Auna S.A.(AUNA) - 2024 Q4 - Annual Report

Financial Performance - EBITDA for the year ended December 31, 2024, was US $268.8 million, an increase from US$ 802.4 million in 2023, reflecting a 33.5% growth[511] - The adjusted EBITDA for 2024 was US $263.9 million, up from US$ 824.8 million in 2023[511] - Adjusted EBITDA for 2024 reached US $263.9 million (S/993.3 million), up from US$ 824.8 million in 2023, indicating a year-over-year increase of 20.4%[529] - The Adjusted EBITDA Margin for 2024 remained stable at 22.6%, compared to 21.3% in 2023[529] - Total income for the period in 2024 was US $32.9 million (S/124.0 million), a significant recovery from a loss of S/214.3 million in 2023[531] Membership and Patient Growth - The number of plan memberships increased to 1,365,028 in 2024, up from 1,270,930 in 2023, representing a growth of 7.4%[512] - The number of patients treated rose to 58,559 in 2024, compared to 57,022 in 2023, indicating a growth of 2.7%[513] - The number of plan members treated increased by 1.6% year-over-year, attributed to general healthcare plan coverage[584] - Oncosalud membership base increased by 7.4% for the year ended December 31, 2024, driven by growth in general healthcare plans[584] Operational Metrics - Average monthly revenue per plan membership slightly increased to S/58.9 in 2024 from S/58.3 in 2023[512] - The total number of outpatient consultations in Peru increased to 938,655 in 2024, up from 830,032 in 2023, a growth of 13.0%[513] - The total number of surgeries performed in Mexico was 21,033 in 2024, compared to 20,641 in 2023, reflecting a growth of 1.9%[513] - Bed utilization in Peru increased by 4.2 percentage points, in Colombia by 3.3 percentage points, and in Mexico by 0.3 percentage points for the year ended December 31, 2024[584] Financial Position and Capital Structure - The company reported a negative working capital of S/241.4 million as of December 31, 2024[538] - The Adjusted Leverage Ratio was reported at 3.56x as of December 31, 2024[536] - As of December 31, 2024, total contractual obligations amounted to S/3,767.7 million, including S/3,619.8 million in loans and borrowings[553] - The company aims to improve its capital structure through potential public or private equity or debt financings[539] - The company has access to revolving credit lines of up to S/600 million, with S/446 million drawn as of December 31, 2024[579] Cash Flow and Investments - Net cash from operating activities for the year ended December 31, 2024 was S/668.5 million, an increase of S/86.1 million compared to S/582.4 million in 2023, driven by revenue growth across all segments and an improved cash conversion rate from 15.0% to 15.2%[542] - Net cash used in investing activities for the year ended December 31, 2024 was S/(236.8) million, an increase from S/(173.2) million in 2023, primarily due to a S/141.8 million investment in facility maintenance and medical equipment[543] - Net cash used in financing activities for the year ended December 31, 2024 was S/(418.1) million, compared to S/(370.0) million in 2023, including S/502 million in interest payments[544] - Capital expenditures for the year ended December 31, 2024 were S/178.7 million, with 37.9% allocated to land and facilities, 32.8% to medical equipment, and 29.4% to intangibles[549] - The company plans to allocate S/177.3 million for capital expenditures in 2025, primarily for maintenance, financed through operational cash and additional debt[552] Debt and Financing Agreements - The company redeemed US$ 57.8 million of 2025 Notes at a redemption price of 101.625% on December 23, 2024[557] - The 2029 Notes, issued on December 18, 2023, have an aggregate principal amount of US $310.8 million and bear interest at a rate of 10.000% per year[561] - As of December 31, 2024, the company's Leverage Ratio was 3.56:1.00 and Interest Coverage Ratio was 1.87:1.00, in compliance with the covenants of the 2029 Notes Indenture[562] - Oncosalud entered into a financing agreement for S/70.0 million to build a new hospital in Chiclayo[568] - The Credit Agreement includes term loans of US$ 550.0 million, with US$533.7 million used to repay existing obligations[572] Research and Development - Auna Ideas manages over 120 active clinical trials and conducts more than 50 ongoing applied research projects[582] - The company expects future expansions to result in temporary increases in costs due to integration and ramp-up efforts[583] - Auna Peru plans to grow organically by expanding installed capacity and evaluating additional expansion opportunities[585] - A strategic partnership with Opción Oncología was announced on March 7, 2025, to enhance oncology services in Mexico[585] - The company expects to invest in the expansion of existing facilities and new plan products throughout 2025[585] Cost Structure - The medical loss ratio (MLR) increased to 57.3% in 2024 from 53.8% in 2023, suggesting higher claims relative to revenue[513] - Pharmaceutical costs represented 47.8%, 41.8%, and 46.3% of the cost of services in Mexico, Peru, and Colombia, respectively[587] Risk Management - As of December 31, 2024, 37.2% of the company's liabilities were denominated in U.S. dollars, with 94% of these liabilities hedged[736] - The company maintains a general policy of holding financing at fixed rates, mitigating interest rate risk[737]