggest healthcare crisis in over a decade. The outbreak of COVID-19 has severely impacted countries across both the developed and the developing world and has challenged healthcare system and infrastructure at a never seen before scale. The loss of human lives and suffering of people have been overwhelming and deeply disturbing. Lockdowns being witnessed in countries across the globe and travel ban to break the chain of transmission of virus impacted economies and industries forcing further hardships and turmoil economically and otherwise. The rapid spread of pandemic and limited understanding of the virus and its various strains has altered the ways of both social and personal interactions as well as revised professional working styles.

India too has borne the brunt of the pandemic in FY 2020-21 and witnessed a second wave in early FY 2021-22, which has had a worse impact in terms of COVID cases and resultant deaths. While challenges in healthcare infrastructure and lack of medical resources have been a severe constraint in controlling the pandemic, healthcare institutions, both public and private have acted on a war footing to scale up infrastructure across the healthcare value chain, be it in terms of bed, isolation centers, medical equipment, medicines or testing capabilities. Clinicians, nurses and paramedics have and continue to work dedicatedly to ensure best available care for COVID-19 patients.


With the COVID-19 pandemic testing even the more developed healthcare systems globally, the foundation of Indian healthcare system have naturally also been shaken. The overall response to the pandemic witnessed both the Private and Government (Central and State) sector working in tandem. The private Indian healthcare players rose to the occasion and have been providing all the support that the government needs, such as testing, isolation beds for treatment, medical staff and equipment at government COVID-19 hospitals and home healthcare.

Indias private healthcare sector has contributed significantly and accounts for about 60 per cent of inpatient care.

Most private facilities initiated their plans in response to the COVID-19 pandemic, which involved significant investments to prepare facilities for controlling and preventing the infection, building infrastructure for quarantine and treatment, and equipping the facility with suitable medical supplies and additional workforce. Additionally, hospitals and labs witnessed a sharp decline in revenue due to delayed medical tourism and elective procedures. The OPDs (outpatient departments) had also been closed almost throughout the year as per the government advisory. The health tech industry recorded a surge in teleconsultation which encouraged the Government of India to issue telemedicine guidelines, enabling seamless operations of the Indian healthcare fraternity over the internet.

In order to effectively manage the outbreak, the Government of India leveraged technology and developed various applications both at the central and state-levels. The Aarogya Setu mobile app assisted in syndromic mapping, contact tracing and self-assessment was widely used throughout the country. Technology platforms including Aarogya Setu and CoWIN were used to supplement the response management, which included delivery of essential items in containment zones, tele-consultations with patients, bed management and real-time monitoring and review by the authorities.

With the approval of vaccines, India has embarked on the largest mass immunization exercise witnessed anywhere in the world and there are many reasons to feel proud about it. As we look back at the start of the pandemic, developing and having these vaccines available at a commercial scale within a year is by no means a small feat. This not only demonstrates the perseverance of our scientific community, but also establishes the will of the Government and the healthcare community in investing on quality care.


India has made significant advancements in the way healthcare is delivered in the country, both by public and private providers. The public healthcare focuses on delivering primary healthcare through community-level health programmes mainly focusing on reducing mortality and morbidity caused by various communicable and non-communicable diseases. It follows a tiered system of infrastructure wherein basic health services are provided through sub-centers and primary health centers, while secondary and tertiary care are delivered at better equipped establishments such as district hospitals and medical colleges that are mostly at district headquarters, thereby reaching out to the remotest villages.

The private sector largely has its presence concentrated in tier I and II cities. The disparities and the challenges to equitable, accessible and quality healthcare get exposed when compared geographically. The National Health Policies over the years have served well in guiding the approach towards a more inclusive healthcare system in the country.

Indias healthcare industry has been growing at a Compound Annual Growth Rate of around 22% since 2016. At this rate, it is expected to reach USD 372 Billion in 2022. Healthcare has become one of the largest sectors of the Indian economy, in terms of both revenue and employment. In 2015, the healthcare sector became the fifth largest employer, employing 4.7 Million people directly. As per estimates by the National Skill Development Corporation (NSDC) healthcare can generate 2.7 Million additional jobs in India between 2017-22, over 500,000 new jobs per year.

On the policy front, the Indian Government is undertaking deep structural and sustained reforms to strengthen the healthcare sector; it has also announced conducive policies for encouraging Foreign Direct Investment (FDI). In fact, Indias FDI regime has been liberalised extensively. Currently, FDI is permitted up to 100% under the automatic route (i.e., the nonresident investor or Indian company does not require approval from the Government of India for the investment) in the hospital sector and in the manufacture of medical devices.

The government has proposed outlay of 2,23,846 Crores for health and well-being, an increase of 137 per cent from the previous year, with 35,000 Crores earmarked for COVID-19 vaccine in the coming fiscal. Ministry of Health and Family Welfare has been allocated 71,269 Crores in FY 2021-22, an increase of 10 per cent over previous year ( 65,012 Crores). This includes the budgetary allocations to National Health Mission ( 36,577 Crores), Ayushman Bharat Pradhan Mantri Jan Arogya Yojana ( 6,400 Crores), Centrally Sponsored Schemes ( 22,044 Crores) and Establishment Expenditure ( 6,245 Crores). Department of Health Research has been allocated 2,663 Crores, an increase of 27 per cent over previous year ( 2,100 Crores). Apart from the 35,000 Crores announced for COVID-19 vaccination, the Made in India Pneumococcal vaccine, currently available in 5 states, will be rolled out pan-India, potentially averting 50,000 child deaths annually.

In a nutshell, the healthcare sector witnessed an increased public spend on health and well-being. However, addressing the persistent manpower and skill gap and measures to improve private sector participation will bode well for an overall improvement in healthcare delivery as well as education facilities. Success would now lie in how these new initiatives are implemented. It will be important to shift the focus towards the quality of implementation of the new programmes and schemes as well as on fostering convergence across health programmes. It might also lead to creation of a robust, collaborative ecosystem for the public and private healthcare providers to work together in quest of desirable outcomes.


Despite initial hiccups, the healthcare system in India managed to withstand the pandemic. The various efforts in manufacturing of medical equipment, disposables, drugs and the most recent vaccine efforts made by India has placed us as a global leader. India not only fulfilled the domestic requirements, but also rose to the occasion and supported other countries. The healthcare sector, therefore, as an investment opportunity looks promising. A few factors encouraging future investments in the sector are:

Medical infrastructure in Tier II and III cities: The shortfalls such as the required number of beds or the accessibility of advanced equipment that were highlighted during the worst-hit times of the pandemic are highlighting the need for a healthcare system that is ‘emergency-proof for such situations in the future.

Hospital chains and specialty centers are coming forward to build more capacities, especially in Tier II and III cities. Numerous hospital chains have started expanding in these cities by setting up small clinics and associating with reputed local doctors. This is also aligned with government efforts to increase the number of hospital beds per thousand population and close the accessibility gap mainly in sub-urban and rural parts of the country.

Government policies: Though planned before the pandemic, government efforts in achieving a universal health cover under ‘Health for All and schemes, such as Ayushman Bharat and National Digital Health Mission have sped up exponentially. These efforts to make healthcare affordable and accessible for the entire population also offer scope for private players to widen their reach and presence.


Reporting symptoms, quarantining responsibly, practicing hand hygiene and social distancing were some of the steps all of us took together to stop the spread of the virus. In fact, the outbreak could be stalled only through community-based action and discipline. Going forward, individual based healthcare philosophy will need to be replaced with community-based measures to effectively tackle any new outbreaks.


COVID-19 has become an unprecedented disruption to all facets of the healthcare industry in a very short period of time. Although the healthcare technology industry has been slow growing in the past, innovation is needed to deal with the pandemic. Artificial Intelligence in healthcare, as well as other important technologies, are critical to resolving the crisis and for generating future growth. After the pandemic, governments and organizations are more focused towards building digital infrastructure and preventive healthcare.

Shift from Communicable to Lifestyle Diseases

With increasing urbanisation and problems related to modern-day living in urban and semi-urban settings, currently, about 50% of spending on in-patient beds is for lifestyle diseases this has increased the demand for specialised care. In India, lifestyle diseases have replaced traditional health problems. Major lifestyle diseases can be categorised under Endocrinology, Cardiology and Gastroenterology.

Expansion to Tier II and Tier III cities

To encourage the private sector to establish hospitals in Tier II and III cities, Government of India has increased the Tax Holiday under Section 80-IB of the Income Tax Act, 1961 for private healthcare providers in non-metros for minimum of 50 bedded hospitals. Benefit under the same Section has been extended to 100 bedded hospitals if set up in rural areas. Such hospitals are entitled to 100% deduction on profits for five years.

Emergence of Telemedicine

Telemedicine is a fast emerging sector in India. Virtual care constituting tele-consult, tele-pathology, tele-radiology and e-pharmacy is experiencing a stimulus in India. According to a study by Ernst & Young, in collaboration with Indian Pharmaceutical Alliance (IPA) in September 2020, domestic telemedicine market is expected to reach USD 5.5 Billion by 2021.

Rising adoption of Artificial Intelligence (AI)

Increasing adoption of Artificial Intelligence Tools and application has enabled to bridge the gap of specialists, doctors and healthcare workforce in India. Clinical Decision Support System leverage AI to alleviate doctors, support them in administrative tasks and allowing them to precisely diagnose using large amount of clinical data and images.

Mining patients clinical data and scientific literature to gather meaningful medical insights and further improving current therapies and creating novel therapies.

Introduction of Vaccine Delivery Digital Platforms

In December 2020, a new COVID-19 Vaccine Delivery Digital Platform called CoWIN was launched by Government of India, As a beneficiary management tool with different modules, this user-friendly mobile app for recording vaccine data. In January 2021, the Government of India offered help to other countries using CoWIN Indias indigenous vaccination management system.

Increasing penetration of Health Insurance

In FY21, Gross healthcare insurance stood at 29.5% of the overall gross direct premium income by non-life insurers segment. Gross Direct Premium underwritten by health insurance grew 13.7% YoY.

Focus on Universal Health Coverage (UHC)

Covid-19 has exposed the fragility of Indias healthcare system and the need to accelerate progress towards Universal Health Coverage (UHC). The recent launch of Reimagining Indias Health System a Lancet Citizens Commission will layout the roadmap for achieving UHC in India. The commission will work towards developing a citizens blueprint by 2022 for the implementation of UHC through a participatory and consultative process across Indias healthcare landscape.



Information and Service Integration: The medical community easily welcomes big data advancement, but implementation is not as fluid. Use of connected medical devices and AI-integrated software application can provide a massive amount of data to the healthcare companies which they can use to generate information. This data can be of different types such as administrative data, patient medical records, connected device data, transcript & clinical notes, and patient surveys. However, most care providers, even top healthcare companies, lack advanced architecture and data management systems to manage data collected from multiple sources.

High Attrition Rate: The high attrition rate in hospitals makes it difficult to plan and allocate human resources. Healthcare specialists are finding opportunities abroad more lucrative and rewarding, prompting them to leave. The highest attrition rate in the country is in the Healthcare sector.

Less Acceptance of Technology: The whole world is becoming digitized, and hospitals and medical institutions are not far off. Digitization helps efficient and quick provision of treatment and services to the patients.


Health insurance awareness: There has been an increased awareness of health insurance products in the past few years and more people are investing in health insurance with each passing year.

Government policies: Though planned before the pandemic, government efforts in achieving a universal health cover under ‘Health for All and schemes, such as Ayushman Bharat and National Digital Health Mission have sped up exponentially. These efforts to make healthcare affordable and accessible for the entire population also offer scope for private players to widen their reach and presence.

Medical tourism: The healthcare sector in India is attractive to foreign patients because of the availability of quality services at relatively lower costs compared to countries in Western Europe or the U.S.

Use of technology: Online consultations and technology platforms are in high demand especially in todays times. The Ministry of Health and Family Welfare introduced the ‘eSanjeevani app, an integrated web-based telemedicine solution. It aims at making healthcare services fair by bridging the gap between urban and rural India.


Regulatory changes and regulatory scrutiny: The healthcare landscape continues to evolve, with regulatory changes and scrutiny on the rise.

Cybersecurity: Connected medical devices and a greater need to keep the records of patient information attract the attention of malicious hackers to healthcare providers. These attacks call for a robust system for cybersecurity in healthcare, which could prevent data theft and loss of information and customers conviction.


Kovai Medical Center and Hospital Limited (KMCH) was incorporated under Companies Act, 1956 in 1985 and started its commercial operation on June 1990, with a capacity of 200 Bed Hospital in the outskirts of Coimbatore. Today it is grown as a 1500 bed multi-locational, multi-disciplinary Super specialty hospital. The Main Center and the Medical College Hospital is located in Coimbatore (around 1 kilometer from Coimbatore Airport).


KMCH has pioneered several unique techniques like that of the steroid free "Kidney Transplantation", GDC coiling and clipping for "Brain Aneurysms" which saves lives and improve patients comfort without any complication. KMCH has 24 operation theaters and several modern equipment including the state of the art "Robotic Surgical System" of the "da Vinci. Si", Varian Trilogy Linear Accelerator, the worlds most advanced PET CT scan, 3D MRI, 3rd Generation Dual Source CT Scanner (latest in technology), Endo Bronchial Ultrasound (EBUS), 4D ultrasound scanner, Bi plane Cath lab, Cardiac Electro Physiology Lab, Bone Mineral Densitometer, Digital Mammography, Various Laser Equipment, Ultramodern Video endoscope operating neuro microscope, Computer assisted navigation for Hip & Knee replacements, ESWL for the removal of urinary stones.

Super specialty procedures like Deep Brain Stimulation, Bilateral Hip & Knee replacement, Kidney Transplant, Liver Transplant, Heart and Lung Transplant, Bone Marrow Transplant, Valve replacement, and advanced spine surgeries are being performed frequently. KMCH also continues to be a leader in transplant surgeries and has been continuously doing kidney, liver, pancreas and cardiac transplants and have done extraordinarily well transplant program. KMCH has recently commenced KMCH Center for Advanced Lung Diseases and Transplantation with the induction of two senior pulmonologists.

The cornerstones of KMCH legacy are its unstinting focus on clinical excellence, affordable costs, adoption of technology and academics. KMCH is one of the few Hospitals in India to leverage technology to facilitate best in class healthcare delivery. The organization embraced the rapid advancement in Medical Equipment worldwide and pioneered the introduction of several technology innovations in India.

As a responsible corporate citizen, KMCH take the spirit of leadership well beyond business and has adopted the responsibility of keeping India healthy. The last year saw the starting of a one of its kind "Project Heal Mammography on Wheels Program" in a joint collaboration with the Rotary Club of Mettupalayam. This one of its kind vehicle hosts a state-of-the-art digital mammography unit used to screen women for breast cancer. This machine has gone to several centers screening patients for both breast cancer and cancer of the uterus.

The hospital is actively involved in preventive health care too, through its health check-up programs, which are fairly popular in this region with various institutions and corporates subscribing to such health check-up schemes. We strictly practice the "Patients Centric" culture in our approach. All our systems, people, process are geared towards delivering total care to the patients.

The hospital has over 135 internationally renowned full time clinicians and over 225 postgraduate medical professionals assisting them. With more than 4300 Technicians, paramedical, patient care and administrative staff the hospital delivers a complete care to the patients.



KMCH once again demonstrated our capability of the hospital to handle extremely sick and difficult patients especially those requiring Extracorporeal Membrane Oxygenation Equipment (ECMO) and other multiple complications. We are proud to inform that your Hospital KMCH is one of the few in the country which had several patients who survived even after weeks on ECMO, which is an extremely difficult and arduous task considering the fact that several complications can take place as the function of the lung is completely taken over by a machine.

KMCH successfully treated five patients with novel pacemaker technology called Conduction System Pacing. A team of doctors including Heart Rhythm Specialist activated the heart by placing a pacemaker in the natural electrical pathways, to stimulate the normal ventricular system of the heart which avoids the worsening of heart pumping activity in long run. Out of the five patients, four underwent Bundle Pacing, while the fifth underwent a more complicated Left Bundle Pacing, which can perform the function of increasing the pulse rate and provides additional advantage of improving the pumping capacity of the heart with weakened muscles and this can be a boon to this selected group of patients to avoid costlier and complicated procedures like Heart Transplantation.

Four-month old premature baby with a large abnormal sized head and neurological deficits was referred to KMCH for expert management. The baby, one of the twins was weighing only 800 grams at the time of birth, showed progressive increase in head size and down rolling eye balls and abnormal limb movements that alarmed the parents to seek medical advice. The baby was seen by a team of doctors comprising Neonatologists and Neurologist who evaluated the baby with MRI and diagnosed the child having Congenital Hydrocephalous, a condition in which the fluid cavities were dilated abnormally with locked up brain fluid called Cerebro Spinal Fluid due to an obstruction in the drainage system. This profound locked up fluid in the natural cavities produce unprecedented pressure exerted on the neural tissue leading neurological deficits, in capacitating the baby and finally leads to death.

This condition that may not be treated with medical management, warranted diversion of the fluid from the cavities immediately to save the child. While the baby recovered from COVID-19 on admission was found to have abnormal electrolyte disturbances and that was effectively managed in Neonatal Intensive Care unit. Senior Neurosurgeons, performed a Key Hole Endoscopic Brain surgery to divert the locked up fluid with in the drainage system thus bypassing the congenital block in the cavities. This technique is unique in establishing normal fluid circulation in the brain and reduces the pressure in the cavities. The conventional tube surgery done using a long silicon tube diverting the fluid from brain cavities to abdominal cavity is thus avoided in this baby. Subsequent to the procedure the patients neurological status improved remarkably, with near normal eye and limb movements to the delight of the parents.

The Vein Center which is dedicated towards the treatment of varicose veins introduced a minimally invasive procedure called the VenaSeal, where a medical grade glue is injected into the abnormally dilated veins of the leg. This procedure has several advantages when compared to conventional surgery and the patient can get back to normal activity the very next day.

Medical Education

KMCH Medical College admitted the second batch of students amidst the pandemic. As in the last year, all the seats were quickly mopped up without a single vacancy emphasizing the trust on KMCH. Infrastructure is complete and the offerings are truly of international standards. The Library, Lecture Halls and Wards are way beyond the standards expected by the regulators. We are convinced that within the next decade, KMCH Institute of Health Sciences and Research will become one of the best centers for education in the country.


The Hospital continues to receive several awards, all of which goes on to say KMCH not only takes care of patients to be best of its abilities, but also is a role model in the industry. Notable among the many awards won by KMCH is the "Excellence in Management of COVID-19 and Nursing Excellence Award 2021 from Association of Healthcare Providers of India (AHPI)".


Below detailed table presents summaries of Financial Results of Operations for the year ended 31 March 2020 and 2021. The Company operates on two segments Healthcare Services and Education Services.

( in Lakhs)

Particulars 2020-21 2019-20
Operating Income 69,036.18 71,172.88
Other Income 1,185.35 1,059.14
Total Income 70,221.53 72,232.02
Medicines & Hospital Consumables 19,355.40 20,479.55
Employee Benefit Expense 11,866.77 12,486.51
Finance Costs 3,130.86 1,461.87
Depreciation & Amortisation Expense 6,802.51 5,211.93
Other Expenses 18,492.37 21,400.89
Total Expenses 59,647.91 61,040.75
Profit Before Taxation (PBT) 10,573.62 11,191.27
Provision for Taxation 2,805.08 1,732.56
Profit After Taxation (PAT) 7,768.54 9,458.71
Add: Other Comprehensive Income 127.61 112.12
Total Comprehensive Income for the year 7,896.15 9,570.83


Healthcare Services Total Operating Revenue for FY 21 was 66,840.28 Lakhs as against 69,715.48 Lakhs in FY 20 registering a reduction in growth of 4%. Inpatient Revenues showed a small increase of 0.28% from

48,628.32 Lakhs in FY 20 to 48,766.89 Lakhs in FY 21. Increase in Revenues is due to compensated increase in COVID-19 Revenues and reduction in elective Surgery Revenues.

Education Services This is the second year of reporting on Education Services consequent to the commencement of KMCH Institute of Health Sciences & Research (KMCH Medical College). Revenues under this segment increased from 1,457.40 Lakhs for FY 20 to 2,195.90 Lakhs in FY 21 with the intake of the second batch of next 150 Medical College students.

Below table shows the key drivers of revenues for the periods presented Year ended 31 March 2021.

Particulars 2020-21 2019-20 Increase / (Decrease) % Increase / (Decrease)
Inpatients (Nos.) 54,586 76,924 (22,338) (29.04)
Inpatients Revenue ( in Lakhs) 48,766.89 48,628.32 138.57 0.28
Outpatients (Nos.) 5,88,626 9,15,396 (3,26,770) (35.70)
Outpatients Revenue ( in Lakhs) 17,986.44 20,996.38 (3,009.94) (14.34)
KMCH IHSR Students (No. of Students) 300 150 150 100.00
AHS Courses (No. of Students) 729 668 61 9.13
Income from Educational Institutions ( in Lakhs) 2,060.38 1,342.26 718.12 53.50
Other Operating Income 222.47 205.92 16.55 8.04
Total 69,036.18 71,172.88 (2,136.70) (3.00)

KMCH IHSR KMCH Institute of Health Sciences & Research Medical College AHS Allied Health Sciences

Particulars 2020-21 2019-20
Bed Capacity at the end of the Period (Nos.) 1,629 1,390
Operating Beds at the end of the Period (Nos.) 1,202 1,286
Inpatient (Nos.) 54,586 76,924
Outpatient - New & Review (Nos.) 5,88,626 9,15,396
Bed Occupancy Rate 51.52% 63.51%
Average Length of Stay (in Days) 4.15 3.89
Average Revenue per occupied bed (in ) 21,574 16,267



During the year ended FY 21, Cost of Medicines and Hospital Consumables decreased from 20,479.55 Lakhs in FY 20 to 19,355.40 Lakhs in FY 21. Decrease is primarily due to reduction in Surgeries due to COVID-19.


Employee Benefit Expenses decreased from 12,486.51 Lakhs in FY 20 to 11,866.77 Lakhs in FY 21. Decrease is due to attrition and Hospital functioning at reduced occupancy due to COVID-19.


Finance Costs increased from 1,461.87 Lakhs in FY 20 to 3,130.86 Lakhs in FY 21, an increase of 1,668.99 Lakhs. This increase in Finance Costs is primarily due to substantial capitalization of Borrowing Cost in respect of Medical College Assets which was hitherto categorized under Capital Work in Progress.


Depreciation and Amortization Expenses has increased from 5,211.93 Lakhs in FY 20 to 6,802.51 Lakhs in FY 21, an increase of 1,590.58 Lakhs. Increase is due to capitalization of Medical College Infrastructure. Additional Medical Equipment bought during the year is another reason for increase in Depreciation Expense.


Table below summarizes the Operating and Other Administrative Expenses for the year ended 31 March 2021

Particulars Year ended 31.03.2021 in Lakhs % of Revenue Year ended 31.03.2020 in Lakhs % of Revenue Increase / (Decrease) % Increase/ (Decrease)
Stores, Dietary, Power & Fuel 2,312.87 3.35 2,583.49 3.63 (270.62) (10.47)
Consultant & Professional Fees 10,438.03 15.12 12,174.81 17.11 (1,736.78) (14.27)
Hospital Upkeep Expenses 1,292.99 1.87 1,566.24 2.20 (273.25) (17.45)
Marketing & Advertising 210.49 0.30 417.28 0.59 (206.79) (49.56)
Repairs & Maintenance 1,558.17 2.26 1,493.63 2.10 64.54 4.32
Rent 242.12 0.35 391.80 0.55 (149.68) (38.20)
Other Administrative Expenses 2,437.70 3.53 2,773.64 3.90 (335.94) (12.11)
18,492.37 26.79 21,400.89 30.07 (2,908.52) (13.59)


The details of significant changes (25% or more) in the key financial ratios in FY 21 compared to FY 20 is as follows:

Ratios 31 March 2021 31 March 2020 Reasons for Change % Change
Interest Coverage Ratio 6.55% 12.22% Enhanced Interest on Loans debited to P&L due to Capitalisation -46.40%


Primary Sources of Liquidity are Cash Flows generated from our operations as well as Long Term Borrowings. It is expected that internally generated Cash Flows and our proposed drawdown from sanctioned debt will be adequate to service existing debt, fund internal growth and deploy funds for all Capital Expenditure.


On account of multi-fold increase in scale and the expanded area of operations, your company gets exposed to a wide range of both internal and external risks and uncertainties. These internal and external factors may affect achievement of the companys objectives whether they are strategic, operational or financial. Risk managements objective is to assure that uncertainty does not deflect the endeavor from the business goals. Adequate measures are taken to mitigate areas of significant risks that have been identified. Our risk management systems also ensure that risks are contained within manageable levels.


KMCH is committed to maintain high standard of internal controls throughout its operations. Your company follows an internal control program that aims at safeguarding funds, provides efficient and effective management of assets and ensures accurate financial reporting. While reviewing our internal controls, sufficient regard is given to the risks to which the business is exposed, the likelihood of such risks occurring and the costs of protecting against them. Your company has a dedicated team of internal auditors. They review the entire operations of the company and submit their findings to the audit committee. The audit committee takes note of the same and guides the management in implementing the suggestions.


Statements in this Management Discussion and Analysis describing the health care sectors objectives, projections, estimates, expectations and predictions contain "forward looking statements" within the meaning of applicable laws and regulations. These statements and forecasts involve risk and uncertainty because they relate to events and depend upon circumstances that may occur in the future. Actual results might differ materially from those either expressed or implied.