But, without doubt, the most relevant fact for us was the change of government in early June, following the success of a motion of censure that very few predicted. By its nature, the system of mutual companies collaborating with the Social Security Institute is a highly regulated sector and, as a result, dependent on the Executive's guidelines. In this regard, we must express our satisfaction that we were able to establish a professional relationship of trust through a frank and effective collaboration in complete transparency. The new management team, which came with a lot of experience and knew Mutua Universal well, was able to see - as we were told - how we had evolved in recent years to be a reference for the sector in quite a few respects.

However, this did not prevent us from working hard to adapt to the new regulatory provisions or other measures that were adopted with the aim of maintaining a system composed of profitable and healthy mutual companies. A vision that we share and work for every day.

Without any reasons for optimism, we are addressing the design of a new Strategic Plan with precaution, but with firm determination to comply with our mission of "ensuring the health and well-being of our mutual society members, managing the services and allowances with rigour and excellence, committed to society and sustainability of the system."

To achieve this, it was more necessary than ever to make progress on the two fundamental lines that form part of our DNA: continuous improvement and innovation. We aim to improve the efficiency of procedures and to focus on reducing costs.

To this end, the effort was intensified to optimise purchasing management, optimise our facilities, reduce dependence on suppliers outside the system and establish partnerships with other mutual companies.

The challenges we face require an up-to-date and accurate knowledge of the progress in procedures to systematically identify the deviations and opportunities for improvement; ensuring, furthermore, that the impact of decisions is uniformly implemented throughout the organisation. In 2018, the management team worked increasingly on the ground: The management committees are now mobile, and the travel of professionals from the areas is encouraged.

It is functional in regard to Spanish territory and a greater mainstreaming is sought in project management. All of this has involved a review of our business culture to eliminate barriers, promote talent and the resolution of challenges and conflicts in a transversal or collective way.

We are progressing towards a highly centralised organisation in the administration of resources, but oriented towards Spanish territory, where contact with workers and companies takes place and, in turn, more transversal than vertically hierarchical, to stimulate anticipation, responsibility and creativity through collaboration.

To achieve these objectives, as well as maintaining the vocation of excellence in our services, we count on innovation as a natural ally for speeding up processes and contributing added value. The pages of this report also contain a chronology of the innovative action, from the digitalisation of clinical history in 1996, or the development of our Online Clinic telemedicine system in 2009 to recent applications such as the design of prevention apps, the integration of virtual reality into psychological treatment, the implementation of Artificial Intelligence or customised management platforms. Amongst the latter, the INSS Private Area stands out, an initiative of its own to speed up procedures with medical inspectors from the National Social Security Institute that the Administration is implementing throughout the system. These examples confirm our conviction in innovation as a driving force for continuous improvement and development, long before the advent of the "era of digitalisation."

In short, 2018 was a very intense year that consolidated us as a renewed, healthy and solvent mutual company, prepared to take on the greater challenges that undoubtedly lie ahead.

My thanks go to all the affiliated workers, also to the self-employed and to the companies that have trusted us, as well as to each and every one of Mutua Universal's professionals who, with their work, dedication and commitment, make us better every day.

My thanks also go to the Board of Directors and especially to its Chairman for their dedication and support.

Juan Güell Ubillos
Managing Director of Mutua Universal

We highly value the management results in a year that, despite the good performance of the main indicators of the national economy and given the countercyclical trend of our sector, has been adverse for mutual companies.