Advancing patient care

Demographic change is posing fundamental challenges to societies worldwide. Not only are people living longer, but the pace of population aging is also increasing significantly. As a result, the social and healthcare systems of many countries are coming under increasing pressure. As the average age of the population increases, so does the number of critically and chronically ill patients.¹ Health is thus a critically important factor for the benefit of individuals and societies as a whole. The extent to which these opportunities can be leveraged depends heavily on one factor: health.

At Fresenius, we are at the heart of healthcare. We offer healthcare products and services for critically and chronically ill individuals, in line with the megatrends of health and demographics. We improve people's lives by providing high-quality and affordable healthcare. In doing so, we consider significant paradigm shifts in the healthcare environment with regards to biologic products and therapies, technological change, and new forms of data generation, processing, and usage.

Advancing patient care is always the focus of our activities. Our goal is to expand Fresenius position as a leading global provider of products, services, and therapies for critically and chronically ill people. At the same time, we want to grow profitably and use our capital efficiently, in order to create value for our stakeholders and enable us to continue investing in better medicine.

For more efficient and focused management, since the beginning of 2023 we have differentiated between our Operating Companies, Fresenius Kabi and Fresenius Helios, which we own 100%, and our Investment Companies, Fresenius Medical Care and Fresenius Vamed, in which we hold 32% and 77% of the shares, respectively.

In the fiscal year, we deconsolidated the Fresenius Medical Care business segment by changing the legal form of Fresenius Medical Care AG & Co. KGaA into a stock corporation. Further information can be found in the "Deconsolidation of Fresenius Medical Care" section.

Fresenius operates in key healthcare areas indispensable for critically and chronically ill patients. We continuously develop our business segments and strive to assume leading positions in system-critical healthcare markets and segments. We orient our portfolio towards healthy, profitable growth, a strong focus on margins and capital returns, and the highest ambitions for operational excellence and competitiveness.

At Fresenius, we hold ourselves accountable to the highest standards of quality and integrity. All of our business segments make an overall contribution to increasing the quality, affordability, and efficiency of healthcare as well as patient satisfactionPatient satisfactionFresenius ​Vamed ​measures ​the ​level ​of ​patient ​satisfaction ​in ​the ​VAMED ​healthcare ​facilities ​and ​the ​overall ​patient ​satisfaction ​with ​the ​services ​offered ​in ​the ​VAMED ​healthcare ​facilities. ​Each ​patient ​receives ​a ​questionnaire ​at ​or ​immediately ​after ​discharge, ​which ​contains ​16 ​standardized ​questions ​that ​are ​evaluated ​for ​the ​patient ​satisfaction ​target.. At the same time, we care for our environment by protecting nature and using its resources carefully.

Fresenius Kabi's commitment is to improving the quality of life of its patients. The quality and safety of its products and services is thus of paramount importance to Fresenius Kabi.

Fresenius Helios hospitals are characterized by high standards of treatment quality, hygiene, patient safety, and quality of care.

Fresenius Vamed bases its quality processes on clearly defined and generally established standards.

At Fresenius, we combine our medical expertise with extensive production capacities, and clinical practice with technology know-how to continuously improve therapies for our patients. We will continue building on our strength in technology, our competence and quality in patient care, and our ability to manufacture cost-effectively. Developing products and systems that provide a high level of safety and user-friendliness and enable tailoring to individual patient needs is an inherent part of our strategy of sustainable and profitable growth.

We plan to develop more effective products and treatment methods for critically and chronically ill patients in order to offer best-in-class medical standards. Digitalization is playing an increasingly important role whether it is in healthcare facilities or in production. It drives innovative technologies and treatment concepts and can contribute to solving numerous challenges in the healthcare system.

The commitment of our more than 190,000 employees worldwide is key for the success and sustained growth of Fresenius. We firmly believe in a culture of diversity, as we are convinced that different perspectives, opinions, experiences, and values enable Fresenius to continue successfully growing as a global healthcare company.

To tackle the upcoming challenges and be able to continue to grow as a company, attracting new employees is key. Not only do we try to attract new talent, but also do everything we can to retain and develop our employees over the long term. We offer a variety of flexible working-time models and incentive programs to ensure that our long-term needs for highly qualified employees are met. Furthermore, we offer our employees attractive opportunities to develop their careers in an international and dynamic environment.

Executing segment strategies

The Fresenius Group offers a broad spectrum of system-critical products and services for the health and quality of life of our patients. Our business segments hold leading positions in key areas of healthcare, and all of them are continuing to execute their respective strategic priorities to sustain leadership and contribute significantly to the benefit of healthcare systems. At the level of the Fresenius Group, we manage the strategic direction of the Group, and orient our portfolio towards value-maximizing business areas and maximum patient impact.

With its Vision 2026, Fresenius Kabi has developed a strategic plan to transform the company for the next decade and to better capture new growth opportunities. Fresenius Kabi will continue to focus on high-quality products for critically and chronically ill patients. Within this clear direction, Fresenius Kabi has defined three growth vectors, alongside the strengthening of the resilience of our volume businesses (3+1 strategy). The growth vectors are:

• the broadening of our biopharmaceutical offering,
• further rollout of clinical nutrition,
• expansion in the MedTech area.

Fresenius Kabi's growth strategy was transparently presented at a Capital Markets Day in May 2023.

With the acquisition of a majority stake in mAbxience, we form a fully integrated, vertical biopharma business that holds a strong portfolio and pipeline, provides extensive and cost-efficient manufacturing, and is strengthening the targeted commercial footprint in Fresenius Kabi's and mAbxience's target regions.

Successful market launches have made Fresenius Kabi the leading provider of intravenous lipid nutrition in North America. This strengthens the global clinical nutrition business beyond its solid base in Europe, Latin America, and Asia-Pacific.

Our newly bundled MedTech business has been further strengthened by the acquisition of Ivenix. With the award-winning Ivenix infusion system, we are entering the infusion therapy market in the United States. The design of the Ivenix infusion system is easier to use than conventional systems and increases the safety of infusions. The pump also works seamlessly with other systems.

In parallel, Fresenius Kabi has continued to build resilience in its volume-driven IV business and is extending the portfolio with continued launches in all regions.

Fresenius Helios wants to further strengthen its position as the leading private healthcare service provider in Europe.

Helios Germany will continue to focus its offerings on cross-sector healthcare, further specialize hospitals, and coordinate their respective medical service portfolios within regional structures. In regional competence centers, we are already pooling expertise in various specialist areas in order to achieve the best treatment results for our patients.

We will continue to drive this clustering forward in the future in order to further enhance medical quality. We intend to exploit the growth potential in the outpatient sector by linking our medical care centers (MVZs) even more closely with hospitals. In addition, we will seize the newly created regulatory opportunity of daytime inpatient treatment as a further form of care. We also aim to increase the efficiency of our energy consumption in the interests of sustainability and climate protection.

In Spain, we expect demand for hospital and other healthcare services to continue to rise. We want to continue to exploit this potential by building new clinics and expanding existing hospital sites. We aim to integrate our diverse range of inpatient and outpatient services even better and further expand them across the entire network of sites. We consistently focus on the strategic factors of medical excellence, innovation, and service quality in order to attract patients. Our focus here is on optimal treatment quality as well as patient satisfaction. In addition, we expect growth opportunities from consolidations in the fragmented private hospital market.

Fresenius Helios is constantly advancing its digitalization agenda in order to further improve patient care and service. In addition to the digitalization of our documents and internal processes, we will focus even more strongly on the digitalization of direct clinical processes and clinical decision support in the future. In doing so, we also want to make responsible use of the opportunities offered by artificial intelligence.

Fresenius Vamed manages projects in the area of integrated healthcare services to support healthcare systems more efficiently. Fresenius Vamed uses state-of-the-art standards such as building information modeling (BIM) in the construction of healthcare facilities. In operational management, Fresenius Vamed relies on new concepts, the use of innovative technologies, and digitalization measures. All of this serves to improve medical care and reduce the workload of medical staff.

#FutureFresenius

In the 2023 fiscal year, we advanced our #FutureFresenius program in order to transform our Group and position it for the coming decades. We made great progress in the 2023 financial year, particularly in the structural progression of the Group.

The healthcare industry has a long runway for growth, which will be accelerated by quickly evolving technologies, new therapies such as biopharmaceuticals, more and more professional steering of patient journeys, and a true digital revolution. We want Fresenius to be at the forefront of these trends and have thus charted our course to continued system relevance in our businesses.

The first step of this journey was a Reset: strengthening our return focus, driving structural productivity, and creating change momentum across the organization. With the closure of the Reset phase, we are now in the Revitalize phase, gearing up for continuous portfolio optimization and the pursuit of growth verticals.

In the 2023 fiscal year, the deconsolidation of Fresenius Medical Care and targeted divestments sharpened the focus of the portfolio and achieved structural simplification. Clear structures and responsibilities were also defined with the initiation of a new operating model. This framework will enable us to steer and improve performance in a more targeted manner in future based on the Fresenius Financial Framework.

Portfolio focus

We have executed a comprehensive diagnosis of our Group portfolio at sub-segment level, in order to highlight growth opportunities aligned with market trends, further refine our management approach for each business we operate and identify areas to strengthen our portfolio focus.

Going forward, we want to increasingly orient our portfolio to three platforms: (Bio)Pharma including clinical nutrition, MedTech, and Care Provision. With these platforms, we cater to major trends in healthcare and become a more therapy-focused company. The health and quality of life of our patients who we serve with high-quality, affordable products and services is at the core. At the same time, our platforms address attractive value pools in healthcare, which will provide opportunities for future profitable growth.

We will prioritize growth investments for the healthcare products and services of tomorrow in our Operating Companies Fresenius Kabi and Fresenius Helios.

Across all segments, we are seeking opportunities to strengthen the focus on core business cells, in order to safeguard a sound capital structure and availability of capital for future growth prospects. Within the Fresenius Group, we will under the operating model initiated in 2023 provide strategic direction, effective governance and risk management and provide targetedservices to the benefit of our segments and the overall capital efficiency of the Group.

As announced, Fresenius continued to focus on and prioritize its core business areas in the 2023 fiscal year as part of its active portfolio management. The following portfolio measures were agreed as part of this:

• Disposal of the majority interest in a co-holding entity of the Clínica Ricardo Palma hospital in Lima, Peru, and resulting exit from the Peruvian hospital business
• Sale of the Eugin Group to the global fertility medicine group IVI RMA to further focus Fresenius Helios on its core business; closed on January 31, 2024
• Transfer of the Fresenius Kabi plant in Halden (Norway) to HP Halden Pharma AS, a company of the Prange Group, as part of the Vision 2026 strategy, which aims, among other things, to reduce complexity and optimize capacity utilization in the global production network
• Termination of the activities of Curalie GmbH, a provider of healthcare apps belonging to Fresenius Helios, and sale of the Curalie subsidiaries meditec and ibs

Deconsolidation of Fresenius Medical Care

With the deconsolidation of the Fresenius Medical Care business segment in the 2023 fiscal year, we reached a milestone in the implementation of our #FutureFresenius strategy. The resulting significant reduction in the complexity of the corporate structure creates the conditions for greater flexibility and more efficient, faster decision-making.

In February 2023, it was announced that Fresenius intends to deconsolidate Fresenius Medical Care via a change of legal form of Fresenius Medical Care AG & Co. KGaA into a stock corporation (Aktiengesellschaft, AG). At the Extraordinary General Meeting of Fresenius Medical Care in July 2023, this legal form change was approved by 99% of the shareholders. At its constituent meeting following the Annual General Meeting, the new Supervisory Board of Fresenius Medical Care AG elected Michael Sen as its Chair and Fresenius CFO Sara Hennicken as Deputy Chair. This underscores Fresenius close ties with Fresenius Medical Care and its ongoing commitment to the company. Following the entry of the conversion in the commercial register on November 30, 2023, the change of legal form and the associated deconsolidation of Fresenius Medical Care became effective.

As a result of the approval of the legal form change at the Extraordinary General Meeting on July 14, 2023, Fresenius Medical Care was presented as a separate line item (activities held for deconsolidation) in the consolidated income statement, the consolidated statement of financial position, and the consolidated statement of cash flows for the first time in the third quarter of 2023, in accordance with IFRS 5.

Following the entry of Fresenius Medical Care's change of legal form in the commercial register on November 30, 2023, the investment in Fresenius Medical Care was deconsolidated and subsequently accounted for using the equity method in accordance with IAS 28.

Structural productivity

While fundamentally healthy and geared toward long-term growth, our market environment is also characterized by strong current macro headwinds that challenge our operations and increase our cost base. With that in mind, we have reinvigorated our focus on structural productivity and are running corresponding programs in all our business segments and at the corporate center.

Structural productivity improvements are expected to offset market headwinds and to create financial flexibility for future growth investments in the coming years.

We have increased the original target of saving around €350 million (excluding Fresenius Medical Care) annually in sustainable costs at EBIT level from 2025. We now plan to save around €400 million (excluding Fresenius Medical Care) in structural costs at EBIT level from 2025.

The cost savings program includes programs in all business segments and in the Corporate Center, which are managed and controlled centrally by the Group. The most important elements are process optimization, the reduction of sales, administration and procurement costs as well as digitalization measures.

The Group-wide cost and efficiency program is making excellent progress. In the 2023 fiscal year, we increased the annual savings achieved since the start of the program to around €280 million (excluding Fresenius Medical Care). This significantly exceeded the original target of €200 million for 2023. One-time costs incurred as part of the program amounted to around €221 million (excluding Fresenius Medical Care) in the 2023 fiscal year.

For 2024, Fresenius expects to increase the annual cost savings under the cost and efficiency program to €330 to 350 million

To achieve the targeted cost savings, additional one-time costs of around €80 to 100 million are expected at EBIT level for the period 2024 to 2025. The one-off costs will continue to be classified as special items in line with previous practice.

Transformation of Fresenius Vamed

As a result of the continuing negative earnings development at Fresenius Vamed, Fresenius comprehensively analyzed the business model, governance, and all processes of Fresenius Vamed and initiated a comprehensive transformation of the company's organization. At the same time, a far-reaching restructuring program was initiated with the clear objective of increasing the company's profitability. The reorganization of the management of Fresenius Vamed was announced at the end of June 2023. Dr. Michael Moser, member of the Fresenius Management Board, is now responsible for Fresenius Vamed. In addition, the control function of the Vamed Supervisory Board was strengthened by new appointments and the establishment of an Audit Committee, consisting of Sara Hennicken as Chair and Dr. Michael Moser as Deputy Chair, among others.

As part of the transformation, Fresenius Vamed has realigned its project business, particularly in Germany. Moreover, Fresenius Vamed has initiated the withdrawal from non-core activities in main non-European markets in the service business. This will lead to a redimensioning of activities and thus to a significantly lower risk profile.

In the future, Fresenius Vamed will focus on attractive functional business areas comprising:

• Health Facility Operations (HFO) centered on inpatient and outpatient rehabilitation and nursing
• High-End Services (HES) for hospitals focused on the management of medical equipment, hospital operating technology, and sterile supplies
• Health Tech Engineers (HTE) covering the project business for the healthcare sector

Despite a negative EBIT before special items of -€16 million (compared to a positive EBIT before special itemsBefore special itemsIn ​order ​to ​measure ​the ​operating ​performance ​extending ​over ​several ​periods, ​key ​performance ​measures ​are ​adjusted ​by ​special ​items, ​where ​applicable. ​Adjusted ​measures ​are ​labelled ​with ​“before ​special ​items”. ​A ​reconciliation ​table ​is ​available ​within ​the ​respective ​quarterly ​or ​annual ​report ​and ​presents ​the ​composition ​of ​special ​items. of +€20 million in the 2022 fiscal year), Fresenius Vamed made progress in the 2023 financial year, to which the successfully initiated transformation processes in particular contributed.

As a result of this transformation, Fresenius Vamed remeasured the affected business activities in the 2023 fiscal year and recognized special items of €554 million. These are attributable in particular to impairments of loans, investments, receivables, inventories and orders, restructuring expenses, and the recognition of corresponding provisions. These special items are largely non-cash items.

From the 2025 fiscal year, Fresenius Vamed is expected to achieve the structural EBIT marginEBIT marginEBIT ​margin ​is ​calculated ​as ​the ​ratio ​of ​EBIT ​to ​revenue. range of 4% to 6% specified in the Fresenius Financial Framework.

Change momentum

At Fresenius, our collective actions have always been driven by our enormous passion and the strongest possible commitment to patients. On our pathway to #FutureFresenius, we want to nurture this passion, and combine it with a strong appetite for change, preparing us for the dynamic shifts in the healthcare industry for the best of our patients. As part of #FutureFresenius, we aim to embrace new ways of working and establish a culture of excellence, where we measure ourselves against the best and maintain trusting dialog that welcomes diverse perspectives. Throughout our company, we engage in such trusting dialog with our employees, stakeholders, and external partners, and our global top leaders are agreed about the need for change. We aim to continuously pick up the pace of change and improvement and use this momentum to create #FutureFresenius.

Sustainability program

For Fresenius, sustainability is an integral part of its business model. The company is working to establish global sustainability standards and continuously improve its own sustainability performance. To this end, Fresenius continued to drive forward its ESG (Environment, Social, Governance) initiatives in fiscal year 2023.

Fresenius has set a climate target for the Group complementing its existing sustainability targets and programs. The company aims to be climate-neutral by 2040 and to reduce 50% of absolute Scope 1 and Scope 2 emissions by 2030 compared to 2020 levels. Fresenius will continuously assess Scope 3 emission impacts for inclusion in our targets.

Further information on our sustainability organization and the measures taken in the 2023 fiscal year can be found in the Non-financial Group Report.