Auna S.A. (AUNA) Earnings

Management highlights

### Overall Business Momentum - Sustained commercial momentum across AUNA's regional healthcare platform, with robust underlying performance and strong demand across all markets. Revenue growth was driven by volume gains and an improved mix of higher complexity services. - Strong cash generation and disciplined cash management: Operating cash flow for H1 2026 reached 441 million soles (45% YoY growth), free cash flow grew 181% YoY, and total cash increased 43% from year-end 2025. Leverage ratio decreased sequentially to 3.6x net debt to adjusted EBITDA. - Overall platform capacity utilization increased 2.3 percentage points YoY to 66% year-to-date, with a 2.8 percentage point sequential increase. Insurance platform membership grew 6% YoY, and medical loss ratio (MLR) remained stable at ~50%. ### Mexico Operational Updates - Volume recovery accelerated, with high complexity services leading growth: surgeries up 7% sequentially, and oncology chemotherapies/radiotherapies up 20% sequentially. Oncology revenue increased 110% YoY from Q1 2025. - In September 2026, AUNA will inaugurate an advanced ELEKTA EVO linear accelerator for oncology treatment in Monterrey to expand oncology capabilities. - Improved tier classifications with major insurers, expansion of oncology offerings, and favorable pricing for high complexity care drove growth. Management is focused on enhancing variable cost efficiencies to strengthen competitive positioning. ### Peru Operational Updates - Gained 7,000 new members from a new B2B plan covering Serapal employees, marking progress in large corporate segment commercial execution. New commercial initiatives increased emergency treatments by 9% YoY and 14% sequentially. - Post-quarter, AUNA took possession of a new asset-light clinical facility in southern Lima that will add 30 beds and expand surgery and chemotherapy capacity, expected to open between late 2027 and early 2028. The company also acquired a new robotic surgical system to enhance high complexity surgical capabilities. - Management is actively shortening internal billing cycles to mitigate future billing penalty risks, and expects to close all open prior-year billing reconciliations by the end of 2026. ### Colombia Operational Updates - Successfully diversified the payer base: intervened payer revenue declined to 12% of total revenue from 18% YoY, with growth from private payers and risk-sharing agreements fully offsetting this reduction. Risk-sharing agreements now cover more than 3 million lives, improving cash conversion and revenue predictability. - Post-quarter, AUNA expanded operating capacity at its IMAT Oncomédica facilities in Montería, adding 18 adult ICU beds and 24 hospitalization beds with minimal incremental capex, expected to be accretive in the remainder of 2026. - After two years of cautious capital spending amid political transition, management is resuming selective, capital-efficient capacity expansion to capture new market opportunities under the new administration.

Guidance

- Full-year 2026 FX-neutral revenue growth guidance is reaffirmed at approximately 12%. - Excluding the impact of accepted prior-year billing penalties in Peru, management expects full-year 2026 adjusted EBITDA growth to land toward the low end of the previously guided 10% to 14% range. - Leverage is expected to continue declining through the end of 2026, moving closer to the medium-term target of 3.0x net debt to adjusted EBITDA. - Free cash flow for 2026 is currently expected to exceed original full-year guidance. - Sequential adjusted EBITDA improvement is expected in the second half of 2026, driven by volume growth and operational progress in Mexico, full effect of contractual price increases and stabilized risk-sharing contracts in Colombia, and normalized onboarding costs for new B2B contracts at OncoSalud in Peru.

Segment performance

Mexico: Achieved 4% year-over-year (YoY) revenue growth, 5% sequential revenue growth, and 3% sequential adjusted EBITDA growth. Adjusted EBITDA declined 16% YoY due to ongoing investments in medical and leadership talent, plus temporary headwinds from the Easter holiday and new value-added tax on insurance. High complexity service volumes led growth, with surgery volumes up 6% YoY and chemotherapy/radiotherapy volumes up 86% YoY. Peru: Delivered 8% YoY revenue growth. OncoSalud, a key sub-segment, grew revenue 11% YoY driven by price adjustments, improved service mix, and 6% membership growth. Adjusted EBITDA was flat YoY, weighed down by accepted billing penalties for prior-year receivable reconciliation, higher B2B onboarding costs, physician incentives, overtime, and increased pharmacy costs. Capacity utilization reached 83%. Colombia: Grew revenue 13% YoY, driven by growth in private payers (up 17% YoY, 18% of total Colombia revenue) and risk-sharing agreements, which now make up 24% of total Colombia revenue (up from 14% YoY). Adjusted EBITDA declined 12% YoY due to higher complexity costs, statutory minimum wage increases, talent investments, and the mix shift to risk-sharing agreements, but increased 18% sequentially with margins expanding 1.7 percentage points. Capacity utilization reached 79.2%, above pre-Nueva EPS intervention levels. Consolidated: Total consolidated revenue grew 9% YoY, while consolidated adjusted EBITDA declined 9% YoY on an FX-neutral basis.

Risks & headwinds

- Forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially, including: execution risk for strategic initiatives, growth plans, and capacity expansion projects; uncertainty related to the outcome of open prior-year billing reconciliation negotiations in Peru; regulatory changes (such as Mexico's new value-added tax on insurance); and macroeconomic and sector-level pressures. - Peruvian payers face broad sector-wide financial pressure, leading to tightened enforcement of billing deadlines and higher-than-historical retrospective billing penalties for prior periods. - Temporary margin pressures across all three operating markets, from cost increases (statutory minimum wage hikes, pharmacy cost inflation) and investment spending (talent acquisition and retention, capacity expansion). - Foreign exchange volatility impacting reported gross debt levels, although 85% of USD-denominated debt is hedged to Peruvian soles to mitigate this risk.

Analyst Q&A

• Q: The sharp improvement in H1 2026 working capital came largely from receivables and payables. Excluding legacy receivable collections, how much of the benefit comes from ordinary payment timing versus supplier financing? What is the current supplier financing balance, adjusted days payable outstanding, and underlying cash conversion after adjustment? Additionally, after multiple quarters of prior-period billing deductions in Peru, have revenue recognition methodologies and controls been updated, and what evidence confirms 2026 receivables will not need similar retrospective adjustments?

  A: Most of the receivables improvement comes from reduced current-period billing cycle times across Colombia and Peru, and faster payments from the growing share of risk-sharing contracts in Colombia. These improvements are expected to be sustained. Supply chain financing initiatives do not impact the sustainability of working capital improvements, and no adjustments to DPO or cash conversion are needed. Working capital also benefited from the utilization of tax credits in Peru. For billing in Peru, higher penalties stem from sector-wide financial pressure that led payers to tighten billing rules. AUNA has shortened internal billing cycles and strengthened financial controls to eliminate future exposure. All open prior-year reconciliations are expected to be finalized in 2026, so this is a short-term impact that will be resolved by 2027.

• Q: Does supplier financing negatively impact costs, and could this explain recent margin pressure?

  A: No, supply chain financing initiatives do not impact AUNA's cost structure. These programs were developed through collaborative negotiations with suppliers, and do not create incremental margin headwinds.