Morning, everyone. Welcome to the earnings call of the first quarter of 2025 of Rede D'Or. Here with us today, Mr. Paulo Moll, President, Rodrigo Gavina, CEO of Hospitals, Otávio Lazcano, VP of Finance and Investor Relations, and Raquel Reis, CEO of Healthcare and Dental of SulAmérica. This event should take about one hour, and the recording will be available at the IR website of the company. After this presentation, we will start with a Q&A session. You will receive further instructions. Before continuing, any forward-looking statements that are done in this earnings call in regards to the business projections, operational goals, and financial goals are based on premises and beliefs of the board of directors, based on information that is currently available. Forward-looking statements are not guarantees of performance, and they involve risks and uncertainties. They refer to events and circumstances that may or may not take place.
Investors should understand that macroeconomic conditions, industry conditions, and other operational factors may affect the performance of the company and might lead to results that are different from the forward-looking statements. I'd like to give the floor to Mr. Paulo Moll. He will start the earnings call. The floor is yours.
Thank you. Good morning, everyone. Great to be here. Another earnings call with solid results, strong results, reinforcing the success of the combination of businesses Rede D'Or and SulAmérica. This joint venture was concluded over two years ago. The numbers show our great results and the resilience of the company going through challenging moments. In the gross revenue, we got to BRL 14.1 billion, which is 7% growth. EBITDA consolidated is BRL 2.3 billion, a growth of 22% year-on-year, a margin of 17.7%.
If we add the technical reserves of the insurance, we got to BRL 2.6 billion of adjusted EBITDA with a margin of 20%. Net income, we delivered BRL 1 billion, which is a growth of 21.1% year-on-year. I will let Raquel and Otávio get into the details of SulAmérica and Rede D'Or individually. Also, in the financial part, we have a generation of cash, operational cash that is very strong, BRL 3.2 billion, a growth of 86% year-on-year, a reduction of the leveraging of the company. Remember that the company distributed through this period the interest of our capital. We had a repurchasing program, very successful. Still, we did a CAPEX that is important with an expansion of beds and still a reduction of the EBITDA relation to debt in the first quarter of 2025.
It's 1.7%, 1.7 times the indebtedness of the EBITDA debt. We have a strong cash flow of the company. Without considering the technical reserves, we're talking about BRL 19.4 billion. That places us at a situation that is very flexible. We can analyze new investments, organic or inorganic. With our debt, we have the average cost that is very competitive, CDI plus 0.9% with an average deadline of five and a half years. Talking about the expansion, at the beginning of the year, we have the new Barra D'Or. We also consolidated the structure of São Luiz Campinas in Atlântica D'Or and still a good expansion of the operational beds. This was a point that we really discussed in the fourth quarter, where we had a closing of the year 2024 with a growth that was lower than the expectation with the operational risk.
Nonetheless, in the first quarter, even though we still have the first two months of the year until Carnival with movements and frequencies in regards to previous year that is lower in comparison, we still close the quarter with 10,148 operational beds, a growth of 291 beds in regards to the closing of last year, a growth of 409 beds in regards to the same quarter of 2024. We still see this dynamic of the closing of the quarter until today. Today, we got to 10,356 operational beds, a growth in the year of over 500 operational beds. Still, in this first quarter, we have an important contract in Rio de Janeiro that was discontinued. Nonetheless, we still had a growth very accelerated after Carnival and the beginning of the proper year here in Brazil. We had lower frequencies in regards to the same profile of last year.
We had then respiratory diseases that were earlier on in the year. Perspectives of the year. We hope to have an accelerated ramp of the assets in Atlântica D'Or. You've been following up on them. A series of organic projects that should be delivered over the next years. Still strong in these investments and the works. And annually, we have updated you through the Reference Form. Keeping our financial discipline with a leverage on control with a cash generation that is strong, as I discussed with a lot of flexibility to take a look at opportunities, organic or inorganic, accelerating the repurchasing of shares as we have done the careful capital allocation of the company. Trustworthy that we will have a sustainable growth for 2025 and the following years with the characteristics, the DNA of the company and innovation, efficiency, and care for patients.
Now I'll give the floor to Raquel, and I am available for the Q&A.
Thank you, Paulo. Welcome. Great to be here to talk about the numbers of the beginning of the year of SulAmérica. We started the year as we finished 2024, growing, keeping the growth that is responsible. Almost 100,000 new beneficiaries in the quarter, 65,000 in health and 34,000 in dental, keeping a positive trend over the next months. And the cross-sell strategy is ever more present in our day-to-day. As I reinforced it in the previous calls, after a few difficult years where agents were necessary, you remember, we still have a profitability that is controlled, which allowed us to go back to sustainable growth, expanding access to quality healthcare, launching new products, new regions, and better utilization of our partners.
The claims of 79.3% improved in the same period of last year, going back to the current standards of the first quarters that we used to see in the pre-pandemic period. Still, we kept the discipline in the administrative expenses. We got to 4.2% of the revenue. That's a big characteristic of the new SulAmérica. Discussing the new SulAmérica, I would like to thank all the team. In fact, you're very much responsible for all the results that we've achieved at the insurance company. I'll give the floor to Gavina. I remain at your service for the Q&A.
Thank you, Raquel. Good morning. Let's start from where you ended, thanking all the team of Rede D'Or in SulAmérica for all the results that this company has delivered.
Regardless of all the difficulties and the challenges that we have in our market, Paulo has mentioned a few in regards to the new configuration with the healthcare plans operators. We delivered on page five. You can see the number of patient days. Respecting the seasonality of the quarter, we delivered a number of patient stays that is similar to last year, regardless of all the adjustments. And remember, the last year, our doors, emergency doors, were very much fuller. Obviously, that brought us a bigger challenge, and we managed to compensate a great deal of this with the growth of surgeries. That we can follow up on the graph on the right. We have a growth of surgeries and also a growth of complex surgeries in the order of almost 9%.
If we go to page six, rectifying the words of Paulo, we grew quarter on quarter close to 4.3 operational beds, so without the responsibility of growth and the ramp-ups of the beds of the new hospitals so that we can respect all the events of growth of the hospitals and technical quality, perceived quality that we deliver along with these financial results and the responsibility that we had, we managed to grow 4.3 operational beds, and if we look at the total beds quarter on quarter, it grew over 11%, so I'll give the word to Otávio so he can continue with the presentation. Thank you.
Thank you, Gavina. Once again, good morning. We are on page seven. The gross revenue on average ticket exclusively of hospital services. Let's start on the graph on the left.
Company reported in the first quarter of 2025 the gross revenue in the segment of BRL 7.9 billion, a growth of 6.8% if you compare it to the first quarter of 2024. There was a stability in the number of patient days and the increase of the average ticket of 6.8%. There was also a growth of 0.2% in the comparison with the fourth quarter of 2024, a result of the increase of the patient day of 1.6% and a drop in the average ticket of 1.3%. That way, there is no doubt on the pricing and the results of the company. When we compare the average ticket of the first quarter of 2025 with the first quarter of 2024, it increased 6.8%. When we do the same thing with the fourth quarter of 2024 and the fourth quarter of 2023, the increase was 10%.
Now the average ticket, the third quarter of 2024 with the third quarter of 2023, also a growth, and the second quarter of 2024 also increased in comparison to last year. Ladies and gentlemen, please wait for our speakers to reconnect to the call. Can you hear us now? Just a minute. We had an issue with the power, and we are reconnecting. Let's go to page eight. The gross revenue on average ticket exclusively on oncology always started on the left. The company reported the gross revenue for the segment of the first quarter of 2025, BRL 869 million, a growth of 16.5% in the annual comparison, an increase in the number of infusions, 3.8%, and the average ticket increase of 12.2%. In the comparison quarterly, the growth is 4.8%, a growth in the number of infusions, 3.8%, and the average ticket increase of 2.5%.
On the right, we present graphically the evolution of the average ticket since the first quarter of 2024. Page nine, the cost and expenses. Once again, hospital services. On your left, the company reported the total cost of BRL 5.5 billion in the first quarter of 2025, a growth of 10% in comparison to the first quarter of 2024, a drop of 1.3% in regards to the previous quarter. On the right, we have graphically the evolution of the general and administrative expenses. In the first quarter of 2024, we have a positive BRL 65 million of reversal of a provision, a questioning of the records of SulAmérica because of the entry in the capital of many, many years ago.
Regardless, we had a one-off positive in the fourth quarter of 2024 of BRL 18.5 million regarding to the transference of operational expenses and the general administrative expenses for the cost of the company. I'm saying that because the SG&A on the first quarter of 2024, 2025, of BRL 327 million, which corresponded to 4.1% of the gross revenue of the company with the serious adjustments in the historical record, this number is stable throughout. Page 10, EBITDA and net income of the hospital services. As always, starting on your left, the company reported an EBITDA accounting in the first quarter of 2025, BRL 1,672 million, a growth of 0.9% in the annual comparison, a growth of 9.1% in comparison with the previous quarter, and a margin EBITDA of 23.8%. On your right, the evolution graphically of the net income.
The company had an accounting net adjusted of BRL 1,017 million and BRL 1,070 million, respectively, in the first quarter of 2025. Page 11, data on the performance of SulAmérica. Let's start on the left. Net revenues in the first quarter, BRL 8,047 million, a growth of 1.2% in the annual comparison, still above on the right. The consolidated loss ratio dropping to 3.9%, 78.6% in the first quarter of 2025, still on your right below. Growth of beneficiaries, clients of the company getting to 5 million beneficiaries of the company on adjusted EBITDA of BRL 986 million. When we add the financial revenue on the guaranteeing assets, the EBITDA of the company, therefore, is BRL 2,332 million. The consolidated adjusted EBITDA was BRL 2,641 million, a growth of over 21% in the comparison year-on-year.
Page 12, that profile on the left, you can see the cash and cash equivalents and real estate titles, BRL 41 billion. Let me exclude the technical reserves. The net cash flow of BRL 19 billion. The gross debt of the company is BRL 36.8 billion. The net debt, BRL 17.3 billion. The net debt over EBITDA, 1.7 times. When we add to the calculation, the technical provisions for insurance reserves, that net debt over EBITDA drops to 1.1 times. Center of the page, the evolution of the average cost of debt, very much controlled, CDI plus 0.9%. On the right, we see the schedule of amortization of the commitments until the end, the longest deadline of the debt. Last page, 13, managerial cash flow. Let's start on the left. Basing ourselves in the reported EBITDA of the first quarter with cash variation also of the first quarter, of course.
Starting with an EBITDA reported 2,332 million BRL, we have a cash working capital of 1,463 million BRL. We have negative 102 million BRL of other balance sheet items in the sequence, leasing 187 million BRL of payment of these. On your right, we have the payment of taxes, 314 million BRL. We have negative 1,634 million BRL coming from the financial activities. Here is amortizations, payment of interests, the revenues on the investment of the cash, the distribution of dividends, and repurchasing of shares of the company. In the end, negative investments, 208 million BRL. Here we have the investments in Greenfields, Brownfields, 471 million BRL. We have additionally the investments of Minas, 120 million BRL, and we have the return of investments done on the Campinas Hospital, 383 million BRL.
As we transfer this enterprise to the joint venture with Bradesco, we are reimbursed proportionally to the investments that were already done. On your right, we see graphically the evolution of the average days receivables and DIO and DPO. We finish the presentation here, and we open the space for Q&A. Thank you. Let's proceed with the Q&A.
Should you want to ask any questions, please click on raise hand. If your question has been answered, please lower your hands, and we ask the analysts to limit to two questions so we can have more people taking part. First question, Leandro Bastos, Citibank. Please, the floor is yours.
Good morning. Thank you. Two questions. First, on the operational bed expansion. We would like to, well, when we have the updated figure close to 500 this year, I wanted to understand how you imagine the seasonality of the evolution of beds.
We see that until Q2, there is a big expansion, and then the second semester is a bit weaker with the closing. Should it be like that, the operational, or due to the projects and the ramp-ups of the different hospitals, we have a space to see something different? That would be the first question. Second, the part of intercompany of SulAmérica growing in participation and growing in the hospital segment. So what are you selling in opportunities? We have a cycle of gain in the preservation of the hospitals that are within the network of SulAmérica. But what is the commercial context with the other operators? What do you see of markets and conditions with other players?
Hi, Leandro. Thank you for the questions. Let's talk about seasonality. Last year, we had, obviously, any year, you have first and fourth quarter with less frequency than the second and third.
That is the trend. Nonetheless, last year, we had specifically the first quarter that was stronger than usual, second quarter very strong, a few months of the quarter that were the strongest in the year. This year, even though you can still expect the first and fourth quarter, naturally, with lower frequencies, we still expect to have a seasonality that is a bit different from last year, where we accelerate the growth of beds in the second quarter of this year. Due to the fact that we're doing the ramp-up of several new units, as we have discussed, our growth in the comparison with the previous year, and I'm talking about the hospital part, it tends to be stronger in the second quarter of the year than in the first quarter of the year because of the reasons that we've just discussed.
Regarding growing, the intercompany SulAmérica is growing its portfolio, of course. The participation of Rede D'Or, it naturally evolves. And if you look at the percentage, let's remember that we have these continuations that were important that we mentioned throughout the year, including this first quarter. So that makes it that within the mix of operators, big operators such as SulAmérica and Bradesco, have a trend of growing within our mix.
Thank you, Paulo.
Next question, Rafael Elage from XP. Please, the floor is yours.
Good morning, everyone. Thank you for taking our questions. Two, first, in regards to the claims of SulAmérica. If Raquel can give us some more detail of what is this effect, the positive results, can it be something of the market?
When you commented on the previous call, the less occupancy of the hospital beds, maybe there is a positive effect in the claims, not just discussing the issue of the hospitals of the network. But the second point would be to understand from the growth of tickets of the hospitals. Otávio anticipated the capacity of the company of adjusting the pricing, but I wanted to understand the readjustments of the pricing on the table and the evolution of the mix. How do they influence the results? Thank you.
I'm going to take the second question, and then I'll give the floor to Raquel. We always request that all of the investors and analysts look at our evolution of the ticket with care and look at it on an annual basis. Never do a sequential quarter comparison.
You can see that all throughout our history, one year, two years, three years, ten years. We have been going over a few one or two points above the inflation. That is the best way that I would suggest that you keep looking, always looking at a period of 12 months because you can have fluctuations quarter on quarter because of the profile, the seasonality that you have. Last year, for example, you had dengue fever, you have more volume, but there is an impact in the ticket. So always to give amortization and avoiding the mistake in the analysis, looking at the year-on-year period.
Hi. Thank you for the question. Well, a part of the answer in regards to the first quarter is given to the seasonality, and Paulo has answered a part.
Last year, when you compare specifically to last year, we had dengue before we had the emergency room fuller, and that impacts our consolidated loss ratios, so what we've seen thus far is a seasonality that is much more known. What we used to see in previous years, it makes a lot of sense. We have to observe the carnival if it's in the middle of the year, and all of that causes an impact for the insurance company and also the hospital, and as you know, we are a big ship. Any decision that you make, it demands 12 months to impact the face of the clients, so what we are seeing in the first quarter of consolidated loss ratio, it went over the recomposition of pricing with the new sales, with the readjustments, the modular products, and come back to 64%, 64,000 increase of lives last year.
All of them got into this new logic of products. This year, another 65,000 lives also in this new logic. If we look at co-participation, which is a fundamental factor so we can have a rational use of the healthcare benefit, we also see a growth in the retail, which is 100% sold, 40% of the small companies, small and medium-sized companies, also with co-participation. So when we add all that, that is the answer that you are seeking for this consolidated loss ratio.
Thank you.
Next one is from Joseph Giordano from JP Morgan. Please, the floor is yours.
Good morning, everyone. Paulo, Raquel. So I wanted to explore that strong growth in SulAmérica that is connected to a very healthy margin.
You commented on the co-participation, and I wanted to understand how do you see the network issue, if it's a regional product, if you can work the network in a more adequate way. And we've been working forehands with the hospital side. Second question for Gavina. Of course, the seasonality hinders the reading of the ramp-up of the new beds. But I wanted to see how do you see the schedule outside of the Bradesco SulAmérica binomial with the new assets. How do you see this acceleration of the occupancy of these beds and what we have for the next quarter? Thank you.
Thank you, Joseph. Well, we see with optimism and careful, well, with optimism, we have a few negotiations with the market with carefulness. Now, remember that the geographies are different.
The assets are in different geographies, and therefore, that would make us do different negotiations where the business has more power with other operators that are not Bradesco and SulAmérica. Yes, we have a few registrations outside of Bradesco SulAmérica. We have negotiated with other operators. We may continue with the negotiations with the others. So we believe that this will grow and evolve. Remember, the ramp-up has been very positive.
Joseph, this is Raquel. Thank you for the question. When we look at the growth, there is a factor that I have to mention before. Any other? Obviously, we have a very robust commercial team.
They're day-to-day talking to all the insurance companies, all the companies trying to get disruptive products, not just delivering what we have available on the shelf, but more and more assembling along with our clients with the insurance representative, something that makes sense for a company. But it's not just a commercial area. This is a big differential. So when I look at the SulAmérica team and the Rede D'Or team, everybody is always generating a lead. Purchasing procurement is always remembering SulAmérica on the other hand. That synergy is fundamental. So we can achieve this growth along with all the strategy of launching in non-obvious regions. I mentioned Parauapebas, the regional product of João Pessoa. In a few places, yes, it makes sense to have a product that is closed and it has an average ticket that is lower.
But what we see in growth of beneficiary databases is also in our products that are more traditional that have an average ticket that is higher. And for that, we've done a strategy of concierge, not just attracting new clients, but keeping these clients for as long as possible. So we have an exclusive area that is dedicated to the satisfaction of these clients so that they remain with us longer. The growth and the base is always a product between selling and non-canceling. These two points are equally important for the team. Thank you.
Thank you.
Next question, Samuel Alves from BTG Pactual.
Good morning, Paulo, Rodrigo, Rodrigo, Otávio, Raquel. Well, two questions on our side. On the consolidated loss ratio of SulAmérica, Raquel commented on seasonality and the other levers that can be captured. The question is, the company believes that you got your threshold that is optimal.
When we look at the numbers, Consolidated Loss Ratio is below what was delivered in the first quarter of 2019 with the pre-pandemic threshold. The question is, can you go further? Can you find other additional levers to reduce even more? And the second question is, you even opened the impact of the assets that were recently launched with the EBITDA. Could you give us an idea of the magnitude of the margin just so we can understand if these assets, they send that margin lower or that drop of the margin was due to the lower occupancy rate in January and February, as you commented in the previous call?
Samuel, let me start with the second question. We do not give the opening of the margin, but so you can understand. The first quarter is a margin that is below the company.
Our expectation, given that the ramp-up is doing very well, is that this will converge in the aggregate to a similar margin for the company with the assets that are superior to the assets of the company because of the level of the ticket, the mix in the second quarter.
Samuel, thank you for the question. I would say that the threshold that we are reaching in the consolidated loss ratio is a good threshold recognized by the market. On the other hand, I have shareholders that are demanding that are always looking for an improvement in this number. That is a constant following up along and very balanced with our growth of the base of the beneficiaries. We always try to pass on part of that gain in the readjustment and the pricing with new clients.
So we have that beneficiary basis. We have 3 million lives serviced in health, getting close to another position in the ranking of the biggest operators in the market. Another relevant point that I can mention in this line is the reduction in your readjustment of the pool. The small contracts up until 29 lives, we did a readjustment for April to 4 percentage points less than last year. So it's a combination of these two factors, but always seeking the improvement of the consolidated loss ratio. Thank you.
Next question is Mr. Mauricio Cepeda from Morgan Stanley. The floor is yours.
Good morning, Paulo, Raquel, Gavina, Otávio. Thank you for the opportunity. First, I would like to start by a sectoral question, the issue of regulation of ANS.
There seems to have a lot of issues going on, the reduced coverage, the adjustment of the individual, the size of the pool, even discussions at the Senate level on the unilateral cancellation, the judicialization of the sector discussed with the judicial powers. If you, Raquel, can give us a vision on how is your opinion of where that is progressing, what seems to be a trend, and how can that impact you? And the second question, going back to the previous theme, that trade-off of profitability versus expansion of the portfolio. We can see that clearly the profitability is increasing. I imagine that the profitability of the contracts is increasing either by design on how the plan is done or price, but it's still very strong with the profitability of the contracts.
So do you see space to continue with the profiting levels, or should you migrate, and when should you migrate because of the expansion of the portfolio? And in this expansion of portfolio, the type of clients that you're looking after. Raquel, you mentioned the higher tickets, but if this new logic of products, as you've discussed, is that opening other profiles of clients that allow for an expansion of portfolio. Thank you.
Hi, Cepeda. Thank you. Let's start by the most difficult one, talking about the regulation. There are several public consultations ongoing. Some are more publicized than others. There is vacancy of a few chairs in the regulatory body. So we are at a moment that is complicated in terms of regulation. Last night, there is a new fact. I don't know if everybody knows.
The Public Consultation 145 dealt with four themes: the readjustment of individual co-participation, selling online, and new grouping of the pool, determining the risk of consolidated loss ratio to be followed. When we published Abramge, which is one of the associations that represent the healthcare plans, got in with a request of an appeal. There was a judge that was ruling, and yesterday it was approved, the appeal indicating the suspension of the Public Consultation 145, demanding that ANS regulator presents all the studies of analysis of regulatory impact. This is fundamental for the market. There was, well, at the moment of the public consultation, they didn't consider it. So we're breathing calmer, and now there will be more data to face these themes.
So the suspension, all of that analysis of the regulatory impact, there should be a discussion of each of the themes individually, very important for the market, and that there is a deadline so that this analysis and so this occurs. So the deadline was 90 days. In several others, there is one that changes the value of the fines, the issue of the ambulatory plans. There's a lot of things happening. And we defend the evolution, and I think that there is always a space so that there are regulatory changes, but we always have to increase the access so we can help the public healthcare system. We have to work with an agenda that is of the Ministry of Health, all in all.
In regards to the previous theme of consolidated loss ratio and profitability versus the expansion of beds, a lot of things that what we're seeing now go through the mix of products, mix of regions, and a strategy that is well performed by the commercial team. Obviously, we choose to get into a region, so we choose to get with higher claims to start a region, or we have a higher claims ratio in a geography because I need the doors that it opens with the service provider. So this analysis is done case by case, and we have weekly committees that will define this. Thank you very much.
Next question is Gustavo Mieli, Goldman Sachs. The floor is yours.
Good morning, everyone. Thank you for the presentation. Two questions as well.
I want to address the first question on SulAmérica without trying to be repetitive on the commercial side, but I wanted to explore an angle that is geographical growth strategy of the company. Looking at the first quarter, we've seen a competitive environment in São Paulo that is ever more challenging. In general, there is a market issue. There was a big erosion of the base of beneficiaries in the first quarter, very expressive drop. So my question is, how do you see the prioritization of regions for the growth of portfolio throughout 2025? You commented on the focus on São Paulo and Rio, but as you see the relevance of other geographies that might have in the growth strategy throughout 2025 and 2026? If you can give us your two cents on that, I would really thank you.
Second question, more objective. One hospital, CAPEX in expansion.
There is a drop that is expressive, sequential, and year-on-year. I wanted to understand if this can indicate an improvement of commercial conditions for the providers of works. Can we have a delay of CAPEX throughout the year? But we see the nature of the CAPEX that is lower than we've seen. Thank you.
Hi, Gustavo. Thank you for the question. Commercial, first relevant point. We have grown off Brazil. So there is a team of 400 people spread through the regions of the country looking for growth everywhere. Because when we get a big company, most of the time that company has a capillarity that is spread out, and we have to have a network to service. Talking about the regions, of course, there is a big growth and focus in the regions that are obvious, Rio and São Paulo.
But we also have the Curitiba arm, which is a sector with big industries, and we've looked at it with a lot of care. The Northeast has been focused, and Minas Gerais as well. And we've tried to, as I mentioned, Parauapebas and other regions as well. In Rio de Janeiro, you're right. We have a market that is a warm-up growth of base that is very relevant, not only in this quarter, but since last year, we got records of sales. In São Paulo, I see a market that is more aggressive in terms of one player or the other, but remember what I told you at the beginning, growing with responsibility so we can keep this trajectory sustainable. We're very sure of the pricing, specifically talking about wholesale, that this table is very coherent so we can keep a balanced consolidated loss ratio.
We do not participate for a long time of commercial war. In São Paulo, I see one or other operator zooming a price that we have difficulty understanding, but in general lines, this is the strategy. Second question. The best public information to help you to model the investments is established in the reference form of section 2.3, which is the annual plan of growth for organic growth of the company. To help you in this fiscal year, the Greenfields Brownfields investments should be very similar to what was done in the last FY. In the first quarter, the company has BRL 208 million of cash flow resulting from the activities of investments, including BRL 383 million. But I'm going to say it's a reimbursement of investments as we transferred Campinas Hospital from JV to Bradesco.
and the fact that as we have the investments that have been done by the company over the last years, they reach more maturity. We go through the ramp-up of the hospitals that are expanded. The company goes through a financial deleveraging process, and it's expedited. The net debt was BRL 40 billion, and it dropped to BRL 36 billion. The net debt over EBITDA that also dropped this year. It's our best expectation as we go through the cycle of investments, and they go through the ramp-up, and they have a higher level of maturity, that the leveraging of the company, it advances, and the company gains more financial health.
Thank you.
Next question is from Mr. Andrés Salas from UBS. Please, the floor is yours.
I have a question. It's more general, but I just wanted to understand how the company works in regards to capital allocation.
There was a strong cash generation this quarter. We also had selling of assets. With this new volume of money that is getting into the company, how do you see the level of payout? What do you see in terms of opportunities up ahead, the cost of capital that is higher? If you can go over a few more details, I would like to thank you.
Andrés, we are going to continue to analyze all the opportunities. We have a program announced for investments that are organic. We have a repurchasing program, and we have new projects under analysis in the company. I cannot advance a precise number. We are always going to try and get to the level of leveraging of the company that is controlled.
What we are going to pay in dividends is also of the other decisions as we have good opportunities of allocating capital, whether it's with the organic, inorganic or repurchasing of shares with the adequate return level. We're going to do it. There might be a moment where the cash generation of the company is strong and the opportunities are not going to be enough, and then we're going to reevaluate the level of payment of dividends as a consequence.
Thank you.
Next question is from Mr. Vinicius Figueiredo from Itaú BBA. Please, the floor is yours.
Thank you for taking my question. You commented a lot on the previous answers on the stronger frequency, the ramping of Atlântica D'Or as well being important for the margin of the company. But I wanted to explore on besides these levers.
What would be the additional levers for the expansion of the margin of the legacy hospitals? Do we see? I remember that you commented on the last call, the integration, systemic integration of the acquired hospitals in 2021. And you can be one of the promoters, but just to understand if that should be something relevant as a whole and if there is an optimization. And another question would be in regards to the hospitals that were deregistered. In the question of our colleague, he observed that the revenue of SulAmérica has been very strong. The ex-SulAmérica was with a lower growth. So what can you comment in regards to a recovery of the operational beds within these hospitals? How do you observe if this has impacted the margin of the hospitals and what would be the turning point? Those are the two points. Thank you.
First of all, in regards to the additional margin, the opportunities. Obviously, 79 hospitals operating, you always have opportunities of improvement, automation. You have the hospital systems that have a standardization of processes and gains of efficiency that is important. Of course, there are a lot of things that need to be done. But just to highlight one that has to do with the second question, the leveraging due to opening new beds is very important. It's a structure with a very high fixed cost. And we have a lot of growth of brownfields, as you know. A great deal of our organic growth is brownfields. And they have high returns because you have a maintenance of an incremental margin that is much higher than the margin of the company.
Just to give you an example, on our biggest cost, which is the employee, six employees per bed. Every time that we get a bed, we have another 3.5 employees to get this additional bed working. And the other fixed costs. So that's the biggest opportunity that we have. And as we can grow in the operational beds, you highlighted the way the hospital loses a big registration and the decision with the. You have an operational deleveraging and see the inverse effect that we commented. And you have an effect in the margin of the hospital. And we managed to grow the operational beds even though we continued with the policy of discontinuing contracts that we were not interested. And as we discussed with Rio de Janeiro, the other contracts that we discussed.
So we are very optimistic to work with these beds and the growth of the operational beds in these hospitals where we can see positive effects in the margin.
Thank you.
Next question, Flavio Yoshida, Bank of America. Please, the floor is yours.
Good morning, everyone. The technical reserve of SulAmérica, we see that is growing a lot. And this growth even accelerated in regards to the standard in the fourth quarter that was very strong. So I wanted to understand what leads this being so conservative. And when do you think we're going to get to a moment that there is a deceleration of growth and a growth that is aligned with SulAmérica as a whole?
So, Flavio, thank you for the question. In regards to the technical reserve, I think that in the last or the second to last call, it's a recurring theme.
And we've manifested that we've adopted a posture that is more conservative for the technical reserve calculation, very much adherent to the technical note that is approved in ANS. The technical reserve is composed of those claims that occurred, but still not let us know, then the claims that we know and they were not paid. So there is a compensation of the two factors. And it oscillates in regards to the seasonality of each period. You look at the previous period that is longer, so we can prepare up ahead. So looking at the index, we're very much at ease with what we have as a reserve and is very coherent. And there is no change in forecast for the future. We're very at ease with what we have. Thank you.
The Q&A session is adjourned. I would like to give the floor to Mr.
Paulo Moll so he can close the event.
Thank you very much for your participation and the call. I would like to reinforce our thanks to Raquel Reis and Gavina, to our employees of SulAmérica and Rede D'Or. We are trustworthy that we're trusting that we're going to have great growth, good news in the side of the insurance and the hospital. Thank you very much. The earnings call of Rede D'Or is adjourned. Thank you for your participation. Have a nice day.