Geographical concentration in Karnataka: A substantial number of the Company's hospitals are located in Karnataka, from which it derived 46.40%, 51.55% and 59.98% of revenue from operations in Fiscals 2026, 2025 and 2024 respectively. As of March 31, 2026, 19 of its 49 hospitals with 6,404 licensed beds were situated in the state. Any loss of business, disruption in the operations of these hospitals, or geopolitical or policy changes in Karnataka could materially affect its business and results of operations.

Dependence on inpatient volumes and occupancy: The Company primarily generates revenue by providing inpatient care at its hospitals and is therefore susceptible to inconsistent or declining patient volumes and occupancy levels. Occupancy stood at 64.47% in Fiscal 2026 against 67.09% in Fiscal 2025, while inpatient volumes were 527,227 footfalls in Fiscal 2026. Any inability to maintain or improve admissions and hospital occupancy rates could adversely affect its financial condition and cash flows.

Concentration in CONGO-R specialties: The Company derived 64.30%, 62.56% and 61.55% of its gross inpatient revenue from cardiac sciences, oncology, neurosciences, gastro sciences, orthopedics and renal sciences (CONGO-R) in Fiscals 2026, 2025 and 2024 respectively. Any negative change in demand for these specialties, arising from unavailability of preferred doctors, shifts in patient preferences, advancements in alternative treatments or increased competition, could adversely impact its business.

Related-party dimension in use of Net Proceeds: The Company proposes to utilise an estimated ₹55,527.59 million of the Net Proceeds towards redemption of outstanding Non-Convertible Debentures issued by its Subsidiary, Manipal Hospitals Private Limited. Of this, ₹25,201.79 million will be used to redeem NCDs held by DBS Bank Ltd., the parent of DBS Bank India Limited, which is deemed an associate of Imperius Healthcare Investments Pte. Ltd., one of the Promoters and Selling Shareholders.

Acquisition and integration risk: The Company has historically grown through acquisitions and may continue to acquire businesses or enter strategic partnerships. It acquired 89.98% of the share capital of Sahyadri Hospitals Private Limited between October 2025 and December 2025 and is in the process of integrating it. Any delay or failure in realising anticipated benefits, integrating personnel and operations, or retaining key personnel could adversely affect its business and results of operations.

Legal claims and medical negligence liability: The Company is exposed to legal claims and regulatory actions arising from the provision of healthcare services, including alleged medical negligence by its doctors and healthcare professionals, and to liabilities from operational and equipment-related risks. Any such claims, as well as hospital quarantines or sterilizations, may adversely affect its reputation, operations, financial condition and results of operations.

Brand and reputational risk: The Manipal Hospitals brand and the Company's reputation are critical to its success and are influenced by factors that are partly beyond its control. Any failure to maintain and enhance its brand, or any negative publicity or allegations in the media, may reduce the level of trust in its services and market recognition, adversely impacting its business, financial condition and prospects.

Regulatory permits and accreditations: The Company is required to obtain, renew and maintain a range of statutory and regulatory permits, licenses and accreditations, and to comply with prescribed quality standards, in relation to the establishment and operation of hospitals, procurement of medical equipment, and storage and sale of drugs. Any regulatory change, violation, or failure to obtain or renew such approvals in a timely manner may adversely affect its operations.

Bio-medical waste and pollution control compliance: The Company's operations involve the generation and handling of bio-medical waste and are subject to stringent and continuously evolving pollution control laws and environmental regulations. Any failure to comply with applicable bio-medical waste management and pollution control laws and regulations could adversely affect its business, results of operations, financial condition and cash flows.

Dependence on insurance and third-party administrators: The Company derived 49.68%, 49.18% and 49.45% of its gross inpatient revenue from insurance providers and third-party administrators in Fiscals 2026, 2025 and 2024 respectively. Termination, non-renewal, delay or difficulty in collection, or any breach of the conditions of its contracts with insurers, third-party administrators, government and other non-cash payors, could materially impact its cash flows and results of operations.