Hospital Mater Dei SA

Hospital Mater Dei SA

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Q1 FY2026 · Earnings Call TranscriptMay 6, 2026

Operator

Good afternoon, ladies and gentlemen. Welcome to our earnings release for the first quarter of 2026.

At Mater Dei, today we have José Henrique Salvador, our CEO, and Rafael Cordeiro, our CFO and Investor Relations. This earnings call will be recorded and will be available on the company's IR website after completion.

To activate simultaneous translation, please select this globe icon at the bottom part of the Zoom screen. The presentation will be available on the IR website as well for the Mater Dei network.

Before we move on, we'd like to let you know that any possible statements about future events that are subject to risks and uncertainties and that could lead to the non-completion of such expectations or differ from what is expected, and these are reflecting the opinions at the moment they are made, and the company is not obliged to achieve them. If you have any questions after the presentation, please use the raise hand feature and we'll open up your mic.

If you'd rather send this by writing on chat, please identify first. I'll pass the floor on to Mr.

José Henrique to begin the presentation.

José Henrique Salvador

To start off our earnings call, we want to once again start off by thanking a few people. I want to thank the board of Mater Dei that has been providing all of the necessary support so that we can evolve more and more in the different strategies that have been guiding Mater Dei to a more sustainable and perennial future.

I also want to thank our people. This symbiosis between the intelligent management and reference clinical team has been fundamental to reach the best results and achieve our objectives.

I also want to thank our partner companies, and say that it's been a real privilege to build this with companies that have been so close to the Mater Dei network. Finally, I want to thank all of the shareholders that really believe in our thesis and the perennial future of our network.

Now about our results, we're really honored to highlight that we started 2026 with the same celerity as we finished 2025. We've continued in our trajectory of evolution through disciplined execution of our strategic planning.

The first quarter of 2026 had an all-time high in net revenue, reaching R$575 million, and it's the first time we're able to reach this number despite a period with a lot of seasonality, which is the month of February. We have Carnival in Brazil, and that impacts a lot of our units, and thus we have less clinical days.

In the comparison with the first quarter of 2025, the increase in the net revenue was 15%. This is a significant increase, 15%, and this new level is really connected to the increase of the average ticket, which also reached a new all-time high, R$2.85 million per bed in this quarter, and that's an increase of 8.4% against the first quarter of 2025.

This growth reinforces some points that are really important, our positioning despite a market that is more competitive, but of course this provides evidence on the successful execution and guidance of the network, highlighting some points that are essential. First, we've been talking about this regularly, which is the capacity to grow without necessarily having to open up new beds.

This reflects our strategy to improve the mix of procedures and increase the complexity in the care of our network, highlighting oncology. Besides the execution of our approaches to increase revenues, and oncology has an important role at the network, and we've been really having very unique clinical team that has been understood that the Mater Dei network is the right environment to build their future in.

Besides this, we've also been focusing a lot on the ramp up of the units, and that has also been improving the mix. We also have noticed the maturing of our different integration with the units that are acquired, and that has also led to an important highlight, which is the growth of revenue in these units, and also when it comes to margins when we normalize this, and we're going to be able to talk about this a little bit more up ahead.

Another relevant point is our strategy for positioning as one of the main, or if not the main, player in each region we're in. I'm not going to get tired of repeating this: the strategies of the hospital networks have national synergies, but the champions are going to be the references in each region we are positioned in.

This has really given us the opportunity to build champion models with the partnering operators, and this success is really connected to the traction of reference medical teams that have been adapting more and more and really prepared within this strategy, increasing the concentration of procedures of high and medium complexity in our hospitals, and also positioning ourselves as a reference, right? We want to be in each hospital a reference of the best physicians in those markets.

Besides this, we had an increase of 6% in the number of day patients compared to the same period last year. We've been able to achieve this, this is in line with another strategy.

We've also focused on having better operational efficiency, and with this we were able to reach an all-time high of occupation in the quarter, which was 84%. This is a recurring effort in the company besides the selection and opening of beds, and with the selection of these physicians that are going to operate with us, as well as the selection of good relationships with operators that can, through their commercial products, really allow us to service Mater Dei well, and also be convicted of being compensated in the correct timeframe and in a fair manner.

I'm going to talk about the EBITDA, and the EBITDA we had are also a result of the movements we mentioned up ahead. When we report the EBITDA in this quarter to demonstrate the better operational recurring results, we had an adjustment in the profit sharing, complementary profit sharing related to 2025, which was R$5.6 million.

With this adjustment, we were able to reach R$130 million in EBITDA, an all-time high in our network, and 35% higher than the same period in the first quarter of 2025. The margin grew 3.3 percentage points, reaching 22.6%, which is the same level presented in the fourth quarter of '25.

This result reinforces a whole new level of margins that the company is operating in, reinforcing that in a period of seasonality that is unfavorable, right? This stronger operational result was fundamental also to reduce the leverage rate of net debt to EBITDA in the quarter compared to the end of 2025.

We were able to reach 1.6 times, which was a healthy level, and that makes it evident how healthy the company is financially. If we consider the buybacks of shares and dividends that we would have, there would be an adjustment and the leverage level would be 1.4 times.

Now getting into details about our hospitals, I want to highlight some of our units as well. The unit of Salvador has become more mature, demonstrating our work with relationship and attracting medical teams that are references in the market, coming from other institutions, and that reinforces the robustness and strength of our clinical team.

The hospital is really been consolidating itself as a reference, and besides this, we're also positioning ourselves as a highly excellent hospital with NPS levels that are comparable in our more mature units, and also evolving in our capacity to handle high complexity in this unit. In the comparison with the same period last year, we had a growth which was 73% of the oncological patients and 17% in the surgical notices.

These numbers, although they are significant, still do not represent everything we can build for this unit, and we're going to continue to work in this direction to have numbers that are better and better. In the Nova Lima unit, we are still having an EBITDA margin that is higher than the consolidated numbers in the network, and that's a fruit of the average ticket that's higher considering the mix of operators and high and medium complexity which this unit has been able to consider.

Besides of course, as we have already mentioned, a lower need for support administratively considering the efficiencies we have in the metropolitan region of Belo Horizonte. We've been able to through this unit incorporate and build new relationships with medical teams that are really unique and that weren't very close to us in the metropolitan region of Belo Horizonte, and that allows us to accommodate these teams within the strategy of Mater Dei, bringing in a better mix of procedures in-house.

These teams are bringing better production, more revenue, and especially in strategic lines such as oncology, cardiology, orthopedics, urology, ICU, and among others. In the quarter, compared to the fourth quarter of 2025, the last quarter, there was a growth of 13% in the number of patients and also in the number of surgical notices.

If we compare with the first quarter of 2025, we grew in this unit a total of 71% in the amount of surgical notices. I want to remind you that in the first quarter of 2025, we still did not have oncology in this unit, and we see an important means for growth there and to acquire new areas in our network.

We were able to reach an all-time high in net revenue with a growth of 83% in the oncological patients and 8% of the surgical notices compared to the same quarter of 2025. Among these units, we must highlight Mater Dei in Santa Genoveva, which had the highest quarterly net revenue in history, and this grew 12% in regards to the same period, and 4.5% in regards to the fourth quarter of 2025.

Not only financial results, but also in this first quarter we can see that the Mater Dei network was recently certified as a educational hospital in the metropolitan region of Belo Horizonte, and that reinforced their commitment to educational excellence and high clinical performance upon consolidating the strategic partnership with American Heart Association. Physicians, nurses, and students will be able to increase their professional levels with training and scientific rigor through the experienced instructors and technological infrastructure in Mater Dei Contorno, Mater Dei Santo Agostinho in Belo Horizonte.

Besides this, the intensive care units in Uberlândia had dual recognition with a ICU top performer and efficient ICU granted by Epimed Solutions along with the intensive medical Brazilian association and also a Fitch rating recognition about the health and financial discipline of the company, reaffirming in the month of April 2026 our rating of a AA+ rating reflecting the resilience of cash generation amidst a challenging environment and the capacity and expectation for maturing gradually in the hospital assets and the advancing of our operational strategy. To wrap up here, strategic discipline, which was the basis for new evolution operationally and financially in 2025, continues to be the basis for the results in the first quarter of this year, and that will be our pillar in the journey of sustainable growth in the network.

There's a lot of value to be unleashed in-house, and with discipline and consistency and seriousness, we'll be able to continue to work to demonstrate that there are feasible strategies to strengthen our company and the sector. Now I'm going to pass the floor on to Rafael Cordeiro to go a bit deeper into our numbers.

Rafael Cordeiro

Good afternoon, everyone, and thank you, José Henrique. I'm really pleased to go over our numbers here, and I'm going to cover some of the main highlights in the quarter.

We start off with page four, and we discuss the operational beds in the company. We demonstrate what's been discussed constantly, we're actually able to have significant growth keeping the same level of beds.

In the first quarter of 2025, we reached 1,168 beds, and what made this revenue be achieved is an occupation rate that is higher and a ticket as well that's higher. Here we're highlighting an occupation rate that grew 4.6 percentage points in regards to the first quarter of '25, and it was almost 4 percentage points above the fourth quarter.

You can see that, as highlighted, the first quarter has a lot of holidays, and we still had an average closing of 39 beds even with a maintenance and growth of revenue quarter-over-quarter. On the bottom part of the graph, you can see there's growth of 6.1% in the amount of patients per day and a significant growth of the average ticket per patient.

I'm going to highlight this growth in the next page as well, page five, where I want to highlight the revenue we have per bed used. Here we're going to give you some major news, which is the growth of this ticket year-over-year, the first quarter of '25 compared to the first quarter of 2026, of 8.4%, and that's 4% above inflation that has been following a dynamic in the company of having these adjustments in time, and also increasing the average ticket per specialty, and also the increase of oncology within our mix.

Quarter-over-quarter, we've been also growing 2.2% in the average ticket, R$2.79 to R$2.86 million per bed. On the right side of the same page, moving on to the net revenue, the growth of the revenue is 15.1% year-over-year, reaching R$575 million.

The ticket grows 8% and the revenue grows 15%, and it's a very important number to dilute a lot of the costs we have in the company, but even in this quarter, quarters that are so difficult from a business day perspective, we had a growth of R$13 million in our net revenue, or 2.3%. Moving on to the next slide, when it comes to costs, we have this number we've been highlighting, which is the importance of really keeping up the gross margin above 30%, costs below 70%.

Once again, with 69.8%, we were able to get this number here considering the profit sharing, and if we didn't have it, it would be even lower than 70%, and that's where we worked on this actually directly in the EBITDA. It's a reduction of 1.4 percentage points, and a stability in regards to the fourth quarter of '25, right?

On expenses, just some other points here, with this we have a dilution and improvement of personnel. We've been diluting this from the medical part considering the growth of the revenue, and we have a slight increase in materials and medication because we've been working on the increase of revenue in oncology, and there's this profile of having a little more use of these inputs, right?

That's all within the strategy, which is completely diluted by even greater growth in our revenue. When you get into expenses on the bottom part, you reach 13.6% of adjusted net operational expenses, and that's pretty stable in the last five quarters, but a reduction of 1.3 percentage points in regards to the first quarter of '25.

This is due to our growth in the revenue, where we've had an expense with personnel that's pretty stable in absolute numbers, and the growth of the revenue leads to this dilution, right? There is no type of non-recurring point.

In the fourth quarter, we had a reversal, and in this quarter we don't have this. It's really stable in regards to the provision for losses and PL and contingencies.

Here you just have that PLR with the profit sharing part, that part of it is in costs and part of it is in expenses. We also reach R$130 million, and that's compared to the first quarter of '25, or 3.3 percentage points in the margin.

This margin of 22.6% is consistent, and we've been entering into this period of better seasonality in the sector with costs being really well controlled. We've been very optimistic for the next quarters with everything that we've been seeing in the company, right?

In regards to the fourth quarter, that's pretty stable in the margin and R$3 million above the absolute numbers of EBITDA. Moving on to the net income and working capital, we have significant growth in regards to the first quarter of '25.

It's a growth of 80%. This adjusted profit as we adjusted in EBITDA made us reach R$36 million of profit, and this leads to a margin of 6.3%.

They're 2.3 percentage points above the first quarter of '25, and these are R$16 million more and very stable profits in the last three quarters. As I mentioned, looking at the capital structure in the company, and we also have a more timid trend with reduction of the interest rate, and all of the improvements we can bring in of absolute results for the company with the financial results being stable, we'll see probably that we can start noticing all of this improvement dropping through the profit, and so we expect to have better seasonality in absolute numbers and our profit being even more consistent.

When it comes to working capital, I even mentioned this in the call in the fourth quarter, we had some specific negotiations and some receipts that were anticipated, and then in the first quarter, we kind of stabilized this temporary difference, going on to 111 days, a number that is 4 days lower, but an increase of 4 days within the normality and variation of our accounts receivable. We reduced two days of our terms, and we also had some strategic purchases in the fourth quarter, and we see this increase of three days in our stock, which is keeping up very good efficiency considering the specialties have been growing in a lot with, especially in the mergers.

On the last slide, the cash flow and debt, you can see that there's a net debt that's pretty stable. We have a debt of R$800 million, and the gross debt drops R$41 million.

We could have a net debt that's lower financially, but we had a significant installment of R$24 million of payment in our Goiânia unit. Next year it'll be the last installment, R$50 million, and we also had R$2 million buybacks in the quarter.

R$26 million applied to our cash that are not recurring items and that could be reflected in our cash and in our net debt. In regards to the other items of the cash flow, we had a normalized quarter and a working capital in line with what we expect.

We're working always to have improvements in the cycle because the revenue cycle is quite complex, and we have partners that are very good that have helped us to improve the fluidity of our revenue cycle to reach better results and reflect this in our cash generation. Our debt is extended.

We have R$1.3 billion, and we have a debt that is 5.2 years, and it costs below CDI - 0.79% per year. On the last bottom graph in the presentation, we have a equivalence or comparison of what our net debt would be if we had not performed the payments to our shareholders, direct and dividends, as well as participation with the buyback program as José Henrique mentioned.

We would have R$705 million and R$95 million better in our net debt, and so it's part of our capital allocation strategy to have these dividends. We demonstrate that the company has cash generation that is stable, generating cash every quarter with very significant discipline for the capital allocation in the next quarters.

I want to wrap up here and start up with the Q&A now. Thank you very much.

Operator

Now we're going to start our Q&A session, and I want to invite Vinícius Figueiredo from Itaú BBA for his question.

Vinícius Figueiredo

Good afternoon, guys. Thanks for taking my question.

I wanted to just take advantage of the points on the last slide you presented. The company has been consistently delivering earnings that leads to a very significant cash generation as well.

When you see the photograph here on the debt, I think there's a question we always see when we consider capital allocation looking forward, right? You can see that there has been a delivery in the dividends in the last quarters, but we also want to understand how this could be allocated for inorganic growth opportunities, or also if you guys see a short-term, about two, three years, with opportunities to have more density in the networks you're in and markets in.

The second question would be a little simpler just for this model: when you look at this, how should we look at this occupation rate versus the operational beds in the next quarters, right? I know this has been just to understand how much this also interacts with the operational beds you have.

José Henrique Salvador

Vinícius, how's it going? Good afternoon, and thank you for the question.

As you mentioned, and we demonstrated on this slide, we've been demonstrating this in the last quarters, and no doubt this year will be stronger than it was last year. We have a projection for positive cash generation, and this is a projection also to maintain margin levels that are a bit higher.

We've been working strongly in the revenue cycle as well, and we've been able to work on PMR as well as PMP, and we've been also working on our stock efficiency, and we feel that the tools are set out there, and this is very carefully considered in our strategic planning so we can really generate fundamentally this a vision that we are looking at from now on. The movements we've been working on at this moment when it comes to growth, most of them are movements that have more of an asset-light approach than those we experienced at other moments.

When we talk about unleashing value at our units, this is a demonstration of how most of our CapEx exposure to build new units and to acquire units happened in a recent past, right? This is very important to position ourselves, right?

Our movements now are to attract new medical teams, opening up new services, partnerships with operators and payers that are searching for solutions that can be adhered to their growth and in service their beneficiaries better, creating conditions in our different units so that we can service physicians better that are sometimes not very well serviced in other structures that are set out there today. Having said all of that, besides the strategic movements for growth, our main priority is to delever, and we've been experiencing a scenario of high Selic rates, and we've been thinking about different ways to delever with a more robust cash position, looking ahead at other opportunities to always take care of our capital structure.

Despite the fact that we are at a very healthy level, we understand we are in a country with macroeconomic conditions that could possibly give us any kind of discomfort, right? As we advance and we feel cash positions comfortable, the deleveraging levels are comfortable, then we'll also have the possibility to have new dividend distribution above what we've already done so far, and also looking at a more careful perspective and also even more aggressive for opportunities related to M&As that could come up.

Once again, our main proposal is to really be able to attract volume without necessarily performing major capital allocations. When it comes to occupation rates and operational beds, we don't want to provide guidance for hospital bed openings.

We still have room to improve our operational efficiency, and we've been working on some movements that quite frequently bring revenue that is not necessarily connected to beds. Having said that, the second and third quarters especially are moments where we open up beds.

Yes, we will open up hospital beds in the next quarters, but we need to have maintenance of the occupation always above 80%, and that's really important for our margin maintenance as well, all right?

Vinícius Figueiredo

Very clear. Thank you so much, José.

Operator

Now we're going to invite Gustavo Miele at Goldman Sachs.

Gustavo Miele

Hi, guys. Good afternoon.

Thanks for the presentation. I have two points here on my side.

First, I wanted to cover medical materials, it's a cost line that you mentioned there's a bit of dilution with the increase of revenues that you guys mentioned, but I understand as you mentioned that from a nominal perspective there's a slight increase because of more penetration of oncology. My question is related to really understanding what could be a lever for possible nominal reductions in mat-med, and if you guys are seeing any like this, and maybe even renegotiations with some suppliers as you guys gain scale, and what can be done more commercially searching for new suppliers so that you guys can be even more efficient.

I think that would be a first point, please. Then a second point would be just going after a bit of Vinicius's question here.

As we think about growth, José Henrique mentioned that the growth of the revenue of 12% in the acquired units, I want to understand what you guys consider to be as challenges to be able to continue to ramp up the revenue of the new units. You already have been mentioning how happy you are in attracting the clinical team, and I want to understand this from an accreditation perspective: do you guys see room so that new health plans coming in the base of the new assets can really help the revenue from '26 and '27 onwards?

I think that's it, guys. Thanks.

José Henrique Salvador

Hi, Miele, how's it going? Thank you so much for the questions.

I think Rafael has already mentioned the possible growth that we've been seeing in the line of medical materials and expenses, and especially on the medical expenses considering this growth that is a bit disproportional when you consider the oncological and infusion lines. There is a trend with an increase on this line, but of course the revenue is also going to grow, and this revenue that's higher will help dilute the other expense lines we have for personnel costs, as well as some other services that are not going to vary as much as the growth in medical material expenses.

We've been having a real extensive process to negotiate with suppliers, and we've seen suppliers quite interested in finding other options actually that are related to the quality of care, understanding the trend that exists so that oncology especially can be more connected to hospital groups, considering the complete patient journey and the possibility of finding formulas and means or products that can really consider a full oncological journey for patients, which is a thesis we've always defended, and so we are engaged in this topic here of trying to renegotiate so that this impact can be the least possible. In regards to the acquired units and the growth in revenue, we also expect a revenue growth in these units.

These are units that are stable. These are units that have been gaining pace when it comes to quality in each of their units and regions.

They were able to attract clinical teams, and they're also benefiting from a more clear oncology strategy. Today, for example, we have a team for oncology that's set in Feira de Santana.

We have a really well-established team in Uberlândia as well, and then we're thinking also about some other relevant movements as well for Goiânia. This is an important growth avenue for us besides the other avenues when it comes to attracting the clinical teams and products with the payers.

Strengthening this unit also makes them become more and more important for those partners that are local and supporting the Mater Dei network. We've been operating to have significant growth in these revenues, but we want to pass the word on to Rafael so he can add on to this.

Rafael Cordeiro

Miele, we have this effort now, and we've been noticing, first José Henrique mentioned this, as the numbers consequently become greater, you also open up a full scope of opportunities and options in these conversations, as mentioned, and we've really kept our eyes open because we're going to be even more relevant with this that'll give us even more opportunities. Then about the companies acquired, we have a growth of revenue, and sometimes the results when you look at this consolidated minus controller and you find the EBITDA of the consolidation, sometimes the EBITDA has some factors we have to disclose here.

Specifically in this quarter, we had almost R$6 million of contingencies that go through the results of the company acquired, and the responsibility for this contingency is for the sellers of that M&A, right? We have some amounts in our assets that we have the exchange of this contingency that we launched, and who has this asset today is the Mater Dei network, the whole thing.

There's a launch that when you look at this consolidated level it's zero, but then it's a cost of the acquired company, then there's a reversal of this. If you were to look at the results of the controlled companies, you would consider the R$6 million as an actual result of the consolidation and not the controller.

This is important so you can see that this growth is also coming with a margin, and every quarter we notice this growth. We also have to be very careful with this, not only by the companies acquired, but also in operators and payers with a short flight, let's say.

We test some things, we don't do anything too big, but what we try to do is increase accreditation of the payers that are our partners with some service that is still not there. This growth of importance brings in opportunity for us to be even more competitive in other accreditation processes, and that will help us have more revenue the next quarters.

We're really excited in this dynamic, and we really believe we'll be able to retrofit this growth, bring in new opportunities.

Gustavo Miele

Great. Thank you very much, that's very clear.

Thank you, Rafael. Thank you, José Henrique.

Operator

Now we're going to invite Flavio Yoshida from Bank of America so he can share his question.

Flavio Yoshida

Hi, guys. Thanks for this.

I have two points here. You talked about reinforcing the medical team, and I wanted to understand if you guys see an opportunity considering that you have a strong oncology player with a strong presence in Belo Horizonte going through a more delicate situation.

Have you been seeing this movement with the clinical team that you can attract with a bit of ease, and has this movement happened in an intense or one-off manner? The second question is about the ticket.

You demonstrated positive growth of 8% in the ticket, but this level has been slowing down a bit in regards to the last quarters, which is 9 and 11%. Then you mention also a series of reasons for this increase, right, a mix of procedures, hospitals, negotiations with the payers.

I want to understand where you see more space to mess with this and continue to grow the ticket in a robust manner, and if we should expect some acceleration in this growth looking up ahead.

José Henrique Salvador

I'm going to start off here, okay? About the attraction in the clinical team, this is quite recurrent ever since the beginning of Mater Dei's creation.

Whenever you have maturity in our units, of course you gain more strength, and we have good opportunities. In oncology, we've already had a strategy actually set up to strengthen the oncological lines for the Mater Dei network in a very robust strategy also in the metropolitan region of Belo Horizonte, as well as a very robust strategy in Salvador with the arrival of physicians that are benchmarks and references to be able to lead our services there.

It's a very robust strategy in Feira de Santana as well as in Uberlândia, and what we've observed in the more recent past was that more and more we have more attention and interest from people in oncology where we have in-depth admiration wanting to interact, and some of them actually started to migrate into our units, incorporating even more of our services, right? We look at this strategy and we're very careful, we want to identify who would be these figures that are really part of this clinical team at Mater Dei, and also if they are capable of attracting new relationship networks, right?

This is super important, together with a good oncologist you should have a whole network of professionals involved for referrals, and we've been working on this a bit in the last few months where we've been able to accelerate the strategy as well. When we talk about the ticket, as I mentioned, we've been improving our mix in procedures, we've been improving our mix also of revenue for hospitals as some hospitals grow and they have higher tickets and they contribute also to the growth of the general ticket in the network, and then we're going to continue in this sense.

This is an important point. We do not manage the ticket value, we just encourage the mix of strategic procedures, and of course we encourage the mix of payers that we consider to be relevant and strategic.

In line with what Rafael mentioned, we're very disciplined and we're always going to look at insurance or payers that bring in healthy revenue and capacity for payment. These are the guys we are associating ourselves with, and they're the ones we're going to work with, and as they grow, the revenue mix will also evolve.

Rafael Cordeiro

To add on to this point here on the ticket, we had 2.64% in the first quarter, the second and third we have a drop and it goes to 2.56, then we keep on an evolution 2.67, 2.86, and then in the fourth quarter and the first, there were very similar characteristics when it comes to company strategy, and we've seen a growth of 2.2 in the quarter. If you annualize this, you reach the levels of growth that we've demonstrated of 8.4.

In the next quarter where we start with a reference of 2.55, we're going to demonstrate this growth that's even greater considering this drop that the second and third maybe showed because of the dynamic that we have in the quarter. From our perspective, we already have a sustainable growth in the ticket that is way above inflation, not because we were able to get adjustments that were way above inflation, but because of this, right?

We're not going to have a extraordinary peak, but we've been consolidating this slowly but surely, and this is going to be reflected in our numbers, in the company that reflects this profitability, and we've been seeing this.

Flavio Yoshida

Very clear. Thank you so much.

Now

Operator

our last question is from Giordano at JPMorgan to share his question.

Joseph Giordano

Hi, guys, thanks for taking my question here. I have two, one of them which is the quickest.

You talked about the issue with the seasonal impact in the quarter, and I want to know if there's any estimate of what would be the level of revenue and what's the percentage as well of this impact. Now my second question, there was an expectation that we would have this broken down by the end of '28, but when we saw the release of Bradesco Saúde, we've already seen that it's closer to 2029.

Could you guys update this and explain why there was this change maybe?

Rafael Cordeiro

Thank you, Giordano. On seasonality, I think the best way to capture this factor is on the amount of business days, right?

Why is that? Because during vacation, people tend to have less surgical activity, and around the 15th of December there's a significant drop, right?

Then at the end of the year, you have less effectiveness of business days, and then when you want to compare the quarters, you have to consider this amount as well. Carnival gets in the way.

Besides having 20 days in February, you have Carnival, and now you also look at months where people use hospitals more, they have more business days, and we have been controlling our revenue today with more sensitivity based on this performance. What have we done within this initiative that's very important?

You guys ask about occupation rates a lot, and the numbers we present are average numbers, right? When we say that we have a number of beds in the quarter, of course it was smaller than the beginning, and then it ended greater in the end of March, and then there's a pace of starting April a bit higher.

Then when it comes to occupation, we also have an occupation rate of 85% that we demonstrated when there's the day hospital fees, but in the weekend this bed is also going to lead to lower occupation. During the week and during certain peaks, we can reach 95 or 100% occupation rate, but that's why we can't increase this rate too much more.

We have some operational gains, as José Henrique mentioned, but we always work to represent average numbers. We can bring in this volume into the hospitals with more business days.

We still haven't gone through this, but we can notice that there are more business days that are going to bring in a proportional increase in the revenue. To answer here in relation to our project in São Paulo, right, with Atlântica, we've been carefully working with Fênix and to accelerate these projects as much as possible.

We started a very positive pace of approvals and hiring the construction company that's going to be working on this project, and we understand that we're going to be able to open this up at a positive term. We've been carefully following along with this so we can try to open this in time, right?

We had one effect, which was the suspension of some licenses, you also have to think about this from this perspective, right? This is kind of killed by the Supreme Court, and we also have a challenge depending on the moment when the construction process starts, and then we have some possibilities to try to dilute this, but we know that the hospital has to be built well, and so there's this normal projection, let's say, but there's a lot of interest also to be able to overcome our metrics and start this as soon as possible.

Joseph Giordano

Thank you. Very clear.

Operator

Now I want to invite José Domingues to also share his question. José Domingues?

I think he left, with that we're going to end the Q&A session. I'll pass this on to José Henrique for his final comments.

José Henrique Salvador

As we mentioned, it's a promising year ahead, and we've seen many levers that were placed in our strategic planning taking place, and some different buttons selected which also have led to positive results, and we are going to continue to advance to be able to continue having perennial activity at Mater Dei network, and really take advantage of opportunities and be a consolidator in the private health sector in Brazil. Thank you very much.

Have a great afternoon.