Good morning, and thank you for standing by. Welcome to Viveo's conference call to discuss results regarding the fourth quarter of 2021 and the full year of 2021. With us here today, we have Mr. Leonardo Byrro, Chief Executive Officer and Investor Relations Officer, Guilherme Fonseca Goulart, Chief Financial Officer, Flavia Carvalho, Investor Relations Officer, Thiago Liska, Director of Diagnostics, Flavio Leal, Executive Director of Projects, and André Augusto Pacheco, Director of Strategy and Marketing. We would like to inform you that this event is being recorded, and that all participants will be in listen-only mode during Viveo's presentation. We will then begin the question and answer session when additional instructions will be provided. If you need support during the conference call, please request assistance from an operator by typing star zero.
This event is also being broadcast simultaneously over the internet via webcast and can be accessed at https://ri.viveo.com.br, where the respective presentation is available. The selection of slides will be controlled by you. The replay of this event will be available soon after it is over. We would like to remind you that the webcast participants will be able to register via website question for Viveo, which will be answered after the conference ends or during the conference call. Before proceeding, we would like to clarify that any forward-looking statements made during this conference call regarding Viveo's business prospect, financial and operational projects and goals constitute the beliefs and premises of the company's management, as well as information currently available to Viveo. Forward-looking statements are no guarantee of performance as they involve risks, uncertainties, and assumptions, and therefore depend on circumstances that may or may not occur.
Investors and analysts should understand that general economic conditions, industry conditions, and other operating factors could affect Viveo's future results and could lead to results that differ materially from those expressed in such forward-looking statements. I would now like to give the floor to Mr. Leonardo Byrro, Chief Executive Officer and Investor Relations Officer, who will start the presentation. Mr. Byrro, you may proceed.
Thank you. Good morning, everyone. Welcome to our conference call to discuss the results. I would like to start talking about the essence of our year and the execution of our strategy that has been broadly commented by you during the IPO process, and how we reached growth with high profitability along the year.
We closed the fourth quarter with 2.3% higher than last year, and we align not only organic growth above 14%, and we also executed our strategy of M&A along the year, and the growth of profitability with our gross margin and all our EBITDA margin. We are going to discuss it in detail along our presentation. We are going to discuss the growth, the adjusted EBITDA of BRL 44 million. An important highlight is our discipline and how we manage the cash flow. We ended 31 days, the cash. The 30 days. We added five days in comparison to the previous years, and the 31 days year to date. We were able to have an ROIC of 20.16% in the pro forma vision considering all the M&As or an accounting ROIC of practically 19% along the year.
We were very disciplined in executing our agenda and the return of capital and the growth of profitability. We are going to discuss all this during the presentation. On slide number three, I would like to highlight some important points of our service schedule. As we have always mentioned, one of differentiators for the long term is the growth of our ecosystem, the B2B and storage and transportation. We have 79 hospitals in our base, and we provide transport services for more than 122 industries. We changed our fleet to a green fleet that will bring more competitiveness according to our sustainability long-term strategy. We would like to highlight the growth of our NPS, which is a base that we use for two years. We have reached 80% in terms of customer satisfaction.
This is a corporate target that we defined by me and by the team, and we have been investing technology and infrastructure in our operations so that we can improve the service level in all places in Brazil. Moving on to the next slide. We would like to talk about some growth initiatives that are part of the 14 major priorities for the years to come. I would like to draw your attention to some of them. In terms of hospital clinics, we have an organic growth in for materials of high added value. We had some M&As in this line, and we have the growth team are all doing all those actions. Now we have some relationships with industries that we didn't have before. We are very enthusiastic with our agenda.
We have Teleflex, the Edwards, and some other players, and this is going to be a recurring revenue for our business. As to oncology, we talked about clinics, and we had an opportunity of growth, a greater share in the market, and we closed with 46% of growth in comparison to the fourth quarter 2020, and we grew above the market. This has been a new segmentation with a dedicated sales team for this team that started in 2021. As to the public sector, we did the same thing. We wanted a dedicated team to the public sector, which is a minor part of our profit and our share, and we grew more than 200% in comparison to the previous year. That means that throughout the year 2021, we want to capture all the portfolio that we developed, and we are going to see the results along the year.
All these agreements require discipline in terms of how we are going to dimension the ROIC, and this has been approved by the board. We expect very positive returns in the long term. As to M&As, we have Pointmed, Medcare, Tecno4. All those platforms are part of this pillar with high value added. In labs, we reinforce our presence in other regions that we were not present before, and our partnership with Roche by means of Macromed, Apijã and Laborsys. In terms of health product, we had already completed in the fourth quarter, FW, and we are now going to materialize all the synergies with all those companies.
In the next slide, we show the overview of all the M&As. I would like to draw your attention, the Profarma Specialty that we are awaiting the closing, and we expect for this to happen along the next weeks. Azimute Med, which was our latest announcement in January. We are still waiting for the closing, and we are going to submit it to the Brazilian competition authority. We can see all the other ones. We had all those closing completed to February. We tried to make it all very explicit to you as of the beginning, so we can understand the size of the companies, both in terms of net revenue and EBITDA, and all the synergies start to be captured along 2022 and also in 2023.
In the next slide, I would like to draw your attention to the fact that most acquisitions reinforce the growth in each of our divisions. We can capture organic and inorganic growth in all our divisions. When we consider all the completed acquisitions in 2021, without considering those which are awaiting closing, we can combine the result of BRL 600 million and a combined EBITDA and synergy of BRL 87 million. This is the base that we already have to work on so that we can capture all the synergies and execute our strategy. Then I'm going to speak quickly some highlights of our results, and then we are going to start the Q&A session, okay? Net revenue, the main highlight that we like to discuss is the growth, the organic growth of 14.2%, and this is reflected in all our business units.
Hospital clinics, we have a market share, which is already higher. We got organic growth of 20.5%, in line with the market growth, and this growth reaches 30.5% when we consider all the acquisitions that we made along the year. Laboratories was a very important segment, very strong, with a growth of 31.6% along the year, and 62% when we consider the acquisition. We'd like to remind you that the latest three only started operating in December, so the relevant impact will be felt this year. As to retail, we had a strong organic growth of 26%, and 85% when we look at an overview. Daviso has been with us for six months, and FW started as of November, so most of FW is going to be captured in 2022. As to services, there was organic growth of 23%, and a total of 25%.
Here, there has been an important change because the business of Cirúrgica Mafra that we implemented along 2021 will be reflected in this division of services. We see this delivery both for patients or healthcare professionals, when we are going to get closer to the patients. This is going to be added to other movements that we're going to be implementing along the time. After the approval of some other initiatives, they're going to be incorporated in this business division. So you're going to see a higher or more accelerated growth in this business as a result of the acquisitions that we made along the year. Now, moving on to the gross profit. We can see a clear growth for the half of the year of 0.2 as of the year of 0.1. We'd like to remind you that there has been an impact.
This margin that I am showing is in 2020. We had only the half of the year, and as to last year, we had the complete year. We are going to see in the pro forma view, and you are going to understand the gross margin and how it has improved. This is a very important premise for us, a very important deception to focus on businesses with higher margins. This is how we see our business along with 2022, and there is a possibility of expanding our gross margins with the growth in those divisions. We always draw your attention to the default case in our business, and we report what is non-recurring, so we are not considering the default case. On next slide, we show the EBITDA margin, as we mentioned.
Once again, this year, we managed to make headway in terms of profitability from a margin of 6.8% in the fourth quarter 2020 and reached 8% in the fourth quarter 2021. So we had managed to reach a level of 8% for subsequent quarters. As of average of the year, we reached 7.9% as EBITDA margin year to date. This has been a result of work that we have done, not only considering the expansion of the margin, but we also captured the synergy of all the M&As that were incorporated into the ecosystem, and we were managed to leverage many expense lines. This is the result we see. On the slide number 11, we see the pro forma figures. These are the important points. In 2020, we reached BRL 5.1 billion pro forma, and this year, BRL 6.66 billion.
Adjusted, excluding the default case, BRL 6.4 billion versus BRL 5.1 billion of the previous year. As gross profit, adjusted gross profit was about BRL 1 billion, with a margin of 15.5%, as I mentioned before. 13.9% is compared to 15.5%. The expansion of the gross margin was very positive, driven by the acquisitions that we made that provided higher margins to the company. Adjusted EBITDA of BRL 535 million for the year, with a margin of 8.3%, 1.3% growth in comparison to our pro forma margin of 2020. On slide 12, we would like to highlight the net profit, and we made the same adjustments related to default case and EBITDA adjustments that are non-recurring. We managed to reach 102.5% of net profit for the quarter. Year to date, we reached 133.5% of growth.
In spite of the cost of debt has been increasing, we managed to have good renegotiations of the debt, and we decreased our total debt cost in the short term and improving our capital structure and also our capacity to generate more profit with our operations. On slide 13, the main highlight would be the reduction of five days of our cycle in comparison to the fourth quarter 2020. So we continue to adopt this policy of being very strict of managing our accounts payable and our inventories, and also the control of the receivables of our main clients, even with the movement of consolidation that generates a higher pressure for them.
In the fourth quarter 2020, we had operating activities of the company that generated BRL 280 million, investments consuming BRL 313 million, especially CapEx and some M&A payments, and the financing related to the reorganizations of the fourth issue of the ventures in October. That amounted to BRL 530 with this additional amount. We ended the year with this positive balance so that we could start 2022 more comfortably. This is a snapshot on slide 14 of our debt. Most of our debt is maturing in the long term, and this was a very important discipline that we adopted in 2021 to extend our payment dates. When we look at the cost of our debt, we managed to reduce the average cost of CDI to 2.19% from CDI and 2.45%, so that we could continue growing organically, and we also reduced the cost of the debt for us.
When we look at the maturity schedule for 2022, as we can see here, we have BRL 2,250 million to be matured in 2022. This is also related to the acquisitions payment. The payment of the debts and the growth of our EBITDA will leave us below the optimum level of leverage, which would be 1.5x our net debt over EBITDA. On slide 15, we are going to discuss some highlights. First is the growth of our total base of clients by 420% in comparison to the previous year. A little bit more, 1,020, which is the recurring model. In the PSP model, we have partnerships with major players in the health. We have 536, and this is a snapshot by the end of the year. As for spot sales, we are still beginning. We are starting the integration with the main systems, and we have 76 patients.
This is a pilot project for us. Our churn continues to be low at 2.7%. The retention is 17.55 months, and our NPS is very high, 94%. We would also like to discuss the clinical pharmacy. This is something that we have been investing more and more. We want to have intelligence behind the prescriptions and everything that we receive in terms of drugs and sell to the patients. We start to analyze those drug interactions, and we understand whether there is any problem, if there is any risk in terms of the drugs used by our clients. We are going to report not only to medical plan but also to the physicians, to the doctors. This is one of the pillars that has been valued in our value proposition. On the right, we see the main initiatives.
The current channels are the nursing homes and home care. This is our major channel. Health operators started to become more relevant along the year. Hospitals, we also have some specific initiatives with some of them. As to companies, we have some negotiations with the major companies to operate together with the management of chronic patients in order to reduce all those expenses. B2B is one of the leverage that we see as an opportunities. We also focus on specialty clinics and industries. In terms of technology, we have been investing a lot in user experience to decrease the friction when the purchase process is going on. Artificial intelligence and also PSP. Acquisition of Azimute Med in January. Even though it is very small asset, it is very strategic to this construction of this technology to interact with the customers, and it is a differentiator for the long term.
We continue very enthusiastic with initiatives of our B2B service, not only for me, but all the assets that we have been adding, such as delivery and all the other models that we have been creating. This is one of the long-term initiatives, and we are sure that we are going to generate value, and we are going to provide differentiation in our sector. Lastly, I would like to give you a save the date, May 19, 2022. It's going to be our Viveo Day, and it's going to be in person, no longer virtual, so that we can organize a very nice day so that we can have interaction, so that we can open the doors to welcome you. We are going to give more details of each business unit.
We are going to talk about the future growth potential, and I would like to give you this invitation, and we are going to give you more information soon. With this, we start the Q&A session, and I'll be here together with my team, available to take your questions and clarify your doubts. Thank you.
Ladies and gentlemen, we are now going to start the Q&A session. To ask a question, please enter star one. To remove the question from the list, type star two. Our first question comes from Samuel Alves, BTG Pactual. You may proceed, sir. We have his line disconnected. The next question is from Gustavo with Bank of America.
Can you hear me?
Yes, Gustavo, good morning.
Okay, thank you. Good morning, everyone. Thank you very much for answering our questions, and we have two questions on our side. Could you talk a little bit about Profarma and the timeline, but if you could give more details of what can we expect and when can we expect a higher scale, how would you fit the new acquisitions in? The second question is related to Profarma synergies. You mentioned services, but its margin is a bit compressed. So what can we expect in terms of timeline as to Profarma so that it's going to start operating along this year? This would be the questions we have.
Gustavo, thank you. I'm going to divide the answer into three big chunks. First is the delivery, which comes from Cirúrgica Mafra and from Profarma Specialty, which also gives delivery services and Box, which is our recurrence model and involves the direct channels. Delivery, what are our expectations?
Based on the combinations of the businesses, we expect double-digit accelerated growth, both for healthcare professionals as for final patients. This business will start off from a very relevant revenue or income base, considering what we already have from Cirúrgica Mafra. We start from BRL 400 million, BRL 500 million in terms of turnover, and then we are going to combine an accelerated growth. It starts to have some relevance considering the total share. In terms of health plans, we organized this in May last year, and last year we started with BRL 5 million per month in this modality, where we include the health plan, the patient, and the agent, and sometimes we have different focuses, and we deliver the product in the patient's house. So we have seen a very accelerated growth when we work with medical plans and insurance plans.
This will touch upon the B2B because we are working with companies that have self-management of their health plans. This is a way that we are taking, and if we negotiate with major companies, we can change the direction considering the base and the population that these companies already have. The B2B did not use to be a very major focus, but it grew faster than B2C, and it became an alternative for growth. Box, which is the model that I mentioned, we ended the year with about 1,000 patients, a little bit more than that. Our expectation is at least to triple this along this year. We have M&A movement that we are considering to accelerate the growth of the space, and we are completing our integration with the system of capturing digital transcription, both for drugs. This year, we expect to accelerate.
We are still working as a pilot project. We are working with trial and error, and along the year, we believe that this is going to accelerate. For the first time, we are going to see the turnover of services. Look, I am only considering B2C. I am not even considering B2C for hospitals. We consider B2C too. We expect it to have a relevant turnover this year. In terms of the other point, we have an integration point, and we are waiting for the consumer defense to approve. We have been doing business with integration, and we are very confident with the synergies that we can have. We doubled our EBITDA with the synergies that we completed home. We see something similar happening in other items. This is Expressa.
It used to have the same system of LP, which is ours, which is Box, and it had a distribution center in Brasília, where we had a distribution center already. It was faster to have this integration. Profarma has five distribution centers. We have a timing for capturing the synergy, which is lower than we managed with Expressa. Even so, we managed to see this. Since it is an asset of distribution, we believe that in 12 months, we are likely to have this captured and incorporated into our results.
That was very clear. Thank you very much for the answers, and congratulations on the results.
Our next question comes from Samuel Alves with BTG Pactual. You may proceed, sir.
Good morning, Leo and other officers. Good morning, everyone. I have two questions on my side. The first one is more for information purposes.
If you tell us what was the organic growth in terms of EBITDA revenues in the fourth quarter, excluding the default case. The other question is related to the margins for 2022, considering the cost inflation, which is very high, and also the dynamics of recomposition of prices, which is expected. Does the company see any risks of lagging behind the inflation run, or what can offset this? I would like to take the opportunity to congratulate on the successful acquisitions that we saw described in the release.
Samuel, how are you? Thank you very much for the questions. The fourth quarter, without a doubt, was the most difficult fourth quarter along the year because of the transition of COVID world and also the increase of elective surgeries, which are still low, and some divisions that played a part that had a peak previously of material supplies and PPE.
The growth was a bit below what we saw in the other quarters. The margin dynamics for this year, I would divide into two. First, we are going to continue to have a positive effect of the mix. As I said, many of the companies had the closing in the last quarter, so we are going to have the weighted margin and the mix, such as Profarma Specialty and Profarma has a low gross margin, and it is going to drive the business down. Then we are going to offset this by capturing synergy with the margin higher than the company used to operate along the year. But apart from Profarma effect, all the other effects will be positive for us.
In terms of cost effects, we passed on the prices in a very important movement in October, November last year, and we can see the return of this movement in the beginning of the year. So we are being able to reestablish a large part of our margins. So we are going to look ahead in terms of the increase of the fuel prices, but also other raw material price increases that continue going on. So cotton has reached an all-time high. So all those prices are very high, and the petrol prices also impact the residents. So we are likely to see all those increases. So we anticipate that we are going to need to make new price adjustments along the semester. In the first quarter, we have healthier margins than we had in the previous quarter, considering all the movements that we made.
And we are going to try to anticipate all those movements and be ahead of the game so that we can have a more active attitude, different from what we had last year. So I am very optimistic in terms of margins for the year. And we are likely to see an evolution of our margins along this year.
Okay. It is very clear. Thank you.
Thank you.
Again, to ask a question, please press star one. To remove your question from the list, press star two. We close the question and answer session now. I would like to give the floor to Mr. Leonardo for his final consideration. You may proceed, sir.
Again, thank you very much for attending this call and for participating in this question and answer session.
We are starting 2022 very enthusiastic based on what we built in 2021, and we are moving forward to capture all the synergies with the acquisitions. And we have other potential movements that we can have along the year, but we are very attentive to the macro scenario. We understand that this is going to be very tough, so we are well prepared internally to see all those movements beforehand and start off before other competition so that we can increase the margin along the year. So we continue very confident, and we are continuing adopting the discipline and the implementation of a strategy. Have a nice weekend, everyone.