I must advise you that this conference is being recorded today, Friday the 3rd of May, 2019. I would like to hand the conference over to the speaker today, Fredrik Rågmark. Please go ahead.
Hello. Good morning, everyone, welcome to our first quarter report announcement 2019. We very soon celebrate our two-year anniversary as a listed company on the stock exchange, I think it's very pleasing to be able to start this year with such a strong result. Our top-line revenue growth increased from already strong levels last year to 23%, it's a long time ago since our company had a plus 20% revenue growth. I think that's notable, of which about two-thirds being organic, very significant top-line growth. Over the eight quarters we now have been listed, we have grown 41% revenue, of which some 75% being organic growth. Indeed, I think the historic organic growth track record on which we listed the company has carried on and even increased. Run rate-wise, you see first quarter, EUR 200 million.
Run rate-wise, we're running at EUR 800 million, which is already now a 19% growth from full year 2018, there's plenty more to come for the three quarters yet to go. Very positive start. EBITDA grew at 24%, up to EUR 27.5 million, a 10-basis point expansion. We also introduced a new alternative performance measure, which is EBITDAaL, EBITDA after lease costs. Really to try and reflect the historic measure that we used, that measure was up 28% to EUR 18.5 million. Also a margin expansion with some 30 basis points. Also, the established financial profit target that we have, the organic adjusted EBITDA grew 18.7%, that's just spot on in our 18%-20% established target. We had very strong operating cash flow, up 76%. Joe will speak more about that in a second.
Our Healthcare Services team and division had outstanding growth of 28%, some 18% organic growth. Again, I think a very strong reflection on the trading conditions, both in our integrated employer-paid business as well as the fee-for-service developments that we have underway. You recall we had some headwinds last year in our Diagnostic Services business. That started to come back in the fourth quarter, we had really now in the first quarter of the year seen a very strong comeback there with 19% top-line growth for the diagnostic team, of which plus 70% being organic growth. Really good. The Neomedic acquisition in Poland that we announced some time back has now received competition clearance, we expect to close that during the month of May, rather shortly.
Another very important strategic acquisition that we did, that we just closed shortly after the new year, being the Klein genetic lab in Munich. We've had very good integration work and developments in that acquisition during the first quarter of the year. Overall, indeed very pleased with how this year has started. If we then look at a bit more detail on the Healthcare Services division, as you recall, the first quarter is typically the quarter in this business or in this segment where we have the lowest margins because of the way that actually quite a lot of healthcare is being consumed in our funded business in this quarter. Mentioned very strong revenue growth to plus EUR 100 million. It's notable to see that this is the first quarter ever as well, where both our segments have revenue of plus EUR 100 million.
Organic growth 18%, as already mentioned. It's notable to see here the second bullet, you recall that in this division, some 60% is our funded integrated model where the employers pay, and the other short of 40% is the different fee-for-service lines of business, for example, dental. This quarter, the fee-for-service component contributed 55% of the absolute growth. That's actually very significant. Not because the prepaid funded business is not doing well, it's growing very nicely, but that's a good illustration that all of these different fee-for-service businesses that we are pushing investing in is really starting to become noticeable in the total picture. One example that we speak about quite often is our dental business in Poland, you see that grew a very strong 71% versus the first quarter last year. Indeed very significant.
EBITDA was just north of EUR 11 million, up 26%, a slight margin contraction versus last year of some 20 basis points. If you look at the alternative performance measure here, where we add back the lease costs, that is up some 38%, which you really should interpret in the way that we are running our business in a much more efficient way over the rather wide range of leased space that we operate. The member growth was some 14.5%. Indeed, a strong member growth quarter as well to just a tad above 1.2 million members. A strong start for Healthcare Services. On the Diagnostic Services side, also a good top-line growth, 19%, of which organic being 13%. Significant growth on EBITDA, some 26% up with just short of 21% EBITDA margin. The alternative performance measure also strong growth, 27% up and 16.5% margin on that alternative measure.
Plus 100 basis points margin expansion on both of those measures. That's really driven by principally the resumed performance in our German lab trading business following the weakness in the second and third quarter last year on the back of the price reforms that you remember. We reported a good stabilization in the fourth quarter, the first quarter this year has really carried on that trend. We've also had good mix effects from the integration of the Klein genetic laboratory in terms of our German genetics business. We've also seen very good development of our German clinics project. You see we had some 16% revenue growth in the German market in our clinics business, which is very significant, not to be underestimated in the German market.
That really did flow through in very nice margin and profit pickup with 60% growth in the EBITDA up to EUR 2.4 million or just short of 16% margin. Also on the alternative performance measure, we were above 10% margin, and that result actually more than doubling versus the prior year. Very significant. The other main markets in Diagnostic Services also traded very strongly, Romania and Ukraine. In Ukraine, we had actually significant currency pickup as well on the back of the Ukrainian currency strengthening. Overall, a strong picture across Diagnostic Services. Briefly on our Indian venture. The MaxCure hospital business that you recall, we still do not consolidate as we don't control that yet. The effective ownership now is 45.1%. We have completed the share restructuring process.
We continue with good progress, I should say, with the construction of two cancer centers, one in Hyderabad and one in Nellore, that will open sometime during the second half of this year. Revenue-wise, was about EUR 16 million in MaxCure, 18% local currency growth. Remind you again, this is a hospital group with now 11 hospitals operating. You see the most recent one, Nashik, in the state of Maharashtra on the picture there to the right. That is off to a very good start, having now operated four months or so. On the fertility side, volumes are picking up nicely. The volume of fertility treatments ranges from 220-250 a month currently, and that is more than a doubling on the same period last year.
Already now, this business in India, although it is still loss-making, as we keep on developing that quite strongly, it already makes up about 40% of our group total activity in fertility. With that introduction and overview, I hand over to Joe to talk a little bit about the specific financials.
Thank you, Fredrik. Just having a look quickly at the key financial data. We've added onto this the EBITDA margin for the segments, Healthcare and Diagnostics for your information to try and give you a little bit more insight. In terms of for the earnings per share, you can see that this is down EUR 0.046 versus EUR 0.06. A large part of that reduction, despite the very strong numbers that Fredrik has just gone through, is due to the other income we recognized in Q1 2019 in respect of revaluation of the options that we have on our Indian positions. That itself was EUR 0.025.
If you strip that out, then we've had very good growth of about 31% in terms of the EPS, which is a reflection then of the strong operating profit growth and the flow through of that to the net line. Just reiterating that's a quarter I'm happy with the results. I think Fredrik Rågmark has given a very good summary of the performance there, and I don't think you can look at it any other way than see that as very strong. We're very happy with it. This is the results of the work that we've been doing last year, the investments we've been doing, the development work we're doing. Now we've moved on in terms of the investments we're doing now.
We're looking forward to the growth of 2020, such as the dental, inpatient areas. The blood drawing points that we're putting on and working on over this year to expand the business. We brought in terms of the acquisition update, with Dr. Klein down in Bavaria, just outside Munich, consolidated that for the quarter. We paid EUR 25.3 million for this, and we'll see synergies coming through, particularly in the second half of the year, and through into 2020. In the acquisition that we announced previously in Ukraine for a lab, this is going very slowly. It's increasingly unlikely that this will happen. It doesn't really have much an impact for us. The Ukrainian underlying business is doing fantastically strongly there, and we don't think it's going to have any real impact that's going to hurt us, whether it happens or not. The Neomedic acquisition, we have approval for this.
We expect to consolidate that in mid-May. The consideration that we'll pay there will be around just north of EUR 70 million. That will be a good acquisition and fit into our Polish lineup of operations and work very well in terms of integrating with our clinical business in the south of Poland. Just moving on. We have adopted the IFRS 16 in respect of leases. We have applied a full retrospective application for that, so we had restatement release, which we did, and a separate call in respect of that. All of these numbers that you see have been fully restated for comparatives. That's why we haven't really spent any time talking about IFRS 16.
We also then did the IFRIC 23 restatement and applied the adjustment to the opening balance for the start of the year, which was a EUR 1.9 million impact in terms of retained reserves. As I mentioned earlier, in terms of the earnings per share, other income was low in this quarter compared to the prior year quarter. We had this one-off revaluation with the Indian options. There's no real large movement in respect of that for this quarter. As I said, that's about EUR 0.025 of the profit earnings per share that we had back in Q1 in the comparative quarter. Net interest cost has gone up on the back of IFRS 16. We had EUR 2.4 million net, EUR 2.7 million interest charge and EUR 0.3 million in income. Of that charge, EUR 1.5 million was related to lease charges, EUR 1.4 million last time around.
You can see that the underlying interest is EUR 1.2 million, and we had EUR 1.3 million last time around. Although we show a foreign exchange gain for the quarter, within that we have a loss of EUR 300,000 in respect of the lease revaluations during the IFRS 16 call. I mentioned that that will be a feature going forward, will be volatility in respect to foreign exchange impact of our foreign exchange denominated leases on our balance sheets, mainly in Poland and Romania, where we have euro-denominated leases, and we need to mark those to market every quarter, and that resulted in a EUR 300,000 loss for the quarter, mainly coming out of the weaker currency in Romania. Net operating cash flow, very good, EUR 28.8 million, EUR 22.7 million last time around. Happy with that. Good development in there.
The working capital was quite benign, we had then some EUR 5.1 million of tax payments. Normally it's a higher quarter in terms of tax payments, the Q1s, we settle the prior year and start to make new interim payments for the current year. We have, in terms of the tax rate, a projected 27%. We had, for the full year, an effective tax rate of 23% last year for 2018. When you strip out these revaluation incomes that were recognized in respect of India, that came up to more like about 29%. We're expecting this to come down to around about 27% this year, and that's what we're providing for currently. In terms of equity, that's grown up to just short of EUR 322 million from EUR 317 million.
That also takes account of the opening balance restatement of EUR 1.9 million for IFRIC 23 in respect of uncertainty for income taxes. Net financial debt, this has increased to EUR 243 million from EUR 218 million. If you look at the ratio on an LTM basis to EBITDA, that's gone up to 2.5x leverage level. Within that is then the increase of about EUR 15.5 million for our lease liabilities since the end of the year. Within that, about half of that increase in lease liabilities is in relation to acquisitions when we've consolidated on the balance sheet. Some EUR 6.7 million is pickup of lease liabilities which are recognized within acquisitions. The rest is then just lease extensions and some new leases. It goes up pretty quickly.
You sign a 10-year lease, you're going to end up with EUR 1 million to EUR 2 million coming on for each new lease onto the balance sheet. It moves quite quickly when we start to expand. You expect to see that number expanding as we continue to grow the business and as we continue to add new premises and we're always going to see that number of lease liability level expanding. Net financial debt, excluding lease liabilities, which is more akin to how we expressed our leverage previously before IFRS 16, and more in terms of in relation to the covenant levels that we have with our external debt. This was EUR 102 million versus EUR 93 million. That's gone up a little bit.
If you look at the ratio on an LTM basis to EBITDA, a metric which is more in line to the previous EBITDA, you see that as being 1.6x leverage, which was the same as we had at the end of the year. Our leverage in terms of that level has remained static. We have increased our debt facilities to EUR 300 million from EUR 200 million. We did that now just in the new year. The same terms as we had previously, the same lending banks. We have also now, after the quarter end, extended that maturity of that by another year, so that is through to June 2022. Just coming on to recap in terms of our financial targets. Growth, very strong there. Our organic growth, 15.4%. We are north of our targets there.
If you look on a full year basis, we have more than already achieved pretty much our full year targets, if you do it on a run rate basis. If you look at our profit, our EBITDA growth, which is similar to the previous EBITDA levels, that is 18.7% on growth. There is around about EUR 500,000 difference in terms of lease acceleration in respect of EBITDA versus how we would have reported under the old standard. Under the old standard, the EBITDA level would have been a little bit higher. On the new measure, EBITDA, that is 18.7% growth, so within our target levels. If you look at our capital level, we are on a 2.5x leverage, including lease liabilities to EBITDA. Excluding lease liabilities compared to EBITDA, we are on a 1.6x level, same as year-end. Thank you.
I hand over to-
Thank you, Joe. Now I think we are open to take any questions the audience may have.
Thank you. Ladies and gentlemen, we'll now begin the question and answer session. As a reminder, if you wish to ask a question, please press star and one on your telephone and wait for your name to be announced. If you wish to cancel your request, please press the hash key. Once again, please press star and one if you wish to ask a question. The first question is coming from the line of Caroline Elg from Danske Bank. Please go ahead.
Hi. Good morning. I have a couple of questions. The first one is on the M&A pipeline. You've made a lot of acquisitions during the year. How do you see the pipeline going forward? Will you be able to keep up the high pace?
Shall we answer them one at a time? Okay. Yes. We start with your first question. There's never going to be exactly a straight line of acquisitions happening quarter by quarter. We are certainly very busy on developing our pipeline. You should expect to see us being busy on M&A as we go forward. Clearly, the more acquisitions we have done, the more of the work also is being focused on successful integration. A lot of work is going into that. Now with the Neomedic thing closing in a few weeks. We're conscious to finding that right balance to ensure successful integration and going after additional deals. The short answer is we will remain active on M&A.
Okay, thank you. Then also a question on the MaxCure. Where are MaxCure now in terms of numbers of beds? Where is it in terms of capacity utilization?
Well, the 11 hospices, they're just short of about 2,000 beds, so 1,700, 1,800 somewhere, number of beds. Capacity utilization is a little bit tricky because you sort of need to look at an overall capacity utilization won't necessarily tell you that much because it depends on where is the particular location. But if you want to have one overall number, it probably is in the sort of 60% range somewhere, in terms of overall bed capacity utilization.
Thank you. Also because you talked about the Polish dental operations, and high growth, how large is that operation in absolute numbers?
It's about 5% of segment revenue.
Growing.
Okay, perfect. Thank you. That was all from me.
Thank you. Once again, if you wish to ask a question, please press star and one on your telephone and wait for your name to be announced. There are no further questions at this time. Please continue Sorry, we have a question again from Caroline Elg. Please go ahead.
Hi again. I just realized I forgot to ask you about the net debt in MaxCure. Where is it now?
Yeah. When we end up consolidating MaxCure, Probably going to have something like about EUR 26 million, that sort of order of money, in terms of net debt that will come on. That will mean that will probably have a small effect of pushing up our net debt, our leverage level, but it will not be anything of any significance overall.
Yeah. What's the interest rate on that debt?
Yeah, pretty high. We haven't got a pick-up for this quarter. Their net profit was pretty much around about zero. We haven't got any pick-up in terms of net profit for our participation. We're running around about somewhere between, depending on the particular loan line, anywhere between 10%, 11% and 12% in terms of debt interest cost. We will look, once we bring that on, in terms of restructuring that debt to bring that cost down. We'll work on that when we consolidate it in as a subsidiary. That's something we'll work on.
Yeah. Do you still expect to consolidate next year by mid 2019?
No, probably more like about Q4 2019 will be when we would take control of the investment. We have a shareholders agreement which stipulates that the other parties are in control at the moment, even though we have the largest shareholding block, 45.1%. We expect that will go through the 50% level, and then under the shareholders agreement, we would become the controlling party. We expect that will probably happen in Q4 this year.
starting from Q4 or during?
During Q4, yeah. We'll pick up not a full quarter in Q4, but we'll consolidate that in.
Okay. Thank you.
You're welcome.
Thank you. Once again, if you wish to ask a question, please press star and one on your telephone and wait for your name to be announced. There are no further questions at this time. Please continue.
That's it, yeah?
Yeah.
No more questions? All right. Okay. Well, we say, thank you for participating in our earnings call, and we look forward to, if not before, hear you, see you again on the phone at the end of July for our second quarter announcement. Thank you.
Ladies and gentlemen, that does conclude our conference for today. Thank you for participating. You may all disconnect. Speakers, please stand by.