Good morning, ladies and gentlemen. Welcome to the earnings release for the fourth quarter of 2024, Mater Dei. Today we have José Henrique Salvador, CEO, and Rafael Cordeiro, CFO and Director, Investor Relations Director. This earnings call is being recorded and will be available on the investor relations website of the company. After completion, to activate the translation option, you can select this by selecting the globe icon on the bottom. The presentation will be available on the IR website at the Mater Dei Network. Before we continue, we'd like to say that any possible statements about future events are subject to risks and uncertainties, and that could lead to certain expectations not being fulfilled or occurring differently than expected. These provisions issue opinions at the date they're made, and the company is not obliged to achieve them. After the presentation, we'll start the Q&A session.
If you would like to submit a question, please raise your hand, and we'll open up your audio. Or if you'd rather send a question by chat, we'd ask you to please identify yourself. We'll pass on the word to José Henrique to begin the presentation.
Good morning, everyone. We're here to report the results of the Mater Dei Network on the year of 2024. Just as we've been talking to our investors, we've been presenting our results also in the last quarters. Here you can see a summary of what we've observed in the year of 2024. No doubt, this was a year of challenges that were very important in our sector. Also, macroeconomic challenges, as we've seen the situation in the country.
For the company, it was a year of important adjustments as we consider exactly what we need to build in the future of the company, and some adjustments that made our position financially more robust, but also a year planting new perspectives for the next few years and for the next years as well. For our call today, I would like to, first of all, start off with the metropolitan region of Belo Horizonte, where Mater Dei started off. The year of 2024, quarter- over- quarter, demonstrated the resilience and leadership of our operations. At some moments in the past, actually, there were questions about if we would be able to keep this leadership and consolidate the leadership.
I think we were able to present in a very clear manner the way in which each of our operations in the metropolitan region of Belo Horizonte have been performing. We demonstrate this through our numbers with the growth in a year that was challenging of 7% of our revenue in 2024 compared to 2023. In the same way, we were able to demonstrate to be able to handle the operational challenges an increase of 5 percentage points in our occupation rate in the metropolitan region of Belo Horizonte. The fourth quarter of 2024 also presented to this region some important readjustments that were in line with IPCA, but also will contribute to the results of the company in 2025, as well as in the next quarters. In the same way, in the metropolitan region of Belo Horizonte, we also started an important hospital there.
We opened a hospital that's part of our strategy in our region. That was the opening of the Mater Dei Nova Lima unit, which is a unit that has been surprised positively with how it's ramping up ever since the beginning of the year of 2025. We've already had a breakeven, and it's a hospital that has NPS rates that are really above what we see in other hospitals on average in Brazil in a region that's so important for our growth and our strengthening. At the corporate level, what we also that's also here in the metropolitan region of Belo Horizonte, we can we've also performed some important adjustments. We can also consider what we've seen this year with Porto Dias.
In order to make the company as big as it needs to be when it comes to the corporate aspect, we've also performed some cuts in our personnel structure, especially in the months of February, March, and April that have the termination costs. Of course, they'll bring an annualized projection of about BRL 20 million in reduction of our corporate structure. The exit of Porto Dias was super important to strengthen our cash position. At this moment, we need to perform these adjustments also to be able to share our general and administrative expense structure and make it as big as we need it to be for the new company without the revenues we had in the year of 2024. Another point I want to highlight also is what we've observed in the Salvador hospital.
That hospital has had a very positive ramp-up in the production and margin, especially when we look at what's going on in the end of the fourth quarter of 2024. What we've observed in this year, specifically in the months of January and February, the first two months of the year of 2025 compared to the first two months of 2024, already shows a growth in revenue for Salvador that is already representing about 30% in regards to what we observed for last year. This is due to new accreditation that brought in new lives to this hospital and a robust growth in our oncology with the team that's handling oncology today.
We have noticed that we have new medical teams, the teams that came in ever since September last year, bringing in the complexity, volume, and a mix of processes that are very attractive to this unit. We know how Salvador represents a disproportional weight due to the size of the investment, the size of the hospital, the capacity and complexity that the hospital has to attract volume and bring in new customers and improve our ticket. The path to make Salvador become more and more of a champion unit is really set. We noticed this in the year of 2025. Now, when we get into the acquired units, I would like to, first of all, announce the situation in Uberlândia specifically.
Ever since the end of last year, we've been talking to Unimed Uberlândia to really establish an operational agreement that could bring to both institutions, the Mater Dei Network, but also Unimed, an opportunity to grow in order to attract even more customers, disseminate more volume in the institution, and make each of the entities also strengthen their presence in a more positive manner. Yesterday, specifically, we signed an agreement to refer patients through some different lines of care and also some restricted network products based on an innovative clinical integrated model, which is a model that intends to reduce waste and losses and increase in volumes for our institutions and increase in the complexity as well for both hospitals in the Mater Dei Network, which is Santa Genoveva and Mater Dei Santa Clara. This is a model that can also be used for other regions.
Unimed through these different forms of care, has a commitment to send patients and volumes to the Mater Dei Network. This helps us dilute the fixed costs, improve our average tickets, and really help our hospitals that are already leaders in the region consolidate themselves with even more leadership. What we expect is a significant improvement in the profitability of the hospital with a clear partnership and helping our main customer there to be more sustainable and grow with more quality. We want to thank the board and Unimed Uberlândia and the management there that are supporting us during this journey to build a more valuable win-win model for both institutions. At Mater Dei Goiânia, we also performed some changes in our management. We adjusted the need of management for that specific region and market.
We have other plans to perpetuate Mater Dei Goiânia as one of the main hospitals in the Midwest of Brazil, with plans also for growth in that region. Feira de Santana, we've noticed in the beginning of 2025 that there's been an increase in production as well as an increase in profitability. This is a hospital that's also consolidated as a leader in that region. Along with Mater Dei Salvador, they are setting up two very important hospitals for our Bahia hub. As we leave a bit of the hospital reality and we talk about corporate movements we've been working on, it's important to highlight that in the year of 2024, we had a significant movement with the buyback of stock. About BRL 60 million were employed in buying back Mater Dei Network stock. In 2024, we also had the distribution of BRL 20 million in dividends.
The 60 plus 20 are representing BRL 88 million that go straight to the shareholders that trust and are part of the company with the BRL 60 million in buybacks. That is 12% less stock in the free flow in the market, which also increases the profits per share for the shareholders that really trust the company. For 2025, the program is still open with new perspectives for the unit and a focus also on our financial cycle and cash generation so that we can evolve even more with our buyback program and also with our dividend distribution proposals and with the application of the company's capital for the projects that are already hired today, even knowing that in 2025, we have a CapEx projection that is a lot lower than what we had done in 2024. Investments were already made and the values are already in-house.
We have an opportunity in 2025 to unleash these revenues even more that are already hired. Last, before we move on to Rafael Cordeiro, at the end of 2024, we also had the recertification of the GPTW certification, which basically certifies institutions that have the best organizational climate and work environment. Mater Dei was certified as one of the best companies to work in in Brazil and one of the benchmarks also in the health sector. With this, I want to pass this on to Rafael so he can give us more details about the financial indicators.
Thank you, José Henrique. Good morning, everyone. We are here to talk about our results in 2024. Still a result that has effects of the Porto Dias sale, which was a decision we made in the middle of 2024.
Every day, the company and the board really understand that we made the right decision and that helped us have the strength to go through this difficult moment. We have been going through this economic period in Brazil and the world. We expect 2025 to be a year where the initiatives we have planted as a result of this decision can lead to results that are even better in 2025. From an operational perspective, we are going to start talking about one of the initiatives that are really fundamental for the growth and profitability of the company, which is the desire and execution we have had with the increase in the occupation rate. We always talk about how the Nursing Bill really brought in an effect that really hindered the results of many hospitals.
The moment when we saw this, we had this health sector where the payers were going through a very intense challenge. Yesterday, we had results that came in that were very positive considering the reduction of the claims rate and also improvements in the operational results and financial results, which we believe will also lead to a better relationship and improvement with some plays we've been working on ever since the bill was implemented. In regards to the occupation rate, we ended the year with 77% with and 71.7% when we do not consider the day patients. This is significant growth because in the fourth quarter, we had 68.4% occupation rate and 73.5% with day patients. This is really important because all of the results we are going to be reporting here in this call, we are talking about the variation year- over- year.
We have Porto Dias to give us a good comparison between 2023 and 2024. Even in the last quarter, despite the last quarter not having Porto Dias, all of the quarterly comparisons are without Porto Dias. The fourth quarter of 2023 against 2024 is the legacy, right? The actual growth of 3.5 percentage points in our occupation rate. On the bottom part of the slide, you can also see the amount of patients per day. We had 1% growth of day patients in regards to the fourth quarter of 2023. We operated with minus 64 in regards to the beds and 46% less beds in the fourth quarter of 2026. That demonstrates that we really have this internal mission. We were able to operate with 80% of the occupation rate.
Moving on to this slide on revenue, here you see our work alongside what José Henrique highlighted really helped us to reach the greatest annual ticket in the company with BRL 2.56 million, a growth of 6% in regards to the third quarter of 2024 and 4% growth in regards to the fourth quarter of 2023. The adjustments that were more concentrated because of negotiation issues kind of unleashed this value. We believe this is going to have fruits in 2024. We noticed that the last four quarters, we had flat net revenue. This net revenue had less beds, as I mentioned, which makes us have intense work to improve the company's profitability. When we look at year- over- year, we had a growth of 2% of the revenue, 2,226, compared to 2,188.
In the annual ticket, we had a growth of only 2%. This company that we're going to be importing the results from this year onwards in 2025, we've noticed growth and sustainability in this ticket. Porto Dias was a significant company, but that really reduced our ticket a lot because they were operating in lower tickets. Moving on to the next slide, we had a drop of 3.4 percentage points in the fourth quarter of 2023 to the fourth quarter of 2024. Here you can see the main, we have two percentage points, which are due to the Nursing Bill. This had major effects. We're not in a region where we already had these amounts. All of the work we started in 2024, we have to reap in 2025.
These are initiatives to offset this because this is a change that came along. We have this challenge in the beginning of the year, now in March and April, with the discussions with the unions. These are going to be fundamental to not have to index this risk in the next years and have a reduction besides other initiatives we have. Absolute value was BRL 358 million in our costs. That made us reach 73.3% of the net revenue. In annual terms, our costs went up from 76.5% to 79.9% of the net revenue, an add of 2.4%, which is very close to the effect, which is just due to the effect of the Nursing Bill. On the bottom part of the slide, you have another issue, which is the dilution of the costs, something José Henrique mentioned.
We have a company that is 20 to 25% lower than what it was with Porto Dias. With this, we have a smaller dilution, which hindered by 1.4% our expenses. We went from 14.7% to 16.1%, an add of 1.4%. In the fourth quarter, we also had, in a non-recurring manner, an expense with strategic consulting services to help us with the revenue cycle and supplies, etc. We had BRL 2.5 million. That is not something that is going to continue in 2025. When we get into the effects, we can see the sum of these effects between the worst quarterly results ever since we have started reporting our results. On the negative side, we see a company that is worse than it was performing. We look at the positive side, which is what we do daily tirelessly to recover the margins in the company.
We notice a company that has a baseline that is lower, but many, many projects. We are at the third generation of the Salvador family. We have been working a bit more than a year. We have different initiatives. We understand will generate fruits in the year of 2025, including initiatives in our corporate level to dilute expenses as well as initiatives that José Henrique mentioned. We really focused on the unit in Uberlândia with an agreement to bring in this dilution in a city that has three hospitals, and two of them are ours, and another hospital that has an approach that is not really focused on the kinds of hospital services we offered. Unimed understood our quality. That provides a perspective of improving the region and the consolidation of our results.
The 15.9% in margins, we had BRL 78 million in EBITDA against BRL 92 million in the previous quarter and BRL 91 million in the quarter before. We had 19.9%, these numbers. We were always searching for work for these internal calculations. Here, we're trying to make this very transparent so you can have a good comparison and understand the company's profile. In the last quarter, 18.6%. The seasonality is also very important. When we summarize the EBITDA part, we also see a company that grew a lot in units that are in a ramp-up and that did not have a margin in 2024, but they are going to grow in the year of 2025, bringing even more, as José Henrique has mentioned. We have this perspective with the margins. We have cost reduction, and we have dilution in these units.
These are perspectives that, as we mentioned in the beginning, they're not promises, but it's the spirit the company has for the next quarters in the company. Moving on to the next slide here, we have our net income and the cash flow. Let me just adjust this here. We had BRL 196 million in the year with 8.8% in the net margin against 9.7% margin in 2023 and BRL 213 million in profits. This is going to be a last quarter. We have this adjustment in our profits of the goodwill/losses of the Porto Dias operation, which made the company not perform the payment of income tax in the year of 2024. These were BRL 65 million accumulated in the year. And we adjust this because it's not in the profits. This was a direct effect of the cash flow in the company.
This is an important moment because we had major investments in the units in 2024, especially in Nova Lima, with an investment of BRL 130 million. We had less than BRL 65 million in the income tax line. We understand that the company, these resources were important for cash generation, and we needed to have them reflected in the profits. When we look at the quarterly perspective, we had 5.1% of the net margin and BRL 25 million in the quarter against BRL 40 million in the previous quarter with 8.2% in the net margin and in the previous year with BRL 38 million and 8.2%. Everything I presented in the EBITDA, considering that we had an improvement even in the financial results with the arrival of the Porto Dias sale with BRL 400 million more in the cash,
we noticed that all of this EBITDA effect drops into the net income.
When it comes to improvements, all of the improvements we're able to achieve in our results will be reflected net of the taxes and the net margin in the company, as José Henrique mentioned. We had the buybacks of BRL 60 million in shares for our shareholders, considering a reduction in the base. We moved on to BRL 339 million with a reduction of 12% in this base. There is also an increase in the net income for our shareholders. It is important to highlight also that from now on, we're going to be monitoring our presentations and our events with investors. We're going to be talking about this a lot more because it's going to be something we're going to be monitoring, and we really want to show the potential for growth in our company. We had BRL 219 million in the end of 2023.
We ended the year with BRL 675 million. Here, we're going to highlight some points. We had BRL 254 million in investments. Within this, we had the payment of an installment of purchases from companies that we had in that M&A cycle. We also have an effect from the Nova Lima investments, as I mentioned, BRL 130 million. The others were investments we had in the units for the purchase of equipment and tangibles. One of the highlights in this capital discipline is that we had in October when we started our budget cycle, we had BRL 91 million in the CapEx estimated for 2025. We will have an execution with an important reduction in this amount, which is already a lot lower than what we practiced. We will have a significant reduction because we understand that the results at the end of the year were not good.
We need to have an improvement in these results to be able to get back to having a higher level of investments. We are searching for profitability in cash generation and preservation of this cash in the company. Another important highlight that you can see here in the source of funding and financing, we have the debentures coming in at BRL 200 million at CDI plus 0.95. You have the exit also for investors and shareholders of the dividends of BRL 28 million and the BRL 60 million of buyback of the stock. These are the main highlights in our cash flow. This is also going to be, as you mentioned, the net income is going to be something closely monitored by the company's management based on an analysis where we need to generate cash because the investments were already made at the units right now.
After the main ramp-up beginnings, we believe in a better operational cash flow, a revenue cycle that's more consistent. In the company today, we have BRL 487 million, BRL 488 million in net revenue. That's a lot healthier than the BRL 488 million in the net revenue in the first quarter because we've had a more disciplined cycle as we come into the heavy entrance of the inflow of the revenues in the company. We have the maintenance of the average term for receipt, 110 days. We had 130 in the first quarter with Porto Dias. We reached almost 150 days. That demonstrates this discipline of not constantly having a working capital expense. After this exit, we also had the maintenance. We expect to have, or we hope to have, an improvement with a healthier cycle and a better average term of receipt.
When it comes to stock and when it comes to payment methods, it's really been constant with what we've always been delivering. Here, we also see opportunities to reduce this. This average payment term is something we've been working on to be able to extend this with our suppliers and have this more aligned with the average term of receipt. To wrap up the presentation, the last slide here, we had 1.5 of the net debt to EBITDA ratio with a cash position that's healthier, BRL 675 million, net debt of BRL 1,447 million. That made us 1.5 against 1.3 in the same indicator in the last quarter of 2024 and 1.8 in the fourth quarter of 2023. The schedule for the payment is 4.3 years, no changes, no extraordinary events in the fourth quarter.
The cost of debt, especially considering the excellent relationship debt we have with BNB, we have less CDI in our debt costs. I am going to wrap up here, and we will hop into the Q&A session. Thank you so much for the call.
The first question comes from Mirela Oliveira from Bank of America.
Good morning, everyone. Thank you for this opportunity to share my question. I have two questions on my side. First, I think you guys already talked about this in the end of the presentation with the costs of the expenses, but we have still seen these two lines kind of pressured in the fourth quarter. I would like to get some input of when you expect normalization with these two lines and maybe also the margin levels.
The second question is if you guys could talk about how the ramp-up has been with the new hospitals in Nova Lima and when you expect them to start having a positive margin impact. Thank you.
Thank you, Mirela. First of all, first question here, what we've been doing to normalize the situation with costs and expenses, right? In regards to our costs, this is something that was already presented here by Rafael and the impact that the Nursing Bill has towards our direct personnel costs. Also, we know that there are major impacts in the last year, also with the post-pandemic scenario in regards to inputs.
The company's been operating in a very strong manner to increase our occupation rates and work with the level of efficiency in our operations, which is something that helps us to dilute our personnel costs, which are our main costs. We've been working on an in-depth analysis unit by unit to understand the contingent of people required to be able to handle our different operations in each of these units. We've been working also, Mirela, on significant initiatives to grow our revenue in each of our units, whether they're the units in the Metropolitan Region of Belo Horizonte or Salvador or the acquired units.
The work done for this agreement in the Uberlândia Unimed Agreement process intends to help base again on value medical services without additional costs to the company with pre-agreed price increases and increase in revenue and complexity, improvement in the margins because of all of this through a bigger volume of patients and greater complexity. We will be able to dilute this in a better manner with the costs and fixed costs and the unit costs. Besides this, this agreement is still bringing an improvement in our financial cycle. We have some points related to the payment of these invoices that are better also in regards to the ones we had previously. When we talk about expenses, that's kind of what we discussed in the beginning of the presentation.
We identified in a very clear manner whenever we have a hospital leaving just as big as the Porto Dias one with that level of revenue that we also have adjustments that must be made in the company, especially when they're related to our expenses, our financial and administrative expenses, as well as corporate expenses. The last quarter of last year was a quarter to help us really work on these calculations, start with some developments. The strength, especially in the expenses and reduction, really comes in the beginning of this year. We have the costs, of course, of contract terminations. From March or April onwards, we're going to see a company that's leaner when it comes to expenses. This is our main focus and what we've been working on a lot.
We also have been reducing some services and contracts with opportunities also in the beginning of the year to also reduce these expense lines. These initiatives provide some financial projections, actually, so that throughout the year, we can really get back to the historical margins in the company and perform a lot better than the units required. Now, about the ramp-up, which was, I think, your second question, and also getting, I'll pass this on to Rafael to contribute.
Nova Lima has been a unit that surprised us positively in four months of operation. This is where we were able to really provide a positive EBITDA in the unit with an operational breakeven also in that unit. It's a unit that we've been able to concentrate the mix of operators. That's very significant and positive.
We've also been able to concentrate new medical teams, and that's attracting new patients as well. We haven't been feeling any kind of cannibalization. This has been an opportunity to reinforce our position in the Metropolitan Region of Belo Horizonte. This is a unit where this year specifically, it's already been contributing with positive EBITDA to the Mater Dei Network. Not considering the margins of our mature hospitals, but it's not going to be an impending factor for the EBITDA in the year of 2025. We believe, especially in the second semester this year, it'll already start contributing with numbers that are very significant in the increase of EBITDA in the company. Another unit that is also ramping up. We have some ramping up because they're younger units, but the Mater Dei in Betim-Contagem has only been around for five years.
Mater Dei in Salvador is a unit that's also quite young. Then you have the ramp-up of the Salvador unit. It has been very positive, especially in these six months, with a special highlight on the last quarter of the year 2024, where we have already in the revenue, but also with some services, we've been able to have positive margins. The year 2025 starts off in a very positive manner for the unit. As I mentioned previously, the first two months in 2025 compared to the first two months in 2024 already had a growth in revenue of about 30% with positive margins. For the year 2025, Salvador will already start contributing to an increase in margins in the company.
Just to add on to what José Henrique mentioned, I think we have results, as we just reported, that are way below what we've had as a potential to generate in the company. There is no silver ball that will help us solve all of our problems. It's also not something we're going to solve in one quarter to get back to the levels within this new mix of hospitals at the same level of margins we had in the past. This initiative with discipline in our cost of personnel, when annualized, is going to be BRL 20 million. It's an initiative. A specific partnership like this in Uberlândia has volume and reduction costs. The growth of the units ramping up, which had zero all the way to negative margins, represent growth and margins.
We have different initiatives with the dilution of costs and this growth. The sum of this internal work, the better cycle, structuring adjustments in some markets, this is all what we believe can add up to results in the year of 2025. It is important that you guys understand this from a strategic perspective and operational perspective. This is why we've been very extensive with José Henrique's presentation to demonstrate that this has a level of importance that we should be reestablishing with the EBITDA margin and the net income as well, the margins and also cash generation because the cycle was consumed in the last 18 months way above what we had in the last year. Thank you for your question.
Thanks, guys.
We have another question on the chat.
José Henrique, on the Uberlândia agreement, will there be a payment on behalf of the company?
No, in the specific agreement, we do not have financial expenses. We do not have any type of need to have a down payment on behalf of the company to the operator, to the payer. Actually, all of our units are already prepared to be able to receive this increase in volume because this is an agreement we have already been designing for a few months. Now what we have is the creation of this virtuous win-win scenario, right, with a value-based medicine practice so that we can actually meet the needs of both sides and strengthen our position in the region. This is a partnership we believe in, and that will be fundamental for Uberlândia. As José Henrique mentioned, that is not going to require investments.
are some bonuses based on good performance, growth in volume, and a new way to receive these payments with the anticipation of these payments. It is a partnership that, on behalf of the operational line, cost reduction, and cash flow, is going to be fundamental to give us better results in our Uberlândia hub. Thank you for the question.
Once again, another question here on the chat. The impact that the results could have for the payers in 2025.
Rafael Cordeiro explored this a bit in his presentation with the results that we have observed with many of the payers, demonstrating operational results and net results also that were very positive in the year of 2024. This is a positive bit of news in our sector. We went through a moment in 2024 with contextual situations that were very concerning for the health sector.
We noticed that the operators, the payers, were able to control their levels of claims, and especially with the price increases. They were also able to control their expenses in some way operationally. In the end of 2024, more precisely in the fourth quarter, we already observed the impact of this. We were able to have most of the adjustments with our main payers during this period. This had been a year that was more challenging when it comes to price transfers and adjustments with the payers. In the end of the year, we were able to achieve this with the maintenance of the base date. Now in mid-2025, we have another round of negotiations with the payers and another readjustment period.
Considering the results we observed, we believe we'll have an opportunity that's even better to be able to have some recompositions that are more of an advantage. That has been very constructive with the main payers so that we can strengthen their position as well in each of these regions, observing in each region who are our main partners, which partners have a greater ambition to build and grow in each of these regions. This is super important if we consider the maintenance and growth of our addressable market. We've actually had different initiatives with these payers to be able to get closer to them and offer solutions that can be more adherent to their needs. This makes the company have this relationship that's closer with the payers.
The company also helps the company influence the global sustainability in the health market and also help us see growth in the volumes and the revenue and margins. No doubt, the year of 2025 will start off in a more positive manner in regards to the sector news than 2024 did.
Great. Thank you, José Henrique. We have no other questions at this point in time. We will end our earnings call here for 2024. I want to thank you all for your presence. We'll meet again in the events with the one-on-one meetings as well, as well as the events organized by the company and analysts at the sell side. Thank you so much, everyone. Have a great day.
Bye, guys. Thanks. Take care. I hope we can have a great year of 2025. Bye-bye.