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Edited Transcript of MCOVb.ST earnings conference call or presentation 14-Feb-20 8:30am GMT

Full Year 2019 Medicover AB Earnings Call

STOCKHOLM Feb 14, 2020 (Thomson StreetEvents) -- Edited Transcript of Medicover AB earnings conference call or presentation Friday, February 14, 2020 at 8:30:00am GMT

TEXT version of Transcript

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Corporate Participants

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* Fredrik Rågmark

Medicover AB (publ) - CEO & Director

* Joe Ryan

Medicover AB (publ) - CFO

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Conference Call Participants

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* Carolina Elvind

Danske Bank Markets Equity Research - Analyst

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Presentation

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Operator [1]

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Good morning, ladies and gentlemen, and thank you for standing by. Welcome to the fourth quarter 2019 results presentation call. (Operator Instructions) I must advise you that this conference is being recorded today.

And I would now like to hand the conference over to your first speaker, Mr. Fredrik Rågmark. Thank you. Please go ahead.

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Fredrik Rågmark, Medicover AB (publ) - CEO & Director [2]

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So good morning, everyone, and welcome to our quarter 4 and full year 2019 reporting. We are very happy, proud and pleased with how the quarter and the year came out. We've had a year with a very good organic growth, complemented with good acquisition growth. For the year, 25.7% growth and 14.8% organic. So very, very good. We have also been able to keep expanding our margins with EBITDA for the year up 33% and 113 -- sorry, 78 basis points margin expansion for the year. So that's confirming the trend that we have reported for a number of quarters.

Likewise, when you look at net profit, and we then exclude the other income line to look at what the underlying operations are doing, were up a strong 51%, 52% for the year. So all profit measures are indicating the trends that we have reported throughout the year. So overall, very happy, proud and pleased with how we've been able to deliver both over the full year and also for the last quarter of the year.

Medicover is, as you know, and I keep repeating that every time we talk and present, it is an organic growth business. We have grown organically ever since we started. And organic growth, despite us being much larger, now it's even ticking up percentage-wise. If we look at the total annualized growth rate at -- on the final quarter of the year, it's EUR 194 million. So you can see we're growing at a rate which is equivalent to 40% of the entire group when we listed less than 3 years ago. So I think that very well illustrates that fact. And 56% of this growth was organic, some EUR 109 million. So we're running at a rate of plus EUR 100 million of annual organic growth, which is indeed very, very strong. We have favorable market conditions on all our major markets. The economies continues to be strong. Although, particularly in Poland, as we have talked about, unemployment is almost, if not 0, so very, very low, and that has a knock-on implication short, midterm on the GDP growth in Poland. But overall, in our main markets, we see very strong fundamentals.

We acquired Neomedic during the year as our largest acquisition since we listed, and integration of that business has gone very well. The last month of the year, we consolidated in what we now call Medicover Hospitals India, the previous Max Care Group -- MaxCure Group and we will speak a little bit more about that. Very importantly, we said what I think was quite ambitious financial targets 3 years ago in February 2017, ahead of the IPO. Now we have come out that 3-year period ahead of the financial targets that we set, which I think is very strong, particularly sometimes memory short. So one shouldn't forget that we had some hiccups in 2018, driven by the German side of our business. So to be able to catch up that 2018 shortfall and come out above our targets, I think, is also a very strong position to be in. That is then knocking on to the new financial targets that we are now communicating. I'll come back to that later on in this call. But fundamentally, we say, we expect that we will keep growing very robustly organically. We will keep expanding our margins and we have a strong balance sheet, which will allow us to keep being active on the M&A front. So I think those are all very strong messages.

I want to draw your attention to the 2 pie charts to the right, I remind you, I think, in every call of the importance and the strength in our business of diversification. On the left hand, you see the payer groups, where the original integrated funded model, where we have our employer paid business, you see that is growing 12%. Our publicly funded business, the upper right-hand slice, is growing 38%. That is mainly point out acquisition-driven growth on the back of the Neomedic acquisition that has quite significantly public money in it. And the big slice to the left, which is then 52% by now of the total group revenue being a private fee-for-service out-of-pocket payments growing 30%. So 30% for the year, indeed, very strong. Most importantly with that pie chart, is I think that is a healthy balance between the 3 types of payers, and if anything, the fee-for-service slice will continue to grow a little bit relatively to the others.

And then to the right hand, you have our geographic split with Poland still being by far, the largest geography, you see 26% up as a geography; Germany, significantly up 20% as a geography; Romania, up 27%; and Ukraine partly on the back of a very strong currency situation, but you see expanding 39%. So indeed, across the board, very strong numbers, but importantly, I keep reiterating that message, the strength of diversification in our revenue and earnings stream.

If we then go to quarter 4, again, strong revenue growth, with organic up 15%. Total growth just short of 27%. Likewise, EBITDA, strong growth, expanding by 113 basis points up to 14.5%. So just reconfirming the trends that we have reported throughout the year 2019. Net profit, likewise, again, we exclude other income as we had so much exceptional income in the comparable period. So looking at net profit, excluding other income, up more than 90%, so almost doubling versus the prior year period. And again, fee-for-service that I just talked about on a full year basis was up even 31% in the final quarter of the year. So overall, a very strong growth picture, very strong margin expansion. So we're in a good position.

If I then turn over to Healthcare Services, again, strong growth, almost wherever we look, we have strong underlying growth, particularly in Healthcare Services, up 27.8% for the final quarter. Up 29.8% for the full year, so indeed, strong numbers. EBITDA grew 133% up for Healthcare Services in the final quarter. Good margin expansion, and likewise, for the full year grew well with 33%, so reaching EUR 61 million EBITDA to Healthcare Services for the year versus just short of 46% the prior year. So again, you see with growth and operating efficiency and scale effects, margins are creeping up, and then that makes quite a big impact on the absolute profit growth.

Fee-for-service, as we talk about on every call here is a very important piece of the strategy here. You recall that in this division, historically, our prepaid funded model was very dominating. It is still very significant, but as we have embarked on our ambitious fee-for-service strategy and have been quite active and will remain quite active on acquiring attractive fee-for-service businesses, where we can find them at reasonable prices. That helps to push the proportion of fee-for-service up in this division, which is good and positive.

The growth in our funded business, the member growth is ticking down a little bit, as we have mentioned over the past couple of quarters, partly driven by us being a bit more disciplined or actually more disciplined on pricing, so where we can't agree with the customers on price adjustments. We separate, but also partly driven by the Polish economy softening a little bit on the back of really full employment, pretty much throughout the economy. So we're still growing nicely, but the member growth is coming down a little bit from the heights we have seen over the past few years. Overall, as mentioned, it is really a scale effect and operating efficiencies that is pushing improved margins, improved profits throughout the business in this division. So all very good.

If I then switch over to Diagnostic Services, and you recall, we have grown a bit slower in Diagnostic Service for some time. So it's even -- it's really nice to see and be able to report a much stronger growth coming back in diagnostic services. So 25.2% for the quarter. That's really, really strong, which just short of 17% being organic, which are really good numbers. Full year growth north of 21% and organic out of that 13.6%. So I think that's a strong sign that we are growing very strongly in Diagnostic Services. In Germany, which is our largest and most mature market, but of course, even stronger in the economist in the east.

Also, we have talked about that in several calls that the Ukraine business has done phenomenally well, and that has continued also in the final quarter of the year. That has, of course, resulted in a good EBITDA growth, EBITDA contribution. So that was up 25% for the final quarter of the year and up by 29% for the full year with good margin expansion when we look on the full year basis.

In Diagnostic Services, as you recall, fee-for-service has always been a larger proportion of overall divisional revenue on the back of most of our business outside Germany being all fee-for-service. So you see 68% of divisional revenue being a fee-for-service here, and that is up a super strong at 31%. And the laboratory tests, so the underlying test numbers grew just north of 8%, and customer demand really is strong across the board here. So really, really a strong picture across the board where we look. We continue to open BDPs. So a total of 46 new ones opened during the quarter, net. So at 670 BDPs operating across the region by the end of the year. And you remember that we keep reiterating that the BDP distribution network is a significant part of the growth drivers here. So the more distribution we can put on, the more our revenue will grow over time. So that's really an important KPI to follow.

And likewise, here just wanted to put your attention to the 2 pie charts to the bottom right. There were the 2 shades are public money and private money, and you see public money, which is growing a strong 14%. So it is not that we are not growing in the publicly funded segments. So 14% is not a bad number, certainly not. But of course, 31% in the private pay segment, which is, the vast majority here is a number that stands out. And to the right, you see how our geographies are going, and they've been growing. And you see perhaps the number. I commented on that last quarter as well. Many of you probably will find it quite surprising to see our German business, growing 22%, which is an outstanding number, I should say. It's quite remarkable to see such growth coming out of that particular country. And perhaps the other number to comment on is, you see 52% coming out of our Ukraine business again, which is a very strong underlying growth, one can't put it any other way than that.

So overall, the final quarter of the year was really good. The full year was really good. And I think we're in a position, when I come back after Joe's section to talk about our new financial targets to keep growing from the position we're in.

So I hand over to Joe to talk of our Medicover Hospitals business in India and then the financial section.

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Joe Ryan, Medicover AB (publ) - CFO [3]

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Thank you, Fredrik. So we -- Medicover Hospitals India, we took controlling stake in December, beginning in December. So we moved from our previous 49.2% position to a controlling stake of 54.4%, a mixture of primary shares and secondary shares. So we have consolidated the company for 1 month for December. And obviously, we'll have the full year now for 2020.

Now the total cash that we've invested into the business since we got involved in 2017, is EUR 35.6 million. And on top of that, we have also advanced another set of financing loans of EUR 7.9 million, which have a convertible feature to be able to convert to ordinary equity. So if we look at that EUR 35.6 million, EUR 22.7 million of that is -- was as primary new capital in the company, so that's money that's got into the company to finance its operations and expansion and increase the value of the business, and 12.9 million were secondary shares that we bought from existing shareholders. So almost -- over 2/3 of the money has been into -- actually injected into the company itself. So that obviously very supportive for the development of the company. On the convertible shares that would probably -- if we converted all of those or when we expect to convert them, they'll probably bring it around to a diluted ownership basis of something like around the 58% for our stake. Revenue was EUR 5.9 million in the fourth quarter numbers. We recognized and we had 11 month share of our loss as an associate of EUR 2 million for the 11 months of the year, which we accounted for. And the company is in a loss position, expanding facilities, adding new locations on. The interest costs are quite high. And then we also did a rebranding exercise for the -- pretty much almost all of the locations, not quite all of them, but the majority of them in India and changed the name from MaxCure into Medicover Hospitals. So I mean, you see some photographs there in terms of where we've been spending that money. And that was all expensed through the P&L account. So increasing the loss for the business. When we consolidated, we brought on EUR 23.5 million of external third-party debt. Our average cost is around about 11.5% for that -- cash cost is about 11.5% for that debt. We will refinance that now in this first quarter, and we'll refinance that essentially from the group at considerably lower financing rates, which will be positive for the results. And it effectively means because we'll be financing that and taking that onto the group balance sheet that would effectively have a bigger pickup of the net profits of the company because we'll have the interest charges, which will be coming through to the group charge through to the minority.

If I flip over and have a look then at some of the key financial data just to Fredrik's talked quite extensively about the numbers, the strong revenue growth, but really, very happy to see there really strong growth and strong across both divisions, both at the organic level and then with the inorganic growth, pushing that up even further. And the EBITDA number, we -- which is quite important as we have those acquisitions coming in now, and we amortized quite a bit of the intangibles that we recognize when we do the accounting for that. And that number is up in all areas very strongly. So if I look at the year as a whole the adjusted EBITDA number is up 44%. If I look at the Healthcare Services side, that is up 43%, and the margin expands about 0.5 percentage point. And if I look at the Diagnostic Services side, that is up some 34% and 1% margin expansion as well on that. So you can see that the business is generating improved profit performance on that additional revenue growth.

I come over and just add a little few little bits in terms of -- on the accounting for the Medicover Hospitals India acquisition, this is a step acquisition. So we bought this in stages since 2017, exercising the options we have, and the cash cost is some EUR 35 million --- sort of EUR 35 million cash cost for us. Part of that exercise is then we need to do a fair value exercise for the 49.2% that we owned just before we took control, and we've done that using a discounted cash model. We done that on a very conservative basis in terms of the growth projections. We didn't want to inflate that valuation in any way. So we wanted that to be on a conservative basis. And that generates effectively a noncash loss of EUR 5.8 million when we booked that through.

So on here, I've broken out some slides here on the top left-hand side, you have 1 in terms of where the allocation, in terms of the movements on this, and the historical investment cost. On the top right-hand side, we have the P&L impact in terms of how that impacts us in the year for the P&L impact. And then on the bottom right-hand side, how that impacts us for the equity side. And one important factor in terms of the equity side, I'm sure some people will be interested in terms of analyzing that, is that we have a put option from part of the minority shareholders, where they can put the shares back to the group. And we have to recognize that as a future liquidity liability. So we recognize that on the balance sheet at EUR 21.7 million as a future liquidity obligation. So that then reduces the net impact of the consolidation onto our equity.

I've talked about the conversion rates. Estimate that will be up to around about 58%, if -- when we were to exercise those. And we also had quite significant impact on the P&L account through renegotiation and lapse a part of the adviser liability we had earlier recognized.

I go over then in terms of talking a little bit about the financials, strong growth. Underlying operating performance has been great. So EUR 46.5 million net operating profit for the year, margin of 5.5%, so an increase of about 0.5 percentage point for the year versus the prior year, and we're well set up now for our growth into 2020. So you'll see in terms of our guidance that we come on to, which Fredrik will talk about shortly in terms of that, that we're giving a very strong guidance and targets for the next 3 years.

If we look at in terms of the inorganic side, we took control of -- in the year of the remaining part of OK Systems, the sports benefit employer paid package business in Poland, and we're also now investing in expanding our own gym network to support that business and also investing and supporting networks of gyms as well to expand their facilities so we can grow that business dynamically. Dental has been very strong. We talk about the fee-for-service growth, and you saw that with Fredrik earlier on in terms of the private paid part of the business with out-of-pocket payments. So we've acquired now 8 dental businesses in -- since we did the IPO, plus new centers that we put on. 5 of the acquisitions were in 2019 and 3 of them in Q4. We have now some 187 dental chairs at the end of the year. And we've also been expanding our own controlled, our own greenfield dental clinics as well, and we invested some EUR 3.7 million in growth CapEx in the year. It's growing. It's a very interesting business area. There's lots of growth space for us. There's a lot of consolidation opportunities within the market. So we've invested some EUR 20 million -- just short of EUR 21 million since the IPO, both in acquisitions and then in growth CapEx, and revenue now for 2019 was just over EUR 27 million and growing strongly.

Neomedic, very happy with that. We -- investment of $69 million in cash and assumed debt. Integration has gone well, performing very well on target. So very happy with that. And we've also now invested in expanding the facilities there to expand the bed capacity, seeing that some of the facilities effectively running at full capacity, and that should help us through into 2020.

The Munich-based genetics laboratory we acquired at the beginning of the year, are happy with that. We paid out EUR 25 million for this synergies. We're seeing those coming through. We're very happy with the development on that. So that's definitely working and I'm very happy. And it also means that with this polemic around the coronavirus, their genetic expertise were set up in terms of being able to provide analysis to our clients, if that was to come through to Europe in any big way.

Then we look at on the next slide, continuing in terms of some of the other aspects of the financials. The net interest cost EUR 3.4 million for the quarter, 11.9% for the full year. And within that EUR 3.4 million, EUR 2.1 million related to a lease liability obligation. So our net excluding that, cost of financing was EUR 1.3 million. If I look at the debt, we have at the end of the quarter, some EUR 240 million. That effectively comes out to just over 2% in terms of our cost of funding. So quite a nice situation for us on the back of our restructuring of our debt during the year. Cash flows from 28 -- just over $28 million for the quarter before tax payments and EUR 100 million for the full year. Working capital has increased. You'll see that in the cash flow statement. But when you strip out the acquisitions and look at it, it's actually in line with the growth of the business in terms of the investment increase in working capital. With the Medicover Hospitals India, this has higher working capital requirements, some of their other businesses, a long cash cycle. So you see on the previous slides, we have EUR 12.6 million of net working capital that we picked up on the consolidation. So that runs a little bit higher than some of our other business areas.

Effective tax rate, 20 -- just down to 26%. You can expect a similar sort of level running around the 26% for 2020. Capital expenditure, we've been very busy doing that and supporting the growth of the business, EUR 63 million CapEx in the business during the year. So some EUR 20 million up on the prior year. About 2/3 -- just over 2/3 of that was growth CapEx. Just over EUR 43 million of that was in growth -- on the growth side of the business. If I look at the maintenance side of the CapEx, we're effectively running around for the full year about 2.3% in terms of the maintenance side. And if we look at the full growth and maintenance, we're running around 7.5% CapEx for the year. The Pelican Hospital is a big part of that in Q4. So we had some EUR 8.3 million, we went out in terms of the capital program for that. So now with this quarter now, we start to actually use that facility, not fully. It's not fully commissioned yet, but we expect that to be fully commissioned and opened and running in Q2, new modalities and round about 100 beds that we add there, and we're running completely full. So we should be able to use that capacity quite quickly.

Equity, just short of EUR 360 million IFRS equity, reflecting that EUR 20 million increase due to the net increase due to the Medicover Hospitals India consolidation and then we had good movements positive on the translation. And so obviously, our net profit for the year.

Just moving over to Slide 13 on the net financial debt. So here, we are just short of EUR 420 million. So effectively, including lease liabilities, up some EUR 200 million for the year. And if we look at the report -- adjusted reported EBITDA ratio of 3.3x. So as we annualize the acquisitions, that will tick down a little bit. Our net financial debt, so excluding the lease liabilities was 200 -- just over EUR 240 million. So an increase from some 93 -- from EUR 93 million at the end of 2018. And if we look at that in relation to our adjusted EBITDA, so EBITDA after adjustment leases, lease costs, then that was at 2.8x. So this is equivalent to our former leverage metric, and that would also tick down a little bit as we annualize the income from the acquisitions that we have made during 2019. On the right-hand side there, you have a little bridge graph in terms of where the debt has gone. So we've picked up some EUR 30 million of net debt in the acquisitions we did during the year. We've got just short of EUR 5 million that we have as deferred consideration for those. We paid some just short of EUR 60 million in cash for the Neomedic acquisition. Medicover Hospitals India was 12.3% for the equity and the loans, the convertible loans that we advanced during the year. And then we've got other acquisitions just short of EUR 20 million, and the noncontrolling interest that we picked up in OK Systems and then some other debt movements, cash and noncash, to bring us up to EUR 240 million of cash at the end of the period. We restructured our debt structure during the year, so issued in Q2, we issued a EUR 2 billion commercial paper program in Sweden in SEK and euro, and we have at the end of the year about EUR 80 million outstanding under that program. So we have the revolving credit facility standing behind that program, and we've reduced that from EUR 300 million to EUR 220 million. And we have that standing behind the CP program. And that, of course, stores any liquidity issues. So even though as we show that debt as short-term on our balance sheet is effectively long-term because we have the committed revolving credit facility behind that, which is some just over 2.5 years still to run.

And then we have the German Schuldschein loan that we issued. So our debut in that market, very well received. We issued EUR 140 million in that and fixed and floating mix, and a very good profile of 5, 7 and 10 years, so very well received. And cost of that is between 1.2% to 1.6%, depending on the maturity. So very happy with that and very well received, and that's a market that we would probably go back to in the future as well, so gives us good flexibility and gives us good diversity in our funding base.

We look at the lease liabilities. We started the year at EUR 125 million on there ended up at EUR 176 million. So we put some EUR 50 million of lease liabilities on. So quite a significant expansion in terms of percentage from the opening balance, about 25% of our opening balance, we came in with acquisitions. So when we've acquired businesses, we recognize the lease liabilities on those to just over EUR 30 million. Did our -- obviously, our repayments as the leases were paid during the year. And then we have a quite strong expansion in terms of our facility base during the year. So we added on some EUR 48 million for new facilities, which also covers our expansion of our own gyms network in Poland to support the employer paid gym benefits and sports benefits.

So just looking at then the outcome for 2019. So I think we talked extensively about the strong growth, I think, on any measure, in any way you want to look at it, then our growth has been very strong. In Q4, up 15% organic, 14.8% for the 12 months. So a good bit above our targets that we set back in 2017, and our profit up 27.7% on the adjusted EBITDA growth for the quarter and 23.7% for the 12 months, catching up on the lower levels that we had in 2018 on the back of the German lab changes. So really happy to see that in terms of being able to come up to that 3-year targets as well. And the capital structure there. You can see now, we're starting to pick up in terms of our debt levels. So EUR 3.3 billion on a full basis, including lease liabilities and 2.8x to -- on the adjusted EBITDA to net financial debt, excluding lease liabilities. And as I mentioned, that will tick down a little bit as we annualize those profit measures.

So Fredrik, I hand back to you to talk about our performance over the last 3 years, and...

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Fredrik Rågmark, Medicover AB (publ) - CEO & Director [4]

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Thank you, Joe. That was a lot of information. And so on Slide 15, we have summarized just the details of the financial -- the 3-year financial targets that we have behind us and that were then set, as I mentioned, in February 2017, ahead of the IPO. So 9% to 12% organic growth revenue, 18% to 20% organic EBITDA growth, and the outcome, as we already mentioned, then being 14.8% on the revenue line, organic and just a tick above 20% on the EBITDA growth. So tick box well achieved and point to make, they were certainly not set in an unambitious way. So we are very happy, proud and pleased to be able to report that back to you. And you see in that very right-hand column, we also just note the total compounding growth rate, including nonorganic. So just short of 20% on revenue and 23.4% on EBITDA. So that's good. So pleased with that.

And that then knocks onto the new targets, so we're then communicating new targets for the 3-year period in 2020 to 2022, where, obviously, the base year is the year behind us, 2019. So the base year is more or less twice what the prior base year was. So 2016, from memory, I think, was EUR 496 million. So it's not fully double, but not so far away. So we start from EUR 844 million this time around, and we maintain then our organic revenue growth target of 9% to 12%, which, I think, is a strong signal to send that we are expecting that we should be able to maintain the same revenue growth rates going forward, another 3 years despite the business being twice as large. Comment I made before the run rate we're at right now is about EUR 100 million or EUR 110 million of annualized organic growth rate. So that's more or less what we then expect to be able to do as well over the coming years -- coming 3 years. So I think that's very strong. We're also in a position with the balance sheet that Joe just talked about extensively and the cash we generate in our business to be able to be active on the M&A front, where we see the strategic fit and we can buy at reasonable prices. So you should certainly expect us to continue to add on top of the organic growth, also acquisition growth.

Then the margin target. So we shift away from an EBITDA growth target to establishing a specific target to reach. So we take the new definition of the IFRS 16 definition of EBITDA and we use adjusted EBITDA here, that's adjusted for M&A cost and IFRS too, so noncash based compensation. So the adjusted EBITDA to reach in the range 15.5% to 16.5% by 2022. So I think the way to read that is to -- we expect alongside the ongoing revenue, organic growth rates, also to be able to keep expanding our margins in a way not very dissimilar to what you have seen over the prior year period. We maintain the same leverage target. So not above, at least not above for an extended period of time at 3.5x net debt over adjusted EBITDAaL. So the same leverage metric really that we've had over the prior year's period.

Last but not least, we adjust somewhat the potential dividend payout ratio. So you saw we didn't comment on that actually. But the board will suggest to the shareholders meeting with Annual General Meeting to have an inaugural dividend payment. We are turning 25 as a company here in 2020 and being able to celebrate that with an inaugural dividend payment of EUR 0.05, I think, is a strong signal, and it's something we are very nice to be -- very pleased to be able to communicate. We also say that going forward, we may be paying a dividend up to 50% of net profit as opposed to 30% of net profit where it has been historically. So overall, I think good, solid, robust new targets going forward. And of course, we are happy and confident that we will be able to deliver on that.

So I think with that, we close and give over -- we have actually a summary slide that I'm not going to talk you through right now, how we talked through most of that by talking through the financial targets with you. So we go straight in, I think, given time, go into the Q&A. So we are very happy to take any questions you may have now.

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Questions and Answers

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Operator [1]

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And your first question comes from the line of Carolina Elvind from Danske Bank.

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Carolina Elvind, Danske Bank Markets Equity Research - Analyst [2]

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So I was wondering if you could please confirm again what the total loss for MaxCure 2019 was? And then approximately how much cost you've invested in the change in profile from Mexico to maybe cover? Just trying to get a sense of the underlying profitability and how we should view that going forward?

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Joe Ryan, Medicover AB (publ) - CFO [3]

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Yes. So the loss -- the total loss for the Max Medicare Hospitals India group is around the order towards EUR 6 million, and about EUR 1 million that is -- has been the rebranding costs. And then we have also, within there some prior year elements, so it's probably about EUR 1.3 million to EUR 1.5 million of prior year adjustments elements within that figure.

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Carolina Elvind, Danske Bank Markets Equity Research - Analyst [4]

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Okay. And on EBIT level, what do you think will be a reasonable margin on a medium-term horizon?

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Joe Ryan, Medicover AB (publ) - CFO [5]

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Sorry, can you say that question again, please, Carolina?

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Carolina Elvind, Danske Bank Markets Equity Research - Analyst [6]

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Yes. On EBIT level, what do you think is a reasonable margin level going forward?

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Joe Ryan, Medicover AB (publ) - CFO [7]

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For India?

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Carolina Elvind, Danske Bank Markets Equity Research - Analyst [8]

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No, EBIT.

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Fredrik Rågmark, Medicover AB (publ) - CEO & Director [9]

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But you're asking regarding Medicover Hospitals India?

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Carolina Elvind, Danske Bank Markets Equity Research - Analyst [10]

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Yes, yes.

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Joe Ryan, Medicover AB (publ) - CFO [11]

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Yes, I think as we said before, we -- before we started opening up and expanding the facilities, we were running around about mid-teens in terms of EBITDA measure for the units. And on a combined basis, including the central costs we were a few percentage points below that. So that still is where we are operating in terms of the units themselves. We have the Nashik hospital, which is now into its second year, 350-bed hospital in Maharashtra, performing very well. So that's now actually coming into positive figures. And then we have working on 2 facilities to open with the cancer centers. And we'll probably open several new facilities that we're working on during the year. So we'll move from 11 to probably north of 15 units before the end of 2020.

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Carolina Elvind, Danske Bank Markets Equity Research - Analyst [12]

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Okay. So we should expect continued pressured profitability then for the coming year, I guess?

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Joe Ryan, Medicover AB (publ) - CFO [13]

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Yes. It's -- we're seeing development. So this -- the seasonality in that business, the lowest part of the year is December, January, which is their winter. And so what you're seeing is in the current results, and you see now in this 1 -- in the first quarter is lowest part of the seasonality of the year.

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Carolina Elvind, Danske Bank Markets Equity Research - Analyst [14]

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Okay, perfect. And just if you could comment on the fertility clinics that you're closing down, the write-down that you're making.

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Joe Ryan, Medicover AB (publ) - CFO [15]

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Yes. We closed 3 facilities in India. And as you see, we've expanded quite aggressively there with that business. And we tried a number of different models, good type of models. And so we're doing a little bit of learning as well. And those ones, 2 of them, it was certain the model was wrong. It didn't really work, when we transplanted it to the Punjab. So we step back from that. So we're now in 3 facilities. We've got 1 up there. And that one actually works. It was a slightly different model. So we sort of discovered what works. And 1 was just one-spoke in Delhi, where the model works, the hub-and-spoke model works, it works very well. And that was just a poor location. So we closed that and we'll relocate to probably somewhere else later in the year.

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Carolina Elvind, Danske Bank Markets Equity Research - Analyst [16]

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Okay. And just a final one on the fee-for-service growth. So as you say fee-for-service growth 30% approximately in Q4. Could you comment anything on the organic growth for that business? Is it below or above the group average?

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Fredrik Rågmark, Medicover AB (publ) - CEO & Director [17]

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No, the fee-for-service piece is above group average organic. So...

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Carolina Elvind, Danske Bank Markets Equity Research - Analyst [18]

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Okay. And could you comment anything on the relationship between volume and price in the organic growth?

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Fredrik Rågmark, Medicover AB (publ) - CEO & Director [19]

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Well, I mean, I think the way to comment on that currently. Historically, we've said that there really wasn't pretty much any price element in our growth, it was all sort of volume driven. Over the past sort of 18-odd months or so, you've had a little bit of price growth coming into it. So I'm not going to give a specific number, but it's a little minority piece in our growth, which is price-driven. But there is a little bit of it nowadays, where previously, it was none. So -- and it's increasingly important. And as I think I said that on the prior quarter call, where you -- one should not forget, fee-for-service is good in many respects. And one particular element of it in this question is that you have a much wider flexibility to adjust price when it comes to the underlying medical inflation. So it's -- that's one angle, why that is such an important segment to us.

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Operator [20]

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(Operator Instructions) There are no further questions I think at this time, please continue.

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Joe Ryan, Medicover AB (publ) - CFO [21]

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So we have one question from the web in terms of question in terms of CapEx levels, where do we see this being is the future to achieve our growth targets. We can -- we expect to continue to invest quite heavily in terms of the growth area of our capital side of the business. So this is 1 of the drivers for our ability to be able to grow strongly. Not all of our businesses, but a large part of the business is facilities based. So when we expand, we need to also add those facilities as well. So you should expect to see an increase in level in terms of the lease liabilities as well because this is how we approach our property needs within the business, and we should also expect to see that we continue to invest in our growth CapEx as well at a reasonable level, consistent with where we've been in the past. Yes, it's the best return that we get in terms of our investments is on our growth CapEx. So we're expanding the facilities, leveraging more in terms of the core structures that we have. So yes, it's an important part for our growth.

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Fredrik Rågmark, Medicover AB (publ) - CEO & Director [22]

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All right. So I think if there's no more questions, we thank you for having listened, and we look forward to another exciting year for Medicover 2020, and we will meet you when we report for the first quarter. Thank you.