Fresenius : Annual Report 2023 (IFRS)

Operating Companies		Investment Companies

Fresenius is a global healthcare company. We offer system-critical products and services for therapies for care of critically and chronically ill patients. Fresenius comprises the Operating Companies Fresenius Kabi and Fresenius Helios as well as the Investment Companies Fresenius Vamed and Fresenius Medical Care.

GROUP IN FIGURES

€ in millions

Revenue and earnings

Revenue 1

EBITDA 1,2

EBIT 1,2

Net income 1,2,3

Depreciation and amortization 1,2

Earnings per share in € 1,2,3

Cash flow and balance sheet

Operating cash flow 1

Free cash flow before acquisitions, dividends and lease liabilities 1

Free cash flow after acquisitions, dividends and lease liabilities 1

Cash conversion rate 1

Total assets

Non-current assets

Equity 4

Equity ratio 4

Net debt 1

Net debt / EBITDA1,2,5

Investments 1,6

Profitability

EBIT margin 1,2

Return on invested capital (ROIC)1,2

Dividend per share in €

Employees (December 31) 1

2023	2022	2021	2020	2019
22,299	21,532	19,969	18,476	17,993
3,422	3,315	3,353	3,042	3,191
2,262	2,190	2,337	2,113	2,332
1,505	1,729	1,867	1,796	1,879
1,160	1,125	1,016	929	859
2.67	3.08	3.35	3.22	3.37
2,131	2,031	2,589	2,316	1,696
1,024	942	1,401	986	376
115	-318	388	18	- 394
1.0	0.9	0.9	0.8	0.5
45,284	76,400	71,962	66,646	67,006
32,764	58,121	54,501	50,874	51,742
19,651	32,218	29,288	26,023	26,580
43%	42%	41%	39%	40%
13,268	13,316	12,650	13,021	12,980
3.76	3.80	3.64	4.12	3.93
1,346	2,015	1,635	1,841	1,664
10.1%	10.2%	11.7%	11.4%	13.0%
5.2%	5.6%	6.2%	5.9%	6.7%
-	0.92	0.92	0.88	0.84
193,865	188,876	185,827	178,140	165,834

Prior-yearfigures have been adjusted due to the application of IFRS 5 to the deconsolidated operations of Fresenius Medical Care
Before special items
Net income attributable to shareholders of Fresenius SE & Co. KGaA; before special items
Including noncontrolling interests
At average exchange rates for both net debt and EBITDA; pro forma closed acquisitions / divestitures, including lease liabilities, including Fresenius Medical Care dividend
Investments in property, plant and equipment, and intangible assets, acquisitions

For a detailed overview of special items please see the reconciliation tables on pages 64 to 67.

View our interactive tool	3

TARGETS, RESULTS, AND OUTLOOK

		TARGETS 2023 1	RESULTS 2023		OUTLOOK 2024

Fresenius Group

		Growth in a mid-single-digit	6%		3% to 6%
Revenue growth ex FMC (organic)	percentage range		(base: €21,776 m)
		Broadly flat	2%		4% to 8%
EBIT growth ex FMC (in constant currency) 2		(base: €2,220 m)
Liquidity and capital management

Cash conversion rate ex FMC	Below 1	1		Around 1
Net debt / EBITDA ex FMC3	Below 4.0×	3.76x		3.0 to 3.5x

Capital efficiency

Return on invested capital (ROIC) ex FMC2,4	Around 5%	5.2%	Within a range of 5.4% to 6.0%

Updated in October 2023
Before special items
At average expected exchange rates for both net debt and EBITDA; pro forma closed acquisitions / divestitures; before special items, including lease liabilities
Pro forma acquisitions

For a detailed overview of special items please see the reconciliation tables on pages 64 to 67.

TARGETS, RESULTS, AND OUTLOOK

		TARGETS 2023 1	RESULTS 2023		OUTLOOK 2024

Operating and Investment Companies

Fresenius Kabi
		Mid-single-			Mid-single-digit
Revenue growth	7%		percentage growth
(organic)	digit percentage growth		(base: €8,009 m)
		Around 14%			Around 15%
				(structural margin band:
		(structural margin band:	14.3%		14% to 17%;
EBIT margin 2	of 14% - 17%)		base: €1,145 m)
Fresenius Helios
		Mid-single-digit			Low-to-mid-single-digit
Revenue growth	5%		percentage growth
(organic)	percentage growth		(base: €11,952 m)
		Within structural			Within the structural
		EBIT margin band	10 .0%		margin band of 9% to 11%
EBIT margin 2	of 9% - 11%		(base: €1,190 m)
Fresenius Vamed

		Low-to-mid-single-digit			Mid-single-digit
Revenue growth	1%		percentage growth
(organic)	percentage growth		(base: €2,201 m)
		Clearly below structural			1% to 2%-points below the
		EBIT margin band	-0.7%		structural margin band
EBIT margin 2	of 4% - 6%		of 4% to 6% (base: -€16 m)

Updated in October 2023
Before special items

For a detailed overview of special items please see the reconciliation tables on pages 64 to 67.

Group Management Report

Group Non-Financial Report

Corporate Governance

Consolidated financial statements

Further information

TABLE OF CONTENTS

Group in figures
Targets, results, and outlook

To our shareholders
Letter to our shareholders

Management Board
Report of the Supervisory Board

Fresenius share

Group Management Report
Fundamental information about the Group
26 The Group's business model
31 Strategy and goals
36 Corporate performance criteria
42 Research and development
48 Employees
49 Change to the Supervisory Board
49 Change to the Management Board
50 Procurement
50 Quality management
50 Responsibility, environmental management, and sustainabil- ity

51 Economic report

51 Macroeconomic conditions

51 Healthcare industry

56 Overall business development

59 Results of operations, financial position, assets and liabilities

79 Overall assessment of the business situation

79 Outlook

79 General and mid-term outlook

80 Healthcare sector and markets

84 Group revenue and earnings

84 Revenue and earnings by business segment

85 Expenses

85 Tax rate

85 Cost and efficiency program

85 Liquidity and capital management

86 Investments

86 Capital structure

86 Dividend

86 Non-financial targets

87	Opportunities and risk report	204	Corporate Governance	360	Responsibility statement
	87	Opportunities management	205	Corporate Governance Declaration
	87	Significant characteristics of	220	Further information on
		the Fresenius risk manage-		Corporate Governance	361	Auditor's report
		ment system and entire inter-	222	Compensation report
		nal control system
	91 Assessment of the overall risk				369	Further information
		situation	261	Consolidated financial statements	370	Boards
	91 Risks affecting the one-year	262	Consolidated statement of income		370	Supervisory Board
		forecast period	263	Consolidated statement of			Fresenius SE & Co. KGaA
	92	Risk areas		comprehensive income		372	Management Board
			264	Consolidated statement			Fresenius Management SE
				of financial position		373	Supervisory Board
102	Separate	265	Consolidated statement			Fresenius Management SE
	Group Non-Financial Report		of cash flows	374	Glossary
103	Strategy and management	267	Consolidated statement	379	Imprint
116	Well-being of the patient		of changes in equity	380	Financial Calendar
132	Innovation	269	Consolidated segment reporting	380	Fresenius share / ADR
137	Digital transformation				380	Contact
142	Cybersecurity
146	Employees	271	Notes
157	Occupational health and safety		272	General notes
164	Diversity and equal opportunities		295	Notes on the consolidated
169	Compliance and Integrity			statement of income
184	Environment		302 Notes on the consolidated
194	Further key figures			statement of financial
199	Report profile			position
201	Independent practitioner's report		327	Other notes

Group Management Report

Group Non-Financial Report

Corporate Governance

Consolidated financial statements

Further information

Letter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share

TO OUR SHAREHOLDERS

Letter to our shareholders

Management Board
Report of the Supervisory Board

Fresenius share

LETTER TO

OUR SHAREHOLDERS

Dear Shareholders,

The healthcare industry is not only of fundamental importance to people's well-being, but also a highly attractive economic sector: nowhere are more investments currently being made. Healthcare is the most exciting field of activity right now for future technologies like artificial intelligence (AI) and robotics.

Fresenius is at the heart of healthcare and will continue to draw on these developments in the future to further strengthen its position as a leading therapy-focused company. In the 2023 fiscal year, we achieved important milestones and shall maintain the high pace of implementation in the coming years.

Michael Sen	8
Chairman of the Management Board

Group Management Report

Group Non-Financial Report

Corporate Governance

Consolidated financial statements

Further information

Letter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share

The healthcare industry offers tremendous opportunities. It is growing structurally, yet at the same time facing the challenge of having to use resources more efficiently.

A demographic shift is taking place: in many regions of the world, the population is aging and the number of people with chronic diseases is increasing. The importance of health equity - that is to say, fair, affordable, and high- quality healthcare for all people - is rightly growing. Health awareness has improved among many people, too.

At the same time, great progress has been made in rec- ognizing, treating, and curing diseases that were until recently considered incurable. This is thanks to disruptive changes such as cell and gene research in biology, technological advances in AI and robotics, and ever greater quantities of usable data.

We have realigned our company to the #FutureFresenius strategy and are now focusing on simplifying the structure, sharpening our focus, and enhancing performance. Fresenius previously had a complex corporate structure. In today's fast-paced world, we must be faster and more focused. Only by improving Fresenius can we fulfil our mission and thus improve people's health.

Humans and machines for optimal therapy: robot-assisted surgery enables greater precision and therefore a faster recovery.

Simplified structure

We have reduced complexity and created transparency and flexibility. Fresenius completed the deconsolidation of Fresenius Medical Care (FMC) at the end of November 2023. This historic step offers both companies tremendous advantages: decisions are now made faster and more effi- ciently. The management teams can concentrate on their respective core business. Capital allocation has improved. FMC is no longer part of the fully consolidated subsidiaries of Fresenius. The latter continues to hold a 32 percent stake in of FMC's share capital however and therefore has a vested interest in its value-preserving development.

Great progress has been made in recognizing, treating, and curing diseases that were until recently considered incurable. «

Sharper focus

We are now concentrating on our operating companies Fresenius Helios and Fresenius Kabi. Both businesses afford attractive market positions and good growth oppor- tunities. We manage FMC and the hospital and healthcare provider Fresenius Vamed as investment companies. At the same time, we are divesting ourselves of businesses for which we are no longer the "best owner." We have sold our hospital business in Peru and the Eugin chain of fertility clinics, for example.

With Fresenius Helios in Germany and Quirónsalud in Spain, Fresenius is Europe's leading private hospital operator and treats around 26 million patients every year. Two things that makes us proud: in 2023, Newsweek magazine voted five Quirónsalud clinics among the world's best specialized hospitals. And Wirtschaftswoche business magazine named Fresenius Helios the top healthcare provider in Germany in the "Regional clinic/hospital groups" category.

Group Management Report

Group Non-Financial Report

Corporate Governance

Consolidated financial statements

Further information

Letter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share

A few examples of innovations:

At Quirónsalud, digital solutions already support a large part of the patient journey. The Casiopea platform developed in-house is used to assign patients to the right location and to initiate the correct course of treat- ment before a patient has even visited the doctor or clinic. Overall, the outcome is better coordinated pro- cesses, more pleasant treatment paths, and more suc- cessful therapies.
AI applications and digital solutions are also increasingly being integrated into everyday clinical practice at our Fresenius Helios facilities in Germany. Thanks to AI, for

example in the analysis of radiological images or use of robots during minimally invasive procedures, diagnoses and medical interventions are becoming more precise and efficient. This is good for both the medical quality and the company's economic success.

Fresenius Kabi is successfully implementing the Vision 2026 strategy. The generics we produce save healthcare systems around the world substantial sums of money and make high-quality medicines available to a growing number of people. Seventy percent of the intravenous drugs we deliver to the USA are on the list of essential medicines of the U.S. Food and Drug Administration (FDA). With our portfolio and pipeline of biosimilars, new treatment options with affordable medicines and medical products are constantly becoming available - in 40 countries worldwide already.

Fresenius is at the heart of health- care and will continue to draw on these developments in the future to further strengthen its position as a leading therapy-focused company. «

Biosimilars are follow-on versions of biopharmaceuticals, that is to say, biotechnological drugs that are authorized after the patent period of the original active ingredient has expired. They are used to treat autoimmune diseases

or cancer.

Biosimilars from Fresenius Kabi allow more people access to state-of-the-art therapies.

Some highlights at Fresenius Kabi:

In 2023, we among others achieved two milestones with our biosimilars: with the launch of Tyenne®, which is used to treat inflammatory and autoimmune diseases, a biosimilar with the active ingredient tocilizumab is now available in the EU for the first time. And in the USA, we significantly expanded the treatment options for patients with autoimmune diseases and cancer through the market launches of the two biosimilars Idacio® and Stimufend®.
In terms of medical technology, we offer state-of-the-art infusion pump technology with the Ivenix® infusion sys- tem. In the USA, we have signed a multi-year agreement with the renowned U.S. hospital group, the Mayo Clinic, for the supply and service of 10,000 Ivenix® large-volume infusion pumps for its hospitals and clinics.
Fresubin® PLANT-BASED Drink, a vegan alternative, complements our extensive range of clinical nutrition and meets the growing demand for plant-based alternatives.

Enhanced performance

With the implementation of our strategy at the start of the year, we also established our Fresenius Financial Frame- work. The main new feature is a focus on returns through clearly defined EBIT margin bands for the business segments and capital returns at Group level.