Fleury SA. Update Following Change in Outlook to Negative. CREDIT OPINION 1 June Update. Summary Rating Rationale.

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CREDIT OPINION Fleury SA Update Following Change in Outlook to Negative Update Summary Rating Rationale RATINGS Fleury SA Domicile Sao Paulo, Brazil Long Term Rating 2 Type LT Corporate Family Ratings - Dom Curr Outlook Negative Please see the ratings section at the end of this report for more information. The ratings and outlook shown reflect information as of the publication date. The 2/Aa2.br ratings are supported by Fleury's strong and well recognized brand, its market position in Brazil, focused on the more resilient higher income level population, and the positive long-term prospects for the Brazilian health care industry, despite the short term challenges arising from Brazil's weak macroeconomic conditions. The ratings also incorporate the improved diversification in terms of branding, consumer's profile and geographic footprint derived from Fleury's 27 acquisitions between 2002 and 2012 and the company's adequate credit metrics and liquidity profile, even when considering the recently announced expansion plan. The ratings are constrained by Brazil's sovereign ratings, the company's small size compared to global peers as well as the fragmented nature of the industry, which provides room for M&A activity. Furthermore, we see risks related to large dividend distributions going forward, although we expect Fleury to prudently manage creditors and shareholders interests to preserve its creditworthiness. Credit Strengths Contacts Carolina A Chimenti 55-11-3043-7318 Analyst carolina.chimenti@moodys.com Marianna Waltz, CFA 55-11-3043-7309 MD-Corporate Finance marianna.waltz@moodys.com Strong and well recognized brands in the local market Long term fundamentals for the health care industry remain favorable, but Brazil's weak macroeconomic conditions pressure operations in the short term Adequate credit metrics and liquidity even with announced expansion plan Disciplined and successful acquisitions Credit Challenges Ratings are constrained by Brazil's sovereign ratings Relative small size when compared to global peers Highly fragmented industry increases likelihood of further M&A activity Rating Outlook The negative outlook on Fleury's ratings mirrors the negative outlook on Brazil's sovereign ratings.

Factors that Could Lead to an Upgrade An upgrade of Fleury's ratings would depend on an upgrade of Brazil's sovereign rating. Positive pressure on the ratings would also require Fleury to continue generating consistent organic growth while pursuing its expansion strategy, and to maintain stable profitability, leverage and liquidity levels even during tougher macroeconomic conditions. Factors that Could Lead to a Downgrade The ratings could be lowered if the company fails to deliver organic growth or to maintain EBITDA margins near current levels. The ratings could also come under pressure if leverage ratio remains above 3.5x, if free cash flow remains negative on a consistent basis or if liquidity deteriorates. Negative actions on Brazil's sovereign ratings would also trigger a downgrade of Fleury's ratings. Key Indicators Exhibit 1 Key Indicators [1] Fleury S.A. 3/31/2017(L) 12/31/2016 12/31/2015 12/31/2014 12/31/2013 $0.7 $0.6 $0.6 $0.7 $0.8 22.8% 21.4% 18.0% 16.6% 14.8% 1.6x 1.8x 2.6x 3.2x 3.3x EBITA / Interest 3.4x 2.9x 2.0x RCF / Net Debt 19.7% 27.7% 50.0% 21.3% 33.6% Revenue (USD Billion) EBITA Margin Debt / EBITDA [1] All ratios are based on 'Adjusted' financial data and incorporate Moody's Global Standard adjustments for Non-Financial Corporations. Source: Moody's Financial MetricsTM. Detailed Rating Considerations STRONG AND WELL RECOGNIZED BRANDS IN THE LOCAL MARKET Fleury operates under six brands (Fleury, Clínica Felippe Mattoso, Weinmann, a+, Diagnoson a+ and Labs a+) in six Brazilian states and in Distrito Federal, providing premium and intermediary level services mainly for customers in classes A and B. The brands Fleury, Clínica Felippe Mattoso and Weinmann Labs enjoy leading positions in the A social class in São Paulo, Rio de Janeiro and Rio Grande do Sul states, some of the most economically robust regions of the country. The national brand "a+" was launched in 2011 as a result of the consolidation process of brands previously acquired. Currently, "a+" operations are present in the six main economic centers of Brazil, offering diagnostic services to beneficiaries of intermediary level health plans. The Fleury brand, which accounted for 50.1% of the company's revenues in the 12 months ended March 2017, benefits from the resilience of the consumption patterns of the higher income level population, which confers defensive characteristics to Fleury's business model. This is particularly important in the current challenging environment in Brazil, where weak macroeconomic conditions are constraining a sustainable recovery in unemployment rates and consequently in the total number of health plan beneficiaries. Unlike the US and other markets, the choice of a health care provider in Brazil is usually determined by the patient and procedures are performed outside of hospitals and medical consultations. In Moody's view, Fleury's successful branding strategy, which is evidenced by the widely recognition of the Fleury brand by patients and physicians, provides a competitive advantage to the company during the patient's decision making process. The company's wide coverage and integrated solution for physicians also contribute to its strong market position in Brazil. LONG TERM FUNDAMENTALS REMAIN FAVORABLE, BUT WEAK MACRO CONDITIONS PRESSURE THE SHORT TERM The long-term prospects for the Brazilian health care industry remain favorable, but contrast with the short-term challenges related to high unemployment rates and a decline in total health plan beneficiaries. This publication does not announce a credit rating action. For any credit ratings referenced in this publication, please see the ratings tab on the issuer/entity page on www.moodys.com for the most updated credit rating action information and rating history. 2

Over the last several years, the increase in the population's average income level and the importance of health spending for Brazilians - third consumption priority, lagging behind only education and housing, according to Datafolha - led to a gradual growth in private health spending in the country. There were about 16.6 million net additions to health plans between 2005 and 2014, as a consequence of the 13.9 million jobs created in the same period. On the other hand, although health expenditures tend to be relatively resilient to economic cycles, the current weakness in the macro environment will continue to pressure the sector's operations as we do not foresee a recovery in the labor market in the short term. Since the beginning of 2015 until April 2017, the accumulated number of health plan beneficiaries decreased by 2.8 million as a result of an acute macroeconomic contraction in Brazil. In the same period, almost 2.9 million formal job positions closed in the country. Despite the early signs of improvement in the number of health plan beneficiaries and in the creation of formal job positions in the country during 2017, uncertainties regarding reform momentum following recent political events could threat the economic recovery in the country and Brazil's medium-term economic strength. Nevertheless, Fleury's brands have been proving relatively resilient given the high quality level of service and brand recognition, and its focus on higher income level customers, which should continue to temper the impact of the economic slowdown in the company's operating performance. In the long-term the population aging will support an increased demand for health care services in Brazil. According to the Brazilian Institute of Geography and Statistics - IBGE, the proportion of Brazilians aged 60 years or older should reach 34% by 2060 (or 73.6 million inhabitants) from 13% in 2013. Also, the private health plan segment is still under-penetrated in the country, especially when compared to international standards. By April 2017, only 25% of the Brazilian population had a health plan contracted, while in developed economies the penetration rate is approximately 37%, according to ANS - National Health Agency. It is noteworthy that the individual penetration rate is higher than Brazil's average in more developed states such as São Paulo (42%) and Rio de Janeiro (34%), where Fleury has a particularly strong presence. Exhibit 2 Exhibit 3 Exhibit 4 Population aging supports long term fundamentals... but reduction in formal jobs and in health plan additions......will constrain the sector's growth in the short term In million pax Brazil's net additions of formal jobs Number of health plans beneficiaries in Brazil 2016 90+ 80-84 70-74 60-64 50-54 40-44 30-34 20-24 10-14 0-4 2060 Male Female 150 52 100 50 50-2.8 million beneficiaries 48 0 46 (50) 44 (100) 42-2.9 million formal jobs (150) Note: IBGE estimates. Source: IBGE Apr-17 Oct-16 Jan-17 Jul-16 Apr-16 Jan-16 Oct-15 Jul-15 Apr-15 Apr-17 Nov-16 Jan-16 Note: in thousand, 12-month trailing average. Source: CAGED. Jun-16 Aug-15 Oct-14 Mar-15 May-14 Jul-13 10 Dec-13 5 Feb-13 0 Apr-12 5 Sep-12 10 Jan-15 40 (200) Note: In million. Source: ANS. HIGHLY FRAGMENTED INDUSTRY INCREASES LIKELIHOOD OF FURTHER M&A ACTIVITY The private health care sector in Brazil is highly fragmented and has no dominant player. There are currently more than five thousand health care centers servicing private health plans in the country. In such a fragmented industry, we believe larger players like Fleury are in a more advantageous situation and have broader bargaining power when dealing with health insurance providers and hospitals. Negotiations with health insurance providers are usually made once a year, and include the price adjustment to be implemented by the health care service providers. 3

Also, under this scenario, further industry consolidation is expected, especially involving larger and capitalized players such as Fleury. The assigned ratings incorporate our expectations that Fleury would conduct any future acquisition in a prudent manner in order to preserve its creditworthiness. DISCIPLINED AND SUCCESSFUL ACQUISITIONS Acquisitions were key in Fleury's growth strategy in the recent past and we believe the company will continue to pursue opportunistic acquisitions to further consolidate its position in the Brazilian market. Although M&A activity can entail integration challenges, higher working capital and investment needs, we recognize that Fleury has so far managed well its acquisitions. Originally, the Fleury group targeted the A social class in the state of Sao Paulo. Through acquisitions, it managed to diversify its revenues, both in terms of customer base and geographic footprint. Currently, Fleury is present in six Brazilian states and Distrito Federal and its portfolio of brands covers social classes A and B. Despite the acquisitions, the company's growth has been mainly organic-driven, with most of the group's revenues increase coming from its existing operations - with the exception of the Labs D'Or deal, a BRL 1.2 billion acquisition announced in 2011. The Labs D'Or acquisition (i) increased Fleury's presence in the state of Rio de Janeiro; (ii) brought business opportunities through the alliance with Rede D'Or and Sao Luiz Hospitals; (iii) diversified the company's product portfolio mix, with an increase in imaging diagnosis and hospital services; and (iv) turned Fleury into a bigger player, with higher market strength and broader bargaining power. Since 2013, Fleury did not announce any acquisition and focused on business integration and cost efficiencies to recover profitability. ADEQUATE CREDIT METRICS AND LIQUIDITY EVEN WITH ANNOUNCED EXPANSION PLAN At the end of March 2017, Fleury's adjusted leverage of 1.6x compared favorably to similarly rated companies. During 2013 and 2014 the company faced some headwinds and margins were negatively impacted by: (i) operational adjustments and integration costs in Rio de Janeiro; (ii) the early stage of new a+ brand labs; (iii) the company's strategy to adequate its service offering by focusing on more profitable clients and on cost synergies; and, lastly, (iv) inflationary cost pressures. Following these pressures, the adjustments and strategic focus improved Fleury's profitability in 2015 and 2016, even as the company faced challenges related to a contracting market, rising inflation (as approximately 50% of Fleury's costs relate to labor), and currency depreciation (which increases dollar denominated costs, about 10% of total). Going forward, market consensus point to lower inflation in Brazil (3.9% and 4.3% inflation rate in 2017 and 2018, according to latest expectations, down from 6.3% in 2016 and 10.7% in 2015), which should contribute to lower margin volatility and lower dependence on the adequate pass-through of cost increases. Nevertheless, we expect the labor market to remain weak in the short to medium term, which will limit organic growth opportunities. In this context, Fleury announced an expansion plan that includes the opening of up to 90 new service centers until 2021, focused mainly on its regional brands (including the a+ brand) and on fast-sites - smaller units that offer simpler procedures. The fast-sites require lower investments and usually present higher margin than larger units, which should increase Fleury's operating leverage in the medium term. In the short term, however, the early stage of the new centers will limit margin expansion and capex will increase, although we expect Fleury to remain free cash flow positive given its healthy cash flow generation from operations. Even with the ramp-up of new units and under adverse market conditions, we expect that Fleury will be able to sustain operating margins fairly close to current levels in the next 12-18 months, given continued efficiency gains and its position within the A and B social classes in Brazil, for whom health care spending is more resilient. For the LTM ending March 2017, Fleury's adjusted EBITDA margin reached 33.6%, up from a low of 26% at the end of 2013, reflecting the operational adjustments made by the company in the last years. In the 1Q17, Fleury posted revenues/m2 of BRL 5.4, the highest level since 2011, with same store sales increasing 15% in 1Q17 versus 1Q16. We also expect leverage (measured by total adjusted debt to EBITDA) to continue to decline with the amortization of the company's debentures, which represents approximately 88% (BRL 716 million) of Fleury's total reported debt. Fleury has an amortization of BRL 100 million in debentures until the end 2017. Pro forma to the 2017 amortization, Fleury's adjusted leverage would decline to 1.5x, providing the company more room under financial metrics. 4

Exhibit 5 Exhibit 6 Fleury's Adjusted Leverage Fleury's Adjusted Interest Coverage Total adjusted debt/ebitda Adjusted EBITA/Interest Expense 3.3x 3.4x 3.4x 3.2x 2.9x 2.6x 1.8x 2012 2013 2014 Note: Moody's 2017 estimates Source: Moody's Investors Services. 2015 2016 2.0x 2013 2014 2015 1.6x LTM 1Q17 2017E 2012 2016 LTM 1Q17 2017E Note: Moody's 2017 estimates. Source: Moody's Investors Services. RELATIVE SMALL SIZE WHEN COMPARED TO GLOBAL PEERS Although acquisitions have increased Fleury's size, the company remains relatively small when compared to global peers, with annual net revenues of BRL 2.2 billion in the LTM ending March 2017. In Moody's view, larger companies generally have greater resilience to changes in demand, wider geographic diversity, are often better able to realize economies of scale, to benefit from broader access to potential customers and to have more access to capital markets if needed. Nevertheless, Fleury's ratings incorporate its position as one of the largest providers of diagnostic medicine in Brazil. RATINGS ARE CONSTRAINED BY BRAZIL'S SOVEREIGN RATING Fleury generates 100% of its revenues in the local market and, although it operates in a resilient segment, one of its main growth drivers is the creation of formal jobs, which has deteriorated significantly in the last year, and is expected to remain weak in the short to medium term. In our view, rising unemployment and reduced additions to health plans could pressure Fleury's operating performance, leaving the company exposed to Brazil's domestic fundamentals. Liquidity Analysis Fleury's liquidity continues to be adequate and debt maturities remain manageable. As of March 2017, the company's cash position of BRL 337 million was sufficient to cover reported short term debt by 1.1 times and corresponded to 41% of total reported debt. At the current margin level, Fleury's cash flow from operations should be sufficient to cover capex (including the recently announced expansion plan) and its upcoming debt amortizations. Nevertheless, given the high dividend payment of BRL 384 million in 2016, free cash flow was negative. Although Moody's tends to view large shareholder distributions as credit negative, we believe Fleury's current metrics accommodate extraordinary dividend payments, especially when considering the debt amortizations that have been occurring in the last quarters. Going forward, we expect Fleury to manage shareholders and creditors distributions on a prudent manner, being able to post positive free cash flow after dividend payments, which should be used together with a portion of its cash balance to meet debt maturities. Furthermore, although we recognize that Fleury's free cash flow generation will increase after the completion of its expansion plans and could eventually accommodate M&A activity, we expect the company to maintain its conservative approach to leverage and liquidity, not entering transformational deals that could jeopardize its credit quality. 5

Exhibit 7 Fleury's Debt Amortization Schedule In BRL million, as of March 2017 337 302 216 186 114 Cash & Cash Equivalents ST Debt 2018 2019 2020+ Source: Moody's and company's financials. Profile Founded in 1926, Fleury is a major provider of high quality diagnostic medicine in Brazil through its Patient Service Centers (84% of gross revenues), operations in Hospitals (15% of gross revenues) and others (2% of gross revenues) business segments. The group has a diversified portfolio of brands that envisages different social classes in six Brazilian states and Distrito Federal. In the LTM ending March 2017, Fleury posted revenues of BRL 2.2 billion (approximately USD 659 million converted by the average exchange rate) and adjusted EBITDA margin of 33.6%. Corporate Governance Fleury is a public owned company listed in the São Paulo Stock Exchange, BM&F Bovespa. Currently, 44.6% of its shares are in free float and the company is part of Bovespa's Novo Mercado, the level with the highest standards of corporate governance in Brazil. Fleury's largest shareholders are the partner doctors via their direct stake of 13.9% and indirect stake, through Integritas, of 12.0%. In September 2015, the partner doctors sold 13.1% of Fleury's total shares to Advent International (unrated) private equity firm, through the sale of Core Participações' ("Core", unrated) shares. The transaction resulted in the election of a new Board of Directors, which is now composed of 10 members, of which 3 are nominated by the partner doctors, 2 by Advent, 2 by Bradseg (Fleury's second largest shareholder with 16.4% of total shares) and the remaining 3 as independent members. There were no changes to Fleury's senior management as a result of the transaction. The company is ruled by a shareholders agreement signed between Integritas, Bradseg and Core and valid through 2030. In Moody's opinion, the implementation of a permanent fiscal committee and formal financial policies regarding leverage target and minimum liquidity would be positive for Fleury's corporate governance practices. Currently, the company has a non formal target of maintaining reported net debt/ebitda below 1.5x (0.9x in the LTM ending March 2017). Rating Methodology and Scorecard Factors Fleury's grid-indicated rating under Moody's Business and Consumer Service Industry Rating Methodology maps to a "1" rating, one notch above the assigned ratings. The grid reflects the company's good profitability and debt protection metrics, while the assigned ratings are primarily constrained by Brazil's sovereign ratings. Prospectively, Moody's 12-18 month forward view maps to a "1" rating, reflecting improvement in debt protection metrics, but lower, although still adequate, profitability coming from the early stage of the company's new service centers. 6

Exhibit 8 Rating Factors Fleury S.A. Current LTM 3/31/2017 Business and Consumer Service Industry Grid [1][2] Factor 1 : Scale (20%) Moody's 12-18 Month Forward View As of 5/30/2017 [3] Measure Score Measure Score $0.7 B $0.5 - $1.5 B a) Demand Characteristics a a a a b) Competitive Profile 22.8% a 15% - 20% a) Revenue (USD Billion) Factor 2 : Business Profile (20%) Factor 3 : Profitability (10%) a) EBITA Margin Factor 4 : Leverage and Coverage (40%) a) Debt / EBITDA 1.6x A 1x - 2x A b) EBITA / Interest 3.4x 3x - 6x c) RCF / Net Debt 19.7% 25% - 40% a Factor 5 : Financial Policy (10%) a) Financial Policy Rating: a) Indicated Rating from Grid 1 b) Actual Rating Assigned 1 2 [1] All ratios are based on 'Adjusted' financial data and incorporate Moody's Global Standard Adjustments for Non-Financial Corporations. [2] As of 03/31/2017(L). [3] This represents Moody's forward view; not the view of the issuer; and unless noted in the text, does not incorporate significant acquisitions and divestitures. Source: Moody's Financial MetricsTM. Ratings Exhibit 9 Category FLEURY SA Outlook Corporate Family Rating -Dom Curr Senior Unsecured -Dom Curr NSR Corporate Family Rating NSR Senior Unsecured Moody's Rating Negative 2 2 Aa2.br Aa2.br Source: Moody's Investors Service 7

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Contacts Carolina A Chimenti 55-11-3043-7318 Analyst carolina.chimenti@moodys.com 9 CLIENT SERVICES Rodrigo Rosa Associate Analyst rodrigo.rosa@moodys.com 55-11-3043-6061 Americas 1-212-553-1653 Asia Pacific 852-3551-3077 Japan 81-3-5408-4100 EMEA 44-20-7772-5454