LEADING THE WAY IN CUSTOMER-CENTRIC, PROACTIVE CARE · 2 An Adjusted EBITA margin 12–13% of...

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terveystalo.com #terveystalo LEADING THE WAY IN CUSTOMER-CENTRIC, PROACTIVE CARE terveystalo.com #terveystalo CEO Ville Iho CFO Ilkka Laurila

Transcript of LEADING THE WAY IN CUSTOMER-CENTRIC, PROACTIVE CARE · 2 An Adjusted EBITA margin 12–13% of...

Page 1: LEADING THE WAY IN CUSTOMER-CENTRIC, PROACTIVE CARE · 2 An Adjusted EBITA margin 12–13% of revenue in the medium- to long-term. 3 Indebtedness may temporarily exceed the target

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LEADING THE WAY IN CUSTOMER-CENTRIC,

PROACTIVE CARE

terveystalo.com #terveystalo

CEO Ville Iho CFO Ilkka Laurila

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Agenda

• Terveystalo in brief 1

• Terveystalo as an investment 2

• Q&A 3 2

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We are the leading private healthcare service provider in Finland

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Our growth strategy

4

1 Growth in the long term through a combination of organic growth and bolt-on acquisitions. 2 An Adjusted EBITA margin 12–13% of revenue in the medium- to long-term. 3 Indebtedness may temporarily exceed the target level, for example, in conjunction with acquisitions. 4 Taking Terveystalo’s long-term development potential and financial position into account.

Experienced Quality

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5 REASONS TO INVEST IN TERVEYSTALO

MEGATRENDS ACCELERATE STRUCTURAL

MARKET GROWTH

CUSTOMIZED SERVICES FOR

DIFFERENT CUSTOMER

GROUPS ENABLE GROWTH IN EVOLVING MARKETS

COMPETITIVE ADVANTAGE FROM SCALE

OPPORTUNITIES TO ACCELERATE

GROWTH THROUGH

ACQUISITIONS

COMPANY CULTURE THAT

ATTRACTS HEALTHCARE

PROFESSIONALS

1 2 3 4 5

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6

Finland's deteriorating dependency ratio requires more efficient use of resources

Age dependency ratio on the rise

Example: Diabetics per 1,000 people (2014)(3)

Rising Prevalence of

Lifestyle Diseases

88,2 83,6 83,5 56,8 52,5 49,9

Fin Ger UK Swe Den Nor

World’s 2nd

Fastest Aging Population

54

56

58

60

62

64

66

68

70

72

2040 2020 2014 2030

Age dependency ratio Number of children and citizens aged +65 years in relation to 100 working age citizens

1970 1980 1990 2000 2010 2020 2030 2040

3,0

1,0 1,5

3,5

2,0

4,0

2,5

Population aged under 15 and 65 and over Population aged 15-64

Mill.

1

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Private provision market is an established and growing component of the Finnish market

…Supported by a number of factors

7

Private provision is an established, critical and growing component of Finnish healthcare

40% of all primary care outpatient visits in Finland are provided

by private sector(1)

Used across all income classes(2)

Long Tradition of Private Provision

of Healthcare

Four robust and growing payor groups

Corporate Private Insurance

Out of Pocket Public

Well Established Payor Mix

~50% waited over a week for public primary healthcare service in

Helsinki(3) vs

Immediate access in private healthcare

Capacity Pressures on

Public Provision

Source: NHG Report; 1) Source: KELA and Statistics Finland (2014); 2) Source: KELA; 3) Waiting times in public primary healthcare services in Helsinki (March, 2017); Source: THL

1

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Example: Annual Disability Contribution of a Company with € 60 Million Payroll

Occupational health = population health management

8

Occupational healthcare linked to statutory pension system - provides employers with strong incentives to invest in preventive care

2

Note: An employer is categorised as a large employer in 2017 when the payroll for 2015 was at least € 2,044,500 1) Source: Ilmarinen (Large Employer’s TyEL contribution 2017); 2) Employer’s TyEL contribution i.e. earnings-related pension contribution and work capacity are interlinked and depending on the total payroll of an employer and disability risk

2 970

2 430

1 890

1 485 1 215

945 729

540 351

189 54

5,0% 4,1%

3,2% 2,5%

2,0% 1,6%

1,2% 0,9% 0,6% 0,3% 0,1% 0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

0

500

1 000

1 500

2 000

2 500

3 000

3 500

11 10 9 8 7 6 5 4 3 2 1Contribution category

Contribution '000 €/year (LHS) Contribution, % of payroll (RHS)

Material savings in disability pension cost

by managing work capacity well and moving to lower contribution

category

Emphasis On Measurable

Quality

Cost Efficiency is Critical

Health & Safety

Preventive care

Primary healthcare

Secondary healthcare

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Private customers

Public Sector customers

Corporate customers

Channels Drive Large Customer Flows…

…To Whom Additional Services are Provided …To Become Loyal Terveystalo Customers…

Convenience Quality

Speed Digital

Service Network

~700,000 Individual Customers(1)

~350,000 end users (1)

~1,200,000 Annual Visits(2)

Family Packages

Retiring OH Customers

Dental

Preventive care

wellbeing

9

1) Number of end-users as of Dec 31, 2018 excluding Attendo Health care; 2) Terveystalo 2018 visits

Scale and diversified payor groups provide a large customer base for cross-selling 2

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Our service offering for public sector – tailored according to customer needs

26/02/2020 10

2

Specialty care outsourcing

Public facilities

Examples

• Comprehensive, customized long-term outsourcing of secondary care services

Public sector occupational health

Own / Public facilities

Examples

• Service agreements, or outsourcing of public occupational healthcare units

Kirkkonummi Pori

Ylöjärvi

Outsourcing

Public facilities

Examples

• Provision of all of municipalities’ healthcare and/or social care services

Staffing

Public facilities

Examples

• Personnel service

• Mainly doctors and dentists

• Growth area nurses

Almost all Finnish municipalities

Service Sales

Own facilities

Examples

• Fee for service, including: appointments, diagnostics, imaging and hospital services customized for customers

Generalist/specialist appointments

Screenings Imaging

Rantasalmi Kouvola Puolanka

Varkaus Iisalmi Eksote

Expertise Resources

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New solutions complement the traditional care chain and enable faster growth

11

Customer groups

’System layer’ to optimize customer flows

Corporate

Private

Public

Physician appointments

Laboratory

Imaging

Surgery

Optimize who, what and when

What does the customer need and how acute is their need?

Which professionals offer relevant services for the care need?

Who pays? Does the contract cover it?

Which available time TTALO wants to offer for the customer?

Other professionals

Directly to psychotherapy

Directly to Labs

Traditional value creation model

2

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Extensive nationwide network offers scale benefits

12

Operating costs & Adjusted EBITDA before IFRS 16 impact, Mill. Eur.

Variable costs

Semi-fixed costs

Fixed costs 109 136 98 74

197 314

351

473

2019 2018 Other operating expenses Materials and services

Employee benefit expenses Adjusted Adjusted EBITDA

3

+25.3%

-24%

+59.5%

+34.6%

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Funnel Approach to

Target Selection

Accelerating growth and creating value through M&A

There are still opportunities for acquisitions in the market

13

Projected cost synergies

exceeded by 20%

in healthcare acquisitions(1)

Target Categories Healthcare Centers Bolt-ons /

dental, well-being Care Chains, Adjacencies

Fragmented

market Several

potential acquisition targets ~200

Acquisitions

1) Comparing budgeted expected cost synergies with realized cost synergies for all healthcare acquisitions between Jan 2015-Mar 2017 (excluding Diacor and Porin LT) and the four largest acquisitions between 2011 and 2014 (excluding dental); 2) Median LTM acquisition multiples for all healthcare acquisitions between Jan 2015-Mar 2017 and the four largest acquisitions between 2011 and 2014 (excluding dental)

Consistently Over-Delivered on Synergies Resulting in Significant Value Creation

Cost synergies significantly reduce pre-synergy acquisition multiples(2)

~11x ~5x

EBITDA EBITDA

Strong Track-Record in M&A Execution

4

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Satisfied customers and professionals

NPS 73% Appointments

NPS 89% Hospital services

88% of employees are satisfied with Terveystalo as a place of work

The most desired employer

5

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© Terveystalo 26.2.2020 15

Corporate responsibility is one of our strategic focus areas

• The interest rate margin of our EUR 410 million financing agreement takes into account how we meet our targets for customer satisfaction, employee job satisfaction and wellbeing, and reduction in mixed waste: KPI Target in 2020 2019 act

NPS, appointments 74 72.5

eNPS 14 9

Mixed waste intensity (mixed waste [metric tons] relative to total revenue [100 million])

7.40 4.85

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Terveystalo has an integrated platform with multiple avenues for growth

16

Extensive Network

Large Loyal Customer Base

Customer Oriented Strategy

Preferred Employer

A Frontrunner in Digital Offering

Quality and Brand

Market Growth and Capturing Share

Continued M&A in a Fragmented Market

Aim to Increase Revenue per Customer

• Proven track record of sourcing, integration

and synergy realisation

• Strong structural demand drivers

• Increasing share of private-provision

• Expanding addressable market due to technology

• Loyal customer base with frequent interaction

• Preventive care

• Expanding services to family members

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Market outlook

• The market environment remains favorable in spite of weakened consumer confidence.

• Corporate customers keep up a steady demand. Price competition is intensifying in certain customer groups in occupational health. At the same time, the relative share of preventive services is increasing, which is a trend that will be further strengthened by the change in legislation concerning Kela reimbursements at the beginning of 2020.

• Private customer demand also remains strong, and the trend of comprehensive well-being is creating broad growth in service demand. This is particularly reflected in growth in the demand for services other than physician appointments.

• Public sector demand remains strong in various service categories.

26.2.2020 17

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FINANCIAL PERFORMANCE

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2019- A year of financial and operational excellence

2/26/2020 19

0

5

10

15

20

25

30

0100200300400500600700800900

1 0001 100

744.7

10.0

2015

10.4

2016

10.6 11.8

2017 2018

11.2

2019

1 030.7

505.6 547.0

689.5

+103.9%

Revenue, Mill.EUR Adjusted EBITA, % of revenue

01234

2018 2019

3.5 3.7 +6%

*Phycisian appointments, mill.

020406080

2017 2018 2019

66.9 70.9 72.4 +5.5

NPS, appointments

0

5

10

15

6.0

2017 4.3

4.4 4.9

2018

8.7

5.1

2019

8.7 10.9

13.8 37%

Employees, k. Private practitioners, k.

94

150

0

50

100

150

2019 2018

+60%

Remote appointments, k.

*Number visits do not include public outsourcings, dental or Rela.

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Operations

Increased scale, improvement in key corporate responsibility areas

20

3,9 3,7

2018 2019

-6,4%

Sickness absence, %

26 25

2018 2019

-4%

Accident occurrence

rate

1,2

2018

1,2

2019

0,0%

2019

3,5

2018

3,7

+5,7%

Units

270 299

2018 2019

+10.7%

*Customers, mill.

*Visits to a physician, mill.

5,9 6,2

2018 2019

+5%

*Visits, mill.

13,8 10,9

2018 2019

+26%

94 150

2019 2018

+60%

Remote appointments, k.

People working at TTALO, k.

People Environment

58 50

2019 2018

-14%

Mixed waste, tonnes

74%

10% 15%

Scope 1, transport

Scope 3, waste Scope 3, work related travel Scope 2, electricity

CO2 footprint

Tax footprint, mill.

94 149

2018 2019

+59.3%

163 261

2019 2018

+60%

Salaries and fees, mill.

Economic

*Number of customers, and visits do not include public outsourcings, dental or Rela. Same boundary applies for people and environment KPIs

Accident occurrence refers to the ratio of accidents to hours worked. The ratio is calculated per million working hours. The national average is 39

2,643.9 tCO2

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Q4 HIGHLIGHTS

Broad scale growth across all customer groups

New processes and digital solutions improved access to care

Profitability (EBITA margin) remained at a strong level

Strong cash flow from operating activities, investments in digitalisation continued to grow

A dividend of EUR 0.26 (0.13 + 0.13) per share proposed

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Strong growth in all customer groups

• In corporate customer group, strong growth continued in preventive occupational health services and well-being services. Mental well-being services and digital services increased significantly. Slight increase in illness-related appointments.

• Private customer group saw strong, broad based growth. In addition to well-being and digital services, the sales of diagnostics and surgical services grew as well.

• Public customer revenue more than tripled; In addition to the acquisition of Attendo Health Services, occupational health services grew significantly.

• There were 62 business days in October–December, same as in the reference period (62).

Q4 Revenue by payor group, M€

22

Q4: Strong organic growth and Attendo deal increased revenue significantly

109 116

67 79 22

24

51

0

50

100

150

200

250

300

0

Q4 2018 Q4 2019

198

270 +37%

Corporate Private

Public excl. Attendo Public, Attendo share

+11.5 % +18.4 %

+5.8 %

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Q4: Strong profitability

• Adjusted EBITA before IFRS 16 impact EUR 31.9 million (27.1)

• Adjusted EBITA % before IFRS 16 impact 11.8 % of revenue (13.7 %)

• Profit for the period EUR 16.1 million (10.1)

• The Board of Directors proposes that a dividend of EUR 0.13 per share be distributed and that the Board be authorized to resolve on the payment of additional EUR 0.13 dividend in the Autumn 2020, EUR 0.26 (0.20) per share in total.

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Revenue, Adjusted EBITDA*, % Before IFRS 16 impact (comparable)

Adjusted EBITA*, M€ and % Before IFRS 16 impact (comparable)

26.2.2020 24

Strong profitability despite the Attendo deal and increased investments in digitalization and IT

0

5

10

15

20

25

30

0

50

100

150

200

250

300

Q2 2019

Q2 2018

Q1 2018

11.2 13.5

Q3 2017

15.3

258.6

Q4 2017

15.6

Q4 2019

12.5

Q3 2018

16.4

Q4 2018

14.2

Q1 2019

234.0

11.9 12.8

Q3 2019

13.9 155.4

189.9 197.5 189.0

160.3

197.9

267.8 270.3

Revenue Adjusted EBITDA

0

5

10

15

20

25

30

0

5

10

15

20

25

30

3531.9

13.0

Q4 2019

Q3 2019

8.0

13.7

Q3 2017

Q2 2018

12.6

Q4 2017

9.9 10.7

Q1 2018

9.2

Q3 2018

Q4 2018

12.0

Q1 2019

Q2 2019

10.2

25.6

11.8 12.4

23.9

20.2

24.0

14.8

27.1

32.1

25.5

Adjusted EBITA, M€ Adjusted EBITA, %

* Alternative performance measure

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M€ 10-12/2019 10-12/2018 Change, % 2019 2018 Change, %

Revenue 270.3 197.9 36.6 1,030.7 744.7 38.4

Other operating income 0.8 0.7 15.1 2.1 18.2 -88.4

Materials and services -122.7 -93.5 31.2 -472.9 -351.3 34.6

Employee benefit expenses -81.8 -50.9 60.8 -314.3 -197.1 59.5

Other operating expenses -15.6 -16.6 -6.0 -58.4 -52.6 11.0

Rents, leases and premises * -4.0 -10.9 -63.0 -16.0 -45.3 -64.7

EBITDA, comparable 46.8 26.6 76.2 171.2 116.6 46.9

Adjustments (** 1.0 5.9 5.1 -7.7 Adjusted EBITDA, comparable 47.8 32.5 47.1 176.3 108.9 62.0

EBIT 23.8 16.1 47.9 81.4 75.4 7.9

Operating leverage still applies, the scale has changed post Attendo

Group P&L

* The presented number is not comparable, because the rent expenses have decreased by 39.9 million euro during 1-12/2019 and 10.2 million euro during 10-12/2019 due to implementation of IFRS 16. ** Adjustments are material items outside the ordinary course of business and these relate to acquisition related expenses, restructuring related expenses, gain /losses on sale of assets (net), strategic projects including the IPO and other items affecting comparability.

Variable costs Fixed costs, scalable on a group level Semi-fixed costs, scalable on a unit level

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M€ 31.12.2019 31.12.2018

ASSETS

Property, plant and equipment 86.3 83.6 Right of use assets 176.4 - Goodwill 779.2 768.7 Other intangible assets 161.9 167.7 Other assets 114.9 105.4 Cash and cash equivalents 40.6 36.9 TOTAL ASSETS 1 359.3 1 162.3 EQUITY AND LIABILITIES TOTAL EQUITY 541.2 511.8 Interest bearing liabilities 588.8 450.1 Other liabilities 229.2 200.4 TOTAL LIABILITIES 818.0 650.5 TOTAL EQUITY AND LIABILITIES 1 359.3 1 162.3

The impact of Attendo deal and the adoption of IFRS 16 is reflected in the balance sheet

• Total assets of the Group amounted to EUR 1,359.3 (1,162.3) million. The growth was mainly attributable to the adoption of IFRS 16.

• Equity attributable to owners of the parent company totaled EUR 541.2 (511.7) million. The growth was mainly due to improved profitability.

• Adjusted net debt before IFRS 16 impact (comparable), amounted to EUR 369.5 (413.3) million. The effect of IFRS 16 on lease-related interest-bearing debt was EUR 178.7 million.

• Adjusted net debt/adjusted EBITDA before IFRS 16 impact was 2.7 (3.8). Adjusted net debt/adjusted EBITDA was 3.1, well below the updated financial target of 3.5.

26.2.2020 26

IFRS 16 impact

176.4 M€

IFRS 16 impact

178.7 M€

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Net debt/adjusted EBITDA (last 12 months)

Operational efficiency is reflected in the negative net working capital

26.2.2020 27

Deleveraging the balance sheet continues, indebtedness well below the target

Q3 2019 before

IFRS 16 impact

Q2 2019 before

IFRS 16 impact

Q1 2018

Q2 2018

Q4 2018

Q3 2018

Q1 2019 before

IFRS 16 impact

Q4 2019 before

IFRS 16 impact

3.8

2.5 2.1 2.0

3.3 3.2 3.0 2.7 82 72 73 90 110 101 101 102

-119 -115 -111

-51 -58 -70 -59 -58

-200

-150

-100

-50

0

50

100

150

Q1 2018

-32

Q3 2018

-166

5 6

-38

Q2 2018

5

-33

6

-147

Q2 2019

Q4 2018

6

-174

Q1 2019

6

-176

6

Q3 2019

6

-165

Q4 2019

Inventories Net working capital Trade and other receivables Trade and other payables

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Gross capex, M€ and %- of revenue Net capex, M€ and %- of revenue

26.2.2020 28

The share of intangible investments continue to grow (excluding M&A)

5 5 3 4 5 5 7

17 15 15 15 18 19 19

7 8 10 10

14 16 18

05

1015202530354045

4.0

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5

4.5

1 Q2.2019

LTM

1 Q3.2019

LTM

1 Q4.2019

LTM

31 29 30 31

41

45

4.0

Q4.2018 LTM

4.3

38

Q3.2018 LTM

1 2 Q2.2018

LTM

2

4.3

1 Q1.2019

LTM

3.9 3.7

4.3 4.3

% of revenue Intangible assets Machinery and equipment Improvement to premises

Other

16 16 18 20 24 28 33

14 11 10 10

14 12

11

05

1015202530354045

2.0

4.5

0.0 0.5 1.0 1.5

2.5 3.0 3.5 4.0

Q3.2019 LTM

Q1.2019 LTM

4.3

Q2.2018 LTM

Q3.2018 LTM

Q4.2018 LTM

Q2.2019 LTM

Q4.2019 LTM

29 27 28

30

38 41

44

4.0 3.7 3.6 3.7

4.3 4.2

Non Cash Capex Net Cash Capex

% of revenue

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Key figures

26.2.2020 30

* Adjustments are material items outside the ordinary course of business, associated with acquisition-related expenses, restructuring-related expenses, gain on sale of assets, strategic projects, and other items affecting comparability. 1) Alternative performance measure. Additional information is provided in notes 13 and 14. 2) Not comparable because of the adoption of IFRS 16. The adoption of IFRS 16 had a significant effect on adjusted EBITDA, which increased by EUR 10.2 million in October–December and by EUR 39.9 million in January–December. The impact of IFRS 16 on earnings before interest, taxes, and amortization (EBITA) was not material. Operating cash flow increased due to the impact of IFRS 16 by EUR 39.9 million in January–December. In addition, the adoption of IFRS 16 increased interest-bearing lease liabilities by EUR 178.7 million. 3) The net profit of the January–December reference period was improved by a non-recurring deferred tax asset of EUR 13.0 million related to confirmed losses and non-recurring capital gains, totaling EUR 15.9 million.

EUR million 10-12/2019 10-12/2018 change, % 2019 2018 change, % Revenue 270.3 197.9 36.6 1,030.7 744.7 38.4 Adjusted (EBITDA) * 1) 2) 47.8 32.5 47.1 176.3 108.9 62.0 Adjusted (EBITDA), % * 1) 2) 17.7 16.4 - 17.1 14.6 - EBITDA 1) 2) 46.8 26.6 76.2 171.2 116.6 46.9 EBITDA, % 1) 2) 17.3 13.4 - 16.6 15.7 - Adjusted earnings before interest, taxes and amortization (EBITA) * 1) 2) 32.3 27.1 19.2 115.1 87.7 31.2 Adjusted earnings before interest, taxes and amortization (EBITA), % * 1) 2) 12.0 13.7 - 11.2 11.8 - EBIT 2) 23.8 16.1 47.9 81.4 75.4 7.9 Net profit 2) 3) 16.1 10.1 59.6 54.1 68.7 -21.3 Net debt 2) - - - 548.2 413.3 32.7 Net debt/Adjusted EBITDA (last 12 months) * 1) 2) - - - 3.1 3.8 - Return on equity (ROE), % 1) 2)3) - - - 10.3 14.2 - Equity ration, % 1) 2) - - - 39.9 44.1 - Gearing, % 1) 2) - - - 101.3 80.8 - Earnings per share (€) 2) 3) 0.13 0.08 - 0.43 0.54 - Operating cash flow 2) 49.5 38.6 28.2 173.6 100.6 72.5 Personnel (end of period) - - - 8,685 6,018 44.3 Private practitioners (end of period) - - - 5,068 4,877 3.9 Number of working day 62 62 251 251

Before IFRS 16 impact (comparable), EUR million 10-12/2019 10-12/2018 change, % 2019 2018 change, % Adjusted EBITDA * 1) 37.6 32.5 15.6 136.4 108.9 25.3 Adjusted EBITDA, % * 1) 13.9 16.4 - 13.2 14.6 - Adjusted EBITA * 1) 31.9 27.1 17.5 113.4 87.7 29.3 Adjusted EBITA, % * 1) 11.8 13.7 - 11.0 11.8 - Adjusted net debt * 1) - - - 369.5 413.3 -10.6 Net debt/adjusted EBITDA (last 12 months) * 1) - - - 2.7 3.8 -