Annual Report 2019

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We achieved our sales and earnings outlook. The investments made in connection with regulatory requirements in Germany are showing positive effects. The business in Spain continues to grow dynamically. We have strengthened our presence in Latin America.

Fresenius Helios is Europe’s leading private hospital operator. The company comprises Helios Germany and Helios Spain (Quirónsalud); both are part of the holding company Helios Health. Helios Germany operates 86 hospitals, around 125 outpatient clinics, and 8 prevention centers. The company is the largest provider of inpatient and outpatient care in Germany. Helios Germany offers high-quality treatment across the entire range of medical services. Quirónsalud operates 47 hospitals, 71 outpatient centers, and around 300 occupational risk prevention centers. Quirónsalud is Spain’s largest private hospital operator with a comprehensive range of inpatient and outpatient medical care. In addition, the company is active in Latin America with 4 hospitals and as a provider of medical diagnostics.

Business development

Fresenius Helios increased sales by 3% (5% ¹) to € 9,234 million in 2019. Organic sales growth was 5%.

Helios Germany’s sales declined by 1% (increased by 3% ¹) to € 5,940 million. Organic sales growth was 3%, positively influenced by price effects. The reclassification of nursing staff funding from other income to sales also contributed to growth. The measures initiated in 2018 to increase sales and implement regulatory requirements were successfully continued. For example, vacancies were filled in the area of specialized medical personnel. In addition, the areas of prevention and occupational health care were expanded and digital services were developed, such as the Helios patient portal. This platform allows patients in Germany to access their medical documents such as doctor’s letters, medical reports, or laboratory results, and make appointments with doctors, online.

¹ Adjusted for the post-acute care business transferred from Fresenius Helios to Fresenius Vamed as of July 1, 2018.

In order to benefit from the continuing trend towards increasing outpatient treatment, Helios Germany restructured its outpatient clinics and strengthened its patient service in 2019.

Helios Spain increased sales by 9% to € 3,292 million. Organic sales growth was 7%.

The EBITEBIT (Earnings before Interest and Taxes)EBIT does include depreciation and write-ups on property, plant and equipment. EBIT is calculated by subtracting cost of sales, selling, general and administrative expenses, and research and development expenses from sales. ¹ of Fresenius Helios decreased by 4% to € 1,015 million (- 3% ²). The EBIT marginEBIT marginEBIT margin is calculated as the ratio of EBIT to sales. was 11.0%. The EBIT ¹ of Helios Germany fell by 8% (- 6% 2) to € 576 million, the EBIT margin to 9.7%. The EBIT development was adversely affected by investments in connection with regulatory requirements.

The EBIT ¹ of Helios Spain rose by 5% to € 434 million. The EBIT margin was 13.2%.

¹ Adjusted for IFRS 16 effect

² Adjusted for the post-acute care business transferred from Fresenius Helios to Fresenius Vamed as of July 1, 2018.

Investments

Investments in Germany focused on the construction and modernization of hospitals in Duisburg, Wuppertal, and Wiesbaden as well as digitalization projects such as the Helios patient portal.

In Spain, Fresenius Helios invested in building expansions, including the Sagrado Corazón hospital in Seville. The opening of the new facility is planned for 2021. The total investment is approximately € 20 million.

The construction of a proton therapy center in Madrid was completed on schedule and during an initial pilot phase a small number of selected patients have already been treated. It is the first center of its kind for cancer treatment in Spain.

Acquisitions / New hospital buildings

In May 2019, Helios Spain acquired a hospital in Albacete that is an excellent complement to the region’s existing network of clinics. In addition, the company acquired Digest, an outpatient center in Badalona, and opened additional outpatient centers in Alicante, Algeciras, Bilbao, and Toledo.

In 2019, Helios Spain continuously expanded its presence in the attractive private hospital market in Colombia. In the metropolis of Medellín, the acquisition of Clínica Medellín was completed in April. Clínica Medellín operates two hospitals with a total of about 185 beds. The total investment was more than € 50 million. The acquisitions of two further centrally located hospitals in Medellín, Clínica Las Vegas and Clínica del Prado, were completed in December 2019, and January 2020, respectively. The hospitals have a total of around 300 beds. The total transaction volume amounted to approximately € 50 million.

Helios Spain has also signed an agreement to acquire Centro Médico Imbanaco (CMI) which is located in the metropolis of Cali. The hospital has about 350 beds and is one of the most prestigious private hospitals in Latin America. The total transaction volume amounts to approximately € 300 million. Closing is expected in the first quarter of 2020. A further agreement has been signed to acquire Clínica de la Mujer, located in Colombia’s capital city Bogotá. The hospital has a special focus on gynecology, pediatrics and obstetrics, and generated sales of about €20 million in 2019. The transaction is expected to close in the second quarter of 2020.

In addition, Helios Spain acquired CediMed, a leading provider of medical diagnostics and laboratory services in Colombia. The transaction volume amounts to approximately € 40 million.

Regulatory changes

The Act to Strengthen Nursing Staff (PpSG) entered into force on January 1, 2019, in Germany, aiming to increase the number of staff in the nursing professions. In contrast to 2018, in 2019, each additional or increased nurse position at the bed was completely refinanced by the health insurers. Fresenius Helios was able to recruit additional nursing staff in all its hospitals as part of a large-scale campaign. From 2020, nursing costs will be deducted from the standardized base rates and the costs for direct nursing patient care will instead be fully reimbursed by the health insurance companies via separate care budgets at costs.

In addition, since 2019, a regulation setting a minimum level for nursing staff has applied to hospitals in Germany for the following areas: geriatrics, intensive care, cardiology, and trauma surgery. In 2020, the areas of heart surgery, neurology, neurological stroke units, and early neurological rehabilitation will be added.