Page. 3 - 71 · josÉ de mello saÚde relatÓrio integrado 2017 Índice page. 3 - 71 pág. 72 - 245 pág.246 - 279 pág.280 - 317

JOSÉ DE MELLO SAÚDE

RELATÓRIO INTEGRADO 2017 ÍNDICE

Page. 3 - 71

Pág. 72 - 245

Pág.246 - 279

Pág.280 - 317


INTEGRATED REPORT 20172 INDEX

About José de Mello Saúde

Organisational overview

Economic performance

José de Mello Saúde in figures

Clinical performance

External environment

Social performance

Dialogue with stakeholders

Environmental performance

Message from the chairman

Investment Case

Business model

Strategy, achievements and goals

Governance Model

Research, Development and Innovation

Make-up and powers of the governing and supervisory bodies

Risk management, main risks and uncertainties

Performance

Materiality Matrix

Commitment to the Sustainable Development Goals (SDG)

INDEX

01

02 Corporate Governance

Integrated Report

05

06

07

10

12

16

18

20

22

24

25

26

32

37

37

44

48

51

53

55

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INTEGRATED REPORT 2017

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3REPORT PROFILE

José de Mello Saúde’s Integrated Report contains financial and non-financial information of the organization and is drafted according to the guidelines of the IIRC – International Integrated Reporting Council. Regarding the period between 1 January and 31 December 2017, this document includes information about the strategy, management and performance of the main business areas of José de Mello Saúde, S.A. (hereinafter José de Mello Saúde or JMS), the holding company of a private healthcare corporate group, with headquarters at Av. do Forte, No 3, Suécia III building – Floor 2, in Carnaxide. The share capital of José de Mello Saúde is owned by José de Mello S.G.P.S., S.A. (65.85%), by Amélia de Mello Foundation (4.15%) and by Farminveste, S.A. (30%).

José de Mello Saúde’s Integrated Report is published annually and is complemented with the information provided in the (i) Financial Statements Report, (ii) Clinical Quality Report and (iii) Sustainability Report – GRI Appendix. All information is available in the institutional website at http://www.josedemellosaude.pt/

In 2017, José de Mello Saúde revisited its materiality1, listening to its stakeholders and adjusting the expectations to the strategy. In line with this financial year, José de Mello Saúde also evolved to the use of the latest requirements and orientations of the Global Reporting Initiative (GRI), GRI Standards that replace the G4 version used in the latest report, adopting the option “Agreed – Essential”.

José de Mello Saúde welcomes comments on this document or on any matter related to its corporate reporting practices, which should be sent to the Communication and Sustainability Department using the following e-mail address: [email protected]

1Detailed information about José de Mello Saúde’s Materiality Matrix can be consulted in chapter ‘Dialogue with stakeholders’

REPORT PROFILE



01INTEGRATED REPORT JOSÉ DE MELLO SAÚDE

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5ABOUT JOSÉ DE MELLO SAÚDE

ABOUT JOSÉ DE MELLO SAÚDE

Organizational overview

and employees, José de Mello Saúde places ethical issues at the centre of its activity. Governing its conduct by values such as the Respect for Human Dignity and Well-being of the Individual, José de Mello Saúde decided to create a Code of Ethics for all CUF units. An Ethics Council2, an advisory body of José de Mello Saúde’s Executive Committee, was also established.

In parallel with the Ethics Council, the larger healthcare units have their own Ethics Committee, under the law. This Committee is composed by internal staff, alongside external individuals with deep knowledge of the ethical matters.

OrganizationJosé de Mello Saúde develops its activity through a network of CUF private healthcare units and hospitals integrated in the Portuguese National Health Service (Serviço Nacional de Saúde), operated under public-private partnership (PPP).

In 2017, José de Mello Saúde expanded its portfolio with the opening, in October, of CUF S. João da Madeira Clinic, and the acquisition, in December, of Coimbra Private Clinic. This will, in the future, become the CUF Coimbra Hospital.

With the expansion of the network to eight hospital and nine outpatient clinics, CUF is now present in Lisbon, Oeiras, Cascais, Sintra, Mafra, Torres Vedras, Santarém, Matosinhos, Porto, Viseu, S. João da Madeira and Coimbra.

José de Mello Saúde also ensures, via public-private partnerships (PPP), the management of Braga Hospital and Vila Franca de Xira Hospital, both part of the Portuguese National Health Service.

From an organizational perspective, the hospital and outpatient units were grouped into two Coordinating Committees – CUF and PPP. The CUF network is broken down into three geographical clusters – Descobertas, Tejo and Norte – in a rationale of coordination around the three large CUF Hospitals: CUF Infante Santo Hospital, CUF Descobertas Hospital and CUF Porto Hospital.

Who we areFounded in 1945, with the CUF Hospital, José de Mello Saúde operates in the healthcare sector in Portugal.

VisionTo be a leader in deliveringdistinctive quality health care supported by an integrated network of high-performance units, both in the private and public sectors, and presenting growth options in select markets.

MissionTo promote the provision of healthcare services with the highest level of knowledge, respecting the primacy of life and the environment, through the development of the intellectual capital of the organizations, in a permanent search for excellence.

Values

• Respect for human dignity and well-being• Human development• Competence • Innovation

Ethics

Business Ethics is a fundamental value of José de Mello Saúde, both due to the area in which it operates as well as to relevance of the theme for José de Mello Group. As an entity that provides healthcare, governed by principles of good management and transparency, striving for respect for customers, partners, shareholders

2 More information about the Ethics Council can be found in chapter ‘Governance Model’.


RELATÓRIO INTEGRADO 2017 6



From an organisational perspective, the hospital and outpatient units were grouped into two Coordinating Committees – CUF and PPP, with CUF network divided into three geographical clusters – Descobertas, Tejo and Norte – in a rationale of coordination around the three largest CUF Hospitals.

VISEU

COIMBRA

CUFPORTO

INSTITUTOCUF

CUF VISEU

CUF COIMBRA

CUFDESCOBERTAS

CUFINFANTE SANTO

CUFALMADA

CUFBELÉM

CUFMIRAFLORES

CUFSINTRA

CUFSÃO DOMINGOSDE RANA

CUFCASCAIS

CUFAlVALADE

CUFMAFRA

CUFTORRES VEDRAS

CUFSANTARÉM

CUF SÃO JOÃO DA MADEIRA

SANTARÉM

ALMADA

VILA FRANCADE XIRA

TORRES VEDRAS

LISBOA

PORTO

BRAGA

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CASCAIS

José de Mello Saúde


RELATÓRIO INTEGRADO 2017JOSÉ DE MELLO SAÚDE IN FIGURES 7

ONE YEAR IN NUMBERS

ADMISSIONS

EMERGENCIES

IMAGING EXAMS*

CHEMOTHERAPY SESSIONS

RAMI:RISK-ADJUSTED MORTALITY INDEX

SURGERIES

CONSULTATIONS

BIRTHS

RADIOTHERAPY SESSIONS

1,1 MILLION

658 THOUSAND

828 THOUSAND

21 THOUSAND

0,6

93 THOUSAND

2,4 MILLION

7.843

62 THOUSAND

0,48RARI:RISK-ADJUSTED READMISSIONS INDEX

José de Mello Capital

FundaçãoAmélia de Mello

Farminveste, S.A.

66%4%

30%

EMPLOYEES

OPERATING INCOME

DOWNLOAD’S APP MYCUF

HEALTHCARE UNITS

EBITDA

CALLS ANSWERED BY THE CONTACT CENTRE

INPATIENT BEDS

CONSOLIDATED INVESTMENT

OPERATING THEATRES

CONSULTATION ROOMS

8.058637,4M€ | +8,7%

345 THOUSAND

1972,0M€ | +5,3%

3 MILLION

1.543 190,3M€

92

1.165saudecuf.pt

* MRI, Ultrasound, CT and ECG

INSTALL IT NOW

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INTEGRATED REPORT 20178 MAIN INDICATORS

OPERATING INCOME

EBITDA

INVESTMENT IN R&D+I

ENERGY INTENSITY

HOURS OF TRAINING

No. OF VOLUNTEERS

DOCTORS IN MEDICAL INTERNSHIP

637,4M€

72,0M€

1,8M€

45 kgep/m2

133.314

65

485

Financial Capital (€)

Intellectual Capital

Natural Capital

Human Capital

Social Capital

2015

2015

2015

2015

2015

Operating Income

Investment in R&D+I (M€)

Electricity consumption (MWh)

Human Resources Indicators

Investment in the community (€)

Social indicators

Clinical Events and Education for Healthcare Indicators

Training Indicators

560,2

2,6

46.406

586,3

3

48.120

EBITDA

Medical Internship (No. Doctors)

Energy intensity (kgep/ m2)

Number of employees

Donations

63,5

316

47

7.055

212.000

68,4

785

49

7.469

218.537

EBIT

Clinical Trials (No. Trials)

Water Consumption (m3)

Women

Natural gas Consumption (MWh)

Men

No. of Volunteers

Hazardous waste accumulated (ton)

Number of Hires

Number of participants in training activities

Number of Hours of Training

Average hours per employee

42,2

n.a.

323.716

25.632

1.500

53

5.555

21.108

1.561

1.113

1.187

8.756

115.988

16,44

41,5

130

349,342

25.757

1.570

50

5.899

25.838

1.360

1.209

945

8.086

121.748

16,30

Net profit 21,9 23,9

2016

2016

2016

2016

2016

2017

2017

2017

2017

2017

CO2 emissions (tCO2)

Number of Hires

Main indicators 2017

637,4

1,8

50.185

72,0

485

45

8.058

286.746

42,6

124

368.392

22.873

1.683

65

6.375

21.334

1.797

1.252

1.205

16.831

133.314

16,54

22,8



INTEGRATED REPORT 201710 EXTERNAL ENVIRONMENT

3| 4| 5| 6| 8 e 10Portugal Eurosistema – Economic Bulletin – December 2017https://www.bportugal.pt/sites/default/files/anexos/pdfboletim/be_dez20176_p.pdf

7 e 9Autumn 2017 Economic Forecasthttps://ec.europa.eu/info/business-economy-euro/economic-performance-and-forecasts/economic-forecasts/autumn-2017-economic-forecast_en

External Environment

In 2017, Portugal followed the moderate economic growth trend recorded throughout Europe. The national Gross Domestic Product (GDP) recorded an annual variation rate of 2.6%, an amount that represents a year-over-year increase of 1.1 pp3 and is higher than the GRP’s growth estimate in the Euro area (2.2%). From 2018 to 2020, Portugal is expected to maintain its economic growth, albeit at a gradually lower rate: 2.3%, 1.9% and 1.7%4. Within three years, it is expected that the GDP will be 4% above the levels prior to the global financial crisis5.

Internally, the economic recovery remains supported by the acceleration of exports and growth of domestic demand. In 2017, public consumption grew 0.1% and private consumption grew 2.2% (with a variation of -0.5 pp and +0.1 pp, respectively, in comparison with the previous year). This last change reflects the growth in disposable income and the maintenance of consumer confidence at particularly high levels, resulting from the improvement in the labour market conditions. It should be noted that private consumption grew in line with disposable income, which resulted in a relatively stable savings rate that was up from previous years6.

Economic growth was reflected in a recovery of the labour market, with employment growing 3.1% year-over-year (+1.5 pp vis-à-vis 2016) and growing above estimated for the euro area (+1.5%)7 – the highest variation since 2008. The unemployment rate dropped to 8.9% in Portugal, down 2.2 pp year-over-year8, while it is believed to have been 9.1% in Europe9.

In 2018, Portugal is expected to continue to see growth in the annual employment rate, although at a slower pace, and to maintain the downward trend of the unemployment rate. The persistence of external and internal constraints, namely the burden of the debt, the adverse demographic developments and the inefficiencies in the labour and product markets, has prevented real convergence with the euro area10.

INTEGRATED REPORT 2017 11EXTERNAL ENVIRONMENT

11INE [National Institute of Statistics], Cont a Satélite da Saúde 2014 – 2016Pe https://drive.google.com/file/d/1QCbdSY3diCDaGJ6S90L6BlNYmLUw-eXP/view?pli=1

12Associação Portuguesa de Seguradores [The Portuguese Association of Insurers], Management Indicators – Health 2017.09 https://drive.google.com/file/d/1FajX9YpgAT7TW-D3YrqxtL7XWM8-4q2d/view?pli=1

opening CUF São João da Madeira Clinic and acquiring Clínica Particular de Coimbra, the future CUF Coimbra Hospital, a land in Sintra for the construction of the future CUF Sintra Hospital (which will replace the CUF Sintra Clinic), a land in Leiria for the construction of the future CUF Leiria Hospital and the surface rights of Hospital Ortopédico José de Almeida, in Parede, Cascais. The reinforcement of the growth strategy was also materialised in the construction of the future CUF Tejo Hospital and in the expansion of CUF Descobertas Hospital and of CUF Almada Clinic.

Regulatory and legislative changes with impact on the activityIn 2017 there were no regulatory and legislative changes with significant impact on José de Mello Saúde’s activity.

Healthcare IndustryIn 2015 and 2016, the current expenditure in health grew again in Portugal, recording, in nominal terms, an increase of 3.1% and 2.7%, respectively. In both years, and according to the Portuguese National Statistics Institute (INE), the nominal growth rate was below that of the GDP (3.7% in 2015 and 3.0% in 2016), a trend that has been observed since 2010.

In the same period, the growth ofpublic current expenditure was more pronounced than the private current expenditure. In 2015, public current expenditure grew 3.3%, with current private expenditure at 2.7%. Preliminary results for 2016 indicate a variation of 2.8% and 2.6%, respectively.

From 2014 to 2016, about 64.9% of current expenditure in healthcare was supported through funding schemes from the Public Administrations. In the past two years, the relative value of the public current expenditure grew slightly, standing at 66.2%. In 2016, the public current expenditure per capita was 1,061.15 euros, while the private one was 540.74 euros. To the contrary, the weight of the current expenditure of the Portuguese National Health Service and Health Sub-Regions (58.2% in 2014 and 57.2% in 2016) and households (27.7% in 2014 and 27.4% in 2016) declined slightly. On the other hand, there was an increase in the relative importance of the financing of insurance companies (4.0% of current expenditure in 2016, 0.4 pp more than in 2014)11.

The health insurance market confirmed the expected growth trend, with the number of insured people growing 11.4% between 2015 and 2016. The report from September 2017 recorded a year-over-year increase of 2.7%, with the number of insured people going from 2,262,257 to 2,324,371. This growth is mostly explained by the sharp rise in individual insurances, which grew 4.9%12.

In this macroeconomic scenario, and despite the persistence of external and internal constraints, in 2017 José de Mello Saúde was able to strengthen its aspirations of consolidating the CUF network,

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INTEGRATED REPORT 201712 DIALOGUE WITH STAKEHOLDERS

José de Mello Saúde has several mechanisms to interact with its stakeholders.

Stakeholder ReportingInteraction Mechanism

Main topics for the stakeholders

Shareholders

Funders

Payers

Portuguese Securities Market Commission (CMVM)

Suppliers

Portuguese Health Regulatory Authority

Meeting of the Board of Directors

Regular meetings, contract negotiations

Regular meetings, contract negotiations, administrative interactions

Investor Relations Office

Regular meetings, contract negotiations

Audits, surveys, clarification meetings

General Meeting

Specific meetings and events

Value creation

Financial sustainability

Access to private healthcare, Pricing

Compliance with applicable securities regulation

Contracts and Payments, risk and impact mitigation mechanisms, ethics and transparency

Regulation, Licensing, National Health Evaluation System (SINAS)

Periodic, thorough information

Ethics and transparency

Regular provision of institutional information (Institutional Communication, Integrated Report, Financial Statements Report, Clinical Quality Report and GRI Appendix)

Regular provision of information, Financial Statements Report

Webservices (electronic interaction means), Integrated Report, Financial Statements Report, Clinical Quality Report and GRI Appendix


Internal evaluation report of clinical consumables suppliers

SINAS Portal, Clinical Quality and Safety Report

Dialogue with stakeholders

INTEGRATED REPORT 2017 13DIALOGUE WITH STAKEHOLDERS



Regional Health Authorities (ARS – Ministry of Health)

Employees

Contract manager, annual contracting of the activity and performance indicators, biannual and annual performance evaluation report

Staff meetings

Corporate events

Welcome programme

+Talento Programme

+VIDA Magazine & Newsletters

CUF Academy

Employee satisfaction surveys

Breakfast meetings (with Chief Executive Officer and Directors of units)

Contact visit (with Chief Executive Officer)

Monitoring through people management systems (e.g., Performance Evaluation)

Meetings of Medical Council and Nursing Council

Contract compliance, accessibility, clinical quality and safety of the healthcare provided, continuous improvement of performance indicators

Evolution of José de Mello Saúde and growth strategies

Stability, prospects for professional and personal development, salaries, organization and working conditions

Monthly reports of activity and monitoring of performance indicators, annual patient and employee satisfaction surveys

People management processes within the company (performance evaluation, salaries, careers, training etc.)

Integrated Report, Financial Statements Report, Clinical Quality Report and GRI Appendix

Internal events

Internal channels of communication

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Customers

Customer Care Office, Customer’s Ombudsman

My CUF App

Contact Centre

Institutional and healthcare units websites

Accessibility to healthcare; Clinical quality and quality of service; Integrated offer; Accommodation and safety conditions of the units; Technological innovation

Customer satisfaction surveys

Phone number

Information leaflets

SMS

Institutional releases

+VIDA Magazine

Advertising campaigns

Smartphones

Innovation accelerators and Start-ups

Academic and Scientific Community

Collaboration or service agreements

Cooperation protocols, R&D activities in partnership, negotiation of contracts, clinical trials, observational studies, regular meetings

Channels of communication and marketing of units

Institutional publications

Strategic development challenges, support and investment models

Company’s performance, long-term commitment, Innovation and Sustainability

External events, boot camps, press releases, institutional information

Regular meetings, regular provision of institutional information (institutional communication, Integrated Report, Financial Statements Report, Clinical Quality Report and GRI Appendix)

Media Dialogue with the media Community impact, environmental and social impacts, Innovation


DIALOGUE WITH STAKEHOLDERS

INTEGRATED REPORT 2017 15



Industry associations

General public

Cooperation protocols, regular meetings, participation in working groups

Institutional and healthcare units websites, telephone and online communication channels

Company’s good practices; company’s strategy; Ethics and Transparency; signing of protocols

Portfolio of services, Innovation


Advertising campaigns, Regular provision of institutional information (Institutional Communication, Integrated Report, Financial Statements Report, Clinical Quality Report and GRI Appendix)

DIALOGUE WITH STAKEHOLDERS

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Materiality Matrix

José de Mello Saúde revisited its materiality exercise in 2017, identifying relevant key topics and collecting information that enables aligning the organization’s strategy to the expectations of the consulted parties.

Based on the recommendations of the Global Reporting Initiative (GRI), the process of drafting José de Mello Saúde’s materiality matrix helps to strengthen relationships of trust and dialogue with the stakeholders, to whom it is asked to help identify, select and prioritize the topics relevant to the organization.

The consultation of stakeholders, as well as the benchmark analysis and the analysis of the healthcare sector’s trends, enabled to identify 23 material topics, broken down into six major areas with impact on José de Mello Saúde’s value chain.

MATERIALITY MATRIX

15

15

20

25

30

35

40

45

50

55

60

65

70

20 25 30 35 40

Stakeholders Internos

Saúde e Bem-Estar da População SAÚDE

SOCIEDADE

ORGANIZAÇÃO DA EMPRESA

ECONOMIA

CIÊNCIA

AMBIENTE

Segurança do Doente

Prevenção da Doença

Capacitação do Doente

Desempenho Económico do Grupo

Atendimento das Urgências

Funcionamento em Rede de Unidades

Setor Social e VoluntariadoConsciência Ambiental

Formação dos Cuidadores/ Familia

Parcerias com a Universidade

Plano Integrado ao Longo da Vida

Gestão do RiscoE-Health

Financiamento de Formação Cientifica

Cidadania Empresarial

Atenção ao Colaborador

Conciliação vida pessoal/ vida profissional

Alinhamento com a Investigação Cientifica

Inovação e Investigação Terapêutica

Atenção e Cuidado ao Doente

Tendências Demográficas

Atração e Fixação de Talentos

Stakehold

ers Externo

s

45 50 55 60 65 70

INTEGRATED REPORT 2017 17MATERIALITY MATRIX

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Fornecedores de serviços (imateriais)

Fornecedores de serviços (materiais)

Seguradoras

Banca

Universidades

Comunicação Social e líderes opinião

Associações de Doentes

Outras Associações da Área da Saúde

Setor Social Solidário

Câmaras Municipais

Entidades Públicas do setor da Saúde

Politicos

Grupo José de Mello

Médicos

Enfermeiros

Técnicos de Saúde

Administrativos

Técnicos Superiores

Dirigentes

Auxiliares

Fornecedores de medicamentos, equipamentos e consumíveis

5 10 15 200

Characterization of the StakeholdersFor the analysis of stakeholders’ expectations, the following groups were consulted:

• External stakeholders (customers, suppliers and society): For customers, questionnaires were sent by email to those who visited a CUF unit in the previous month. In the case of suppliers, the largest suppliers per good/service were consulted. In terms of social context, a set of entities/personalities with long relationships with José de Mello Saúde was identified.

• Internal Stakeholders: the Human Resources Department selected the employees considering two criteria: diversity (job category, geographic, tenure in the company) and quality (people with key roles in the organization to help build a structured thinking about Corporate Social Responsibility).

In the process, 119 people were heard in person and 300 valid replies were received for the electronic questionnaires.

Caracterização da Amostra - Número de Participantes por Tipologia

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Commitment to the Sustainable Development Goals (SDG)

COMMITMENT TO THE SUSTAINABLE DEVELOPMENT GOALS (SDG)

The 2030 Agenda for Sustainable Development of the United Nations consists of 17 Sustainable Development Goals (SDG) and 169 targets. Approved in September 2015, it was signed by 193 members, including Portugal.

Considering that companies should also contribute to reaching these goals, José de Mello Saúde prioritized the SDGs, identifying those that can have the greatest impact considering the nature of its activity, and those that can be directly associated with the relevant topics identified by the stakeholders in the preparation of the materiality matrix.

Thus, José de Mello Saúde believes that its activity and strategy can have a greater impact on eight SDGs.

In this report, we identify the chapters/sections with relevant information for each of the eight SDGs. José de Mello Saúde considers, however, that its activity can contribute indirectly to other SDGs (for more information, see the Sustainability Report – GRI Appendix).

In 2018, a more extensive analysis of the strategy alignmentwith the SDGs will be carried out, considering the risks/impacts and opportunities in the value chain of José de Mello Saúde.

ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES

ENSURE INCLUSIVE AND EQUITABLE QUALITY EDUCATION AND PROMOTE LIFELONG LEARNING OPPORTUNITIES FOR ALL

PROMOTE SUSTAINED, INCLUSIVE AND SUSTAINABLE ECONOMIC GROWTH, FULL AND PRODUCTIVE EMPLOYMENT AND DECENT WORK FOR ALL

BUILD RESILIENT INFRASTRUCTURE, PROMOTE INCLUSIVE AND SUSTAINABLE INDUSTRIALIZATION AND FOSTER INNOVATION

ENSURE SUSTAINABLE CONSUMPTION AND PRODUCTION PATTERNS

TAKE URGENT ACTION TO COMBAT CLIMATE CHANGE AND ITS IMPACTS

PROMOTE PEACEFUL AND INCLUSIVE SOCIETIES FOR SUSTAINABLE DEVELOPMENT, PROVIDE ACCESS TO JUSTICE FOR ALL AND BUILD EFFECTIVE, ACCOUNTABLE AND INCLUSIVE INSTITUTIONS AT ALL LEVELS

STRENGTHEN THE MEANS OF IMPLEMENTATION AND REVITALIZE THE GLOBAL PARTNERSHIP FOR SUSTAINABLE DEVELOPMENT



INTEGRATED REPORT 201720 MESSAGE FROM THE CHAIRMAN

Continuing its strategy, José de Mello Saúde, in 2017, once again consolidated its leadership in the provision of healthcare of excellence in Portugal. We remain focused on quality and clinical differentiation, on flawless customer experience, on an efficient and sustained operation, on human development and on a growth agenda that generates value, crucial principles for us to serve the Portuguese people, asserting José de Mello Saúde as a partner for the development of the sector and of the country.

We are the largest national player in the healthcare sector, featuring a network with wide geographic coverage, which was reinforced in 2017 with the opening of CUF S. João da Madeira Clinic and the acquisition of Clínica Particular de Coimbra, currently CUF Coimbra Hospital. We have created the conditions to extend our activity to Leiria and Sintra, where we acquired land for the construction of the future CUF Leiria and CUF Sintra hospitals, the latter replacing the current CUF Sintra Clinic. We continued the works to expand the CUF Descobertas Hospital and the construction of the future CUF Tejo Hospital, in Lisbon, an investment of over 100 million euros, designed from scratch to fight and treat the Diseases of the Future.

Since its origin, José de Mello Saúde has been investing in a differentiating clinical project that is materialized daily in the clinical excellence of its units, where it guarantees a response centred on the patient. Annually, we subject the healthcare provided across the network to external evaluation, either by the assessment of the National System for Healthcare Evaluation (SINAS) or by applying clinical benchmarking models that evaluate via comparison the processes of clinical efficiency and quality. Two years ago we put in motion a project to measure clinical outcomes, which allows us to support a provision of healthcare based on results that are relevant for the patient. This project evolved into a clinical management model based on the creation of value in the provision of healthcare, the Value-Based Healthcare, which takes on a strategic role for our organization.

In the coming years, we will work to continue to expand this value cycle, increasing the monitoring of value in healthcare and investing in the Value-Based Healthcare model that contributes to measuring and supporting the results, putting the patient’s perspective at the centre of the decision.

MESSAGE FROM THE CHAIRMAN

Salvador de MelloChairman of the Board of Directors

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21MESSAGE FROM THE CHAIRMAN

José de Mello Saúde is, in fact, an agent of the NHS itself by running, under public-private partnership, the Braga and Vila Franca de Xira hospitals, which, in 2017, once again presented excellent results in clinical quality, being considered, respectively, the first and third Portuguese public hospitals with the highest number of maximum ratings in the National System For Healthcare Evaluation of the Portuguese Health Regulatory Authority.

We are therefore convinced that managing under the PPP model in healthcare is a success recognized by all the involved parties, with quality improvements, better access to healthcare and efficiency gains that are very important for the Portuguese Government and which must, in the future, be balanced between it and the private partner, ensuring the model’s sustainability.

I am elated by the work developed, in 2017, by the organization, which is increasingly prepared to face the challenges coming in the next few years. José de Mello Saúde is in a key moment of its history, with major achievements and a new and greater dimension of performance coming. Due to the corporate project we built and to all we have achieved as a team, I am confident that we will be able to meet the challenges the future will bring.

We also achieved other goals that enable us to consolidate José de Mello Saúde’s differentiating clinical project: CUF Oncology Institute secured the EUSOMA European certification as a Specialized Centre in the treatment of breast cancer in Portugal, and saw CUF Infante Santo Hospital recognized as a National Reference Centre for Cochlear Implants. CUF Viseu Hospital became the first private unit in the Centre of the country to receive the ISO 9001 certification from SGS for all of its services.

2017 also brought us significant achievements in the remaining strategic pillars of José de Mello Saúde’s performance. We continue working to ensure a flawless customer experience, which was once again recognized by the users, with CUF being once more the “Consumer’s Choice” in the Health & Well-being category and receiving the “Five Starts” and “Trusted Brand” awards in the Private Hospital category. Additionally, we reinforced our focus on a growing digital relationship with the customer through the launch of version 2.0 of the MyCUF application, now with more and better features, streamlining the customers’ relationship with CUF.

The efficient and consistent management of the operation, also a strategic pillar of José de Mello Saúde, has secured a solid performance in recent fiscal years and 2017 was not an exception. The operating income reached 637.4 million euros and EBITDA was 72.0 million euros, with growths of 8.7% and 5.3%, respectively, also resulting from a sustained growth trajectory in its assistance activity in the different areas of performance.

We continue to invest on human talent by attracting, training and promoting excellent professionals, one of the aims of José de Mello Saúde’s corporate undertaking. For example, in 2017, we launched the first edition of the Management for Doctors Course, we created the Aging discipline in Nova Medical School, within the scope of Tagus Tank, and we again rewarded research by granting five PhD scholarships in medicine amounting to 100 thousand euros, an unparalleled investment in postgraduate training in Portugal.

We know that an extensive and accessible network of private healthcare is important in the complementarity to the National Health Service, which will be both more efficient and sustainable as the relationship between the public and private services is greater.


INTEGRATED REPORT 201722 INVESTMENT CASE

INVESTMENT CASE

DIFFERENTIATING CLINICAL PROJECT

FLAWLESS CUSTOMER EXPERIENCE

The CUF network was awarded, for the second year in a row, with the “Consumer Choice” (Health & Well-being category), “Five Stars” and “Trusted Brand” prizes (in the Private Hospitals category);

CUF’s brand notoriety is higher than the competitors’ in terms of Top of Mind, Suggested Notoriety and Spontaneous Notoriety, according to studies carried out in June 2017;

Version 2.0 of MyCUF mobile application launched in 2017, with new and improved functionalities: scheduling of several medical acts at the same time, access to prescriptions and information about the nearest pharmacy;

Optimization of the access of CUF’s customers to their units, being possible for example, to perform automatic check-in and payment of medical acts through digital kiosks.

EFFICIENT AND CONSISTENT OPERATION

Through a strong effort to centralize and apply cross-cutting practices, José de Mello Saúde was the first operator in Portugal to implement a centralized purchasing department; In 2017, it created CUF Serviços, which includes Customer, Logistics and Operations areas, which facilitates the interconnection between corporate processes;

José de Mello Saúde’s operating blocks are provisioned via advanced logistics solutions;

José de Mello Saúde implemented a new approach to the development of Information Systems, based on Agile; Braga Hospital has the lowest operating cost per patient among all of the National Health Service’s hospitals, according to ACSS’s national benchmark;

Braga Hospital was awarded for the development, in cooperation with Vila Franca de Xira Hospital, of an innovative project to rationalize energy consumption;

Value Based Healthcare programme and monitoring of the value in healthcare in terms of pathologies: cataract, breast cancer and osteoarthritis of the knee;

EUSOMA certification of the CUF Oncology Institute, created in 2016, to enable an integrated and specialized approach centred on cancer patients and their family members;

ISO 9001:2015 quality certification in CUF Viseu Hospital and ISO 9001:2008 quality certification in CUF São João da Madeira Clinic, both obtained in the units’ first year of activity;

Gamma Knife Centre, equipped with a unique equipment in Portugal, highly differentiating in the treatment of brain tumours, arteriovenous malformations and metastases;

Renewal of the Joint Commission International (JCI) Accreditation at Vila Franca de Xira Hospital;

Recognition by the Portuguese Health Regulatory Authority of Braga Hospital and Vila Franca Hospital as the best and third best national public hospitals, classified through the National Health Evaluation System (SINAS).

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23INVESTMENT CASE

INVESTMENT IN HUMAN TALENT

With over 70 years of experience, José de Mello Saúde governs its performance with values such as Respect for the Person’s Dignity and Well-being, Human Development, Competence and Innovation, which guide the incessant desire to be and do better;

It maintained a close relationship with the academic community through the Tagus Tank consortium, created with Universidade Nova de Lisboa;

It created research programmes in Medicine and launched a set of lectures on Biolaw, promoted by the Associação de Estudos do Biodireito (ABIO), which resulted from the partnership with Nova’s Law School; For the fourth consecutive year, it awarded five PhD Scholarships in Medicine, amounting to 100 thousand euros, to doctors in José de Mello Saúde’s units and who are enrolled in PhD programmes in Medical Schools.

VALUE-GENERATING GROWTH AGENDA

José de Mello Saúde is the largest player in the domestic healthcare sector, having a network with high geographical coverage;

CUF network continued to expand in 2017 with the opening of CUF S. João da Madeira Clinic and the acquisition of Clínica Particular de Coimbra, future CUF Coimbra Hospital; Progressed with the construction ofthe future CUF Tejo Hospital; Designed from scratch to fight and treat the Diseases of the Future, this unit represents an investment of over 100 million euros;

Works to ensure the adaptation of existing units to the different regions’ levels of demand (e.g., expansion of the CUF Descobertas Hospital).

INTEGRATED REPORT 2017BUSINESS MODEL 24


BUSINESS MODEL

José de Mello Saúde provides healthcare supported by over 70 years of experience, based on a model that enables differentiation, through major hospitals which include sub-specialities in reference and convenience areas, via a network of local hospitals and clinics.

To be a leader in distinctive quality healthcare provision, based on an integrated network of high performance units, both in private and public sector, and to present options for growth in selected international markets.

The performance of José de Mello Saúde is governed by values such as Respect for the Person’s Dignity and Well-being, Human Development and Competence and Innovation.

VISION

VALUES

Academic and Scientific Community

Industry Associations

Local communities

Payers Suppliers Employees

Efficient andConsistentOperation

Value-generatingGrowth Agenda

Investment on Human

Talent

Strategic Pillars

OUTPUTS

Generation of shareholder valueThe capture of synergies and a strong focus on an efficient management enabled obtaining dividends of €20.6M.

Promotion and training of professionals:The remuneration of professionals exceeded €357M;

133,314 hours of training, an average of 16.54 hours per employee, were carried out;

Employee satisfaction is high: 75% are happy to be working in the company, according to the annual satisfaction survey.

Outstanding quality of service:Consumer Choice in the Health & Well-being category;

Portuguese Most Trusted Brand;

Five-Star Award in the Private Hospitals category.

Benchmark environmental performance:Braga Hospital was honoured with the EDP Electricity and Environment Prize, which awards good practices in the fields of energy efficiency and environmental sustainability;

Renewal of the ISO 14001 Environmental Certification in Braga and Vila Franca de Xira Hospitals;

Reduction of CO2 emissions by 16.8% in comparison with 2016.

Contribution to knowledge generation:A total of 124 clinical trials were carried out and PhD scholarships in medicine amounting to 100,000 euros were awarded;

€1.8M were invested in Research, Development and Innovation;

485 Doctors carried out their medical internship in José de Mello Saúde’s units.Consórcio

Consortium with Universidade Nova de Lisboa that reconciles hospital practice with teaching and research.

Excellence of clinical services:Award of the EUSOMA certification of the CUF Oncology Institute;Renovada a Acreditação

Renewal of the Joint Commission International (JCI) Accreditation of Vila Franca de

Xira – Recognition of the CUF Infante Santo Hospital as a National Reference Centre for Cochlear Implants;

The Service Quality Management system of CUF Viseu Hospital was certified by SGS under the ISO 9001:2015 standard.

Shareholders

Portuguese Health Regulatory

Authority

Regional Health

Authorities

Funders

DifferentiatingClinical Project

FlawlessCustomer

Experience

Financial capitalManages the activity seeking to optimize efficiency in the management of financing and results.

INPUTS

Human capitalEnsures the promotion and recognition of its 8,058 employees, encouraging collaboration, competence and rigour.

Technological and manufactured capitalUses tangible and intangible technological resources to implement its activities, supported on its own real estate which includes 19 healthcare units, 1,165 consultation rooms, 92 operating theatres and 1,543 inpatient beds.

Social and relational capitalWorks with elements of the scientific and innovation ecosystems (start-ups and others), boosting its research, development and innovation activities to identify opportunities for differentiation.

Natural capitalPromotes the sustainable use of natural resources, namely energy and water, preventing pollution and promoting proper waste management.

Intellectual capitalDevelops education and training programmes with the goal of permanently updating its professionals and the scientific and medical community.

Uses management practices that generate efficiency, such as standardization in the use of consumables across healthcare units and the optimization of a billing alarm system.

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INTEGRATED REPORT 2017STRATEGY, ACHIEVEMENTS AND GOALS 25


STRATEGY, ACHIEVEMENTS AND GOALS FOR 2018

MATERIALIZED IN 2017

PLANNED FOR 2018

DIFFERENTIATING CLINICAL PROJECT

FLAWLESS CUSTOMER EXPERIENCE

EFFICIENT AND CONSISTENT OPERATION

VALUE-GENERATING GROWTH AGENDA

INVESTMENT IN HUMAN TALENT

Excellent clinical performance consistent across the network, with differentiated offer in CUF Hospitals.

High satisfaction indices across the network, maximising the focus on digital as a mean for convenience and effectiveness.

Creation of network synergies, reaching EBIT efficiency levels in line with the most efficient players of the market.

Consolidation of the leadership position in the Portuguese market, leveraging value-generating growth opportunities.

Reinforcement of the value proposition, attracting, creating and promoting excellent professionals.

EUSOMA Certification of the CUF Oncology Institute;

Recognition of CUF Infante Santo Hospital as a National Reference Centre for Cochlear Implants;

Increase in the number of pathologies with single protocol and systematic measurement of clinical outcomes;

Renewal of the Joint Commission International (JCI) Accreditation at Vila Franca de Xira Hospital;

ISO 9001:2015 certification of CUF Viseu Hospital and ISO 9001:2008 quality certification of CUF São João da Madeira Clinic, both obtained in their first year of activity.

Accreditation by the Joint Commission International (JCI) of CUF Porto Hospital;

Value-Based Healthcare: increase in the number of pathologies in measurement and implementation phase.

Preparation of the RGPD (Regulamento Geral sobre Proteção de Dados – General Regulation on Data Protection) audit;

(Award-winning) rationalization of the energy consumption in Braga Hospital;

Renewal of the ISO 14001 Environmental Certification in Braga and Vila Franca de Xira Hospitals.

Centralization of the Logistics Process;

Reorganization of the core systems in a single information system for the entire network, homogenizing procedures and processes;

Maintenance of the ISO 14001 Environmental Certification in Braga and Vila Franca de Xira Hospitals.

Opening of CUF S. João da Madeira Clinic;

Acquisition of Clínica Particular de Coimbra, future CUF Coimbra Hospital

Continuation of the expansion of CUF Descobertas Hospital;

It continued to build the future CUF Tejo Hospital;

Expansion of the CUF Almada Clinic;

Acquisition of land in Sintra for the construction of the future CUF Sintra Hospital (CUF Sintra Clinic);

Acquisition of land in Leiria for the construction of the future CUF Leiria Hospital;

Acquisition of the surface rights for Hospital Ortopédico José de Almeida, in Parede, Cascais.

Opening of CUF Descobertas Hospital’s new building;

Opening of the new CUF Sintra Hospital;

Opening of the new CUF Coimbra Hospital;It continued to build the future CUF Tejo Hospital;

Reinforcement of the interaction with the innovation ecosystem (start-ups and others) to capture differentiation opportunities.

1st Edition of the Management for Doctors course;

Creation of the Aging discipline in Nova Medical School, under Tagus Tank.

Creation of research programmes in Medicine;

Award of 100 thousand euros in medical PhD scholarships.

Launch of the group’s new Intranet portal, optimizing the means of communication and collaboration among teams and professionals.

Launch of version 2.0 of MyCUF, with more and better features;

“Consumer Choice” (Health & Well-being” category), “Five Stars” and “Trusted Brand” (Private Hospitals category) prizes.

Continuation of the focus on a growing digital relationship with the customer, leveraged on the My CUF App;

Reassignment of the consumer awards.

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INTEGRATED REPORT 201726 RESEARCH, DEVELOPMENT AND INNOVATION

Research, Development and Innovation (R&D+I) is as an essential asset in sustaining a competitive offer that exploits new solutions that generate differentiation and value for José de Mello Saúde’s customers and professionals.

Starting from the five strategic pillars of José de Mello Saúde, multiple activities are promoted to foster innovation (incremental, planned exploratory and scientific activity) and training (pre and post-graduate and clinical and educational events for health), the latter being carried out through the CUF Academy, José de Mello Saúde group’s company responsible for research, training and teaching in the group’s healthcare units and in other external entities that deal with it for this purpose.

Innovation, a mission shared by all: José de Mello Saúde’s investment in spreading a culture of innovation with its employees has been materializing since 2012 with the i9+ Programme, which enables any member of the organization to contribute ideas that improve the company’s activities or create products and/or processes. The proposals must fit within the company’s strategic pillars or respond to specific challenges launched each year. The best ideas are recognised at the annual i9 + Innovation Afterhours event, where the authors present an Elevator Pitch to the organization and to a jury that will choose the year’s three best ideas.

RESEARCH, DEVELOPMENT AND INNOVATION

Nº of ideas submitted

2014 101

2015 227

2016 274

2017 346

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27RESEARCH, DEVELOPMENT AND INNOVATION

Vila Franca de Xira Hospital initiated a project designed to monitor, in an articulated and integrated way, children with diabetes under hospital care, in primary healthcare and schools. The programme includes training and support actions for children and families, as well as training actions in the schools directed to professionals who accompany children with diabetes.

Digital access in permanent evolution: MyCUF service, created in 2013, enables an effective and convenient interaction between the customers and the administrative services of CUF. In a personal online area, accessible via Web or mobile (App), customers can safely access a set of features and information about their activity in the CUF units, including scheduling of appointments, receiving results of exams, consulting prescriptions and payments. In 2017, it became possible to carry out simultaneous appointments for several medical acts in the same day, identifying favourite doctors, knowing in real time the waiting times in 24-Hour Service of the several units and/or search on-duty pharmacies.

Promotion of entrepreneurship in the healthcare sector: In 2017, the Grow programme was launched. Operating across all subsidiaries of José de Mello Group, Grow focuses on the areas of Mobility, Health and Chemicals. Seeking to provide a selected set of start-ups with access to the Group’s knowledge, experience and infrastructure. Grow enables the development of joint pilot projects, as well as testing and adaptation of products and services in a real market environment.

In parallel, the creation of a Mentor Pool is useful to start-ups, providing them systematic monitoring by people with considerable experience and expertise in the areas of business management and/or other areas of expertise. Start-ups are chosen based on their ability to respond to challenges and priority areas for the development of the group’s organizations, considering the relevant strategic pillars.

In 2017, three questions were analysed: “how to meet the needs of the chronic patient?”, “how to increase customization in healthcare?” and “how to increase the efficiency of task management in the units?”. The winning idea proposed the creation of a “customer post-operative online channel”, which will enable direct communication between the post-operative patient and the surgical nursing post, supporting the patient during the recovery period. It will be implemented in 2018.

Continuous innovation in the units: Considering the specific day-to-day needs of each unit of José de Mello Saúde, countless innovation projects promoted directly by the clinical teams were materialised throughout the year. Of these, we highlight five projects launched in 2017:

An epilepsy surgery group was created in CUF Descobertas Hospital, covering the entire process in an integrated and multidisciplinary way, with advanced patient monitoring. Under inpatient care, the patient remains under constant supervision, with the brain’s electrical activity and behaviour being recorded continuously via high-definition video;

CUF Infante Santo Hospital has established a protocol of cooperation with Hemocircuitos, Lda., seeking the creation of a centre of excellence capable of implementing Extracorporeal Life Support (ECLS) in its multiple aspects. The centre will be able to transfer patients from other institutions who are candidates for ECLS techniques, with a response time of less than 12 hours, with referrals at country level. There are already two referral poles supporting ECLS within the NHS, with this third centre seeking to be an option in the private national health system;

Intensive online programmes were developed at CUF Porto Institute for cognitive training of patients with memory loss and other cognitive problems. These programmes, created in articulation with Neuroinova, will be complemented by in-person and group sessions, and contemplate the constant supervision of the patients by highly skilled professionals;

The latest ophthalmic technology to treat cataracts was established in CUF Porto Hospital, for the first time in Portugal. In Cataract Surgery with implantation of Trifocal lens, the eye lens is replaced by an intraocular lens that will correct all refractive errors, enabling since at three distances: close, medium and far.



Through Grow Health, the area of the programme focused onthe healthcare area, José de Mello Saúde surveyed 280 start-ups. The detailed analysis of 137 start-ups led to seven mentoring sessions and six pilot projects, with an emphasis on Nutrium and Sword, which developed pilots in some of José de Mello Saúde’s units. Nutrium developed software that simplifies everyday tasks of nutritionists. Complemented by a mobile application which supports and motivates the patients in the execution of their food plan, the software enables remote medical support. As for Sword Health, it created a solution that enables the autonomous execution of physiotherapy exercises, with support from a set of sensors placed on the area of the body that is in recovery and from a tablet that provides the exercise plan in real time. Nutrim’s project is framed by the Efficient and Consistent Operation strategic pillar and they both contribute to a Flawless Customer Experience.

Being a lever for the paradigm shift within the organization, Grow proves to be crucial to guide José de Mello Saúde’s innovation strategy according to current trends, opening the Group up to new domestic and foreign players. In addition, Grow reinforced José de Mello Saúde’s proximity with the start-up ecosystem, namely in the areas of health and well-being, through presence in multiple events of entrepreneurship and innovation (Health Cluster Portugal, Lisbon Investment Summit, Scale Up Porto, Web Summit, GIANT Health Event, for example) and of the academic community, namely via the initiatives promoted by Católica Lisbon School of Business and Economics, Instituto Superior Técnico, MIT Portugal and College of Science and Technology of Universidade Nova de Lisboa. In 2017, partnerships were also developed with Bright Pixel, Impact Hub and Microsoft, leading to the launch of challenges in acceleration programmes and hackathons.

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The number of medical students who interned units amounted to 2,084:

In terms of Postgraduate Training, José de Mello Saúde received 485 internal doctors, distributed as follows:

Continuous investment in training, research and development: José de Mello Saúde’s formative activity is centred in CUF Academy, created to value and reinforce the knowledge and skills of the Group’s healthcare professionals. Based on principles of thoroughness and ethics and in the highest standards of quality and knowledge, CUF Academy positions itself as a Centre of Reference in the healthcare sector and develops its activity with domestic and foreign players.

In partnership with the main universities, CUF Academy promotes training and scientific events seeking the permanent sharing, update and innovation of the medical and scientific community. Within the scope of Undergraduate Training, in 2017, José de Mello Saúde received 3,170 interns:

Professional Group

Medical Students

Internal of the common year

Especiality Interns

Other Interns

Total

922

0

14

0

14

1162

101

221

149

471

2084

101

235

149

485

CUF

CUF

PPP’S

PPP’S

Medical Students

Internal Doctors

Profissional Group

Medical Studentsand Doctors

9 313 322

Other Groups

Total

1 2Administrative

Ther. Diag. Tec

Ther. Health. Tec

Auxiliary

Nursing

Others

78 0

27 196

52 41

181 395

684 843

63 285

1095 2075

3

78

223

93

576

1527

348

3170

CUF PPP’S Number of Trainees




In terms of soft skills, José de Mello Saúde maintained a strong focus on the “Cuidar Mais” Movement, working on communication and empathy skills with all of their professional groups:

Throughout the year, around 17,000 people participated in the 378 events promoted by CUF Academy, including Clinical Events, More Knowledge Sessions and Education for Health Events.

Seeing the relationship with academic community and the scientific community as an essential means of generating and sharing knowledge, José de Mello Saúde has 39 partnerships with multiple R&D+I entities. Similarly, for the fourth consecutive year, five PhD scholarships amounting 100,000 euros were assigned, with this investment in research being the only one of its kind in Portugal.

Number of Events

Number of Events

Number of Events

Number of Events

Number of Participants




76

131

121

328

6028

0

3752

11809

24

0

26

50

2269

0

2753

5022

100

131

147

378

8 297

0

6505

16 831

CUF PPP’S TotalClinical Events

More Knowledge

Education for Health Events

Total

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José de Mello Saúde’s clinical trials started in 2011, having presented a gradual and sustained growth throughout the past seven years. The existence of a Central Legal Department and an Ethics Committee in each unit enables the Academic Research Core of CUF Academy to present very competitive approval periods.

26

32

8

7

71

104

24

2

97

136

32

9

Total CUF Total PPP’S Total

Clinical Trials

Clinical Trials

Observational Studies

Observational Studies

Ongoing

Feasibility

Welcome to new Employees

Integration

Cuidar + | FOCUS

Cuidar + | Train the Trainers (Doctors and Nurses)

Cuidar + | Líder Care

Other (Triagem Manchester e Peri-operatório)

Total

474

307

42

68

3318

349

677

16

0

0

14

2637

823

2441

323

216

42

82

5955

CUF PPP’S Nº de Colaboradores JMS

1764

216

Gazeta Médica: 4 editions

Book “Angiology and Vascular Surgery”by Dr. Armando Mansilha

Indexing Process in SCIELOand DOAJ

Funded by the Active and Assisted Living (AAL) Programme, Clockwork aims to create a support system and to improve the living conditions of the shift workers. Using mobile devices, sensors and intelligent lighting systems, the project seeks to gather parameters of the daily and professional life of its workers, proposing adjustments in lighting and supporting their reflection and self-awareness. The project also has a second Portuguese partner, Fraunhofer Portugal, and partners from Spain, Italy and Hungary.

20 since 2014

97 in progress

32 observational studies in progress

SCIENTIFIC PUBLICATIONS

I&DCONSORTIA

DOCTORALSCHOLARSHIPS

CLINICALTRIALS



INTEGRATED REPORT 201732 RISK MANAGEMENT, MAIN RISKS AND UNCERTAINTIES

José de Mello Saúde’s risk management policy is based on the International COSO (Committee of Sponsoring Organisations of the Treadway Commission) methodology. Clinical risk, specific to the healthcare activity, is added to the four categories defined in the methodology. Through this policy, an integrated and effective risk management strategy is established, ensuring the recognition of the risks and opportunities associated with the organization’s operations.

The identification of the risks allows to develop actions that minimize the negative impacts of possible unfavourable factors underlying these risks in the financial structure and sustainability of José de Mello Saúde. The risk management policy also enables maximizing the effects of the identified opportunities.

By decision of the Board of Directors, the Audit and Risk Management Committee was established in February 2017.

A risk (re)assessment process is on-going and should be completed in 2018. Developed by the business areas, with the sponsorship of the Executive Committee, this exercise aims to: (i) update the risk matrix, (ii) identify and quantify possible impacts, and (iii) strengthen the explicit connection to mitigation strategies.

RISK MANAGEMENT, MAIN RISKS AND UNCERTAINTIES

External and Internal Context

EXTERNAL CONTEXT

INTERNAL CONTEXT

Public-private partnerships Competition Laws and Regulations

Healthcare ProvisionAdmission

Clinical

Liquidity, financingand interest rates

Information security andavailability of the

information systems

Innovation Revenue Recognition

Discharge

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33RISK MANAGEMENT, MAIN RISKS AND UNCERTAINTIES

Reference

1

3

5

2

4

Strategy

Operational

Compliance

Clinical

Financial

Risks associated with the decision-making process/strategic information

Risks associated with infrastructure and processes that support the operation

Risks associated with non-compliance with statutory, legal and fiscal regulations,citizenship, ethics, as well as with policies and procedures of José de Mello Saúde

Risks associated with the social assistance processes (all activities that competedirectly/indirectly for the clinical act)

Risks associated with the management of financial resources, balance sheet,financial/fiscal reporting, taxes and insurance

Category Description

Risk

The risk of non-compliance with legislative and regulatory changes applicable to José de Mello Saúde and/or internal policies can lead to losses, fines and reputational damages.

Innovation, especially in the healthcare market, dictates the organizations’ success. The inability to keep up with the pace of innovation may have negative impacts for José de Mello Saúde, both in terms of clinical quality and in terms of the portfolio of services provided.

There are several operational factors which may lead to excesses or deficits in terms of revenue recognition.

Monitoring by the Legal Department of legislative and regulatory changes and communication to the operational managers of the impacted areas, using external experts whenever necessary.

Strategies for relationship with stakeholders.

Supervision by the Executive Committee and by the Board of Directors

Establishment of the Department of innovation, integrated into the Planning and Management Control Department, seeking to:

Foster cross-cutting innovation;

Coordinate and implement strategic initiatives with impact in the short, medium and long term, seeking to create value for José de Mello Saúde and for the stakeholders.

Creation of the I9+ programme for the capture and implementation of innovative ideas. I9+ provides for the presentation of ideas by José de Mello Saúde’s employees on a dedicated platform. The ideas, whose feasibility will be evaluated, should be in line with the company’s strategic pillars;

Establishment of cooperation agreements with major Portuguese universities, especially in the areas of Medicine and Health Sciences, seeking to create value through synergy maximization.

Creation of the Grow Programme to support start-ups, with the purpose of reinforcing the connection to the innovation and entrepreneurship ecosystem, supporting and accelerating the development of innovative projects in the healthcare and well-being areas, through the access to unique knowledge, experience and infrastructure of José de Mello Saúde.

Establishment of the Business Assurance Department, currently integrated in the Operations Department, whose main objectives are: Monitoring of operations at the transaction level (use of alert software);

Assessment, design, and control over the implementation of billing and registration procedures, with the support of the Commercial Department which evaluates the suitable context for the contractual arrangements in effect with the responsible financial entities (insurers and subsystems), as well as other relevant impacts in the relationship with individuals.

1

5

1

2

3

3

Description Mitigation strategies Category

Legal and Regulatory

Innovation

Recognition of revenue



Risk

The provision of healthcare services, in accordance with the best practices, technological excellence, and the latest and proven scientific developments in the prevention, diagnosis and treatment of the disease have an increasingly greater level of complexity and therefore a greater risk of causing damage. Damage whose clinical result deviates from the plan, and may prolong hospitalization and temporarily or permanently affect the patient’s functional state.

In hospitals, the risk of worsening sickness, including the risk of cardiorespiratory arrest is real, both for hospitalised patients and for those in outpatient care. An immediate start of basic life support and, when indicated, defibrillation upon detection of a cardiorespiratory arrest, significantly decrease the risk of associated morbidity and mortality.

Infections associated with healthcare are a risk present in the activity to which the utmost vigilance is given in order to provide proper prevention and treatment.

The possibility of critical situations such as epidemics, disasters and accidents with multiple victims are risks sized according to the type, characteristics and location of each unit.

Constitution of the Safety in Health Programme;

Consolidation of the implementation of the national programme for patient safety 2015-2020;

Evaluation of the culture of patient safety in the hospitals according to regulation 025/2013 DGS;

Promotion of the notification system for adverse events;

Adjustment of processes based on near-incidents;

Analysis of root causes for adverse events with damages;

Risk assessment of major processes (HFMEA – Failure Mode and Effect Analysis);

Monitoring of clinical indicators of process and outcomes;

Morbidity and mortality meetings;

Implementation of the early warning scale for adults and children;

Training of all employees in basic life support;

Internal emergency team trained in adult and paediatric advanced life support that ensures defibrillation in 3-5 minutes after collapse, both in inpatient and in outpatient contexts, including not only for the patients but also for people accompanying them, visitors and employees.

Establishment of the Local Coordination Groups of the National Infection and Antimicrobial Resistance Prevention and Control Programme;

Epidemiological surveillance;

Monitoring of the basic precautions regarding infection control and of the precautions based on the routes of transmission;

Implementation of the infection prevention bundles associated with medical devices;

Promotion of proper usage of antimicrobials.

Outbreak and epidemic management protocol;

Internal and external emergency plan;

Execution of simulacra;

Training of the teams.

2

Description Category

Clinical

Mitigation strategies


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Risk

The information and security of data are critical success factors. The risks, including cyberattacks, are related to improper access to information systems and the integrity and confidentiality of the data. The breach of information systems, as well as other factors, can lead to their unavailability, which may prevent their use and interrupt the normal course of operations.

José de Mello Saúde manages under PPP the Braga and Vila Franca de Xira Hospitals, whose contracts expire in 2019 and 2021, respectively. The renewal of these contracts depends on the will of third parties and of contractual conditions to be negotiated.

Inadequate management of treasury needs, impossibility of accessing external funding and exposure to variable interest rates may result in the failure to ensure the commitments entered into with third parties.

The pressure and uncertainty generated by competitors already in the market and by those that may appear with their own strategies to approach the market.

Access management controls;

Definition of development/change management processes; •

Monitoring of compliance with service level agreements signed with third parties;

Monitoring and supervision;

Project management teams with experience;

Implementation of the Business Continuity and Disaster Recovery policy.

Implementation of a programme for alignment to the General Data Protection Regulation

Development of a culture of clinical excellence, through the definition of the processes necessary to ensure the provision of top quality healthcare services;

Permanent monitoring by the management with a focus on maximising the efficiency of the operation;

Careful assessment of the impacts of the decision;

Strategies for relationship with stakeholders.

Permanent monitoring of treasury forecasts through active management of the business plan, which allows comprehensive mapping of the treasury needs and surpluses in the short, medium and long terms;

Permanent relationship with financial partners;

Selection of the strategies suitable for every business area in order to ensure that the exposure to variable interest rates does not affect negatively their respective operational capacity;

Use of financial derivative instruments to cover the risks of variation in interest rates;

Funding sources diversification.

Strategic planning;

Proactive monitoring of the market;

Development of a culture of clinical excellence, through the definition of the processes necessary to ensure the provision of top quality healthcare services;

Permanent monitoring of the operation with the goal of maximising its efficiency levels.

3

1

4

4

1

Description Mitigation strategies Category

Information security and availability of the information systems

Public-Private Partnerships

Liquidity, financing and interest rates

Competition




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37PERFORMANCE

Operational performance

Healthcare service provision indicators of José de Mello Saúde

Consultations 2.434,12.208,6 10,2%

Emergencies 658,2638,2 3,1%

Patients operated on

Days of hospitalisation

92,886,3 7,5%

Discharged patients

Births

75,273,8

470,0461,7

7,87,8

2,0%

1,8%

0,9%

20172016* Var %(thousands)

It does not include patients discharged from UCIPs*Pro-forma values based on the current activity accounting methodology

13Considers gross financial debt less cash and cash equivalents and other financial instruments

In 2017, José de Mello Saúde maintained a trajectory of sustained increase across its healthcare activity in the different fields of action. Over 2.4 million appointments were recorded (10.2% increase versus 2016), 92,800 surgeries (+7.5% year-over-year) andapproximately 75,200 patients discharged from hospitalisation (+2% more than in the previous year). There was also a slight increase in the number of births , which improved by 0.9% vis-à-vis the previous year.

CUFIn the private sector, JMS registered over 1.8 million appointments (increase of +12.6%), 52.9 thousand surgical patients (improvement of +10.4% year-on-year) and 36 thousand patients discharged from hospitalisation (+6.7% than in 2016) were recorded.

Public-Private PartnershipsIn the public sector, hospitals managed under public-private partnership, there were around 596 thousand appointments (+3.4% vis-à-vis 2016), 39.9 thousand surgical patients (+4.0% in comparison with 2016) and 39.2 thousand patients discharged from hospitalisation (-2.0% vis-à-vis 2016).

PERFORMANCE

Economic performance

Executive summaryThe 2017 financial year was characterised by a strong operating and financial performance, with an emphasis on the following facts:

Operating income was 637.7 million euros, an increase of 8.8% vis-à-vis 2016; in the private activity, we recorded an increase of 9.9% over the previous year, to 408 million euros. In the public sector, operating income was 227 million euros, growing 4.4% in comparison with the previous year;

EBITDA was 72.0 million euros, an increase of 5.3% versus 2016, driven by growth in the healthcare activity;

EBITDA on the private activity grew from 56.6 million euros to 60.9 million euros (+7.5%);

In the public sector, despite growth in operating income, EBITDA decreased by 1.5 million euros, to 7.8 million euros. EBITDA margin was 3.4%, a decrease of 0.8 pp;

Consolidated net profit was 22.8 million euros, a decrease of 1.1 million euros in comparison with 2016;

Total assets increased by 242.5 million euros (+48.2%) compared to the end of 2016, a consequence of the increase in tangible fixed assets (+188.6 million euros);

José de Mello Saúde’s consolidated investment was of 188.3 million euros;

On 31 December 2017, net financial debt stood at 338.6 million euros, resulting in a Net Debt to EBITDA ratio of 4.7x..


INTEGRATED REPORT 201738 PERFORMANCE

Consolidated results

Income Statement

Operating Income

EBITDAR

EBITDA**

EBIT

EBT

Net Profit

Net profit attributable to José de Mello Saúde shareholders

Operating Costs*

Margem EBITDAR

EBITDAR Margin

EBIT Margin

Depreciation and Provisions

Financial Results

Taxes

Net profit attributable to non-controlling interests

637,4

83,8

72,0

42,6

32,1

23,3

22,8

586,3

79,4

68,4

41,5

32,6

24,2

23,9

8,7%

5,6%

5,3%

2,5%

-1,7%

-3,8%

-4,6%

51,2

4,4

3,6

1,1

-0,5

-0,9

-1,1

(565,4)

13,2%

11,3%

6,7%

(29,4)

(10,5)

(8,8)

0,5

(517,9)

13,5%

11,7%

7,1%

(26,8)

(8,9)

(8,4)

0,3

-9,2%

-9,6%

-18,0%

-4,3%

67,1%

(47,5)

-0,4%

-0,4%

-0,4%

(2,6)

(1,6)

(0,4)

0,2

20172016 Var. %Var.(Million Euros)

*Total menos Amortizações e Provisões** Resultados Operacionais mais Amortizações e Provisões

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The operating income of José de Mello Saúde reached 637.7 million euros, increase of 8.8% versus the same period in 2016, following the strong performance across all areas of healthcare activity. Operating costs amounted to 565.7 million euros, 9.2% more than in the previous year, mainly due to the 10% increase in personnel costs and fees.

As a result of this growth in operating income, especially in the private sector, EBITDA and EBIT improved to 72 million euros (+5.3% compared to 2016) and 42.6 million euros (+2.5% compared to the previous year), respectively. However, there has been a reduction in EBITDA (-0.4 pp) and EBIT (-0.4 pp) margins’, since the increase of operating income did not yet compensate for the increase in the fixed costs structure, as a result of the opening of new units in the past two years (CUF Viseu Hospital and CUF Almada Clinic in 2016 and CUF São João da Madeira Clinic in 2017).

CUFIn the private sector, Operating income reached 408.1 million euros (+9.9% than in 2016), as a result ofgrowth acrossall healthcare activities, with an EBITDA of 60.9 million euros and EBITDA margin slightly decreasing by 0.3 pp, now standing at 14.9%.

Public-Private PartnershipsVila Franca de Xira Hospital maintained its positive operating performance, with a 1.6% growth in operating income vis-à-vis 2016. However, EBITDA decreased 1.4 million euros, as well asthe EBITDA margin, which was 7.4% in 2017 (-2.3 pp vis-à-vis 2016).

Operating income of Braga Hospital reached 161 million euros (+5.6% vis-à-vis 2016) whereas the EBITDA margin fell to 1.8% (-0.1 pp vis-à-vis 2016). 2017 was the second consecutive year in which Braga Hospital presented a negative result of around 4 million euros. This situation is driven by ARS North’s non-renewal of the vertical funding programmes for HIV and Multiple Sclerosis, with an approximate value of 7.5 million euros per year. A Request for Financial Recovery was cautiously lodged at the end of 2016 for the purposes of clause 127, paragraph 9, subparagraph (b) of the Management Contract, seeking the beginning of an arbitration process for the settlement of this dispute. We believe a favourable result for Escala Braga is very likely to come from this arbitration process, with our estimate of this contingent asset being 15 million euros.

Indicadores Assistenciais da José de Mello Saúde

Consolidated financial results (10,5)(8,9) -18,0%

Financial income 1,00,5 83,2%

Income/costs for Financial Assets 0,70,7 10,7%

Financial Costs (12,2)(10,1) -20,9%

20172016* Var %(Million Euros)

As a reflection of the strong investment taken place during 2017, and the subsequent increase in financial costs, financial results were negative by 10.5 million euros (1.6 million increase versus 2016).

Thus, José de Mello Saúde’s net profit was 22.5 million euros, which represented an annual decrease of 1.4 million euros (-5.7%) in comparison with 2016.

PERFORMANCE



InvestmentThe total investment carried out in 2017 was €190.3 million. The most relevant investment amounted to €142 million and was due to the acquisition of real estate operated by José de Mello Saúde, belonging to the ImoSaúde Closed Real Estate Investment Fund and to the ImoSocial Closed Real Estate Investment Fund. In addition, 7.6 million euros were invested in the acquisition of four companies that provide healthcare in the regions of Almada, São João da Madeira and Coimbra, and in another company holding a property in the region of Sintra.

The expansion investment, both organic, with the expansion works in CUF Descobertas Hospital, CUF Torres Vedras Hospital and CUF Santarém Hospital, and geographical, with the opening of CUF Almada Clinic and with the construction of CUF Tejo Hospital, totalled 27.9 million euros.

Recurrent investment, mostly for technological replacement and update, reached €12.9 million (+0.9 million euros than in 2016).

Financial Situation

Fixed Assets

Current Assets

Total Assets

452.5

292,9

745,4

43,9

14,2

13,4

122,9

378,4

3,3

16,7

0,2

47,7

0,8

35,3

8,3

52,7

3,8

3,7

252,5

250,4

502,9

33,4

11,3

12,9

95,4

189,8

5,1

13,5

0,2

16,1

0,5

48,7

8,3

60,4

4,3

3,2

200,0

42,5

242,5

10,5

3,0

0,5

27,5

188,6

-1,8

3,2

0,1

31,6

0,3

-13,3

0,0

-7,7

-0,5

0,6

20172016 Var. %(Million Euros)

Goodwill

Stocks

Intangible

Clients

Tangible

Other Debtors and Creditors

State

Other investments

Other Financial Instruments

Deferred Tax Assets

Investments in Subsidiaries

Cash and Cash Equivalents

Other MLP Assets

Other Current and Non-current Assets

Assets Held for Sale

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Total Liabilities

Equity

Financial Liabilities

92,4

653,0

53,0

26,5

22,8

-14,1

4,2

421,6

351,6

70,0

81,7

421,2

53,0

12,2

23,9

-11,4

4,0

219,6

150,0

69,6

10,8

231,8

0,0

14,3

-1,1

-2,7

0,3

202,0

201,6

0,4

20172016 Var. %(Million Euros)

Capital + Additional Payments

Retained Earnings + Reserves

Net Profit

Interim Dividends

Leasing

Minority Interests

Loans

Non-Financial Liabilities

Liabilities + Equity

231,4

745,4

1,4

12,3

94,5

10,8

22,0

11,7

78,7

201,6

502,9

1,5

14,0

87,5

8,5

19,3

2,9

67,9

29,8

242,5

-0,1

-1,8

7,0

2,3

2,7

8,9

10,8

Pension fund

Provisions

Suppliers

Other debtors and creditors

Deferred Liabilities

State

Accruals and Deferrals (liabilities)

Total assets increased 242.5 million euros (+48.2%) in comparison with the end of 2016, reaching 745.4 million euros. This variation was largely due to the increase in tangible fixed assets (+188.6 million euros), on the back ofthe various expansion works and the acquisition of properties belonging to the ImoSaúde Closed Real Estate Investment Fund and to the ImoSocial Closed Real Estate Investment Fund, namely the buildings operated by CUF Porto Hospital, CUF Porto Institute, CUF Belém Clinic, CUF Cascais Hospital and CUF Torres Vedras Hospital.

The decision to acquire the buildings was taken in a context of opportunity and anticipation:

These are strategic properties for José de Mello Saúde, making their control a relevant factor;

The funds holding the properties entered into liquidation;

The maintenance of interest rates at all-time lows enabled the contracting of funding at competitive conditions, which allowed for relevant cost savings (amortisations and financial charges versus the previously contracted rents) and in cash flows (financial charges and debt service vis-à-vis the previously contracted rents);

The mandatory application of IFRS 16 in January 2019 also implies the recognition of the operating leases in the balance sheet, recording the right of use in assets and the underlying responsibilities in liabilities. With the acquisition of the properties, it was possible to anticipate what would be the balance structure from 2019 onwards.

PERFORMANCE



Financial Sustainability

Financial debt profile of José de Mello Saúde

Others

CP

Financial Leasing

MLP

Bonds

Bonds

Others

CP

MLP

Financial Leasing

2,1%

10,9%

31,6%

10,0%

45,4%

35,6%

0,2%

11,5%

36,1%

16,6%

2016 2017

José de Mello Saúde closed 2017 with an equity increase of around 10.0 million euros, from 2016, to 91.6 million euros. On 31 December 2017, net financial debt stood at 338.4 million euros, 183.5 million more than at the end of the previous year, reflecting the investment carried out throughout the year.

In 2017, José de Mello Saúde maintained the focus on maintaining a sustainable financial policy and solid capital structure, in line with its growth strategy, as one of its strategic goals. This policy has undergone active management of its debt profile in recent years both in terms of source diversification as well asextension of its maturity profile.

As a result, José de Mello Saúde has been able to access diverse funding sources, having finished 2017 with a similar weight of bank funding (MLP) and bond loans raised in the capital market in the mix of its gross financial debt.


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421,6

338,6

4,08

2,77%

219,6

154,9

3,04

3,18%

20172016(Million euros)

Gross financial debt

Net financial debt*

Average maturity of debt (years)**

Average spread

*Considers gross financial debt less cash and cash equivalents and other financial instruments **Excluding leasing


In 2017, José de Mello Saúde was once again able to reduce its average cost of funding as well as extend its average maturity.

Despitehaving presented a robust operational and financial activity in 2017, the performance of JMS’ financial ratios translates the strong investment effort in the multiple expansion works in course across the network and on the acquisition of relevant real estate assets during the year. For those reasons, and even considering the increase of EBITDA, there is a growth of the Net Debt/EBITDA ratio to 4.7x. José de Mello Saúde has included a financial covenant of Net Debt/EBITDA ratio below 6x in all its bond transactions placed in the financial markets. On 31 December 2017, José de Mello Saúde, S.A. complied with the financial covenants defined in all bond loans.

Main Financial Ratios

12,4%

14,2%

4,7

3,5

16,2%

19,4%

2,3

4,1

-23,7%

-27,0%

107,5%

-15,2%

20172016 Var. %

Financial Autonomy

Solvency

Net Financial Debt1 /EBITDA

EBIT/ Financial Charges

PERFORMANCE



/


Clinical QualityOrganised around an integrated network of high-performance units, grouped into large hospitals with subspecialties in reference areas, and a network of local clinics and hospitals that focus on the users’ convenience, José de Mello Saúde presents a differentiated clinical project.

On a continuous basis, José de Mello Saúde evaluates the healthcare provided in its units, submitting them to the external assessment of the National Health Evaluation System (SINAS), which acknowledges the fulfilment of the quality parameters established by the Portuguese Healthcare Regulation Authority (ERS) (Entidade Reguladora da Saúde – ERS). Through clinical benchmarking models, the clinical efficiency and quality processes are identified and evaluated, which is translated into learning for the organisations involved.

The Clinical Outcomes project, launched by José de Mello Saúde in 2015,which allows emphasising the provision of healthcare based on relevant results for the patient, evolved in 2017, to the Value-Based Healthcare Programme.

Value in Healthcare – Value-Based Healthcare Programme In order to implement a clinical management model based on the creation of value in healthcare, and assuming a strategic role for the organisation, the Value-Based Healthcare Programme assumes the involvement of multidisciplinary teams that define and implement the standard sets and analyse in an integrated way the clinical and management information. The presence of multidisciplinary teams in the measurement of outcomes enables the transversal reorganisation ofhealthcare based on pathologies, reinforcing a patient-centered viewand its clinical pathway and allows for progressively more informed decisions of doctors and patients.

In 2017, and in partnership with The International Consortium for Health Outcomes Measurement (ICHOM), José de Mello Saúde consolidated the processes of monitoring clinical outcomes in cataracts, breast cancer and knee osteoarthritis. The monitoring of these pathologies occurred at the CUF Descobertas

Hospital in 2016 and 2017, with the measurement of the value of cataract disease being extended to the CUF Infante Santo and CUF Cascais hospitals. In addition to the collection of clinical information, it was chosen tocollectinformation reported by the patient based on validated measurement tools (PROMs – Patient Reported Outcome Measures).

The internal validation of the measurement of outcomes for cataract surgery was accompanied by the international approval of the results through the ICHOM-GLOBE International Benchmarking. The first ICHOM preliminary reports confirm the clinical management model of José de Mello Saúde, since they place the group in the category of excellence in healthcare provision worldwide, with a star rating, by the quality of results, in four of the six dimensions evaluated by the programme.

Clinical Quality ManagementIn 2017, CUF Santarém and CUF Viseu hospitals received the ISO 9001:2015 certification, given by the SGS, for the first time, thus following the continuous and updated development of the culture and practice of José de Mello Saúde’s values. In addition, all CUF units successfully renewed the certification of their quality management systems in ISO 9001:2008.

Braga Hospital was accredited again and received the ISO 9001:2015 certification for all support services. At the same time, the maintenance of the Environmental Certification was confirmed (the

Star rating according to results above expectations in four of the six evaluated dimensions

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Certification was renewed and transitioned to ISO 14001:2015), as was the Organisational Health and Safety Certification (renewal of the certification according to the OHSAS 18001:2007 standard by the Société Générale de Surveillance (SGS)).

The Vila Franca de Xira Hospital, in 2017, after an annual reassessment, had its accreditation from the Joint Commission International (JCI) renewed. The Environmental Certification, according to the ISO 14001:2015 standard, the Certification of the Organisational Health and Safety System according to the OHSAS 18001:2007 and the certification of the Quality Management System in clinical and support services, according to ISO 9001:2015, were also confirmed.

National Health Evaluation System (SINAS)José de Mello Saúde reaffirms its commitment to the National Health Evaluation System (SINAS) which, through adequate and intelligible information, favours more informed decision-making by patients, while promoting the continuous improvement of the quality of provided care.

All of José de Mello Saúde’s units receive the maximum rating and were given a star in the quality dimensions of the first level of evaluation.

In the evaluation of Clinical Excellence, Braga Hospital and Vila Franca de Xira Hospital were once again considered by the Portuguese Health Regulatory Authority as leaders in their peer groups for the benchmark of the Portuguese National Health Service hospitals. The former received the maximum rating for Clinical Excellence in five areas (Neurology, Obstetrics, Intensive Care, Outpatient Surgery and Venous Thromboembolism). As for Vila Franca de Xira Hospital, it received the highest rating in four areas (Neurology, Obstetrics, Orthopaedics – Surgical Correction of Proximal Fracture of the Femur – and Outpatient Surgery. Additional emphasis on the high rating for the area of Outpatient Surgery at the CUF Porto Hospital, CUF Cascais Hospital and CUF Torres Vedras Hospital, as well as for the area of Orthopaedics (Hip and Knee Replacement) of CUF Descobertas Hospital.

ClinicalExcellence

Patient Safety

Comfortof Facilities

UserSatisfaction

User FocusHospital

CUF Descobertas Hospital

CUF Torres Vedras Hospital

CUF Infante Santo Hospital

CUF Santarém Hospital

CUF Porto Hospital

CUF Viseu Hospital

CUF Cascais Hospital

Braga Hospital

Vila Franca de Xira Hospital

The provider meets all quality parameters required.Dimension not evaluated.

PERFORMANCE



Clinical Quality IndicatorsJosé de Mello Saúde’s units with inpatient care and outpatient surgery are involved in benchmarking models, making it possible to evaluate and compare the performances of these units in variables such as clinical efficiency and quality.

By participating in the IAmetrics, which enables monitoring of results via models which adjust to the complexity of the cases and the execution of benchmarking with equivalent hospitals in Portugal and Spain, allows José de Mello Saúde to achieve greater efficiency and quality in the provision of healthcare. The performance assessment system is based on the comparison of performance with standard values (indexed to risk), in which a better performance will have values between 0 and 1.

Patient SafetyPatient Safety is a strategic priority for José de Mello Saúde, which thus establishes its commitment to a differentiating clinical project, materialised in the clinical excellence and in the response focused on the patient.

The Safety in Health Programme, which is transversal to all of José de Mello Saúde’s units, is guaranteed by multidisciplinary teams representing the risk management committees and the programme for the prevention and control of infections and resistance to antimicrobials. Operating under medical coordination, the programme aims to establish common policies and lines of action, ensuring the continuous improvement cycle and reinforcing the single-operator model.

The 2015-2020 National Plan for Patient Safety, created by Decree No. 1400-A/2015, of 10 February 2015, includes the activities carried out by José de Mello Saúde under the Safety in Health Programme and its respective goals.

Adverse Event Reporting System The World Health Organisation and the European Commission recommend to Governments the development of notification systems for safety incidents that promote learning from errors and the subsequent implementation of improvement actions. An Adverse Event Report System (HER+, Health Event Risk Management) is implemented across José de Mello Saúde with the support of top management, which reinforced the organisation’s learning process with incidents at the expense of the identification of their auditing, consolidating a non-punitive culture, crucial to reinforcing the safety of the patients.

Efficiency indicators

Quality indicators

AAPDI

RAMI

RACI

RARI

0.17In process consolidation in 2017, stemming from the transition from the ICD-9 to the ICD-10 coding reference

0.60

0.69

0.48

CUF Units PPP Units

Caption:Standard = 1.0 | Risk adjustment: Adjusted calculation of the likelihood of a given event occurring based on patient characteristics, type of admission, pathology and Healthcare Unit. Values resulting from the average between units.

AAPDI: Adjusted Average Pre-operative Delay Index Adjusted (programmed + urgent) | RAMI: Risk-adjusted Mortality Index | RACI: Risk-adjusted Complication Index | RARI: Risk-adjusted Readmission Index.

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Recording a relevant volume of notifications, the management of the HER+ platform has contributed significantly to collect, aggregate and analyse clinical information with a focus on the risks, hazards and vulnerabilities of the patients. The findings of this analysis and the undertaken corrective measures are reported to the notifier for the cause which motivated the incident to not happen again.

CUF Oncology Institute (I.C.O.)The CUF Oncology Institute (I.C.O.), CUF’s national cancer care network, ensures an integrated offer, a differentiated and experienced clinical staff, and an innovative technological complex prepared to respond to all needs presented by the cancer patient, from diagnosis to treatment.

Maintaining the focus on external quality recognition by certification and accreditation systems specific to the approach to cancer, I.C.O. saw the Breast Integrated Diagnostics and Treatment Unit be certified, in 2017, by EUSOMA a reference in Breast cancer. This certification recognises the clinical excellence and the safety in the diagnosis and treatment of patients, confirming full compliance with strict guidelines in services provided to patients, in the entire organisation and in the experience and structuring of multidisciplinary teams. I.C.O. wasalso recognised by the Ministry of Health as a National Reference Centre for the Treatment of Rectal Cancer.

2015 1456

11932016

2017

Total Reported Events - JMS Evolutionary Analysis

1246

CUF PPP

PERFORMANCE



As a national platform that brings together all CUF’s units, the CUF Oncology Institute articulates all necessary network’s resources – professionals, equipment and facilities – in a care model centered by pathology. I.C.O.’s network consists of 15 diagnostics and treatment units (IDTU), including breast, lung, colorectal, prostate, gynaecology, head and neck IDTUs, among others. I.C.O. maintains a strong commitment of cooperation with the National Cancer Registry, thus contributing to the epidemiological study of cancer in Portugal and continuously evaluating and monitoring the survival rates of patients treated entirely by the I.C.O.

Aware of the role it plays in the country, José de Mello Saúde is structuring a Corporate Citizenship Programme. In line with the principles of Social Responsibility, this will be a public statement of its social, economic and environmental commitment. With implementation planned for 2018, the Corporate Citizenship Programme will be materialised at a time of expansion of the organization and opening to new challenges and a new dimension of intervention.

Also in this context, José de Mello Saúde joined GRACE – Grupo de Reflexão e Apoio à Cidadania Empresarial (Group for Reflection and Support to Corporate Citizenship), being represented in the current board and participating in the mission to reflect, promote and develop Corporate Social Responsibility in Portugal.

Throughout the year, José de Mello Saúde promotes and cooperates with local development, maintaining an ethical and transparent relationship with its different audiences through a set of initiatives that include:

The Education for Health Programme, dedicated to the communities of the geographies in which there are José de Mello Saúde hospitals – with an emphasis on schools, public bodies and social welfare institutions, with which there is a close relationship – made it possible to raise the awareness of over 6,505 people in 2017. Our healthcare professionals carried out 146 training actions in several topics of prevention. Within the many initiatives carried

out, we highlight the training in Basic Life Support (BLS) provided to 215 students from schools in Viseu. Affected by the dramatic consequences of the fires that devastated the centre of the country in October 2017, namely in the region of Viseu, José de Mello Saúde created a bank account with 100 thousand euros to support the affected populations. In addition to the monetary contribution, CUF Viseu Hospital provided free care to the population affected during the period of the fires.

Under the partnership between José de Mello Saúde and Instituto Marquês de Valle Flôr (IMVF) for the “Health for All” programme, CUF regularly sends, since 2009, healthcare professionals to São Tomé e Príncipe, who provide care to the populations. In

Social Performance

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recruits employees who become volunteers in social welfare institutions with whom partnerships exist for this purpose: Associação Coração Amarelo (Lisbon and Porto Cores), ATL da Galiza, Community Centre and Parish of Carcavelos, Movimento Defesa da Vida, Obra do Frei Gil, Junior Achievement Portugal and, more recently, Refood, Associação dos Albergues Noturnos do Porto and Bebés de S. João. The Volunteer Programme is managed by a Steering Committee, composed of representatives from each of José de Mello Group’s business platform, joined by a member of José de Mello family and a representative from Amélia de Mello Foundation. In September 2017, the event Caring is Sharing, which brought together all the employees of the corporate centre and shared services for a volunteer action in Alcobaça, which allowed to raise four metric tons of apples for the users of Leiria’s Food Bank.

In 2017, Vila Franca de Xira Hospital joined the agents in charge of the Social Action of the five municipalities it serves to identify the institution most in need of an intervention. The chosen institution was Residência da CERCI Flor da Vida, which promotes the adaptation and integration of people with disabilities into society.

the field of otolaryngology, for example, CUF Infante Santo Hospital has been providing teams of doctors, technicians, nurses, audiologists and therapists since 2011, who operatebetween 20 to 30 patients per mission and carry out an average of 100 to 150 appointments. In 24 missions, over 1,000 screenings and over 500 surgeries were carried out. The teams from CUF Infante Santo Hospital also developed special programmes for deaf children, namely for their social integration, as well as sign language programmes.

In addition to the presence in the archipelago on missions, the team from the Dermatology Centre of CUF Descobertas Hospital, a pioneer on this programme, promotes in-person training events with doctors from São Tomé in Lisbon, as well as remote training. The Centre of Orthopaedics and Traumatology of CUF Descobertas Hospital also carries out annual missions since 2009, with the next one scheduled for March 2018.

José de Mello Saúde’s employees also integrate the Volunteer Programme of the José de Mello Group, which aims to transfer the Group’s knowledge and skills to the supported institutions. The programme

PERFORMANCE



The living and dining rooms of the institutionwere recovered, a new kitchen was offered and the façade was renovated.For the fourth consecutive year, CUF supported financially and was a partner in disseminating the Health Marathon, an initiative dedicated to funding scientific research in Portugal. In 2017, the Health Marathon supported the fight against cardiovascular diseases, having raised around 50 thousand euros for research in this area.

Projeto Ser Solidário (Be Supportive Project), transversal to the José de Mello Group, in which each employee voluntarily contributes with a minimum of one euro per month of their salary, allowed to support Comunidade Vida e Paz (Life and Peace Community), Lar S. José Home and the Raríssimas Association.

The actions of internal social responsibility allowed to distribute benefits of around 155 thousand euros among the employees and their families. Among the developed actions, we highlight the Holiday Camps for children between 7 and 18 years old, the award of school books scholarships – 511 grants, amounting to 72 thousand euros, to co-finance expenses in school supplies. For the Holiday Camps, developed to occupy the time of the employees’ children during the summer holidays, José de Mello Saúde gave around 60 thousand euros, supporting the accommodation, food, insurance and transport of 162 children. In celebration of the Christmas season, José de Mello Saúde distributed 2,333 Christmas Baskets to employees with the lower salaries, an initiative worth 71 thousand euros.

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Environmental Performance

José de Mello Saúde acknowledges the importance of environmental protection to business sustainability and believes that its benefits are clear for current and future generations. Although the provision of healthcare presents a reduced consumption of natural resources and raw materials, José de Mello Saúde seeks to minimise the environmental impact associated with its activity, regularly controlling the sources of environmental degradation in its units. In 2017, José de Mello Saúde maintained its growth trajectory, expanding its installed area by 1,606 m2, with the inauguration of the CUF São João da Madeira Clinic, and registering an increase in activity in all units, which had animpact on the consumption of utilities and the production of waste. However, the increase in production(the days of hospitalisation grew by 2% and the appointments/month indicator rose 10% in total, and 13% in the private units), was once again not reflected in the group’s energy consumption. As a result of the effort for energy rationalisation, there was a 5.5% reduction of consumptions in the analysed units for similar periods of operation.

José de Mello Saúde systematically monitors the consumptions of energy, water and hospital waste for each of its units. This evaluation is performed via comparison metrics for the consumption between units, in part equal to those used by the Ministry of Health in the ECO.AP project of the Energy Agency.

In 2017, José de Mello Saúde maintained the ISO 14001 Environmental Certification of Vila Franca de Xira Hospital and of Braga Hospital. The latter was also honoured for its Eco-Efficiency Project in the 10th edition of the EDP Electrical Energy and Environment Award, with the “Absolute Winner – Services and Other Activities” prize, which honours the Portuguese companies with best practices in the field of electrical efficiency and environmental sustainability. The measures implemented in Braga Hospital in the last four years have already reduced energy consumption by over 26%, which also represents a saving of emissions and costin the largest unit managed by José de Mello Saúde.

The experience gained in the current energy efficiency projects will be predominantly used to ensure the best possible performance in José de Mello Saúde’s new units, expected to open in 2018-2019.

PERFORMANCE



02CORPORATE GOVERNANCE

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GOVERNANCE MODEL

José de Mello Saúde is composed of a set of companies and complementary groups of companies (Agrupamentos Complementares de Empresas – ACE) that operate in the healthcare area.

Headed by José de Mello Saúde, S.A., which holds shares in the companies that manage and operate each of the operating, hospital and outpatient units, and shares in other companies that develop ancillary activities, the governance model of José de Mello Saúde Group follows a matrix logic.

José de Mello Saúde S.A. takes on the definition of the strategy and the social, economic and financial planning, and the coordination of the management of the ACE and subsidiary companies, through binding instructions and/or through the exercise of its shareholder rights.The Board of Directors is responsible for managing José de Mello Saúde, delegating the day-to-day management of the company to an Executive Committee. This is assisted by the corporate and shared-services departments and by a set of advisory bodies in their corresponding fields of expertise.

The subsidiary companies are, in turn and in corporate terms, managed by their corresponding Boards of Directors, with members of José de Mello Saúde’s Executive Committee, which, depending on the nature and size of the company, delegate day-to-day management to an Executive Committee or a Managing Director.

From an organisational perspective, the hospital and outpatient units were grouped into two Coordinating Committees: CUF and PPP. The CUF network is divided into three geographical clusters – Descobertas, Tejo and Norte – in a rationale of coordination around the three large CUF Hospitals, which are managed by Executive Committees made up of a CEO, an Assistant Director and an Operating Director.

The establishment of the Coordinating committees for CUF and PPP aims to implement a single-operator model in strategic alignment, standardisation, operational control and risk management, reinforced in 2017 by the creation of CUF Services, which includes the Customer, Logistics and Operations areas.


INTEGRATED REPORT 201754 GOVERNANCE MODEL

INFRASTRUCTURE PROJECT TRACKING COMMITTEE

AUDITING AND RISK MANAGEMENT COMMITTEE

ETHICS COUNCIL

ADVISORY COUNCIL

MEDICAL COUNCIL

SUPERVISORY BOARD

Executive Committee

Board of Directors

GENERAL MEETING

STATUTORY AUDITOR

REMUNERATION COMMITTEE

COMPANY SECRETARY

NURSING COUNCIL

PHARMACY COMMITTEE

Customer Ombudsperson

Corporate Centre CUF PPP’s Participadas

Internal AuditAdministrative and Occupational AccidentsCommercialProcurementCommunication and SustainabilityPharmacyFinancialInfrastructuresLegalStrategic Marketing and Brand ManagementOrganization, Quality and SafetyStrategic Planning, Management and Innovation Control DepartmentHuman ResourcesInformation Systems

CUF DescobertasCUF TejoCUF NorteCUF of Oncology InstituteCUF Services

Braga HospitalVila Franca de Xira Hospital

SAGIESImoHealthInfraHealthDigiHealthAcademia CUFLoja Saúde CUF

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MAKE-UP AND POWERS OF THE GOVERNING AND SUPERVISORY BODIES

BOARD OF DIRECTORS

Salvador de MelloChairman of the Board of Directors and CEO

Chairman of the Board of Directors and CEO of José de Mello Saúde (since 2001) and member of the Board of Directors of José de Mello Capital, (he is responsible), is responsible for the strong growth momentum and expansion of the network to its current 19 healthcare units. Salvador de Mello holds a degree in Economics and Business Administration from the University of Neuchâtel, Switzerland.

Pedro de MelloDeputy Chairman of the Board of Directors

Pedro de Mello holds a degree in Textile Engineering and he is also Vice-President of José de Mello Capital, member of the Board of Directors of CUF Consultoria and Services and Chairman of the Board of Directors of MGI Capital.

João Gonçalves da SilveiraDeputy Chairman of the Board of Directors

Deputy Chairman of the Board of Directors of José de Mello Saúde since 2001, João Gonçalves da Silveira holds a degree in Pharmacy from Universidade de Lisboa, Chairman of the Board of MONAF (Montepio Nacional da Farmácia).



INTEGRATED REPORT 201756 MAKE-UP AND POWERS OF THE GOVERNING AND SUPERVISORY BODIES

Rui DinizDeputy Chairman of the Executive Committee

Deputy Chairman of the Executive Committee of José de Mello Saúde, Rui Diniz holds a degree in Economics from Universidade Católica de Lisboa. He is also an Executive Director of José de Mello, SGPS.

Rui Assoeira RaposoExecutive Director

Rui Assoreira Raposo holds a degree in Pharmacy from Universidade do Porto; he is a Specialist in Pharmacy Industry by the Portuguese Pharmacists’ Association and a Postgraduate degree from IMD-Lausanne/Switzerland and from the AESE Business School – Lisbon/Portugal.

Guilherme MagalhãesExecutive Director

Holds a degree in Mechanical Engineering from Instituto Superior Técnico and an MBA from Universidade Nova de Lisboa; is also the Chairman of the Board of Trustees of Fundação do Gil.

Inácio BritoExecutive Director

Inácio Brito holds a degree in Economics from Universidade Católica de Lisboa, with postgraduate studies in Actuarial Sciences.

Vasco Luís de MelloExecutive Director

Vasco Luís de Mello holds a degree in Mechanical Engineering from the Catholic University of Leuven – Belgium, later obtaining a Master’s Degree in Business Administration from the same University.

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Paulo Cleto DuarteNon-Executive Director

Paulo Cleto Duarte holds a degree in Pharmaceutical Sciences from the Universityof Lisbon and an MBA in Information Management from Universidade CatólicaPortuguesa. He is Chairman of the Portuguese Association of Pharmacies andCEO of Farminveste, SGPS.

Luís Brito de GoesNon-Executive Director

With a degree in Law by Universidade Católica Portuguesa, Luís Brito de Goes he is also an Executive Director at José de Mello Capital, member of the Board of Diretors of Brisa and CUF Consulting and Services and President of the Board of Directors of MGI Capital.

Raúl Galamba de OliveiraNon-Executive Director

Raúl Galamba de Oliveira holds a degree in Mechanical Engineering from InstitutoSuperior Técnico, an MSc in Systems and an MBA from Nova School of Businessand Economics, is currently a senior partner at McKinsey in Portugal and Spain,and leads McKinsey’s Risk Management area.

Celine Abecassis-MoedasNon-Executive Director

Céline Abecassis-Moedas holds a PhD in Business Strategy, from ÉcolePolytechnique, Paris, a Master’s degree in Management, from École NormaleSupérieure and Université Paris Dauphine and a degree in Economics andManagement from the Sorbonne. She is an Associate Professor in the areas ofStrategy and Innovation at the Universidade Católica Portuguesa. Additionally,she is a member of the Board of Directors of CTT and Europac.

Vera Pires CoelhoNon-Executive Director

Vera Pires Coelho holds a degree and a master’s degree in Economics with anMBA from Universidade Nova de Lisboa and a postgraduate degree in ActuarialSciences from Catholic University of Lisbon; she is currently the ManagingDirector of the subsidiaries of Grupo Vendap in Angola, Mozambique and Brazil,Director of the Serralves Foundation and Deputy Chairman of the GeneralCouncil of Universidade Nova.




EXECUTIVE COMMITTEESalvador Maria Guimarães José de Mello (Presidente)Rui Alexandre Pires Diniz (Vice-Presidente)Rui Manuel Assoreira Raposo Vasco Luís José de Mello Inácio António da Ponte Metello de Almeida e BritoGuilherme Barata Pereira Dias de Magalhães

OFFICERS OF THE GENERAL MEETINGChairman:Vasco Vieira de Almeida

Secretary:João Vieira de Almeida

SUPERVISORY BOARDChairman:José Manuel Gonçalves de Morais Cabral

Members:José Luís Bonifácio Lopes João Filipe de Moura-Braz Corrêa da Silva

Deputy:Miguel Luís Cortês Pinto de Melo

STATUTORY AUDITORErnst & Young Audit & Associados – SROC, S.A., representada por Luís Miguel Gonçalves Rosado

REMUNERATION COMMITTEELuís Miguel Cortes Martins (Presidente)Pedro Norton de MatosMaria Luísa José de Mello Amaral CabralVasco Guimarães José de MelloPedro Maria Guimarães José de Mello

CORPORATE SECRETARYRui Manuel da Costa Ramalhal


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ETHICS COUNCILPaula Cristina Ruivo Duarte Martinho da Silva (Presidente)Maria Isabel Semedo Carmelo Rosa Renaud João Paulo Mouro Rosa Camilo MaltaNuno João Amador Silvestre CarlosRita Maria Lagos do Amaral CabralPresidente do Conselho de Enfermagem da José de Mello Saúde, Fátima FariaPresidente do Conselho Médico da José de Mello Saúde, João Carlos Lopes Simões Paço

ADVISORY COUNCILAntónio Manuel Bensabat Rendas (Presidente)António Manuel de Carvalho Ferreira VitorinoAntónio Bernardo Aranha da Gama Lobo XavierPaulo Jorge Cleto DuarteSalvador Maria Guimarães José de MelloRui Alexandre Pires Diniz

INFRASTRUCTURE PROJECT TRACKING COMMITTEEVera Margarida Alves Pires Coelho (Presidente)Pedro Maria Guimarães José de MelloRui Manuel Assoreira Raposo

AUDITING AND RISK MANAGEMENT COMMITTEERaúl Catarino Galamba de Oliveira (Presidente)Paulo Jorge Cleto DuarteLuís Eduardo Brito Freixial de Goes

MEDICAL COUNCIL:João Paço, Diretor Clínico do Hospital CUF Infante Santo (Presidente)Piedade Sande Lemos, Diretora Clínica do Hospital CUF CascaisJorge Mineiro, Diretor Clínico do Hospital CUF DescobertasVitor Correia da Silva, Diretor Clínico do Hospital CUF PortoAlberto Bessa Peixoto, Diretor Clínico do Hospital de BragaCarlos Rabaçal, Diretor Clínico do Hospital Vila Franca de XiraEduardo Pegado, Diretor Clínico do Hospital CUF Torres VedrasJoaquim Pedroso da Costa, Diretor Clínico do Hospital CUF SantarémEduardo Jorge Mendes, Diretor Clínico do Hospital CUF ViseuJosé Fragata, Consultor Clínico da José de Mello SaúdeCláudia Simões, Diretora de Qualidade e Desenvolvimento Organizacional da José de Mello Saúde




NURSING COUNCIL:Fátima Faria - Hospital de Braga (Presidente)José Coelho - Hospital CUF Infante SantoCarlos Costa - Hospital CUF DescobertasHelena Valentim Abrantes – Hospital Vila Franca de XiraBenilde Folgado - Hospital CUF Torres VedrasSara Martins - Hospital CUF Porto e Instituto CUF PortoCélia Leitão - Hospital CUF CascaisHelena Conduto - Hospital CUF SantarémDuarte Mendonça - Hospital CUF Viseu

PHARMACY COMMITTEERui Manuel Assoreira Raposo (Presidente)Abel Rua - Hospital de BragaCarla Ferrer - Hospital Vila Franca de XiraIsabel Queirós - Compras José Neves Luisa Fontes - Hospital CUF DescobertasLuis CaldeiraMaria Teresa Aires Pereira - Paulo Bettencourt - Hospital CUF PortoRita Oliveira - Hospital CUF Ifante Santo

CUSTOMER OMBUDSPERSONJosé Carlos Lopes Martins


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POWERS OF THE GOVERNING BODIES:The functioning of the Board of Directors, the Executive Committee and the rules of conduct of its members are governed, in addition to the Law, the Statutes and the Code of Ethics of José de Mello Saúde, by their respective Regulations. The supervision of José de Mello Saúde is under the purview of a Supervisory Board and the Statutory Audit firm.

BOARD OF DIRECTORSThe Board of Directors is responsible for defining the strategy, the major policies and the social, economic and financial planning of José de Mello Saúde, ensuring their application in its subsidiary companies. To that extent, it is responsible, namely, to decide on:

The acquisition of real estate and movable goods, including equity interests, as well as to sell or encumber such property by any acts or contracts, even if they serve to establish real guarantees;

Budget approval, preparation of the balance sheet and financial statements of the accounting period and preparation of reports on José de Mello Saúde’s activities and economic situation, as well as the proposal for distribution of profits, to be submitted to the General Assembly;

Amicable or judicial settlement of questions regarding rights and interests of José de Mello Saúde;

Appointment of people, among thosewho do not belong to the governing bodies, of those who will be responsible for top-level executive management of all of José de Mello Saúde’s technical and administrative services the establishment of representatives for any other purposes;

Contracting of internal or external funding required by José de Mello Saúde in order to carry out its corporate purpose;

Decision on the issuance of bonds and/or other securities;

Preparation and approval of all regulations that detail the exercise of social rights, as well as those that concern practical aspects of the operation of the Board of Directors or of other bodies, such as regulations concerning the exercise of the right of information; vote by mail and the use of long-distance communication for participation in meetings, including the exercise of the right to vote.




EXECUTIVE COMMITTEEThe Executive Committee assumes a set of responsibilities, delegated by the Board of Directors, from which stand out the following:

Proceed to the current management of José de Mello Saúde, with the ability to deliberate on all matters related to the exercise of its activity with respect to its corporate purpose, by the resolutions made by the Board of Directors and by the General Assembly;

Preparing and submitting to the Board of Directors the main policies of José de Mello Saúde, namely the remuneration policy, the staff management policy and the commercial and pricing policy;

Preparing and submitting to the Board of Directors, for approval, the Business Plan and the Budget of José de Mello Saúde for the following year, as well as to propose subsequent amendments;

Coordination and monitoring of the day-to-day management of the companies, directly and indirectly owned by José de Mello Saúde (“Subsidiaries”) by issuing, in the case of Subsidiaries in a group relation, i.e., whose share capital is wholly owned by José de Mello Saúde, mandatory instruction with the ability to, namely, deliberate on the definition of the strategy and economic and financial planning of the Subsidiaries; the approval of any business plan, as well as any changes and updates to it; the approval of the annual budget and any updates to it and the contracting of any funding or the signing of relevant contracts;

Signing all acts and contracts inherent to the activity of José de Mello Saúde, as long as their value does not exceed an amount equivalent to fifteen million euros;

Entering into bank loans or similar operations, granting shareholders’ loans and other forms of providing capital to Subsidiaries, as long as the corresponding amount does not exceed the equivalent to fifteen million euros,

To propose the holders of the governing bodies of the Subsidiaries on whose Boards of Directors all or part shall participate of the members of the Executive Committee of José de Mello Saúde will participate.


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The activity of the Board of Directors and the Executive Committee of José de Mello Saúde is supervised and monitored by the Supervisory Board, the Statutory Auditor, the Remuneration Committee and by the Company Secretary.

SUPERVISORY BOARDThe Supervisory Board is responsible for:

Supervising the management of José de Mello Saúde and monitoring compliance with the rules governing its operation;

Participate in the meetings of the Board of Directors of José de Mello Saúde where financial statements for the accounting period are evaluated;

To request the Chairman of the Board of Directors to convene the Board of Directors to evaluate facts that it considers relevant to the supervision of José de Mello Saúde’s management;

To verify the correctness of the accounting information, the accuracy of accounting documents and evaluate the accounting policies and the underlying valuation criteria;

Prepare annually the report of its activity and give an opinion on the management report and accounts submitted by the Board of Directors;

Monitor the effectiveness of the risk management system, the internal control system and internal audit system;

Supervise the preparation and dissemination of the financial information;

Supervise the auditing of accounting documents;

Supervise the independence of the statutory auditor.




STATUTORY AUDITOR In accordance with the Law and the Articles of Incorporation, it isresponsibility of the statutory auditor to examine the accounts of José de Mello Saúde, namely:

Verify the good standing of the books, accounting records and documents that support them;

Verify the extent of cash and stocks of any types of goods or values;

Verify the accuracy of the accounting documents;

Verify whether the accounting policies and the valuation criteria adopted by José de Mello Saúde lead to a correct evaluation of the assets and of the results.

REMUNERATION COMMITTEEThe Remuneration Committee is responsible for the definition of the remuneration policy of the members of the statutory bodies, to be approved by the General Meeting, as well as the setting of the remunerations of the members of the statutory bodies.


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CORPORATE SECRETARYThe Company Secretary is in charge of advising the Governing Bodies, according to the powers established in the Law, in the Articles of Association and in the Regulation of the Board of Directors, acting in order for the performance of the administrative and management bodies to be in accordance with the applicable legislation, with the Articles of Association and with internal regulations.

The Board of Directors and the Executive Committee are assisted by the corporate and shared-services departments and by a set of advisory bodies in their corresponding fields of expertise.

ADVISORY BODIES:

ETHICS COUNCILThis advisory body has, among its main tasks, the responsibility to analyse, on an ethical level, the questions raised by scientific advances, social developments and legislative activity in the fields of biology, medicine or health in general.

ADVISORY COUNCILThe Advisory Council is responsible for:

Analysing and discussing topics related to the industry, market and health policy;

Supporting the Board of Directors in the definition of José de Mello Saúde’s development strategy;

Preparing written opinions on questions raised by the Board of Directors of José de Mello Saúde.

INFRASTRUCTURE PROJECT TRACKING COMMITTEEThe Infrastructure Project Tracking Committee is responsible for:

Supervising the suitable execution of the projects in terms of quality, costs and deadline, namely in the technical and financial aspects;

Being consulted on new projects in their technical and financial aspects;

Assessing the key execution risks of the projects and proposing corrective and/or mitigating measures.




AUDITING AND RISK MANAGEMENT COMMITTEE The Auditing and Risk Management Committee is responsible for:

Evaluate and monitoring the Risk Management system;

Evaluate and monitoring the Internal Control system;

Evaluate and issue an opinion on the Annual Audit Plan;

Propose improvement measures to the Risk Management and Internal Control systems.

MEDICAL COUNCILAdvises the Board on clinical issues and continuous improvement of the services provided to all customers of José de Mello Saúde, with the following main tasks:

Advise on the definition of José de Mello Saúde’s clinical development strategy;

Propose the launch and follow-up of clinical projects common to José de Mello Saúde’s units;

Foster the development of clinical protocols applicable across all of José de Mello Saúde’s units;

Assist on the development of clinical innovation projects which simultaneously ensure clinical differentiation and increased efficiency;

Assist on in the definition of recruitment criteria and evaluation of medical professionals, for application across all José de Mello Saúde’s units.

NURSING COUNCILAdvises the Board on issues concerning nursing within the clinical activity of José de Mello Saúde, with the main responsibilities of:

Define the strategy of talent development and Nursing performance standards;

Consolidate the culture of evidence-based best practices;

Develop innovative projects that promote technical differentiation, improving efficiency of the processes of care and their respective levels of service;

Develop clinical quality and patient safety, based on the principle of continuous improvement; and,

Monitor the CUF Academy activity.


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PHARMACY COMMITTEEAdvises the Board on issues concerning pharmacy within the clinical activity of José de Mello Saúde, with the main responsibilities of:

Develop policies for use of medication in the context of José de Mello Saúde;

Develop therapeutic protocols for application across José de Mello Saúde;

Acts as a liaison entity between the Pharmacy and Therapeutic committees of José de Mello Saúde’s different units;

Annually approves José de Mello Saúde’s Medication Form, issuing a minute with such document attached, signed by the Chairman and by the Pharmacy Board of José de Mello Saúde;

Ensures compliance with the Medication Form of José de Mello Saúde (list of medications used in all units);

Issues opinions on the proposals for introduction of new medications in José de Mello Saúde’s form;

Promotes good pharmaceutical and therapeutic practices in José de Mello Saúde;

Promotes training in the medications area;

Selects the medications to be used in José de Mello Saúde’s units, ensuring the best cost-benefit and cost-effectiveness relationships.




CUSTOMER OMBUDSPERSONThe Customer Ombudsperson will carry out his/her functions with independence and impartiality, being responsible for

Receive and consider conflicts and complaints made by Clients, directly related to the activity developed by José de Mello Saúde’s units;

Mediate disputes and potential conflicts between Clients and José de Mello Saúde’s units;

Submit to the Executive Committee proposals for the resolution of conflicts or complaints from Customers;

Draft and present recommendations for improvement of Customer services to the Executive Committee;

Issue opinions on matters concerning the service provided to the Customers, when requested by the Executive Committee or by the boards of directors or executive committees of José de Mello Saúde’s units.


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69MAKE-UP AND POWERS OF THE GOVERNING AND SUPERVISORY BODIES


FINANCIAL STATEMENTS REPORT 20172

Remuneration policy of the members of the management and supervision bodies of the company

Annex To Individual Financial Statements on 31 December 2017

Supervisory Board’s Report For 2017

Statement of Compliance of the Supervisory Board

Individual Financial Statements on 31 December 2017

Legal Accounts Certificate

Consolidated Financial Statements on 31 December 2017

Individual Financial Information

Consolidated financial information

TABLE OF CONTENTS

Management Report

Proposal for the Appropriation of Results

Annex to consolidated financial statements on 31 December 2017

Board of Directors’ Declaration of Compliance

Information on the Shareholder Structure, Organisation and Corporate Governance

Report and Opinion of the Supervisory Board for 2017

Legal Accounts Certificate

Statement of Compliance of the Supervisory Board

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FINANCIAL STATEMENTS REPORT 2017 3

MANAGEMENTREPORT



The 2017 financial year was characterised by a strong operating and financial performance, with an emphasis on the following facts:

• Operating income was 637.4 million euros, an increase of 8.7% vis-à-vis 2016; in the private activity, we recorded an increase of 9.9% over the previous year, to 408 million euros. In the public sector, operating income was 227 million euros, growing 4.4% in comparison with the previous year;

• EBITDA was 72.0 million euros, an increase of 5.3% versus 2016, driven by growth in the healthcare activity;

• EBITDA on the private activity grew from 56.6 million euros to 61.5 million euros (+7.5%);

• In the public sector, despite growth in operating income, EBITDA decreased by 1.5 million euros, to 7.8 million euros. EBITDA margin was 3.4%, a decrease of 0.8 pp;

• Consolidated net profit was 22.8 million euros, a decrease of 1.1 million euros in comparison with 2016;

• Total assets increased by 242.5 million euros (+48.2%) compared to the end of 2016, a consequence of the increase in tangible fixed assets (+188.6 million euros);

• José de Mello Saúde’s consolidated investment was of 203 million euros;

• On 31 December 2017, net financial debt1 stood at 338.6 million euros, resulting in a Net Debt to EBITDA ratio of 4.7x.

In 2017, José de Mello Saúde maintained a trajectory of sustained increase across its healthcare activity in the different fields of action. Over 2.4 million appointments were recorded (10.2% increase versus 2016), 92,800 surgeries (+7.5% year-over-year) and approximately 75,200 patients discharged from hospitalisation (+2% more than in the previous year). There was also a slight increase in the number of births , which improved by 0.9% vis-à-vis the previous year.

Operational performance

Does not include patients discharged from MICUs (Multipurpose Intensive Care Units) *Pro-forma values based on the current activity accounting methodology

10.2%

7.5%

1.8%

3.1%

2.0%

0.9%

2,434.1

92.8

470.0

658.2

75.2

7.8

2,208.6

86.3

461.7

638.2

73.8

7.8

(thousands)

Consultations

Patients operated on

Days of hospitalisation

Emergencies

Discharged patients

Births

20172016* Variation %

Healthcare service provision indicators of José de Mello Saúde

Executive summary

1Considers gross financial debt less cash and cash equivalents and other financial instruments.


*Total less depreciation and provisions**Operational results plus depreciation and provisions

In the private sector, JMS registered over 1.8 million appointments (increase of +12.6%), 52.9 thousand surgical patients (improvement of +10.4% year-on-year) and 36 thousand patients discharged from hospitalisation (+6.7% than in 2016) were recorded.

In the public sector, hospitals managed under public-private partnership, there were around 596 thousand appointments (+3.4% vis-à-vis 2016), 39.9 thousand surgical patients (+4.0% in comparison with 2016) and 39.2 thousand patients discharged from hospitalisation (-2.0% vis-à-vis 2016).

Consolidated results

The operating income of José de Mello Saúde reached 637.4 million euros, increase of 8.7% versus the same period in 2016, following the strong performance across all areas of healthcare activity. Operating costs amounted to 565.4 million euros, 9.2% more than in the previous year, mainly due to the 10% increase in personnel costs and fees.

As a result of this growth in operating income, especially in the private sector, EBITDA and EBIT improved to 72 million euros (+5.3% compared to 2016) and 42.6 million euros (+2.5% compared to the previous year), respectively. However, there has been a reduction in EBITDA (-0.4 pp) and EBIT (-0.4 pp) margins’, since the increase of operating income did not yet compensate for the increase in the fixed costs structure, as a result of the opening of new units in the past two years (CUF Viseu Hospital and CUF Almada Clinic in 2016 and CUF São João da Madeira Clinic in 2017).

In the private sector, Operating income reached 408.4 million euros (+9.9% than in 2016), as a result ofgrowth acrossall healthcare activities, with an EBITDA of 61.5 million euros and EBITDA margin slightly decreasing by 0.6 pp, now standing at 14.8%.

(Million euros)

Operating income

EBITDAR

EBIT

EBT

Net profit

Net profit attributable to JMS shareholders

EBITDA**

Operating costs*

EBITDAR margin

EBIT margin

Taxes

Net profit attributable to non-controlling interests

Financial results

EBITDA margin

Depreciation and Provisions

20172016 Var. %Var.

INCOME STATEMENT

Public-private partnerships

CUF

CUF

8.7%51.2

5.6%

2.5%

-1.7%

-3.8%

-4.6%

4.4

1.1

-0.5

-0.9

-1.1

5.3%3.6

-9.2% (47.5)

-0.4 p.p.

-0.4 p.p.

(0.4)

0.2

-4.3%

67.1%

(1.6) -18.0%

-0.4 p.p.

(2.6) -9.6%

637.4

83.8

42.6

32.1

23.3

22.8

72.0

(565.4)

13.2%

6.7%

(8.8)

0.5

(10.5)

11.3%

(29.4)

586.3

79.4

41.5

32.6

24.2

23.9

68.4

(517.9)

13.5%

7.1%

(8.4)

0.3

(8.9)

11.7%

(26.8)



Vila Franca de Xira Hospital maintained its positive operating performance, with a 1.6% growth in operating income vis-à-vis 2016. However, EBITDA decreased 1.4 million euros, as well as the EBITDA margin, which was 7.4% in 2017 (-2.3 pp vis-à-vis 2016).

Operating income of Braga Hospital reached 161 million euros (+5.6% vis-à-vis 2016) whereas the EBITDA margin fell to 1.8% (-0.1 pp vis-à-vis 2016). 2017 was the second consecutive year in which Braga Hospital presented a negative result of around 4 million euros. This situation is driven by ARS North’s non-renewal of the vertical funding programmes for HIV and Multiple Sclerosis, with an approximate value of 7.5 million euros per year. A Request for Financial Recovery was cautiously lodged at the end of 2016 for the purposes of clause 127, paragraph 9, subparagraph (b) of the Management Contract, seeking the beginning of an arbitration process for the settlement of this dispute. We believe a favourable result for Escala Braga is very likely to come from this arbitration process, with our estimate of this contingent asset being 15 million euros.

As a reflection of the strong investment taken place during 2017, and the subsequent increase in financial costs, financial results were negative by 10.5 million euros (1.6 million decrease versus 2016).

Thus, José de Mello Saúde’s net profit was 22.8 million euros, which represented an annual decrease of 1.1 million euros (-4.6%) in comparison with 2016.

The total investment carried out in 2017 was €203 million. The most relevant investment amounted to €143 million and was due to the acquisition of real estate operated by José de Mello Saúde, belonging to the ImoSaúde Closed Real Estate Investment Fund and to the ImoSocial Closed Real Estate Investment Fund. In addition, 16 million euros were invested in the acquisition of four companies that provide healthcare in the regions of Almada, São João da Madeira and Coimbra, and in another company holding a property in the region of Sintra.

The expansion investment, both organic, with the expansion works in CUF Descobertas Hospital, CUF Torres Vedras Hospital and CUF Santarém Hospital, and geographical, with the opening of CUF Almada Clinic and with the construction of CUF Tejo Hospital, totalled 31 million euros.

Recurrent investment, mostly for technological replacement and update, reached €13 million (+0.9 million euros than in 2016).

(Million euros)

Consolidated financial results

Income/costs for financial assets

Financial income

Financial costs

20172016 Var %

Financial results

Public-private partnerships

Investment

-18.0%

10.7%

83.2%

-20.9%

(10.5)

0.7

1.0

(12.2)

(8.9)

0.7

0.5

(10.1)


Total assets increased 242.5 million euros (+48.2%) in comparison with the end of 2016, reaching 745.4 million euros. This variation was largely due to the increase in tangible fixed assets (+188.6 million euros), on the back of the various expansion works and the acquisition of properties belonging to the ImoSaúde Closed Real Estate Investment Fund and to the ImoSocial Closed Real Estate Investment Fund, namely the buildings operated by CUF Porto Hospital, CUF Porto Institute, CUF Belém Clinic, CUF Cascais Hospital and CUF Torres Vedras Hospital.

The decision to acquire the buildings was taken in a context of opportunity and anticipation:

• These are strategic properties for José de Mello Saúde, making their control a relevant factor;

• The funds holding the properties entered into liquidation;

• The maintenance of interest rates at all-time lows enabled the contracting of funding at competitive conditions, which allowed for relevant cost savings (amortisations and financial charges versus the previously contracted rents) and in cash flows (financial charges and debt service vis-à-vis the previously contracted rents);

• The mandatory application of IFRS 16 in January 2019 also implies the recognition of the operating leases in the balance sheet, recording the right of use in assets and the underlying responsibilities in liabilities. With the acquisition of the properties, it was possible to anticipate what would be the balance structure from 2019 onwards.

José de Mello Saúde closed 2017 with an equity increase of around 10.8 million euros, from 2016, to 92.4 million euros.

On 31 December 2017, net financial debt2 stood at 338.6 million euros, 183.7 million more than at the end of the previous year, reflecting the investment carried out throughout the year.

(Million euros) (Million euros)

Fixed assets Equity

Current assets

Total assets Total liabilities

Liabilities + Equity

Intangible Retained earnings + reserves

ProvisionsClients

Leasing

Other investments Minority interests

State Cash and cash equivalents

Deferred tax assets

Other current and non-current assets

Goodwill Capital + additional payments

Pension fundStocks

Borrowings

Investments in subsidiaries Interim dividends

Other Debtors and Creditors

Deferred tax liabilities

Other current and non-current liabilities

State

Tangible Net profit

SuppliersOther Debtors and Creditors

Other MLP assets

Other financial instruments

Assets held for sale

2017 20172016 2016Var. Var.

Financial situation

2 Considers gross financial debt less cash and cash equivalents and other financial instruments.

10.8

29.8

202.0

231.8

242.5

14.3

-1.8

0.4

0.3

2.7

10.8

0.0

-0.1

201.6

-2.7

2.3

8.9

-1.1

7.0

92.4

231.4

421.6

653.0

745.4

26.5

12.3

70.0

4.2

22.0

78.7

53.0

1.4

351.6

-14.1

10.8

11.7

22.8

94.5

81.7

201.6

219.6

421.2

502.9

12.2

14.0

69.6

4.0

19.3

67.9

53.0

1.5

150.0

-11.4

8.5

2.9

23.9

87.5

Non-financial liabilities

Financial liabilities

200.0

42.5

242.5

0.5

27.5

0.3

31.6

-0.5

-7.7

10.5

3.0

0.1

3.2

188.6

-1.8

0.0

-13.3

0.6

452.5

292.9

745.4

13.4

122.9

0.8

47.7

3.8

52.7

43.9

14.2

0.2

16.7

378.4

3.3

8.3

35.3

3.7

252.5

250.4

502.9

12.9

95.4

0.5

16.1

4.3

60.4

33.4

11.3

0.2

13.5

189.8

5.1

8.3

48.7

3.2



In 2017, José de Mello Saúde maintained the focus on maintaining a sustainable financial policy and solid capital structure, in line with its growth strategy, as one of its strategic goals. This policy has undergone active management of its debt profile in recent years both in terms of source diversification as well asextension of its maturity profile.

As a result, José de Mello Saúde has been able to access diverse funding sources, having finished 2017 with a similar weight of bank funding (MLP) and bond loans raised in the capital market in the mix of its gross financial debt.

In 2017, José de Mello Saúde was once again able to reduce the avarage spread of its loans and, on the other hand, extend the associated avarage maturity.

*Considers gross financial debt less cash and cash equivalents and other financial instruments.** Excluding leasing

Financial Debt Profile of José de Mello Saúde

2016Financial leasing

MLP

31,6%

10,0%MLP36,1%

16,6%

CP10,9%

Bonds45,4%

Bonds

35,6%

Others2,1%

Others0,2%

2017

CP

11,5%

Financial leasing

(Million euros)

Net financial debt*


Average maturity of debt (years)**

Average spread

20172016


338.6

421.6

4.08

2.77%

154.9

219.6

3.04

3.18%


Main financial ratios

1 Considers gross financial debt less cash and cash equivalents and other financial instruments

Ratios

Solvency

Financial autonomy

Net financial debt1/EBITDA

EBIT/Financial charges

20172016 Var %

Despite having presented a robust operational and financial activity in 2017, the performance of JMS’ financial ratios translates the strong investment effort in the multiple expansion works in course across the network and on the acquisition of relevant real estate assets during the year. For those reasons, and even considering the increase of EBITDA, there is a growth of the Net Debt/EBITDA ratio to 4.7x. José de Mello Saúde has included a financial covenant of Net Debt/EBITDA ratio below 6x in all its bond transactions placed in the financial markets. On 31 December 2017, José de Mello Saúde, S.A. complied with the financial covenants defined in all bond loans.

Additional and detailed information about José de Mello Saúde can be consulted in the 2017 Integrated Report document and in the GRI Annex*, in the following chapters:

• About José de Mello Saúde (External Environment)

• Strategy, achievements and goals;

• Risk management, main risks and uncertainties;

• Research, Development and Innovation;

• Social Performance;

• Environmental Performance;

Additional information

From December 31, 2017 until March 22, 2018, the date on which the individual financial statements were authorized by the Board of Directors, there were no events that were not already adjusted and / or disclosed in the financial statements.

14.2%

12.4%

4.7

3.5

19.4%

16.2%

2.3

4.1

-23.7%

107.5%

-27.0%

-15.2%

*Sustainability Report - GRI Annex



PROPOSAL FOR THE APPROPRIATION OF RESULTS


The Board of Directors proposes that the net profit of the individual accounts of José de Mello Saúde, S.A. for 2017, in the amount of 29,554,175.64 euros, be appropriated as follows:

• Legal reserve: 1,477,708.78 euros

• Interim dividends: 14,100,000 euros

• Dividends: 13,500,000 euros

• Retained earnings: 476,466.86 euros

The Board of Directors

Lisbon, 22 March 2018




BOARD OF DIRECTORS

Salvador de MelloChairman of the Board of Directors and CEO

Chairman of the Board of Directors and CEO of José de Mello Saúde since 2001, he is responsible for the strong growth momentum and expansion of the network to its current 18 healthcare units. Salvador de Mello holds a degree in Economics and Business Administration from the University of Neuchâtel, Switzerland.

Pedro de MelloDeputy Chairman of the Board of Directors

Pedro de Mello holds a degree in Textile Engineering and he is also Deputy Chairman of José de Mello, SGPS, member of the Board of Directors of CUF and Chairman of the managing boards of the companies Sociedade Agrícola D. Diniz and M Dados.

João Gonçalves da SilveiraDeputy Chairman of the Board of Directors

Deputy Chairman of the Board of Directors of José de Mello Saúde since 2001, João Gonçalves da Silveira holds a degree in Pharmacy from Universidade de Lisboa, Chairman of the Board of MONAF (Montepio Nacional da Farmácia).


Rui DinizDeputy Chairman of the Executive Committee

Deputy Chairman of the Executive Committee of José de Mello Saúde, Rui Diniz holds a degree in Economics from Universidade Católica de Lisboa. He is also an Executive Director of José de Mello, SGPS.

Rui Assoeira RaposoExecutive Director

Rui Assoreira Raposo holds a degree in Pharmacy from Universidade do Porto; he is a Specialist in Pharmacy Industry by the Portuguese Pharmacists’ Association and a Postgraduate degree from IMD-Lausanne/Switzerland and from the AESE Business School – Lisbon/Portugal.

Guilherme MagalhãesExecutive Director

Holds a degree in Mechanical Engineering from Instituto Superior Técnico and an MBA from Universidade Nova de Lisboa; is also the Chairman of the Board of Trustees of Fundação do Gil.

Inácio BritoExecutive Director

Inácio Brito holds a degree in Economics from Universidade Católica de Lisboa, with postgraduate studies in Actuarial Sciences.

Vasco Luís de MelloExecutive Director

Vasco Luís de Mello holds a degree in Mechanical Engineering from the Catholic University of Leuven – Belgium, later obtaining a Master’s Degree in Business Administration from the same University.



Paulo Cleto DuarteNon-Executive Director

Paulo Cleto Duarte holds a degree in Pharmaceutical Sciences from the Universityof Lisbon and an MBA in Information Management from Universidade CatólicaPortuguesa. He is Chairman of the Portuguese Association of Pharmacies andCEO of Farminveste, SGPS.

Luís Brito de GoesNon-Executive Director

With a degree in Law by Universidade Católica Portuguesa, Luís Brito de Goesis also an Executive Director of José de Mello, SGPS, member of the boardsof directors of Brisa and CUF and Chairman of the Board of Directors of MGICapita, SGPS.

Raúl Galamba de OliveiraNon-Executive Director

Raúl Galamba de Oliveira holds a degree in Mechanical Engineering from InstitutoSuperior Técnico, an MSc in Systems and an MBA from Nova School of Businessand Economics, is currently a senior partner at McKinsey in Portugal and Spain,and leads McKinsey’s Risk Management area.

Celine Abecassis-MoedasNon-Executive Director

Céline Abecassis-Moedas holds a PhD in Business Strategy, from ÉcolePolytechnique, Paris, a Master’s degree in Management, from École NormaleSupérieure and Université Paris Dauphine and a degree in Economics andManagement from the Sorbonne. She is an Associate Professor in the areas ofStrategy and Innovation at the Universidade Católica Portuguesa. Additionally,she is a member of the Board of Directors of CTT and Europac.

Vera Pires CoelhoNon-Executive Director

Vera Pires Coelho holds a degree and a master’s degree in Economics with anMBA from Universidade Nova de Lisboa and a postgraduate degree in ActuarialSciences from Catholic University of Lisbon; she is currently the ManagingDirector of the subsidiaries of Grupo Vendap in Angola, Mozambique and Brazil,Director of the Serralves Foundation and Deputy Chairman of the GeneralCouncil of Universidade Nova.


INDIVIDUAL FINANCIAL STATEMENTS



31-12-2017 31-12-2016Notes

Assets

Non-current liabilities

Liabilities

Current assets

Equity

Equity and Liabilities

Non-current assets held for sale

7

9

14

15

9

9

11

11

9

11

8

9

9

9

9

11

11

9

9

4

10

12

11

5,716,378

158,189,064

15,832,914

874,938

1,627,604

6,864,409

40,012,059

(37,434,593)

(14,100,000)

29,554,176

13,199,329

30,271,560

(37,434,593)

(11,408,000)

29,103,683

13,364,148

5,811,644

20,024,203

4,356,460

122,780

(1,249,145)

1,885,798

(2,288,872)

3,094,216

53,000,000

1,753,134

53,000,000

4,825,114

105,303,388

15,846,938

1,053,852

2,301,120

67,137,753

29,869,000

169,361,037

700,000

3,181,964 2,292,714

64,129,913

-

100,847,068

-

243,090,106

206,218,582

75,594,141

16,500,000

19,398,704

-

10,000,000

1,288,616

-

62,526,220

305,616,326

50,443,794

221,299,740

170,855,946

123,451,447

65,600,238

Shareholders

Other reserves

Retained earnings

Financial assets adjustment

Net profit for the period

Interim dividends

Clients

Share equity

TOTAL ASSETS

Total non-current assets

Total non-current liabilities


Cash and bank deposits

Total current assets

TOTAL EQUITY

Tangible fixed assets

Loans obtained

Deferred tax assets

Financial derivative instruments

Non-current assets

Provisions

Other financial assets

Other accounts payable


Government and other public entities

Legal reserves

Investments in subsidiaries and affiliates

Other financial liabilities

Other Accounts Receivable

STATEMENT OF FINANCIAL POSITION ON 31 DECEMBER 2017 AND 2016

(Amounts in euros)


Current liabilities

12

9

9

9

9

29,108

623,336

2,608,736

26,392

843,016

1,223,302

2,812,800

17,729,624

6,454,253

23,701,092

23,803,603

230,022,185

305,616,326

32,248,055

155,699,502

221,299,740

Total current liabilities

TOTAL LIABILITIES

TOTAL EQUITY AND LIABILITIES

Government and other public entities


Suppliers

Loans obtained

Other financial liabilities

31-12-2017 31-12-2016Notes

STATEMENT OF FINANCIAL POSITION ON 31 DECEMBER 2017 AND 2016

(Amounts in euros)

31-12-2017 31-12-2016Notes

16

14

18

20

23

21

15

20

11.3

8

19

17

22

1,786,383

97,000

(2,728,515)

(230,412)

(5,898,305)

(1,302,610)

3,077,291

1,400,283

6,266,078

(1,137,733)

(291,765)

(4,809,044)

(1,093,922)

2,487,707

(94,766)

521,975

-

(3,990,572)

2,330,052

36,508,629

371,117

(813,312)

(66,100)

(3,181,056)

1,216,255

27,941,863

(2,830,830)

(4,133,440)

29,554,176

30,076,151

2.84

26,476,884

4,577,079

3,483,158

29,103,683

28,290,371

2.67

26,615,976

Results before depreciation, financing expenses and taxes

Operating profit (before financing expenses and taxes)

Net profit for the period

Comprehensive Income

Earnings per share

Profit before tax

Sales and services provided

That might be subsequently reclassified to profit:

Provisions (increases/reductions)

Personnel expenditure

Other expenses and losses

Interest and similar expenses supported

Expenses/reversal of depreciation and amortisation

Income tax for the period

Income and Expenses

Other recognised income and expenses in equity:

External supplies and services

Other incomes and gains

Interest and similar income obtained

Gains / losses allocated to subsidiaries

Hedging financial instruments (net of taxes)

Impairment of investments not depreciable/amortisable (Losses/Reversals)

STATEMENT OF INCOME AND OTHER COMPREHENSIVE INCOME FINANCIAL YEAR ENDED ON 31 DECEMBER 2017 AND 2016

(Amounts in euros)



Paid-up capital

(Nota 11.1)

Other equity instruments(Nota 11.3)

Legal reserves(Nota 11.3)NotesDescription

POSITION AT THE BEGINNING OF THE 2016

POSITION AT THE BEGINING OF THE 2017

1

7

8

9

2

3

4

10

5=3+4

11=9+10

6

12

7=1+2+3+4+6

13=7+8+9+10+12

-

53,000,000

53,000,000

14,350,000

-

3,430,501

4,356,460

925,958

1,455,184

1,455,184

925,958

11.3

11.2 / 11.3

11.3

11.2 / 11.3

11.3

11.3

11.4/11.2

11.4/11.2

-

-

-

-

-

(14,350,000)

(14,350,000) -

--

-

-

-

-

-

-

-

-

53,000,000

53,000,000

-

-

-

-

4,356,460

5,811,644

POSITION AT THE END OF THE 2016 PERIOD

POSITION AT THE END OF THE 2017 PERIOD

Constitution of the legal reserve

Constitution of the legal reserve

Interim dividends distributions

Interim dividends distributions

APPROPRIATION OF RESULTS

APPROPRIATION OF RESULTS

CHANGES DURING THE PERIOD

CHANGES DURING THE PERIOD

NET PROFIT FOR THE PERIOD

NET PROFIT FOR THE PERIOD

COMPREHENSIVE INCOME

COMPREHENSIVE INCOME

Transfer of the financial year results to retained earnings

Transfer of the financial year results to retained earnings

Return of supplementary payments

Distribution of Dividends

Other Operations

Net losses in hedging

Net gains in hedging

STATEMENT OF CHANGES IN EQUITY OF THE FINANCIAL YEAR ENDED ON 31 DECEMBER 2017 AND 2016

(Amounts in euros)


STATEMENT OF CHANGES IN EQUITY OF THE FINANCIAL YEAR ENDED ON 31 DECEMBER 2017 AND 2016

Retained earnings(Nota 11.3)

Other reserves(Nota 11.3)

Financial assets and liabilities adjustments(nota 11.3)

Interim dividends(Note 11.4)

Net profit for the period Total Equity

12,678,352

30,271,560

(1,475,560)

(2,288,872)

(37,434,593)

(37,434,593) (11,408,000)

18,519,167

29,103,683

63,067,867

65,600,238

(11,195,683)

(925,958)

(1,455,184)

-

-

-

- - (18,519,167) -

17,593,209

9,740,499

9,740,499

17,593,209

(17,593,209)

(9,740,499)

-

-

-

-

-

-

-

(14,350,000)

(6,500,000)

(25,758,000)

517,752

(20,082,248)

-

- 517,752

517,752

-

-

29,103,683

29,554,176

29,103,683

29,554,176

29,103,683

29,554,176

28,290,371

30,076,151

(11,408,000)

(14,100,000)

(11,408,000)

11,408,000

(2,692,000)

0

(17,908,000)

(17,908,000)

(11,408,000)

(14,100,000)

(813,312)

521,975 521,975

(813,312)

521,975 521,975

(813,312)

(813,312)0

0

30,271,560

40,012,059

(2,288,872)

(1,249,145)

(37,434,593)

(37,434,593)

(11,408,000)

(14,100,000)

29,103,683

29,554,176

65,600,238

75,594,141




31-12-2017 31-12-2016Notes

5,475,520

230,150,000

(6,690,883)

(37,652)

(176,795,634)

(5,282,356)

(193,723,708)

5,615,635

1,708,561

7,573,904

78,800,000

27,829,448

(38,618)

(65,783,489)

(4,491,145)

(83,621,665)

1,116,494

1,594,749

(5,728,209)

159,901,424

(7,905,500)

(1,235,974)

-

(20,600,000)

(20,000,000)

177,666

31,493,755

11,196,924

(1,364,107)

13,500,000

19,392,933

(7,943,152)

38,995,618

(417,637,672)

403,551,424

8.1

11.4

9.5

8.1

2.2

9.5

4

4

(462,530)

(7,890,730)

62,979,176

(9,186,688)

(45,000)

(947,689)

(14,350,000)

(11,408,000)

-

-

24,066,269

(10,853,360)

(1,159,056)

-

(6,690,883)

(83,618)

26,777,512

(180,601,989)

141,779,176

(875,482)

(1,616,796)

9,117,598

31,052,466

(14,086,248)

26,083,816

(1,475,882)

(13,204,724)

26,693,894

(38,822,812)

(25,333,643)

Cash generated by operations

Cash flow from operating activities (1)

Cash flow from investment activities (2)

Cash flow from financing activities(3)

Changes in cash and cash equivalents (1+2+3)

Cash receipts from customers

Bank loans

Cash and cash equivalents at the start of the period

Bank loans

Payments relating to:

Payments relating to:

Cash receipts relating to:

Cash flow from operating activities – direct method


Effect of exchange differences

Cash flow from investment activities

Cash paid to employees


Cash and cash equivalents at the end of the period

Financial Investments

Amortisation of finance lease contracts


Dividends


Other assets

Dividends

Other cash receipts/payments

Cash paid to suppliers

Other financing operations (loans)

Changes in cash and cash equivalents


Interest and similar expenses

Other financing operations (loans)

Financial investments

Interest and similar income

Income tax received/paid

SEPARATE STATEMENT OF CASH FLOWS OF THE FINANCIAL YEAR ENDED ON 31 DECEMBER 2017 AND 2016

(Amounts in euros)



1. GENERAL INFORMATION ON THE ENTITY’S ACTIVITY

José de Mello Saúde, S.A. (hereinafter “Company” or “JMS”) is a public limited company, with headquarters in Lisbon, in Av. do Forte, No. 3, Suécia III Building, Floor 2, 2790-073 Carnaxide, incorporated in December 1992.

The Company has as its corporate object the purchase, sale and rental of equipment, the provision of management, consulting, IT, administrative, negotiation/provisioning services, as well as to provide health services.

José de Mello Saúde is the holding company of a group whose main activity is to provide healthcare services, namely in the private healthcare, in the public-private partnerships, services in the field of medicine, occupational hygiene and health as well as home healthcare. The group also develops other secondary activities in the real estate and infrastructure sector.

The Company’s equity is owned by José de Mello Capital, S.A. (65.85%), its parent company, by Fundação Amélia da Silva de Mello (4.15%) and by Farminveste – Investimentos, Participações e Gestão, S.A. (30%).

It should be noted that on 12 December 2017, the companies José de Mello Participações II, SGPS, S.A., Guimarães de Mello Portugal, SGPS, S.A., Guimarães de Mello Investimentos, SGPS, S.A., and José de Mello – Sociedade Gestora de Participações Sociais, S.A. (the former parent company of JMS) were incorporated, via merger, into SOGEFI – Sociedade de Gestão e Financiamentos, SGPS, S.A., which was renamed to José de Mello Capital, S.A. This corporate restructuring jeopardize any commitments made by the intervening Companies, since all of their rights and obligations are now concentrated on José de Mello Capital, S.A.

2. SUMMARY OF THE MAIN ACCOUNTING POLICIES

2.1. BASES OF PREPARATION

The Financial Statements of José de Mello Saúde S.A. were prepared under the assumption of continuity of operations and in accordance with the “International Financial Reporting Standards” (IFRS), as adopted by the European Union, in force for the financial years beginning on or after 1 January 2017. The IFRS issued by the International Accounting Standards Board (IASB), the International Accounting Standards (IAS) issued by the International Accounting Standards Committee (IASC) and respective interpretations – IFRIC and SIC, issued by the International Financial Reporting Interpretation Committee (IFRIC) and Standing Interpretation Committee (SIC), respectively, are deemed to form part of those standards. Hereinafter, this set of standards and interpretations shall be generally referred to as “IFRS”.

The financial statements are presented in euros.

2.1.1. NEW STANDARDS AND INTERPRETATIONS APPLICABLE TO THE 2017 FINANCIAL YEAR

As a result of the endorsement by the European Union (EU), the following issues, revisions, amendments, and improvements of standards and interpretations took effect from 1 January 2017, which were adopted by the Company, when applicable:

Standard Effective date

IAS 12 – Recognition of deferred tax assets for unrealised losses (amendments) 1 January 2017

IAS 7 – Disclosure initiative (amendments)

Improvements concerning the 2014–2016 cycle (IFRS 12 Disclosure of interests in other entities)

1 January 2017

1 January 2017

The adoption of these standards, interpretations and amendments to standards did not have a significant impact on the financial statements.

NOTES ATTACHED TO THE INDIVIDUAL FINANCIAL STATEMENTS ON 31 DECEMBER 2017


2.1.2. NEW STANDARDS AND INTERPRETATIONS ALREADY ISSUED BUT NOT YET MANDATORY

The norms and interpretations recently issued by the IASB, whose application is mandatory only in periods after 1 January 2018 or later:

a) Already endorsed by the EUOn 31 December 2017, the following improvements of the Standards and Interpretations issued by the IASB were already endorsed by the EU; however, their application is only mandatory for the financial years beginning after 1 January 2018:

The new IFRS 15 – Revenue from Contracts with Customers standard establishes a five-step model for the recognition of revenue resulting from contracts entered into with customers. According to the provisions of the standard, the revenue is recognised at the value the entity expects to receive from the customer in exchange for the goods or services provided.

The application of the standard is mandatory for the financial years started on or after 1 January 2018, with their adoption needing to follow the full retrospective method or the modified retrospective method.

The Company adopted this standard from 1 January 2018, and carried out an analysis of the implications of their adoption, with no significant impact being expected in the Financial Statements. In the preparation for the adoption of the IFRS 15, the Company considered the following relevant aspects:

Provision of Services – This revenue stream concerns the sublease rents related to the lease of medical equipment to the Group’s companies. The revenue is recognised on a monthly basis based on the sublease agreements made. Indeed, the Company concluded that the application of this standard will have no significant impacts on the financial statements.

The Company has not carried out the anticipated adoption of these standards and, with the exception of IFRS 16 – Leases, no significant impacts stemming from their adoption are expected in the financial statements. The application of IFRS 16 will have significant impacts on the Company’s balance sheet. The registration of the right of use of the buildings that are in operation by the Company shall involve an increase in the assets and liabilities to third parties.


IFRS 15 – Revenue from contracts with customers

Application of IFRS 9 with IFRS 4 – Amendments to IFRS 4

1 January 2018

1 January 2018

Clarifications to IFRS 15

IFRS 10 and IAS 28 – Sales or contributions of assets between an investor and its associate or joint venture

IFRS 9 – Financial Instruments

IFRS 16 – Leases

Improvements relating to the 2014–2016 cycle

1 January 2018

1 January 2018

1 January 2018

1 January 2019

1 January 2018



b) Not yet endorsed by the EU

Regarding the standards presented above whose mandatory implementation has not yet taken place, the Company has not yet completed the determination of all impacts stemming from their application and, as such, chose to not adopt them in advance. However, it is not expected that these will produce materially relevant effects on its assets and results.

2.2. MAIN ACCOUNTING POLICIES

TANGIBLE FIXED ASSETS

Tangible fixed assets are those used in the provision of services or administrative procedures.

Tangible fixed assets are valued according to their respective acquisition cost, including all related costs, less accrued depreciation and impairment losses.

Depreciation is calculated on a duodecimal base, from the time the good is available for use, according to the straight-line method, so the value of the assets is depreciated by the end of their estimated service lives, with the following rates being applied:

The impairment of these assets is determined according to the criteria set forth in the “Impairment of non-current assets”.

The gains or losses resulting from the sale or disposal of tangible fixed assets are determined as the difference between the sale price and net book value on the date of sale/disposal, and are included in the Net result of the period in the year in which the asset is derecognised.

Assets acquired through finance lease are depreciated using the same rates as other tangible fixed assets, that is, based on their respective useful lives.

The residual value is considered null and void, whereby the depreciable value on which the depreciations incur coincides with the cost.


IAS 28 – Long-term interests in Associates or Joint Ventures (Amendments)

IAS 40 – Transfer of Investment Properties (Amendments)

1 January 2019

1 January 2018

IFRS 2 – Classification and measurement of payment transactions based on actions (Addendum)

IFRS 17 – Insurance Contracts

IFRIC 22 – Foreign currency transactions and advance consideration

IFRIC 23 – Uncertainty over different Income Tax Treatments

IFRS 9 – Anticipated payments with negative compensations (Amendments)


1 January 2018

1 January 2021

1 January 2018

1 January 2019

1 January 2019

1 January 2019

2017 2016

14,28%-33,33%

12,50%-25%

5%-10% 5%-10%

14,28%-33,33%

12,50%-25%

Basic equipment

Office equipment

Buildings and other constructions


Current maintenance and repair costs are recognised as expenses in the period in which they occur.

Improvements are only recognised as assets when it is demonstrated that these increase their useful life or increase their normal efficiency, resulting in increased future economic benefits.

Tangible fixed assets in progress represent tangible assets still under construction, installation or development and are recorded at cost of acquisition, and only amortised when available for use.

INTANGIBLE ASSETS

Intangible assets acquired separately are measured at their cost price on the date of initial recognition. The cost of the intangible assets acquired in a merger of corporate activities is their fair value at the date of acquisition.

Intangible assets generated internally, excluding capitalised development costs, are not capitalised, and expenses are reflected in the Profit and loss statement and Other Comprehensive Income in the year in which the expenses take place.

After initial recognition, intangible assets are recorded at cost price less accrued amortisations and losses due to subsequent impairment.

The useful lives of intangible assets may be finite or indefinite.

Intangible assets with indefinite useful lives are not amortised but undergo impairment tests regardless of whether or not there are indicators that they may be impaired.

Intangible assets with finite useful lives are amortised during their estimated economic life and evaluated with regard to their impairment whenever there are signs that the asset may be impaired.

The impairment of these assets is determined according to the criteria set forth in the “Impairment of non-current Assets”.

Reversals of impairment are recognised in results and only performed up to the limit verified if the impairment had never been recorded.

For an intangible asset with a finite useful life, the amortisation methods, estimated useful life and residual value are revised at the end of each year, and the effects of the changes made are treated as changes to estimates, i.e., the effect of the changes is treated prospectively.

The amortisations are calculated on a duodecimal basis using the straight-line method. The residual value is considered null and void, whereby the depreciable value on which the amortisations incur coincides with the cost.

Amortisation rates are defined with a view to the full amortisation of assets until the end of their expected useful life, and are as follows:

Expenditure incurred from amortisation of intangible assets with finite useful lives is recognised in the Statement of Income and Other Comprehensive Income under the caption “Depreciation and amortisation expenditure/reversals”.

The gains or losses resulting from the sale or disposal of tangible fixed assets are determined as the difference between the sale price and net book value on the date of sale/disposal and are included in the Net result of the period in the year in which the asset is derecognised.

2017 2016

25% 25%Software



INVESTMENTS IN SUBSIDIARIES AND AFFILIATES

Financial investments of capital shares in subsidiaries and affiliates are valued according to their respective cost on the IFRS transition date, or rather 1 January 2012. Under this caption are also recorded, at nominal value, the supplementary payments granted to subsidiaries and affiliates.

Capital share dividends are only recognised as income when their respective receipt is guaranteed and interest from securities are accounted for in the period to which they are related.

Goodwill is included in the value of the carrying amount of the investment and is not amortised nor subject to individual impairment testing. However, if signs of impairment are detected in the financial investments, they are subject to impairment testing. The impairment of these assets is determined according to the criteria set forth in the “Impairment of non-current assets”.

IMPAIRMENT OF NON-CURRENT ASSETS

At each reporting date, a review of the recorded amounts of non-current assets is carried out to determine whether there is any indication that they can be impaired. If there areindicators, the recoverable amount of the corresponding assets is estimated to determine the extent of the impairment loss (if any). When it is impossible to determine the recoverable amount of an individual asset, the recoverable amount of the cash-generating unit to which that asset belongs is estimated. The recoverable amount of the asset or cash-generating unit is the largest of (i) the fair value minus costs to sell and (ii) the usage value. In the determination of the usage value, the estimated future cash flows are discounted using a discount rate that reflects the market’s expectations regarding the time value of money and the specific risks of the asset or cash-generating unit for which the future cash flow estimates have not been adjusted. Whenever the recorded amount of the asset or cash-generating unit exceeds its recoverable amount, an impairment loss is recognised. The impairment loss is recorded immediately in the Statement of Income and Other Comprehensive Income, unless if the loss offsets a surplus of revaluation in the equity.

The reversal of impairment losses recognised in prior financial years is recorded when there are indications that the impairment losses no longer exists or has decreased. The reversal of impairment losses is recognised in the Income Statement and Other Comprehensive Income. The reversal would be carried out up to the limit of the amount that would be recognised (net of amortisations) if the previous impairment loss had not been recorded.

FINANCIAL ASSETS (IN ADDITION TO FINANCIAL INVESTMENTS)

Financial assets are recognised in the Company’s Statement of Financial Position at the date of negotiation or contracting, which is the date on which the Company agrees to acquire the asset.

Financial assets are classified as follows, depending on whether or not the Board of Directors intends to acquire them:

• Clients and Other Receivables Accounts

Non-derivative Financial assets, with fixed or determinable payments, are included. The balances for Clients, Other Receivable Accounts and Other Financial Assets are recorded at fair value and subsequently, at amortised cost, minus impairment adjustments, if applicable.

At the end of the year, the company evaluates the impairment of these assets. When there is objective evidence of impairment, the company recognises an impairment loss on the profit and loss statement.


The objective evidence that a financial asset is impaired takes into account the following aspects:

• Debtor’s significant financial difficulty

• Breach of contract, such as failure to pay or non-compliance with interest payments or debt amortisation

• Likelihood that the debtor will become bankrupt.

• Other financial instruments

Financial assets included in this caption concern financial instruments held to maturity, measured at amortised cost, using the effective interest rate method, less impairment.

• Shareholders

Balances with shareholders are presented at their corresponding cost, net of impairment losses, where applicable, determined based on the criteria defined for the remaining accounts receivable.

INCOME TAX

Income tax for the period includes current and deferred costs from the financial year.

Current income tax is calculated based on the taxable income in accordance with the tax rules in force to which the company is subjected.

The Company is taxed according to the Special Corporate Group Tax Regime (RETGS – Regime Especial de Tributação de Grupo de Sociedades).

According to current legislation, tax returns are liable for review and correction by the Tax Authorities for a period of four years.

Accordingly, the tax returns of the Company for the years 2014 to 2017 may still be reviewed, although the Company believes that any adjustments resulting from tax revisions to those tax documents will have no significant impact on the Financial Statements referring to 31 December 2017.

DEFERRED TAX ASSETS AND LIABILITIES

The Company recognises deferred taxes, as established in IAS 12 – Income Tax, as a way of adequately accruing the tax effects of its operations, and to exclude distortions related to the criteria of a fiscal nature that impact on the economic results of certain transactions.

Deferred tax assets are recognised when there is reasonable assurance that future taxable profit may be achieved against which those assets can be deducted. Deferred tax assets are reviewed annually and reduced when it is no longer probable that they may be used.

The value of deferred tax is determined by applying the tax rates (and laws) enacted or substantively enacted at the reporting date and which are expected to apply in the period of realisation of the deferred tax asset or of the deferred tax liability settlement. According to the legislation in force, the corporate income tax rate of 21% was considered and, in the situations not connected to tax losses, a municipal surtax of 1.5% on the temporary differences that led to deferred tax assets and liabilities.

The movement occurring during the financial year, the reconciliation between the nominal tax and effective current tax rate, as well as the decomposition of deferred tax balances, are presented in Note 15.



CASH AND BANK DEPOSITS

The amounts included in the Cash and bank deposits caption correspond to cash, bank deposits, term deposits and other short-term investments maturing in less than three months, and which may be immediately redeemed at insignificant risk of changes in value.

For the purposes of the Cash Flow Statement, the caption “Cash and cash equivalents” also includes bank overdrafts included in the “Loans Obtained” item, in the Statement of Financial Position.

NON-CURRENT ASSETS HELD FOR SALE

This caption includes non-current assets (or disposal groups) whose carrying amount will be recovered mostly through a sale transaction, rather than through continued use, and which meet the following conditions:

• They are available for immediate sale in their present condition, subject only to terms that are usual and customary for the sale of this type of assets and

• Their sale is highly probable. That is:

• The appropriate management hierarchy is involved in a plan to sell the assets (or disposal groups);

• A programme was started to locate a buyer and complete the plan;

• The asset was widely advertised for sale at a price that is reasonable in relation to its current fair value;

• The sale will be completed within one year from the date of classification.

The events or circumstances that may extend the period to complete the sale for more than a year do not exclude that an asset is classified as held for sale if the delay is caused by events or circumstances beyond the control of the entity and if there is sufficient evidence that the entity remains committed to its plan to sell the asset.

Immediately before the initial classification of the non-current assets (or disposal groups) as held for sale, the carrying amounts of the assets (or of the group’s assets and liabilities) are measured in accordance with the applicable IFRSs.

On the date of initial recognition, non-current assets (or disposal groups) held for sale are measured at the lower value between their carrying amount and fair value less selling costs or, if purchased as part of a combination of business activities, at fair value less selling costs.

When the sale is expected to occur more than a year later, the selling costs are measured at their present value. Any increase in the present value of the selling costs resulting from the passage of time is recognised in the results as cost of funding.

Any initial or subsequent reduction of the asset (or disposal group) to the fair value less selling costs is recognised as an impairment loss. Any gain resulting from a subsequent increase in the fair value less costs of selling an asset is recognised, but not beyond the previously recognised cumulative impairment loss.

Non-current assets, while classified as held for sale or while they are part of a disposal group classified as held for sale are not depreciated (or amortised).

Interest and other expenses attributable to the liabilities of a disposal group classified as held for sale continue to be recognised.

FINANCIAL LIABILITIES

Financial liabilities are classified according to the substance of the contract, regardless of their legal form, as shown below:

• Bank Loans

Loans are valued at amortised cost, with the received value being net of commissions with the issuing of these Loans. Financial charges are calculated in accordance with the effective interest rate method and accounted for in the Statement of Income and Other Comprehensive Income, based on the financial year specialisation principle.

• Suppliers, Other Payable Accounts and Other Financial Liabilities

Balances of Suppliers, Other Payable Accounts and Other Financial Liabilities are initially recorded at their nominal value, which is understood to correspond to their fair value and, subsequently, whenever applicable, are recorded at their amortised cost, according to the effective interest rate method. The accounts payable are recognised as current liabilities except if their settlement is contracted after twelve months following the date of the Statement of Financial Position.

DERIVATIVE FINANCIAL INSTRUMENTS AND HEDGE ACCOUNTING

The Company’s policy is to contract financial derivative instruments for hedging financial risks to which it is exposed, which are mainly due to interest rate variations.


• Hedging Instruments

The possibility of calling a derivative financial instrument a hedging instrument complies with the provisions of IAS 39, namely, with regard to its respective documentation and effectiveness evaluation.

Financial derivative instruments are recognised for their fair value on the date they are negotiated. Fair value is evaluated on a regular basis, and gains or losses resulting from that evaluation are recorded in the profit and loss statement, except cash flow hedging derivatives, in which the variation is recognised in Equity (“Other financial instrument reserves”).

Accounting is discontinued when the hedging instrument reaches maturity or is sold, or when the hedging relationship ceases to comply with the requirements of IAS 39.

LEASES

• Finance leases

Contracts are considered to be financial leasing if all risks and benefits associated with the possession of the corresponding assets are substantially transferred through them.

Assets acquired under finance lease contracts, as well as the corresponding liabilities, are recorded by the financial method, with the assets, the corresponding accrued amortisations and the debts pending settlement being recorded according to the contracting financial plan. Additionally, the interest included in the value of the rents and the amortisations of the tangible and intangible fixed asset are recognised as costs in the income statement for the period they concern.

• Operating leases

Contracts are considered to be of operational leasing if all risks and benefits associated with the possession of the corresponding assets are not substantially transferred through them. The classification of the leases as financial or operational is made according to the substance and not the form of the contract.

In operating leases, rent payments are recognised as a cost in the income statement during the period of the lease contract.

PROVISIONS

Provisions are established when the Company has a present obligation (legal or constructive) as a result of past actions, or when economic resources may probably be used to meet this obligation and this may be measured reliably.

Provisions are measured according to the best estimate of expenditure required for settling the present obligation on the balance sheet date.

EQUITY CAPTIONS

• Paid-up capital

In compliance with art. 272 of the Portuguese Commercial Companies Code (CSC), the company contract specifies the deadline for paying-up the subscribed and not paid capital at the time of the deed.

• Other equity instruments

Equity instruments are classified in accordance with the contract substance, irrespective of their legal form. Equity instruments issued by the Entity are recorded at their received value, net of issuing costs.

• Legal Reserves

In accordance with art. 295 of the CSC, at least 5% of the result must be used for establishing or strengthening the legal reserve until it represents at least 20% of the company’s share capital. The legal reserve is not distributable unless in case of liquidation, and can only be used to absorb losses after all other reserves are exhausted, or for incorporation in share capital (art. 296 of the CSC).

• Other reserves

This account includes the changes in the fair value of risk-hedging derivatives from variability in the interest rate, currency risk, risk of price of goods within the framework of a commitment or high probability of future transaction that, in accordance with paragraph 2 of article 32 of the CSC, will only be available for distribution when the elements or rights that gave rise to them are disposed, executed, extinguished or settled.

• Retained earnings

This caption includes the realised results available for distribution to shareholders and gains from increases in fair value, financial investments and investment properties that, in accordance with point 2, art. 32 of the CSC, will only be available for distribution when the elements or rights giving rise to them are disposed of, exercised, eliminated or settled.



• Net Profit of the Financial Year

This caption includes gains from increases in fair value, financial investments and investment properties that, in accordance with point 2, art. 32 of the CSC, will only be available for distribution when the elements or rights giving rise to them are disposed of, exercised, eliminated or settled.

• Adjustments to financial assets

This account also includes the adjustments connected to the application of the equity method from previous years, namely appropriation of changes in equity of subsidiaries and unallocated profits.

• Interim dividends

This account reflects the advance on profits made in the course of financial year under the provisions of article 297 of the CSC, in the following terms:

• Carried out in the second half of the year;

• Does not exceed half of the amount that would be distributed on the date the mid-term review concerns.

RECOGNITION OF INCOME

Income is recognised as such when it is likely that the Company will receive economic benefits that can be evaluated reliably.

For income to be recognised, the following criteria must also be complied with in full:

• Provision of Services

The provisions of service are measures at the fair value of the compensation received or to be received net of amounts concerning granted discounts.

Income from services supplied is recognised when the outcome of the transaction may be estimated reliably, which occurs when the following conditions are met:

• The amount of income can be measured reliably;

• Economic benefits from the transaction are probably received by the company;

• Costs incurred from the transaction and from its completion can be measured reliably.

• Interest

Income from interest receivable is specialised, so that it is recognised in the period they concern, regardless of whether or not the respective support document is issued.

• Dividends

This income is recognised when, in substance, the obligation to declare dividends is established in the declaring Entity.

RESPONSIBILITY FOR EMPLOYEE BENEFITS

Personal expenses are recognised when the service is provided by the employees regardless of their payment date. Here are some specificities regarding each of the benefits:

• Termination of employment

Benefits for termination of employment are due to be paid when employment ends before the usual retirement date or when an employee accepts to leave voluntarily in exchange for these benefits. The Company recognises these benefits when it can be shown it is committed to a termination of employment of current employees, according to a formal detailed plan for the termination, and there is no realistic possibility of withdrawal or if these benefits are granted to encourage voluntary departure. When the employment termination benefits are due over 12 months after the balance sheet date, they are discounted to their current value.

• Holidays, holiday entitlement and bonuses

According to labour law, employees are entitled to 22 working days of annual leave, as well as a month of holiday entitlement, rights acquired in the year prior to their payment. These liabilities of the Company are recorded when incurred, regardless of the time of their payment, and are reflected in the caption “Other Payable Accounts”.

INTERESTS AND SIMILAR SUPPORTED EXPENSES

The financial costs of loans obtained related to the acquisition, construction or production of assets that necessarily take considerable time before being ready for use or sale, are capitalized and part of the cost of the asset. All other financial costs are spent in the period in which they occur. Financial costs consist of interest and other costs stemming from obtained financing.

STATEMENT OF CASH FLOWS

The statement of cash flows is prepared according to the direct method, through which the cash inflows and outflows in operating, investing and funding activities are disclosed.


CONTINGENT ASSETS AND LIABILITIES

Contingent liabilities are not recognised in Financial Statements but are disclosed in these Notes, unless the possibility of an outflow of resources is remote, in which case they are not subject to disclosure.

Contingent assets are not recognised and only disclosed in circumstances embodying future economic benefits.

SUBSEQUENT EVENTS

Events occurring after the reporting date that provide additional information on conditions existing on the date of issue of the Statement of Financial Position are shown in financial statements. Events occurring after the reporting date that provide additional information on conditions existing on the date of issue of the Statement of Financial Position are disclosed in the Notes to Financial Statements, if material.

2.3. MAIN ESTIMATES AND JUDGMENTS OF THE MANAGEMENT

When preparing Financial Statements according to the IFRS, the Board of Directors uses estimates and assumptions that affect the application of the policies and the reported amounts. Estimates and judgements are continuously evaluated and are based on the experience from past events and other factors, including expectations for future events considered probable in view of the circumstances on which the estimates are based, or as a result from acquired information or experience. The most significant accounting estimates shown in the Financial Statements are as follows:

• Useful Life of Tangible and Intangible Fixed Assets

The useful life of an asset is the period during which the Entity expects that asset to be available for its use and is reviewed at least at the end of each financial year.

The amortisation/depreciation method to apply and the estimated losses stemming from the replacement of equipment before the end of their useful life, for reasons of technological obsolescence, is crucial to determining the effective useful life of an asset.

These parameters are defined according to the management’s best estimate, for the assets and deals in question, also considering the practices adopted by companies from the sectors where the Government operates.

• Recognition and measurement of provisions

The recognition of provisions has associated the determination of the probability of exit of future flows and their reliable measurement.

These factors are often dependent on future events and not always under the control of the Entity and, as such, may lead to significant future adjustments, both via the variation of the assumptions used and via the future recognition of provisions previously disclosed as control liabilities.

• Impairment of receivable accounts

The credit risk of the balances of receivable accountsis assessed at each reporting date, taking into account the historical information of the debtor and its risk profile.

The receivable accounts are adjusted by the evaluation of the estimated risks of collection existing at the balance sheet date, which may come to differ from the actual risk to incur in the future.

• Fair Value of Financial Instruments

When the fair value of the financial assets and liabilities on the balance sheet date is not determinable based on active markets, it is determined based on valuation techniques that include the discounted cash flow model or other suitable models under the circumstances. The inputs for these models are taken, whenever possible, from variables observable in the market; however, when this is not possible, a degree of judgment becomes necessary to determine the fair value, which encompasses considerations on liquidity risk, credit risk and volatility.



• Impairment of non-financial assets

The impairment occurs when the accounting value of an asset of cash-generating unit exceeds its recoverable amount, which is the highest between the fair value net of costs of selling and its usage value.

The calculation of fair value net of costs of selling is based on the existing information from contracts already signed in transactions of similar assets with entities which have no relationships among them, or prices observable in the market net of incremental costs of selling the asset.

The value in use is calculated based on a discounted cash flow model that takes into account a budget for the next five years which does not include restructuring activities for which there still is no commitment, or future significant investments seeking to improve the future economic benefits that will arise from the cash-generating unit that is being tested.

The recoverable amount is particularly sensitive to:

• The growth rate used to extrapolate the cash flows beyond five years;

• The discount rates used to discount future cash flows.

• Taxes on income and deferred taxes

The determination of the amounts of income taxes and deferred taxes require the exercise of judgment and is subject to interpretation. Different interpretations could result in a different level of taxes on profits, both current and deferred, recognised in the period.

Only deferred tax assets are recognised to the extent it is likely that there will be taxable profit on which they can be used.

2.5. POLICIES OF FINANCIAL RISK MANAGEMENT

José de Mello Saúde’s Financial Risk Management Policy seeks to ensure the proper identification of risks associated with the businesses undertaken, as well as to adopt and implement the necessary measures to minimise the negative impacts that adverse developments of the factors underlying these risks may have on the financial structure of the Company and on its sustainability.

Under the risk management process, José de Mello Saúde identified a set of risks associated with the company’s financial performance considered materially more relevant, among which stand out the market (exposure to variations of interest rates), credit and liquidity risk.

The Company has a risk management model that seeks to minimise the potential adverse effects, using the instruments suited to cover the risks to which it is exposed.

• Market risk

The market risk is the risk of the changes in market prices, such as interest rates, foreign exchange variations or evolution of the stock markets, affecting the Company’s results and its financial position.

The Company is only exposed to risks stemming from changes in interest rates, thus the management of market risks is mostly focused on monitoring the evolution of the interest rates, which influence the remunerated financial liabilities (contracted on the basis of interest rates indexed to the evolution of the markets) and their impact on Financial Statements.

• Risk of exposure to variations in interest rates

The management of the interest rate risk aims to minimise exposure to changes in interest rates and their impact on the Financial Statements within the established limits.

Through the adopted control policy, the intention is to select the suitable strategies for each business area, seeking to ensure that this risk factor does not negatively affect the corresponding operating capacity. On the other hand, the exposure to interest rate risk is also monitored via the simulation of adverse scenarios with a certain degree of probability which can negatively affect the Group’s results.


Whenever the expectations of evolution of interest rates are justifiable, the Company seeks to contract operations to protect against adverse movements through derivatives. The economic aspects of the instruments are the main factors in their selection.

Currently, the Company has contracted hedging instruments for cash flow risk with the sole intent of setting the interest rates of some of its credit lines. Plain vanilla interest rate swaps were contracted in 2015 covering 100% of the amounts of the bond loans issued in 2014 and 2015 (100 million euros in total). The contracted swaps respect the characteristics of the aforementioned bond loans in order to be considered hedging products (similar indexer, time period and interest-payment deadlines). On the date of interest payment, José de Mello Saúde receives interest indexed to 6-month Euribor for 100% of the capital and pays interest at a fixed rate on the same amount.

In 2017, following its policy to reduce exposure to interest rates, José de Mello Saúde issued a bond loan with a fixed interest rate. Thus, considering the effect of the contracted swaps, at the end of 2017, José de Mello Saúde held 36% of its financial debt contracted at fixed interest rates (46% in 2016).

The table below provides a sensitivity analysis of the impact of a potential increment of Euribor rates in José de Mello Saúde’s financial costs in 2017 and 2016:

+30,904

+6,748

+16,620

+19,233

+13,853

+11,273

+61,377

+37,254

+0.5

+0.5

+0.5

+0.5

+0.5

+0.5

-

-

Non-current loans

Non-current loans

Current and non-current finance leases


Current loans

Current loans

Total

Total

Changes in Euribor rates (pp)

Impact in financial costs (euros)

2017

2016



Accounts Receivable

The Company’s credit risk is essentially related to the operational and investment activity with its subsidiaries.

The management tracks the activity of all subsidiaries, enabling this risk to be monitored.


Other Financial Instruments include bonds issued by José de Mello Capital, S.A. and Farminveste – Investimentos, Participações e Gestão, S.A. Risk monitoring is carried out periodically by the management via the analysis of the accounts of José de Mello Capital, S.A. and Farminveste – Investimentos, Participações e Gestão, S.A.

• Liquidity risk

Liquidity risk stems from the potential inability to finance the Company’s assets, or to meet the contracted liabilities on the expiration dates.

The management of the liquidity risk seeks to permanently track the treasury forecasts in order to ensure the fulfilment of all of the Company’s liabilities toward the entities with which it deals in its activity. Through active management of the business plan and comprehensive mapping of needs or future cash surpluses, it also seeks to reduce the risk of financing by having a permanent relationship with the financial partners.

The table below presents the Company’s liabilities according to intervals of contractual maturity at the end of 2017 and 2016, respectively. The amounts represent the non-discounted cash flows to be paid in the future.

Funding contracted at a fixed rate was excluded, namely the bond loan mentioned previously;

Since the vast majority of the loans contracted by José de Mello Saúde are supported by the application of a floor at zero if Euribor rates are negative, and given that these, in 2017 and 2016, were always negative, a scenario of rate reduction was not simulated.

• Credit risk

The credit risk is the risk of a counterparty failing to comply with its obligations under the cover of a financial instrument, thus resulting in a loss.

The following table presents the Company’s maximum exposure to credit risk:

1,753,134

114,046,398

2,292,714

10,000,000

3,094,216

176,225,446

3,181,964

16,500,000

Clients

Other Financial Assets

Other accounts receivable


199,001,626 128,092,245

2017 2016

1,591,858

777,810

104,512,353

52,422,008

50,133,333

50,416,693

-

-

Financial debt* < 1 year 1-3 years 3-5 years > 5 years

2017

2016

* Short-term debt used to support treasury is excluded


3. FAIR VALUE ESTIMATE

The hierarchy for purposes of determining the fair value shall have the following levels and measurement bases:

• Level 1 – market quotes net of assets, which the Company can access at the balance sheet’s date of reference;

• Level 2 – generally accepted evaluation models, based on inputs observable in the market, in alternative to those mentioned in level 1;

• Level 3 – evaluation models whose main inputs are not observable in the market.

The Company has valued at fair value the assets and liabilities listed in the table below, in which their corresponding hierarchy is also specified:

The fair value of the financial derivatives was determined by banking entities, based on inputs observable in the market and according to the generally accepted evaluation models and techniques.

Level 1Market Quotes


Level 2Inputs

Observable In The Market

Level 2Inputs


Total

Total

Level 3Inputs Non-


Level 3Inputs Non-


Liabilities Valued at Fair Value

Liabilities Valued at Fair Value

-

-

1,627,604

2,301,120

1,627,604

2,301,120

-

-

1,627,604

2,301,120

-

-

-

-

1,627,604

2,301,120



Cash Flow Hedge (note 9.10)

Cash Flow Hedge (note 9.10)

HIERARCHY OF FAIR VALUE


Fair Value at 31 December 2017




1,097,931

418

200

1,288,616

(6,690,883)

190,067

(7,979,498)

19,398,086

418

200

19,398,704

19,392,933

-

(5,771)

Current accounts

Cash

Other bank deposits

Balance in the Statement of Financial Position

Balance in the Cash Flow Statement

Other Short-term Investments

Bank overdrafts

2017 2016

4. CASH AND BANK DEPOSITS

The caption “Cash and Banks” in the Financial Position Statement and the balance of “Cash and Cash Equivalents” in the Cash Flows Statementis broken down as follows, as of 31 December 2017 and 2016:

The variation in the caption “Other Short-term Investments” is justified by the disposal of the shares in Montepio Geral.


5. RELATED PARTIES

5.1 NATURE OF THE RELATIONSHIP WITH RELATED PARTIES

The company’s Financial Statements are included in the consolidated Financial Statements of José de Mello Capital, S.A., which holds control over José de Mello Saúde. The nature of the relationships with the related parties are shown in the following table:

Services Received/Transactions ReceivedLocation

Services Provided/ Transactions Carried OutCompany

Farminveste - Investimentos, Participações e Gestão, S.A.

Academia CUF, Lda

JMS - Prestação de Serviços Administrativos e Operacionais A.C.E.

Hospital CUF Torres Vedras, S.A.

Hospital CUF Porto, S.A.

Imo Health - Investimentos Imobiliários, S.A.

Valir - Sociedade Gestora de Participações Sociais, S.A.

Clinica CUF Belém, S.A.

Loja Saude CUF - Produtos e Serviços de Saude e Bem Estar, S.A.

Hospital CUF Descobertas, S.A.

PPPS - Gestão e Consultoria, S.A.

Hospital CUF Santarém, S.A.

PPPS II - Gestão e Consultoria, S.A.

José de Mello Capital, S.A.

Clinica CUF Alvalade, S.A.

JMS - Prestação de Serviços Saude, A.C.E.

Escala Vila Franca - Sociedade Gestora do Estabelecimento, S.A.

Instituto CUF - Diagnóstico e Tratamento, S.A.

Hospital CUF Viseu, S.A.

Vramondi International Bv

Hospital CUF Cascais, S.A.

Sagies - Segurança, Higiene e Saude no Trabalho, S.A.

Simplygreen - Investimentos Imobiliários, S.A.

Hospital CUF Infante Santo, S.A.

Infrahealth - Gestão de Infraestruturas, Lda.

Escala Braga - Sociedade Gestora do Estabelecimento, S.A.

PPPS III - Gestão e Consultoria, S.A.

CPIS - Clínica Particular de Coimbra, S.A.

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal

Portugal


Shared services

Shared services

Rental of equipment

Rental of equipment

Shared services

Loans

Rental of equipment

Loans

Rental of equipment

Loans

Loans

Loans


Rental of equipment

Shared services

Shared services

Consulting

Rental of equipment

Loans

Rental of equipment

Loans

Rental of equipment

Loans

Consulting

Loans

Loans

Loans

Loans

Loans

Occupational health

Shareholders

Subsidiary Companies

Other Related Parties



Year

Debit Balances Credit Balances Transactions

Accounts receivable

Accounts payable IncomeShareholders

/ SubsidiariesShareholders / Subsidiaries Expenses

Other Financial

InstrumentsCompany


Academia CUF, Lda

Hospital CUF Torres Vedras, S.A.



Valir - Sociedade Gestora de Participações Sociais, S.A.

Clinica CUF Belém, S.A.













Infrahealth - Gestão de Infraestruturas, Lda.




2017

2017 3,247

14,117

1,634

62,321

15,639

198,840

352,530

434,699

500,631

16,700,000

16,500,000

21,600,000

1,112,537

902,712

1,318,419

2,000,000

137,726

15,940

167,139

65,850

31,680 1,927

28,234

742

59,424

3,540

182,463

339,037

302,002

401,529

36,497

54,746

1,081,800

74,237

57,848

666,540

350,867

-

9,987

43,496

4,313

560,983

1,181

54,978

350,043

131,765

252,150

98,179 99,997

81,542

121,104

96,482

4,313

1,910,801 1,135,048

172,754 1,599

127,636

119,912

272,592

131,765 32,681,800 6,454,253

16,700,000

16,500,000

21,600,000

2,000,000

2,000,000 3,000,000

3,000,000 96,597,305 36,973,036 4,003,359 4,024,190

3,170,000 3,170,0003,500,000

6,788,732 6,788,732

175

548

365,000

1,041,121

791,679

1,206,665

3,200,000

139,703

10,101

159,435

28,032

18,804 2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017

2017 122,780 6,500,000

10,000,000 10,000,000 2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

2016

Shareholders

Subsidiary Companies

INDIVIDUAL FINANCIAL INFORMATION

The accounted income mostly results from: (i) lease of equipment from the group’s companies in sub-lease; (ii) administrative services common to the entire group (shared services); (iii) interest from loans. The main expenses result from legislation concerning occupational health.

No impairments were identified in receivable balances.

5.2. TRANSACTIONS AND PENDING BALANCES

The amounts of pending transactions and balances with related parties are shown in the following table:


Year

Debit Balances Credit Balances Transactions

Accounts receivable

Accounts payable IncomeShareholders

/ SubsidiariesShareholders / Subsidiaries Expenses

Other Financial

InstrumentsCompany

JMS - Prestação de Serviços Administrativos e Operacionais A.C.E.


JMS - Prestação de Serviços Saude, A.C.E.

Sagies - Segurança, Higiene e Saude no Trabalho, S.A.

Simplygreen - Investimentos Imobiliários, S.A.

(126,040) 1,418,351 513,188

5,161 1,635

7,976 48,481

328

401,400

401,400 25,176 15,948

77,818 498 81,421 33,014

206 40,026

2017

2017

2017

2017

2017

2016

2016

2016

2016

2016

Other Related Parties

5.3. WAGES OF KEY MANAGEMENT PERSONNEL

The wages of the Company’s key management personnel are discriminated in the table below:

Remunerations concern wages received by the governing bodies.

The gross carried amount, accrued depreciation and impairment losses at the beginning and end of the period are as follows:

6. INTANGIBLE ASSETS

464,676

464,676

467,975

467,975

Total remuneration paid

2017 2016

71,262

71,262

71,262

71,262

71,262

-

-

-

71,262

71,262

71,262

71,262

71,262

71,262

-

-

-

71,262

At 1 January 2016

At 31 December 2016

At 1 January 2016

At 31 December 2016

At 31 December 2017

Acquisitions

Depreciations for the period

Depreciations for the period

At 31 December 2017

Software Total Intangible Assets

Cost:

Depreciation and impairment losses:



-

-

-

-

-

-

Net book value:

At 31 December 2017

At 31 December 2016

At 1 January 2016

Software Total Intangible Assets

The gross carried amount, accrued depreciation and impairment losses at the beginning and end of the period are as follows:

The caption “Basic Equipment” concerns the medical-surgical equipment acquired to be leased to the group’s companies. The recorded increase mainly concerns the acquisition of magnetic resonance devices.

No signs of impairment were identified.

7. TANGIBLE FIXED ASSETS

6,206,301 5,309,252

9,186,5868,206,040

2,183,179 10,695

1,073,677 698,158

2,167,599

1,302,610

3,470,209

1,602,573

2,710,310

1,107,738

(3,472)

789,883 713,610

1,093,922 904,415

5,716,378 5,495,730

4,825,114 4,420,289

5,132,624 4,611,094

6,992,712

2,193,874

6,022,861

254,730 642,319

261,953718,593

171,039 204,480

189,395

207,826

18,431

375,631

552,072

176,441

(3,472)

76,273

18,356 171,151

54,127 166,521

61,863 342,962

83,691 437,840

251,258 718,593

At 1 January 2016

At 31 December 2017

At 1 January 2016

Net book value:

At 31 December 2016

At 31 December 2017

Increases

Increases

Revaluations

Depreciation and impairment losses:

Depreciation (Note 21)

Depreciation (Note 21)

At 31 December 2017

At 31 December 2016

At 1 January 2016

At 31 December 2016

Office equipmentBuildings and other constructions

Total Tangible Assets

Basic equipment

Cost:


8.1. MOVEMENTS OF THE FINANCIAL INVESTMENTS PER SUBSIDIARY

The movement that took place in the current financial year under the caption of financial investments is the one shown in the following table:

8. INVESTMENTS IN SUBSIDIARIES AND AFFILIATES

Total Financial Investments

2016% HoldingRet. Issue

PremiumsIncreases Supplementary

payments Business activity

Total Financial Investments

2017

(1,058,706)

(4,473,953)

50,000

50,000

1

8,440,500

Training

Healthcare service provision

Provision of management services

and consulting in healthcare

Parapharmaceutical

Shareholdings management




Real estate





Distribution and commercialization of

medication and medical devices



Research




5,000

6,357,407

50,000

117,188

0

5,000

6,357,407

50,000

117,188

-

1,164,124

21,536,188

189,958

412,500

50,000

50,000

1

14,454,760

50,000

5,000

12,390,104

8,440,500

1,865,024

100.00%

100.00%

88.00%

100.00%

96.00%

100.00%

100.00%

100.00%

100.00%

100.00%

100.00%

99.00%

100.00%

5.00%

100.00%

100.00%

60.00%

1,164,124

21,536,188

189,958

412,500

-

-

-

18,928,713

50,000

5,000

12,390,104

-

2,923,730

Academia CUF, Lda


Digihealth, S.A.


Valir - Sociedade Gestora de Participações Sociais, Sgps S.A.







Centro Logístico - CUF, Unipessoal, Lda.



IBET -Instituto de Biologia Experimental e Tecnológica


CPIS - Clínica Particular de Comibra, S.A.


Subsidiary companies

Associated companies

8,540,501 (1,058,706) (4,473,953) 67,137,75364,129,913



All subsidiaries and associated companies operate in Portugal, except for Vramondi International, B.V., which operates in the Netherlands.

The main variations in “Financial Investments” are justified by the following movements:

• Participation in the total capital of PPPS II – Gestão e Consultoria, S.A. (50,000 euros) and PPPS III – Gestão e Consultoria, S.A. (50,000 euros) and Centro Logístico – CUF, Unipessoal, Lda., companies established in August 2017;

• Participation in the total capital of CPIS – Clínica Particular de Coimbra, S.A., company acquired in December 2017 for 8,440,500 euros;

• Return of share premiums’ by Vramondi International B.V., amounting to 4,473,953 euros;

• Return of Supplementary Payments of Escala Vila Franca – Sociedade Gestora do Estabelecimento, S.A., in the amount of 1,058,706 euros.

The movement that took place in the previous financial year under the caption of financial investments is the one shown in the following table:

ImpairmentTotal Financial Investments

2015% Holding

Reclassifica-tion

(Note 10)Increases Supplementary


Total Financial

Investments 2016

(403,719)

(52,880)

(13,220)

45,000

Training




Parapharmaceutical





Real estate





5,000

6,357,407

50,000

117,188

0

5,000

6,357,407

50,000

117,188

0

1,164,124

21,536,188

189,958

412,500

18,928,713

50,000

12,390,104

2,923,730

100.00%

100.00%

88.00%

100.00%

96.00%

100.00%

100.00%

100.00%

100.00%

99.00%

100.00%

100.00%

60.00%

1,164,124

21,589,068

203,178

367,500

18,928,713

50,000

12,390,104

3,327,449

Academia CUF, Lda


Digihealth, S.A.











Subsidiárias


8.2. SUMMARY OF SUBSIDIARIES FINANCIAL INFORMATION

The assets, liabilities and equity, income and statutory results of the subsidiaries on 31 December 2017 are as follows:

Academia CUF, Lda


Digihealth, S.A.












Equity 2017

(576,280) 334,799 23,310 934,389 934,389 (45,891) 473,771

2,364,122 2,895,406 1,541,585 1,925,063 147,806 1,031,751 9,338,843

16,283,484 62,339,514 18,609,753 41,620,048 23,045,735 13,377,352 114,159,846

16,080,925 49,901,017 18,673,496 24,748,646 27,744,941 9,716,634 98,335,796

(1,143,609) 266,412 6,788,732 1,310,597 6,888,156 (8,584) -

19,786,741 70,742,458 190,641,980 14,157,079 227,440,648 (2,803,267) 4,881,102

(5,258,098) 4,787,820 5,076,822 9,115,402 6,007,339 (2,297,048) 10,467,130

1,297,826 6,182,355 7,699,520 7,508,574 5,075,476 781,760 14,636,629

48,657 50,000 - 1,344 - (1,344) -

48,284 50,000 - 1,716 - (1,716) -

220,133 248,747 20,704 49,318 - 25,363 397,738

9,203,619 22,794,534 12,698,601 17,687,323 8,602,193 1,003,142 65,728,415

Assets2017

Current CurrentNon-current

Non-current

Liabilities 2017

Net profit2017 Income

(712,775)

140,984

313,203

Research

Management of healthcare

infrastructures and car parks

Management of healthcare

infrastructures and car parks

5,000 5.00%

20.00%

20.00%

5,000

399,572

(140,984)

IBET -Instituto de Biologia Experimental e Tecnológica

Escala Braga - Sociedade Gestora do Edifício, SA

Escala Parque - Gestão de Estacionamento SA

Associadas

358,203 (975,510) (66,100) 64,129,91364,813,320

ImpairmentTotal Financial Investments

2015% Holding

Reclassifica-tion

(Note 10)Increases Supplementary


Total Financial

Investments 2016



8.3. IMPAIRMENT OF FINANCIAL INVESTMENTS

The assumptions used in the impairment tests were as follows:

• The recoverable amounts of cash-generating units were determined based on the value-in-use calculation. The use of this method requires an estimation of future cash flows from the operations of each cash-generating unit and the choice of an appropriate discount rate;

• The values of the evaluations are supported by past results and by future perspectives regarding development of the markets in which the Group operates, with 5-year projections of future cash flows prepared for each of the businesses, in accordance with the plans set by the Board of Directors;

• Each healthcare unit is a cash-generating unit, except for Valir – Sociedade Gestora de Participações Sociais, Sgps S.A., which includes the Instituto CUF – Diagnóstico e Tratamento, S.A. unit which is analysed with Hospital CUF Porto, S.A. given the complementarity of provided services and geographical proximity, with these two units continuing to be a single cash-generating unit.

The following assumptions were used:

The revenue growth rate is reviewed annually in cash flow projections. It is calculated for each cash-generating unit and for each of the five years considered in the projections, with the rate shown in the table above the average growth rate for the five years and for all cash-generating units.

In the 2017 financial year, impairment tests were carried out in the most relevant subsidiaries, finding the absence of any impairment concerning the value of the recognised Financial Investment, with the exception of the impairment already recorded in 2016 for S.P.S.D. - Sociedade Portuguesa de Serviços Domiciliários, S.A., amounting to 66 thousand euros.

Sensitivity analyses were performed on the main variables: (i) discount rate (+/- 0.5%) and (ii) perpetuity growth rate (+/- 0.5%). The results of the sensitivity analysis performed do not indicate the existence of impairment.

9. FINANCIAL INSTRUMENTS

The Company’s only financial instruments held at fair value are the financial derivative instruments, as mentioned in note 3, with their fair value determined by banking entities, using inputs observable in the market and in accordance with the generally accepted evaluation models and techniques.

3.00%

3.00%

6.97%

6.97%

-

1.80%

8.24%

8.24%

Period Risk-Free Interest Rate Wacc Rate Perpetuity Growth Rate The Revenue Growth Rate

Explicit

Perpetuity


FINANCIAL ASSETS

The breakdown of financial assets according to the different categories is indicated in the following tables:

100,847,068

1,753,134

13,199,329

1,885,798

2,292,714

10,000,000

1,288,616

169,361,037

3,094,216

6,864,409

122,780

3,181,964

16,500,000

19,398,704


Non-current

Current


Loans (Note 9.1)

Customers (note 9.3)

Loans (Note 9.1)

Shareholders (Note 9.2)

Other accounts receivable (note 9.4)

Other financial instruments (Note 9.5)

Cash and bank deposits (Note 3)

169,361,037

49,162,072

100,847,068

30,419,591

2017 2016



9.1. OTHER FINANCIAL ASSETS

On 31 December 2017 and 2016, the caption of other financial assets was broken down as follows::

9.2 SHAREHOLDERS

On 31 December 2017 and 2016, the shareholders caption was broken down as follows:

21,600,000

480,000

2,000,000

12,608,059

16,500,000

20,831

4,003,359

-

24,364,977

-

16,700,000

-

3,200,000

90,440

2,690,000

-

6,788,732

-

3,000,000

-

21,600,000

480,000

2,000,000

2,828,000

16,500,000

-

4,003,359

175

93,769,305

55,359

16,700,000

3,500,000

2,000,000

-

2,690,000

548

6,788,732

328

2,944,642

365,000

Loans to subsidiaries

Non-current assets

Current assets



PPPS - Gestão e Consultoria, S.A

Imohealth - Investimentos Imobiliários, S.A.




PPPS II - Gestão e Consultoria, S.A

Imohealth - Investimentos Imobiliários, S.A.

INFRAHEALTH - Gestão de Infraestruturas, Lda




Manuel Guimarães, Lda


PPPS III - Gestão e Consultoria, S.A

Valir, SGPS, S.A.

Simply Green - Investimentos Imobiliários, S.A.

INFRAHEALTH - Gestão de Infraestruturas, Lda


Loans to subsidiaries

169,361,037

6,864,409

100,847,068

13,199,329

2017 2016

122,780

1,763,018

122,780

-



122,780 1,885,798

Current assets

2017 2016


9.3. CLIENTSThe total amount written of in relation to clients is broken down in the table below:

9.4. OTHER ACCOUNTS RECEIVABLE

On 31 December 2017 and 2016, the “Other Receivable Accounts” caption is broken down as follows:

Seniority and Impairment of Clients

The seniority of clients is broken down as indicated in the table below:

No impairments were identified in trade payables balances.

1,753,1343,094,216Customers

2017 2016

-

173,577

--

252,150 -

2017 3,094,216 818,258 1,834,830 441,128

1,753,134 562,335 520,444 244,628 2016

Year Total UnexpiredDebt ≤ 180 days

Expired debt

181-365 days 546-730 days366-545 days >730

1,963,238

59,857

31,171

753

195,200

-

35,945

5,199

1,350

2,644,761

63,201

-

663

150,378

272,229

34,518

715

15,498

Debtors from accrued increase

Recognising expenses

Personnel

Other debtors

Interest receivable

Rents

IT

Others

Insurances

Interest

Others

2017 2016

3,181,964 2,292,714

The caption “Interest Receivable” concerns the interest of loans and overdrafts charged to the group’s units with which the company has a balance, as well as the interest of bond loans issued by Farminveste – Investimentos, Participações e Gestão, S.A. and José de Mello Capital, S.A. (note 9.5).



9.5. OTHER FINANCIAL INSTRUMENTS

The amount of 16.5 million euros concerns bonds issued by Farminveste – Investimentos, Participações e Gestão, S.A. and José de Mello Capital, S.A.:

At 29 December 2017, the bond loans of José de Mello Capital, S.A. (10 million euros) and José de Mello Participações II (10 million euros), until then held by Hospital CUF Descobertas, S.A., were acquired by José de Mello Saúde, S.A. for 20 million euros.

In December, 13.5 million euros were reimbursed, with a remaining debt of 6.5 million euros concerning the original contract with José de Mello Capital, S.A., whose repayment period was changed to June 2022.

These bonds have a put option that gives the Company the right to redeem the amount in question at any time, which is why they are categorised as a current asset.

The sale option was recorded at face value, without any associated derivative.

There are no indications of impairment for the amounts of the bond loans listed above.

16,500,000 10,000,000

10,000,000

-

10,000,0002020

2022 6,500,000



2017Maturity yearIssuer 2016


FINANCIAL LIABILITIES

The breakdown of financial liabilities according to the different categories is indicated in the following tables:

158,189,064

623,336

190,385,668

17,729,624

23,774,495

105,303,388

843,016

107,604,508

23,701,092

32,221,663

2,970,211

843,016

-

6,454,253

102,333,177

-

2,301,120

1,043,783

777,810

3,456,905

623,336

29,869,000

2,812,800

154,732,159

-

1,627,604

1,431,991

1,591,862

700,000

14,700,000

5,771

2,608,736

13,900,000

7,979,498

1,223,302

Loans Obtained

Suppliers

Loans Obtained

Non-Current

Current

Loans obtained through leases (note 13)

Suppliers, current account

Other financial liabilities (note 9.8)

Other financial liabilities (note 9.8)

Other Financing (Note 9.7)

Suppliers, invoices in reception and under verification

Financial derivative instruments (note 9.10)

Loans obtained through leases (note 13)

Other Financing (Note 9.7)

Other accounts payable (note 9.9)

Commercial paper (Note 9.6)

Bank overdrafts (Note 4)

Other accounts payable (note 9.9)

2017 2016



9.6. COMMERCIAL PAPER

The company has contracted three commercial paper programmes with the limit of 36 million euros. On 31 December 2017 and 2016, these liabilities had the following detail:

Although there are programmes with maturities exceeding one year, there are annual renewals, leading the Commercial Paper to be categorised as current.

The commercial paper programme of Banco Finantia contains financial covenants that are common in financing contracts. These contracts include compliance requirements for the following debt ratios: Net Financial Debt / EBITDA.

On 31 December 2017, José de Mello Saúde, S.A. met the financial covenants in the commercial paper programme of Banco Finantia.

9.7. OTHER FINANCING

The caption “Other Financing” was broken down as follows on 31 December 2017 and 2016:

Contracting company

Nominal amount

hiredCurrent Current Maturity Non-

currentNon-

current Periodicity

Outstanding amount 2017

Outstanding amount2016 Amortisation

Interest rate

Euribor do prazo + 1,75%


1%


6,000,000

10,000,000

10,000,000 9,700,000 4,900,000

- 3,000,000- - Nov. 2019 Annual

- - Dez.2018 Annual

- 6,000,000- - Jan.2019 Annual

- - Mar. 2021 Single

10,000,000 5,000,000 -

Banco BIC

Banco Finantia

Montepio Geral

Bankinter

36,000,000 14,700,000 - 13,900,000 -

154,732,159 102,333,177

99,494,476

2,838,701

150,153,144

4,579,015

Other Financing

Non-current

Bond loans

Bank Loans

2017 2016

1,591,862 777,810

-

777,810

-

1,591,862

Other Financing

Current

Bond loans

Bank Loans


Bond Loans

Bondloans concern the following issues:

In September 2017, José de Mello Saúde, S.A. issued a new bond loan at fixed rate, in the amount of 50 million euros, having requested admission to trading in the regulated market of the Luxembourg Stock Exchange and in Euronext Lisbon.

These contracts include a financial covenant for the following debt ratio: Net Financial Debt / EBITDA.

On 31 December 2017, José de Mello Saúde, S.A. met the financial covenants in all bond loans.

Bank Loans

On 31 December 2017 and 2016, the balance of this caption is broken down as follows:

The reference index used in the financing contracts is the EURIBOR rate, whose time frame varies between 6 months and 12 months, with a spread within the values practiced in the market.

There are no financial covenants associated with bank funding. These loans have an associated guarantee: a blank promissory note, seeking to record and enable the collection of the loan.

9.8. OTHER FINANCIAL LIABILITIES

The caption “Other financial liabilities” is broken down as follows:

1,591,862 4,579,015 777,810 2,838,701

Pledge current account

Mutual

-

2,838,701

--

4,579,015 777,810

-

1,591,862

Financing

Outstanding amount 2016Outstanding amount 2017

Current Current Non-current Non-current

32,681,800 6,454,253

-

6,454,253

29,869,000

2,812,800

Loans of subsidiaries

Loans of subsidiaries

Non-current

Current liabilities

Vramondi International B.V.

Vramondi International B.V.

2017 2016

50,000,000 10,000 09/06/19 Euribor 6M + 3,875%

50,000,000 10,000 17/05/21 Euribor 6M + 2,95%

50,000,000 10,000 28/09/23 4%

José de Mello Saúde 2014/2019



Total loan amount Nominal Value (bond loan) Maturity Interest rateEmissions



9.9. OTHER ACCOUNTS PAYABLEOther payable accountsare discriminated as follows:

The amount recorded under the caption “Other Creditors” predominantly concerns the acquisition of CPIS – Clínica Particular de Coimbra.

9.10. FINANCIAL DERIVATIVE INSTRUMENTS

In 2014, José de Mello Saúde, S.A. had almost all its financing indexed at variable rates. In order to reduce the risk of exposure to interest rate changes, plain-vanilla interest rate swaps were contracted in May, June and July of 2015, covering 100% of the amounts of the debenture loans issued in June of 2014 and May of 2015, amounting to 100 million euros in total. Swaps contracted respect the characteristics of the aforementioned loansso that they may be considered hedging products (same indexer, same interest period and payment deadlines). On the date of interest payment, the Company receives interest indexed to 6-month Euribor for 100% of the capital and pays interest at a fixed rate on the same amount.

The 50 million concerning bond loans issued in September 2017 have no associated financial derivative, as this is a fixed rate funding - disclosed in note 9.7.

On 31 December 2017 and 2016, the fair value of the contracted financial derivatives can be presented as follows:

2,608,736

700,000

1,223,302

300

-

611,530

562,913

40,169

700,000

33,607 8,391

-

144

22,396

2,212,415

340,174



Personnel

Creditors from income increase

Non-current

Current

Other creditors

Investment suppliers

Insurances

Others

Remunerations payable

Other creditors

2017 2016

- - 1,627,604 2,301,120

Cash flow hedging derivatives

Interest rate swap

2016 Liabilities2017 Liabilities


1,627,604 2,301,120 Total liabilities derivatives


The figure recognised in this caption refers to six swap interest rate contracts signed by the company to cover the risk of interest fluctuation.

The characteristics of the financial derivative instruments contracted in association with financing operations on 31 December 2017 and 2016 were as follows:

The fair value of the hedging derivatives is classified as non-current when the maturity of the hedging transaction is higher than 12 months, and as current when the maturity of the operation being covered is under 12 months.

Cash flows are paid and received from hedging derivative financial instruments every six months:

The Company hedges an instalment of future payments on the interest of bond loan issues, through the allocation of interest rate Swaps in which it pays a fixed rate and receives a variable one, with a notional of 100 million euros. This is an interest rate risk hedge related to payments of interest at a variable rate arising from recognised financial liabilities. The hedged risk is the variable rate indexer to which interest on loans is associated. The aim of this hedge is to transform variable interest rate loans into a fixed interest rate. The fair value of the interest rate Swaps on 31 December 2017 is -1,627,604 euros.

(1,627,604) (2,301,120)

(273,774)

(130,616)

(566,865)

(313,183)

(237,253)

(105,913)

25,000,000

12,500,000

25,000,000

12,500,000

12,500,000

12,500,000

Eur

Eur

Eur

Eur

Eur

Eur

jun/19

jun/19

mai/21

mai/21

mai/21

jun/19

Cash-flow coverage of bond issuance






(403,663)

(191,344)

(788,611)

(432,585)

(334,886)

(150,030)

Interest rate swaps

Swap 13121-001

Swap 13136-001

Swap 13121-002

Swap 13137-001

Swap 13152-001

Swap 13153-001

Fair value

Economic goal 2017MaturityCurrencyNotionalCash flow hedging

derivatives 2016

19/05/15 19/05/15 23/06/15 23/06/15 30/07/15 30/07/15

21/05/15 21/05/15 25/06/15 25/06/15 31/07/15 31/07/15

09/06/19 17/05/21 25/06/15 17/05/21 17/05/21 09/06/19

25,000,000 25,000,000 12,500,000 12,500,000 12,500,000 12,500,000

Trade Date

Effective Date

Termination Date

Notional Amount

SWAP’s

13121-001 13121-002 13136-001 13137-001 13152-001 13153-001Ref



Non-Current Assets Held for Sale

On 31 December 2017 and 2016, the “Non-current assets held for sale” caption is broken down as follows:

10. NON-CURRENT ASSETS HELD FOR SALE

It is José de Mello Saúde, S.A.’s intention to transfer its stake in the share capital, along with all its associated rights and obligations, to the following entities:

• Escala Braga - Sociedade Gestora do Edifício, S.A. (20%);

• Escala Parque – Gestão de Estacionamento, S.A. (20%).

To this end, a contract was signed in 2016 for the purchase and sale of stocks and supplementary payments with an investor, with the completion of the transaction still dependent on the authorisation of the Contracting Public Entity (Regional Health Administration – Administração Regional de Saúde).

The Long Stop Date contractually provided to obtain this authorisation was extended. However, the authorisation from ARS – Administração Regional de Saúde for the transfer of shares has not been obtained. The involved parties maintain the intent to sell the shares. The Company believes that the approval process will be completed in 2018.

The expected impact of the sale of these shares is estimated to be approximately 5,915 thousand euros.

11. EQUITY

11.1. SHARE CAPITAL

The share capital is fully subscribed and paid-up. It is divided into 10,600,000 shares, valued at five euros each, which are divided up as follows:

-

-

-

-

Escala Braga - Soc. Gestora do Edifício, S.A.

Escala Parque - Gestão de Estacionamento, S.A.

- -

2017 2016

AmountAmount QuantityQuantity % Holding% Holding

Equity

34,900,500

15,900,000

2,199,500

53,000,000

34,900,500

15,900,000

2,199,500

53,000,000

6,980,100

3,180,000

439,900

10,600,000

6,980,100

3,180,000

439,900

10,600,000

65.85%

30.00%

4.15%

100%

65.85%

30.00%

4.15%

100%


Fundação Amélia da Silva de Mello

Farminveste-Investimentos, Participações e Gestão, S.A.

20162017


31 December 2017

31 December 2016

11.2. CHANGES IN EQUITY

The main variations in Equity are related with the application of the Net Profit from the previous year in the amount of 29,103,683.29 euros, pursuant to minute 55 of the general meeting:

• Transfer to Retained Earnings in the amount of 9,740,499.13 euros;

• Establishment of Legal Reserves in the amount of 1,455,184.16 euros;

• Distribution of Interim Dividends in the amount of 11,408,000 euros;

• Distribution of Dividends in the amount of 6,500,000 euros.

11.3. RESERVES AND OTHER EQUITY ITEMS

Reserves and other equity items recorded the following movements during the financial years ended in 31 December 2017 and 2016:

The legal reserve is not fully established under the law (20% of share capital), whereby the minimum amount stipulated was donated (5% of the net profit). Changes in “Other Reserves” concern the recognition of gains with hedging operations.

The amount recorded in “Adjustments to Financial Assets” includes the adjustments connected to the application of the equity method from previous years, namely appropriation of changes in equity of subsidiaries and unallocated profits.

11.4. DIVIDENDS

According to resolution of the Board of Directors held on 29 November 2017, in the financial year ended on 31 December 2017 interim dividends of 14.1 million euros were paid on the mid-term review prepared on 31 October 2017.

In the financial year ended on 31 December 2016, interim dividends were paid in the amount of 11.4 million euros.

In 2017, dividends concerning the financial year of 2016 were paid in the amount of 6.5 million euros.

4,356,460

5,811,644

(2,288,872)

(1,249,145)

30,271,560

40,012,059

(37,434,593)

(37,434,593)

-

-

(37,434,593)

(37,434,593)

14,350,000

-

(1,475,560)

(2,288,872)

17,593,209

9,740,499

(14,350,000)

12,678,352

30,271,560

3,430,501

4,356,460

925,958

1,455,184

517,752

(813,312)

521,975

1 January 2016

1 January 2017

Appropriation of results

Appropriation of results


Other operations

Adjustments for results

Changes to MTM regarding hedging financial instruments (Note 9.10)

Changes to MTM regarding hedging financial instruments (Note 9.10)

Adjustments to Financial AssetsOther reservesLegal reserves Other equity

instruments Retained earnings



The finance lease liabilities have the following maturities at 31 December 2017:

12. GOVERNMENT AND OTHER PUBLIC ENTITIES

Accounts concerning the Government and other public entities show the following breakdown:

13. OBLIGATIONS ARISING FROM LEASE CONTRACTS

13.1 FINANCE LEASES

The Company has finance lease contracts for various items of its tangible fixed assets, included in the StatementFinancial Position Statement. On 31 December 2017 and 2016, the Company maintains the following assets in a finance lease regime, for each asset category:

29,108

13,364,148

26,392

20,024,203

19,606,734

417,469

11,037

15,355

12,847,972

516,175

13,232

15,876

Balance receivable

Income Tax Withholdings

Government And Other Public Entities

Balance Payable

Income tax

VAT

Social security contributions

2017 2016

5,316,293 4,396,067

56,194

4,339,872

28,097

5,288,196

Tangible


Basic equipment

2017 2016

5,101,889 212,993 4,888,896

1,431,991101,013

3,456,905111,980

--

1,533,004

3,568,884

-

Less than 1 year

From 1 to 5 years

Over 5 years

Minimum Payments Interest Equity

2017


At 31 December 2017

At 31 December 2016

13.2. OPERATING LEASES

On 31 December 2017, the Company’s main liabilities with operating lease contracts concern the lease of the office and vehicles. The total amounts of future minimum payments are as follows:

In the financial year ended on 31 December 2017 and 2016, costs of 760,956 euros and 726,828 euros were respectively recognised, concerning operating lease contracts. The contract concerning the office has a 5-year renewal term.

In 2016 it was impossible to obtain the detail of the minimum payments of the operating and financial leases. However, the recorded operating leases also concerned contracts related to the office, parking and vehicles, and the amounts are similar to those recorded in 2017.

14. PROVISIONS, CONTINGENT LIABILITIES AND CONTINGENT ASSET

Provisions

Transactions occurring in provisions, under each caption, are shown in the table below:

The reduction vis-à-vis 2016, amounting to 97 thousand euros, concerns the sale of the subsidiary Manuel Guimarães, which took place in March 2017.

The recorded value in “Liabilities with Subsidiaries” concerns additional responsibilities in the subsidiary Escala Braga - Sociedade Gestora do Estabelecimento, S.A. This estimate requires the exercise of significant judgment about the costs and income of said subsidiary until the end of the public-private partnership contract in August 2019. The estimate of income includes the co-payment of the vertical programmes for HIV and multiple sclerosis, with the Board being firmly convinced that the result of the arbitration process begun by Escala Braga against the Government – ARS Norte will be favourable.

740,705 1,452,695 -

-43,386

-1,409,309

36,051

704,654

Vehicles

Office

Less than 1 year From 1 to 5 years Over 5 years

2017

22,113,016

15,846,938

342,811

342,811

(6,266,078)

(14,024)

-

-

21,770,205

15,504,127

(6,266,078)

(14,024)

At 1 January 2016

At 1 January 2017

Year’s reversions

Uses in the year

Liabilities with subsidiaries Other provisions TOTAL

15,504,127

15,490,103

342,811

342,811

15,846,938

15,832,914



Deferred taxes considered in the comprehensive income concern only the cash flow hedging derivatives.

The amounts of deferred tax assets and liabilities recognised on the balance sheet for each period are indicated in the table below:

15. INCOME TAXES

On 31 December 2017 and 2016, the spending due to current and deferred taxes is the one indicated in the following table:

27,373

(3,077,291)

(155,623)

(2,487,707)

(2,332,084)

(182,995)

27,373

(3,104,664)

-

27,373

Current tax

Deferred tax

Corporate income tax for the year

Hedging financial instruments (Swaps)

Retirement benefits

2017 2016

The amount of deferred tax assets concerning Retirement Benefits is related to a life annuity insurance contracted by José de Mello Saúde S.A. in January 2016. This insurance allowed to comply with ancontract signed since 2000, where the Company was responsible for ensuring a lifetime payment of a rent to a worker who retired via Social Security on 1 January 2016. The commercial premiumpaid to the insurance company on 28 January 2016 was 2,504,321 euros.

Comprehensive Income

Deferred Tax Assets

201720172017 201620162016

874,938 1,053,852 (27,373) 155,623 (151,541) -

Hedging financial instruments (Swaps)

Income StatementAccounts Balance

Retirement benefits

366,211

508,727

517,752 - 182,995 (151,541) -

536,100 (27,373) (27,373) - -


Reconciliation of the Effective Tax Rate

Numerical reconciliation between the average effective income tax and applicable tax rate is indicated in the table below:

21.00%

-

-

23,913,683

93,996

21.00%

(2,406,946)

(4,105,724)

74,861

6,266,078

103,132

454,187

250

-

-

13,797

23,309

212,893

12,212

223,706

129,744

-

5,589,355

(2,332,084)

-8.76%

26,615,976

21.00%

97,000

94,766

31,493,755

6,709

21.00%

(3,702,080)

(5,630,635)

79,665

-

103,105

-

1,871

-

517,752

-

-

735,428

583

8,787

11,579

8,838

5,560,146

(3,104,664)

-11.73%

26,476,884

Nominal tax rate

Taxable amount/tax loss attributed by ACE

Taxable amount/tax loss attributed by ACE

Tax loss/taxable income

Separate taxation

Reversal of taxed provisions

Accounting Losses

Elimination of double taxation

Donations

Income tax in Portugal

Tax saving


Depreciations and amortisations not accounted as expenses

Cancellation of the equity method

Fines, penalties and interest compensation

Calculated tax

Others

Tax benefits

Non-deductible social contributions

Reimbursement of non-deductible taxes and overestimation of tax

Expenses incurred from renting a car without a driver

Others

Corrections relating to previous periods

Others

Result before Taxes

Non-taxable income

Non-deductible costs for tax purposes

2017

Tax base

2016

TAX ON PROFIT AT THE NOMINAL RATE

INCOME TAX

EFFECTIVE TAX RATE

32,334,971

227,452

31,084,343

362,644



The provisions of services concern the sublease rents billed to the group’s units, concerning the lease of medical equipment.

17. OTHER INCOME AND GAINS

This caption is broken down as indicated in the table below:

The “Unspecified Others” caption includes the value of the office’s lease, which is re-invoiced to JMS – Prestação de Serviços Saúde, A.C.E., as well as consultancy services provided to group’s companies.

18. PERSONNEL EXPENSES

Details of personnel expenses are indicated in the table below:

There were 19 people working for the company on 31 December 2017 (2016: 14 people).

16. SERVICES SUPPLIED

Income is discriminated as follows:

Services

Service provision

2017 2016

Supplementary income

Income and gains in the Group’s companies and associates

Others

Disposals


Tax refund

Excess of the estimate for taxes

Others not specified

Others

2017 2016

Remunerations

Wages of governing bodies members

Personnel wages

Retirement benefits

Charges on remunerations

Occupational accidents and diseases insurances

Other personnel expenditure

Social welfare expenditure

2017 2016

1,400,283 1,786,383

1,786,383 1,400,283

2,330,052 1,216,255

-

-

82,394

102,050

212,893

818,918

20,000

177,666

43,034

698,136

37,293

1,353,924

2,728,515 1,137,733

464,676

33,633

-

37,000

117,868

481,634

2 922

467,975

-

-

33,808

115,890

2,109,346

1,495


The caption “Specialised Works” predominantly comprises fees concerning consultants and lawyers.

19. EXTERNAL SUPPLIES AND SERVICES


Subcontracts

Specialised services

Other services

Specialised work

Rents and leases

Advertising

Communications

Representation expenses

Fees

Insurances

Cleaning, hygiene and comfort

Maintenance and repair

Litigation and notary public fees

Others

Tools and utensils

Office material

Energy and fluids

Travel, accommodation and transport

Books and technical documentation

Articles for free distribution

Electricity

Travel and accommodation

Fuel

Materials

2017 2016

3,663

3,990,572 3,181,056

11,884

793,178

897,249

896,425

31,268

-

922

7,395

236,471

34,794

6,737

-

-

2,228

146,930

55,915

51,949

4,048

23,242

1,045,380

933,103

1,256,724

16,131

12,529

917

2,780

25,002

508,619

41,759

13,233

-

1,585

7,381

1,500

74,049

17,136

9,501



Bad debt

Taxes

20. OTHER EXPENSES AND LOSSES


21. EXPENSES/REVERSAL OF DEPRECIATION AND AMORTISATION

According to the following chart, expenses on depreciations and amortisations amount to 1,302,610 euros in 2017 and 1,093,922 euros in 2016:

22. INTEREST AND SIMILAR EXPENSES OBTAINED


Expenses and losses in the group’s companies and associates

Financial assets adjustment

Expenditure and Losses in Non-Financial Investments


Non-tax fines

Donations

Contributions

Others

Others

Fines and penalties

Other expenses and losses

2017 2016

Expenses of depreciation and amortisation

Tangible Fixed Assets (Note 7)

2017 2016

Interest received

Dividends obtained

From deposits

From other net financial investments

From financing granted to subsidiaries

2017 2016

230,412

94,766

291,765

371,117

371,117

19,823

-

-

129,744

240

5,069

115,000

21,890

94,766

83,147

13

82,656

11,579

188

500

36,000

16,328

1,302,610 1,093,922

1,093,922 1,302,610

36,508,629 27,941,863

42,586

93,838

3,739,170

24,066,269

5,271

93,582

4,916,021

31,493,755


The earned interest concerning funding granted to Subsidiaries are detailed as follows:

The dividends obtained in 2017 and 2016 are detailed according to the following table:




InfraHealth - Gestão de Infraestruturas, Lda

Hospital CUF Viseu, SA.


Instituto CUF - Tratamento e Diagnóstico, S.A.




Valir - Sociedade Gestora de Participações, S.A.

2017 2016


Hospital CUF Infante Santos, S.A.

Escala Parque - Gestão de Estacionamento, S.A.

Clínica CUF Alvalade, S.A.


Loja Saúde CUF - Produtos e Serviços de Saúde e Bem Estar, S.A.



InfraHealth - Gestão de Infraestruturas, Lda

2017 2016

4,916,021 3,739,170

123,106

119,912

1,599

4,313

96,482

634,766

130,735

642,460

849,719

1 135,048

1,030

128,844

127,636

161,229

121,104

81,542

664,352

272,592

672,405

874,769

1,810,801

748

31,493,755 24,066,269

3,637,101

7,946,650

145,361

-

1,209,919

32,360

88,636

10,999,016

7,225

5,046,043

9,823,100

156,675

183,586

1,064,336

41,026

-

15,178,989

-



The “Other” supported interest regards the interest of the contracted hedging instruments (note 9.10).

24. FINANCIAL COMMITMENTS WITH GUARANTEES

On 31 December 2017 and 31 December 2016, the entity has the following provided guarantees in its portfolio:

23. INTERESTS AND SIMILAR SUPPORTED EXPENSES


(a) “Resetting of the original land conditions” for the CUF Descobertas Hospital Expansion.(b) Agreement for capital subscription.(c) Guarantor in the Mutual of Imo Health – Investimentos Imobiliários, S.A.. (d) Guarantor in the leasing of Imo Health – Investimentos Imobiliários, S.A., concerning the building of Travessa do Castro.

25. EVENTS AFTER THE DATE OF THE STATEMENT OF FINANCIAL POSITION

These individual financial statements were authorised for issue by the Board of Directors on 22 March 2018.

From 31 December 2017 until now, no relevant facts have occurred other than those already adjusted and/or disclosed in these consolidated financial statements.

26. DISCLOSURE REQUIRED DUE TO LEGAL INSTRUMENTS

As required by paragraph 5, article 66 of the Portuguese Commercial Companies Code, no operations are excluded from the Statement of Financial Position, whereby the respective nature, commercial objective, financial impact or risks and benefits have to be disclosed.

Interest paid

Other expenses and losses on loans

From loans obtained

From finance leases

Others

Others

2017 2016

Lisbon Municipal Council (a)

Imo Health - Investimentos Imobiliários, S.A. (c)

Imo Health - Investimentos Imobiliários, S.A. (d)

Escala Vila Franca - Sociedade Gestora do Estabelecimento, S.A. (b)

Date of issue2017Beneficiary Date of Expiry2016Bank

Santander Totta

BIC

BIC

Novo Banco

28/06/2025

5,898,305 4,809,044

3,516,061

130,678

685,545

447,057

4,363,719

131,448

828,512

574,626

23,559,195 17,703,195

303,195

5,856,000

15,000,000

2,400,000

303,195

-

15,000,000

2,400,000

24/05/2016

28/06/2017

31/12/2014

19/05/2011

24/05/2020

25/12/2029

-


Sociedade Anónima - Capital Social 1.335.000 euros - Inscrição n.º 178 na Ordem dos Revisores Oficiais de Contas - Inscrição N.º 20161480 na

Comissão do Mercado de Valores Mobiliários

Contribuinte N.º 505 988 283 - C. R. Comercial de Lisboa sob o mesmo número

A member firm of Ernst & Young Global Limited

Ernst&YoungAudit&Associados-SROC,S.A.Avenida da República, 90-6º 1600-206 Lisboa Portugal

Tel: +351 217 912 000 Fax: +351 217 957 586 www.ey.com

(Free Translation from the original in Portuguese)

Statutory and Auditor’s Report

REPORT ON THE AUDIT OF THE FINANCIAL STATEMENTS

Opinion

We have audited the accompanying financial statements of José de Mello Saúde, S.A. (the Entity), which comprise the Statement of Financial Position as at December 31, 2017 (which show a total of 305.616.326 euros and a total equity of 75.594.141 euros, including a net profit for the year of 29.554.176 euros), and the Statement of Comprehensive Income, the Statement of Changes in Equity and the Statement of Cash Flows for the year then ended, and notes to the financial statements, including a summary of significant accounting policies.

In our opinion, the accompanying financial statements present fairly, in all material respects, the financial position of José de Mello Saúde, S.A. as at December 31, 2017, and its financial performance and its cash flows for the year then ended in accordance with International Financial Reporting Standards as endorsed by the European Union.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (ISAs) and with other standards and technical directives of the Institute of Statutory Auditors (“Ordem dos Revisores Oficiais de Contas”). Our responsibilities under those standards are further described in the “Auditor’s Responsibilities for the Audit of the Financial Statements” section of our report. We are independent of the Entity in accordance with the law and we comply with the ethical requirements of the Code of Ethics of the Institute of Statutory Auditors.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Emphasis of matter

As disclosed in note 14 of the Notes to the Financial Statements, the Public-Private Partnership management agreements of Braga Hospital will end in August 2019. The estimate of the provision to cover the liabilities of this affiliate includes complex and volatile assumptions which, for this reason, involve uncertainty, namely the inflow of the amounts claimed from the vertical programs of HIV and Multiple Sclerosis of which management firmly confirms positive outcome. Our opinion is not modified in respect of this matter.

Key audit matters

Key audit matters are those matters that, in our professional judgment, were of most significance in our audit of the financial statements of the current period. These matters were addressed in the context of our audit of the financial statements as a whole, and in forming our opinion thereon, and we do not provide a separate opinion on these matters.

We describe below the key audit matters of the current period:

José de Mello Saúde, S.A Statutory and Auditor’s Report

December 31, 2017

1. Impairment tests of Investments in Subsidiaries and Affiliates and measurement of provisions

Description of the risks of material misstatement

Summary of our approach to the risks of material misstatement

The amount presented in Investments in subsidiaries and affiliates as at December 31, 2017, is 67.138 thousand euros, representing approximately 22% of the total assets of the Entity.

The possible impairment of Investments in subsidiaries and affiliates measured at cost and the recognition of provisions for possible additional responsibilities in subsidiaries and affiliates with negative equity has been considered a key matter because the carrying amount of those assets is significant and the impairment testing process is complex, including the use of estimations and assumptions, namely future market and economic conditions.

We have tested the assumptions used on the valuation models prepared by management, namely the cash flows projections, the discount rate, the inflation rate, the perpetual growth rate and the sensitivity analysis, supported by internal specialists in business valuations.

We have tested the consistency of the assumptions used in the business plans with prior years, with historical data and with external data.

We have tested the arithmetical calculation of the model used.

We have assessed the need to book and / or to maintain provisions for possible additional liabilities deriving from affiliates with negative equity that may not be able to solve their commitments.

We have focused specifically on the sensitivity analysis prepared for the various affiliates, to ensure the disclosures included in Note 8.3 to the financial statements reflect the results of the impairment tests performed.

We have confirmed the applicable disclosure requirements (IAS 36 and IAS 37).

2. Liquidity, refinancing and contractual ratios



The Entity has contracted external financing presented as current and non-current liabilities, in the amounts of 158.189 thousand euros and 17.730 thousand euros, respectively. As part of the Group’s investment strategy, in September 2017 a significant financing transaction was carried out through the issuance of bonds in the amount of 50.000 thousand euros.

The management of cash-flows, refinancing capacity and compliance with the financial ratios are significant matters for our audit.

The test or evaluation is largely based on Management's expectations

We have obtained the support agreements of the various debt instruments and the understanding of the contractual ratios computation method.

We have tested compliance with the contractual conditions.

We have tested and challenged future cash flows forecasts of the subsidiaries and the process by which they were prepared, testing the underlying assumptions, such as the expected cash flows of services rendered and cash outflows from operating expenses.

We have verified the subsidiaries’ ability to distribute dividends.

We have read the minutes of the Board of Directors and other bodies of the Entity and of the Group to understand future plans and identify potential contradictory information.

We have discussed with the Entity’s management the


December 31, 2017



and estimates, which are influenced by subjective assumptions such as projections of volume and margins of operating activities, estimates of future cash flows, forecasting of economic conditions and the capital market, and capacity to fulfill financial ratios.

The ability to secure the commitments entered into with third parties depends essentially on the subsidiaries’ ability to generate and pay dividends, market conditions on the maturity of the financings that allows them to be renewed, and the financing policy of shareholders and dividend distribution.

projections of debt market conditions and confirmed the group policy of dividend distribution and shareholders financing.

We have verified that the amounts, changes, maturity dates and other contractual conditions of the various financing instruments are disclosed, as required by IFRS 7, in Note 9 of the Notes to the financial statements.

Responsibilities of management and supervisory board for the financial statements

Management is responsible for

► the preparation and fair presentation of the financial statements in accordance with the international Financial Reporting Standards as endorsed by the European Union;

► the preparation of the Management Report, including the Corporate Governance Report in accordance with the laws and regulations;

► such internal control as management determines to be necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error;

► adoption of accounting policies and principles appropriate for the circumstances;

► assessment of the Entity’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern.

The supervisory board is responsible for overseeing the Entity’s financial reporting process.

Auditor’s responsibilities for the audit of the financial statements

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

As part of an audit in accordance with ISAs, we exercise professional judgment and maintain professional scepticism throughout the audit. We also:


December 31, 2017

► identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control;

► obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Entity’s internal control;

► evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by management;

► conclude on the appropriateness of management’s use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the Entity’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclosures in the financial statements or, if such disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the Entity to cease to continue as a going concern;

► evaluate the overall presentation, structure and content of the financial statements, including the disclosures, and whether the financial statements represent the underlying transactions and events in a manner that achieves fair presentation;

► communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit;

► from the matters communicated with those charged with governance, including the supervisory board, we determine those matters that were of most significance in the audit of the financial statements of the current period and are therefore the key audit matters. We describe these matters in our auditor’s report unless law or regulation precludes public disclosure about the matter; and

► provide the supervisory board with a statement that we have complied with relevant ethical requirements regarding independence, and to communicate with them all relationships and other matters that may reasonably be thought to bear on our independence, and where applicable, related safeguards.

Our responsibility includes the verification of the consistency of the Management Report with the financial statements, and the verifications under numbers 4 and 5 of article 451º of the Commercial Companies Code.

REPORT ON OTHER LEGAL AND REGULATORY REQUIREMENTS

About the Management Report

Pursuant of article 451º, nº 3, al. e) of the Commercial Companies Code, it is our opinion that the Management Report, that discloses essentially consolidated financial information which includes the company, was prepared in accordance with laws and


December 31, 2017

regulations in force, the information contained therein is in agreement with the audited financial statements and, taking into consideration our assessment and understanding of the Entity, we have not identified any material misstatement.

About the non-financial statement provided for in the article 66-B of the Commercial Companies Code

Pursuant of article 451º, nº 6, of the Commercial Companies Code, we inform that the Entity prepared a separate report of the Management Report, the Integrated Report, which includes non-financial information, as provided for in article 66-B of the Commercial Companies Code, and was published with the Management Report.

About the Corporate Governance Report

Pursuant of article 451º, nº 4, of the Commercial Companies Code, it is our opinion that the Corporate Governance Report (Information of the Shareholders structure, organization and Corporate Governance) includes the items required to the Entity in accordance with article 245º-A of Securities Market Code, no material misstatements were identified in the information contained therein, complying with the provisions of paragraph c), d), f), h), i) and m) of the referred article.

About additional items set out in article 10º of Regulation (EU) nº 537/2014

Pursuant of article 10º of Regulation (EU) nº 537/2014 of the European Parliament and of the Council, of 16 April 2014, and in addition to the key audit matters mentioned above, we report the following:

► We have been appointed as auditors of José de Mello Saúde, S.A. for the first time in the shareholders' general meeting held on October 11, 2007 for the period between 2007 and 2009. We were reappointed in the shareholders' general meeting held on April 29, 2016 for a forth mandate for the period between 2016 and 2018.

► The Management has confirmed that they are not aware of any fraud or fraud suspicion with a material impact in financial statements. In planning and executing our audit in accordance with ISA we maintained our professional scepticism and we designed audit procedures to address the possibility of a material misstatement in financial statements due to fraud. Based on the work performed, we have not identified any material misstatement in the financial statements due to fraud.

► We confirm that our audit opinion is consistent with the additional report that was prepared by us and issued to the supervisory board as of April 9, 2018.

► We declare that we have not provided any prohibited non-audit services referred to in article 77º nº 8 of the Statute of the Institute of Statutory Auditors and we remained independent of the audited Entity in conducting the audit.

Lisbon, April 12, 2018

Ernst & Young Audit & Associados – SROC, S.A. Sociedade de Revisores Oficiais de Contas Represented by: (Signed) Luís Miguel Gonçalves Rosado - ROC nº 1607


December 31, 2017

Registered with the Portuguese Securities Market Commission under licence nr.º 20161217



REPORT AND OPINION OF THE SUPERVISORY BOARD CONCERNING THE INDIVIDUAL ACCOUNTS

Dear Shareholders,

In accordance with legal and statutory terms, the Supervisory Board of José de Mello Saúde S.A., with headquarters at Av. do Forte, 3 – Edifício Suécia III, Piso 2, 2790-073 Carnaxide, presents its supervisory report and provides an opinion on the report, accounts and proposals submitted by the Board concerning the financial year ended on 31 December 2017.

1. In accordance with legal and statutory terms, we have:

• approved the plan of activities for 2018;

• supervised the actions of the Board, through meetings with the internal audit department, financial department, strategic planning, management and innovation control department, information systems department and organisational development and quality department, obtaining the clarifications and comfort deemed necessary;

• verified compliance with the law and fulfilment of the company’s articles of association;

• evaluated whether the accounting policies and valuation/measuring criteria adopted by the company are in agreement with the generally accepted accounting principles and lead to a proper evaluation of the assets and results;

• evaluated the effectiveness of the internal control system implemented by the Board;

• supervised the process of preparation and disclosure of the financial information;

• verified the accuracy of the Statement of Financial Position, the Statement of Income and Other Comprehensive Income, Statement of Changes in Equity, Statement of Cash Flows and Annex of the financial year of 2017;

• evaluated the Management Report issued by the Board and the proposal for the appropriation of profits it introduced;

• evaluated the work carried out by the Statutory Auditor leading to the legal review and additional services;

• verified the terms of the Legal Accounts Certificate, the Audit Report and the Additional Report to the Supervisory Body issued by Ernst & Young Audit & Associados – SROC, S.A., and concluded that its content merits our agreement.

2. The conducted supervisory action allows us to conclude that:

• the actions of the Board that we have knowledge of safeguard compliance with the law and with the company’s articles of association;

• we are not aware of any situations that can call into question the suitability and effectiveness of the internal control system implemented by the Board in controlling the risk to which the company is exposed;

• the accounting and the accounts comply with the applicable legal, statutory and regulatory provisions, reflect the activity carried out and lead to a correct evaluation of the company’s assets and results;

• the Management Report is in agreement with the accounts presented and faithfully shows the evolution of the activity and of the business during the financial year;

• the published report includes the elements listed in article 245-A of the Securities Code on the structure and practices of corporate governance;

• the Statement of Financial Position, the Statement of Income and Other Comprehensive Income, Statement of Changes in Equity, Statement of Cash Flows and Annex of the financial year of 2017 meet the applicable legal and accounting requirements;

• the audit of the financial statements performed by the Statutory Auditor was suitable to the circumstances, and the additional services did not compromise its independence;

• the proposal for the appropriation of profits is appropriate and is properly grounded.



João Filipe de Moura-Braz Corrêa da Silva

(Member)

José Luís Bonifácio Lopes

(Member)

3. We can thus state:

• our agreement with the content of the Legal Accounts Certificate issued by the Statutory Auditor;

• our agreement with the Management Report and accounts for the 2017 financial year presented by the Board of Directors;

• that to the best of our knowledge, the disclosed financial information has been drafted in accordance with current accounting standards and give a true and fair view of the assets and liabilities, financial situation and results of the company, and that the Management Report faithfully describes the business development, financial performance and position of the company, containing a description of the main risks and uncertainties it faces.

4. Accordingly, taking into account the actions carried out, we consider that:

• the Management Report and accounts of the 2017 financial year presented by the Board of Directors should be approved;

• the proposal for the appropriation of profits contained in the Management Report should be approved.

Finally, we would like to thank the Board and all Employees in the service of the Company who we contacted, for all the cooperation we received when performing our duties.

Lisbon, 13 April 2018

The Supervisory Board

José Manuel Gonçalves de Morais Cabral

(Chairman)


STATEMENT OF COMPLIANCE OF THE SUPERVISORY BOARD

In accordance with provisions in Article 245(c)(1) of the Securities Code, José de Mello Saúde, S.A. (“JMS”) Supervisory Board members declare that, to the best of their knowledge, the management report, the individual annual accounts, the legal accounts certificate and the other accounting documents, i) were prepared in accordance with current accounting standards and give a true and fair view of the assets and liabilities, financial situation and results of JMS; ii) they faithfully describe the development, performance and position of JMS; and iii) they contain a description of the main risks JMS faces in its activity.




(Chairman)


(Member)


(Member)



CONSOLIDATED FINANCIAL STATEMENTS


31-12-2017 31-12-2016Notes

Ongoing operations

Operating costs

Operating profit

Earnings per share:

Other items of Comprehensive Income

Pre-tax profit

Consolidated net profit for the year

Other income and expenses directly recognised in equity that will not be reclassified to profit

Consolidated comprehensive income

Other income and expenses directly recognised in equity that might be reclassified to profit:

Net profit for the year attributable to equity holders

5,7

10

12

8

12

15

13

34

18

34

42

5

5,7

18

12

38

5

11

5

5

9

12

15

Operating income

Personnel costs

Profit/loss of associates

Cost of sales

Financial expenses and losses

Basic

Income tax

Net profit for the year attributable tonon-controlling interests

Revaluation of tangible fixed assets (Net of taxes)

Comprehensive income for the year attributable to non-controlling interests

Changes in fair value of hedging instruments (Net of taxes)

Total operating income

Other operating costs

Total operating costs

Sales and services rendered

Amortisations and depreciations

Profit/loss of investment activities

External supplies and services

Financial income and gains

Diluted

Other operating income

Provisions and impairment losses, net

Financial results

CONSOLIDATED COMPREHENSIVE INCOME STATEMENT OF THE FINANCIAL YEAR ENDED 31 DECEMBER 2017

(Amounts in Euros)

Comprehensive income for the year attributable to equity holders

627,691,418

(27,731,514)

82,900

(25,092,368)

(83,070)

(242,738,087)

956,355

2.15

(222,850,139)

522,121

2.26

(202,594,517)

666,471

(184,618,966)

760,181

(116,516,108)

(12,194,236)

2.15

(8,809,655)

474,455

7,034,104

474,455

521,975

30,850,733

30,376,278

28,517,255

28,233,318

7,556,080

(107,414,581)

(10,086,554)

2.26

(8,444,376)

283,937

5,127,649

283,937

(813,312)

4,314,337

578,041,322

9,752,114

(1,687,795)

(10,488,510)

(1,754,594)

(8,887,323)

8,229,524

637,443,532

(3,582,693)

42,592,818

32,104,308

23,294,653

22,820,198

(3,005,581)

41,534,616

32,647,294

24,202,918

23,918,981

(594,850,714) (544,736,229)

586,270,846



31-12-2017 31-12-2016Notes

Non-current assets:

Non-current liabilities:

Current assets:

Equity:

Equity attributable to shareholders

Non-current assets held for sale

17

36

16

35

21

40

26

33

8, 24

31

18

37, 38

19

38

22

22

23

42

27

14

34

23

28

29

30

25

32

Other current debtors

Other reserves and retained earnings

Consolidated net income

Interim dividends

Non-controlling interests

Inventories

Share capital

TOTAL ASSETS

Total non-current assets

Non-current liabilities


Cash and cash equivalents

Total current assets

Total equity

Intangible assets

Finance lease creditors

Other Investments

Other creditors

Goodwill

Borrowings

Investments in associates

Provisions

State and other public entities

Trade receivables and advances to suppliers

Legal reserve


Employee benefits

Deferred tax assets


Other non-current assets

Other non-current liabilities

Other current assets

CONSOLIDATED STATEMENT OF FINANCIAL POSITION AT 31 DECEMBER 2017

(Amounts in Euros)

13,357,220

60,177,688

43,885,257

295,514,364

770,384

3,358,340

16,737,792

22,820,198

(14,100,000)

4,228,716

88,189,849

13,540,692

23,918,981

(11,408,000)

3,960,796

77,706,743

122,870,558

5,811,644

95,377,577

4,356,460

3,316,536

20,658,007

5,088,234

7,839,302

14,216,580

53,000,000

11,262,856

53,000,000

12,877,217

59,964,427

33,366,429

117,984,922

509,672

-

378,408,792

1,355,216

233,956

12,259,474

3,786,717

11,735,363

8,296,945

1,627,604

52,749,441 60,410,979

189,789,608

1,461,775

168,111

14,021,234

4,291,945

2,857,449

8,296,945

2,301,121

448,739,272

386,028,049

92,418,565

35,150,000

47,894,297

3,735,465

48,650,000

16,067,394

3,168,613

292,935,205

745,409,942

250,397,732

502,866,271

249,299,926

198,590,928

81,667,539


Current liabilities:

36

35

40

39

27

41

Total current liabilities

TOTAL LIABILITIES

TOTAL EQUITY AND LIABILITIES

Finance lease creditors

Other current creditors

Borrowings


Trade payables and advances from clients

Other current liabilities

31-12-2017 31-12-2016Notes

CONSOLIDATED STATEMENT OF FINANCIAL POSITION AT 31 DECEMBER 2017

(Amounts in Euros)

9,794,327

56,119,722

7,476,112

9,650,238

32,025,005

8,547,200

94,542,001

21,958,566

77,072,601

87,534,852

19,252,327

65,598,181

266,963,328

652,991,378

745,409,942

222,607,805

421,198,732

502,866,271



Share Capital Additional capital paid inNotes

Balance at 31 December 2015



14

14

Total comprehensive income for the year

Total comprehensive income for the year

Transfer to retained earnings

Transfer to retained earnings

Repayment of additional capital



Appropriation of consolidated net profit for 2015:

Appropriation of consolidated net profit for 2016:

Changes resulting from change of equity in associates


Changes in non-controlling interests resulting from changes in consolidation perimeter

Transfer to legal reserve

Transfer to legal reserve

Capital decrease

Changes in fair value of hedging instruments

Changes in fair value of hedging instruments



Dividends paid out

Dividends paid out

Other

Other

Other income and gains recognised in equity:

Other income and gains recognised in equity:

CONSOLIDATED STATEMENT OF CHANGES IN EQUITY OF THE FINANCIAL YEARS ENDED 31 DECEMBER 2017 AND 2016

(Amounts in Euros)

-

-

-

-

-

53,000,000

53,000,000

53,000,000

14,350,000

-

-

-

-

(14,350,000)

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-


Other reserves and Retained earningsLegal reserve Net profit Interim dividends Non-controlling

interests Total

The accompanying notes form an integral part of the consolidated statement of changes in equity for the year ended December 31, 2017

(15,113,286)3,430,501 21,893,940 - 3,708,111 81,269,266

7,839,3024,356,460 23,918,981 (11,408,000) 3,960,796 81,667,539

20,658,0075,811,644 22,820,198 (14,100,000) 4,228,716 92,418,565

20,967,982- (20,967,982) - - -

11,055,797- (22,463,797) 11,408,000 - -

- - - - (14,350,000)

-925,958 (925,958) - - -

-1,455,184 (1,455,184) - - -

--

-

- - - -

(813,312)- - - - (813,312)

7,034,104

521,975- - - - 521,975

-- 23,918,981 - 283,937 24,202,918

-- 22,820,198 - 474,455 23,294,653

5,127,649- - - - 5,127,649

- - - - 7,034,104

(1,495,329)- - (11,408,000) (206,278) (13,109,607)

(6,500,000)- - (14,100,000) (196,400) (20,796,400)

657,218- - - 175,027 832,245

(32,776)- - - - (32,776)

221,853- - - (10,135) 211,718

(1,491,620)- - - - (1,491,620)

517,752- - - - 517,752

4,314,337- 23,918,981 - 283,937 28,517,255

7,556,080- 22,820,198 - 474,455 30,850,733



31-12-2017 31-12-2016Notes

OPERATING ACTIVITIES:

INVESTMENT ACTIVITIES:

FINANCING ACTIVITIES:



Payments regarding:

Payments regarding:

46

46

Interest and similar income

Additional capital paid in

Intangible assets

Payment of finance lease liabilities

Capital reductions and accessory capital


Financial assets and other investments

Borrowings

Financial assets and other investments

Borrowings

Interest and similar expenses

Net cash from operating activities (1)

Net cash from investment activities (2)

Net cash from financing activities (3)

Cash paid to suppliers

Other cash receipts/payments relating to operating activities

Cash receipts from clients

Income tax received/paid

Dividends




Borrowings to group companies


Borrowings to group companies

Dividends paid and profit distributed


Cash paid to employees

CONSOLIDATED CASH FLOW STATEMENTSOF THE FINANCIAL YEARS ENDED 31 DECEMBER 2017 AND 2016

(Amounts in Euros)

(482,549,151)

705,239,151

(395,668)

266,347

13,500,000

269,774

259,396

13,500,000

1,358,563

227,036

1,853,458

(40,655,580)

(3,150,267)

(21,333,803)

-

82,358

3,990,000

(13,901,628)

-

(12,597,191)

573,661

34,077

(960,949)

(10,407,471)

-

-

417,605

-

(2,674,065)

(9,773,480)

(14,350,000)

(2,171,875)

195,542

466,638,200

(44,994,750)

(341,999,911)

(10,592,310)

1,279,718

244,800,000

(327,600)

(236,191,351)

(8,850,873)

(350,671,062)

576,418,011

1,306,138

(196,604,636)

(9,825,346)

(181,584,069)

(14,820,101)

15,864,349

(85,348,695)

94,811,749

1 262,585

482,295,509

(86,611,280)

(387,483,760)

2,039,077

263,648,563

(16,903,293)

(283,934,771)

30,648,917

(14,864,216)

(20,286,208)


Changes in cash and equivalents (4)=(1)+(2)+(3)

Cash and cash equivalents at the start of the period

Cash and cash equivalents at the end of the period

4

29

29

Effect of currency conversion differences

Changes in cash equivalents

Effect of change in consolidation perimeter

31-12-2017 31-12-2016Notes

CONSOLIDATED CASH FLOW STATEMENTSOF THE FINANCIAL YEARS ENDED 31 DECEMBER 2017 AND 2016

(Amounts in Euros)

The accompanying notes form an integral part of the Consolidated Cash Flow Statements for the financial year ended 31 December 2017.

6,742,179 34,739

-

-

25,327,403

15,814,660

47,884,243

-

(62,150,000)

(4,501,507)

82,431,428

15,814,660



NOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS ON 31 DECEMBER 2017

(Amounts in euros)1. INTRODUCTION

José de Mello Saúde, S.A. (“Company” or “JMS”) is a public limited company, with headquarters in Lisbon, in Av. do Forte, No. 3, Suécia III Building, Floor 2, 2790-073 Carnaxide, incorporated in December 1992 The corporate universe of JMS (“Group” or “JMS Group”) is formed of the subsidiaries, associates and jointly controlled entities described in Note 3. Its core business is the provision of healthcare, particularly in the area of private healthcare, public-private partnerships, the provision of services in the area of medicine, occupational health and hygiene, and also providing home-based healthcare.

The Company’s share capital, as stated in Note 31, is majority-owned by José de Mello Capital S.A. its parent company that publishes consolidated financial statements complying with International Financial Reporting Standards (“IFRS”) and, consequently, the operations and transactions of JMS Group (Note 47) are influenced by the decisions of the José de Mello Capital Group.

It should be noted that on 12 December 2017, the companies José de Mello Participações II, SGPS, S.A., Guima-rães de Mello Portugal, SGPS, S.A., Guimarães de Mello Investimentos, SGPS, S.A., and José de Mello – Sociedade Gestora de Participações Sociais, S.A. (the former parent company of JMS) were incorporated, via merger, into SOGEFI – Sociedade de Gestão e Financiamentos, SGPS, S.A., which was renamed to José de Mello Capital, S.A. This corporate restructuring did not call into question any commitments made by the participating companies, since all of their rights and obligations are now concentrated on José de Mello Capital, S.A.

2. ACCOUNTING POLICIES

2.1. BASIS OF PREPARATION

The consolidated financial statements have been prepared on a going concern basis from the accounting books and records of the companies included in the consolidation (Note 3), adjusted in the consolidation process, when necessary, in order to agree with the provisions of the International Financial Reporting Standards (“IFRS”) adopted by the European Union and effective for years beginning on 1 January 2017. The International Financial Reporting Standards (“IFRS”) issued by the International Accounting Standards Board (“IASB”), the International Accounting Standards (“IAS”) issued by the International Accounting Standards Committee (“IASC”) and respective interpre-tations – IFRIC and SIC, issued by the International Financial Reporting Interpretation Committee (“IFRIC”) and Standing Interpretation Committee (“SIC”), respectively, are deemed to form part of those standards. Hereinafter, this set of standards and interpretations shall be generally referred to as “IFRS”.

The financial statements are presented in euros.

2.1.1. NEW STANDARDS, ALTERATIONS AND INTERPRETATIONS APPLYING IN THE 2017 FINANCIAL YEAR

As a result of endorsement by the European Union (EU), the following issues, revisions, amendments, and im-provements of standards and interpretations with effect from 1 January 2017 had with no significant impact on the Group’s financial statements.

The adoption of these standards, interpretations and amendments to standards did not have a significant impact on the financial statements.


IAS 12 – Recognition of deferred tax assets for unrealised losses (amendments) 1 January 2017

IAS 7 – Disclosure initiative

Improvements concerning the 2014–2016 cycle (IFRS 12 Disclosure of interests in other entities)

1 January 2017

1 January 2017


2.1.2. NEW STANDARDS, ALTERATIONS AND INTERPRETATIONS ALREADY ISSUED BUT NOT YET MANDATORY

New standards, amendments and interpretations now exist that have already been published but whose appli-cation is only mandatory for annual periods starting after 1 January 2018 and which the Group decided not to adopt ahead of time:

a) Already endorsed by the European Union:

On 31 December 2017, the following improvements of the Standards and Interpretations issued by the IASB were already endorsed by the EU; however, their application is only mandatory for the financial years beginning after 1 January 2018:


The IFRS 15 – Revenue from contracts with customers, applies to all income from contracts with clients, replacing the following existing standards and interpretations: IAS 11 – Construction contracts, IAS 18 – Revenue, IFRIC 13 – Customer loyalty programmes, IFRIC 15 – Agreements for the construction of real estate, IFRIC 18 – Transfers of assets from customers and SIC 31 – Revenue – Barter transactions involving advertising services. The standard applies to all revenue from contracts with customers except if the contract is within the scope of the IAS 17 (or IFRS 16 – Leases, when applied).

It also provides a model for the recognition and measurement of sales of some non-financial assets, including sales of goods, equipment and intangible assets. This standard highlights the principles that an entity must apply when it measures and recognizes the revenue. The basic principle is that an entity shall recognize the revenue by an amount that reflects the consideration that it expects to be entitled to in exchange for the goods and services promised under the contract.

The principles of this standard shall be applied in five steps: (1) identifying the contract with the customer, (2) identifying the obligations of the contract’s performance, (3) determining the transaction price, (4) allocating the transaction price to the obligations of the contract’s performance and (5) recognizing the income when the entity meets a performance obligation. The standard requires an entity to apply professional judgment in the applica-tion of each of the model’s steps, taking into account all the relevant facts and circumstances. This standard also specifies how to account for the incremental expenses in obtaining a contract and the expenses directly related to the fulfilment of a contract. The standard shall be applied in financial years beginning on or after 1 January 2018. The application is retrospective, with the entities being allowed to choose if they want to apply the full retrospective approach or the modified retrospective approach. Early application is permitted.

The Group carried out an analysis of the implications of their adoption, with no significant impact being expected in the Financial Statements. In the preparation for the adoption of the IFRS 15, the Group considered the following relevant aspects:



Application of IFRS 9 with IFRS 4 – Amendments to IFRS 4

1 January 2018

1 January 2018

Clarifications to IFRS 15

IFRS 10 and IAS 28 – Sales or contributions of assets between an investor and its associate or joint venture

IFRS 9 – Financial Instruments

IFRS 16 - Leases


1 January 2018

1 January 2018

1 January 2018

1 January 2019

1 January 2018



Private healthcare services

Provision of healthcare

This revenue stream represents almost all of the Group’s income. The provision of healthcare in the private segment is based on the recognition of revenue at the time the service is provided to the customer. The Group identified the Payer Mix, and analysed the contracts with the greatest expression. The deter-mination of revenue for these contracts is based on the application of price lists defined for the provided healthcare. Indeed, the Group concluded that the application of this standard will have no significant impacts on the consolidated financial statements.

Occupational health, safety and medicine

Occupational Medicine – This revenue stream consists of carrying out tests agreed with the customer to the employees, during the contractual period. Revenue is recognized during the contract, with no additional obligations. The recognized value is the final one negotiated between the parties, with that being the expected revenue. The Group thus concluded that the application of this standard will have no significant impacts on the consolidated financial statements.

Health and Safety – Risk evaluations are carried out during the contractual period within the scope of this revenue stream. These evaluations seek to identify and qualitatively evaluate risks for the health and safety of the workers in the places of work, proposing preventive and corrective measurements and also to verify the observance of the applicable regulation, internal rules and prevention measures in the places of work. Revenue is recognized during the contrac-tual period, with no additional obligations beyond the contract. The recognized value is the final one negotiated between the parties, with that being the expected revenue. The Group thus concluded that the application of this standard will have no significant impacts on the consolidated financial statements.

Household Services

This business line includes the care provided at the cus-tomer’s home. The contracts concerning this revenue stream are standard and do not include the lease of any equipment, only the provision of healthcare. Revenue is recognized at the time the service is provided to the customer. Indeed, the Group concluded that the application of this standard will have no impact on the consolidated financial statements.

Public healthcare services


Public-Private Partnerships (“PPPs”) invoice the pro-vision of healthcare to the Public Contracting Entity, Insurers and private customers who are not users of the Portuguese National Health Service (NHS).

The provision of healthcare included in the manage-ment contract with the Public Contracting Entity is based on the recognition of revenue at the time the service is provided to the user. The determination of revenue consists of the management contract’s appli-cation. The recognized value is the one negotiated between the parties, with that being the expected revenue.

For the Hospital’s remaining users, the price tables in effect in the NHS are applied. The recognition of revenue takes place at the time the service is provided to the user.

This way, the Group found that the application of this standard does not cause changes to the registration of this stream’s revenue carried out by the companies.

Provision of medicines

This income stream consists of the debt of medicines supported by the Contracting Public Entity under the management contract or ad hoc authorizations. Re-venue is recognized when the product is transferred. Once again, the Group found that the application of this standard does not cause changes to the regis-tration of this stream’s revenue carried out by the companies.

User charges

This revenue stream consists of the invoicing of user charges defined by the NHS to the Hospitals’ users. The recognition of revenue takes place at the time the service is provided to the user. The Group con-cluded that the application of this standard will have no impact on the consolidated financial statements.


Transfer of a holding

This income stream corresponds to contracts for the transfer of holdings between the hospitals and entities that develop activities in the area of Complementary Diagnostic and Treatment Means (“CDTMs”). The re-venue is determined based on the monthly billing of each of the entities to whom the clinical activity ope-ration is transferred, and is recognized monthly. The Group concluded that the application of this standard will have no significant impacts on the consolidated financial statements.


Space rental

This revenue stream concerns the transfer of the commercial areas existing in the hospitals held by the Group, for the operation of non-clinical activities. The revenue is recognized monthly based on the values negotiated between the parties, with that being the expected revenue. The Group concluded that the application of this standard will have no significant impacts on the consolidated financial statements.

Concerning the remaining standards whose application is not yet mandatory, the Group chose to not adopt them in advance. However, the application of IFRS 16 is expected to have significant impacts on the Group’s balance sheet. The registration of the usage right for the current operating leases shall thus imply an increase in third-party assets and liabilities. The Group is now finalizing the quantification of this standard’s impacts.

b) Not yet endorsed by the European Union:

The following standards, interpretations, amendments and revisions have not been approved (endorsed), by the European Union, at the date of approval of these financial statements:

Regarding the standards presented above, whose compulsory entry into force has not yet occurred, the Group is still measuring the impact of these changes and will apply these standards in the financial year in which they become effective, or in advance when allowed.

2.2. CHANGES IN ACCOUNTING POLICIES

During the year ending on 31 December 2017, no voluntary changes occurred to accounting policies, in relation to those considered when preparing financial information for 2016.

2.3. MAIN ESTIMATES AND JUDGMENTS OF THE MANAGEMENT

The preparation of financial statements in accordance with the principles of recognition and measurement of IFRS requires that the Board of Directors make judgments, estimates and assumptions that may affect the value of assets and liabilities presented, in particular amortisation and depreciation, adjustments, impairment losses and provisions, disclosures of contingent assets and liabilities at the date of the financial statements, as well as the income and expenses.

Those estimates are based on the best knowledge available at any time and on the actions that are planned, and they are constantly revised based on the available information. Changes in facts and circumstances may lead to the revision of estimates, so the actual results in the future may differ from those estimates.


IAS 28 – Long-term interests in Associates or Joint Ventures (amendments)

IAS 40 – Transfer of Investment Properties (Amendments)

1 January 2019

1 January 2018

IFRS 2 – Classification and measurement of payment transactions based on actions (addendum)


IFRIC 22 – Foreign currency transactions and advance consideration


IFRS 9 – Anticipated payments with negative compensations (amendments)


1 January 2018

1 January 2021

1 January 2018

1 January 2019

1 January 2019

1 January 2019



The most significant accounting experiences shown in financial statements are as follows:

Goodwill impairment analysis

The Goodwill value is tested annually and whene-ver there is evidence of impairment. The recoverable amounts of cash generating units were determined based on the value-in-use calculation. The use of this method requires the estimate of future cash flows arising from the operations of each cash-generating unit and choice of an appropriate discount rate;

Valuation and Useful Life of Tangible and Intangi-ble Assets

The useful life of an asset is the period during which the Group expects that asset to be available for its use and is reviewed at least at the end of each financial year.

The amortisation/depreciation method to apply and the estimated losses stemming from the replacement of equipment before the end of their useful life, for reasons of technological obsolescence, is crucial to determining the effective useful life of an asset.

These parameters are defined according to the ma-nagement’s best estimate, for the assets and deals in question, also considering the practices adopted by companies from the sectors where the Group operates.

Recognition and Measurement of Provisions

The recognition of provisions has associated to the determination of the probability of exit of future flows and their reliable measurement.

These factors are often dependent on future events and not always under the control of the Group and, as such, may lead to significant future adjustments, both via the variation of the assumptions used and via the future recognition of provisions previously disclosed as control liabilities.

Fair Value of Financial Instruments

When the fair value of the financial assets and liabi-lities on the balance sheet date is not determinable based on active markets, it is determined based on valuation techniques that include the discounted cash flow model or other suitable models under the cir-cumstances. The inputs for these models are taken, whenever possible, from variables observable in the market; however, when this is not possible, a degree of judgment becomes necessary to determine the fair value, which encompasses considerations on liquidity risk, credit risk and volatility.

Impairment of accounts receivable

The credit risk of the balances of accounts receiva-ble is assessed at each reporting date, taking into account the historical information of the debtor and its risk profile.

The accounts receivable are adjusted by the evalua-tion of the estimated risks of collection existing at the balance sheet date, which may come to differ from the actual risk to incur in the future.

Taxes on income and deferred taxes

The determination of the amounts of income taxes and deferred taxes require the exercise of judgment and is subject to interpretation. Different interpretations could result in a different level of taxes on profits, both current and deferred, recognised in the period.

Only deferred tax assets are recognised insofar as it is likely that there will be taxable profit on which they can be used.

Assessment of the activity and revenue of the Pu-blic-Private Partnerships (“PPPs”)

The determination of the activity and revenue in the PPPs is carried out according to the provisions of the Management Contract (“MC”), namely the provisions of Appendix VII – Remuneration of the Establishment’s Managing Entity: the billing of the provided medical acts is carried out monthly, with the remainder being billed in the next financial period after the completion of the process of validating all medical, hospital and cli-nical acts, CDTMs and the provision of medicines; every month, the activity of the month being referenced and of the previous months of the current year is reported, with the activity accumulated until December (annual activity) being reported by the end of January of the next year; this is followed by a reconciliation payment that is determined, by the end of the following year’s first half, based on the actual value of the share to be borne by the Portuguese National Health Service (as specified in subparagraph 1b of Clause 47 of the MC). The actual value of the share under the Portuguese National Health Service is calculated in accordance with paragraph 22 of the abovementioned annex VII to the Management Contract.

Contractual provisions

The Group carries out a detailed assessment of the potential risks associated with the valuation of the share under the Portuguese National Health Servi-ce, in particular regarding the eligibility of clinical acts reported to the public awarding entity, and also regarding the risks associated with the contractual performance parameters.


In the specific case of Vila Franca Hospital, Clause 123 (Reversal of Goods) of the MC provides that the goods subject to revert to the Public Contracting Entity must be in good working order and fully operational, with all conservation, maintenance and renewal operations met. Considering that all medical equipment reaching the end of their service life before the end of the MC must be subject to investment, an investment plan was drafted where the recognition of the future obligation of replacing said equipment by the end of the contract is forecast; as a result, a provision was created in 2013 with a corresponding entry in the Intangible Assets item – this asset is being amortized until May 2021.

Continuity of the operations of subsidiaries and associated companies

The Group considered the results achieved and un-derstand that the existing measures and those that are being taken regarding freeing operational resources (by reducing consumption and increasing producti-vity), are sufficient to ensure the normal operation of the activity and, therefore, no doubt being cast on the continuity of operations. In particular, in the case of the Braga Hospital, the Group is reassessing its Business Plan to ensure the balance of capital until the end of the concession, estimating that on that date, based on the best available information, the net position will be negative at the time of the concession’s termination.

Escala Braga – Sociedade Gestora do Estabeleci-mento, S.A. (“Escala Braga”)

Checking procedures are currently taking place with Regional Health Authority Administração Regional de Saúde do Norte, I.P. (“ARS Norte”), regarding ad-justments made to Braga Hospital accounts in 2014, 2015, 2016 and 2017.

Regarding the settlements for the accounts of 2014, 2015 and 2016, the assessment of the actual produc-tion, which should have been completed in June 2015, June 2016 and June 2017, respectively, is presently being completed.

According to the provisions of the management con-tract, the agreement concerning 2017 shall take place by the end of June 2018.

The Escala Braga Board of Directors believes that it is duly justified to make its wishes known, without resulting in any negative financial impact that has a significant negative effect on the accounts.

Escala Vila Franca – Sociedade Gestora do Estabe-lecimento, S.A. (“Escala Vila Franca”)

Checking procedures are currently taking place with Administração Regional de Saúde de Lisboa e Vale do Tejo, I.P. (“ARSLVT”), regarding adjustments made to Vila Franca de Xira Hospital accounts in 2013, 2014, 2015, 2016 and 2017.

Regarding the settlements for the accounts of 2013, 2014, 2015 and 2016, the assessment of the actual production, which should have been completed in June 2014, June 2015, June 2016 and June 2017, res-pectively, is presently being completed.

According to the provisions of the management con-tract, the agreement concerning 2017 shall take place by the end of June 2018.

The Escala Vila Franca Board of Directors believes that it is duly justified to make its wishes known, without resulting in any negative financial impact that has a significant negative effect on the accounts.

No errors or omissions from previous periods were detected in the current year.

2.4. CONSOLIDATION PRINCIPLES

a) Controlled companies

The consolidation of controlled companies (Note 3.1) in each accounting period was done by the full conso-lidation method. Control is considered to exist when the Group is exposed, or has rights, to variable returns as a result of its involvement with the subsidiary com-pany and it has the capacity to affect those returns through its power over the subsidiary company (i.e., rights that currently give it the capacity to manage the relevant activities of the subsidiary company).

Third party participation in equity and net profit of such companies is reported separately on the Consoli-dated Statement of Financial Position and Consolida-ted Comprehensive Income Statement, respectively, under the “Non-controlling interests” caption.

When the losses attributable to non-controlling inte-rests exceed the non-controlling interest in the sub-sidiary’s equity, the Group absorbs that excess and any further losses, except when the non-controlling interests have an obligation to and are capable of covering such losses. If the subsidiary subsequently reports profits, the Group appropriates all the profits until the minority share of losses previously absorbed by the Group has been recovered.



The results of subsidiaries acquired or disposed of during the period are included in the income statements from the date of acquisition to the date of their disposal.

Significant transactions and balances between controlled companies were eliminated in the consolidation process. Capital gains arising from the disposal of subsidiaries within the Group are also eliminated.

Whenever necessary, adjustments are made to the financial statements of subsidiary companies in order to stan-dardise the respective accounting policies with those of the Group.

In situations where the Group has, in substance, control over other entities created for a special purpose, even if it has no direct shareholdings in these entities, these are consolidated by the full consolidation method.

b) Business combinations and Goodwill

Business combinations, in particular the acquisition of subsidiaries, are recorded using the purchase method. The acquisition cost corresponds to the sum of fair values, at the transaction date, of the assets obtained, the liabilities incurred or taken on, and equity instruments issued in exchange for control of the acquiree.

Identifiable assets, liabilities and contingent liabilities of a subsidiary that meet the recognition criteria of IFRS 3 are measured at fair value on the acquisition date, except for non-current assets (or asset groups) that are classified as held for sale.

Any excess of the cost of acquisition over the fair value of the identifiable net assets is recorded as goodwill. Goodwill is recorded as an asset and is not amortised. It is reported separately on the Statement of Financial Position. The goodwill values are annually subject to impairment tests, or whenever there are indications of loss of value. Any impairment loss is immediately registered as an expense on the income statement of the period and it cannot be subsequently reversed.

Where the cost of acquisition may be less than the fair value of the identifiable net assets, the difference is re-corded as a gain in the income statement of the period in which the acquisition occurs.

On disposal of a subsidiary, the related goodwill is included in determining the capital gain or loss.

The interests of shareholders who are not controlled are presented according to their proportion of the fair value of the identified assets and liabilities.

c) Investments in associates

An associate is an entity over which the Group exercises significant influence. Significant influence is the power to join in decisions on operational and financial policies but it is not control or joint control, as defined in the point a) above.

These investments in associates (Notes 3.2 and 19) are accounted for using the equity method, except when they are classified as held for sale, which is when they are initially recorded at the acquisition cost, plus or minus the difference between that cost and the value of the equity of those companies proportionally held, as at the acqui-sition date or the date of first application of the equity method. Goodwill in relation to the associate is included in the value of the financial investment and is not individually tested.

According to the equity method, financial stakes are adjusted periodically for the value corresponding to the Group’s participation in the net profits of the associated companies, against the “Profit related to associated com-panies” caption (Note 12), and for other changes that have occurred in their equity against the “Other reserves”


caption, as well as by the recognition of impairment losses.

Losses in associates in excess of the investment in these entities are not recognised, unless the Group has made commitments to that associate.

Moreover, dividends received from these companies are recorded as a reduction in the value of the investment.

Unrealised gains on transactions with associates are eliminated in proportion to the Group’s interest in the asso-ciate, reported against the investment in that associate. Unrealised losses are similarly eliminated but only to the extent that the loss does not show that the transferred asset is in a situation of impairment.

2.5. REVENUE AND ACCRUALS

Revenue from sales is recognised on the income statement when the following conditions are met:

• The Group has transferred to the buyer the significant risks and rewards of ownership of the assets;

• The Group does not retain continuing managerial involvement to the degree usually associated with ownership nor effective control over the goods sold;

• The amount of revenue can be reliably measured;

• It is probable that the economic benefits associated with the transaction flow to the Group; and,

• The costs incurred or to be incurred in respect of the transaction may be reliably measured.

The revenue from sales is recognised net of taxes, discounts and other costs incurred to realize the fair value of the amount received or receivable.

The income arising from services rendered is recognised in the income statement in the period in which they are provided.

The income stemming from dividends is recognized when, in substance, the obligation to declare dividends was established in the declaring Entity.

Interest and financial income are recognised in accordance with the principle of accruals and according to the effective interest rate applying.

Costs and income are accounted for in the period to which they relate, regardless of the date of payment or receipt. Costs and income for which the actual amounts are not known are estimated.

Costs and income imputable to the current period and which have expenses and revenues that will only occur in future periods, as well as expenses and revenues that have already occurred, but which relate to future periods and which will be attributed to the profit/loss of each of those periods in the corresponding value, are recorded under the “Other current assets” and “Other current liabilities” captions.

2.6. OPERATING PROFIT

The results of operations include all costs and income from operations, whether recurring or not, including those related to restructuring and tangible and intangible assets. They also include gains or losses obtained in the sale of companies consolidated using the full consolidation method. Hence, net financing costs, profits obtained from associates and other financial investments, and income taxes are excluded from the operating profit.



2.7. FINANCING COSTS

Borrowing costs are recognised on the income statement of the period in which they occur.

The financial charges on financing directly related to the acquisition, construction or production of tangible fixed assets that take a substantial period of time to be prepared for the intended use are capitalized, forming part of the cost of the asset. The capitalisation of these expenses begins after the start of preparation of the construc-tion activities or development of the asset and is interrupted after the start of the use or end of production or construction of the asset or over periods in which development of the asset is interrupted. Any income generated by loans obtained in advance and which may be allocated to a specific investment is deducted from the financial costs eligible for capitalisation.

2.8. INCOME TAX

Income tax for the period is calculated based on the taxable results of the companies included in the consolidation and it considers deferred taxation.

The current income tax is calculated based on the taxable income (which differs from accounting income) of the companies included in the consolidation, in accordance with the tax rules in force at the registered office of each Group company.

According to current legislation, tax returns are liable for review and correction by the tax authorities for a period of four years (five years for Social Security). Accordingly, the tax returns of the Group companies for the years 2014 to 2017 may still be reviewed, although the Company believes that any adjustments resulting from tax revisions to those tax documents will have no significant impact on the referred financial statements as at 31 December 2017.

2.9. DEFERRED TAX ASSETS AND LIABILITIES

The Group recognises deferred taxes in accordance with the requirements of IAS 12 – Income taxes, as a way of adequately accruing the tax effects of its operations, and to exclude distortions related to the criteria of a fiscal nature that impact on the economic results of certain transactions.

Deferred tax assets are recognised when there is reasonable assurance that future taxable profit may be achieved against which those assets can be deducted. Deferred tax assets are reviewed annually and reduced when it is no longer probable that they may be used. The value of deferred tax is determined by applying the tax rates (and laws) enacted or substantively enacted at the reporting date and which are expected to apply in the period of realisation of the deferred tax asset. According to the legislation in force in Portugal, the corporate income tax rate of 21% was considered and, in the situations not connected to tax losses, a municipal surtax of 1.5% on the temporary differences that led to deferred tax assets and liabilities.

The movement that took place during the financial period and the breakdown of the Deferred Taxes balances are presented in Note 22; the reconciliation between the nominal rate and the actual rate of the current tax is presented in Note 13.

2.10. REVENUE PER SHARE

Basic revenue per share is calculated by dividing the profit attributable to ordinary shareholders of the parent company by the weighted average number of ordinary shares in circulation during the period.

The diluted income per share is equal to the basic income as there is no interest on convertible preference shares nor options on shares.


2.11. INTANGIBLE ASSETS, EXCLUDING GOODWILL

Intangible assets (excluding goodwill) basically comprise the expenses incurred in specific projects with future economic value and are recorded at acquisition cost, less accrued amortisations and impairment losses. Intangi-ble assets are only recognised if it is probable that they will result in future economic benefits for the Group, are controlled by the Group, are identifiable and their value can be reliably measured.

Intangible assets for which the existence of a limited period of future economic benefits cannot be envisaged are called intangible assets with indefinite useful lives. These assets are not amortised but undergo annual im-pairment tests.

Under this caption are reflected, among others:

• Even concession rights corresponding to the right of management and operation of the two hospitals under the Public-Private Partnership arrangement. The amortisation is performed for the period stipulated in the contracts (10 years);

• Responsibility corresponding to the total estimated value of the investments expected until the end of the management and operation contract of the Vila Franca Hospital, stemming from the contractual obligations provided for in its Appendix V, in accordance with the provisions of IAS 37 – Provisions, contingent liabilities and contingent assets, and based on the principles described in IFRIC 12 – Service Concession Arrangements. This asset is to be amortised for the remainder of the contract;

• Surface rights of two properties for the period of 40 years;

• Exploitation right of a car park for the period of 50 years;

• Underground surface rights on a plot of land adjacent to the parking of Descobertas Hospital’s Expansion Building;

• Transfer concerning the facilities of CUF São Domingos de Rana Clinic.

After the beginning of the usage of the goods, amortizations are calculated using the straight-line method from the date when they are available for their intended use in accordance with the following estimated service lives:

2.12. TANGIBLE FIXED ASSETS

Tangible fixed assets used in production, in the provision of services or for administrative purposes are recorded at the cost of acquisition or production, including expenses imputable to the acquisition, less accumulated de-preciation and impairment losses, where applicable.

The premises assigned to healthcare services are carried at the revalued amount, which is their fair value at the date of revaluation. Evaluation of these properties on 31 December 2017 was carried out by an independent spe-cialised company – Ktesios Appraisal – Consultoria e Avaliação Imobiliária, Lda.

Useful life (years)

Software

Total estimated value of the investments

4

10

9

Operation right

Surface rights

Right of entry into hospital management

50

40



Tangible fixed assets are depreciated by the straight-line method from the date on which they are available for use as the intended use, according to the following estimated useful lives:

The depreciable amount of tangible fixed assets does not include the residual value estimated at the end of their useful lives, except in cases where it is estimated to be immaterial or uncertainty exists as to its realisation. Mo-reover, the depreciation ceases when the assets are classified as held for sale.

Improvements are only recognised as assets when it is demonstrated that these increase their useful life or in-crease their normal efficiency, resulting in increased future economic benefits.

Tangible fixed assets in progress represent tangible assets still under construction and are registered at cost of acquisition or production, less any impairment losses. These assets are depreciated from the time they are able to be used for their intended purpose.

The gains or losses resulting from the sale or disposal of tangible fixed assets are determined as the difference between the sale price and net book value on the date of sale/disposal. They are recorded at net value on the income statement under “Other operating income” or “Other operating costs”.

2.13. NON-CURRENT ASSETS HELD FOR SALE

Non-current assets (or discontinued operations) are classified as held for sale if their value is realisable through a sale transaction rather than through their continued use. This situation is considered to occur only when: (i) the sale is highly probable and the asset is available for immediate sale in its present condition; (ii) the management is committed to a sales plan; and (iii) it is expected that the sale will take place within a period of twelve months.

The events or circumstances that may extend the period to complete the sale for more than a year do not exclude that an asset is classified as held for sale if the delay is caused by events or circumstances beyond the control of the entity and if there is sufficient evidence that the entity remains committed to its plan to sell the asset.

Non-current assets (or discontinued operations) classified as held for sale are measured at the lower of book value and fair value, less costs to bear in future sales.

On the date of initial recognition, non-current assets (or disposal groups) held for sale are measured at the lower value between their carrying amount and fair value less selling costs or, if purchased as part of a combination of business activities, at fair value less selling costs.

When the sale is expected to occur more than a year later, the selling costs are measured at their present value. Any increase in the present value of the selling costs resulting from the passage of time is recognised in the results as cost of funding.

Useful life (years)


Other tangible fixed assets

10 - 50

4 - 8

4 - 8

Basic equipment

Transport equipment

Office equipment

3 - 7

4


Any initial or subsequent reduction of the asset (or disposal group) to the fair value less selling costs is recogni-sed as an impairment loss. Any gain resulting from a subsequent increase in the fair value less costs of selling an asset is recognised, but not beyond the previously recognised cumulative impairment loss.

Non-current assets, while classified as held for sale or while they are part of a disposal group classified as held for sale are not depreciated (or amortised).

Interest and other expenses attributable to the liabilities of a disposal group classified as held for sale continue to be recognised.

2.14. IMPAIRMENT OF NON-CURRENT ASSETS, EXCLUDING GOODWILL

An assessment of impairment is performed whenever an event or changes in circumstances are identified that indicate the carrying amount at which an asset is recorded may not be recoverable. If such indications exist, the Group determines the recoverable amount of the asset in order to ascertain any possible extension of the impair-ment loss. In situations where the asset does not individually generate cash flows in a manner independent from other assets, the estimated recoverable amount is made for the cash-generating unit to which the asset belongs.

Intangible assets with indefinite useful lives are subject to annual impairment tests or whenever it appears that there is evidence that such exists.

Whenever the amount at which the asset is recorded is higher than its recoverable amount an impairment loss is recognised, recorded under the “Provisions and impairment losses” caption.

The recoverable amount is the higher of the net sale price (sale price less selling costs) and the value in use. The net sale price is the amount that would be obtained from the sale of the asset in a transaction between knowle-dgeable and independent entities, less the costs directly attributable to the disposal. Value in use is the present value of estimated future cash flows arising from the continued use of the asset and from its disposal at the end of its useful life. The recoverable amount is estimated individually for each asset or, if this is not possible, for the generating unit of cash flows to which the asset belongs.

The reversal of impairment losses recognised in prior years is recorded when there are indications that the impair-ment losses no longer exist or have decreased. The reversal of impairment losses is recognised under “Reversal of amortisation and adjustments” caption. However, the reversal of the impairment loss is done up to the amount that would be recognized (net of amortisation or depreciation) if the impairment loss had not been recognised in prior years.

2.15. INVENTORIES AND COSTS OF GOODS SOLD AND MATERIALS CONSUMED

Goods and raw materials and consumables are valued at cost which is lower than their market value, using ave-rage cost as the costing method.

The cost of inventories includes: (i) purchase costs; (ii) conservation costs; and (iii) other costs incurred to align inventories with the desired conditions.

Whenever their net realisable value (sale price estimated in the ordinary course of business, less respective sales costs) is less than the cost of acquisition, the value of inventories is reduced, which is restored when the reasons that led to such cease to exist.

Sale price estimates take into account the variations related to events taking place after the end of the financial period insofar as those events confirm conditions existing at the end of the period.



2.16. LEASES

Lease contracts are classified as: (i) finance leases if all the risks and rewards of ownership of the leased asset are substantially transferred through these; and (ii) operating leases if all the risks and rewards of their ownership are not substantially transferred.

The classification of leases as finance or operating is based on the substance and not the form of the contract.

Finance Leases

Contracts are considered to be of financial leasing if all risks and benefits associated with the possession of the corresponding assets are substantially transferred through them.

Tangible fixed assets acquired under finance leases and the corresponding liabilities are recorded in accounts by the financial method. According to this method, the cost of the asset is recorded as a tangible fixed asset and the corresponding liability is recorded as a liability and the interest included in the value of the rental payments and depreciation of assets, calculated as described above, are recognised as financial expenses on the income statement of the period to which they relate.

Operating Leases

Contracts are considered to be of operational leasing if all risks and benefits associated with the possession of the corresponding assets are not substantially transferred through them. The classification of the leases as financial or operational is made according to the substance and not the form of the contract.

In operating leases, the rental payments are recognised as a cost in the “External supplies and services” caption, on a straight line basis over the period of the lease.

2.17. RESPONSIBILITY FOR EMPLOYEE BENEFITS

Personal expenses are recognised when the service is provided by the employees regardless of their payment date. Here are some specificities regarding each of the benefits:

Termination of employment

Benefits for termination of employment are due to be paid when employment ends before the usual retirement date or when an employee accept to leave voluntarily in exchange for these benefits. The Group recognises these benefits when it can be shown it is committed to a termination of employment of current employees, according to a formal detailed plan for the termination, and there is no realistic possibility of withdrawal or if these benefits are granted to encourage voluntary departure. When the employment termination benefits are due over 12 months after the balance sheet date, they are discounted to their current value.

Holidays, Holiday entitlement and Bonuses

According to labour law, employees are entitled to 22 working days of annual leave, as well as a month of holiday entitlement, rights acquired in the year prior to their payment. These liabilities of the Company are recorded when incurred, regardless of the time of their payment, and are reflected in the caption “Other current liabilities”.

Retirement Pension Benefits

Liability for the payment of retirement, disability and survivors’ pensions is recorded in accordance with the cri-teria established in IAS 19 – Employee benefits.


The costs of awarding these benefits are recognised as the services are rendered by the beneficiary em-ployees.

At the end of each accounting period actuarial stu-dies by independent entities are produced in order to determine the value of the liabilities at that date and the cost of pensions to be recorded in the period, according to the projected credit unit method. These liabilities estimated in this manner are recognised on the Statement of Financial Position under the “Em-ployee benefits” caption.

Pension costs are recorded under the “Personnel ex-penditure” caption as provided for in the referred standard, based on the values determined by actuarial studies and include current service costs (accrued liability), which corresponds to the additional benefits earned by employees during the period and interest costs, which result from the update of past liabilities.

Costs with past services are recognised immediately to the extent that the associated benefits have already been recognised or, otherwise, recognised linearly in the period in which it is estimated that they are obtained.

2.18. PROVISIONS

Provisions are recognised when: (i) the Group has a present obligation (legal or implicit) resulting from past events; (ii) settlement is expected to result in an outflow of resources; and (iii) the amount can be estimated reliably. Provisions are reviewed on the date of each Statement of Financial Position and adjusted in order to reflect the best estimate at that date.

In particular, provisions are set up to meet contrac-tual obligations in order to maintain or replace the equipment operated under the management and operation contract of Vila Franca Hospital, based on the investment plan arising from the obligations envi-saged in Annex V to that contract, as specified in IAS 37 – Provisions, contingent liabilities and contingent assets and in accordance with the principles descri-bed in IFRIC 12 – Service concession arrangements.

2.19. CONTINGENT ASSETS AND LIABILITIES

A contingent liability arises when there is:

• a possible obligation that arises from past events and whose existence will only be confirmed by the occurrence or non-occurrence of one or more un-certain future events not wholly within the control of the Group; or

• a present obligation that arises from past events but is not recognised because:

• it is not probable that an outflow of resources embodying economic benefits will be required to settle the obligation; or

• the amount of the obligation cannot be mea-sured with sufficient reliability.

Contingent liabilities are not recognised in the con-solidated financial statements. They are disclosed in the Notes to the Financial Statements, unless the possibility of an outflow of resources embodying fu-ture economic benefits is remote, in which case they are not subject to disclosure.

A contingent asset is a possible asset that arises from past events and whose existence will be confirmed only by the occurrence or non-occurrence of one or more uncertain future events not wholly under the control of the Group. Contingent assets are not recognised in the Consolidated Financial Statements but disclosed in the notes thereto when a future economic benefit is probable.

2.20. FINANCIAL INSTRUMENTS

Financial assets and financial liabilities are recognised when the Group becomes a party to the contractual relationship.

a) Cash and bank deposits

The amounts included in the Cash and bank deposits caption correspond to cash, bank deposits, term de-posits and other short-term investments maturing in under three months, and which may be immediately redeemed at insignificant risk of changes in value.

For the purposes of the Consolidated Statement of Cash Flows, the caption Cash and cash equivalents



also includes bank overdrafts included in the Loans caption, in the Consolidated Statement of Financial Position.

b) Customers, Other Debtors and Other Assets

Accounts receivable have no implicit interest and are initially recorded in the accounts at nominal value and subsequently measured at amortised cost, net of estimated realisation losses. Impairment losses are recorded based on the evaluation of the estimated losses associated with doubtful debts at the date of the Statement of Financial Position. The identified impairment losses are recognised against profit and loss in the “Provisions and impairment losses” caption. They are subsequently reversed through profit and loss under the “Reversal of provisions and impairment losses” caption if a reduction of the estimated loss in a subsequent period is verified. The objective evidence showing that a financial asset is impaired took into account the following aspects: (i) Significant financial difficulty by the debtor; (ii) Contractual breach, such as failure to pay or breach in the payment of interest or amortization of the debt; (iii) Probability that the debtor goes into bankruptcy.

c) Investments

Investments are recognised (and derecognised) on the date all the risks and rewards of ownership are substantially transferred, regardless of the date of settlement.

They are initially measured at their acquisition cost, which is the fair value of the price paid, including transaction costs.

Investments other than those in subsidiaries, associates and joint ventures are classified as follows:

• Held-to-maturity investments;

• Assets measured at fair value through profit or loss;

• Financial assets available for sale;

• Other investments.

Investments held to maturity are investments with predetermined financial flows and defined maturity, which the Group has the intention and capacity to hold up to that date. They are classified as non-current investments, unless the maturity is less than twelve months from the date of the statement of financial position. These investments are recorded at amortised cost using the effective interest rate, less repayments of principal and interest earned. Impairment losses are recognised in profit/loss when the recorded value of the investment is less than the estimated cash flows discounted at the effective interest rate determined at the time of initial recognition. The reversal of im-pairment losses in subsequent periods may only occur when an increase in the recoverable amount of the investment is related to events occurring after the date on which the impairment loss was recognised. In any event, the recognised value of the investment resulting from the reversal of the impairment loss cannot exceed the value corresponding to the respective amortised cost if the impairment loss had not been recognised.

The Group categorizes the “Other Financial Instru-ments” as held until maturity.

Assets measured at fair value through profit or loss are financial instruments held for trading acquired for sale in the short term, and are classified as current investments. Financial instruments that on initial re-cognition are designated by the Company at fair value through profit or loss are also included in this category, provided they have a price listed on an active market or the fair value may be reliably measured.

After initial recognition, the assets measured at fair value through profit or loss and financial assets avai-lable for sale are re-evaluated at their fair values by reference to their market value at the date of the statement of financial position, without any deduc-tion for transaction costs that may occur up to their actual sale. In the situations where the investments are equity instruments not admitted to trading on regulated markets, and for which the fair value cannot be reliably estimated, they are kept at their acquisition cost less any impairment losses.

Financial assets available for sale are financial in-vestments that are available for sale or which do not fit under any of the previous classifications and are classified as non-current assets.


The gains or losses arising from changes in fair value of financial assets available for sale are recognised in equity under the “Other reserves” caption until the investment is sold or otherwise disposed of, or in situations where an impairment loss is believed to exist, then the cumulative gain or loss is recognised on the income statement.

d) Financial liabilities and equity instruments

Financial liabilities and equity instruments issued by the Group are classified according to the substance of the contract, regardless of their legal form. Equity instruments are contracts that demonstrate a residual interest in the Group’s assets after deduction of the liabilities.

The equity instruments issued are recorded at the amount received, net of costs incurred with their is-suance.

e) Bank loans

Loans are initially recorded under liabilities at their nominal value, net of issuing costs, corresponding to their fair value at that date. Loans are subsequently measured by the amortised cost method, calculated according to the effective interest method. The cor-responding financial charges are calculated according to the effective interest rate.

f) Suppliers, Other creditors and Other liabilities

The Balances of Suppliers, Other Creditors and Other Liabilities are initially recorded at their nominal value and later, whenever applicable, are measured by the amortized cost and in accordance with the effective interest rate method. The accounts payable are recog-nised as current liabilities except if their settlement is contracted after twelve months following the date of the consolidated statement of financial position.

g) Derivative financial instruments and hedge ac-counting

The JMS Group’s policy is to contract derivative fi-nancial instruments for hedging of financial risks to which it is exposed, which are mainly due to interest rate variations.

Hedging Instruments

The possibility of calling a derivative financial instru-ment a hedging instrument complies with the provi-sions of IAS 39, namely, with regard to its respective documentation and effectiveness evaluation.

Derivative financial instruments are recognised for their fair value on the date they are negotiated. Fair value is evaluated on a regular basis, and gains or losses resulting from that evaluation are recorded in the income statement, except cash flow hedging derivatives in which the variation is recognised in consolidated equity.

Accounting is discontinued when the hedging instru-ment reaches maturity or is sold, or when the hedging relationship ceases to comply with the requirements of IAS 39.

2.21. CASH FLOWS STATEMENT

The statement of cash flows is prepared according to the direct method, through which the cash inflows and outflows in operating, investing and funding activities are disclosed.

2.22. SUBSEQUENT EVENTS

Events occurring after the date of the Statement of Financial Position and which provide additional infor-mation about situations existing on the date of the Statement of Financial Position are reflected in the Consolidated Financial Statements.

Events occurring after the date of the Statement of Financial Position and which provide information about situations occurring after that date, are disclosed, if material, in the notes to the Consolidated Financial Statements.



Business activityRegistered office

Carnaxide

Lisboa

Carnaxide

Cascais

Carnaxide

Matosinhos

Carnaxide

Viseu

S.J.Madeira

Carnaxide

Lisboa

Viseu

Carnaxide

S.J.Madeira

Carnaxide

Lisboa

Carnaxide

Lisboa

Coimbra

99.9049%

62.8068%

100%

99.9995%

100%

95.9955%

100%

100%

100%

100%

33.6490%

100%

99.9995%

100%

100%

69.9294%

100%

100%

100%

Management and operation of a hospital

Provision of medical and nursing services

Management and operation of a hospital and nursing units

Operation of a diagnosis and radiology medical centre


Operation of health unit










Provision of diagnosis services and therapy in the nuclear medicine field




Effective percentageCompany

Private healthcare services:


Clínica CUF Belém, S.A.

Hospital CUF Cascais, S.A. (c)

Ecografia de Cascais, Lda.

Hospital CUF Porto, S.A. (d)



SIM-X - Serviço de Imagem Médica, Lda.

Gabinete de Diagnóstico de Imagem de São João da Madeira, Lda.

Hospital CUF Infante Santo, S.A. (a)

Clínica de Serviços Médicos Computorizados de Belém, S.A. (j)


Nova Imagem - Centro Radiodiagnóstico, S.A.

Celso & Santos, S.A.

Hospital CUF Torres Vedras, S.A. (b)

HD Medicina Nuclear, S.A.

Clínica CUF Alvalade, S.A.

Clínica Dr. Luís Álvares, S.A.


3. COMPANIES INCLUDED IN THE CONSOLIDATION

3.1. COMPANIES CONSOLIDATED BY THE FULL CONSOLIDATION METHOD

In 31 December 2017, the consolidation included, through the full consolidation method, the parent company and the following subsidiaries in which control is held:


Braga

Carnaxide

Carnaxide

Carnaxide

Roterdão

V.F. de Xira

Carnaxide

Matosinhos

Carnaxide

Carnaxide

99.9809%

100%

Empresa-mãe

100%

99.9995%

99.9760%

100%

95.9955%

100%

99.0933%

Management and operation of a public hospital

Operation, management and marketing of healthcare infrastructure, commercial areas and car parks

Purchase and sale of equipment and provision of management and consultancy

Buying and selling real estate, exchange and renting property

Management of shareholdings

Management and operation of a public hospital

Buying and selling real estate, exchange and renting property

Management of shareholdings

Execution of real estate projects, namely the purchase and sale of properties, swap and rental of owned properties and of properties belonging to third parties

Provision of IT, operational, administrative and negotiation services

Public healthcare services:

Infrastructures:

Others:


Infrahealth – Gestão de Infraestruturas, Lda.

José de Mello Saúde, S.A.

SIMPLYGREEN - Investimentos Imobiliários, S.A.

Vramondi International BV

Escala Vila Franca – Sociedade Gestora do Estabelecimento, S.A.

Imo health - Investimentos Imobiliários, S.A.

VALIR - Sociedade Gestora de Participações Sociais, S.A.

Hospimob - Imobiliária, S.A.

JMS - Prestação de Serviços Administrativos e Operacionais, ACE

Carnaxide

Carnaxide

Carnaxide

Carnaxide

Carnaxide

Carnaxide

Carnaxide

Carnaxide

Carnaxide

99.2404%

100%

100%

100%

100%

99.1714%

100%

70.4997%

100%

Provision of operational, administrative and health services

Distribution and commercialization of medication and medical devices

Sale of parapharmaceutical products

Provision of training services in the nursing and clinical services field

Provision of management, consultancy, operating and administrative services in the healthcare sector

Provision of operating services (catering, cleaning and maintenance)


Provision of external services of occupational safety, hygiene and health


JMS - Prestação de Serviços de Saúde, ACE

Centro Logístico CUF Unipessoal, Lda. (e)

Loja Saúde CUF - Produtos e Serviços de Saúde e Bem Estar, S.A.

Academia CUF, Sociedade Unipessoal, Lda.


JMS - Serviços de Logística, ACE


Sagies - Segurança, Higiene e Saúde no Trabalho, S.A.


Business activityRegistered office

Effective percentageCompany



Company Effective percentageRegistered office Business activity

Centro Gamma Knife-Radiocirurgia, S.A. Operation of radiosurgery treatment unitsLisboa 34,000%

(a) The activity of this company includes domiciliary services (resulting from a division-merger operation of SPSD – Sociedade Portuguesa de Serviços Domiciliários, S.A.), as well as the management of CUF Miraflores Clinic and CUF Almada Clinic, which are clinically and administratively accountable to Hospital CUF Infante Santo, S.A.

(b) The activity of this company also includes the management of CUF Mafra Clinic, which is clinically and administratively accountable to Hospital CUF Torres Vedras, S.A..

(c) The activity of this company also includes the management of CUF São Domingos de Rana Clinic and CUF Sintra Clinic, which are clinically and administratively accountable to Hospital CUF Cascais, S.A..

(d) The activity of this company also includes the management of CUF São João da Madeira Clinic, which is clinically and administratively accountable to Hospital CUF Porto, S.A..

(e) This society was formed at the end of 2017, but it has not yet started its activity.

(f) The percentage of control over this entity, given indirectly through Clínica CUF Belém, S.A. is 53.57%.

3.2. ASSOCIATES

The associates registered through the equity method as of 31 December 2017 (Note 19) are the following:

4. CHANGES IN THE CONSOLIDATION SCOPE

The main changes occurred in the consolidation scope in the financial year ended on 31 December 2017 were essentially the following:

4.1. HIRES

Newly consolidated companies

Company Percentage capital heldRegistered office

Control

100%

100% 100%

100%

100%

100%

100%

100%

100% 100%

100%

100%

100%

100%

Carnaxide

S.J.Madeira

Carnaxide

Carnaxide

S.J.Madeira

Lisboa

Coimbra

Carnaxide

100%

100%

Effective

SIMPLYGREEN - Investimentos Imobiliários, S.A. (“Simplygreen”)

Gabinete de Diagnóstico de Imagem de São João da Madeira, Lda. (“GDI”)

Hospimob - Imobiliária, S.A. (“Hospimob”)

PPPS II - Gestão e Consultoria, S.A. (“PPPS II”)

Celso & Santos, S.A. (“C&S”)

Clínica Dr. Luís Álvares, S.A. (“CLA”)

CPIS - Clínica Particular de Coimbra, S.A. (“CPIS”)

PPPS III - Gestão e Consultoria, S.A. (“PPPS III”)


The entry of these entities into the consolidation scope had the following impact on consolidated financial sta-tements:

The stated values are the estimate of the fair values of these subsidiaries’ assets and liabilities.

In 2016, the Group acquired control of Sim X – Serviços de Imagem Médica, Lda. which resulted in a goodwill of 624 thousand euros.

4.2. OTHER OPERATIONS THAT AFFECTED THE SCOPE IN PREVIOUS PERIODS

Digihealth and Haspac

The Ministry of Health terminated the concession contract with the Hospital Amadora Sintra – Sociedade Gestora, S.A. (“HAS”), currently named Digihealth, S.A., on 6 November 2007. This company had managed the Prof. Dr Fernando Fonseca EPE Hospital. Consequently, the activity of another group company, HASPAC – Patologia Clínica, S.A. (“Haspac”), which operated the Clinical Pathology Department on an exclusive basis of Digihealth was also discontinued.

C&S HospimobGDI CPIS TotalSimplygreen CLA

Net assets acquired:


Other assets

Inventories


Intangible assets

Other debtors

Deferred tax assets

Borrowings

Other investments




Goodwill (Note 15)

Other liabilities

Settlement by monetary means (Note 46)



Acquisition price

Other creditors

Amount due (Note 40)

4,228,627 760,973

- 14,561

- -

- 8,826

- 7,301

- (132)

- 5,519

250 246,967

- -

(3,152,707) (761,352)

- 157,684

- (63,567)

-

737,293 207,972 41,099 136,913 36,368,360 (468,250)

2,145,867

(8,501) (140,509)

737,293 1 382,780

29,624 12,184

- (11,543)

737,293 2,282,780

(360,000) (100,000)

- 900,000

1,992 76,766,703

186 355,263

- -

370 -

- - -

- - (4,067,924)

6,572 1,352,007

150 417,845

- 13,020 13,020

83,116,875

144,655

78,680

173,636

1,030,976

601,694

869,617

788,005

6,742,179

(43,850,755)

(4,068,056)

(1,213,809)

(912,451)

(2,223,331)

(4,267,547)

1,170 859,250

166,335

-

135,982 -

33,739 6,194,453

- -

-

-

- - (39,850,000)

56,658 11,095

(1,041) -

19,328 -

(1,230) (775,059)

159,992 34,387,465

4,654 388,070

(774) (859,045)

227,300 36,368,360

(22,565) (1,795,196)

67,308 2,988,134

3,154

122,135 144,634

78,680

(86,696)

16,466 789,073

(51,397) (1,097,804)

94,883 8,258,750

- (1,298,032)

n,a, 6,790,500

4,732 162,430

(2,624) (38,465)

135,982 7,790,500

(56,106) (1,933,680)

n,a, 1,000,000



On 12 December 2012, the arbitration tribunal, in the current arbitration process, issued a ruling ordering the Administração Regional de Saúde de Lisboa e Vale do Tejo, I.P. (“ARSLVT”) to pay Digihealth the sum of 18,123,526 euros. Although ordered to and given notice pay, ARSLVT never paid the ordered amount. ARSLVT filed an action to annul the arbitration ruling in the South Administrative Central Court and the decision is still pending.

At the end of the first quarter of 2014, Digihealth noted that the effort put into collecting from the ARSLVT was not producing the desired outcome. Therefore, and with the aim of paying off, even if partially, the liabilities contracted with its creditors, Digihealth sounded out the market and managed to find an entity, Finanfarma – Sociedade de Factoring, S.A., willing to sign a factoring contract and to pay a very large sum for the acquisition of Digihealth’s credit over ARSLVT, expressly envisaging the possibility of appealing to the Special Revitalisation Process (“PER”). The strategy advocated by Digihealth merited the agreement of a large majority of creditors (74.46%), representatives of its liability On 1 August 2014, Digihealth filed the PER process following approval from 84% of creditors, and subsequently ratified by the Commercial Court of Lisbon on 5 March 2015.

Even though it had obtained support from different creditors (47.98%), representatives of the HASPAC liability, the truth is that it was not possible to achieve the qualified majority of 67%, thereby enabling an arrangement with creditors to be made. In this context, HASPAC Management was forced to proceed with a voluntary submission request to insolvency at the Tribunal da Comarca de Lisboa Oeste.

It had been declared insolvent on 19 February 2015, and the respective insolvency administrator was appointed. As in previous years, the Board of Directors of Digihealth carried out its activity according to the framework and to the commitments made with the creditors, including the Special Revitalisation Process. Thus, JMS Group believes that is a very limited control over this subsidiary and, due to its immateriality, it was excluded from the consolidation perimeter.

5. BUSINESS SEGMENTS

As argued in IFRS 8, the Group presents the operating segments based on the internal management information model provided to the main agent responsible for making the Group’s operational decisions, who is responsible for the allocation of resources to the segment and for the evaluation of its performance as well as for making strategic decisions.

The main activities undertaken by the Group are classified into the following business segments:

• Private healthcare services;

• Public healthcare services;

• Infrastructures; and

• Others.

On 31 December 2017, the “private healthcare” business area includes the following units:

• seven hospitals providing a total of 566 inpatient beds; 385 consultation rooms; 41 operating theatres, 6 delivery rooms, and a wide offer of specialty consultations, exams, dental care, check-ups, physical and rehabilitation medicine;

• nine outpatient units, with 229 consultation rooms, and offering specialty consultations, exams, dental care, check-ups, physical and rehabilitation medicine and also the possibility of carrying out minor surgery;

• one high technology diagnosis and treatment unit including 56 specially consultation rooms; and,

• eight clinical imaging units with a wide range of exams (bone densitometry, ultrasound scan, mammography, radiology, magnetic resonance imaging and computed tomography).


The public healthcare business area results from two partnership contracts with the Portuguese State, in which the Group manages two hospitals:

• Braga Hospital – resulting from a public-private partnership (established in December 2008), the Management Contract was initiated with ARS Norte IP on 1 September 2009, for a period of 10 years, i.e., until 31 August 2019. The new Braga Hospital, which is part of the NHS, opened in 9 May 2011 and has a total hospital floor area of 102,000 m2, 705 inpatient beds and 109 consultation rooms, 12 operating theatres and one delivery block, serving a population of 1.2 million inhabitants in the Braga and Viana do Castelo districts; and

• Vila Franca de Xira Hospital – the Escala Vila Franca de Xira Consortium – took over the management of Reynaldo dos Santos Hospital on 1 June 2011, being responsible for the entire operations of this hospital which belongs to the Portuguese National Health Service. The management of the previous hospital infrastructure was assured for a two-year period. In April 2013, the new Vila Franca de Xira Hospital opened, with a gross construction area of 49,000 m2, 233 inpatient beds and 33 consultation rooms, 9 operating theatre and 6 delivery rooms, serving about 235,000 inhabitants of the Alenquer, Arruda dos Vinhos, Azambuja, Benavente and Vila Franca de Xira municipalities. This management contract will be in effect until 31 May 2021.



The “Infrastructure” segment includes four entities whose corporate purpose is the purchase, sale, management and lease of health infrastructure, commercial spaces and car parks; this way, with this separation, it was possible to separate the clinical business units from the ancillary activities. In its entirety, this segment mostly includes the management and operation of thirteen buildings and seven car parks (for a total of 1,421 parking spaces).

The “Other” segment integrates, in addition to the management of holdings, six entities providing management, training, accounting, consulting, cleaning and maintenance services, and also IT, operational, administrative, leasing of medical equipment, negotiation and procurement services. The Group also has units that (i) provide occupational safety and health services essential for the monitoring of the health of workers and of environmental working conditions, (ii) provide custom home healthcare, namely in the areas of gerontology, maternal and child care, follow-up in convalescence and palliative care, (iii) trade practice of parapharmacy products, which include dermocosmetics, personal hygiene, child care and orthopaedic products, and food and food supplements, dietary food, natural products and non-prescription pharmaceuticals.

The main information concerning the contribution from each segment for the financial years ending on 31 December 2017 and 2016 is as follows:

2017

Intersegment transactions are carried out at market prices, on a similar base to third-party transactions.

EliminationsInfra-structures Consolidated


Others

Services rendered

Intersegment


Operating costs

Pre-tax profit

External clients


Other operating profit

Financial results

Net profit for the year attributable to shareholders

Total sales and services rendered


Segment operating profit

Income tax


Profit attributable to non-controlling interests


8,911,779 47,251,208

332,050 334,421

399,480,468 3,170,601

822,778 5,535,962

(367,510,515) (96,293,529)

43,203,523 (4,698,684)

408,392,246 50,421,809

- 82,900

6,941,366 41,675,286

(4 619 573)

30,872,131

(502 251)

(1,392,780)

47,823,097 (4,196,434)

(11,947,378) 3,397,028

(5,774,401) (6,455,534)

(384,014) (91,123)

- (61,276,235)

- -

225,040,349 -

142 (5,888,769)

(230,290,784) (5,664,915) 104,909,029

(3,535,996) (2,864,535) 486,014

5,113,248 -

- 666,471

- 627,691,418

486,243 956,355

(594,850,714)

32,104,308

225,040,349 (61,276,235)

- -

2,331,281 1,950,961

5,113,248

(43,146,779)

(616 843)

(3,815,271)

(4 263 829)

(2,843,883)

-

486,014

(2,919,153) 486,014

(279,957) -

(616,985) 5,402,755

682 -

627,691,418

- 82,900

9,752,114

(10 488 510)

22,820,198

1,399,294 42,592,818

20,652 (8,809,655)

(4,750,072) (12,194,236)

- (474,455)



Other information:

Assets and liabilities per business segment and corresponding reconciliation with the consolidated total at 31 December 2017 are as follows:


Depreciation and amortisation in profit/loss

Fixed capital expenses (Note 18)

Assets by segments

Liabilities

Goodwill



Other assets by segments


Borrowings


Other liabilities by segments

Total consolidated assets

Total consolidated liabilities



OthersPublic

healthcare services



OthersPublic

healthcare services

(942,143) 70,261

(12,788,280)

15,633,386

(1,946,461)

3,527,277

(815,913) -

(9,908,924)

3,781,510

-

-

- (1,687,795)

(3,087,849)

95,490,880

(27,731,514)

118,433,053

43,850,100

48,110,070

233,956

70,311,906

6,000

5,865,548

-

439,963,066

66,073,717

33,095,036

98,013,786

147,294,701

7,957,749

200,798,998

27,191,913

70,836,077

278,483,466

228,499,807

475,118,728

277,500,623

15,896

71,817,362

-

65,220,269

-

(34,373,657)

-

(436,723,635)

13,191,527

10,000,000

32,197,814

51,927,649

-

-

(34,860,708)

(245,094,602)

13,261

3,122,678

-

61,239,773

43,885,257

94,542,001

233,956

200,011,378

291,185,799

107,740,051

327,753

181,851,467

378,408,792

351,634,085

122,870,558

206,815,292

110,625,506

133,745,010

(471,584,343)

(279,468,259)

352,766,585

292,714,196

745,409,942

652,991,378



2016

Intersegment transactions are carried out at market prices, on a similar base to third-party transactions. Other information:

Services rendered

Intersegment

Operating costs

Income tax

Profit attributable to non-controlling interests



External clients

Other operating profit

Pre-tax profit



Total sales and services rendered

Segment operating profit

Financial results

Net profit for the year attributable to shareholders


Depreciation and amortisation in profit/loss

Fixed capital expenses (Note 18)



OthersPublic

healthcare services



OthersPublic

healthcare services

1,272,399

(320,703,324)

(11,533,047)

(286,016)

382,517

-

40,000,413

(78,737,045)

2,558,552

1,700

4,005,573

(83,070)

360,378,674

4,783,252

42,095,151

(4,331,383)

313,015

3,057,094

32,604,006

(4,055,207)

(5,349,344)

447,166

361,651,073

45,731,002

(3,635,851)

30,276,088

43,057,507

(3,075,532)

(979,675)

(1,494,955)

-

(220,627,433)

663,761

380

533

-

(45,638,822)

78,062,317

-

-

(3,866,502)

-

214,605,554

3,197,257

(3,677,137)

(853,048)

-

-

(32,423,495)

-

3,866,502

-

4,366,010

(2,730,745)

(133,641)

-

-

-

-

(544,736,229)

(8,444,376)

(283,937)

522,121

(83,070)

-

68,503

(1,715,513)

(3,419,282)

-

578,041,322

8,229,524

32,647,294

(10,086,554)

760,181

214,605,554

(2,824,623)

(852,515)

(3,012,997)

(45,638,822)

-

-

-

4,366,010

1,703,769

(3,419,282)

(1,849,155)

578,041,322

41,534,616

(8,887,323)

23,918,981

163,057 120,802

(10,946,727)

15,107,985

(1,757,347)

3,136,739

(2,038,453) -

(10,098,729)

2,850,538

-

-

- (1,754,594)

(2,289,564)

17,894,248

(25,092,368)

38,989,509


Assets and liabilities per business segment and corresponding reconciliation with the consolidated total at 31 December 2016 are as follows:

6. CAPITAL MANAGEMENT

The JMS Group actively monitors its capital structure, controlling the share of financing of its assets between equity and debt capital. In this context, the group tracks the gearing ratio, which is the net financial debt over total equity plus net financial debt. The calculation of the net financial debt includes the gross financial debt net of cash and cash equivalents and other financial instruments. The following table presents the details of the calculation of this ratio for 2017 and 2016:

Assets by segments

Liabilities

Goodwill



Other assets by segments


Borrowings


Other liabilities by segments

Total consolidated assets

Total consolidated liabilities




Equity + Net Financial Debt (A+B)

Gearing ratio (A/(A + B))

31-12-2017 31-12-2016

Net Financial Debt (A)

Equity (B)



OthersPublic

healthcare services

33,331,272

35,581,520

168,111

73,784,529

6,000

4,659,104

-

292,697,687

55,849,826

22,971,455

81,681,345

135,322,901

5,888,671

116,912,739

19,148,552

32,369,490

244,815,082

193,875,876

317,740,910

153,941,333

15,896

68,170,882

-

76,858,534

-

(22,260,555)

-

(263,154,615)

17,125,267

10,000,000

16,736,643

50,104,498

-

-

(22,253,322)

(129,082,729)

13,261

1,383,902

-

3,978,412

33,366,429

87,534,852

168,111

184,164,546

110,925,844

125,734

64,359

94,939,793

189,789,608

150,009,928

95,377,577

183,653,952

110,736,339

128,275,379

(285,407,936)

(151,343,285)

114,981,876

96,449,429

502,866,271

421,198,732

421,606,101 219,624,592

47,894,297 16,067,394

35,150,000 48,650,000

88,189,849 77,706,743

426,751,653 232,613,941

79% 67%

154,907,198338,561,804



Additionally, JMS Group’s analysis concerning their capital ratios focuses in greater detail on the net financial debt to EBITDA ratio, since the Group has a covenant calculated based on this ratio associated with several sources of funding. We must point out the three issued bond loans (for a total of 150 million euros), which include a limit of 6x on the net financial debt to EBITDA ratio as a financial covenant. In the event that the JMS Group does not comply with this covenant, the bondholders may demand early repayment of the bonds. At the end of 2016 and 2017, this ratio recorded values of 4.7x and 2.3x, respectively.

7. OPERATING INCOME

Operating income in the financial years ended 31 December 2017 and 2016 is broken down as follows:

31-12-2017 31-12-2016

Services rendered:

Prior-year corrections

Transport of patients

Occupational Hygiene, Safety and Medicine

Clinical tests and analyses

Internships

Recovery of outstanding debts

Others

Clinical tests, exams, analyses and consumables

Indemnities


Sales

Assignment of space

Prompt payment and discounts abtained

Public health service

Hospital projects and technical consultancy

Gains obtained on sale of assets

Reimbursement of costs

Home Services

Management contracts with regional health authorities

Provisional retirement

Assignment of personnel

Hospital and clinical activity

Personnel transfer

Rappel

Operating grants

Sales and services:

Other operating income:

438,802

2,995,040

2,285,795

257,325

249,756

2,637,432

970,625

38,908

-

135,431

402,559

15,434

38,314

629,474

2,593,141

2,037,457

333,174

230,104

2,523,533

495,478

53,181

435

69,752

358,522

-

65,102

406,107,933

1,015,608

65,236

4,972

217,420,992

934,942

40,893

-

950,828

409,118

27,589

-

367,169,069

920,370

-

28,884

206,830,166

520,425

172,145

2,737

819,328

264,699

14,736

138,935

627,691,418

9,752,114

637,443,532

578,041,322

8,229,524

586,270,846


Sales and provision of services recorded a growth of 8.6% vis-à-vis the previous year, which is mostly justified by:

• an increase in the number of specialty consultations;

• an increase in the number of operated patients;

• the opening of new clinics;

• the opening of new services in the existing clinics;

• the growth of the different areas of activity and increase of installed capacity.

The Provision of space item predominantly includes the amounts concerning the operation of car parks and the cafeteria areas of the Group’s units.

In the year ended 31 December 2016, Corrections concerning previous financial periods item includes the settle-ment, in the amount of 1,265 million euros, generated in the reconciliation of the settlement of the 2014 and 2015 accounts with ARS Norte IP.

8. COST OF SALES

Cost of sales in the financial years ended 31 December 2017 and 2016 was determined as follows:

Inventories at 1 January (Note 24)

31-12-2017 31-12-2016

Inventories at 31 December (Note 24)

Changes in consolidation perimeter:

Procurement

Cost of sales

Incoming

Outgoing

11,295,357 8,951,535

119,276,825

(116,516,108)

173,636

-

109,758,403

(107,414,581)

-

-

11,295,35714,229,710



9. EXTERNAL SUPPLIES AND SERVICES

External supplies and services in the financial years ended on 31 December 2017 and 2016 are broken down as follows:

The External Supplies and Services item recorded an increase of about 8.9% vis-à-vis the previous year, which is justified by the Group’s increased activity. Its main subitem concern:

• Fees (59%) – this item includes the amounts paid to healthcare professionals (doctors, nurses, diagnostic technicians and assistants) of the various units within the scope of the Group’s operating activity;

• Specialized Work (11%) – this item mostly concerns clinical works;

• Subcontracts (12%) – includes contracting specific services such as (i) catering, (ii) cleaning, (iii) patient transport and (iv) CDTMs;

31-12-2017 31-12-2016

Specialised work

Communications

Travel and accommodation

Litigation and notary public fees

Fees

Advertising

Tools and utensils

Maintenance and repair

Water

Road tolls

Transport of goods

Electricity

Collection of waste

Office material

Other supplies and services

Subcontracts

Fuel

Air conditioning

Cleaning, hygiene and comfort

Rents and leases

Insurance

Articles for free distribution

Books and technical documentation

9,109,711

1,295,555

254,055

10,238

6,410,667

2,669,667

1,740,070

1,155,539

868,304

588,226

245,154

144,872

260,239

28,924,978

25,850,818

142,234,579

1,537,951

399,284

167,359

17,180,664

1,568,816

54,896

66,443

11,606,045

1,193,224

238,187

8,555

6,260,843

2,191,508

2,049,940

1,118,923

191,996

301,026

22,899,034

42,573,698

110,190,913

1,728,541

450,923

529,599

1,043,124

136,246

154,538

16,279,333

1,400,043

267,843

36,055

222,850,139242,738,087


10. PERSONNEL COSTS

The number of employees at 31 December 2017 and 2016 by business segment was as follows:

The personnel costs in the financial years ended on those dates were as follows:

Other personnel costs include expenditure on vocational training, medical care and food allowance.


Infrastructures


31-12-2017 31-12-2016

Others

Remuneration of governing bodies

Insurance

Wages

Indemnities

Wage-related expenses

Training

31-12-2017 31-12-2016


Employee benefits (Note 37)

Other personnel costs

4,120 3,926

- -

1,134

3,833

1,009

3,331

8,2669,087

2,275,338

3,452,999

2,265,336

2,883,780

140,194,157

470,314

131,068,432

735,984

33,778,845

417,177

8,486,173

172,731

13,346,782

31,740,081

665,334

8,391,271

226,285

6,642,462

184,618,966202,594,517



11. OTHER OPERATING COSTS

Other operating costs for the financial years ended on 31 December 2017 and 2016 were as follows:

The Taxes item predominantly includes expenditure with Municipal Property Tax (MPT) and with Stamp Duty.

12. FINANCIAL RESULTS

The financial results in the financial years ended 31 December 2017 and 2016 is broken down as follows:

Taxes

Contributions to associations

Prior-year corrections

Fines and penalties

Uncollectable debts

Management contracts with regional health authorities

31-12-2017 31-12-2016

Donations

Losses incurred in the sale of assets

Others

31-12-2017 31-12-2016

Bank fees and services

Foreign exchange gains

Gains on associates

Gains/losses in financial instruments at fair value

Other financial losses and expenses

Interest expenses

Interest earned

Losses in associates

Dividends

Foreign exchange losses

Derivative financial instruments - Interest rate (Note 42)

Other financial income and gains

Financial expenses and losses:

Financial income and gains:

Profit/loss of associates:

Gains /(Losses) relating to investment activities:

1,520,644

196,236

835,136

72,207

637,536

126,110

1,022,222

274,183

561,527

82,353

417,622

20,287

20,379

543,933

-

218,477

5,252

34,172

3,005,5813,582,693

(2,970,864)

26

666,471

82,900

(826,829)

346,039

(8,393,235)

610,291

-

-

(7,736,684)

509,882

-

-

(265,854)

(187)

(3,121)

(685,535)

12,239

(1,398,482)

-

760,181

(83,070)

-

(12,194,236)

956,355

666,471

82,900

(10,086,554)

522,121

760,181

(83,070)


The detail of the values recognised as results concerning interests in associated companies in the years ending on 31 December 2017 and 2016 is as follows:

The JMS Group and its domestic subsidiaries 75% or more directly or indirectly owned are liable for corporate income tax under the Special Taxation Scheme for Groups of Companies (“STSGC”). The companies included in the RETGS determine and record tax on income as if they were taxed individually; the determined responsibili-ties are, however, recognized as debts to the parent company in the tax group, JMS, which is responsible for the global determination and for the reverse charge of the tax. Concerning the companies not covered by the RETGS, current tax is calculated based on the corresponding taxable bases and on the tax rates in effect, in accordance with the tax rules and schemes applicable in the territory of each company’s headquarters.

13. INCOME TAX

Income tax recognised in the financial years ended on 31 December 2017 and 2016 is as follows:

Company 31-12-201631-12-2017

Gains in associates

Gains in associates



Escala Parque – Gestão de Estacionamento, S.A. (note 30)

Centro Gamma Knife-Radiocirurgia, S.A. (note 19)

Escala Braga - Sociedade Gestora do Edifício, S.A. (note 30)

31-12-2017 31-12-2016

In previous financial year

Other transactions

Revaluation of tangible fixed assets

Retirement benefits

Tax losses

In financial year

Temporary difference and reversal

Customer impairments

Provisions not approved for tax purposes

Current tax:

Deferred tax (Note 22):

Tax for the year

260,754 302,691

97,956 -

307,761 457,490

- -

- -

- -

666,471 760,181

(294,608)

-

(510,068)

51,349

57,538

9,182,340

-

99,522

223,582

9,905,474

(282,263)

-

(697,916)

(590,101)

34,793

-

-

74,387

8,887,732

(78,077)

8,809,655

9,315,374

(870,998)

8,444,376



The Company and most of the companies it holds investments in are liable for corporate income tax at the nominal rate of 21%, which may be further increased by a municipal surtax to the maximum rate of 1.5% of taxable income. Moreover, if applicable, a state surtax of 3% is also payable on the excess of taxable income between 1,500,000 euros and 7,500,000 euros, of 5% on the excess of taxable income between 7,500,000 euros and 35,000,000 euros and the rate of 7% for the excess of taxable income over 35,000,000 euros. Pursuant to Article 88 of the Corporate Tax Code, the Company and its subsidiaries are also liable to be separately taxed for a range of charges, at the rates set out in the referred Article.

Temporary differences between the book values of assets and liabilities and the corresponding tax base were recognised in accordance with IAS 12 – Income taxes (Note 22).

Numerical reconciliation between the average income tax and applicable tax rate is indicated in the table below:

31-12-2017 31-12-2016

Standard tax on profits

Excess tax estimate

Fines penalties and compensatory interest

Accounting Losses

Tax benefits

Depreciations and amortisations not accepted as expenses

Irrecoverable debts not accepted as expenses

Others


Expenses incurred from renting a car without a driver

Imparity and credits that are non-deductible or beyond the legal limits



Amortisation of investment property

Donations

Cancellation of the equity method

Reversal of adjustments in inventories

Non tax deductible provisions

Non-deductible adjustments from the application of fair value

Income tax and other taxes on profits

Others

Nondeductible social fringe benefits

Unduly documented expenses

Income before taxes

Nontaxable income:

Nontaxable expenses:

294,608

64,900

94,766

5,220,289

1,635,518

72

2,833,027

50,978

516,025

21.0%

32,104,308

1,240,455

39,609

571,705

-

799,573

34,979

200,775

-

335

659,998

618,483

530,589

107,725

794,090

611,446

21.0%

32,647,294

1,038,621

143,649

898,640

124,262

1,668,767

-

265,108

72,475

-

590,101

32,386

-

2,199,042

1,402,129

1,249,553

684,471

17,393

136,107

6,741,905

9,789,154

5,617,530

6,855,932

4,901,605

7,134,360


31-12-2017 31-12-2016

Tax loss/Taxable profit

Income tax

Effective tax rate

Calculated tax

Local Tax

Effect of the increase/reversal of deferred taxes

Tax benefits


Autonomous taxation

Local Government Tax

Effect of insufficiency/excess tax estimate

Others

Losses carried forward

14. DIVIDENDS

In 2017, dividends concerning the financial year of 2016 were paid in the amount of 6.5 million euros.

Additionally, according to resolution of the Board of Directors held on 29 November 2017, in the financial year ending on 31 December 2017 interim dividends of 1.33 euros per share were paid, amounting to 14.1 million euros, on the result of the mid-term review prepared on 31 October 2017.

In the financial year ended on 31 December 2016, interim dividends were paid 1.08 euros per share, in the amount of 11.4 million euros.

15. REVENUE PER SHARE

The basic and diluted earnings per share in the financial years ended 31 December 2017 and 2016 was calculated considering the following amounts:

On 31 December 2017 and 2016 there were no dilutive effects of earnings per share, so the diluted revenue per share is equal to basic revenue per share.

Net basic earnings per share (euro)

31-12-2017 31-12-2016

Weighted average number of shares for calculation of basic earnings per share

Profit for the purpose of calculating basic earnings per share (profit for the period)

Basic earnings per share

749,432

(78,077)

(231,694)

21.0%

262,135

698,983

1,417,465

(294,608)

737,338

21.0%

541,787

729,521

1,410,237

(590,101)

(123,632)

678,314

(870,998)

-

27,932,685

8,809,655

27.4%

2,998,839

5,810,815

34,880,049

8,444,376

25.9%

1,233,341

7,211,035

2.15 2.26

10,600,000

22,820,198 23,918,981

10,600,000



Public healthcare

services

Infra-structures Total

Private healthcare

servicesOthers

Balance at 1 January 2016



Outgoing

Outgoing

Impairment losses (Note 38)

Incoming

Incoming



16. GOODWILL

The changes in the values of goodwill during the financial years ended 31 December 2017 and 2016 were as follows:

Goodwill in the financial years ended on 31 December 2017 and 2016 was as follows:

31-12-2016Segment (Note 5)














Infra-structures

31-12-2017Company













Gabinete de Diagnóstico de Imagem de São João da Madeira, Lda.


-

-

-

-

-

-

-

-

(66,100)

624,000

10,518,828

-

-

-

33,331,272

43,850,100

32,773,372

13,261

13,261

13,261

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

(66,100)

624,000

10,518,828

15,896

15,896

15,896

6,000

6,000

6,000

33,366,429

43,885,257

32,808,529

- 8,258,750

12,432,81912,432,819

7,269,220 7,269,220

7,035,102 7,035,102

5,220,465 5,220,465

2,145,867

624,000 624,000

482,166 482,166

160,279 160,279

97,265 97,265

94,883 -

-

19,328 -

15,896 15,896

13,261 13,261


31-12-2016Segment (Note 5)

Others

31-12-2017Company

Ecografia de Cascais, Lda.

Clínica de Serviços Médicos e Computorizados de Belém, S.A.

Vramondi International BV

Impairment tests were carried out using the following methods:

• The recoverable amounts of cash generating units were determined based on the value-in-use calculation. The use of this method requires the estimate of future cash flows arising from the operations of each cash-genera-ting unit and choice of an appropriate discount rate;

• The valuations are supported by past results and future prospects of development of the markets in which the Group operates. Five-year projections of future cash flows for each of the businesses have been prepared in accordance with the plans defined by the Board of Directors.

• Each healthcare unit is a cash-generating unit. Valir – Sociedade Gestora de Participações Sociais, SGPS S.A. includes Instituto CUF – Diagnóstico e Tratamento, S.A. unit, which is analysed together with Hospital CUF Porto, S.A., Nova Imagem – Centro Radiodiagnóstico, S.A. and S.P.S.D – Sociedade Portuguesa de Serviços Domiciliá-rios, S.A., given the complementarity of provided services and the geographical proximity;

and using the following assumptions:

The revenue growth rate is reviewed annually in cash flow projections. It is calculated for each cash-generating unit and for each of the five years considered in the projections, with the rate shown in the table above the average growth rate for the five years and for all cash-generating units.

The most significant subsidiaries were reviewed in 2017. This review concluded that there was no evidence of impairment of the value of goodwill that has been recognised.

Sensitivity analyses were performed on the main variables: (i) discount rate (+/- 0.5%) and (ii) perpetuity growth rate (+/- 0.5%). The results of the sensitivity analysis performed do not indicate the existence of impairment.

3%

3%

7%

7%

-

2%

8%

8%

Period Risk-Free Interest Rate Wacc Rate Perpetuity Growth Rate Revenue Growth Rate

Explicit

Perpetuity



6,0006,000

9,1199,119

837 837

43,885,257 33,366,429



17. INTANGIBLE ASSETS

The changes in the value of other intangible assets as well as the corresponding amortisations and impairment losses, during the financial years ended 31 December 2017 and 2016, were as follows:

Software TotalOther

intangible assets (f)

Industrial property and other rights (a) (b) (c) (d) (e)

Intangible assets in

progress (g)

Gross assets:

Depreciation and accumulated impairment losses:

Net value



At 31 December 2017



Outgoing

Outgoing

Outgoing

Outgoing

Additions

Write-offs

Increases

Additions

Write-offs

Increases

Write-offs

Transfers

Transfers



At 31 December 2016

Incoming

Incoming

Incoming

Incoming





8,946,619

-

-

-

-

-

-

(1,541,471)

2,796,638

-

(1,541,471)

-

2,470,117

-

2,382,978

-

-

-

-

1,984,781

-

-

1,123

-

-

-

-

-

15,450,023

(8,687,217)

7,691,452

-

-

-

-

397,074

-

2,381,855

-

-

-

-

17,920,140

(10,228,688)

(11,770,159)

20,716,778

2,381,855

-

-

2,382,978

1,365,538

-

-

-

-

382,950

2,525,650

(707,211)

1,177,125

(2,461,866)

(865,898)

-

-

(182,178)

13,357,220

-

-

-

-

4,290,591

2,525,650

(2,695,566)

3,974,886

(2 461 866)

(2,925,249)

(630,159)

-

(182,178)

13,796,112

(12,312,166)

1,064,782

11,568

(11,568)

(76,551)

89,571

33,764,653

(22,316,562)

12,877,217

11,568

(11,568)

(76,551)

89,571

662,085

-

-

-

-

1,922,860

-

(446,884)

-

-

(517,881)

(630,159)

(2,470,117)

-

4,121,444

(1,317,179)

1,739,128

-

-

-

-

11,728,764

(10,663,981)

(11,447,743)

12,813,282

35,604,946

(22,727,729)

(25,499,846)

38,857,066

3,574,188

(1,835,060)

(2,281,944)

2,944,029


(a) The management contract between ARS Norte and Escala Braga – Sociedade Gestora do Estabelecimento, S.A., which establishes the management and operation of Braga Hospital as a public-private partnership, came into force on 1 September 2009. On the date of transfer, Escala Braga – Sociedade Gestora do Esta-belecimento, S.A. paid the sum of 15 million euros under the hospital management contract, deducted from which was the amount corresponding to inventories and tangible fixed assets, and the remaining amount was called concession rights.

(b) The management contract between the Ministries of Health and Finance and Escala Vila Franca - Sociedade Gestora do Estabelecimento, S.A., which establishes the management and operation of Braga Hospital as a public-private partnership, came into force on 1 June 2011. On the date of transfer, Escala Vila Franca - So-ciedade Gestora do Estabelecimento, S.A. paid the sum of 7.5 million euros under the hospital management contract, deducted from which was the amount corresponding to inventories and tangible fixed assets, and the remaining amount was called concession rights. This amount will be amortised in 10 years, the term of the contract.

(c) This item includes the amount of 2.8 million euros, categorized as “Surface Rights” and which concern a transfer agreement by the City Council of Cascais to CUF Cascais Hospital. This contract concerns the transfer of the surface rights of two properties located in the municipality of Cascais and has a duration of 40 years.

(d) This item includes the amount of 2.4 million euros, corresponding to the right to operate a car park. Initially, a partnership was entered into between Hospital CUF Infante Santo, S.A., ESLI – Parques de Estacionamento, S.A. and the City Council of Lisbon, which awarded the right to operate the car park for a period of 50 years. In 2016, Hospital CUF Infante Santo, S.A. ceded the contractual position to Infrahealth – Gestão de Infraes-truturas, Lda.

(e) This item also includes the amount of 150 thousand euros concerning the transfer of CUF São Domingos de Rana Clinic.

(f) This caption includes the amount of 3,228,817 euros corresponding to the total estimated value of investments expected until the end of the management and operation contract for the Vila Franca de Xira Hospital, arising from the obligations laid down in Annex V of that contract. As specified in IAS 37 – Provisions, contingent liabilities and contingent assets and in accordance with the principles described in IFRIC 12 – Service conces-sion arrangements, this value began to be amortised in April 2013 following the transfer to the new facility, which was when new capacity was acquired and an investment plan was prepared envisaging the recognition of the future liability with the replacement of the referred equipment by the end of the contract. Within the scope of Clause 123 (Reversal of Goods), the goods subject to revert to the Public Contracting Entity must be in good working order and fully operational, with all conservation, maintenance and renewal operations met. Considering that all medical equipment reaching the end of its service life before the end of the management contract shall be the target of investment, a provision was created in 2013 to account for the intangible, with it beginning to be amortized in April of that year following the transfer to the hospital’s new facilities (when the new installed capacity was acquired). To that effect, an investment plan was drafted where the recogni-tion of the future obligation with the replacement of the aforementioned equipment is expected by the end of the contract. During the financial period of 2017, by reviewing the expected purchasing values, this asset was adjusted and reduced by 630 thousand euros, with the corresponding provision adjusted by the same amount (Note 38).

(g) The value recorded in ongoing intangible assets includes the amount of 1.6 million euros concerning the underground surface rights on a plot of land adjacent to the car park of Descobertas Hospital’s Expansion Building, given by the City Council of Lisbon, and which is still under construction.

There are no signs of impairment on the intangible assets.



18. TANGIBLE FIXED ASSETS

The changes in the value of tangible fixed assets as well as the corresponding depreciation and accumulated impairment losses, during the financial years ended 31 December 2017 and 2016, were as follows:

Land and natural

resources

Other tangible assets

Tangible assets in progress

TotalBasic equipment

Land and natural

resources

31-12-2017

Office equipment

Gross assets:

Changes in consolidation perimeter


Fair value variation

Settlements

Additions

Depreciation

Settlements

Disposals and write-offs

Intangible transfers


Transfers

Net value

Transfers



Discontinued operations

Discontinued operations




-

-

-

-

-

-

-

-

-

-

46,333,640

-

-

3,926

982,762

(1,375,951)

(3,926)

-

-

-

-

2,742,471

713

44,352,024

-

-

-

1,981,616

20,639,128

(17,603,856)

-

-

46,333,640

-

22,427,062

(19,684,591)

8,999,371

8,161

72,586,051

(8,305,287)

(8,161)

29,945

-

(25,695)

-

227,860,627

(6,657,691)

-

-

-

-

8,999,371

(63,732)

-

(13,453)

30,544,164 118,433,053

(25,035,948)

-

-

-

-

-

-

63,732

134,640

- - 182,178

-

-

67,093

-

-

61,074,886

(298,596)

-

378,408,792

- 6,655,361 -

114,742,314

(36,077,226)

-

-

82,655,784

(86,939)

3,967,736

(2,451,219)

808,386

708,710

79,910

(42,076)

134,402

(91,689)

23,875,360 364,590,033

(174,800,425)

-

-

-

-

-

-

-

-

89,493,431

(3,288,945)

-

(75,819)

14,320,076

(15,341,257)

75,819

104,695

182,178

(272,901)

-

40,330,075

1,617

160,846,804

(121,027,654)

-

-

272,291,973

(44,431,346)

214,312

(147,219)

61,074,886

-

581,463,202

(203,054,410)

179,121,330

(138,791,254)


JMS Group established that the real estate asset class allocated to health services, which includes the Lands and natural resources and Buildings and other constructions items is a separate class, based on the nature, characte-ristics, usage and risks associated with it. This class is recorded at the revaluated amount and the win/loss, net of the liability deferred tax effect is recognized in the Other items of comprehensive income item. These properties were evaluated using different methods:

CUF Descobertas Hospital, CUF Almada Clinic, CUF S. João da Madeira Clinic, CUF Belém Clinic, CUF Cascais Hospital, CUF Institute, CUF Torres Vedras Hospital, CUF Porto Hospital, CUF Santarém Hospital and “Infante Santos 34” Building

The Income Capitalisation Method was used to make the evaluation. The income capitalisation method is aimed at determining the value of a property according to its income-producing capacity. It relates future income (in an optimistic assumption and according to economic lifetime) to its current value in order to obtain the market value (in terms of continued use). This method is aimed at determining the current value of future income, according to the actual value and state.

Land and natural

resources

Other tangible assets

Tangible assets in progress

TotalBasic equipment

Land and natural

resources

31-12-2016

Office equipment

Gross assets:



Settlements

Additions

Depreciation

Settlements



Net value

Transfers



Fair value variation




-

-

379,058

-

20,577,214

-

-

44,352,024

1,769,366

-

2,044,558

(1,587,555)

-

2,256,665

(2,967,921)

3,035,272

-

20,600,285

1,026,101

-

-

21,559,326

(18,271,054)

-

44,352,024

-

20,639,128

(17,603,856)

214,072

20,858,117

(7,209,039)

(20,507,389)

331,522

(1,040,987)

78,665,089

1,204,845

- - 118,769

-

(13,265)

1,039,604 38,989,509

(22,167,118)

-

-

-

-

-

-

842,810

3,472,605

-

42,713

(183,160)

23,875,360

(5,380,754)

189,789,608

- (3,304,715) 0

108,625,622

(29,039,527)

5,018,856

583,251

(374,252)

1,053,032

(427,712)

3,165

(1,912)

-

-

134,402

(78,424)

26,323,631 322,454,062

(155,420,804)

- -

-

-

6,044,957

1,639,447

(803,876)

(95,303)

14,668,173

(13,357,259)

772,985

884,418

(1,188,686)

39,819,151

330,504

145,210,796

(108,031,798)

-

114,742,314

(36,077,226)

134,402

(91,689)

23,875,360

-

364,590,033

(174,800,425)

160,846,804

(121,027,654)




In December 2017, a purchase and sale promissory agreement was signed with a real estate fund where a sale value of 27,250,000 euros was agreed, with this being the fair value considered for the property.

Evaluations were also carried out on the current state of repair of the properties. The transaction value of similar properties obtained from market research was used for calculation purposes, after adjusting the characteristics of the properties under evaluation. Capitalisation rates used reflect market behaviour of offices in Portugal upon analysing the profitability of medium/long-term investment projects.

At the end of 2017, the Group completed the acquisition of several properties considered strategic to the pro-vision of private healthcare, held by real estate funds: CUF Belém Clinic Building; CUF Torres Vedras Hospital Building; CUF Institute Building; and CUF Cascais Hospital Building. These buildings, acquired from real estate funds, as well as the buildings of CUF Tejo Hospital and of CUF Descobertas Hospital’s Expansion are provided as an assurance for the loans (Note 35).

The remaining items of tangible fixed assets concern:

• Buildings and other constructions – this item includes, in addition to Real estate allocated to healthcare services, the works and improvements in all of the Group’s buildings;

• Basic equipment – this item predominantly concerns the surgical medical equipment acquired and used within the scope of the Group’s activity;

Tangible assets in progress will be recognised as land and natural resources or buildings and other constructions when their promotion is recognised as irresistible. On 31 December 2017, this item predominantly includes the amount of 57.7 million euros corresponding to the investments in architecture projects and studies, as well as to the works already carried out within the scope of the construction of the new CUF Tejo Hospital and of the Desco-bertas Hospital’s Expansion Building. These assets are valued at cost price on the date of the financial statement.

During 2017 and 2016, the Amortisations, depreciations and impairment losses caption had the following impacts on the financial position:

31-12-2017 31-12-2016

Intangible assets

Investment properties


Total amortization, depreciation and impairment losses:

2,695,566

-

25,035,948 22,167,118

2,925,249

-

27,731,514 25,092,368


19. INVESTMENTS IN ASSOCIATES

Equity holdings in associates changed as follows in the financial years ended on 31 December 2017 and 2016:

The Investments in associates caption in the financial years ended on 31 December 2017 and 2016 is broken down as follows:

The main aggregated financial information regarding associates at 31 December 2017 is as follows:

31-12-2017 31-12-2016

Loans granted TotalImpairment

lossesEquity

holdings Total

Balance at 1 January

Effect of currency conversion

Effect on results

Effect on equity

Dividends earned

Acquisitions and increases

Transfers



Equity method application:

Balance at 31 December

31-12-2017 31-12-2016

Associates Equity holdings Equity holdings

Loans granted

Loans granted

Impairment losses

Impairment losses

Balance sheet value

Balance sheet value

Centro Gamma Knife-Radiocirurgia, S.A.

Associates Assets IncomeLiabilities Net profitEquity Expenses


Financial information at 31 December 2017

97,956

-

-

-

-

-

133,845

-

-

-

-

-

(68,000)

- -

34,000

- -

168,111

131,956 233,956

-

-

-

-

-

(68,000)

138,459

-

-

-

(3,171,095)

(68,000)

170,000 3,268,747

35,889

-

-

-

-

-

-

-

(35,889)

102,000 168,111-

168,111131,956

131,956 102,000 - 233,956 34,000 170,000 (35,889)

102,000 - 233,956 34,000 170,000 (35,889)

168,111

1,262,319 674,220 588,099 616,456 1,010,116 393,660



20. ESTIMATE OF FAIR VALUE

The hierarchy for purposes of determining the fair value shall have the following levels and measurement bases:

• Level 1 – market quotes net of assets, which the Company can access at the balance sheet’s date of reference;

• Level 2 – generally accepted evaluation models, based on inputs observable in the market, alternative to those mentioned in level 1;

• Level 3 – evaluation models whose main inputs are not observable in the market.

The Group has valued at fair value the assets and liabilities listed in the table below, in which their corresponding hierarchy is also specified:




Level 2Inputs


Total31-12-2017

Level 3Inputs Non-Observable

In The Market

Assets valued at fair value

Liabilities valued at fair value

Lands and Buildings (Note 18)

Financial Derivative Instruments

Cash flow hedging (Note 42)



Level 2Inputs


Total31-12-2016

Level 3Inputs Non-Observable

In The Market

Assets valued at fair value

Liabilities valued at fair value

Lands and Buildings (Note 18)

Financial Derivative Instruments

Cash flow hedging (Note 42)


314,275,866314,275,866

1,627,604

315,903,470 - 1,627,604 314,275,866

- -

- -

1,627,604

131,389,179131,389,179

2,301,121

133,690,299 - 2,301,121 131,389,179

- -

- -

2,301,121


21. OTHER INVESTMENTS

The other investments at 31 December 2017 and 2016 are as follows:

Other investments include non-current financial assets, measured at acquisition cost and adjusted for estimated impairment losses. This caption recorded the following changes in the financial years ended on 31 December 2017 and 2016:

31-12-2017 31-12-2016

Loans granted

Balance sheet value

Impairment lossesEquity holdingsCompany Balance

sheet value

Centro Clínico Académico de Braga

Digihealth, S.A.

Fundo de Compensação do Trabalho e Fundo de Garantia de Compensação do Trabalho

Diagnosticar - Diagnóstico Computorizado, S.A.

Lisgarante

IBET

Other investments

Increases

Increase

Increases

Increase






At 31 December 2016

At 31 December 2017


Gross investment:

Net value:

Impairment losses (Note 33):

5,300 5,300

5,000 5,000 5,000

50,000 50,0001,315,853 50,000

648,884

35,000 35,000 35,000

26,200 26,200 26,200

-

-

648,884

2,036,238 770,384

-

-

-

- 393,472

-

-

-

-

(1,315,853)

-

50,000 509,672(1,315,853)

1,627,481

509,672

770,384

(1,315,853)

260,713

-

198,044

-

1,825,525

(1,315,853)

2,086,237

(1,315,853)



22. DEFERRED TAX ASSETS AND LIABILITIES

The changes occurred in deferred tax assets and liabilities in the financial years ended on 31 December 2017 and 2016 were as follows:

Impairment losses

on trade receivables

Employee benefits

(Note 33)

Provisions not

approved for tax

purposes

TotalDerivativesOther

Deferred tax assets

Reported tax losses


Composition:

Composition:

Equity

Equity

Reversal:

Reversal:

Net profit

Net profit

Changes in tax rate

Equity


Changes in consolidation perimeter (Note 4)

Net profit

Net profit



126,574

17,162

-

375

-

74,387

57,538

-

-

-

- - -

-

-

-

-

78,680

-

- -

-

-

109,412

109,037

57,537

78,679

-

-

40

184,280

-

-

-

-

-

126,574

-

85,190

51,349

494

226,493

177,273

520,035

-

-

-

-

-

151,542

71,746 334,757 131,924

-

282,303

72,877

-

950,188

- 78,680

-

-

698,410

14,792

- -

3,178,9361,690,321

1,163,708

87,669

-

-

-

-

-

151,542

-

182,995

-

354,009

242,606

864,998

813,649

2 388 237

2,176,536

4 291 945

3,786,717

517,752

366,210


The amount of deferred tax assets concerning the Benefits of employees relates to an annuity insurance con-tracted by JMS in January 2016. This insurance enabled complying with a contracting existing since 2000, where JMS was responsible for ensuring a lifetime payment of a rent to a worker who retired via Social Security on 1 January 2016. The commercial premium was paid to the insurance company on 28 January 2016 and amounted to 2,504,321 euros.

Deferred taxes to be recognised as a result of temporary differences between taxable income and accounting income were evaluated. Where these differences originated deferred tax assets, these were only recorded to the extent considered probable that taxable profits will occur in the future and which can be used to recover the tax losses or deductible tax differences. This evaluation was based on the business plans of the Group companies, which are periodically reviewed and updated, and on the available and identified opportunities for tax optimisation.

Revaluation of tangible fixed

assets

Financial derivative

instrumentsTotal

Balance at 1 January 2016 - - -


Composition:

Equity

Reversal:

Net profit

Equity

Net profit


Composition:

Equity

Reversal:

Net profit

Equity

Changes in scope (Note 4)

Net profit

Balance at 31 December 2017 11,735,363

(368,979) (368,979)

(510,443) (510,443)

5,689,281 5,689,281

4,068,056 4,068,056

2,742,013 2,742,013

115,436 115,436

-

-

2,857,449 2 857 449

-

-

- -

- -

-

-

-

- -

-

-

- 11,735,363



23. OTHER CURRENT AND NON-CURRENT ASSETS

On 31 December 2017 and 2016, these captions showed the following breakdown:

The elements recorded as Non-current concern the values calculated for the responsibilities of Holidays, Holiday Allowance and Christmas Allowance for the employees of São Marcos Hospital and Reynaldo dos Santos Hospital, concerning the year when their corresponding contracts began.

The Provision of unbilled medical services item concerns medical acts provided and not yet billed to the custo-mers. These pending bills result, in general, from the following situations: lack of consent forms, billing only at the end of treatment, lack of confirmation of billing codes.

Current CurrentNon-current Non-current

Accrued income:

Deferred costs:

31-12-2017 31-12-2016

Income from production not invoiced

São Marcos Hospital responsibility

Sliding scale income receivable

Insurance

Maintenance and repair costs

Interest earned

Commissions and Stamp duty

Sale price deferral

Official Court of Auditors (Fees)

Assignment of space

Rents and leases

Deferred interest

Other accrued income

Information systems licenses

Other deferred costs

Provision of medical services not invoiced

Reynaldo dos Santos Hospital responsibility

Clinical analyses and consumables

4,157,148

1,207,954

68,527

6,753,463

1,197,484

7,918

342,081

630,400

772,755

52,244

10,983,783

- -

220,812

33,559,905

- -

5,148,355

161,011

43,999,641

103,061

228,334

11,034

78,014

136,288

182,144

21,413

21,816

697,321

36,158

491,073

827,980

56,522

16,278

983,933

5,570

-

6,129,201 6,129,201

-

- -

-

- -

-

2,167,744 2,167,744

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

49,316,786

3,432,655

52,749,441

56,396,107

4,014,872

60,410,979

-

8,296,945

8,296,945

-

8,296,945

8,296,945


The item of Income for unbilled production includes the accrued income from ARS Norte and ARSLVT, stemming from the determination of the actual production of 2013, 2014, 2015, 2016 and 2017 (and that are also ongoing conference and closing), in accordance with the provisions of the management contract, as mentioned in Note 2.3, as well as accruals from services provided and not billed from third parties and, also, medications to be billed. On 31 December 2017 and 2016, this caption showed the following breakdown:

24. INVENTÁRIOS

On 31 December 2017 and 2016, the inventories predominantly concern Pharmaceutical Products and Material for Clinical Consumption, and present the following balances:

These products and materials are used by the Group’s various clinical units in their activity to provide clinical services.

ARS Norte ARS NorteARSLVT ARSLVT

31-12-2017 31-12-2016

Production for the financial year of 2014





31-12-2017 31-12-2016

Material for office consumption

Uniforms

Other consumption material

Others

Accumulated impairment losses on inventories (Note 38)

Material for clinical consumption

Pharmaceuticals products

65,694 29,677,175

- -

585,676

-

- 2,642,412 - 2,642,412

819,640

204,935

19,902,728

2,770,113

6,996,181

150,444 157,408

2,805,192

446,657 7,692,880

20,554,097 30,701,75013,005,807 13,297,891

225,879

90,647

297,788

(13,130)

116,560

4,946,522

8,552,314

5 095 705

5,670,702

187,618

77,354

150,889

(32,501)

113,089

14,229,710

14,216,580

11,295,357

11,262,856



25. TRADE RECEIVABLES AND ADVANCE PAYMENTS TO SUPPLIERS

The Trade receivables and advances to suppliers caption was broken down as follows at 31 December 2017 and 2016:

The balances in the Statement of Financial Position are net of impairment losses on trade payables balances, which were estimated as described in Note 2.20 (b).

The Board of Directors believes that the carrying value of accounts receivable is close to its fair value.

The Group has no significant concentration of credit risk, as the risk is diluted over a vast range of clients.

The seniority of the caption on “Trade receivables and advance payments to suppliers” is broken down as indi-cated in the table below:

26. OTHER CURRENT DEBTORS

The Other current debtors caption was broken down as follows at 31 December 2017 and 2016:

31-12-2017 31-12-2016

Impairment losses

(Note 38)

Impairment losses

(Note 38)Net value Net valueGross value Gross value

Customers, bills receivable

Trade receivables, current account

Doubtful receivables

Advances to suppliers

Overdue debtYear Total

< 180 days 181-365 days 366-545 days 546-730 days > 730 daysDebt

31-12-2017

31-12-2016

31-12-2017 31-12-2016

Advances on financial investments

Sale of financial investments

Personnel

Re-invoicing

Hospital projects in progress

Service providers

Surety bonds

Other debtors

Bastos Mota Investimentos Imobiliários, Lda.

Seizures and liens

Loans to related entities (Note 41)

22,970

133,023,460

22,855

105,650,818

120,767,384 93,353,001 (1,052,312) (976,496)

47,011 -

12,186,095 12,274,963

- -

(9,100,589) (9,296,745)

-

(10,152,901)

-

(10,273,241) 95,377,577

47,011 -

22,970

122,870,558

22,855

3,085,506 2,978,218

119,715,072 92,376,505

133,023,460

105,650,818

29,528,119

51,570,124

67,149,946

20,935,011

10,852,297

9,521,035

3,789,842

4,219,447

4,401,112

3,250,832

17,302,144

16,154,369

-

132,000

794,132

5,980

152,630

304,715

799,859

11,025

859,250

134,165

122,780

-

134,165

1,885,798

850,000

376,019

732,216

47,895

126,325

237,576

690,891

7,350

3,316,536 5,088,234


In the Other debtors caption, several receivables from different entities for transactions not related to the core activities of the Group, are identified.

27. GOVERNMENT AND OTHER PUBLIC ENTITIES

The balances with these entities at 31 December 2017 and 2016 were as follows:

28. OTHER FINANCIAL INSTRUMENTS

The other financial instruments are made up of debenture loans, which are detailed in the table below:

31-12-2017 31-12-2016

Value added tax

Corporate income tax



Personal income tax

Personal income tax

Other

Value added tax

Other

Corporate Income Tax

Credit balances:

Debit balances:

Year of issue 31-12-2016MaturityIssuerSubsidiary 31-12-2017

José de Mello Participações II, SGPS, S.A.





2014

2010

2014



2007

2007

2008

2008

Dec-22

Dez-22

Jun-18

Dec-17

Jun-20

Dez-20

Jun-20








425

13,282,036

1,409

4,192,515

2,141,292

89,438

13,191

2,253,285

2,316,597

14,406,170

1,328,603

12,206,210

4,658

12,280,671

1,222

3,768,772

904,143

54,222

-

2,244,520

21,958,566

16,737,792

19,252,327

13,540,692

-

6,500,000 -

10,000,000

4,350,000

4,300,000

10,000,000 10,000,000

10,000,000

10,000,000

10,000,000

4,350,000

4,300,000

-

35,150,000 48,650,000



These bonds have a put option that gives the Group the right to redeem the amount in question at any time, which is why they are categorised as a current asset. The option of sale was recorded at face value, without any associated derivative. It is our expectation to exercise the sale option within 12 months.

There are no indications of impairment for the amounts of the bond loans listed above.

29. CASH AND BANK DEPOSITS

On 31 December 2017 and 2016, this caption showed the following breakdown:

30. NON-CURRENT ASSETS HELD FOR SALE

On 31 December 2017 and 2016, the “Non-current assets held for sale” caption was broken down as follows:

It is the intention of the JMS Group to transfer its shares in the equity of Escala Braga – Sociedade Gestora do Edifício, S.A. and of Escala Parque – Gestão de Estacionamento, S.A., along with all corresponding rights and obligations.

To this end, a contract was signed in 2016 for the purchase and sale of stocks and supplementary payments with an investor, with the completion of the transaction being dependent on the authorisation of the Contracting Public Entity (Regional Health Administration – Administração Regional de Saúde). The Long Stop Date contractually provided to obtain this authorisation was extended. Despite ARS’s authorization not yet having been obtained for the transfer of stock, the involved parties maintain their intent to sell the shares. A gain of around 5.5 million euros is expected from the sale of these shares.

In 2017, 568 thousand euros of income were recorded (2016: 760 thousand euros) concerning received dividends.

31-12-2017 31-12-2016

Current accounts

Other cash investments

Term deposits

Cash


Cash and bank deposits


Associates Equity holdings Loans granted Balance

sheet value

31-12-2016

Impairment losses

Balance sheet value

Escala Braga - Sociedade Gestora do Edifício, S.A.

Escala Parque – Gestão de Estacionamento, S.A.

Others

31-12-2017

6,307

2,590

46,323,734

1,561,666

(10,055)

14,124,477

1,743,953

(252,734)

6,307

192,657

47,894,297

47,884,243

16,067,394

15,814,660

1,549,932

281,154

-

1,831,086 1,904,379 - 3,735,465 3,168,613

1,904,379

-

-

-

-

-

3,454,311

281,154

-

2,769,106

323,091

76,416


31. SHARE CAPITAL

The share capital at 31 December 2017 amounted to 53,000,000 euros, fully subscribed and paid-up, and it was represented by 10,600,000 shares each with the nominal value of five euros.

The share capital was held by the following entities at 31 December 2017:

32. LEGAL RESERVE

According to legislation in force, the Company must reinforce the legal reserve by at least 5% of the annual net profit until this reserve equals at least 20% of the share capital.

The legal reserve is not yet fully established and, as such, in 2017, the minimum stipulated value was allocated. This reserve is not available for distribution to shareholders, however it may be used to absorb losses once the other reserves have been exhausted, or to increase the share capital.

33. OTHER RESERVES AND RETAINED EARNINGS

Reserve of fair value

This item includes the variations in the fair value in financial investments and tangible fixed assets that, in accor-dance with No. 2 of art. 32 of the CSC, will only be available for distribution when the elements or rights giving rise to them are disposed of, exercised, eliminated or settled.

In accordance with the legislation in force, the increments resulting from the application of the fair value through equity components are only relevant for distribution when the elements that gave rise to them are alienated.

Reserves and Retained earnings

In accordance with Portuguese legislation, the amount of distributable reserves and retained earnings is deter-mined according to the Company’s individual financial statements, presented in accordance with the IAS/IFRS.

Number of shares Ownership percentageEntity




65.85%

4.15%

30.00%

100.00%

6,980,100

439,900

3,180,000

10,600,000



34. NON-CONTROLLING INTERESTS

The changes occurred in this caption in the financial years ended on 31 December 2017 and 2016 were as follows:

The breakdown of the non-controlling interests caption at 31 December 2017, by company, is as follows:

Dividends

Capital decrease

Capital increase


Profit for year attributable to non-controlling interests

Final balance at 31 December

31-12-2017 31-12-2016

Initial balance at 1 January

CompanyProfit/lossProfit/loss

Percentage not owned

4.00%

0.10%

0.00%

37.19%

66.35%

0.00%

29.50%

30.07%

0.02%

0.02%

4.00%

TotalTotal

Non-controlling interestsNon-controlling interests


Vramondi International

HD Medicina Nuclear, S.A.


Sagies - Segurança, Higiene e Saúde no Trabalho, S.A.

Clínica de Serviços Médicos e Computorizados de Belém, S.A.




Clínica CUF Belém, S.A.


31-12-201631-12-2017

283,937474,455 3,960,7964,228,716

96,27137,455

(577) (923)

22

(39,722) (35,431)

34

(429,561) (464,991)

(603) (344)

-

(1,096)91,467

1,218,6771,218,333

(5) (1) (6)

265,626357,093

152,419261,022

197241

10,62212,709

66,423108,256

1,330,9171,435,244

1,4302,023

18,99923,799

475,601544,241

1,086,8751,124,330

7,765 (11,355)

(206,278)

-

175,027

-

283,937

(196,400)

(10,135)

3,960,796 3,708,111

-

-

474,455

4,228,716 3,960,796


Euribor + 2%

Euribor + 0.85%

Euribor + 1.75%

Euribor + 2.3%

Euribor + 2.75%

Euribor + 1.75%

Euribor + 2%

1%

35. LOANS

Borrowings at 31 December 2017 and 2016 were as follows:

Commercial paper

The Group has contracted eight commercial paper programmes with a limit of 142,000,000 euros. On 31 Decem-ber 2017, these liabilities had the following detail:

Bond loans

Commercial paper

Bonded current accounts

Other bank loans

Other bank loans


31-12-2017 31-12-2016

Non-current liabilities:

Current liabilities:

Contracting companyNominalamount

hired

-

-

-

-

-

-

-

-

jan. 2019

nov. 2019

mar. 2021

nov. 2019

dez. 2018

jan. 2019

jul. 2031

dez. 2018

Annual

Annual

Single

Annual

Annual

Annual

Monthly

Annual

PeriodicityCurrent Interest rateNon-current Maturity









Outstanding amount Amortisation

99,452,814

23,900,000

4,635,000

18,532,108

3,237,272

252,734

149,874,323

48,700,000

1,000,000

145,640,041

6,409,667

10,055

295,514,364

56,119,722

351,634,085

117,984,922

32,025,005

150,009,928

6,000,000

10,000,000

10,000,000

10,000,000

10,000,000

6,000,000

80,000,000

10,000,000

142,000,000 48,700,000

-

-

9,700,000

10,000,000

5,000,000

6,000,000

8,000,000

10,000,000



Although there are programmes with maturities exceeding one year, there are annual renewals, leading the Com-mercial Paper to be categorised as current.

These commercial paper programmes contain financial covenants that are common in financing contracts. The contracts include compliance requirements for the following debt ratios: Net Financial Debt / EBITDA; Ratio of debt service coverage and financial autonomy. The financial covenants are calculated based on the Group’s values.

On 31 December 2017, the JMS Group met all financial covenants in the commercial paper programmes, except in the Imo Health contract with Caixa de Crédito Agrícola, which is under review.

Debenture loans

Debenture loans concern the following issues:

• “JOSÉ DE MELLO SAÚDE 2014/2019”

• Total loan amount: 50,000,000 euros

• Nominal value: 10,000 euros per bond

• Maturity 9 June 2019

• Interest rate: Interest rate: 6-month Euribor plus 3.875%




• Maturity 17 May 2021

• Interest rate: Interest rate: 6-month Euribor plus 2.95%




• Maturity 28 September 2023

• Interest rate: Fixed rate (4%)

These issuances were placed with institutional investors and approved for trading in the regulated market of Euronext Lisbon and Bourse de Luxembourg, except for the last issuance, whose authorization are still pending approval. These contracts include compliance requirements for the “Net Financial Debt / EBITDA” debt ratio. On 31 December 2017, José de Mello Saúde, S.A. met the financial covenants in all debenture loans.


Other bank loans

Other bank loans were broken down as follows at 31 December 2017 and 2016:

The reference index used in the financing contracts is the EURIBOR rate, whose time frame varies between 6 months and 12 months, with a spread within the values practiced in the market.

There are no financial covenants associated with this bank funding. These loans have associated guarantees and collaterals described in Note 45.

Credit lines available but not used

On 31 December 2017 and 2016, the credit lines available and not used amounted to respectively 117,782,000 euros and 29,150,000 euros.

36. OBLIGATIONS ARISING FROM LEASE CONTRACTS

Finance lease

The Group has finance lease contracts for various items of its tangible fixed assets and intangible assets recor-ded on the balance sheet. The carrying amount of these assets for each class of asset, at 31 December 2017 and 2016, is as follows:

These long-term contracts in which the Group has the right to use a specific asset are recorded as finance leases according to IAS 17 – Leases. The liabilities for finance lease have the following maturities:

CurrentType of financing CurrentNon-current Non-current

31-12-2017 31-12-2016

IAPMEI / PME

Bank loan

Loan Agreement

Basic equipment

Other tangible fixed assets


Office equipment

Software

31-12-2017 31-12-2016

Not over one year

Minimum finance leasing instalments:

Over one year and not exceeding five years

Over five years

31-12-2017

6,212,670

75,000

121,997 54,006 34,368 88,017

3,202,904

-179,167

145,406,868 18,444,092

-

6,409,667 3,237,272145,640,041 18,532,108

24,324,951

55,581,261

5,795

594,185

-

24,371,948

57,844,161

2,898

438,186

41,294

82,698,487 80,506,192

24,531,984

9,794,327

35,645,704

69,972,015



Operating lease

The operating lease contracts in force in JMS Group predominantly concern contracts for computer equipment, buildings and car parks, vehicles and medical and office equipment. The total amounts of future minimum pay-ments are as follows:

Costs of 17,181 thousand euros and 16,279 thousand euros were recognised for the financial years ended on 31 December 2017 and 2016, respectively, relative to operating leasing contracts instalments.

In 2016 it was impossible to obtain the detail of the minimum payments of the operating and financial leases. Howe-ver, the leases concerned these contracts and similar ones, thus the values are similar to those recorded in 2017.

37. EMPLOYEE BENEFITS

The subsidiary Hospital CUF Infante Santo, S.A. (“HCIS”) has the liability of topping-up the retirement pensions of some of its employees with whom this liability was agreed. Although it has not established any fund or insu-rance to cover this liability, a provision has been set up for this purpose, which is updated annually according to an actuarial study conducted by a specialised and independent entity.

The expiry of the Collective Labour Agreement with the Ministry of Labour was formally, and in accordance with legislation in force, applied for in relation to employees still working. This came into effect on 6 February 2013. The law envisages, according to a legal opinion, no change to the “remuneration, category and respective defi-nition, duration of working hours and social protection schemes, whose benefits are substituted by those of the general social security scheme or by substitution protocol of Portuguese National Health Service.” The pension top-up does not fit in with this requirement and ceases to have effect from February 2013. Accordingly, the liability remains in force for retired employees of HCIS.

According to the evaluation report presented by CFPO Consulting – Soluções Actuariais e Financeiras, the current amount of liabilities with retirement pensions for past service, at the date of the statement of financial position, is estimated on 1,355,000 euros (1,462,000 euros in 2016). The adjusted provision for retirement pensions is reported in Note 38.

The actuarial evaluation of pension plan liabilities was performed according to the Projected Unit Credit method, taking into consideration the following assumptions:

Less than 1 year Over five yearsBetween 1 and 5 years

31-12-2017

Vehicles

Medical equipment

Buildings

1.30%1.30%

1.30%1.30%

0.00%0.00%

5554

TV 73/77TV 73/77

7374

TV 88/90TV 88/90

Discount rate (after retirement)

Discount rate (before retirement)

Pensions growth rate

Number of pensioners

For men

Mortality table:

Average age

For women

31-12-201631-12-2017

18,609,139

967,048

1,952,950 4,717,822 9,084

204,790,071

-808,772

82,338,946

21,529,137 204,799,15587,865,540


38. PROVISIONS, IMPAIRMENT LOSSES, CONTINGENT ASSETS AND LIABILITIES

Contingent liabilities

The Group is involved in various legal proceedings during the normal course of its business activities. However, given their nature, the expectation is that the respective outcome will not generate any material effects on the business undertaken, financial situation and results of the operations.

Provisions

The changes occurred in provisions during the financial years ended on 31 December 2017 and 2016 were as follows:

The Other item mostly includes provisions for contractual penalties and risks, stemming from the activity of providing hospital services, that are considered likely. It also includes a provision intended to address the liability for replacing equipment as established in Annex V of the Management and Operation Contract of Vila Franca Hospital, This provision was set up in the financial year of 2013 against Intangible assets (Note 17) following the transfer to the new facility, which was when new capacity was acquired and an investment plan was prepared, which envisages the recognition of the future liability to replace the referred equipment by the end of the contract. During 2017, the total value of the investments under the defined plan was revised and reduced by 630 thousand euros, with this provision being reduced by the same amount.

Provisions

Environmentalissues

ambientais

TotalliabilitiesOther

Employeebenefits

(Note 37)Taxes Total

Increase

Increase


Use

Use

Reversal

Reversal

Investment plan (Note 17)



(300,598) -

(106,559) -

- -

1,355,216 390,811

(71,550)

(190,159)

(630,125)

12,259,474

1,461,775 390,811 14,021,234 15,483,009

12,974,908 14,737,2811,762,373 390,811 5,000

- -

- -

1,306,696

799,574

1,306,696

799,574

- -

- -

(188,821)

(1,741,051)

(188,821)

(1,741,051)

-

-

-

-

-

-

-

5,000

5,000

(372,147)

(296,718)

(630,125)

13,614,690

1,306,696

799,574

13,625,422

(71,550)

(190,159)

(630,125)

11,863,662

(188,821)

(1,741,051)

12,579,097



Impairment losses

The changes occurred in accumulated impairment losses during the financial years ended on 31 December 2017 and 2016 were as follows:

Current assets

Non-current assets

Impairment losses on current assets

TotalTrade receivables and advances to

suppliers (Note 25)”Inventories(Note 24)

Increase

Increase


Use

Use

Reversal

Reversal

Transfers



Impairment losses on non-current assets

TotalNon-current

assets held for sale

Associated Companiesand Other

Investments(Notes 19 and 21)

Goodwill(Note 16)

Increases

Reversal


Transfers

Reversal



(304,878)

(564,966)

-

10,152,901

10,273,241 10,305,742

9,637,528 9,659,052

1,555,898

1,880,641

1,566,876

1,882,793

(615,307)

(1,436,015)

(615,307)

(1,436,015)

(304,878)

(564,966)

(21,523)

10,166,031

10,978

2,152

32,501

-

-

(21,523)

13,130

-

-

21,523

(369,593)

-

97,000 4,546,133

97,000 4,988,085

-

(97,000)

66,100

(132,889)

369,593 -

(508,052)

4,413,244

-66,100

(35,889)-

1,351,7423,641,332

(138,459)-

1,315,8533,641,332

(369,593)-

1,859,7943,575,232


During the 2017 and 2016 financial years, the changes occurred in the “Impairment losses” and “Provisions” cap-tions were offset against income:

Contingent assets

2017 was the second consecutive year in which Escala Braga presented a negative result of around 4 million euros. This situation results from the Government not reassessing the vertical funding programmes for HIV and Multiple Sclerosis, with an approximate value of 7.5 million euros for 2016 and 7.9 million euros for 2017. It is our strong belief that this behaviour by the state-owned partner contributed mercilessly to the current financial si-tuation and is a very serious situation of contractual non-compliance. This way, a Request for Financial Recovery was lodged as a protection at the end of 2016 for the purposes of clause 127, paragraph 9, subparagraph (b) of the Management Contract, proposing, in a spirit of loyal cooperation and good faith, an already initiated process of arbitration to settle this dispute.

The JMS Group considers the success of this litigation likely and the best estimate of this contingent asset to amount to 15.4 million euros.

This amount’s consideration in the future projection enables ruling out the possibility of the contract being onerous.

This situation naturally deserves the utmost attention by the hospital’s management team, with the firm expec-tation that it will be reversed by a positive decision of the already formed Arbitration Tribunal in favour of this dispute’s settlement.

39. TRADE PAYABLES AND ADVANCES FROM CLIENTS


31-12-2017 31-12-2016

Reversal ReversalTotal TotalIncreases Increases

Provisions

Employee benefits

Impairment losses on non-current assets

Impairment losses on current assets

Trade payables, invoices pending

Trade payables, current account

Advances from clients

31-12-2017 31-12-2016

1,882,793 1,566,876 (304,878) 1,261,998(564,966) 1,317,827

- - (300,598) (300,598)(106,559) (106,559)

799,574 1,306,696 (71,550) 1,235,147(190,159) 609,415

- 66,100 (508,052) (441,952)(132,889) (132,889)

1,687,795 1,754,594

9,432,203

74,547,613

3,555,036

9,356,007

80,830,747

4,355,247

94,542,001 87,534,852



40. OTHER CURRENT AND NON-CURRENT CREDITORS


(a) According to the Management Contract with ARS Norte, Escala Braga – Sociedade Gestora do Estabelecimento, S.A. shall deliver to São Marcos Hospital 90% of the revenue from the provision of medical services already performed by 1 September 2009, but for which the invoice had not yet been issued, and 90% of revenue from clients which had already been invoiced by that date but had not yet been collected.

(b) The “Acquisition of investments” item fundamentally includes the amounts to be paid for the purchase of SIM-X – Serviço de Imagem Médica, Lda., CPIS, CLA and the building of CUF Almada Clinic. According to the respective acquisition contracts, the corresponding shares to liquidate after the 2019 financial year were considered as non-current.

The “Other creditors” caption contains several balances payable to different entities for transactions not related to the core activities of the Group.

Current CurrentNon-current Non-current

31-12-2017 31-12-2016

Acquisition of investments (b)

Consultants, Advisors and Intermediaries

Fees

Clinical events and conference days

São Marcos Hospital (a)

Fundo de Apoio à Inovação - Energias Renováveis e Eficiência Energética

Available profits

Reynaldo dos Santos Hospital

Personnel and Trade Unions

Base - Serviços Médicos de Imagiologia, SGPS, S.A.

Fixed asset suppliers

Surety bonds

Other creditors

775,114

250,000

555,547

33,765

490,222

1,016,588

281,277

599,524

37,073

3,092,476

286,666

-

57,859

-

-

-

-

3,089,531

344,460

525,000

57,859

-

-

-

-

724,434

-

125,117

33,665

308,480

2,674,400

196,354

441,311

26,589

3,358,340

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

7,476,112 8,547,2003,358,340


41. OTHER CURRENT LIABILITIES

On 31 December 2017 and 2016, this caption showed the following breakdown:

(a) The Fees item concerns the estimate of values payable to employees without a permanent labour contract. This estimate is based on the monthly payment history, on the agreements established with each service provider and on the duration of the work carried out.

(b) This caption contains the accrued expenses incurred at the closing of the year for Costs of sales, External supplies and services (Complementary Diagnostic and Treatment Means “CDTMs”, Insurance and Clinical Specialist Works), Personnel expenditure and Other operating costs.

42. FINANCIAL DERIVATIVE INSTRUMENTS

Within the scope of the financial risk management policy (Note 43), a set of financial instruments intended to minimize the risks of exposure to interest rate variations were contracted in the form of plain-vanilla interest-rate swaps, covering almost the entirety of the bond loans issued in June 2014 and May 2015 (for a total of 100 million euros). Swaps contracted respect the characteristics of the aforementioned loans emitted so that they may be considered hedging products (same indexer, same interest period and payment deadlines). On the interest payment date, the JMS Group receives interest indexed to six-month Euribor for 100% of the debenture capital and pays interest at a fixed rate on the same amount. The bond loan issued in September 2017, amounting to 50 million euros, does not have associated derivative financial instruments because it has a fixed rate, as disclosed in Note 35.

Wages payable

Financial income

Operating costs (b)

Other deferred income

Fees (a)

Rents and leases

Escala Braga accrued costs

Financial expenses

31-12-2017 31-12-2016

Accrued costs:

Deferred income:

26,367,628

525,275

15,039,509

814

20,387,581

14,141

3,190,437

72,798

31,392,404

493,957

15,236,234

249

23,970,098

14,141

4,498,353

1,467,165

76,564,254

508,347

77,072,601

65,057,952

540,230

65,598,181



On 31 December 2017 and 2016, the fair value of the contracted financial derivatives can be presented as follows:

The figure recognised in this caption refers to six swap interest rate contracts signed by the JMS Group to cover the risk of interest rate fluctuation.

Characteristics of financial derivative instruments contracted in relation to financing operations on 31 December 2017 and 2016 were as follows:

The fair value of the hedging derivatives is classified as non-current when the maturity of the hedging transaction is greater than 12 months, and as current when the maturity of the operation being covered is under 12 months.


-

-

31-12-2017 31-12-2016

Interest rate Swaps

Derivatives designated as cash flow hedging

Total derivatives

Derivatives designated as cash flow hedging CurrencyNotional

Eur

Eur

Eur

Eur

Eur

Eur

Cash flow hedge of bonds






June 2019

June 2019

May 2021

May 2021

May 2021

June 2019

Economic objective 31-12-2016

Fair value

Maturity 31-12-2017

Interest rate Swaps

13121-001 Swap

13121-002 Swap

13136-001 Swap

13137-001 Swap

13152-001 Swap

13153-001 Swap

(1,627,604) (2,301,121)

(273,774)

(130,616)

(313,183)

(566,865)

(237,253)

(105,913)

(403,663)

(191,345)

(432,585)

(788,611)

(334,886)

(150,031)

25,000,000

12,500,000

12,500,000

25,000,000

12,500,000

12,500,000

100,000,000

-

-1,627,604

1,627,604 2,301,121

2,301,121


Cash flows are paid and received from hedging derivative financial instruments every six months:

The Group hedges an instalment of future payments on the interest of bond loan issues, through the allocation of interest rate Swaps in which it pays a fixed rate and receives a variable one, with a notional of 100 million eu-ros. This is an interest rate risk hedge related to payments of interest at a variable rate arising from recognised financial liabilities. The hedged risk is the variable rate indexer to which interest on loans is associated. The aim of this coverage is to transform variable interest rate loans into a fixed interest rate. The fair value of the interest rate Swaps on 31 December 2017 is -1,627,604 euros.

43. FINANCIAL RISK MANAGEMENT

The Group, like most companies, is exposed to a number of market risks related to changes in interest rates and liquidity risks arising from its financial liabilities, as well as the credit risk resulting from its operational and cash management activity.

All financial risk management operations, in particular those involving the use of financial derivative instruments require the prior approval of the Finance Director or the Executive Committee.

The JMS Group’s Risk Management Policy aims to ensure proper identification of risks associated with the business undertaken as well as to adopt and implement the necessary measures to minimise the negative impacts that adverse developments of the factors underlying these risks may have on the financial structure of the Company and its sustainability.

Under the risk management process, the Group identified a set of risks associated with the financial performance of each company included in the consolidation scope considered materially more relevant, among which stand out the market (exposure to variations of interest rates), credit and liquidity risks.

The Group has a risk management model that seeks to minimize the potential adverse effects, using the instru-ments suited to cover the risks to which it is exposed.

Analysed below in more detail are the main financial risks that the Group is exposed to and the main measures implemented to manage those risks.

SWAP’s

13136-001 13152-001 13121-002 13153-001 13121-001 13137-001

19-may-15 23-jun-15 30-jul-15 30-jul-1519-may-15 23-jun-15

21-may-15 25-jun-15 31-jul-15 31-jul-1521-may-15 25-jun-15

9-jun-19 17-may-21 17-may-21 9-jun-1917-may-21 9-jun-19

Effective Date

Trade Date

Termination Date

Notional Amount 25,000,000 12,500,000 12,500,000 12,500,00025,000,000 12,500,000



Market risk

JMS Group’s market risk is predominantly on the risk of interest-rate variation since the Group has no exposure to variation in exchange rates, prices of raw materials or stock quotes of financial assets.

Risk of exposure to variations in interest rates

The management of the interest rate risk aims to minimise exposure to changes in interest rates and their impact on the Financial Statements within the established limits.

Through control policy adopted, it seeks to select suitable strategies for each business area in order to ensure that this risk factor does not adversely affect the operational capacity. On the other hand, the exposure to interest rate risk is also monitored via the simulation of adverse scenarios with a certain degree of probability which can negatively affect the Group’s results.

In order to reduce the risk of exposure to interest rate changes, plain-vanilla interest rate swaps were contracted in 2015, covering 100% of the amounts of the debenture loans issued in 2014 and 2015 (100 million euros in total). The contracted swaps respect the characteristics of the aforementioned debenture loans in order to be considered hedging products (similar indexer, time period and interest-payment deadlines). On the date of interest payment, José de Mello Saúde Group receives interest indexed to 6-month Euribor for 100% of the capital in the debenture loans and pays interest at a fixed rate on the same amount.

In 2017, following its policy to reduce exposure to interest rates, José de Mello Saúde issued a bond loan with a fixed interest rate. Thus, considering the effect of the contracted swaps, at the end of 2017, José de Mello Saúde held 36% of its financial debt contracted at fixed interest rates (46% in 2016).

The table below provides a sensitivity analysis of the impact of a potential increment of the Euribor rates in José de Mello Saúde Group’s financial costs in 2017 and 2016:

Analysis notes:

• funding contracted at a fixed rate was excluded, namely the debenture loans mentioned previously;

• since the vast majority of the loans contracted by the JMS Group are supported by the application of a floor of zero if Euribor rates are negative, and given that these, in 2017 and 2016, were always negative, a scenario of rate reduction was not simulated.

+0.5

+0.5

+0.5

+0.5

+0.5

+0.5

-

Non-current loans

Non-current loans



Current loans

Current loans

Total

Total

Changes in Euribor rates (pp)

Impact in financial costs (euros)

2017

2016

+106,586

+88,136

+244,137

+320,432

+39,258

+92,598

+389,981

+501,116


Liquidity risk

Liquidity risk stems from the potential inability to finance the Company’s assets, or to meet the contracted lia-bilities on the expiration dates.

The management of the liquidity risk seeks to permanently track the treasury forecasts in order to ensure the fulfilment of all of the Group’s liabilities toward the entities with which it deals in its activity. Through active ma-nagement of the business plan and comprehensive mapping of needs or future cash surpluses, it also seeks to reduce the risk of financing by having a permanent relationship with the financial partners.

The table below presents the Company’s liabilities according to intervals of contractual maturity at the end of 2017 and 2016, respectively. The amounts represent the non-discounted cash flows to be paid in the future:

Credit Risk

The credit risk is the risk of a counterparty failing to comply with its obligations under the cover of a financial instrument, thus resulting in a loss. The JMS Group is subject to credit risk in relation to the following activities:

• Operating activity – trade receivables, trade payables and other accounts receivable and payable;

• Financing activities.

The following table presents the Group’s maximum exposure to credit risk:

For assets in the statement of financial position, the defined exposure is based on its recorded amount on the face of the financial position.

Financial debt* < 1 year 1-3 years 3-5 years > 5 years

2017

2016

* Short-term debt used to support treasury is excluded

Clients


Other receivable accounts


31-12-2017 31-12-2016

17,188,630

15,647,921

180,380,407

81,733,818

84,396,648

59,860,397

95,697,300

37,736,158

95,377,577

12,877,217

5,088,234

48,650,000

122,870,558

13,357,220

3,316,536

35,150,000

174,694,315 161,993,028



Accounts receivable

Credit risk is mainly related to credits of services provided to customers. This risk is tracked as follows:

• Following previously established policies, procedures and controls;

• Establishing credit limits for the customers, based on internal assessment criteria (average collection period);

• Impairment analyses on the values to be received on a regular basis.

• The amounts owed are regularly monitored and supplies to major clients are normally covered by guarantees;

• The JMS Group has factoring contracts in force, through which it grants credit and transfers the collection risk to the factoring entity.

The Group presents no significant credit risk with any specific customer, insofar as the accounts receivable stem from a high number of customers.

The changes in the impairment losses of accounts receivables are disclosed in Note 38.

It is the understanding of the Board of Directors that, at 31 December 2017, the estimated impairment losses on accounts receivable are adequately reported in the financial statements.


Other Financial Instruments include bonds issued by José de Mello Capital, S.A. and Farminveste – Investimentos, Participações e Gestão, S.A. Risk monitoring is carried out periodically by the management via the analysis of the accounts of José de Mello Capital, S.A. and Farminveste – Investimentos, Participações e Gestão, S.A..

44. FAIR VALUE OF FINANCIAL ASSETS AND LIABILITIES

The fair value of financial assets and liabilities is based on market prices, where available. If these are not available, fair value is estimated using internal models based on discounted cash flow techniques.

The nominal value less estimated credit adjustments of trade receivables and payables is assumed to be close to their fair value. The fair value of financial liabilities is estimated by updating the contracted future cash flows, at the current market interest rate available for similar financial instruments.

There are no significant differences between fair values calculated in this manner and the respective book values.

45. GUARANTEES AND COMMITMENTS

Guarantees

On 31 December 2017, the companies of the Group had provided guarantees to third parties in the amount of 28,182 thousand euros (8,076 thousand euros in 2016), detailed as follows:

Equity funding commitment letter

Municipal councils

Contractual obligations compliance

Services rendered to National Health Service

Supply of electricity, water and gas

31-12-201631-12-2017

Financial guarantees provided:

28,181,989 8,075,600

4,000,0004,000,000

1,320,972423,352

2,636,84523,640,854

116,701116,701

1,0821,082


Some financing contracts and commercial paper programmes have the following associated collaterals:

• Voluntary mortgage of the urban building, Descobertas Hospital’s Expansion Building, and of all carried out constructions and improvements;

• Generic mortgage of the urban building, CUF Tejo Hospital Building, and corresponding improvements;

• Blank promissory note signed by Imohealth and backed by JMS, Hospital CUF Torres Vedras, S.A., Clínica CUF Belém, S.A. and Instituto CUF – Tratamento e Diagnóstico, S.A.;

• Blank promissory note signed by Imohealth and backed by JMS and Hospital CUF Infante Santo, S.A..

Commitments

In the normal course of its business, the Group makes commitments related mainly the acquisition of equipment, under the ongoing investment operations, and the purchase and sale of financial investments.

According to the Portuguese Commercial Companies Code, the parent company, José de Mello Saúde, S.A. is joint and severally liable for the commitments of its associated companies with which it is in a control relationship.

46. EXPLANATORY NOTES OF THE CASH FLOW STATEMENT

46.1 RECEIPTS FROM FINANCIAL INVESTMENTS:

The most significant inflows related to financial investments occurring during the financial years ended on 31 December 2017 and 2016 are:

46.2 PAYMENT FROM FINANCIAL INVESTMENTS AND OTHER INVESTMENTS:

The most significant payments related to financial investments occurring during the financial years ended on 31 December 2017 and 2016 are:

Manuel Guimarães, Lda.

Escala Braga - Sociedade Gestora do Edifício, S.A.


Dr. Campos Costa - Consultório de Tomografia Computorizada, S.A.

31-12-2017 31-12-2016

Asset acquisition

Asset acquisition

Asset acquisition

Business acquisition








Clínica Dr. Luís Álvares, S.A. (P. Suplementares)

Hospimob - Imobiliária, S.A.


CPIS - Clínica Particular de Coimbra, S.A. (P. Suplementares)

399 480 468 - Investimentos Imobiliários, S.A.


CPIS - Clínica Particular de Coimbra, S.A. (Suprimentos)

SIMPLYGREEN - Investimentos Imobiliários, S.A. (P. Suplementares)


31-12-2017Classificação 31-12-2016

-

1,211,718

68,000

-

82,976

-

68,000

44,566

195,542 1,279,718

-

-

-

-

-

-

-

-

-

327,600

6,790,500

100,000

34,387,465

1,382,780

650,000

737,293

159,992

365,000

362,440

59,280

44,994,750 327,600



47. RELATED PARTIES

Transactions and pending balances

Transactions and balances between José de Mello Saúde, S.A. (the parent company) and the Group companies have been eliminated in the consolidation process and are not disclosed in this note. Balances and transactions between the Group and associate companies and other related parties are detailed below:

Debit balances Credit balances

SuppliersBonds(Note 28)

Other debtorsClientsRelated party


Grupo MGI Capital

Grupo José de Mello Residências e Serviços

M Dados – Sistemas de Informação, S.A.

Shareholders:


Grupo Brisa - Auto-estradas de Portugal

Grupo CUF

Grupo José de Mello Imobiliária

Other related entities:

2017

Transactions

External supplies and

services

Financial income


Related party


Grupo MGI Capital



José de Mello Serviços, Lda.

Shareholders:



Grupo CUF


José de Mello Energia, S.A.


35,150,000

16,500,000

-

-

-

4,761

1,472,106

7,996

178,078

18,650,000

-

-

-

-

(21,522)

-

-

1,641,419

122,780

-

-

-

1,449

6,131

36,047

-

122,780121,735

-

-

-

-

-

36,344

41,481

284

4,444,428

41 314

3,415,978

61,929

-

-

-

377,467

-

586,916

2,139

214 366

-

-

-

-

7,847

32,241

92,786

284

454

-370,259

162 916

-

-

-

-

-

185,243

55,656

-

3,595


2016

Debit balances Credit balances

SuppliersBonds(Note 28)

Other debtorsClientsRelated party


José de Mello Participações II, SGPS, SA


Grupo CUF

Shareholders:


Grupo MGI Capital


José de Mello Energi, S.A.

M Dados - Sistemas de informação, S.A.


Transactions

External supplies and

services

Financial income


Related party

José de Mello, SGPS, S.A.

Grupo MGI Capital

José de Mello Participações II, SGPS, S.A.


José de Mello Energia, S.A.

José de Mello Serviços, Lda.

Shareholders:




Grupo CUF



48,650,000

20,000,000

10,000,000

-

-

7,365

-

4,182

-

18,650,000

-

-

-

-

-

1,713,597

15,450

-

296,895

2,037,489

122,780

-

-

-

1,248

-

21,399

821

1,885,798159,435

1,763,018

-

-

-

-

-

92,590

43,364

13

-

4,896,415

28,383

3,404,798

-

-

1,322,201

33,722

-

87,898

47,795

-

-

195,360

-

-

-

-

-

7,783

318,214

-

39,479

-

-

-607,476

-

-

-

-

-

-

182,814

66,251

251

467



The terms and conditions of transactions between the Group companies and related parties are substantially identical to those normally contracted, accepted and practiced between independent entities in comparable transactions.

Wages of key management personnel

The wages of the Group’s key management personnel are discriminated in the table below:

48. APPROVAL OF THE FINANCIAL STATEMENTS

The financial statements were approved and the pu-blication authorised by the Board of Directors on 22 March 2018, and this will be the object of vote for approval at the General Meeting of Shareholders scheduled for 30 April 2018.

49. SUBSEQUENT EVENTS

Since 31 December 2017 until the date accounts were approved, no relevant facts occurred other than those already adjusted and/or disclosed in these consolidated financial statements.

STATEMENT OF COMPLIANCE OF THE BOARD OF DIRECTORS

In accordance with provisions in Article 245(c) (1) of the Securities Code, José de Mello Saúde, S.A. (“JMS”) Board members declare that, to the best of their knowledge, the management report, the con-solidated and individual annual accounts, the legal accounts certificate and the other accounting docu-ments, i) were prepared in accordance with current accounting standards and give a true and fair view of the assets and liabilities, financial situation and results of JMS and of the companies included in the scope of consolidation; ii) they faithfully describe the development, performance and position of JMS business activity and of the companies included in the consolidation scope; and iii) they contain a description of the main risks JMS faces in its activity

Lisboa, 22 de março de 2018

Salvador Maria Guimarães José de Mello

Pedro Maria Guimarães José de Mello

João Gonçalves da Silveira

Rui Alexandre Pires Diniz

Rui Manuel Assoreira Raposo

Vasco Luís José de Mello

Inácio António da Ponte Metello de Almeida e Brito

Guilherme Barata Pereira Dias de Magalhães

Paulo Jorge Cleto Duarte

Luís Eduardo Brito Freixial de Goes

Vera Margarida Alves Pires Coelho

Celine Dora Judith Abecassis-Moedas

Raúl Catarino Galamba de Oliveira

Remuneration

31-12-2017 31-12-2016

The Board of Directors

2,265,336

2,265,336

2,275,338

2,275,338


a) Qualifying holdings in the company’s share capital.

b) Identification of shareholders with special rights and description of these rights.

There are no special rights granted to any company shareholder.

c) Number of shares and bonds held by members of the administrative and supervisory boards, under the terms and for the effects of provisions in article 447(5) of the Portuguese Commercial Companies Code and article 14 of the Portuguese Securities Market Commission (CMVM) Regulation No. 5/2008.

Members of the Company’s administrative do not hold shares or bonds in José de Mello Saúde S.A., as no transaction has taken place on these bonds during the financial year of 2017.

Members of José de Mello Saúde S.A. administrative board do not hold non-voting preference shares representing the share capital in José de Mello Saúde S.A. Hospital CUF Descobertas, S.A., subscribed on the date and under the following terms:

INFORMATION ON THE SHAREHOLDING STRUCTURE, ORGANIZATION AND CORPORATE GOVERNANCE

65.85%

30.00%

4.15%

100.00%

65.85%

30.00%

4.15%

100.00%



Farminveste - Investimentos, Participações e Gestão

Total

% CapitalNo. of sharesShareholder % Voting rights

Balance in31-12-2017

Balance at 31-12-2016 DisposalsAcquisitionsSubscriptions

AmountAmount Value €Value €Value € AmountAmountAmount

236

100

100

92

100

200

305

116

137

92

137

327

69

16

37

37

127

5,00

5,00

5,00

5,00

5,00









Rui Manuel Assoeira Raposo

Inácio António da Ponte Metello de Almeida e Brito



6,980,100

3,180,000

439,900

10,600,000



d) Possible restrictions on voting rights, such as limits on voting depending on the ownership of a number or percentage of shares, time limits imposed for exercising these rights or systems for equity rights.

There are no restrictions of this nature.

e) Applicable rules on appointment and replacement of members of the administrative board and on the change of bylaws.

Under the terms of articles of association of José de Mello Saúde S.A., there are no special rules on the appointment and replacement of members of the administrative board and on change of José de Mello Saúde S.A. bylaws. With regard to these matters, the corresponding provisions of the Portuguese Commercial Companies Code apply.

f) The powers that the administrative board enjoy, in particular with regard to deliberations on capital increases.

Under the terms of articles of association of José de Mello Saúde S.A., there are no special rules on the powers of the administrative board. With regard to these matters, the corresponding provisions of the Portuguese Commercial Companies Code apply.

The Board of Directors of José de Mello Saúde S.A. delegated the following competences to an Executive Committee:

i. Carrying out the day-to-day management of the Company, with the ability to deliberate on all matters concerning the performance of the Company’s activity, following its corporate purpose, the resolutions made by the Board of Directors and by the General Assembly in matters within the latter’s purview;

ii. Prepare and submit to the Board of Directors, for approval, the company’s wage, staff management and trading and price policies of the José de Mello Saúde Group;

iii. Prepare and submit to the Board of Directors, for approval, the company’s business and budget plans for the following year, in addition to proposing possible changes;

iv. Carrying out the coordination and permanent monitoring of the day-to-day management of the direct and indirect affiliates of the Company (“Affiliates”), issuing, in the case of fully owned Affiliates, binding instructions;

v. For the purpose of the previous paragraph, the Executive Committee should discuss the following matters:

(i) Definition of the affiliate companies’ economic planning and financial strategy, namely:

i. opening and/or expansion of establishments;

ii. development of new activities (e.g. new medical specialities) or significant alteration/reorganization of existing activities;

iii. signing of commercial agreements, conventions with insurance companies and scientific and academic subsystems and protocols;

iv. choice of holders of top management positions, namely production, clinical and nursing management;

v. monitoring and supervision of relevant projects through a Steering Committee.

(ii) Approval of any business plan as well as any changes and updates made to same;

(iii) Approval of the annual budget and any updates made to same;

(iv) Signing of contracts relating to employment or service provision, assuming responsibilities, acquisitions or sales of any assets, including shares in other companies, whenever the estimated value exceeds, on an individual basis, (i) 1,000,000.00 euros (one million euros) if foreseen in the annual budget, or (ii) 200,000.00 euros (two hundred thousand euros) if not foreseen in the annual budget;

(v) Loans, financing, bonds, debt securities, commercial paper and other forms of third-party financing, including the issue of warranties or standby warranties whenever their value exceeds, on an individual basis, (i) 1,000,000.00 euros (one million euros) if foreseen in the annual budget, or (ii) 200,000.00 euros (two hundred thousand euros) if not foreseen in the annual budget;


vi. Signing all acts and contracts inherent in the company’s activity, providing that their value does not exceed the amount equivalent to 15,000,000.00 euros (fifteen million euros);

vii. Entering into bank loans or similar operations, granting shareholders’ loans and other forms of providing capital to Affiliates, as long as the corresponding amount does not exceed the equivalent to 15,000,000.00 euros (fifteen million euros);

viii. Conducting banking transactions, such as open and operate any credit or debit bank accounts, withdraw and endorse cheques and withdraw, accept and endorse letters, promissory notes and other debt securities;

ix. Making receipts and payments on behalf of the company, grant discharge and issue the required accounting documents;

x. Signing employment or service contracts for company staff, to exercise or be able to discipline and promote, if necessary, the dismissal of any employee, in addition to recruiting employees or special experts, where appropriate;

xi Establishing new companies, in addition to acquiring or disposing of shares in other companies, as long as the respective holding does not exceed the equivalent of 15,000,000.00 euros (fifteen million euros);

xii. Signing any types of insurance contracts inherent to the exercise of the Company’s activity;

xiii. Proposing to the Board of Directors leases whose annual amount exceeds 1,000,000.00 euros (one million euros), disposal, encumbrance or acquisition of immovable assets for the Company, whose value exceeds 15,000,000.00 euros (fifteen million euros);

xiv. Carrying out provision of all movable property and equipment essential for the exercise of the Company’s activity;

xv. Proposing the company’s organigram to the Board of Directors and keep it informed on the subsequent adjustments that prove to be necessary;

xvi. Establishing proxies to represent the company in the execution of specific acts through issuing the appropriate instrument for that purpose;

xvii. Establishing forensic proxies to represent the Company in any litigations in which it may be involved, granting them sufficient powers to acknowledge, desist and compromise;

xviii. Representing the Company in court and in arbitration as well as appointing arbitrators in any litigation in which it may be involved;

xix. Proposing the holders of the governing bodies of the Affiliates on whose Boards of Directors shall participate the entirety or part of the members of the Company’s Executive Committee.

The amounts indicated presumes prior budgeting of respective expenses and/or liabilities. As they are non-budgeted expenses and/or liabilities, these limits are reduced to 40% (forty percent) of the amount indicated.



-

605,750

545,850

-

Also, under the powers delegated to it, the Executive Committee is able to define responsibilities and areas of operation of each member, in terms of the Company’s internal structure, operation, coordination and monitoring of its business areas, in general, and of affiliate companies in particular.

g) Key elements of the internal control systems and risk management implemented in the company on the process of disclosing financial information.

Matters on internal control and risk management systems in existence in the José de Mello Saúde Group are detailed in point 7 of the Integrated Report.

h) Annual amount for remuneration awarded, in aggregated and individual form, for members of the administrative and supervisory boards of the Company, for the effects of Law No. 28/2009, of 19 June.

i. Gross remuneration paid by José de Mello Saúde, S.A. to members of the Board of Directors during the financial year of 2017

ii. Gross remuneration paid by José de Mello Saúde, S.A. to members of the Supervisory Board during the financial year of 2017

Members of the Supervisory Board have a gross annual remuneration of 7,500 euros for the Chairman and 6,000 for Members.

iii. Gross remuneration paid by José de Mello Saúde, S.A. to members of the Remuneration Committee during the financial year 2017

The members of the Remuneration Committee have a gross annual remuneration of 9,000 euros for the Chairman and 6,000 for the Members.

320,100

279,500

292,145

326,550

-

-

40,000

40,000

40,000

Chairman of the Board of Directors and CEO

Non-Executive Vice-Chairman

Non-Executive Vice-Chairman

Executive Director

Executive Director

Executive Director

Executive Director

Executive Director

Non-Executive Director






Pedro Maria Guimarães José de Mello

João Gonçalves Da Silveira


Rui Manuel Assoeira Raposo

Inácio António P. M. Almeida e Brito



Paulo Jorge Cleto Duarte

Luís Eduardo Brito Freixial de Goes

Vera Margarida Alves Pires Coelho

Celine Dora Judith Abecassis-Moedas

Raúl Catarino Galamba Oliveira

Wage (euros)Name Position


iv. Amount of annual remuneration paid by the company and/or by legal persons in control or group relationship to the auditor and to other natural or legal persons and specification of the percentage for each type of service.

The value of the tax consultancy is mostly related to services rendered in 2014 and 2015, which were only billed in 2017.

215,700

185,475

19,450

420,625

Cost of statutory audit services

Cost of tax advisory services

Cost of other non-audit services

Description

Total

Amount (euros)



• The members of the Board of Directors shall perform their duties diligently and carefully, in the interests of the company, taking into account the interests of its shareholders, employees and remaining stakeholders;

• It is in the interest of the Company and its shareholders to create the suitable conditions and incentives, enablers of the good performance of duties by the Board of Directors, in accordance with the criteria mentioned above;

• It is also intended that the way the members of the governing body are compensated is a transparent, fair and independent process, which guarantees a balance between the shareholders, the company’s positioning in the market and the need to attract and retain talent;

• In this perspective, the remuneration is an essential management tool for framing and motivating the leaders’ performance at the company level;

• The definition and application of the criteria underlying the setting the Board Members remunerations, submitted to the Remuneration Committee, shall thus be consistent and homogeneous, on the one hand taking into account the level of remuneration currently practiced in similar European companies and, on the other hand, the level of compliance with the strategic objectives defined for José de Mello Saúde Group (JMS), the creation of value for the shareholders and the economic context;

• In this sense, the remuneration shall include a fixed component that seeks to, in the context of the corresponding skills and responsibilities, suitably remunerate the effort and work developed throughout each mandate, applicable to the executive and independent non-executive members of the Board of Directors, and a variable component to be given to the executive members to compensate them for the Company’s performance and, at the same time, align his/her interests with the sustainability interests of the company in longer-term cycles. This alignment will be guaranteed, in particular, through the impact on the calculation of the variable remuneration of the operating and financial performance of the company in each financial year, of the intrinsic quality of the presented results (both recurring and extraordinary), of the compliance with the annual budget and of the business plan, taking into account JMS’s positioning in the healthcare market and the expectation of

REMUNERATION POLICY OF THE MEMBERS OF THE COMPANY’S GOVERNING AND SUPERVISORY BODIES

business evolution in the medium and long term;

• The assignment of the variable component, in addition to what was already mentioned, is also dependent on the evaluation of the fulfilment of collective, annual and multi-annual goals, reviewed annually taking into account, namely, the following indicators: Revenue, EBITDA, EBIT, Net Profit and Customers Security Index, not only in terms of evolution according to JMS’s track record but also taking into account the remuneration level of the main companies in the domestic market according to market studies conducted in Portugal;

• Part of the variable remuneration is paid after the end of each financial year and when the corresponding results are determined, with another significant component deferred for a period of three years, with its payment dependent on the continuation of JMS’s positive performance throughout that period, seeking to foster the maximisation of the performance in the long term and the pursuit of the company’s strategic and structural objectives, and to discourage excessive risk taking;

Regarding the supervisory body, considering the provisions of art. 422-A, along with the provisions of paragraph 1 of art. 399, both from the Portuguese Commercial Companies Code, the remuneration of the members of the Supervisory Board shall be a fixed amount, that shall be defined taking into account the complexity and responsibility of the roles performed, the normal compensation practices and conditions in the performance of similar jobs, as well as the company’s economic condition.


Sociedade Anónima - Capital Social 1.335.000 euros - Inscrição n.º 178 na Ordem dos Revisores Oficiais de Contas - Inscrição N.º 20161480 na

Comissão do Mercado de Valores Mobiliários

Contribuinte N.º 505 988 283 - C. R. Comercial de Lisboa sob o mesmo número

A member firm of Ernst & Young Global Limited

Ernst&YoungAudit&Associados-SROC,S.A.Avenida da República, 90-6º 1600-206 Lisboa Portugal

Tel: +351 217 912 000 Fax: +351 217 957 586 www.ey.com

(Free Translation from the original in Portuguese)

Statutory and Auditor’s Report

REPORT ON THE AUDIT OF THE CONSOLIDATED FINANCIAL STATEMENTS

Opinion

We have audited the accompanying consolidated financial statements of José de Mello Saúde, S.A. (the Group), which comprise the Consolidated Statement of Financial Position as at December 31, 2017 (which show a total of 745.409.942 euros and a total equity of 92.418.565 euros, including a net profit for the year of 22.820.198 euros), and the Consolidated Statement of Comprehensive Income, the Consolidated Statement of Changes in Equity and the Consolidated Statement of Cash Flows for the year then ended, and notes to the consolidated financial statements, including a summary of significant accounting policies.

In our opinion, the accompanying consolidated financial statements present fairly, in all material respects, the consolidated financial position of José de Mello Saúde, S.A. as at December 31, 2017, and of its financial performance and its cash flows for the year then ended in accordance with the International Financial Reporting Standards as endorsed by the European Union.

Basis for opinion

We conducted our audit in accordance with International Standards on Auditing (ISAs) and with other standards and technical directives of the Institute of Statutory Auditors (“Ordem dos Revisores Oficiais de Contas”). Our responsibilities under those standards are further described in the “Auditor’s Responsibilities for the Audit of the Consolidated Financial Statements” section of our report. We are independent of the entities that comprise the Group in accordance with the law and we comply with the ethical requirements of the Code of Ethic of the Institute of Statutory Auditors.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Emphasis of matter

As disclosed in notes 5 and 38 of the Notes to the Consolidated Financial Statements, the Public-Private Partnership management agreements of Braga Hospital will end in August 2019 and management estimations of the activity for the remaining period of the partnership include complex and volatile assumptions, which, for this reason, involve uncertainty, namely the inflow of the amounts claimed from the vertical programs of HIV and Multiple Sclerosis of which management firmly confirms positive outcome. Our opinion is not modified in respect of this matter.

Key audit matters

Key audit matters are those matters that, in our professional judgment, were of most significance in our audit of the consolidated financial statements of the current period. These matters were addressed in the context of our audit of the consolidated financial statements as a whole, and in forming our opinion thereon, and we do not provide a separate opinion on these matters.

We describe below the key audit matters of the current period.

1. Recognition and measurement of revenue and compliance with contractual and regulatory requirements of public health services


December 31, 2017

given the complexity of Public-Private Partnership management agreements of Braga and Vila Franca de Xira Hospitals

Description of the risks of material misstatement Summary of our approach to the risks of material misstatement

Sales and services rendered and Other operational revenues of the group are essentially related to two business segments:

► Public health services, that represent 36% of total revenue; and

► Private health services, that represent 64% of total revenue.

The group manages the services rendered by two public hospitals: Braga Hospital and Vila Franca de Xira Hospital. The activity and the revenues of the two Hospitals are determined in accordance with the applicable clauses included in the Public-Private management agreements signed with the Regional Health Administrations, as disclosed in notes 2.3, 2.5 and 5 of the Notes to the Consolidated Financial Statements. The materiality, variety and complexity of the health services rendered, associated with the judgment inherent to the interpretation of the referred agreements represents a significant audit risk. The fact that the production related to prior years is not yet closed, and that changes occurred in the codification of clinical acts, as mentioned in note 2.3 of the Notes to the Consolidated Financial Statements, indicates significant uncertainty about the acceptance of revenues recognized in prior years and in the current year, as detailed in note 23 of the Notes to the Consolidated Financial Statements.

Consequently, the recoverability of the balances related to Braga Hospital (20.554 thousand euros) and Vila Franca de Xira Hospital (13.006 thousand euros) depends on the success of the ongoing negotiations with the Regional Health Administrations for each of the indicated years.

The recognition and measurement of public health revenues involve, as

Our approach to the risks of material misstatement includes: i) a global response with an impact on the way the audit has been performed; and ii) a specific response which translated into a combined approach of assessment of controls and substantive procedures, namely:

► Assessment of the effectiveness of the internal control environment and execution of test of controls and tests related with i) production entitlement, and ii) computation of production based on the assumptions defined in the management agreements;

► Execution of analytical review procedures for all sales and services rendered accounts, including analysis of the significant variances compared to prior year, compared with expectations and with the agreed / budgeted production with the use of data analysis tools (analytics);

► Execution of test of details to validate contractual compliance and eligibility of services rendered related to unbilled production and accrued revenues, including the recalculation of current year revenues in accordance with the incurred production, considering the rules of the different classes, compared with the contracted production;

► Analysis of correspondence / communications between Braga Hospital and Vila Franca de Xira Hospital and the Regional Health Administrations related with the matters that are still under validation for the years that remain under discussion;

► Analysis of the quarterly reports issued by an external independent expert related to the Monitoring and Assessment of Care Assistance Results, which includes the recalculation of the performance factor results and the service performance parameters, and recalculation of the penalties related to those parameters;

► Retrospective analysis of previous years’ settlement agreements, to confirm consistency of the treatment agreed with Braga Hospital and Vila Franca de Xira Hospital and the Regional Health Administrations, for those instances of production not eligible and analysis of coherence for the years that are still under discussion.

Our approach also encompassed the analysis of the disclosures included in notes 2.3, 2.5, 5 and 23 of the Notes to the Consolidated Financial Statements to ensure that those notes are in accordance with the


December 31, 2017


per the above, significant judgement from management as disclosed in note 2.3 of the Notes to the Consolidated Financial Statements, particularly, in what concerns the determination of eligible production and its measurement.

applicable accounting standards.

2. Recognition and measurement of revenues from private health services due to the high volume of transactions, and the variety and complexity of services rendered in the various health units.


As mentioned in the previous Key Audit Matter, consolidated revenues from rendering of private health care services comprise a significant volume of transactions, from various health units that render a variety of complex services. The specificity and complexity of some of the services rendered and the multiplicity of existing agreements with health insurance companies and health subsystems organizations increase significantly the risk of services rendered not being recognized or being incorrectly measured.

Our approach to the risk of material misstatement includes: i) a global response with impact on the way the audit has been performed; and ii) a specific response which translated in a combined approach of assessment of controls and substantive procedures, namely:

► Assessment of the effectiveness of internal control environment and execution of tests of controls related to revenue recognition;

► Perform the reconciliation between the operational invoicing system and the recognition of revenue in the general ledger;

► Execution of analytical review procedures to all sales and services rendered accounts, including analysis of the significant variances compared to prior year, compared with expectations and with the agreed / budgeted production with the use of data analysis tools (analytics);

► Testing of the amounts booked as accrued invoices as at December 31, 2017, through the substantive analysis of the processes that originated the deferral of invoicing, as well as through the subsequent clearance, after the financial year end;

► Execution of data analysis procedures (analytics) to validate the correlation of transactions booked i) between the sales and services rendered accounts and the clients’ accounts and ii) between the clients’ accounts and cash & banks, during the period from January 1, 2017 to December 31, 2017.

Our approach also encompassed the analysis of the disclosures included in notes 2.5, 5 and 23 of the Notes to the Consolidated Financial Statements to validate that the disclosures are in accordance with the applicable accounting standards.


December 31, 2017

3. Impairment of Goodwill


The amount of Goodwill as at December 31, 2017 amounts to 43.885 thousand euros and is related to the business combinations disclosed in note 16 of the Notes to the Consolidated Financial Statements.

An impairment test should be performed in respect of this asset on an annual basis, which involves a high level of subjectivity inherent (i) to the assumptions taken by management in forecasting the business plans of each Cash Generating Unit, as well as (ii) to the remaining assumptions included in the calculation of the value in use, determined in accordance with the discounted cash flows methodology, namely the discount rates and forecast performance, including perpetual growth, as disclosed in note 16 of the Notes to the Consolidated Financial Statements.

Consequently, the potential impairment of goodwill has been considered a relevant matter because the amount booked for this asset is material and the impairment assessment process is complex.

We have tested the assumptions used in the valuation models prepared by management, namely the cash flow projections, the discount rate, the inflation rate, the perpetual growth rate and the sensitivity analysis, supported by internal specialists in business valuations.

We have tested the consistency of the assumptions used in the business plans with prior years, with historical data and with external data.

We have tested the arithmetical calculation of the model used.

We have reviewed the sensitivity analysis of the impairment tests performed on the Cash Generating Units, to validate that the disclosures included in note 16 of the Notes to the Consolidated Financial Statements reflect the outcome of the impairment tests performed.

We have reviewed the requirements of the applicable disclosures (IAS 36) in accordance with notes 2.3, 2.4 b) and 16 of the Notes to the Consolidated Financial Statements.

4. Liquidity, refinancing and contractual ratios



The Group has contracted external financing presented as current and non-current liabilities, in the amount of 355.692 thousand euros and 65.914 thousand euros, respectively. As part of the Group's investment strategy, significant real estate and other businesses were acquired, as disclosed in notes 4.1, 16, 18 and 46.2 of the Notes to the Consolidated Financial Statements, for which purpose financing was contracted through the issuance of bonds in the amount of 50,000

We have obtained the support agreements of the various debt instruments and the understanding of the contractual ratios computation method.

We have tested compliance with the contractual conditions.

We have tested and challenged cash flows forecasts of the subsidiaries and the process by which they were prepared, testing the underlying assumptions, such as the expected cash flows of services rendered and cash outflows from operating expenses.

We have read the minutes of the Board of Directors and other bodies of the Group to understand future plans and identify potential contradictory


December 31, 2017



thousand euros and loans with foreign banks in the amount of 30,000 thousand euros, as disclosed in note 35 of the Notes to the Consolidated Financial Statements

The management of cash-flows, refinancing capacity and compliance with the financial ratios are significant matters for our audit.

The test or evaluation is largely based on Management's expectations and estimates, which are influenced by subjective assumptions such as projections of volume and margins of operating activities, estimates of future cash flows, forecasting of economic conditions and the capital market, and capacity to fulfill financial ratios.

The ability to secure the commitments entered into with third parties depends essentially on the subsidiaries’ ability to generate and pay dividends, market conditions on the maturity of the financings that allows them to be renewed, and the financing policy of shareholders and dividend distribution.

information.

We have discussed with Group’s management the projections of debt market conditions and confirmed the group policy of dividend distribution and shareholders financing.

We have verified that the amounts, changes, maturity dates and other contractual conditions of the various financing instruments are disclosed, as required by IFRS 32, in Note 35 of the Notes to the consolidated financial statements.

Responsibilities of management and supervisory board for the consolidated financial statements

Management is responsible for:

► the preparation and fair presentation of the consolidated financial statements in accordance with the International Financial Reporting Standards as endorsed by the European Union;

► the preparation of the Management Report, including the Corporate Governance Report in accordance with the laws and regulations;

► such internal control as management determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error;

► adoption of appropriate accounting policies and principles for the circumstances;

► assessment of the Group’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern.

The supervisory board is responsible for overseeing the Group’s financial reporting process.


December 31, 2017

Auditor’s responsibilities for the audit of the consolidated financial statements

Our objectives are to obtain reasonable assurance about whether the consolidated financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these consolidated financial statements.

As part of an audit in accordance with ISAs, we exercise professional judgment and maintain professional scepticism throughout the audit. We also:

► identify and assess the risks of material misstatement of the consolidated financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control;

► obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Group’s internal control;

► evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by management;

► conclude on the appropriateness of management’s use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on the Group’s ability to continue as a going concern. If we conclude that a material uncertainty exists, we are required to draw attention in our auditor’s report to the related disclosures in the consolidated financial statements or, if such disclosures are inadequate, to modify our opinion. Our conclusions are based on the audit evidence obtained up to the date of our auditor’s report. However, future events or conditions may cause the Group to cease to continue as a going concern;

► evaluate the overall presentation, structure and content of the consolidated financial statements, including the disclosures, and whether the consolidated financial statements represent the underlying transactions and events in a manner that achieves fair presentation;

► obtain sufficient appropriate audit evidence regarding the financial information of the entities or business activities within the Group to express an opinion on the consolidated financial statements. We are responsible for the direction, supervision and performance of the group audit. We remain solely responsible for our audit opinion;

► communicate with those charged with governance regarding, among other matters, the planned scope and timing of the audit and significant audit findings, including any significant deficiencies in internal control that we identify during our audit;

► from the matters communicated with those charged with governance, including the supervisory board, we determine those matters that were of most significance in the audit of the consolidated financial statements of the current period and are therefore the key audit matters. We describe these matters in our auditor’s report unless law or regulation precludes public disclosure about the matter; and

► provide the supervisory board with a statement that we have complied with relevant ethical requirements regarding independence, and to communicate with


December 31, 2017

them all relationships and other matters that may reasonably be thought to bear on our independence, and where applicable, related safeguards.

Our responsibility includes the verification of the consistency of the consolidated Management Report with the consolidated financial statements, and the verifications under numbers 4 and 5 of article 451º of the Commercial Companies Code.

REPORT ON OTHER LEGAL AND REGULATORY REQUIREMENTS

About the Management Report

Pursuant to article 451º, nº 3, al. e) of the Commercial Companies Code, it is our opinion that the consolidated Management Report was prepared in accordance with laws and regulations in force, the information contained therein is in agreement with the audited consolidated financial statements and, taking into consideration our assessment and understanding of the Group, we have not identified any material misstatement.

About the non-financial statement provided for in the article 66-B of the Commercial Companies Code

Pursuant of article 451º, nº 6, of the Commercial Companies Code, we inform that the Group prepared a separate report of the Management Report, the Integrated Report, which includes the non-financial information as provided for in article 66-B of the Commercial Companies Code, and was published with the Management Report.

About the Corporate Governance Report

Pursuant to article 451º, nº 4, of the Commercial Companies Code, it is our opinion that the Corporate Governance Report (Information of the shareholders structure, organization and Corporate governance) includes the items required of the Group in accordance with article 245º-A of Securities Market Code, and no material misstatements were identified in the information contained therein, complying with the provisions of paragraph c), d), f), h), i) and m) of the referred article.

About additional items set out in article 10º of Regulation (EU) nº 537/2014

Pursuant to article 10º of Regulation (EU) nº 537/2014 of the European Parliament and of the Council, of 16 April 2014, and in addition to the key audit matters mentioned above, we report the following:

► We have been appointed as auditors of José de Mello Saúde, S.A. for the first time in the shareholders' general meeting held on October 11, 2007 for the period between 2007 and 2009. We were reappointed in the shareholders' general meeting held on April 29, 2016 for a forth mandate for the period between 2016 and 2018.

► Management has confirmed that they are not aware of any fraud or suspicion of fraud with a material impact on the consolidated financial statements. In planning and executing our audit in accordance with ISA we maintained our professional scepticism and we designed audit procedures to address the possibility of a material misstatement in the consolidated financial statements due to fraud.

► We confirm that our audit opinion is consistent with the additional report that was prepared by us and issued to the supervisory board as of April 9, 2018.

► We declare that we have not provided any prohibited non-audit services referred to in article 77º nº 8 of the Statute of the Institute of Statutory Auditors and we remained independent of the audited Group in conducting the audit.

Lisbon, April 12, 2018



December 31, 2017

Ernst & Young Audit & Associados – SROC, S.A. Sociedade de Revisores Oficiais de Contas Represented by: (Signed) Luís Miguel Gonçalves Rosado - ROC nº 1607 Registered with the Portuguese Securities Market Commission under licence nr.º

20161217



Dear Shareholders,

In accordance with legal and statutory terms, the Supervisory Board of José de Mello Saúde S.A., with headquarters at Av. do Forte, 3 – Edifício Suécia III, Piso 2, 2790-073 Carnaxide, presents its supervisory report and provides an opinion on the management report and on the consolidated accounts submitted by the Board concerning the financial year ended on 31 December 2017.

1. In accordance with legal and statutory terms, we have:

• approved the plan of activities for 2018;

• supervised the actions of the Board, through meetings with the internal audit department, financial department, strategic planning, management and innovation control department, information systems department and organisational development and quality department, and the auditing and risk management committee and obtaining the clarifications and comfort deemed necessary;

• verified compliance with the law and fulfilment of the company’s articles of association;

• evaluated whether the accounting policies and valuation/measuring criteria adopted by the company are in agreement with the generally accepted accounting principles and lead to a proper evaluation of the assets and results;

• evaluated the effectiveness of the internal control system implemented by the Board;

• supervised the process of preparation and disclosure of the financial information;

• verified the accuracy of the Statement of Financial Position, the Statement of Income and Other Comprehensive Income, Statement of Changes in Equity, Statement of Cash Flows and Annex of the financial year of 2017;

• evaluated the Management Report issued by the Board and the proposal for the appropriation of profits it introduced;

• evaluated the work carried out by the Statutory Auditor leading to the legal review and additional services;

REPORT AND OPINION OF THE SUPERVISORY BOARD CONCERNING THE CONSOLIDATED ACCOUNTS

• verified the terms of the Legal Accounts Certificate, the Audit Report and the Additional Report to the Supervisory Body issued by Ernst & Young Audit & Associados – SROC, S.A., and concluded that its content merits our agreement.

2. From our work, we highlight the following:

• The year 2017 presented a very significant operating and financial performance, although with different trends in private and public provision. Consolidated EBITDA grew 5.3% vis-à-vis the previous year, totalling 72.0 million euros. Whereas in the private area it grew from 56.6 million euros to 61.5 million euros, in the public area it decreased by 1.5 million euros to 7.8 million euros. As mentioned in 2016, the non-renewal by the Regional Health Authority North (ARS Norte) of the vertical funding programmes for HIV and Multiple Sclerosis, with an approximate value of 7.5 million euros per year is a penalizing factor for the imbalance of Escala Braga’s accounts. A Request for Financial Recovery was cautiously lodged at the end of 2016 for the purposes of clause 127, paragraph 9, subparagraph (b) of the Management Contract, seeking the beginning of an arbitration process for the settlement of this dispute. Management believes a favourable result for Escala Braga is very likely to come from this arbitration process, with the estimate of this contingent asset’s value being 15 million euros.

• We emphasise the growth of the Company’s balance sheet by 242.5 million euros, exceeding 745.4 million euros. The continuation of the various expansion works and the acquisition of properties belonging to the ImoSaúde Closed Real Estate Investment Fund and to the ImoSocial Closed Real Estate Investment Fund, namely the buildings operated by CUF Porto Hospital, CUF Porto Institute, CUF Belém Clinic, CUF Cascais Hospital and CUF Torres Vedras Hospital are the main reasons for the recorded increase. The operation to acquire real estate thus far belonging to the funds involved a set of assets that are strategic to José de Mello Saúde, making the control of its property a relevant factor.

• In comparison with 2016, gross debt increased by 202.0 million euros and net debt increased by 183.7 million euros, which is justified by the acquisition of real estate from the Investment Funds, by the several expansion works and by the policy of investing in


new units. The financial leverage ratio, namely D/EBITDA, increased to 4.7x (2.3x in 2016). Even with a significant increase in equity, the financial autonomy and solvency ratios showed reductions, reflecting the previously mentioned investment effort.

3. The conducted supervisory action allows us to conclude that:

• the actions of the Board that we have knowledge of safeguard compliance with the law and with the company’s articles of association;

• we are not aware of any situations that can call into question the suitability and effectiveness of the internal control system implemented by the Board in controlling the risk to which the company is exposed;

• the accounting and the accounts comply with the applicable legal, statutory and regulatory provisions, reflect the activity carried out and lead to a correct evaluation of the company’s assets and results;

• the Management Report is in agreement with the accounts presented and faithfully shows the evolution of the activity and of the business during the financial year;

• the published report includes the elements listed in article 245-A of the Securities Code on the structure and practices of corporate governance;

• the Statement of Financial Position, the Statement of Income and Other Comprehensive Income, Statement of Changes in Equity, Statement of Cash Flows and Annex of the financial year of 2017 meet the applicable legal and accounting requirements;

• the audit of the financial statements performed by the Statutory Auditor was suitable to the circumstances, and the additional services did not compromise its independence;

• the proposal for the appropriation of profits is appropriate and is properly grounded.

4. We can thus state:

• our agreement with the content of the Legal Accounts Certificate issued by the Statutory Auditor;

• our agreement with the Management Report and accounts for the 2017 financial year presented by the Board of Directors;

• that to the best of our knowledge, the disclosed financial information has been drafted in accordance with current accounting standards and give a true and fair view of the assets and liabilities, financial situation and results of the company, and that the Management Report faithfully describes the business development, financial performance and position of the company, containing a description of the main risks and uncertainties it faces.

5. Accordingly, taking into account the actions carried out, we consider that:

• the consolidated Management Report and the consolidated accounts of the 2017 financial year presented by the Board of Directors should be approved;

Finally, we would like to thank the Board and all Employees in the service of the Company who we contacted, for all the cooperation we received when performing our duties.




(Chairman)


(Member)


(Member)



In accordance with provisions in Article 245(c)(1) of the Securities Code, José de Mello Saúde, S.A. (“JMS”) Supervisory Board members declare that, to the best of their knowledge, the management report, the consolidated annual accounts, the legal accounts certificate and the other accounting documents, i) were prepared in accordance with current accounting standards and give a true and fair view of the assets and liabilities, financial situation and results of JMS and of the companies included in the scope of consolidation; ii) they faithfully describe the development, performance and position of JMS business activity and of the companies included in the scope of consolidation; and iii) they contain a description of the main risks JMS faces in its activity.




(Chairman)


(Member)


(Member)

STATEMENT OF COMPLIANCE OF THE SUPERVISORY BOARD



CLINICAL QUALITY AND SAFETY REPORT2

Clinical Quality Indicators

19STOP Hospital Infection

14

Top CUF GCD/GDH

14

12

13

12

14

04

Total Discharged Patients

Quality Management


Clinical quality and safety

TABLE OF CONTENTS

Quality policy

About José de Mello Saúde 05

National Health Evaluation System (SINAS)

14

15

16

18

15

15

SINAS External Evaluation

SINAS Internal Monitoring Tool

Patient Safety

Infection Control

IAmetrics

16Surgical Safety

18General Indicators – Infection Rates

17Safety in the use of Medication

17Patient Falls

18Adverse Event Reporting System

CLINICAL QUALITY AND SAFETY REPORT 3

22

23Measurement of Outcomes for Breast Cancer

20

20

20CUF Oncology Institute (I.C.O.)

Cross-Cutting Areas – CUF Oncology Institute

Breast Diagnostic and Integrated Treatment Unit

22

22

22Value-Based Healthcare – Improvement in the Quality of Care

Value in Healthcare

Measurement of Clinical Outcomes

24

24CUF Infante Santo Hospital

Information on Individual Facilities

33Glossary

Measurement of Outcomes for Cataract Surgery

23Measurement of Outcomes for Knee Osteoarthritis

25

26CUF Porto Hospital


27CUF Cascais Hospital

28

29CUF Santarém Hospital


30CUF Viseu Hospital

31

32Vila Franca de Xira Hospital

Braga Hospital



As a leading healthcare provider in Portugal, José de Mello Saúde is committed to the guiding principles of sustainable development.

Respect for these principles translates into the commitment to ensure, at every moment, the creation of value and, with it, the satisfaction of customers, employees, shareholders and other entities with whom we cooperate in the exercise of their activity.

With this in mind, José de Mello Saúde is developing an integrated management model that defines:

José de Mello Saúde’s provision of healthcare is in line with the best practices in technological excellence and with the most recent and proven scientific evolution. The prevention, diagnosis and clinical treatment of illness, sustained by the achievement of clinical results, periodically monitored and reassessed in light of the goals and targets set. A model of healthcare provision based on the continuous search for solutions that will provide a response to customers’ needs.

An ongoing, Group-wide programme for the management of clinical and non-clinical risk, which establishes and prioritises actions to identify potential risks and prevent them from occurring. The programme is enhanced by the implementation of recommended best practices in order to eliminate unnecessary damage arising from healthcare provision.

The protection of information, as a support for the efficiency of the service rendered to the customers, based on the integrity and availability of the information systems and infrastructures, and on the confidentiality of the data.

Identification of environmental issues arising from healthcare provision, making it possible to assess impacts and prioritise action aimed at minimising and controlling them. The promotion of sustainable use of natural resources including energy and water, pollution prevention and reduction, reuse and recycling of waste generated.

Identification of hazards to which professionals are exposed under health and safety at work, with a view to risk assessment and prioritisation of actions, ensuring that they are minimised and controlled. Prevention of occurrence of injuries, incidents, accidents and occupational diseases.

Compliance with applicable legal requirements and other requirements that are endorsed.

The establishment of a culture of continuous improvement that consolidates the management of processes and promotes the efficiency of the integrated management model.

QUALITY POLICY


Patient safety

Security of information

Environmental efficiency

Health and safety at work

Legal requirements

Continuous improvement



Organizational overview

Council2, a consulting body of José de Mello Saúde’s Executive Committee, was also established.

Along with the Ethics Council, the larger healthcare units have their own Ethics Committee, under the law. This Committee is composed of internal staff, alongside external individuals with deep knowledge of the ethical matters.

OrganizationJosé de Mello Saúde develops its activity through a network of CUF private healthcare and hospital units integrated in the Portuguese National Health Service (Serviço Nacional de Saúde), operated under public-private partnership (PPP).

In 2017, José de Mello Saúde expanded its portfolio with the inauguration, in October, of CUF S. João da Madeira Clinic, and the acquisition, in December, of Coimbra Private Clinic. This will, in the future, become the CUF Coimbra Hospital.

With the expansion of the network to eight hospital and nine outpatient clinics, CUF is now present in Lisbon, Oeiras, Cascais, Sintra, Mafra, Torres Vedras, Santarém, Matosinhos, Porto, Viseu, S. João da Madeira and Coimbra.

José de Mello Saúde also ensures, via public-private partnerships (PPP), the management of Braga Hospital and Vila Franca de Xira Hospital, both part of the Portuguese National Health Service.

From an organizational perspective, the hospital and outpatient units were grouped into two Coordinating Committees – CUF and PPP. The CUF network is broken down into three geographical clusters – Descobertas, Tejo and Norte – in a rationale of coordination around the three large CUF Hospitals: CUF Infante Santo Hospital, CUF Descobertas Hospital and CUF Porto Hospital.

Who we areOriginating in CUF Hospital, founded in 1945, José de Mello Saúde operates in the provision of healthcare in Portugal.

VisionTo be a leader in the provision of healthcare with distinctive quality supported by an integrated network of high-performance units, both in the private and public sectors, and presenting growth options in select markets.

MissionTo promote the provision of healthcare services with the highest possible levels of knowledge, prioritizing life and the environment, through the development of the intellectual capital of the organizations, in a permanent search for excellence.

Values

• Respect for human dignity and well-being• Human development• Competence • Innovation

EthicsBusiness Ethics is a fundamental value of José de Mello Saúde, both due to the area in which it operates and due to the topic’s relevance for José de Mello Group. As an entity that provides healthcare, governed by principles of good management and transparency, striving for respect for customers, partners, shareholders and employees, José de Mello Saúde poses ethical issues at the centre of its activity. Governing its conduct by values such as the Respect for Human Dignity and Well-being of the Individual, José de Mello Saúde decided

to create a Code of Ethics for all CUF units. An Ethics

2 More information about the Ethics Council can be found in chapter ‘Governance Model’.


CUFPORTO

INSTITUTOCUF

CUF VISEU

CUF COIMBRA

CUFDESCOBERTAS

CUFINFANTE SANTO

CUFALMADA

CUFBELÉM

CUFMIRAFLORES

CUFSINTRA

CUFSÃO DOMINGOSDE RANA

CUFCASCAIS

CUFAlVALADE

CUFMAFRA

CUFTORRES VEDRAS

CUFSANTARÉM

CUF SÃO JOÃO DA MADEIRA

TORRES VEDRAS


From an organisational perspective, the hospital and outpatient units were grouped into two Coordinating Committees – CUF and PPP, with CUF network divided into three geographical clusters – Descobertas, Tejo and Norte – in a rationale of coordination around the three largest CUF Hospitals.

VISEU

COIMBRA

SANTARÉM

ALMADA

VILA FRANCADE XIRA

TORRES VEDRAS

LISBOA

PORTO

BRAGA

CASCAIS



José de Mello Saúde


José de Mello Capital

FundaçãoAmélia de Mello

Farminveste, S.A.

66%4%

30%

EMPLOYEES

OPERATING INCOME

DOWNLOAD’S APP MYCUF

HEALTHCARE UNITS

EBITDA

CALLS ANSWERED BY THE CONTACT CENTRE

INPATIENT BEDS

CONSOLIDATED INVESTMENT

OPERATING THEATRES

CONSULTATION ROOMS

8.058637,4M€ | +8,7%

345 THOUSAND

1972,0M€ | +5,3%

3 MILLION

1.543 190,3M€

92

1.165saudecuf.pt

INSTALL IT NOW


ONE YEAR IN NUMBERS

ADMISSIONS

EMERGENCIES

IMAGING EXAMS*

CHEMOTHERAPY SESSIONS

RAMI:RISK-ADJUSTED MORTALITY INDEX

SURGERIES

CONSULTATIONS

BIRTHS

RADIOTHERAPY SESSIONS

1,1 MILLION

658 THOUSAND

828 THOUSAND

21 THOUSAND

0,6

93 THOUSAND

2,4 MILLION

7.843

62 THOUSAND

0,48RARI:RISK-ADJUSTED READMISSIONS INDEX

* MRI, Ultrasound, CT and ECG



OPERATING INCOME

EBITDA

INVESTMENT IN R&D+I

ENERGY INTENSITY

HOURS OF TRAINING

No. OF VOLUNTEERS

DOCTORS IN MEDICAL INTERNSHIP

637,4M€

72,0M€

1,8M€

45 kgep/m2

133.314

65

485

Financial Capital (€)

Intellectual Capital

Natural Capital

Human Capital

Social Capital

2015

2015

2015

2015

2015

Operating Income

Investment in R&D+I (M€)

Electricity consumption (MWh)

Human Resources Indicators

Investment in the community (€)

Social indicators

Clinical Events and Education for Healthcare Indicators

Training Indicators

560,2

2,6

46.406

586,3

3

48.120

637,4

1,7

50.185

EBITDA

Medical Internship at JMS (No. Doctors)

Energy intensity (kgep/ m2)

Number of employees

Donations

63,5

316

47

7.055

212.000

68,4

785

49

7.469

218.537

72,0

485

45

8.058

286.746

EBIT

Clinical Trials at JMS (No. Trials)

Water Consumption (m3)

Women

Natural gas Consumption (MWh)

Men

No. of Volunteers

Hazardous waste accumulated (ton)

Number of Hires

Number of participants in training activities

Number of Hours of Training

Average hours per employee

42,2

n.a.

323.716

25.632

1.500

53

5.555

21.108

1.561

1.113

1.187

8.756

115.988

16,44

41,5

130

349,342

25.757

1.570

50

5.899

25.838

1.360

1.209

945

8.086

121.748

16,30

42,6

124

363.927

22.873

1.683

65

6.375

21.436

1.797

1.252

1.205

16.831

133.314

16,54

Net profit 21,9 23,9 22,8

2016

2016

2016

2016

2016

2017

2017

2017

2017

2017

CO2 emissions (tCO2)

Number of Hires

Main indicators 2017




CLINICAL PERFORMANCE

With an integrated network of hospital units, José de Mello Saúde has a global portfolio of healthcare, in both surgical and medical areas. This offering happens in the private units of the CUF network and in the units man-aged under PPP.

The clinical performance can also be evaluated according to the Homogeneous Diagnostic Groups (HDGs) as a result of clinical coding. It should be noted that the clinical coding for the private facilities reflects discharges of both inpatients and patients who underwent outpatient surgery, and forms the basis for the governance of clinical information used for the purposes of monitoring, management and control of the process and quality indicators.

In 2017, José de Mello Saúde’s private units adopted the ICD-10-CM/PCS coding reference, which uses a more current medical terminology, which enables a greater scope, specificity and precision in the characterisation of the clinical activity. By following the ongoing trend in the NHS hospitals, this update makes it possible to bench-mark the clinical activity.

In the units managed under PPP, the coding reflects the inpatient care, the outpatient surgery and the medical outpatient care, also supporting funding and clinical governance.

Gynaecology Obstetrics

Orthopaedics

General Surgery

Urology

Otolaryngology

Paediatrics

Neurosurgery

Cardiology

Plastic and Reconstructive Surgery

Oncology

Vascular Surgery

Psychiatry

Pulmonology

Ophthalmology

Neurology

Gastroenterology

Paediatric Surgery

Maxillofacial Surgery

Cardiac Surgery

Thoracic Surgery

Others

Internal Medicine 12678

11410

11195

10822

5426

3553

5250

4734

3510

2748

1395

1329

1321

1195

819

769

713

642

628

420

144

142

0

Total hospital inpatient discharges according to specialty

2500 75005000 1250010000 15000

Activity of José de Mello Saúde’s units:


* The PPP Units are consolidating processes resulting from the transition from the ICD-9 to the ICD-10 coding reference, with consolidated results not available at the time of this report.

The Major Diagnostic Categories account for more than 80% of the inpatient care (medical and surgical) and outpatient surgery activities of the CUF* Units.

Top Major Diagnostic Category (MDC)

Main Homogeneous Diagnostic Groups (HDGs)

Diseases and Disorders of the Musculoskeletal System and Connective Tissue

Procedures in the eye except socket

Diseases and Disorders of the Digestive System

Procedures on the tonsils and adenoids

Newborns and Infants with Diseases during the Perinatal Period

Intervertebral disc excision and/or decompression

8

73

6

97

15

310

10.289

6.442

4.784

1.968

3.160

1.405

Eye Diseases and Disorders

Newborn, weight at birth >2499 g, normal or with other problems

Diseases and Disorders of the Circulatory System

Delivery by caesarean section

Diseases and Disorders of the Skin, Subcutaneous Cellular Tissue and Breast

Procedures in the shoulder, arm and/or forearm

Diseases and Disorders of the Ear, Nose, Mouth and Throat

Knee and/or leg procedures, except in the foot

Pregnancy, Childbirth and Puerperium

Other procedures in the ear, nose, mouth and/or throat

Diseases and Disorders of the Kidney and Urinary System

Procedures for inguinal, femoral and/or umbilical hernia

Vaginal childbirth

2

640

5

540

9

315

7.462

2.709

3.840

1.937

3.081

1.378

3

313

14

98

11

228

560

5.247

2.123

3.483

1.877

2.787

1.348

1.126

Description Total



CLINICAL QUALITY AND SAFETY

José de Mello Saúde, as a healthcare provider, is committed to continuously evaluate the quality of the healthcare provided in all of its hospital units.

To that effect, it submits to the external evaluation of the National System For Healthcare Evaluation (SINAS), which evaluates the fulfilment of the quality parameters established by the Portuguese Healthcare Regulation Authority (ERS). Additionally, it participates in clinical benchmarking models, continuously identifying and evaluating the clinical efficiency and quality processes, which contributes to the learning process of the involved organisations.

The use of the IAmetrics platform (IASIST) enables using coded information for monitoring and management of the clinical activity, based on benchmarking and risk-adjustment models.

The Clinical Outcomes Project, launched in 2015, seeking to add value to the provision of care based on health outcomes relevant for the patient, evolved into the Value-Based Healthcare Programme (each pathology is seen as an individual project thus assigning to each area of action the desired scale and cross-cutting nature).

In 2017, José de Mello Saúde continued its Quality Management System’s models within the scope of its healthcare provision processes and with the strategic goal of continuously improving its quality and safety management processes. CUF Santarém and CUF Viseu hospitals received the ISO 9001:2015 certification, given by the SGC, for the first time, thus following the continuous and updated development of the culture and practice of José de Mello Saúde’s values. In addition, all CUF units successfully renewed the certification of their quality management systems in ISO 9001:2008.

Braga Hospital was accredited again and received the ISO 9001:2015 certification for all support services. At the same time, the maintenance of the Environmental Certification was confirmed (the Certification was renewed and transitioned to ISO 14001:2015), as was the Organizational Health and Safety Certification (renewal of the certification according to the OHSAS 18001:2007 standard by the Société Générale de Surveillance (SGS)).

Vila Franca de Xira Hospital, in 2017, after an annual reassessment, had its accreditation from the Joint Com-mission International (JCI) renewed. The Environmental Certification according to the ISO 14001:2015 standard, the Certification of the Organizational Health and Safety System according to the OHSAS 18001:2007 and the certification of the Quality Management System in clinical and support services, according to ISO 9001:2015, were also confirmed.

SINAS external evaluation

José de Mello Saúde reaffirms its commitment to the National Health Evaluation System (SINAS) that, through adequate and intelligible information, favours more informed decision-making by the patients, while promoting the continuous improvement of the quality of provided care.

The global evaluation model of the SINAS considers multiple quality dimensions – Clinical Excellence, Patient Safety, Comfort of the Facilities, User Satisfaction and Focus on the User, seeking to capture different facets of the provision of healthcare. These dimensions are distinct and can be made autonomous, but they are not always fully independent.

All of José de Mello Saúde’s units received the maximum rating and were given a star in the quality dimensions of the first level of evaluation.

In the evaluation of Clinical Excellence, Braga and Vila Franca de Xira hospitals were once again considered by the Portuguese Health Regulatory Authority as leaders in their peer groups for the benchmarking of the Portuguese National Health Service hospitals. The former received the maximum rating for Clinical Excellence in five areas (Neurology, Obstetrics, Intensive Care, Outpatient Surgery and Venous Thromboembolism). As for Vila Franca de Xira Hospital, it received the highest rating in four areas (Neurology, Obstetrics, Orthopaedics – Surgical Repair of Proximal Fracture of the Femur – and Outpatient Surgery. Additional emphasis on the high rating for the area of Outpatient Surgery at the CUF Porto Hospital, CUF Cascais Hospital and CUF Torres Vedras Hospital, as well as for the area of Orthopaedics (Hip and Knee Replacement) of CUF Descobertas Hospital.

Quality management

National Health Evaluation System (SINAS)


SINAS internal monitoring tool

The evaluation on several dimensions, promoted by the SINAS, enables capturing the multidimensionality of the concept of Quality in Healthcare and identifying the institutions’ strengths and weaknesses, as well as areas for priority action.

Reinforcing the sense of prioritisation of improvement cycles, José de Mello Saúde developed an internal mon-itoring tool for the dimensions evaluated by the SINAS. This enables the management of clinical information, with real-time determination of the fulfilment rates per detail indicator for each area of the Clinical Excellence dimension. The guidelines provided by the SINAS thus become used by the clinical teams themselves to obtain information in real time.

IAmetrics

José de Mello Saúde’s units with inpatient care and outpatient surgery are involved in clinical benchmarking models, evaluating and comparing their performances in variables such as efficiency and clinical quality.

The participation in the IAmetrics, which enables monitoring of results via models which adjust to the complexity of the cases and the execution of benchmarking with equivalent hospitals in Portugal and Spain, allows José de Mello Saúde to achieve greater efficiency and quality in the provision of healthcare. The performance assessment system is based on the comparison of performance with standard values (indexed to risk), in which a better per-formance will have values between 0 and 1.

Key:Standard = 1.0 | Risk adjustment: Adjusted calculation of the likelihood of a given event occurring based on patient characteristics, type of admission, pathology and Health Unit. Values resulting from the average between units.AAPDI: Adjusted Average Pre-operative Delay Index (programmed + urgent) | RAMI:Risk-adjusted Mortality Index | RACI: Risk-adjusted Complication Index | RARI: Risk-adjusted Readmission Index

Efficiency indicators

AAPDI

RARI

RAMI

Quality indicators

RACI

* In process consolidation in 2017, stemming from the transition from the ICD-9 to the ICD-10 coding reference

PPP Units

0.17

0,48

0,60

0,69

CUF Units

Clinical Quality Indicators

ClinicalExcellence

Patient Safety

Comfortof Facilities

UserSatisfaction

User FocusHospital





CUF Porto Hospital

CUF Viseu Hospital


Braga Hospital


The provider meets all quality parameters required.Dimension not evaluated.



Patient Safety is a strategic priority for José de Mello Saúde, which thus establishes its commitment to a differ-entiating clinical project, materialised in the clinical excellence and in the response focused on the patient.

The Safety in Health Programme, across all of José de Mello Saúde’s units, is ensured by multidisciplinary teams representing the risk management committees and the programme for the prevention and control of infections and resistance to antimicrobials. Operating under medical coordination, the programme seeks to establish common policies and lines of action, ensuring the continuous improvement cycle and reinforcing the single-operator model.

The National Plan for Patient Safety 2015-2020, created by Decree No. 1400-A/2015, of 10 February 2015, en-compasses the activities carried out by José de Mello Saúde under the Safety in Health Programme and seeks to achieve the following goals:

1. Strengthening the internal environment’s safety culture;

2. Stimulate safety in communication;

3. Increase surgical safety;

4. Increase safety in the use of medication;

5. Ensure unambiguous identification of the patients;

6. Prevent the occurrence of falls;

7. Prevent the occurrence of pressure ulcers;

8. Ensure the systematic practice of notification, analysis and prevention of incidents;

9. Prevent and control infections and antimicrobial resistance.

Surgical Safety

José de Mello Saúde maintains focus on surgical safety with the cross-cutting monitoring provided by the “Safe Surgery Saves Lives” project, which encompasses the following dimensions:

• Preanaesthetic evaluation;

• Anaesthetic consent;

• Pre-surgical evaluation;

• Surgical consent;

• Surgical safety checklist

• Surgical Apgar index;

• Surgical follow-up.

Equivalent to the National Plan for Patient Safety 2015-2020, José de Mello Saúde, in Safe Surgery, seeks to:

• Use the Surgical Safety Checklist;

• Reduce the rate of non-compliance in the use of the surgical safety checklist;

• Mitigate the risk of unacceptable surgical incidents.

Patient safety

1 Number of Completed Surgical Safety Checklists/no. of surgeries carried out in the central surgery block

SSC rate1 per Unit

98,74% 99,21%

99,12% 100%

HCD HCS

HCC HVFX

92,27% 99,80%

99,64%

98,01% 86,70%

HCIS HCV

HCTV

HCP HB

Surgical Safety Checklist Usage Rate (SSC)


Safety in the use of medication

Medications that have a high risk of causing significant damage to the patient as a result of failures in their usage process are categorised as maximum-alert or maximum-risk medications. Though these errors are infrequent, their consequences tend to be more severe. José de Mello Saúde complies with the National Plan for Patient Safety 2015-2020 within the scope of the use of medication, having developed and implemented:

• Rules on safe medication practices;

• Definition and disclosure of maximum-alert medication lists;

• Definition and disclosure of lists of medications having names with similar spelling, that sound similar or have similar appearance;

• Assignment of specific signs for medicines with similar spelling, that sound similar or have similar appearance.

Patient falls

By monitoring the “Patient Fall” indicator, José de Mello Saúde has greater knowledge concerning the extent and characterisation of the problem. Depending on multiple factors, the risk of falling may have a significant impact on the patient’s morbidity and quality of life, in addition to contributing to the increase of healthcare costs. The fall prevention strategy consists of:

• Assessment of the risk of falling in adult patients using the Morse Fall Scale;

• Assessment of the risk of falling in paediatrics patients using the Humpty Dumpty Scale;

• Implementation of preventative measures in accordance with the risk of falling;

• Identification of patients with a high risk of falling;

• Involvement of the patient/carer in fall prevention;

• Notification in the event of a fall.

1 Number of patient falls reported for inpatients on the HER+ platform per 100 days of hospitalisation.2 Management Agreement, “B17 – Falls during Hospitalisation” indicator. [Number of patient falls during the period of hospitalisation, with discharge from hospital during the period under analysis / Total number of days of hospitalisation generated by patients discharged from hospital during the period under analysis]. HB reference rate = 0.16% | HVFX reference rate = 0.11%

MAXIMUM ALERT

Maximum alert medicinesMedicines with the same substance but different

dosages Diluted drugs required Concentrated drugs

electrolytes Acid for external use

COMPULSORY DILUTION

DILUTION

2 B17 Indicator: “Falls during hospitalisation” (%) - 0,13 0,10

Patient Falls during Hospitalisation in 2017

CUF HB HVFX

1 Patient falls (%) 0,08 - -



Adverse event reporting system

The notification system for adverse events (HER+, Health Events Risk Management) is a cross-cutting and crucial tool in the development of the patient safety culture, in the Risk Management area.

With all of José de Mello Saúde’s units participating in a significant way, HER+ contributes to collecting, aggregating and analysing clinical information with a focus on the causes, risks, dangers and vulnerability of the patients. It also enables defining and implementing improvement strategies.

total reported events – JMS evolutionary analysis

Total Events per Type of Occurrence

Infection rates – General indicators

The policies and lines of action to control infection and resistance to antimicrobials are applied across all areas of all of José de Mello Saúde’s units under the clinical coordination of the executive cores of the local coordination groups of all the units. To prevent, detect and control infections in hospital settings, there was a reinforcement of the culture of good practices in the main areas, such as epidemiological surveillance and control of healthcare-associated infections, monitoring of infection rates and antimicrobial resistance, awareness campaigns, training actions for professionals and customers as well as plans for internal audits.

2015 2016 2017

1.028 1.1731.383

1.456 1.1931.246

CUF

PPP

Infection control

Almost-incident Incident Accident Sentinel No classified

CUF

PPP678

310388

254

73

765

52 1188

10




Accumulated2017

Accumulated2017

ReferenceValue

ReferenceValue

Rate of nosocomial blood stream infections in patients subjected to central venous catheterisation (CVC)

Rate of nosocomial blood stream infections in patients subjected to central venous catheterisation (CVC)

Overall surgical wound infection rate in planned surgical procedures in patients with risk level 0

Overall surgical wound infection rate in planned surgical procedures in patients with risk level 0

Surgical wound infection rate in planned surgical procedures in patients with risk level 3


0,05%

1,09‰

2,77%

2,56%

-

-

0,40%

2,15‰

3,90%

2,49%

85,00%

-

Rate of urinary infections in inpatients with urinary catheters

Rate of urinary infections in inpatients with urinary catheters



Respiratory infection rate associated with mechanical ventilation in the ICU

Respiratory infection rate associated with mechanical ventilation in the ICU

Overall surgical wound infection rate in planned surgical procedures (%)

Overall surgical wound infection rate in planned surgical procedures (%)



0,44%

3,52‰

6,72%

3,95%

0,13%

4,11‰

0,47%

3,50‰

17,50%

3,64%

1,90%

8,00‰

-

-

23,08%

2,94%

-

-

38,00%

12,50%

Braga Hospital


Stop Hospital Infection

Braga Hospital participates, since 2015, in conjunction with over 11 hospital centres (19 hospitals) of the National Health Service (NHS), in the Stop Hospital Infection Challenge. This initiative by the Calouste Gulbenkian Foundation, in partnership with the Ministry of Health and in cooperation with the Institute for Healthcare Improvement (IHI), seeks the implementation of a Collaborative Learning System.

The purpose of the Stop Infection Challenge for the 2015–2018 three-year period is to reduce by 50%, or to have at least 300 opportunities between occurrences of the following infections:

• Infection of the surgical site (ILC): colon and rectum, gallbladder, hip and knee prostheses;

• Definition and dissemination of lists of maximum alert medication;

• Bloodstream infection related to central venous catheter (ICSRCVC);

• Pneumonia associated with intubation (PAI);

• Urinary tract infection associated with bladder catheter (ITUACV).

The services of General Surgery, Internal Medicine, Orthopaedics, Operating Theatre and Multipurpose Intensive Care Unit (MICU) began to have operational teams, made up of doctors and nurses, who will monitor the aforementioned infections and implement, in addition to develop, continuous improvement processes. So far, the following results have been observed:

• ITUACV in Internal Medicine – 42% reduction

• PAI in MICU – 75% reduction

• ILC Gallbladder – 66% reduction

• ICSRCVC in MICU – 7767 days of CVC without infection

• ILC in hip and knee prostheses – 523 surgeries between infections (the surgeries from 2017 are still under analysis up to one year after the surgery), corresponding to 0.45% of ILC.

• The ICSRCVC in General Surgery has a rate of 2.17 per 1000 days of CVC, achieving over time several months without infections.



CROSS-CUTTING AREAS – CUF ONCOLOGY INSTITUTE

In 2016, José de Mello Saúde created the CUF Oncology Institute (I.C.O.), CUF’s national cancer care network. This unit ensures an integrated offer, a differentiated and experienced clinical staff, and an innovative technological complex ready to address all needs presented by the cancer patient, from diagnosis to treatment. As a national platform that brings together all of CUF’s units, the CUF Oncology Institute articulates all of the network’s required resources – professionals, equipment and facilities – in a focused and per-condition care model.

I.C.O.’s network consists of 15 per-condition integrated diagnostics and treatment units (IDTU), including the breast, lung, colorectal, prostate, gynaecology, head and neck IDTUs, among others. The IDTUs are responsible for the definition and implementation of the necessary resources, clinical pathways, protocols and indicators of operational performance and clinical quality across the scope of their pathology.

The I.C.O. maintains a strong commitment of cooperation with the National Cancer Registry, contributing to the epidemiological study of cancer in Portugal and continuously evaluating and monitoring the survival rates of patients treated entirely by the I.C.O.

Maintaining the focus on external quality recognition by certification and accreditation systems specific to the approach to cancer, the Breast IDTU was certified, in 2017, by the EUSOMA reference in Breast cancer. The I.C.O. is also recognized by the Ministry of Health as a National Reference Centre for the Treatment of Rectal Cancer.

In 2017, the I.C.O. reinforced its position as an institution of research and teaching in the field of oncology. The I.C.O.’s activity in the field of clinical trials more than doubled, also promoting applications of projects for funding within the framework of Portugal2020, SIFIDE and CREN, in partnership with the NMS/CEDOC (Nova Medical School / Chronic Diseases Research Centre). A partnership was also developed with Biobanco-IMM, with the collection of colorectal cancer material for research projects. In the field of education, we emphasize, in 2017, the regency of the course in NMS’s Master’s Degree in Biomedical Research.

With approximately 4500 new cases per year, breast cancer is the most common malignancy in women and the leading cause of death by cancer. To respond to this situation, the I.C.O. created the Lisbon Breast IDTU, a clinical organisation of integrated management and cross-cutting platform that aggregates the resources and skills of the CUF Descobertas and CUF Infante Santo hospitals in this area.

Created ten years ago, the Lisbon Breast IDTU was the first private unit dedicated to the mammary pathology in Portugal, already having published data. This IDTU has a multidisciplinary team dedicated to and specialised in the diagnosis and treatment of breast cancer, with extensive experience in the early detection and in the approach to cancer in young women (<45 years of age).

With highly qualified human resources and using innovative technology, the Breast IDTU provides a timely re-sponse to the needs of those seeking its services, namely providing a differentiated breast cancer diagnosis in 48 hours. Combining all the necessary skills, the I.C.O.’s Breast unit has the mission of:

• Providing excellent clinical care in the field of breast pathologies, particularly in breast cancer, permanently ensuring a suitable and innovative offering, considering all the needs of the patients and their care providers;

• Promoting health, preventing and combating breast cancer through awareness-raising and educational actions regarding the adoption of healthy habits and of early diagnosis;

• Cooperating in teaching and scientific research in the field of oncological disease. A member of SOLTI, the Breast Unit collaborates with the NMS/CEDOC and FML/Instituto de Medicina Molecular (Institute of Molecular Medicine).

CUF Oncology Institute (I.C.O.)

Breast Diagnostic and Integrated Treatment Unit


In 2017, emphasis on the certification of the IDTU as a specialised centre in the treatment of breast cancer by EUSOMA – European Society of Breast Cancer Specialists, one of the most respected international organisations in this pathology. This certification recognises the clinical excellence and the safety in the diagnosis and treatment of patients, confirming full compliance with strict guidelines in the services provided to the patients, in the entire organisation and in the experience and structuring of multidisciplinary teams.

The Breast Unit complied fully with the goals of clinical quality established by EUSOMA, with an emphasis on:

The continued investment in innovation and research, and the humanisation of care focusing on the patients, their families and caregivers are among the guidelines adopted by the Breast Unit of the CUF Oncology Institute, now certified by EUSOMA.

Indicator Goal Evaluation

I3. Preoperative Diagnosis

I7. Cases referred for genetic counselling

I10. Patients with surgery to preserve the breast who receive Radiotherapy

80%

5%

90%

86%

13%

97%

I4. Complete characterisation of predictive and prognosis factors

I8. Discussion in multidisciplinary meeting

I11. Avoiding excessive treatment

I12. Suitable treatment with hormone therapy

I13. Suitable treatment with chemotherapy

I5. Time to wait between the first observation and the first treatment under six weeks

I9. Percentage of patients with a single breast surgery

90%

90%

70%

80%

80%

91%

100%

92%

100%

100%

75%

80%

82%

97%



VALUE IN HEALTHCARE

Focusing on a culture of quality and on the provision of patient-centred healthcare and clinical excellence, José de Mello Saúde assumes a pioneering position in the country using the health outcomes relevant for the patient as a crucial instrument for the improvement of the provision of healthcare.

In 2017, it created the Value-Based Healthcare Programme, aligned with the Clinical Differentiating Project stra-tegic pillar, which takes on a strategic role for the organisation through the:

• Reorganisation of the healthcare provision according to clinical conditions/pathologies in integrated care units (IPU – Integrated Practices Units);

• Measurement of Outcomes (clinical outcomes and quality of life);

• Integrated Healthcare Provision Systems (multi-site);

• Dissemination of the methodology to boost excellence in the provision of care;

• Provision of information and knowledge technology platforms.

Each project requires the involvement of multidisciplinary teams which define and implement the standard sets and analyse, in an integrated way, the clinical and management information.

The use of multidisciplinary teams in the measurement of outcomes enables the cross-cutting reorganisation of the healthcare provision based on the diseases, reinforcing a vision centred on the patients and their clinical journey, enabling increasingly informed decisions by physicians and patients.

The identification of limitations and the introduction of improvements are closely dependent on the measurement processes, with José de Mello Saúde paying special attention to perfecting methodologies capable of measuring the quality of the healthcare services provided from the patient’s perspective.

In 2017, and in partnership with The International Consortium for Health Outcomes Measurement (ICHOM), José de Mello Saúde consolidated the processes of monitoring clinical outcomes in cataracts, breast cancer and knee osteoarthritis. The measurement of these diseases occurred at the CUF Descobertas Hospital in 2016 and 2017, with the cataract’s value measurement extended to the CUF Infante Santo and Cascais hospitals. In addition to the collection of clinical information, we opted for the collection of information reported by the patient based on validated measurement tools (PROMs – Patient Reported Outcome Measures).

In November 2017, the first internal analysis of the obtained results was completed:

a) The study included 840 episodes spread out across the entire network. In the benchmarking analysis, only the 418 episodes of the CUF Descobertas unit with completed pre and postoperative forms were considered. The analysis took place between 2016 and September 2017.

b) Considering that the global postoperative score has a projected improvement in 90% of the cases in comparison with the pre-operative one (ICHOM Cataracts Data Collection Reference Guide Version 2.0.1.), the result of José de Mello Saúde is very satisfactory, according to the complexity of the treated patients (the value of the average global pre-surgery score in JMS is lower than the ICHOM’s reference value adjusted to risk, but the value of the average global postoperative score proved to be better than the corresponding value indicated by the ICHOM).

c) Star rating for quality in four of the six dimensions evaluated by the ICHOM-GLOBE International Benchmarking. This classification honours the providers with evaluations above expected in the six variables under analysis.

Measurement of Outcomes for Cataract Surgery

Patients(a) Patients Reported Improvements(b)

(Tracked via Catquest 9-SF)Star rating according to results

above expectations in 4 of the 6 evaluated dimensions(c)

418 87%

Value-Based Healthcare Programme – Improving of the Quality of Care

Measurement of Clinical Outcomes

4/6


82%

86%

99%

76%

113

104

The internal validation of the measurement of outcomes for cataract surgery was tracked by the international approval of the results through the ICHOM-GLOBE International Benchmarking. The first preliminary reports of the ICHOM confirm the clinical management model of José de Mello Saúde, since they put the group in the cat-egory of excellence in healthcare provision at the global level.

Currently, the Value-Based Healthcare Programme applied to the Cataract is implemented in the CUF Descobertas, CUF Infante Santo and CUF Cascais hospitals.

Measurement of Outcomes for Knee Osteoarthritis

Measurement of Outcomes for Breast Cancer

a) Patients with invasive ductal carcinoma and in-situ ductal carcinoma were included in the analysis, carried out between November 2016 and November 2017.b) Until September 2017, 99% of the patients cooperated in the completion of the questionnaires.c) According to the ICHOM Standard Set for breast cancer, eight dimensions were studied: pain, fatigue, arm and breast symptoms, vasomotor symptoms, physical

image, sexual dysfunction and vaginal symptoms, neuropathy and arthralgia. Following the guidelines of the ICHOM, instruments of measurement in health were applied: EORT-C30, EORT-BR23, EORT-LMC21 and FACT-ES. In a universe of 113 patients, it was possible to track the PROMs of 41 patients six months after surgery (representative of 100% of the follow-up cases to monitor).

a) Between January 2017 and November 2017, 85 of the initial 104 patients were analysed, since only these presented the necessary parameters (completed general patient form, KOOS form and SF-12 form). After three months, the number of patients that could be managed with PROMs was 62.

b) Compared to the baseline, 76% of patients reported an improvement in physical function and 86% reported an improvement in terms of mental health. We must also mention that the results were obtained through the PCS and MCS subdomains of the SF-12, six months after the date of surgery, contrary to what is recommended by the ICHOM, which provides for the follow-up to take place a year after surgery. Thus, it is to be expected that after one year, the percentage of patients who report physical and mental improvements exceeds 76% and 86%, respectively.

It is expected that the measurement of clinical outcomes will be applied to new pathologies and in other hospitals of José de Mello Saúde. It will also be important to ensure a constant validation of the information needed for use in internal management, inclusion in studies and evidence of clinical excellence.

Patients(a)

Patients(a)

Collaboration of the Patients(b)

Patients Reported Improvements in Terms of Physical Function(b)

(PCS Tracked via SF-12)

Patients Reported Improvements in Terms of Pain and Fatigue 6 months After Surgery(c)

(Rastreado via EORT-C30)

Patients Reported Improvements in Terms of Mental Function(b)

(MCS Tracked via SF-12)



SHEETS FROM THE UNITS

Performance assessment methodology based on the comparison of performance with standard values, in which a better performance will have values between 0 and 1.

Structure

SINAS

Patient safety

Quality indicators

Complexity

1st level of evaluation

Indicator

Overall

2nd level of evaluation

145

22,73%

0,22

0,90

67%

0,63

8

0,02%

0,90

67

92,27%

0,73

Inpatient beds (total)

Clinical Excellence

Type of incident (%):(Medication/Intravenous fluids)

AAPDI

Case mix index

User focus

Overall rate of hand sanitising

RARI

Operating theatres

Patient safety

Patient falls (%)

RAMI

User satisfaction

Consultation rooms

Comfort of facilities

Safe surgery (%)

RACI

-

Medication/Intravenous fluids, most common type of incident

3+

WHO/DGS rating: Satisfactory

3+

Number of patient falls per 100 days of hospitalisation

A iniciar avaliação

3+

Completed surgical safety checklists rate


CUF Infante Santo Hospital, inaugurated in 1945 and, at the time, named CUF Hospital, was the founding unit of José de Mello Saúde. Today, it is a reference hospital in the country in terms of healthcare provision, with a broad and complete hospital service offering. With a profile of enormous hospital complexity, it responds with remarkable clinical performance, observable in the clinical quality and safety results. In 2017, the measurement of clinical outcomes began for cataract disease. It is still an exemplary unit in the development of Teaching and Research activities, a focus of José de Mello Saúde in coordination with the College of Medical Sciences of Uni-versidade Nova de Lisboa.




Structure

SINAS

Patient safety

Quality indicators

Complexity


Indicator

Overall


172

23,08%

0,36

0,64

71%

0,63

11

0,08%

0,66

72

98,74%

0,73


Clinical excellence


AAPDI

Case mix index

User focus


RARI

Operating theatres

Patient safety

Patient falls (%)

RAMI

User satisfaction

Consultation rooms


Safe surgery (%)

RACI

Hip and Knee Replacement: 3+


3+


3+


Starting evaluation

3+



Inaugurated in 2001, CUF Descobertas Hospital is one of the most modern hospital units in Portugal. With a wide range of services, it has a strong orthopaedic capability, which harbours clinical centres and specialised clinical pathways, with international reputation. This unit offers most medical and surgical specialties, having a case mix explained by the profile of some specialties, such as obstetrics, paediatrics and ophthalmology.

In 2017, it presented excellent quality and clinical safety results expressed in the multiple evaluation indicators, with an emphasis on the classification of 3+ in outpatient surgery, in the dimension of Clinical Excellence of the SINAS evaluation. It consolidated the measuring of clinical outcomes for cataract diseases, breast cancer and knee osteoarthritis.




The inauguration of CUF Porto Hospital, in June 2010, represented an important milestone in private healthcare in the North of the country, ensuring a broad offering of medical and surgical specialties and permanent adult and paediatric care. This unit stands out for the performance in all areas of assessment of quality and patient safety, namely by the 3+ rating in the area of Outpatient Surgery, in the dimension of Clinical Excellence of the SINAS evaluation.


Structure

SINAS

Patient safety

Quality indicators

Complexity


Indicator

Overall


154

23,12%

0,15

0,72

75%

0,57

12

0,12%

0,89

73

98,01%

0,66


Clinical excellence


AAPDI

Case mix index

User focus


RARI

Operating theatres

Patient safety

Patient falls (%)

RAMI

User satisfaction

Consultation rooms


Safe surgery (%)

RACI

Outpatient surgery: 3+


3+


3+


Starting evaluation

3+

Rate of complete surgical safety checklists

CUF Porto Hospital

CUF Porto Hospital


CUF Cascais Hospital, running since 2008, offers inpatient care, a versatile intermediate care unit, permanent adult and paediatric care, and a wide range of diagnostics solutions. We should emphasise the positive results obtained in the different areas of clinical quality and safety, including the rating of 3+ in the area of Outpatient Surgery, in the dimension of Clinical Excellence of the SINAS evaluation. In 2017, the measurement of clinical outcomes began for cataract disease.


Structure

SINAS

Patient safety

Quality indicators

Complexity


Indicator

Overall


30

28,09%

0,11

0,73

82%

0,51

3

0,08%

0,52

44

99,12%

0,87


Clinical excellence

Type of incident (%):(Clinical process/procedure)

AAPDI

Case mix index

User focus


RARI

Operating theatres

Patient safety

Patient falls (%)

RAMI

User satisfaction

Consultation rooms


Safe surgery (%)

RACI


Clinical Process/Procedure; most common type of incident.

3+

WHO/DGS rating: Very satisfactory

3+


Starting evaluation

3+






With an offering of inpatient care and permanent adult and paediatric care, CUF Torres Vedras Hospital started its activity in 2008. It has a wide range of specialties, with Orthopaedics and General Surgery being key. It shows good clinical performances in the areas of quality and patient safety, with an emphasis to the rating of 3+ in the area of Outpatient Surgery in the dimension of Clinical Excellence of the SINAS.


Structure

SINAS

Patient safety

Quality indicators

Complexity


Indicator

Overall


16

30,59%

0,06

0,70

74%

0,34

3

0,05%

0,29

28

99,64%

0,73


Clinical excellence

Type of incident (%):(Management of the patient journey)

AAPDI

Case mix index

User focus


RARI

Operating theatres

Patient safety

Patient falls (%)

RAMI

User satisfaction

Consultation rooms


Safe surgery (%)

RACI


Management of the Patient Journey; most common type of incident.

3+


3+


Starting evaluation

2+





CUF Santarém Hospital was inaugurated in 2015, framed in the strategy of growth and geographic expansion of José de Mello Saúde, featuring a broad offer of medical and surgical specialties from the start. In 2017, it re-inforced its culture of quality and patient safety via the external evaluation by the ERS in certain SINAS areas. It participated in the IAmetrics’s clinical indicators benchmarking programme, thus submitting to an evaluation of its performances, by comparison, in the dimensions of clinical efficiency and quality, and in which it obtained results with positive contributions and which reflect its good performance.


Structure

SINAS

Segurança do Doente

Quality indicators

Complexity


Indicator

Overall


26

57,66%

0,11

0,81

51%

0,36

3

0,13%

0,46

18

99,21%

0,44


Clinical excellence

Type of incident (%):(Management of the patient journey)

AAPDI

Case mix index

User focus


RARI

Operating theatres

Patient safety

Patient falls (%)

RAMI

User satisfaction

Consultation rooms


Safe surgery (%)

RACI

-

Management of the Patient Journey; most common type of incident.

3+


3+


Starting evaluation

2+






Open since 2016, CUF Viseu Hospital has a broad offering of medical and surgical specialties, complementary means of diagnosis and specialty examinations, thus contributing to the improvement of access to healthcare in the region. It immediately followed the culture of quality and patient safety inherent to all of José de Mello Saúde’s network of units.

In 2017, it was subjected to an external evaluation by the ERS in certain SINAS areas and started the process of codifying all inpatient care (medical and surgical) and outpatient surgery events, submitting to the evaluation of performance by the IAmetrics clinical benchmarking programme, having obtained positive results.


Structure

SINAS

Patient safety

Quality indicators

Complexity


Indicator

Overall


32

23,01%

0,21

0,79

74%

0,29

5

0,16%

0,48

34

99,80%

0,71


Clinical excellence


AAPDI

Case mix index

User focus


RARI

Operating theatres

Patient safety

Patient falls (%)

RAMI

User satisfaction

Consultation rooms


Safe surgery (%)

RACI

--


3+


3+


Starting evaluation

3+


CUF Viseu Hospital

CUF Viseu Hospital


Braga Hospital is a Portuguese National Health Service facility which has been managed by José de Mello Saúde, under a public-private partnership, since 2009. A teaching hospital, with a strong undergraduate medical training activity, it has a strong partnership with the School of Health Sciences of the University of Minho. It has most of the medical and surgical specialties, achieving good performance results in the multiple areas of clinical quality. Braga Hospital is the best ranked in the SINAS evaluation, with the maximum rating of clinical excellence (3+) in five specialties: Outpatient Surgery, Intensive Care: ICU, General Care: Venous Thromboembolism in Inpatient Care, Neurology: Cerebrovascular Accident (CVA), Obstetrics: Births and prenatal care.

Structure

SINAS

Patient safety

1st level of evaluation 2nd level of evaluation

655

39,05%

83,5%

25

0,13%

126

86,7%

Braga Hospital

Clinical excellence

Type of incident (%):(Patient falls)

User focus


Operating theatres

Patient safety

Patient falls (%)

User satisfaction

Consultation rooms


Safe surgery (%)

5 Specialties with rating of: 3+

Patient falls, most common type of incident.

3+


3+

B17 management contract indicator: falls in inpatient care per 100 days

Starting evaluation

3+


Braga Hospital

Braga Hospital



Vila Franca de Xira Hospital is the second unit in the Portuguese National Health Service managed by José de Mello Saúde in a public-private partnership since June 2011. Operating in new facilities since 2014, it ensures the provision of healthcare services with excellence. Committed to a culture of quality and safety for the patient, Vila Franca de Xira Hospital systematically and periodically tracks evaluation indicators for the different areas, having recorded good performances. In the SINAS evaluation, it obtained, in 2017, the maximum level of clinical excel-lence (3+) in four specialties: Outpatient Surgery, Intensive Care: ICU, Gynaecology: Hysterectomies, Neurology: Cerebrovascular Accident, Obstetrics: Deliveries and Prenatal Care, Orthopaedics: Hip and knee replacement and surgical correction of proximal fracture of the femur.


Structure

SINAS

Starting evaluation

1st level of evaluation 2nd level of evaluation

313

32,80

79,6%

16

0,10%

33

100%


Clinical excellence

Incidence by type (%):(Patient falls)

User focus


Operating theatres

Patient safety

Patient falls (%)

User satisfaction

Consultation rooms


Safe surgery (%)

4 Specialties with rating of: 3+

Patient falls, most common type of incident.

3+


3+

B17 management contract indicator: falls in inpatient care per 100 days

Starting evaluation

3+




GLOSSARY

Healthcare provision at all José de Mello Saúde facilities is classified and grouped into Homogeneous Diagnostic Groups (HDGs), a classification system used for inpatients in acute hospitals that groups patients into clinically coherent and similar groups from the point of view of the consumption of resources.

The Major Diagnostic Categories (MDC) correspond to an organic system or aetiology, usually associated with a particular medical specialty, and constitute the first step in grouping episodes of Homogeneous Diagnostic Groups (HDGs) and are carried out according to the main diagnosis.

The HDGs are grouped on the basis of the coding of diagnoses, co-morbidities and procedures identified during treatment. Other factors that may influence HDGs are, for example, the patient’s age or, in the case of new-born infants, their weight at birth.

In the PPP facilities (i.e. Public-Private Partnerships) – Braga Hospital and Vila Franca de Xira Hospital – the HDGs form the basis of the contractual relationship. In the private units, the HDGs are the basis for the clinical govern-ance system, ensuring the management and control of quality indicators. At these facilities, the task of clinical coding is carried out by a team of 12 encoding doctors and one auditor.

An overall production weighting coefficient which reflects the relativity of any given hospital against others in terms of their greater or lesser proportion of patients with complex pathologies and, consequently, higher con-sumption of resources.

The index is determined by calculating the ratio between the number of equivalent patients weighted by the relative weights of the respective HDGs and the total number of equivalent patients.

Risk-adjusted mortality, complications and readmissions rate, i.e. the actual recorded rate weighted by the indi-vidual probability of each episode happening, taking into account a number of previously established indicators.

CASE MIX INDEX

IAMETRICS INDICES

CLINICAL CODING (HDGs)


Sustainability Report 20172

INTRODUCTIONThis document concerns the seventh annual edition of José de Mello Saúde Sustainability Report for the fiscal year ended on 31 December 2017, and is an integral part of the 2017 Integrated Report.

It is intended to provide detailed information to the stakeholders of José de Mello Saúde, concerning the economic, social and environmental performance of the company in its material topics. This report should be read in conjunction with the information concerning value creation conveyed by the Integrated Report.

José de Mello Saúde has been defining a set of management guidelines (DMA) of its material sustainability topics whose results are reported by a set of indicators in accordance with GRI Standards.

Material Topics Management approach (DMA)


Involvement withthe community

Attraction and retention of talent

Innovation

José de Mello Saúde carries out its activity based on the maintenance of a capital structure that is solid and suitable to the growth strategy of José de Mello Saúde, through an active management of the debt profile, concerning the diversification of the finance sources as well as the extension of their maturity.

José de Mello Saúde maximises the social impact of its activity, by investing in communities where its healthcare units are located, creating relationships of trust and positioning itself as a partner for local health.

By the nature of its business, José de Mello Saúde believes that employees are a key element in realising its vision, systematically promoting the identification, evaluation, development and retention of its employees, with the intention of being recognised as one of the best companies to work for in Portugal.

Innovation is one of the values of José de Mello Saúde, being seen as an essential asset to maintain a competitive offer and explore new solutions that generate value and differentiation for José de Mello Saúde’s customers and professionals. Starting from the five strategic pillars of the Organisation, several activities are promoted in terms of fostering incremental, planned, exploratory and scientific activity innovation.

Sustainability Report 2017 3

Material Topics Management approach (DMA)

Eco-efficiency

Ethics and transparency in the value chain

Quality of healthcare services

José de Mello Saúde invests in the minimisation of the environmental impact associated with its activity, seeking to assert itself as a reference operator in this area. The improvement of the environmental footprint of José de Mello Saúde is focused on the field of eco-efficiency of the energy consumption of its hospital buildings.

José de Mello Saúde recognises the importance of its suppliers in the business of providing healthcare. In addition to requiring maximum quality and safety from its suppliers, José de Mello Saúde considers it essential that they have and promote principles of ethics, transparency and respect for society.

José de Mello Saúde believes that clinical quality is the core element of its value proposition, and remains focused on highlighting its clinical outcomes by participating in evaluation and external recognition systems.



GRI TABLEGRI INDICATOR

STRATEGY AND ANALYSIS

ORGANISATIONAL PROFILE

Message from the Chairman

Main impacts, risks and opportunities

Name of the organisation

Main products and services

Location of the organisation’s headquarters

Nature of ownership and legal form of the organisation.

Markets in which the Organisation operates

Size of the organisation

Total number of employees per type of job, employment contract, gender and region.

Number of countries where the organisation operates, and names of countries where either the organisation has significant operations or that are specifically relevant to the sustainability topics covered in the report.

-

-

-

-

-

-

-

-

-

102-14

102-15

102-1

102-2

102-3

102-5

102-6

102-7

102-8

102-4

2017 Integrated Report: 2. Message from the Chairman

2017 Integrated Report:5. Strategy, achievements and goals;8. Risk Management, Main Risks and Uncertainty.

2017 Integrated Report:Report Profile

2017 Integrated Report:1. About José de Mello Saúde

2017 Integrated Report:Report Profile




Male 1.713

319

96

1.298

117

1.596

1.223

373

4.789

345

6.040

Fixed Term 1.542

469

6.087

462

7.636

Indefinite Term

Open-ended Contract

Part-Time

Full-Time

Female 6.385

Female

Female

Male

Male

Male

Male

Male

Female

Female

Female

Total Number of Employees 8.098

8.098Total Employees per type of contract


LOCATION SDG

North 3.494

South 4.604

Male 802

Male 911

Female 2.692

Female 3.693

Total employees per region and gender 8.098


GRI INDICATOR

Percentage of employees covered by collective employment agreements

List of all entities included in the organisation’s consolidated financial statements or equivalent documents.

Process adopted for the definition of the report’s content and limits of the Aspects

Approach to the principle of precaution.

Supplier chain of the organisation

Significant changes during the reporting period regarding the organisation’s size, structure, shareholding, or its supply chain.

Charters, principles or other externally developed economic, environmental and social initiatives that our organisation subscribes to or which it endorses.

Main memberships in sector organisations

-

-

-

-

-

-

-

102-41

102-45

102-46

102-11

102-9

102-10

102-12

102-13

There are no collective negotiation agreements.

2017 Financial Statements Report

2017 Integrated Report:Report Profile and indicator 102-47

2017 Integrated Report:7. Risk management, main risks and uncertainties.


2017 Integrated Report:5. Strategy, achievements and goals.

José de Mello Saúde is a member of the BCSD Portugal – Business Council for Sustainable Development, the largest national business organisation dedicated to sustainability, with more than 100 global companies engaged in promoting sustainable development and of GRACE – Grupo de Apoio e Reflexão à Cidadania Empresarial (Support and Reflection Group for Corporate Citizenship), dedicated to the promotion of Corporate Social Responsibility.

Considering that the companies have a contribution to the achievement of the Sustainable Development Goals of the United Nations, JMS carried out an exercise to identify the SDG that it considers priorities given their impact potential due to the organisation’s specific activity (see section 1.5 in the 2017 Integrated Report).

More information on external accreditations of José de Mello Saúde units can be found in “Clinical performance”.

Portuguese Association of Private Hospitals (Associação Portuguesa de Hospitalização Privada – APHP) – The Portuguese Association of Private Hospitals (Associação Portuguesa de Hospitalização Privada – APHP) is a non-profit, apolitical and secular organisation, that, since 1974, has represented the interests and values of private Portuguese healthcare units. It advocates the creation of a healthcare system that assumes characteristics of plurality of supply, competitiveness, efficiency and freedom of choice of healthcare unit. That is, a Guarantee by the State with the market’s intervention. More information at: http://www.aphp-pt.org/

The Health Cluster Portugal - has as its main objective the promotion and performance of initiatives and activities designed to consolidate a national hub for competitiveness, innovation and technology with an international outlook and, moreover, bearing in mind requirements of quality and professionalism, to promote and encourage cooperation between companies, organisation, universities and public authorities, with a view to increasing their turnover, exports and qualified employment in economic areas related to the health sector, and the improvement of healthcare provision. For more information: http://healthportugal.com/ National Strategic Health Council - (Conselho Estratégico Nacional de Saúde) – Business Confederation of Portugal (Confederação Empresarial de Portugal – CIP) – is a CIP advisory body whose aim is to prepare recommendations and opinions on matters of interest to the healthcare area,

LOCATION SDG



GRI INDICATOR

IDENTIFIED MATERIAL ASPECTS AND LIMITS

List of the material aspects identified in the process of defining the report’s content

List of the organisation’s stakeholder groups

Basis for identification and selection of stakeholders

Type of approach adopted to involve stakeholders, including the frequency of involvement per stakeholder type and group

Key topics and concerns identified by the stakeholders as a result of the involvement process and measures adopted by the organisation to handle them

Reformulation of information provided in previous reports, and the reasons for such reformulations.

Significant changes in relation to previous reporting periods in the scope and aspect boundaries.

-

-

-

-

-

-

-

102-47

102-40

102-42

102-43

102-44

102-48

102-49

In 2017, José de Mello Saúde revisited the materiality analysis that cross-checked three facets – consultation with stakeholders, peer benchmark and analysis of trends in the healthcare sector, later subjected to discussion by the senior management.

More information on this topic can be found in the Integrated Report, in chapter 1.4. Dialogue with stakeholders

2017 Integrated Report:1.4 Dialogue with stakeholders




José de Mello Saúde carried out satisfaction surveys with customers weekly, through an independent platform that sends an e-mail to a sample of customers who visited the units the prior week.

The survey includes the Net Promoter Score, Secure Costumer Index, questions about the Cuidar+ programme (human relationship) and priority areas concerning the customer experience.The results of 2017 have an average value of 84%:

2017 Integrated Report – Report Profile

2017 Integrated Report – Report ProfileIn 2017, José de Mello Saúde inaugurated CUF São João da Madeira and acquired the Private Clinic of Coimbra.

LOCATION SDG

STAKEHOLDER ENGAGEMENT

-2%

9%

0%

-3%

-1%

84%

86%

83%

84%

84%

85%

79%

83%

86%

85%

CCA

CCS

HCC

HCTV

HCS

n/a

0%

-2%

-1%

2%

84%

83%

85%

84%

85%

n/a

83%

87%

85%

84%

CCAL

CCSDR

CCM

HCD

HCV

-1%

n/a

-1%

-8%

0%

-3%

-1%

85%

87%

87%

84%

83%

84%

84%

85%

n/a

86%

91%

85%

87%

85%

CCB

CCSJM

HCP

CCMF

HCIS

ICDT

CUF

2016

Overall Satisfaction

2017 %


REPORT PROFILE

GOVERNANCE

ETHICS AND INTEGRITY

GRI INDICATOR

Period covered by the report

Date of the most recent previous report

Composition of the Board of Directors and of its committees

Reporting cycle.

Contacts for questions regarding the report or its contents.

Option “agreed” chosen by the organisation and respective GRI content index

Governance structure of the organisation, including committees at the highest level of governance responsible for specific tasks, such as setting strategy or organisational oversight

Organisation’s values, principles, standards and norms of behaviour, such as codes of conduct and ethics

Chairman of the Board of Directors is also an executive officer (and, in that event, his or her function within the organisation’s management and the reasons for this arrangement).

Processes for consultation between stakeholders and the highest governance body on economic, environmental and social topics. If consultation is delegated, describe to whom and any feedback processes to the highest governance body

Current policy and practice adopted by the organisation to submit the report to external assurance

-

-

-

-

-

-

-

-

102-50

102-51

102-22

102-52

102-53

102-54

102-18

102-16

102-23

102-19

102-56

2017 Integrated Report: Report Profile


2017 Integrated Report - Corporate Governance:1. Governance Model.



In 2017, the transition to GRI Standards was carried out for the option “Agreed-Essential”, with the respective correspondence found on this table. The indicators presented in this report refer to the companies whose management is controlled by José de Mello Saúde.

2017 Integrated Report - Corporate Governance:1. Governance Model;2. Make-up and powers of the governing and supervisory bodies

2017 Integrated Report:1. About José de Mello Saúde.Corporate Governance: 2. Make-up and powers of the governing and supervisory bodies

2017 Integrated Report - Corporate Governance:1. Governance Model.2. Make-up and powers of the governing and supervisory bodies


The information in the report, whether from measurements, calculations or estimates, has undergone an external assurance by an independent entity, PricewaterhouseCoopers & Associados – Sociedade de Revisores Oficiais de Contas, Lda. This document ends with the statement of assurance issued by this firm.

LOCATION SDG



GRI INDICATOR

MATERIAL TOPIC: FINANCIAL SUSTAINABILITYForm of Management (103): 103-1) 2017 Integrated Report - 1.4. Dialogue with stakeholders103-2 e 103-3) 2017 Sustainability Report – Introduction; 2017 Integrated Report – 1.2 José de Mello Saúde in figures; 8.1 Economic performance

MATERIAL TOPIC: ETHICS AND VALUE CHAINForm of Management (103): 103-1) 2017 Integrated Report - 1.4. Dialogue with stakeholders103-2 e 103-3) 2017 Sustainability Report – Introduction

ASPECT: ECONOMIC PERFORMANCE

ASPECT: PROCUREMENT PRACTICES

Direct economic value generated and distributed

Proportion of expenditures with local suppliers

201-1

204-1

2017 Sustainability Report.

2017 Sustainability Report

LOCATION SDG

Financial implications and other risks and opportunities for the organisation due to climate change

Coverage of the Obligations concerning the plan of benefits defined by the organisation

Significant financial benefits received from the Government

-

-

201-2

201-3

201-4




Ratios of standard entry level wage by gender compared to local minimum wage in the most significant locations of operation

Proportion of senior management hired from the local community at significant locations of operation

202-1

202-2



ASPECT: MARKET PRESENCE

New suppliers evaluated according to social criteria

Negative social impacts in the supply chain and actions taken

414-1

414-2



ASPECT: SOCIAL EVALUATION OF SUPPLIERS


GRI INDICATOR

MATERIAL TOPIC: ECO-EFFICIENCYForm of Management (103): 103-1) Integrated Report - 1.4. Dialogue with stakeholders103-2 e 103-3) 2017 Sustainability Report – Introduction; 2017 Integrated Report – 1.2 José de Mello Saúde in figures; 8.4 Environmental performance

ASPECT: MATERIALS

Used materials according to weight or volume

Percentage of used materials that are recycled

301-1

301-2



LOCATION SDG

ASPECT: ENERGY

ASPECT: WATER

Energy consumption within the organisation

Total water consumption segmented by source

Water sources significantly affected by water consumption

Energy intensity

Reduction of energy consumption

Percentage and total volume of water recycled and reused

302-1

303-1

303-2

302-3

302-4

303-3









GRI INDICATOR

ASPECT: EMISSIONS

Direct GHG emissions (Scope 1)

Indirect GHG emissions (Scope 2)

Indirect GHG emissions (scope 3)

Carbon intensity

Initiatives to reduce GHG emissions and recorded reductions

NOx, SOx, and other significant air emissions by type and by weight

Emissions of ozone-depleting substances by weight

305-1

305-2

305-3

305-4

305-5

305-7

305-6








LOCATION SDG


GRI INDICATOR

ASPECT: EFFLUENTS AND WASTE

Water discharges by quality and destination

Total waste by type, destination and disposal method

306-1

306-2



LOCATION SDG

MATERIAL TOPIC: ATTRACTION AND RETENTION OF TALENTForm of Management (103): 103-1) 2017 Integrated Report - 1.4. Dialogue with stakeholders 103-2 e 103-3) 2017 Sustainability Report – Introduction; 2017 Integrated Report – 1.2 José de Mello Saúde in figures; 8.3 Social performance

ASPECT: EMPLOYMENT

Total number and rates of new employee hires and employee turnover by age group, gender and region

Return to work and retention rates after parental leave, by gender

Benefits provided to full-time employees that are not provided to temporary or part-time employees, by significant operating units

401-1

401-3

401-2




ASPECT: OCCUPATIONAL SAFETY AND HEALTH

Workers represented in safety committees that help to monitor and advise on health and safety programmes

Health and safety topics covered in formal agreements with trade unions

Type of injury and rates of injury, occupational diseases, lost days, absenteeism, and total number of work-related fatalities, by region and by gender

403-1

403-4

403-2






GRI INDICATOR

ASPECT: TRAINING AND EDUCATION

Average hours of training per year, per employee, by gender, and by category

Percentage of employees who regularly receive performance reviews

404-1

404-3



LOCATION SDG

Composition of the governance bodies and breakdown of employees per category, according to gender, age group, minority group membership and other diversity indicators

Ratio of base salary and remuneration of women and men by employee category and by significant operation units

405-1

405-2



ASPECT: DIVERSITY AND EQUAL OPPORTUNITIES

MATERIAL TOPIC: INVOLVEMENT WITH THE COMMUNITYForm of Management (103): 103-1) Integrated Report - 1.4. Dialogue with stakeholders103-2 e 103-3) 2017 Sustainability Report – Introduction; 2017 Integrated Report – 1.2 José de Mello Saúde in figures; 8.3 Social performance

ASPECT: INDIRECT ECONOMIC IMPACTS

Development and impact of the investments in infrastructure and supported services

Indirect economic impacts, including the extent of the impacts

203-1

203-2



Operations with the local community, impact assessments and development programmes

Operations with significant actual and potential negative impacts on the local communities

-413-1

413-2



ASPECT: LOCAL COMMUNITIES


GRI INDICATOR

ASPECT: SOCIO-ECONOMIC COMPLIANCE

Monetary value of significant fines and non-pecuniary sanctions for non-compliance with laws and regulations in the economic and social area

419-1 2017 Sustainability Report

LOCATION SDG

MATERIAL TOPIC: QUALITY OF THE HEALTHCARE SERVICESForm of Management (103): 103-1) 2017 Integrated Report - 1.4. Dialogue with stakeholders 103-2 e 103-3) 2017 Sustainability Report – Introduction; 2017 Integrated Report – 1.2 José de Mello Saúde in figures; 8.2 Clinical performance

ASPECT: CUSTOMER HEALTH AND SAFETY

ASPECT: LABELLING AND MARKETING

ASPECT: CUSTOMER PRIVACY

Evaluation of the health and safety impacts of the products and services categories

Information and labelling requirements of products and services

Total number of substantiated complaints regarding breaches of customer privacy and losses of customer data

Events of non-compliance related to information and labelling of products and services

Incidents of non-compliance related with health and safety impacts caused by the products and services

-416-1

417-1

418-1

417-2

416-2









Aspect: Economic Performance

Aspect: Market presence

201-1 Direct economic value generated and distributed (Millions of euros)

201-2 Financial implications and other risks and opportunities related to climate changeJosé de Mello Saúde believes that its operations have little exposure to this risk and does not have enough information to describe the financial implications and other risks and opportunities for its activities arising from climate change.

201-3 Coverage of the Obligations concerning the plan of benefits defined by the organisationJosé de Mello Saúde does not have a pension plan.

201-4 Significant financial benefits received from the GovernmentJosé de Mello Saúde did not receive any significant financial support from the government during the 2017 financial year.

202-1 Ratios of standard entry level wage by gender compared to local minimum wage in the most significant locations of operationSince there is a wide range of working hours in José de Mello Saúde, only the three most representative working hours in the existing workforce (35, 36, 40 hours) and the following working arrangements: “mixed regime”; “permanent”; “contract staff” and “public servants” were considered for the calculation of this indicator.

ECONOMIC CATEGORY

Direct economic value generated

Gender

586,2637,4

Revenues

Lowest wage in the organisation

Remunerations

Communities

586,2

557557501,3501,3487,4487,4

637,4

Direct economic value distributed

NMW adjusted for the normal period

Ratio

Dividends

Operating Costs

550,3

557557501,3501,3487,4487,4

1,001,001,001,001,001,00

618,1

Payments to the Government

Direct economic value retained

184,6

11,4

21,0

0,0

333,3

35,9

202,6

22,8

31,8

0,0

363,1

19,6

2016

Working hours 35

Female FemaleMale Male

36 40

2017

Female Male

GRI IndicatorsAll of the GRI Standards indicators were subjected to external assurance. The generic management forms of the indicators can be consulted through the DMAs in the introduction of this document, as well as through the information indexed in the GRI Table.



We conclude from the analysis that for the most representative working hours, the minimum wage earned corresponds to the national minimum wage (NMW), taking as a reference a normal working week of 40 hours.

Formulas:

The calculation of the national minimum wage (NMW) is adjusted for normal period of work (NPW), according to Article 271 of the labour code.

Calculation of the hourly rates: The hourly rates are calculated according to the following formula: (Rm × 12): (52 × n), where “Rm” is the monthly wage and “n” the normal working week, defined in average terms in case of adaptability.

202-2 – Percentage of senior management hired from the local community at significant locations of operationJosé de Mello Saúde does not practice any kind of discrimination in the choice of its employees, being prevented for legal reasons from engaging in any discrimination in the recruitment of new employees.

Aspect: Indirect Economic Impacts

Aspect: Procurement Practices

203-1 – Development and impact of the investments in infrastructure and services supplied essentially for the Public GoodBy the nature of its business, José de Mello Saúde believes that it has an indirect positive impact on the communities in which it has healthcare units.

In addition to the provision of healthcare services, José de Mello Saúde units promote an active involvement with the communities they serve. More information on these initiatives as well as results and amounts invested, can be found in the Integrated Report, in the “Social Development” chapter.

203-2 – Significant Indirect Economic Impacts, including the extent of the impactsJosé de Mello Saúde has no information on the assessment of the indirect economic impacts of its activity.

204-1 – Proportion of expenditures with local suppliers All suppliers (over 700) of José de Mello Saúde have Portuguese tax codes.


ENVIRONMENTAL CATEGORY

Aspect: Materials Used

301-1 – Materials used by weight or volumeJosé de Mello Saúde is a services company that does not perform manufacturing processes and that has a reduced consumption of natural resources and raw materials. Information on energy and water consumption can be found in the indicators EN3, EN4 and EN8.

301-2 – Percentage of materials used that are recycledIn the exercise of its activity as a healthcare provider, José de Mello Saúde does not use recycled materials.

Aspect: Energy

302-1 – Energy consumption within the organisation In 2017, the total energy consumption of José de Mello Saúde was 80,068,788 kWh: 63% concerns electricity consumption, 29% gas consumption and 9% of enthalpy, representing a decrease of 2% in comparison with 2016.



Natural Gas

Natural gas is the main energy source used in the air conditioning systems in the José de Mello Saúde units, and is mainly used for heating hot water, for the HVAC system, and for supplying the kitchens. The overall consumption of natural gas in 2017 was 22,873,520 kWh, which represented an absolute reduction of 11.2% in comparison with the previous year.

Braga Hospital continued to be the largest gas consumer amongst all José de Mello Saúde units, representing 42% of total consumption in 2017. Vila Franca de Xira Hospital increased, in comparison with the previous year, its percentage weight to 25% of total consumption as a result of the very significant consumption reduction in Braga Hospital with a considerable weight in overall performance.

The following chart shows the variation of gas consumption in the different group units:

Variation of Gas Consumption - 2017 (MWh)

Gas Consuption - 2017 (%)

0

2.000

2015

2016

2017

4.000

6.000

8.000

10.000 9.574

956 1.643

223

1.173956

201 24 830

1.648

5.645

12.000

14.000

16.000

18.000

2017

CUF Porto4%

Instituto CUF6%

CUF Descobertas1%

CUF Infante Santo5%

Hospital Vila Franca de Xira25%

CUF Cascais4%

CUF Torres Vedras1%

CUF Santarém4%

CUF Viseu7%

CUF S. João da Madeira0%

Hospital de Braga42%

Hos

pita

l de

Brag

a

CUF

Port

o

Inst

ituto

CU

F

CUF

Des

cobe

rtas

CUF

Infa

nte

Sant

oHo

spita

l Vila

Fra

nca

de X

ira

CUF

Casc

ais

CUF

S. J

oão

da M

adei

ra

CUF

Torr

es V

edra

s

CUF

Sant

arém

CUF

Vise

u


The following chart shows the variation of electricity consumption in the different group units:

Of note is the very significant consumption reduction in Braga Hospital, which contributed decisively to the overall improvement of this utility’s use. The calculation of these results enabled a 14.1% reduction in overall consumption compared to the previous year, for equivalent units and periods.

Electricity

Electricity is the main source of energy used in the José Mello Saúde’s units. The overall consumption of indirect primary energy in 2017 was 50,185,499 kWh.The largest electricity consumers in 2017 were Braga Hospital (28%) and Vila Franca Xira Hospital (17%).

Electricity Consuption - 2017 (MWh)

Variation of Electricity Consumption (MWh)

0

2.000

2015

20162017

4.000

6.000

8.000

10.000

13.791

6.664

4.965

8.467

2.233

3.194 3.906

692114 101

1.21569

2.073

215267 172 3171.086 501

146

12.000

14.000

16.000

CUF Porto13%

Instituto CUF6%

Hospital de Braga

27%

CUF Descobertas10%

CUF Infante Santo8%


Dif. Sede1%

CUF Alverca1%

CUF Cascais4%

CUF Torres Vedras2%

CUF Belém1%

CUF Alvalade1%

CUF Santarém2%

CUF Viseu4%

Contact Center, CUF Mafra, CUF S. João da Madeira, CUF Sintra, CUF SDR, CUF Miraflores 0%

2017

Hos

pita

l de

Brag

a

CUF

Port

oIn

stitu

to C

UF

CUF

Des

cobe

rtas

CUF

Infa

nte

Sant

oCU

F M

iraflo

res

CUF

Alm

ada

CUF

Casc

ais

Hosp

ital V

ila F

ranc

a de

Xira

CUF

S. D

om R

ana

CUF

Sint

raCU

F To

rres V

edra

s

CUF

Maf

raCU

F Be

lém

CUF

Alva

lade

CUF

Sant

arém

CUF

Vise

u

CUF

S. J

oão

da M

adei

ra

Cont

act C

ente

r

Edif.

Sed

e



In 2017, José de Mello Saúde started to include CUF Almada Clinic, CUF São João da Madeira Clinic and also its headquarters, in Carnaxide. The absolute increase in electricity consumption amounted to 4.3% in comparison with 2015. However, comparing the performance in equivalent conditions – identical periods of operation in the same units – there was a small reduction in the consumption values: -0.6% (-280,359 kWh).

Braga Hospital’s project of energy efficiency, developed between June 2014 and March 2017, which received the award of “Absolute Winner – Services and Other Activities” in the 10th edition of the EDP Prize, contributed to this effect. The project, representing an investment of over 1 million euros, ensured the implementation of seven major measures of energy saving, which will be detailed next.

In the remaining units, as a general rule, the levels of consumption were maintained through a balance between the savings measures and the intensification of the various units’ activity. The exception was the CUF Viseu Hospital, whose consumption corresponded to the whole of 2017, whereas the consumption from 2016 also reflected the period after the inauguration.

Enthalpy

Concerning enthalpy – usage of hot and cold water in the HVAC and Hot Water circuits, existing only in CUF Descobertas Hospital, in CUF Alvalade Clinic and in CUF Contact Centre – total consumption in 2017 was 7,009,769 kWh, with a significant decrease (-7.7%) in comparison with 2016.

The values of CUF Alvalade Clinic were obtained via estimation from its track record since the supplier did not bill any consumption in 2017 and, as such, 2016’s values were used.

Entalpia Consuption - 2017 (kWh)

0

2.000

2015

2016

2017

4.000

6.000

8.000

10.000

6.007

744 259

CUF Descobertas

CUF Alvalade

Contact center

12.000

14.000

Variation in Consumption - 2017 (kWh)

2017CUF Descobertas86%

CUF Alvalade11%

Contact Center4%


302-3 – Energy intensityThe energy intensity of José de Mello Saúde, in 2017, was 45.4 kgep/m2 of usable area. For the calculation of this indicator, we used the power, gas and heat consumed in the group as the numerator and, as denominator, the usable area air-conditioned according to the values calculated in the several units’ Energy Certificates. This figure shows a slight increase over the previous year, a result of the downward revision of some of the building’s usable areas.

Although other analyses of ratios are presented in this report, the usable area is the only common denominator to all units, so it was used in this analysis. It should also be noted that only the energy consumed within the organisation was considered.

302-4 – Reduction of energy consumptionJosé de Mello Saúde established a plan for the development and implementation of projects to improve the reduction of energy consumption and sustainability in its units. The following projects were the highlights of 2017:

1. Braga HospitalBraga Hospital won the 10th edition of the EDP Electricity and Environment Award, which seeks to distinguish Portuguese companies for good practices in the field of electrical efficiency and environmental sustainability. The award, “Absolute Winner – Services and Other Activities”, recognized the work developed by the Hospital as part of an energy efficiency project. The intervention in the building’s Centralised Technical Management stands out: fine-tuning of the algorithms governing the operation of the energy transport systems, with the integration of new significant variables, allowing them to be capable of modelling and adapting the working conditions to the system’s operating needs;

Other measures introduced under this project were the change of hydraulic circuits for installation of new equipment with higher energy efficiency, installation of CO2, temperature and humidity sensors that allow, among other functions, better use of energy by maintaining air quality and comfort in the different spaces of the building and the installation of energy recovery batteries that enable, for example, the reuse of the existing energy in the air extraction system.

All of these measures, added to the those already implemented in the previous year, enabled a reduction of over 26% in this hospital’s energy consumption in four years, which represents significant savings of energy, emissions and costs in this unit, which is the largest among those managed by the José de Mello Saúde group.

2. New ProjectsThe measures applied in all the above-mentioned facilities demonstrate the need for a bet on technologies suitable to the optimal operation of each building; it is, however, vitally important that the integration of these technologies begins from the buildings’ design phase. Due to this fact, in 2017 and continuing in the two-year period 2018-2019, the development of the projects for the Group’s future units and the expansions in the existing ones—such as CUF Tejo Hospital, CUF Sintra Hospital and the new buildings for expansion of CUF Descobertas and CUF Torres Vedras hospitals—has taken into account all the experience developed in this area to strengthen, not only in the short term, but also in the medium and long term, the commitment of José de Mello Saúde group to the sustainability of its buildings.

303-1 – Total water consumption segmented by sourceTotal water consumption in José de Mello Saúde units in 2017 was 363,927 m3, 4% more than in 2016. This evolution was due mainly to the increase in the number of healthcare units.

The units with the most weight were Braga Hospital (38%), Vila Franca de Xira Hospital (14%) and CUF Descobertas (13%).

Aspect: Water



The following chart shows the variation of water consumptions in the different units of the group:

Water Consumption - 2017 (m3)

Variation in Water Consumption (m3)

0

20.000

2015

2016

2017

40.000

60.000

80.000

100.000

136.856

37.437

46.195 50.007

17.61816.073

35.818

3.439 1.041 700

6.306232 2.381 1.4281.332 236 2.554

6.117

542

120.000

140.000

160.000

CUF Porto10%

Instituto CUF4%

CUF Descobertas13%

Hospital de Braga

37%

CUF Infante Santo10%


CUF Viseu1%

CUF Cascais5%

CUF Alvalade1%

CUF Santarém2%

Contact Center1%

2017

CUF Torres Vedras2%

CUF Mafra, CUF Belém, CUF Almada, CUF Sintra, CUF SDR, CUF Miraflores0%

Hos

pita

l de

Brag

a

CUF

Port

o

Inst

ituto

CU

FCU

F D

esco

bert

asCU

F In

fant

e Sa

nto

CUF

Mira

flore

sCU

F A

lmad

a

Hosp

ital V

ila F

ranc

a de

Xira

CUF

Casc

ais

CUF

Sint

raCU

F To

rres

Ved

ras

CUF

Maf

raCU

F Be

lém

CUF

Alv

alad

eCU

F Sa

ntar

ém

CUF

Vise

uCo

ntac

t Cen

ter

Edif.

Sed

e

CUF

S. D

omin

gos d

e Ra

na


Overall, there was a 4.1% increase in water consumption, for which there was a significant contribution from the full year of operation of the CUF Viseu unit, and also the accounting of CUF Almada and CUF São João Madeira, as well as the contribution from the increases in the largest units, related to their production increase, both in the number of hospitalization days and in the number of consultations carried out in 2017. The intensification of the maintenance actions in the cold and hot water networks, seeking to prevent microbiological development, contributed significantly to the aforementioned increase.

303-2 – Water sources significantly affected by water consumption

This indicator is not considered applicable to the activity of José de Mello Saúde.

303-3 – Volume total e percentagem de água reciclada e reutilizada

Braga Hospital and Vila Franca de Xira Hospital have reservoirs to which part of the volume of water collected in the rainwater collection system is re-routed. This same water is later used for irrigation. The reservoirs’ capacity, 170 m3 and 132 m3 respectively, enable roughly three days worth of irrigation water to be stored in summer time.

305-1 and 305-2 – Direct GHG emissions (Scope 1) and Indirect GHG emissions (Scope 2)

The global value of greenhouse gas emissions from José de Mello Saúde was 21,436 tCO2 in 2017, with a reduction of approximately 17% in comparison with the previous year, a reduction that is related to the strong reduction in the usage of fuel gas

CO2 Emissions (ton)

Aspect: Emissions

2017

CUF Descobertas11%

CUF Infante Santo7%


CUF Cascais4%

CUF Torres Vedras2%

CUF Porto11%

Instituto CUF6%


CUF Alvalade

1%

CUF Santarém

2%

CUF Viseu5%

CUF Almada1%

ED. Sede1%

Contact Center, CUF Miraflores, CUF Mafra, CUF Belém, CUF SDR, CUF Sintra, CUF S. João da Madeira

0%



CO2 Emissions - 2017 (ton)

The emission values indicated were determined based on total bills issued by providers, the coefficient for calculating CO2 equivalent emissions being supplied by the electricity companies and, in the case of gas and enthalpy consumption, by calculation using the emission factor indicated by the suppliers.

The chart above enables the contribution of each consumption to the total CO2 emissions in each unit to be calculated.

Variation in Emissions - 2017 (ton)

305-3 – Other significant indirect GHG emissions (Scope 3)

Business travel is mostly carried out in José de Mello Saúde’s fleet vehicles, accounted as direct emissions and being considered non-relevant, given their reduced expression, and are thus not considered within the scope of the answer to the indicator.

0

1.000

Entalpia

Gás

Electricidade

2.000

3.000

4.000

5.000

6.000

7.000

1.000

2015

20162017

2.000

3.000

4.000

5.000

6.300

2.376 2.243

3.816

889

1.354 1.502

22135 34

44311

990

9688 58 175509

16244

6.000

7.000

8.000

9.000

Hos

pita

l de

Brag

a

CUF

Port

oIn

stitu

to C

UF

CUF

Des

cobe

rtas

CUF

Infa

nte

Sant

oCU

F M

iraflo

res

CUF

Alm

ada

Hosp

ital V

ila F

ranc

a de

Xira

CUF

Casc

ais

CUF

Sint

raCU

F To

rres

Ved

ras

CUF

Maf

raCU

F Be

lém

CUF

Alv

alad

eCU

F Sa

ntar

ém

CUF

Vise

uCo

ntac

t Cen

ter

Edif.

Sed

e

CUF

S. J

oão

da M

adei

ra

CUF

S. D

omin

gos d

e Ra

na

Hos

pita

l de

Brag

a

CUF

Port

oIn

stitu

to C

UF

CUF

Des

cobe

rtas

CUF

Infa

nte

Sant

oCU

F M

iraflo

res

CUF

Alm

ada

Hosp

ital V

ila F

ranc

a de

Xira

CUF

Casc

ais

CUF

Sint

raCU

F To

rres

Ved

ras

CUF

Maf

raCU

F Be

lém

CUF

Alv

alad

eCU

F Sa

ntar

ém

CUF

Vise

uCo

ntac

t Cen

ter

Edif.

Sed

e

CUF

S. J

oão

da M

adei

ra

CUF

S. D

omin

gos d

e Ra

na


305-4 – Carbon intensity

The Carbon Intensity of José de Mello Saúde, in 2017, was 73.1 kgCO2/m2 of usable area. For the calculation of this indicator, we used the power, gas and heat consumed in the group as the numerator and, as denominator, the usable area air-conditioned according to the values calculated in the several units’ Energy Certificates. This number presents a significant decrease in comparison with 2016, resulting in a large part of the significant reduction of natural gas usage.

Although other analyses of ratios are presented in this report, the usable area is the only common denominator to all units, so it was used in this analysis. It should also be noted that only the energy consumed within the organisation was considered.

305-5 – Initiatives to reduce GHG emissions and recorded reductions

José de Mello Saúde has developed certain initiatives that have resulted in reduced greenhouse gas emissions (see response to indicator EN6) although it is not possible to estimate the total savings from these actions.

305-6 – Emissions of ozone-depleting substances by weight

This indicator is not considered to be applicable to the activity of José de Mello Saúde, since the organisation’s processes and services do not use substances that destroy the ozone layer.

305-7 – NOx, SOx, and other significant air emissions by type and by weight

The SOX value emitted by José de Mello Saúde’s units are negligible, since Natural Gas contains a sulphur content which enables the GHG emissions to be considered null.

The total amount of NOx emissions was 5,517 kg, with the consumption of Natural Gas in José de Mello Saúde’s units being considered for this calculation. NOx emissions were therefore estimated using the conversion factor of 67 g/GJ indicated by the Portuguese Agency for the Environment. The value is 11.2% lower than that in 2016, concurrent with the reduction of natural gas usage achieved in 2017.

NOx Emissions - 2017 (%)

306-1 – Water discharges by quality and destination

It is not possible to quantify water discharges by quality and destination in José de Mello Saúde’s units.

Aspect: Effluents and Waste

2017

CUF Porto4%

CUF Viseu7%


Instituto CUF7%

CUF Descobertas1%

CUF Infante Santo5%


CUF Cascais4%

CUF Torres Vedras1%

CUF Santarém4%



306-2 – Total waste by type, destination and disposal method

Hospital Waste is divided into:

Non-hazardous hospital waste (includes Groups I and II):

- Group I (equivalent to urban waste) - example: waste from general services such as consultation rooms, meeting rooms, lounges, toilets, cloakrooms etc.

- Group II (non-hazardous hospital waste) – example: orthopaedic materials – splints, plaster casts and bandages, uncontaminated and with no trace of blood –, nappies and sanitary pads, uncontaminated and with no traces of blood; empty packages of medicines (vials, blister packs etc.), or products for clinical or common use other than those included in Groups III or IV.

Hazardous hospital waste (includes Groups III and IV):

- Group III (biohazardous hospital waste) - example: All contaminated waste from rooms or wards of infectious or suspected infectious patients, haemodialysis units, operating theatres, treatment rooms, autopsy rooms and pathology labs.

- Group IV (biohazardous hospital waste) - example: identifiable body parts (amputations), foetuses and placentas; sharp and spiked materials, rejected chemicals and drugs, cytostatics and all materials used in their handling and administration.

Obs.: Unit Measure Tonne

In 2017, there has been a 31% reduction in waste produced.

Note: The calculation of production for non-hazardous hospital waste and recoverable waste in the José de Mello Saúde units had to be estimated, since each healthcare unit has its own solutions for routing these different waste materials. The basis of this calculation used the amounts recorded by AMBIMED in the units in which this service was provided (CUF Descobertas Hospital and Vila Franca de Xira Hospital).

By Type

By Type

Quant. Acum 2017

Quant. Acum 2017

Quant. Acum 2016

Quant. Acum 2016

Hazardous

Deposition

1.209

6.200

1.252

4.536

Non-hazardous

Valorization

5.349

358

3.284

367

0

0

1.000

1.000

2.000

2.000

3.000

3.000

4.000

4.000

5.000

5.000

Quant. Acum 2016

Quant. Acum 2016

Quant. Acum 2017

Quant. Acum 2017

6.000

6.000

7.000

Hazardous

Deposição

Non-hazardous

Valorização


SOCIAL CATEGORY

Aspect: Employment

401-1 – Total number and rates of new employee hires and employee turnover by age group, gender and region.

Hires 1.797

Departures

Rate of New Employee Hires

Hires

Region

1205

Employees at the End of the Period

Rate of Departures

Female

North

8.058

Turnover Rate

Male

South

22,30%

14,95%

18,63%

1.439

586

358

1211



30-50 years

Region

Female

Norte

>50 years

<30 years

30-50 years

>50 years

Male

Male

>50 years

>50 years

581

360

Male

Sul

Female

Female

Female

Female

Rate of new employee hires

Rate of departures

<30 years

<30 years

Total

Total

140

845

Male

Male

Male

Male

Female

Female

30-50 years

30-50 years

69

434

443

84

12

97

126

21

12,35%

6,59%

22,30%

14,95%

1,01%

1,30%

17,86%

11,93%

4,44%

3,03%

8,95%

7,06%

<30 years

Departures

Female

Female

Male

Male

789

961

206

244


Male

>50 years

Turnover rate

<30 years

Total

Female

30-50 years

9,47%

18,63%

1,15%

14,89%

3,74%

8,00%

Note: Does not include governing bodies.

401-2 – Benefits provided to full-time employees that are not provided to temporary or part-time employees, by significant operating units

Only employees with individual employment contracts and at least one year of tenure benefit from the health insurance offered by the company. Those who have a contract with units under a PPP scheme are excluded.

401-3 – Retention and return rates after parental leave, by gender

Male

Male

Male

Male

Male

Return rate

Retention rate

Employees who returned to work who were granted paternity/maternity leave in the reporting year

Employees who returned to work after parental leave ended who were still employed 12 months after their return to work

Employees who returned to work after parental leave ended 2017

Female

Female

Female

Female

Female

75%

56

53

64

94%

87%

89%

180

195

191



403-1 Workers represented in safety and health committees that help to monitor and advise on health and safety programmes

Each José de Mello Saúde unit has an occupational health, hygiene and safety representative, but there are no formal committees created to monitor this issue, this being the responsibility of SAGIES, the company that provides this service to José de Mello Saúde.

403-2 Type of injury and rates of injury, occupational diseases, lost days, absenteeism, and total number of work-related fatalities, by region and by gender

Assumptions José de Mello Saúde calculates the rate of injuries based on the hours of absence due to occupational accidents.

Rate of Absenteeism: Each FTE is considered equivalent to an average of 2,080 hours per year (173.33 per month). Hours of absenteeism related to marriage, study, death and parental leave are excluded from the calculation.

Does not include governing bodies.

Occupational Accident

Occupational Accident

Strike

Unjustified Absence

Suspension

Family Assistance

Unpaid Leave

Justified Absence

TOTAL

Authorised Absence

Legal Obligations

Illness

South

North

0,32%

0,32%

0,06%

0,11%

0,00%

0,29%

0,02%

0,03%

3,70%

0,04%

0,01%

2,81%

51.072

51.072

8.962

17.378

416

46.722

2.469

5.481

585.850

5.704

1.832

445.812

0,24%

0,24%

0,07%

0,05%

0,00%

0,05%

0,06%

0,00%

1,91%

0,05%

0,03%

1,35%

7.952

7.952

2.399

1.801

64

1.737

1.910

152

63.202

1.738

829

44.619

0,34%

0,34%

0,05%

0,12%

0,00%

0,36%

0,00%

0,04%

4,17%

0,03%

0,01%

3,20%

43.120

43.120

6.563

15.577

352

44.985

559

5.329

522.648

3.966

1.003

401.193

INJURY RATE

TYPE OF ABSENCE

PER REGION

TOTAL

Female

Female

Male

23.599

39.604

63.202

Lost Work Hours – Absenteeism

Female

247.878

274.770

522.648

Hours Lost Work

Hours Lost Work

Hours Lost Work

Hours Lost Work

Rate

Rate

Rate

Rate

Male

Male

Total

Total

Hours Lost Work

Hours Lost Work

Rate

Rate

Género

Aspect: Occupational Health and Safety


403-4 Health and safety topics covered in formal agreements with trade unions

There are no topics related to health and safety covered by formal agreements with trade unions.

404-1 Average hours of training per year, per employee, by gender, and by category

In 2017, José de Mello Saúde carried out 133,314 hours of training, recording an average of 16.54 hours per employee.

TOTAL 8.058 133.314 16,54

By gender AverageHoursNo. of Employees

Female 6.375 105.207 16,50

Male 1.683 28.106 16,70

Administrative

CUFA

Governing Bodies

HCP

Nurses

CUFT

Ther. Health Tec.

HVFX

Ther. Tec.

ICUF

Auxiliary

CUFB

General Services

HCUV

Interns

HBCC

TOTAL

Managerial

CUFC

Ther. Diag. Tec.

HSCL

Doctors

HCIS

9,54

0,94

23,09

33,25

7,17

4,29

75,86

11,67

16,54

10,94

15,60

26,74

16.255

658

38

7.436

46.545

4.050

2.694

25.048

15.056

365

849

1.584

18.359

65.374

3.442

406

133.314

1.882

3.599

7.442

2.662

20.753

5.147

2.691

72

24

1.921

7.830

317

392

6.312

1.817

40

305

551

4.546

13.347

1.032

98

28.106

542

729

1.487

607

7.443

985

13.563

586

14

5.516

38.715

3.733

2.302

18.735

13.239

325

544

1.033

13.813

52.027

2.411

309

105.207

1.340

2.869

5.955

2.055

13.310

4.162

PER EMPLOYEE CATEGORY

PER UNIT

Hours

Hours

Female

Female

Male

Male

Total

Total

Average

Aspect: Training and Education



Assumptions

Only hired, permanent and on mixed regime employees and public servants are considered.

404-3 Percentage of employees who regularly receive performance reviews

JMSH

Behavioural

RACE

Services

SAGI

Management

TOTAL

TOTAL

SGHD

Technical

1.220

20.389

9.159

4.520

56

4.066

133.314

133.314

6.553

104.339

185

4.032

1.734

715

46

699

28.106

28.106

1.164

22.660

1.035

16.357

7.425

3.805

10

3.367

105.207

105.207

5.389

81.678

PER UNIT

BY TYPE

Hours

Hours

Female

Female

Male

Male

Total

Total

% of evaluated employees 60.82%

Total evaluated employees 4.901

GPS 297

MAPPA 4.604

A total of 61% of José de Mello Saúde’s workers were covered by one of the existing evaluation systems – 297 via the GPS (Global Performance System) intended for the management staff and 4,604 via the MAPPA (Modelo Avaliação, Performance e Potencial Anual – Annual Evaluation, Performance and Potential Model). Public Servants are evaluated by SIADAP. It should be noted that only employees with a minimum tenure of six months are subject to evaluation.

405-1 Composition of the governance bodies and breakdown of employees per category, according to gender, age group, minority group membership and other diversity indicators

Additional information on the composition of José de Mello Saúde’s governance bodies can be found in José de Mello Saúde’s Integrated Report, in the “Corporate Governance” chapter.

The most representative employee categories in José de Mello Saúde are medical and nursing assistants. Also noteworthy is the administrative group, with 21% of the population. As regards composition by gender, the population at José de Mello Saúde is mostly female, with 79% of female employees to only 21% of male employees.

Aspect: Diversity and equal opportunity


With respect to other indicators of diversity, the more representative age group is between 30 and 50 years of age, representing 58% of the employees considered.

The job categories of Senior Health Technicians, Auxiliary Staff, Nurses and Administrative Staff are the groups where there is greater gender discrepancy, with the female gender being predominant. With more balanced distributions, managers, doctors and general services stand out. The Governing Bodies are composed of Deputy Directors, Executive Committee, Board of Directors, Audit Committee and Remuneration Committee .

Administrative

Administrative

Governing Bodies

Governing Bodies

Nurses

Nurses

Ther. Health Tec.

Ther. Health Tec.

Ther. Tec.

Ther. Tec.

Auxiliary

Auxiliary

General Services

General Services

Interns

Interns

TOTAL

TOTAL

Managerial

Managerial

Ther. Diag. Tec.

Ther. Diag. Tec.

Doctors

Doctors

83% 17% 21%

25% 75% 0%

83% 17% 25%

88% 12% 1%

86% 14% 26%

51% 49% 2%

71% 29% 3%

66% 34% 4%

79% 21% 100%

60% 40% 2%

78% 22% 6%

60% 40% 10%

1.416 287 1.703

10 30 40

1.674 342 2.016

71 10 81

1.812 287 2.099

100 97 197

171 71 242

196 99 295

6.385 1.713 8.098

103 69 172

370 107 477

462 314 776

EMPLOYEE CATEGORY Female Male Overall Total

2.035 4.695 1.368 8.098

Professional Group >50 Total30-50<30

463

6

174

0

159

105

1.066

142

68

10

257

171

174

24

0

30

61

19

1.703

172

242

40

477

295

447

630

2

21

28

1.112

1.169

532

122

46

540

217

242

54

7

2.099

2.016

776

197

81



Concerning the ratios of base salaries in men versus women, the general proximity of the ratios stands out, especially in the categories of: Auxiliary, Administrative and Nurses. Within José de Mello Saúde’s operation, no difference between base salary and monthly compensation is identified.

Assumptions

Calculation formula: Female/Male Ratio ;

Only employees working 35, 36 and 40 hours per week are taken into consideration;The average Base Salary per employee group was used for the calculation.Does not include governing bodies.

413-1 Operations with the local community, impact assessments and development programmes

The large-scale José de Mello Saúde units (hospitals) undertake outreach programmes with the communities in which they are located. Further information about these initiatives can be found in the Integrated Report of José de Mello Saúde in the “Social Development” and “Research, Development and Innovation” chapters, specifically in the information about the activity of the CUF Academy.

405-2 Ratio of base salary and remunerations of women and men, by employee category and by significant operation units

Administrative

Nurses

Ther. Health Tec.

Ther. Tec.

Auxiliary

General Services

Interns

OVERALL TOTAL

Managerial

Ther. Diag. Tec.

Doctors

0,7 0,7 0,8

Hours/Week

Employee Category

40

Ratio

36

Ratio

35

Ratio1,0

0,7

-

0,6

0,7

1,1

0,8

-

1,1

-

1,0

0,9

1,0

0,8

1,0

0,9

1,0

1,0

1,0

1,0

1,1

1,0

1,4

1,0

1,3

1,0

1,0

0,9

0,9

0,9

Aspect: Local Communities


413-2 Operations with significant actual and potential negative impacts on the local communities

José de Mello Saúde manages and provides healthcare that reflects the best industry practices, in accordance with Portuguese law. For this reason, José de Mello Saúde believes that its operations have little potential significant or don’t have negative impact on local communities.

419-1 Monetary value of significant fines and non-pecuniary sanctions for non-compliance with laws and regulations in the economic and social area

In 2017 there were no significant fines for non-compliance with laws and regulations.

414-1 New suppliers evaluated according to social criteria

In line with the commitment to provide excellent healthcare, José de Mello Saúde selects its new suppliers via quality criteria and product technical specifications, working with the best suppliers in the market where it operates.

Without information enabling reporting the percentage of suppliers selected according to criteria of impact on society, José de Mello Saúde considers it crucial that they have and promote principles of ethics, transparency and respect for society.

414-2 Negative social impacts in the supply chain and actions taken

There was no potential or negative impact on society and in the José de Mello Saúde supply chain.

416-1 Evaluation of the health and safety impacts of the products and services categories

José de Mello Saúde manages and provides healthcare. The nature of this activity requires these procedures to be present during the entire life cycle of its services, through a set of procedures involving safety practices and self-protection measures followed by its employees. The measurement of compliance or otherwise with the safety measures and the assessment of their impact is conducted by sampling in proactive internal audits and also by monitoring clinical performance indicators linked to Risk Management and Infection Control. The quality management system in place, the identification of spontaneous non-compliance and the conduct of external audits of the system also represent reviews of the organisation’s safety practices.

416-2 Incidents of non-compliance related with health and safety impacts caused by the products and services

No incidents occurred in 2017 regarding this indicator.

Aspect: Socio-economic Compliance

Aspect: Social Assessment of Suppliers

Aspect: Customer Health and Safety



417-1 Information and labelling requirements of products and services

The provision of healthcare does not involve “labelling” of products and services but José de Mello Saúde offers a set of information about its service portfolio.

The investment on digitising the relationship with the customer, creating tools, promoting and enabling greater interaction of patients with their healthcare units (websites, Facebook page, MyCUF app) is noteworthy.

417-2 Events of non-compliance related to information and labelling of products and services


418-1 Total number of substantiated complaints regarding breaches of customer privacy and losses of customer data


Aspect: Labelling and Marketing

Aspect: Customer Privacy


GLOSSARY

ACUF – CUF Academy

CCA – CUF Alvalade Clinic

CCB – CUF Belém Clinic

HB – Braga Hospital

HCC – CUF Cascais Hospital

HCD – CUF Descobertas Hospital

HCIS – CUF Infante Santo Hospital

HCP – CUF Porto Hospital

HCS – CUF Santarém Hospital

HCTV – CUF Torres Vedras Hospital

HCV – CUF Viseu Hospital

HVFX – Vila Franca de Xira Hospital

ICUF – CUF Porto Institute

JACE – Prestação de Serviços Administrativos e Operacionais, A.C.E.

JMSH – José de Mello Saúde S.A.

LACE – Serviços de Logística, A.C.E.

CDTs – Complementary Diagnosis and Therapy

SAGIES – Company providing Occupational Health and Safety services

Documents

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