Fresenius Annual Report 2021 0
Uploaded by
xacaFresenius Annual Report 2021 0
Uploaded by
xacaMedia Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
ANNUAL REPORT
2021
Front page Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius is a global health care Group providing products and services for dialysis,
hospitals, and outpatient medical care. In addition, Fresenius focuses on hospital opera-
tions. We also manage projects and provide services for hospitals and other health
care facilities worldwide. More than 300,000 employees have dedicated themselves
to the service of health in over 100 countries worldwide.
Fresenius | Annual Report 2021
Play Image Film
2
Front page Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
GROUP IN FIGURES
€ in millions 2021 2020 2019 1 2018 2017
Sales and earnings
Sales 37,520 36,277 35,409 33,530 33,886
EBITDA 2 6,854 7,132 7,104 6,055 6,267
EBIT 2 4,252 4,612 4,688 4,561 4,830
Net income 3 1,867 1,796 1,879 1,871 1,816
Depreciation and amortization 2 2,602 2,520 2,416 1,430 1,437
Earnings per share in € 3 3.35 3.22 3.37 3.37 3.28
Cash flow and balance sheet
Operating cash flow 5,078 6,549 4,263 3,742 3,937
Operating cash flow as % of sales 13.5 18.1% 12.0% 11.2% 11.6%
Total assets 71,962 66,646 67,006 56,703 53,133
Non-current assets 54,501 50,874 51,742 41,913 40,529
Equity 4 29,288 26,023 26,580 25,008 21,720
Equity ratio 4 41% 39% 40% 44% 41%
Net debt 24,391 24,076 25,604 16,275 17,406
Net debt / EBITDA 5, 6 3.51 3.44 3.61 2.71 2.84
Investments 7 3,117 3,300 5,086 3,249 8,680
Profitability
EBIT margin 2 11.3% 12.7% 13.2% 13.6% 14.3%
Return on equity after taxes (ROE) 3 9.8% 10.6% 11.2% 12.1% 13.3%
Return on operating assets (ROOA) 5 6.5% 7.3% 7.6% 9.0% 9.4%
Return on invested capital (ROIC) 5 5.9% 6.5% 6.7% 8.3% 8.0%
Dividend per share in € 0.92 8 0.88 0.84 0.80 0.75
Employees (December 31) 316,078 311,269 294,134 276,750 273,249
1
Including IFRS 16 effect
Fresenius | Annual Report 2021
2
Before special items
3
Net income attributable to shareholders of Fresenius SE & Co. KGaA; before special items
4
Including noncontrolling interests
5
Before special items; 2017, 2018, 2019, 2020, 2021 pro forma acquisitions
6
At average exchange rates for both net debt and EBITDA
7
Investments in property, plant and equipment, and intangible assets, acquisitions
8
Proposal
For a detailed overview of special items please see the reconciliation tables on pages 74 to 76.
View our interactive tool
3
Front page Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
TARGETS, RESULTS, AND OUTLOOK
TARGETS 2021 1 RESULTS 2021 OUTLOOK 2022 2
Fresenius Group
Sales growth Mid single-digit Mid single-digit
(in constant currency) percentage growth 5% percentage growth
Net income 3 growth Around the top-end of Low single-digit
(in constant currency) low single-digit percentage growth 5% percentage growth
Investments in property,
plant and equipment ~ 6% of sales 5% of sales ~ 6% of sales
Liquidity and capital management
Cash flow margin 10% to 12% 13.5% 10% to 12%
Around the top-end Without further acquisitions,
of the self-imposed target corridor we project an improvement into
Net debt / EBITDA of 3.0 × to 3.5 × 4 3.51 × the self-imposed target corridor
Fresenius | Annual Report 2021
1
Before special items; including expected COVID-19 effects (updated in November 2021; more information within table of achieved Group targets on p. 68)
2
Before special items, including expected COVID-19 effects
3
Net income attributable to shareholders of Fresenius SE & Co. KGaA
4
At average expected exchange rates for both net debt and EBITDA; excluding further potential acquisitions; before special items 4
Front page Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
TARGETS, RESULTS, AND OUTLOOK
TARGETS 2021 1 RESULTS 2021 OUTLOOK 2022 2
Business segments
Fresenius Medical Care 3
Expecting to be at the lower end
Sales growth of the guidance range of low-to- Low-to-mid single-digit
(in constant currency) mid single-digit percentage growth 2% percentage growth
Expecting to be at the lower end
of the guidance range
Net income 4 growth of high-teens to mid-twenties Low-to-mid single-digit
(in constant currency) percentage decline -23% percentage growth
Fresenius Kabi
Sales growth Low-to-mid single-digit Low single-digit
(organic) percentage growth 4% percentage growth
Around the top end of the Decline in high single- to
EBIT growth low single-digit percentage low double-digit
(in constant currency) guidance range 7% percentage range
Fresenius Helios
Sales growth Mid single-digit Low-to-mid single-digit
(organic) percentage growth 7% percentage growth
EBIT growth High single-digit Mid single-digit
(in constant currency) percentage growth 10% percentage growth
Fresenius | Annual Report 2021
Fresenius Vamed
Sales growth Mid-to-high single-digit High single- to low double-digit
(organic) percentage growth 11% percentage growth
Returning to
High double-digit absolute pre- COVID levels
EBIT € million amount € 101 million (2019: € 134 million)
1
Before special items, including estimated COVID-19 effects (updated in November 2021, more information within table of achieved Group targets on p. 68)
2
Before special items, including estimated COVID-19 effects
3
These targets are based on the 2021 results excluding the costs related to FME25 of € 49 million (for Net Income). They are based on the outlined assumptions, in constant
currency and exclude special items. Special items include further costs related to FME25 and other effects that are unusual in nature and have not been foreseeable or not
foreseeable in size or impact at the time of giving guidance.
4
Net income attributable to shareholders of Fresenius Medical Care AG & Co. KGaA 5
Front page Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
FRESENIUS STRATEGY
CORE
COMPETENCIES
Improve
profitability
Drive
FOCUS internationalization
Hospital Dialysis
supplies & products &
Innovation services services
Hospital MISSION Hospital
projects & operations
services We improve people’s lives
by providing high-quality and
Quality affordable health care. Employees
Fresenius | Annual Report 2021
PURPOSE
Ever better medicine for ever more people
6
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care | Fresenius Kabi | Fresenius Helios | Fresenius Vamed
Front page
OUR SUCCESS FACTORS
FRESENIUS MEDICAL CARE. ▶ Sustainable business based on
high-quality products and services
▶ Strong global footprint
Fresenius Medical Care is the world’s leading provider of products ▶ Leading market positions
and services for individuals with renal diseases. We aim to create ▶ Highly qualified employees
▶ High level of vertical integration
a future worth living for chronically and critically ill patients – world
wide and every day.
OUR GROWTH DRIVERS
▶ ging population and increasing number
A
of patients with chronic diseases
▶ Increasing presence in emerging markets
COMPREHENSIVE DIALYSIS PRODUCTS Our value-based care models will push forward the transi-
▶ Standardizing medical procedures
AND SERVICES tion from fee-for-service to pay-for-performance models
▶ Increasing demand for home hemo
to offer even better and affordable care. We are expanding
dialysis
When the kidney function of patients fails, dialysis takes these models to the treatment of chronic kidney disease
▶ Providing integrated solutions for
over the vital task of cleansing the blood of toxins and sur- and plan to include kidney transplant patients as well.
patients and health care systems
plus water. We offer products and services along the
▶ Developing and enhancing value-based
entire dialysis value chain. In addition to dialysis machines, Critical care solutions
care
dialyzers, and related disposables, we operate our own In addition to acute dialysis, we will therefore increasingly
dialysis clinics worldwide. As part of our strategy 2025, we rely on our expertise in intensive care. In this area, we can
will concentrate on three key areas in which we want to draw in particular on our experience in extracorporeal blood
leverage our core competencies – innovation of products, treatment and cardiopulmonary support in acute kidney
operating outpatient facilities, standardizing medical failure.
Fresenius | Annual Report 2021
procedures, and efficiently coordinating patients:
Complementary assets
Renal care continuum To create an additional basis for future growth, we are further
By applying digital technologies such as artificial intelligence, expanding our network of complementary assets through
we work on new forms of renal therapy to foster personal- partnerships, investments, and acquisitions. This will help
ized medicine and holistic home care, among other things. us to create additional medical value while cutting costs.
7
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care | Fresenius Kabi | Fresenius Helios | Fresenius Vamed
Front page
MARKET DYNAMICS SALES BY REGION
Asia-Pacific
Increase in worldwide demand Quality in dialysis treatments and Latin America
enables saving
~ 1.6 million in the U.S. market 15% North America
patients worlwide, 69%
who will need continuous renal US$ 4.9 bn savings EMEA
replacement therapy to treat acute created by all dialysis providers for 16%
kidney failure in 2030 Medicare and taxpayers since QIP
(quality incentive program) was
Home dialysis
enacted
By 2025, the Company aims
to perform
25 % Big Data is driving new
treatment models
of all treatments in the U.S.
SALES BY SERVICES AND PRODUCTS
in a home setting
~ 53 million
dialysis treatments in 2021
Global market for dialysis providing sound data basis to further
products and services standardize medical setups at Products
21%
Fresenius Medical Care
~ € 79 bn
Fresenius | Annual Report 2021
Services
79%
Source information can be found on page 402. 8
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care | Fresenius Kabi | Fresenius Helios | Fresenius Vamed
Front page
MAJOR EVENTS SALES AND EARNINGS DEVELOPMENT
▶ Realignment of the operating model expands production
as part of the FME25 program.
EMEA
In the future, the simplified structure will comprise only two global segments: Growth
in constant
in the Care Enablement segment, Fresenius Medical Care consolidates its pre in € millions 2021 2020 Growth currency
viously decentralized product business under one global medical technology Sales 2,765 2,763 0% 1%
umbrella. The global health care services business will be combined in the EBIT 322 412 -22% -21%
Employees 29,983 30,185 -1%
Care Delivery segment. In this way, the company aims to become more agile,
make better use of existing know-how, accelerate innovations, and deploy its
capital in a more targeted and thus more efficient manner. With the implemen- NORTH AMERICA
Growth
tation of the new global operating model, Fresenius Medical Care expects to in constant
in € millions 2021 2020 Growth currency
reduce its annual costs by € 500 million by 2025.
Sales 12,088 12,478 -3% 0%
EBIT 1,673 2,120 -21% -18%
▶ Fresenius Medical Care trains patients with virtual Employees 66,232 67,028 -1%
reality technology for the home dialysis.
The VR training helps patients learn how to use the stay•safe system for Con-
tinuous Ambulatory Peritoneal Dialysis correctly. It appeals to several senses ASIA-PACIFIC AND LATIN AMERICA
Growth
and makes it particularly easy to learn new procedures and consolidate con- in constant
in € millions 2021 2020 Growth currency
ventional training. Patients can adjust the learning pace individually and repeat
Sales 2,713 2,578 5% 9%
the learning units as often as necessary until they are confident in their use. EBIT 362 382 -5% -4%
Employees 34,036 35,916 -5%
▶ Fresenius Medical Care improves clinical care perfor-
mance through continuous digital quality improvement.
Fresenius | Annual Report 2021
Following the introduction of the Medical Patient Review Continuous Quality
Improvement (MPR-CQI) program in 20 countries in the EMEA region, an
improvement in medical performance indicators was observed, which was
associated with a significant reduction in mortality risk of about 30%. This
was confirmed by a study. For the development of the MPR-CQI program, the
company used therapy data from more than 70,000 patients from its own
NephroCare network.
9
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care Fresenius Kabi | Fresenius Helios | Fresenius Vamed
Front page
OUR SUCCESS FACTORS
FRESENIUS KABI. ▶ I mprove the quality of life of our patients
▶ Affordable high-quality products
▶ Supply reliability
Fresenius Kabi is a global health care company that specializes in ▶ Highly qualified employees
lifesaving medicines and technologies. Our daily work has a major ▶ Strong global footprint
▶ Leading market positions
impact on patients’ quality of life. Our goal is to meet the needs of ▶ Innovation in products, processes, and
systems
patients and health care professionals while driving forward the topic
of sustainability in health care.
OUR GROWTH DRIVERS
▶ Organic growth through geographic
product rollouts and product launches
COMPREHENSIVE PRODUCT PORTFOLIO Infusion therapy
▶ Development of qualified and talented
Infusion solutions and blood volume substitutes.
employees
IV drugs
▶ Strong product pipeline
Intravenously administered generic drugs (IV) across a wide Biosimilars
▶ Development and rollout of biosimilars
array of therapeutic categories: oncology, anesthetics, A biosimilar is a biological medicine highly similar to
▶ Increasing presence in emerging markets
analgesics, anti-infectives, and critical care. This type of another already-approved biological medicine (the “reference
▶ Selective small and mid-sized acquisi-
administration is used in cases of emergency, since the medicine”). Fresenius Kabi’s focus is on autoimmune dis-
tions
drug reaches the entire human body directly through the eases and oncology.
bloodstream and can be effective within a few seconds.
IV drugs are also administered in intensive care and during Medical devices
surgery. Devices and disposables used to administer IV generic
Fresenius | Annual Report 2021
drugs, infusion therapies, and clinical nutrition products.
Clinical nutrition
Parenteral nutrition (administered intravenously) and enteral Transfusion technology
nutrition (administered as sip or tube feed via the gastro Products for collection of blood components and extra
intestinal tract). Both serve to help patients who cannot eat corporeal therapies.
any, or sufficient, normal food.
10
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care Fresenius Kabi | Fresenius Helios | Fresenius Vamed
Front page
MARKET DYNAMICS SALES BY REGION
Continuing growth of generics Rising cost consciousness in North America
and biopharmaceuticals in 2022
expected
health care spending – significant
savings from generics 32% Europe
35%
high single-digit ~ US$ 313 bn
% range savings p.a.
in the United States Emerging markets
for generic IV drugs
(in sales/€) 33%
Expected market growth of
4 – 6% biosimilars 2021 to 2028
for biopharmaceuticals
(in volume)
+ 27% SALES BY PRODUCT SEGMENT
average growth p.a.
in the United States
Global addressable market 2021
~ € 114 bn Growing health care spending in
Infusion technology
emerging markets 12%
Fresenius | Annual Report 2021
Increase of population older than + 6.3% Medical devices / TT
60 years to growth p.a.
over the next decade
19% IV generics
1.4 bn Clinical nutrition
39%
in 2030 (2020: 1 bn)
30%
Source information can be found on page 402. 11
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care Fresenius Kabi | Fresenius Helios | Fresenius Vamed
Front page
MAJOR EVENTS SALES AND EARNINGS DEVELOPMENT
▶ ision 2026 defined and launched.
V
Vision 2026 is the framework to transform Fresenius Kabi for the next decade
EUROPE
and defines a sustainable growth path. Fresenius Kabi will focus on three Growth
in constant
growth vectors in the future: broadening our biopharmaceutical offering; in € millions 2021 2020 Growth currency
further introducing clinical nutrition products; expanding in MedTech. Sales 2,544 2,458 3% 3%
In the volume-driven IV business, we will continue to build our resilience. EBIT 374 355 5% 5%
Employees 15,306 15,124 1%
▶ djustment of organizational structure.
A
As part of Vision 2026, we want to improve our global competitiveness and the NORTH AMERICA
Growth
effectiveness of our organization. A first step in this process is the introduction in constant
in € millions 2021 2020 Growth currency
of a business-oriented instead of a regional organization. In the new organiza-
Sales 2,258 2,376 -5% -2%
tional structure, more responsibility will be assigned to the business segments EBIT 637 785 -19% -16%
and regions to support Fresenius Kabi’s growth targets, and the number of Employees 9,815 8,809 11%
interfaces in the company will be reduced.
▶ Important milestone towards approval of another EMERGING MARKETS
Growth
biosimilar. Positive news for our goal of improving treatment options for in constant
in € millions 2021 2020 Growth currency
patients. MSB11456, a tocilizumab biosimilar candidate, successfully met pri-
Sales 2,391 2,142 12% 12%
mary and secondary endpoints in two consecutive clinical trials. New products EBIT 646 471 37% 38%
serve a key role in the implementation of our strategic agenda for sustainable Employees 16,276 16,586 -2%
growth.
Fresenius | Annual Report 2021
▶ ollaboration to improve supply of key medicines
C
to U.S. patients. Together with the non-profit Phlow Corporation, we will
improve access to affordable intravenous medicines for U.S. pediatric hospital
patients. This is in line with our commitment to provide ever more people with
state-of-the-art therapies and medicines.
12
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care | Fresenius Kabi Fresenius Helios | Fresenius Vamed
Front page
OUR SUCCESS FACTORS
FRESENIUS HELIOS. ▶ ocus on patients’ safety and satisfaction
F
▶ Leading market positions
▶ Achieving measurable, high-quality
Fresenius Helios is Europe’s largest private hospital operator, standards of medicine
offering expertise in all areas and at all levels of inpatient and out ▶ Future-oriented workplace
▶ Strong hospital network and develop-
patient care as well as in telemedicine. Moreover, the company is ment of centers of excellence
▶ Digital support tools for patient treat-
active in the field of f ertility treatments. Fresenius Helios treats ment
over 22 million patients who undergo medical treatment with it
every year.
OUR GROWTH DRIVERS
▶ Organic growth through growing patient
COMPREHENSIVE INPATIENT AND Quirónsalud operates 49 hospitals as well as 88 outpatient
admissions and increasing prices for
OUTPATIENT CARE centers, and around 300 occupational risk prevention cen-
hospital services
ters. It is the largest private hospital operator in Spain. The
▶ Growth opportunities in the outpatient
Fresenius Helios comprises Helios Germany and Helios company offers comprehensive health care that encom-
sector and development of new patient
Spain (Quirónsalud) as well as Eugin Group and Curalie; all passes all medical specialties. In addition, the company is
care models
are part of the holding company Helios Health. active in Latin America with 7 hospitals and as a provider
▶ Expanding fertility services
Our extensive expertise and know-how in ensuring of medical diagnostics.
▶ Increasing digital connectivity with
high-quality, efficient, and patient-focused health care are
patients
exchanged across borders. This mutual knowledge transfer Eugin Group’s network comprises 33 clinics and additional
▶ Carrying out greenfield projects
aims to continuously optimize the care of our patients. 39 sites across 10 countries on 3 continents. The company
▶ Providing development opportunities
offers a wide spectrum of state-of-the-art services in the
for doctors and nurses
Fresenius | Annual Report 2021
Helios Germany operates 90 hospitals, around 130 out field of fertility treatments.
▶ Selective inorganic growth
patient clinics, and 6 prevention centers. It is the largest
provider of inpatient and outpatient care in Germany. The platform Curalie bundles the digital offerings such as
digital screening, diagnosis, treatment and aftercare pro-
grams of Fresenius Helios.
13
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care | Fresenius Kabi Fresenius Helios | Fresenius Vamed
Front page
MARKET DYNAMICS SALES BY REGION
Inpatient treatments could be Average increase of private Spain, Latin America
performed in outpatient settings health insurance policies in and other regions
Germany
in Spain of
38%
62%
25% ~2.5% p.a.
of cases.
An increased focus on ambulatory
care offers opportunities for hospital
operators.
Private hospital market in Spain
Hospital market in Germany
~ € 16 bn
~ € 111bn KEY HOSPITAL INDICATORS
The most common positive
benefit with e-health applica-
2021 2020 Change
tions is improved health status,
Downloads of e-health apps in Acute clinics Germany 87 86 1%
for
Germany increased in 2020 to Beds 29,955 29,451 2%
Acute clinics Spain and Latin America 56 52 8%
2 million. ~75%. Beds 8,174 7,936 3%
Fresenius | Annual Report 2021
Patient numbers Germany 5,444,546 5,151,717 6%
Higher cost efficiency and Patients treated in h
ospital 1,048,946 1,044,959 0%
As a result of the COVID-19 pandemic,
time savings are next, some distance Patients treated as o
utpatients 4,390,553 4,101,716 7%
they doubled compared to the previous
behind. Patient numbers Spain and Latin America 17,122,592 15,037,804 14%
year.
Patients treated in hospital 982,204 927,414 6%
Patients treated as o
utpatients 16,140,388 14,110,390 14%
Source information can be found on page 402. 14
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care | Fresenius Kabi Fresenius Helios | Fresenius Vamed
Front page
MAJOR EVENTS SALES AND EARNINGS DEVELOPMENT
▶ Positivedevelopment in case numbers over the course
of the year. In view of the trend towards digital and outpatient services,
as well as increasing COVID-19 cases once again towards the end of the year, the
overall number of cases in Germany was 2% below pre-pandemic levels. We
recorded sustained high demand for treatments as well as for services for occu-
pational risk prevention (ORP) in Spain, in addition to good contributions from
HELIOS GERMANY Growth
our hospitals in Latin America. in constant
in € millions 2021 2020 Growth currency
▶ Cluster
strategy driven forward with the acquisition of Sales 6,733 6,340 6% 6%
EBIT 613 602 2% 2%
two hospitals in northern Hesse. Together with the existing Helios
Employees 75,459 73,757 2%
site in Warburg in North Rhine-Westphalia, the aim is to form and expand a
regional network over the next few years.
HELIOS SPAIN
Growth
▶ Hospital in Volkach sold. The transaction is a first result of the in € millions 2021 2020 Growth
in constant
currency
ongoing strategic review and optimization of Helios’ hospital portfolio Sales 4,021 3,475 16% 17%
in Germany. EBIT 514 420 22% 24%
Employees 47,332 43,195 10%
▶ Digital services expanded. Important health parameters of cardiology
patients can be tracked via our platform Curalie. Digital offerings in the area
FERTILITY SERVICES
of prevention or in the diagnosis of minor ailments have been introduced, e.g.
a digital “symptom check”. We have also expanded the scope of our telemedi- in € millions 2021
cine offerings, both regionally and to additional indications. In Spain, we per- Sales 133
Fresenius | Annual Report 2021
formed more than one million digital consultations with our doctors in 2021. EBIT 19
Employees 1,629
▶ Growth opportunities in the field of fertility treatments
exploited. We have acquired leading reproductive clinics and centers in the
United States and Canada, and opened a new reproductive medicine facility in
Vicenza, Italy.
15
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care | Fresenius Kabi | Fresenius Helios Fresenius Vamed
Front page
OUR SUCCESS FACTORS
FRESENIUS VAMED. ▶ nique range of services
U
▶ Extensive competencies in all health
care areas
Fresenius Vamed is a leading global provider of services for hospitals ▶ Leading position in the area of
and other health care facilities. Its portfolio ranges from project PPP models
▶ Long-term life cycle models
development and planning to the total operational management of ▶ Providing access to health care services
▶ Worldwide education and training
health care facilities and providing services to patients. Our services programs
are aimed at various areas of health care, ranging from prevention
to acute care, rehabilitation, and nursing.
OUR GROWTH DRIVERS
▶ Expansion of health care infrastructure
in emerging markets
▶ Outsourcing of non-medical services
to private operators
COMPREHENSIVE PRODUCT PORTFOLIO of rehabilitation and care in Central Europe, and builds a
▶ Post-acute care business as platform
bridge between preventive medicine and health tourism
for further international growth
Service business with its spa and health resorts.
▶ Selective small and mid-sized
High-end services
acquisitions
Fresenius Vamed’s range of services covers all areas of Project business
▶ Expanding positions in preventive
technical, commercial, and infrastructural facility manage- Fresenius Vamed’s project business comprises consulting
medicine such as health tourism
ment as well as the highly specialized areas of medical on projects, project development, planning, turnkey con-
technology management, sterile services, operational tech- struction, and financing management of projects. Fresenius
Fresenius | Annual Report 2021
nology, and IT development. In 2021, we provided tech Vamed responds flexibly to the local needs of clients, pro-
nical facility management services for 840 health care facil- viding custom-tailored solutions all from a single source to
ities with 227,000 beds worldwide. put the project on the right track in functional, technical,
and financial terms. Fresenius Vamed is a pioneer in the field
Total operational management of public-private partnerships (PPP) for hospitals and other
Fresenius Vamed is responsible for the total operational health care facilities and is currently implementing the larg-
management of health care facilities, is a leading provider est PPP project in the German health care sector.
16
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care | Fresenius Kabi | Fresenius Helios Fresenius Vamed
Front page
MARKET DYNAMICS SALES BY REGION
Telemedicine market in Europe Outsourcing of non-medical Emerging markets
is estimated to grow services provided by public
institutions to private providers 16% Europe
19.1% p.a. grew in Germany by around
84%
from 2020 to 2026.
40%
from 2014 to 2019.
Global preventive health care is
estimated to grow
Emerging markets’ share of
9.5% p.a. global health expenditure will
grow to
till 2025.
33% SALES BY SERVICE AND PROJECT BUSINESS
by 2022.
The share of the EU population
older than 80 years is projected
to increase from 5.9% to
14.6%
between 2020 and 2100.
Fresenius | Annual Report 2021
Project business
31% Service business
69%
Source information can be found on page 402. 17
Media Hub Group in figures Targets, results, and outlook Fresenius strategy Business segments Table of contents
Fresenius Medical Care | Fresenius Kabi | Fresenius Helios Fresenius Vamed
Front page
MAJOR EVENTS BUSINESS DEVELOPMENT
▶ The order backlog reached € 3,473 million.
Fresenius Vamed was awarded the total turnkey contract for the Wiener
SALES BY REGION
Neustadt regional hospital in 2021.
In addition, Fresenius Vamed received orders for the construction of three % of total
Fresenius
turnkey general hospitals in Angola, a general hospital in Papua New Guinea, € in millions 2021 2020 Growth Vamed sales
and other major orders from Austria, Germany, the United Arab Emirates, Kenya, Europe 1,923 1,815 6% 84%
Africa 173 80 116% 7%
Turkmenistan, and Guyana.
Asia-Pacific 119 136 -13% 5%
Latin America 82 37 122% 4%
▶ Crisis helper in overcoming the global pandemic. Total 2,297 2,068 11% 100%
Worldwide, Fresenius Vamed’s employees again demonstrated outstanding
commitment in the second year of the pandemic. In the service business,
Fresenius Vamed ensured uninterrupted operation of the health care facilities
supported in technical management and reliable quality in high-end services.
SALES BY BUSINESS SEGMENT
With great care in the acute, rehabilitation, nursing, and health tourism facilities,
% of total
the recovery, recuperation, and safety of patients and guests was ensured. In Fresenius
€ in millions 2021 2020 Growth Vamed sales
the project business, Fresenius Vamed successfully met the COVID-19- related
Project business 717 633 13% 31%
challenges with competence and experience and thanks to long-standing Service business 1,580 1,435 10% 69%
project partnerships.
▶ Expansion of outpatient rehabilitation and creation
of a new fully integrated health care facility. Fresenius Vamed
ORDER INTAKE AND ORDER BACKLOG FOR PROJECTS
developed a special post-acute rehabilitation program for the follow-up treat-
Fresenius | Annual Report 2021
ment of COVID-19 patients. To meet the growing demand for rehabilitation, sites € in millions 2021 2020 Growth
were expanded, and two further outpatient rehabilitation centers were opened Order intake 1,290 1,010 28%
in Austria. Order backlog 3,473 3,055 14%
The Oberlaa site was upgraded to create Fresenius Vamed’s first fully inte-
grated health care facility – from prevention and acute care to rehabilitation
and nursing, as well as telemedicine service.
18
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
TABLE OF CONTENTS
3 Group in figures 57 Change to the Management 95 Opportunities and risk report 219 Corporate Governance 384 Responsibility statement
4 Targets, results, and outlook Board 95 Opportunities management 220 Corporate Governance Declaration
6 Fresenius strategy 57 Change to the Supervisory 95 Risk management 232 Further information on
7 Business segments Board 98 Assessment of the overall risk Corporate Governance 385 Auditor’s report
7 Fresenius Medical Care 58 Procurement situation 234 Compensation report
10 Fresenius Kabi 58 Quality management 98 Risks affecting the one-year
13 Fresenius Helios 58 Sustainability forecast period 392 Further information
16 Fresenius Vamed 99 Risks with effects on our 277 Consolidated financial statements 393 Boards
medium-term goals 278 Consolidated statement of income
393
Supervisory Board
59 Economic report 99 Risk areas 279 Consolidated statement of Fresenius SE & Co. KGaA
20 To our shareholders 59 Health care industry 111 Compliance and legal risks comprehensive income 395 Management Board
21 Letter to our shareholders 65 Overall business development 280 Consolidated statement Fresenius Management SE
27 Management Board 69 Results of operations, financial of financial position
396
Supervisory Board
28 Report of the Supervisory Board position, assets and liabilities 114 Separate 281 Consolidated statement Fresenius Management SE
34 Fresenius share 87 Overall assessment of the Group Non-Financial Report of cash flows 397 Glossary
business situation 115 Strategy and management 283 Consolidated statement 402 Source
87 Outlook 121 Well-being of the patient of changes in equity 403 Imprint
37 Group Management Report 87 General and mid-term 141 Digital transformation and 285 Consolidated segment reporting 404 Financial Calendar
38 Fundamental information about outlook innovation 404 Fresenius share / ADR
the Group 89 Future markets 154 Employees 404 Contact
38 The Group’s business model 89 Health care sector and 178 Diversity 287 Notes
42 Strategy and goals markets 182 Compliance and Integrity 288 General notes
43 Our core competencies 92 Group sales and earnings 199 Environment 308 Notes on the consolidated
Fresenius | Annual Report 2021
46 Path to accelerated growth 93 Sales and earnings by 216 Report profile statement of income
46 Cost and efficiency program business segment 217 Limited assurance report of the 314 Notes on the consolidated
47 Sustainability program 94 Expenses independent auditor statement of financial
48 Corporate performance 94 Cost and efficiency program position
criteria 94 Liquidity and capital
342
Other notes
51 Research and development management
56 Employees 94 Investments
94 Capital structure
94 Dividend
19
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share
TO OUR SHAREHOLDERS
21 Letter to our shareholders
27 Management Board
28 Report of the Supervisory Board
34 Fresenius share
1
Fresenius | Annual Report 2021
20
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
L
etter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share
LETTER TO
OUR SHAREHOLDERS
Fresenius | Annual Report 2021
Stephan Sturm
Chairman of the Management Board 21
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
L
etter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share
Fresenius is a healthcare group. Our task is to protect peo- into less demand for various Fresenius Kabi products.
ple’s health as best we can. Rarely have we been as chal- Finally, Fresenius Vamed’s project business continued to
lenged as during the coronavirus pandemic. However, we suffer from travel restrictions and a COVID-19-related
have done our part. We have lived up to our responsibility – hesitation on the part of many clients.
also in the year gone by.
In 2021 we treated more than 42,000 COVID -19 patients
and vaccinated well over one million people against the » Our task is to protect people’s
virus. Once again, we did all we could to maintain our abil- health as best we can. Rarely
ity to deliver crucial medicines and medical products, even
as demand in some cases rose substantially. And to provide
have we been as challenged as
follow-up treatment, we developed a special post-covid during the coronavirus pan
rehabilitation program at Fresenius Vamed.
demic. However, we have done Providing people with the best possible care, and a deep commitment
to improving patients’ quality of life every day: That is what drives us.
Notwithstanding that, the pandemic continues to impose a our part. We have lived up to Our employees have shown tremendous dedication in ensuring the care
heavy burden on all of us, as well as on our business. An
important and very sad aspect is the excess mortality among
our responsibility. « of our patients during the COVID-19 pandemic.
our dialysis patients due to COVID-19 infections. This is a
human tragedy, and it affects our business – with reduced At Fresenius Kabi, we have also defined a new strategy:
treatment volumes resulting in lower sales as costs con- Nevertheless, we achieved a lot in 2021 and set a decisive Vision 2026. It is the guideline to transforming the company
tinue to rise. In our hospitals, also, treatments were again course. A milestone was the FME25 transformation pro- for the next decade. Going forward, Fresenius Kabi will
down significantly compared with prior to the pandemic – gram. The simplified corporate structure will in future com- focus on three growth paths: broadening our biopharmaceu-
this applies to Fresenius Helios’ acute care hospitals and to prise only two global segments: In the Care Enablement tical offering, more launches of clinical nutrition products
Fresenius Vamed’s rehabilitation facilities. At the same segment, Fresenius Medical Care is consolidating its previ- and an expansion in the medical technology field. The cor-
time, we had higher expenses for additional hygiene mea- ously decentralized product business under a global medical nerstone is our volume-driven IV business, i.e. infusions
Fresenius | Annual Report 2021
sures. And fewer treatments and operations also translate technology umbrella. The global healthcare services busi- and liquid medications. Here we aim to increase our resil-
ness will be combined in the Care Delivery segment. This will ience. We have put this into a handy formula: 3 + 1.
make the company more agile, enable better use of existing
know-how, accelerate innovation and deploy capital in an
even more efficient manner.
22
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
L
etter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share
Another milestone: A new record order backlog at Fresenius
Vamed, despite the pandemic. And at Fresenius Helios,
we made further attractive acquisitions. In Germany, we
» We met all our communicated
acquired the two hospitals of DRK (German Red Cross) targets for 2021, even after
Kliniken Nordhessen in Kassel. Together with the Helios
twice raising our outlook during
hospital in nearby Warburg, we will form a regional
medical network and expand it over the next few years, the year. «
in line with our cluster strategy. We also acquired an
oncological center and an ophthalmic clinic in Colombia
and, at the beginning of this year, a majority stake in an Under the circumstances, 2021 was also a decent year for
additional fertility center in the United States. us in business terms. We were able to increase sales by
5 percent in constant currency. EBIT, unfortunately, declined
6 percent in constant currency – due mainly to negative
The Eugin Group, part of Fresenius Helios, acquired a majority stake in
COVID-19 effects at Fresenius Medical Care. Nonetheless,
the Delaware Institute for Reproductive Medicine. This renowned repro-
we were again able to increase net income – by 5 percent ductive medicine center in the U.S. state of Delaware has been established
in constant currency, in line with sales growth. Not least due for 35 years.
to a strong fourth quarter, I can state: We met all our com-
municated targets for 2021, even after twice raising our out-
look during the year. You can see that we continue to work simple, convenient way of reinvesting the dividend directly
on rebuilding capital market confidence in us as a reliable, back into your company.
high-growth company.
In another first for us, we have set a climate target for the
For that matter, we want you, dear shareholders, to partici- Fresenius Group. We want to reduce our direct and indirect
pate in our success also this year. We are therefore propos- CO2 emissions by half by 2030, starting from around 1.5
ing a 5 percent dividend increase, to 92 cents per share. million metric tons of emitted greenhouse gas in 2020. By
Fresenius | Annual Report 2021
This would be our 29th consecutive dividend increase! For 2040 at the latest, we want to be climate neutral. We are
Fresenius Vamed developed a special post-covid rehabilitation program
the first time we would like to offer a scrip dividend. You guided by the scientifically based targets of the Paris Agree-
for the follow-up treatment of COVID-19 patients.
should have the choice of receiving your dividend in cash, as ment to limit global warming to 1.5 degrees Celsius.
before, or in the form of new shares. The latter is a very
23
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
L
etter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share
How do we intend to achieve this ambitious goal? The key important markets and the possible emergence of other
for the first few years will be to switch our global electricity dangerous variants of the virus. Despite that, we expect to
consumption to renewable energy. Alongside this, we will increase sales by a mid-single-digit percentage on a cur-
continue to work on making our hospitals, clinics and pro- rency-adjusted basis, and for net income to increase by a
duction sites ever more energy efficient. We will look at low single-digit percentage on a constant-currency basis.
every investment also from a “green” perspective and –
wherever economically and ecologically feasible – we will We also confirm the medium-term targets that we set in
also install more renewable energy generation capacity at 2019, so before the onset of the pandemic: for the period
our sites. 2020 to 2023, annual average organic growth in sales of
4 to 7 percent and 5 to 9 percent in net income. Concurrently,
we are specifying our expectations: for sales growth, we
expect to reach the bottom to middle of the range; for net
» We aim at optimizing Fresenius income growth, we will probably end up at the lower end.
Ambitious target: By 2025, Fresenius Medical Care aims to perform 25%
and have set the course for To achieve this, we will have to meaningfully accelerate our of all its treatments in the United States in the patient‘s home.
earnings growth in 2023. We are confident of achieving
accelerated profitable growth this. Our medium-term growth strategy, as defined last year,
in the coming years. « will help us noticeably. We have also put our Group structure to the test – open-
ended and without taboos. We have analyzed very carefully:
A year ago, we started down the path to becoming an even Where are the best growth opportunities? How do we want
stronger healthcare group. We aim at optimizing Fresenius to seize them? And finance them?
To continue peering into the future – this time our 2022 finan- and have set the course for accelerated profitable growth
cial guidance and medium-term targets. We must assume in the coming years. We have, among other things, started First of all, our broad-based Group structure has proven its
the COVID-19 pandemic will continue to have a noticeable an ambitious cost-cutting and efficiency program. We are value, especially in difficult times such as these. It has made
impact on our business this year. Just how much depends, making good progress – even faster than originally thought. possible the growth of past decades, and today it offers us
among other things, on the progress of vaccination in our This is why we substantially increased our sustainable many advantages: Stability through diversification and size.
Fresenius | Annual Report 2021
cost savings target for 2023 to more than € 150 million after
taxes and minority interests. And following that, we are
aiming for even higher sustainable earnings contributions.
24
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
L
etter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share
Economies of scale. Synergies from the cooperation For this reason, we will have to tap new sources of capital products side. And fourthly, Fresenius Kabi’s pharma
between business segments. Tax advantages. And even and distribute the available capital wisely. To this end, we ceutical business is the nucleus of our company: drugs,
more important: Attractive financing conditions, espe have analyzed our current setup – i.e., our four business infusions – that’s where we come from.
cially when it comes to borrowing. And low borrowing costs segments – very closely and have developed a strategy for
are also a big advantage for you, dear shareholders. optimal capital allocation within the Group. In this way, we As a listed company, Fresenius Medical Care already
aim to combine more dynamic growth with the advantages largely finances its growth independently. Through its
Another important result of our analysis: We see continued of a broad, diversified structure in an optimal fashion. FME25 transformation program, Fresenius Medical Care will
excellent growth opportunities for all four business seg- strengthen its long-term profitable growth and create
ments. All four have strong market positions – either we are additional value; of course, this also relates to our share in
among the leaders in the business segment’s respective the company. Fresenius Helios and Fresenius Vamed will
field or, for example in dialysis, we are clearly the number » We see continued excellent
one. And for all four business segments we have identified growth opportunities for
very promising strategic growth areas.
all four business segments.
We want to exploit this potential. We want to promote and All four have strong market
actively drive this growth. Organic growth was, is, and will
remain the basis for us. But we also want to take strategic
positions. «
growth steps in the future. Make significant investments,
for example in digital transformation, or in realizing large
acquisitions. Just as we have repeatedly and successfully The top priority for capital allocation within the Fresenius
done in the past. Group will be Fresenius Kabi. Why? First, in a comparison
of all four business segments, we see Fresenius Kabi as
having the best overall growth prospects and the best return
profile. Vision 2026 will make a significant contribution
here. Secondly, unlike Fresenius Medical Care and Fresenius
Fresenius | Annual Report 2021
Biosimilars from Fresenius Kabi are playing a key role as we implement
Vamed, we are the sole owner. Thirdly, whilst we have pri- our strategy for accelerated, sustainable growth.
marily expanded the services business over the past three
decades, we now intend to again strengthen Fresenius’
25
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
L
etter to our shareholders | Management Board | Report of the Supervisory Board | Fresenius share
continue to be able to finance smaller acquisitions from As you can see, we are in eventful times. We have some
Fresenius Group funds. For larger growth steps by these challenges to overcome, no question, but we have a clear
two business segments, we will now consider bringing course. We have defined a strategic path to achieve profit-
suitable equity investors on board – not with Fresenius SE & able growth at an even faster pace. Our goal is, and remains,
Co. KGaA, but at the level of these business segments. to create value and benefit for all our stakeholders by doing
what we have done best for more than 110 years: providing
high-quality medicine at affordable prices, tailored to
the needs of more and more people in the world who need
» We are in eventful times. medical care. In short: Ever better medicine for ever more
We have some challenges to people. We will continue to move forward boldly and steadily
along this path. Come with us!
overcome, no question, but
we have a clear course. « ‘‘Ever better medicine for ever more people’’ is our purpose
Sincerely yours, at Fresenius.
These decisions will enable accelerated growth of the indi- greatest concern and special commitment at present are
vidual business segments, and thus for the entire Group. the protection of our employees in Ukraine and care for
We are moving Fresenius ahead at speed, with a measured Stephan Sturm our patients, who remain in urgent need of our medical
and well-managed transformation of our company. Fresenius Chairman of the Management Board assistance. Our responsibility as a healthcare company also
remains a diversified healthcare group, with a sharper includes not leaving alone our patients in Russia – to also
profile, that will be active in wide-ranging and very exciting continue providing them with medical care. We hope the
areas of medicine. Russian leadership will come to its senses, and we since-
P.S.: As I write these lines, a cruel war has been raging in rely wish for an end to the violence and the return of peace
Ukraine for a few weeks – a war of aggression provoked by to the region.
Fresenius | Annual Report 2021
the Russian leadership, and one we strongly condemn. At
present, we can only speculate about the future course of the
war and its impact on the world and our company. Our
26
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders Management Board | Report of the Supervisory Board | Fresenius share
MANAGEMENT BOARD
Stephan Sturm Rachel Empey Dr. Sebastian Biedenkopf
Chairman of the Management Board Chief Financial Officer Responsible for Human Resources (Labor Relations
Director), Risk Management and Legal
Fresenius | Annual Report 2021
Rice Powell Michael Sen Dr. Francesco De Meo Dr. Ernst Wastler
Business Segment Business Segment Business Segment Business Segment
Fresenius Medical Care Fresenius Kabi Fresenius Helios Fresenius Vamed
(since April 2021)
27
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board Report of the Supervisory Board | Fresenius share
REPORT OF THE
SUPERVISORY BOARD
Fresenius | Annual Report 2021
Wolfgang Kirsch
Chairman of the Supervisory Board 28
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board Report of the Supervisory Board | Fresenius share
REPORT OF THE SUPERVISORY BOARD and in its plenary meetings, depending on their areas of MEETING PARTICIPATION
responsibility. The Management Board of the general part- Prof. D. Michael Albrecht did not attend the meeting of the
In the reporting year, the Supervisory Board of Fresenius ner discussed the Company’s strategic direction with the Supervisory Board on March 16, 2021. Otherwise, all meet-
SE & Co. KGaA fulfilled its obligations in accordance with Supervisory Board. The Supervisory Board passed resolu- ings of the Supervisory Board and its committees in 2021
the provisions of the law, the articles of association, and the tions within its legal and Company statutory authority. were attended by all sitting members of the Supervisory
rules of procedure. It regularly advised the Management The Supervisory Board of Fresenius SE & Co. KGaA con- Board of Fresenius SE & Co. KGaA or of the respective com-
Board of the general partner, Fresenius Management SE, vened for four regular meetings in 2021, in March, May, mittee.
regarding the management of the Company and has super- October, and December, as well as two extraordinary meet- Participation in meetings of the Supervisory Board and
vised the management in accordance with its Supervisory ings in February and June. Before the meetings, the Man- its committees is reported individually for each member on
Board responsibilities. agement Board of the general partner sent detailed reports the Company’s website. Information on this can be found
and comprehensive approval documents to the members in the Supervisory Board section.
COOPERATION BETWEEN THE MANAGEMENT of the Supervisory Board. At the meetings, the Supervisory
AND THE SUPERVISORY BOARD Board discussed with them in detail the business develop- MAIN FOCUS OF THE SUPERVISORY BOARD’S
Carrying out its monitoring and advisory activities, the ment and any important matters based on the reports from ACTIVITIES
Supervisory Board was regularly kept informed by the man- the general partner’s Management Board. In 2021, once again, the Supervisory Board mostly focused
agement in a timely and comprehensive oral and written All matters requiring Supervisory Board approval were its monitoring and consulting activities on supporting busi-
manner about, among other things: submitted with sufficient time for proper scrutiny. After ness operations and investments carried out by the business
reviewing the related approval documents and following segments. The Supervisory Board thoroughly reviewed and
▶ allimportant matters relating to business policy detailed consultation with the Management Board of the discussed all business activities of significance to the Com-
▶ the course of business general partner, the Supervisory Board approved all matters pany with the Management Board of the general partner.
▶ profitability submitted to it. The Supervisory Board also dealt with the following items:
▶ the situation of the Company and of the Group The Supervisory Board was also informed about any
▶ corporate strategy and planning important transactions occurring between meetings. In ▶ Budget
▶ the risk situation addition, the Chairman of the general partner’s Management ▶ Medium-term planning of the Fresenius Group
▶ risk management and compliance, and Board regularly informed the Chairman of the Supervisory ▶ Cost-cutting and efficiency-enhancing measures
Fresenius | Annual Report 2021
▶ important transactions. Board in separate meetings about the latest development of ▶ Strategic orientation of the Fresenius Group and its
the business and forthcoming decisions and discussed business segments
Based on the reports provided by the Management Board them with him. ▶ Further development of the risk management and
of the general partner, the Supervisory Board discussed all internal control system
significant business transactions in the Audit Committee
29
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board Report of the Supervisory Board | Fresenius share
At its meetings and within the Audit Committee, the Man- tuted itself. The Chairman and the two Deputy Chairmen of of the Fresenius Group and its business segments. Further-
agement Board of the general partner also regularly informed the Supervisory Board as well as the respective members more, information was provided on plans for the years 2022
the Supervisory Board about the Group’s risk situation and and chairmen of the Audit Committee and the Nomination to 2024 for the Group and separately for all four business
risk management activities as well as compliance. Committee were elected. The rules of procedure of the segments. The Management Board of the general partner
At the meeting on February 19, 2021, the Supervisory Supervisory Board were also amended. In addition, the reported on the business performance from January to
Board approved the Supervisory Board remuneration Management Board reported to the general partner on October 2021. The Chairman of the Audit Committee reported
system. business performance for the months January through April in detail on the status of preparation of the financial state-
At its meeting on March 16, 2021, the Supervisory Board 2021. ments. Furthermore, a resolution was passed on the decla-
dealt in detail with the audit and approval of the financial The meeting of the Supervisory Board on June 17, 2021 ration of conformity with the German Corporate Gover-
statements and the consolidated financial statements (IFRS), focused on cost-cutting and efficiency-enhancing mea- nance Code.
as well as the management report and the Group manage- sures. In addition, at this meeting, the Supervisory Board
ment report of Fresenius SE & Co. KGaA. The results for 2020 conducted a self-assessment in accordance with Recom- CORPORATE GOVERNANCE
were discussed on the basis of a detailed report provided mendation D.13 of the German Corporate Governance Code. On December 20, 2021, the Supervisory Board of Fresenius
by the Chairman of the Audit Committee and statements by At the Supervisory Board meeting on October 14, 2021, SE & Co. KGaA and the Management Board of the general
the auditor, PricewaterhouseCoopers GmbH Wirtschafts- the members of the Supervisory Board were informed in partner issued the declaration of conformity with the German
prüfungsgesellschaft, Frankfurt am Main. At the same meet- detail about business performance from January through Corporate Governance Code in accordance with Article 161
ing, a resolution was passed on profit distribution proposed September 2021. In addition, the progress of the planned of the German Stock Corporation Act (AktG) and made it per-
by the general partner, Fresenius Management SE, and the cost-cutting and efficiency-enhancing measures, the obser- manently available to the shareholders on the Company’s
separate Group Non-financial Report for 2020. In addition, vations on the strategic orientation of the Fresenius Group website. In March and October 2021, the Management
the business segments reported in detail on the course of and its business segments, and the further development of Board of the general partner and the Supervisory Board of
business in the first two months of the fiscal year. Another risk management were reported on. The Supervisory Board Fresenius SE & Co. KGaA decided to update the previous
topic of discussion was the Annual General Meeting of also discussed the declaration of conformity with the Ger- declaration of conformity from December 2020.
Fresenius SE & Co. KGaA, which was again held virtually due man Corporate Governance Code. In 2021, the Chairman of the Supervisory Board of
to the ongoing COVID-19 pandemic. At the meeting of the Supervisory Board on December 7, Fresenius SE & Co. KGaA was ready, to the extent permitted
At its meeting on May 21, 2021, following the immedi- 2021, the Management Board reported to the general part- by law and in close consultation with the Management
Fresenius | Annual Report 2021
ately preceding election of shareholder representatives at the ner on the further progress of the planned cost-cutting and Board of the general partner, to hold discussions with inves-
Annual General Meeting, the Supervisory Board reconsti- efficiency-enhancing measures. A further key topic of the tors on topics specific to the Supervisory Board. In October
meeting was the progress report on the strategic orientation
30
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board Report of the Supervisory Board | Fresenius share
2021, the Chairman of the Supervisory Board of Fresenius well as experts from the Company provide information financial Report. At its meeting on March 17, 2022, the
SE & Co. KGaA participated in a Corporate Governance about important developments, for example about relevant Supervisory Board approved the separate Group
Roadshow. new laws and precedents or changes in the IFRS accounting Non-financial Report presented by the general partner.
The Management Board of the general partner and the and auditing standards. In addition, the Company holds The separate Group Non-financial Report is published
Supervisory Board of Fresenius SE & Co. KGaA have a duty an onboarding event for new members of the Supervisory on pages 114 to 216 of the Annual Report and the auditor’s
to act in the best interests of the Company. In performing Board. findings are published on page 217f. of the Annual Report.
their activities, they do not pursue personal interests or For more information on corporate governance at
bestow unjustified benefits on others. Any secondary activ- Fresenius, please see the Corporate Governance Declara-
WORK OF THE COMMITTEES
ities or dealings with the Company by members of the tion on pages 219 to 232 of the Annual Report. Fresenius
In order to perform its duties efficiently, the Supervisory
corporate bodies must immediately be reported to, and has disclosed the information on related parties on page
Board has formed various committees, which prepare the
approved by, the Supervisory Board. 380 of the Annual Report.
consultations and resolutions in the plenary session or can
There were no conflicts of interest of Supervisory Board
pass resolutions themselves. The committees of the Super-
members in the past fiscal year.
SEPARATE GROUP NON-FINANCIAL REPORT visory Board consist of an Audit Committee, a Nomination
There are regular separate preliminary meetings of the
PricewaterhouseCoopers GmbH Wirtschaftsprüfungsgesell Committee, and a Joint Committee.
employee representatives and consultations among the
schaft, Frankfurt am Main, audited the separate Group The Audit Committee held four meetings and four con-
shareholder representatives.
Non-financial Report for 2021. ference calls in the reporting year. The main focus of its
The members of the Supervisory Board independently
The separate Group Non-financial Report and the audit monitoring activities was the preliminary audit of the annual
undertake necessary training and further education measures
report of the appointed auditor were made available to each financial statements and consolidated financial statement
required for their tasks. They keep themselves regularly
member of the Supervisory Board of the Company in good for 2020 and discussions with the auditor about their reports
informed, through internal and external sources, about the
time. At their meetings on March 16 and 17, 2022, the Audit and the terms of reference of the audit. Another matter
latest requirements with regard to their supervisory acti
Committee and then the Supervisory Board discussed all dealt with by the Audit Committee was its recommendation
vities. The Supervisory Board at all times ensures that its
the documents in detail. to the Supervisory Board regarding which auditing firm to
members are suitably qualified, keep their professional
The auditor delivered a detailed report on the results of propose as auditor for the annual financial statements and
knowledge up to date, and further develop their judgment
the audit at each of these meetings. The Audit Committee consolidated financial statements for 2021. Following the
and expertise. They are supported appropriately by the
Fresenius | Annual Report 2021
and the Supervisory Board approved the auditor’s findings.
Company in accordance with the Code. External experts as
The Audit Committee’s and the Supervisory Board’s own
review also found no objections to the separate Group Non-
31
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board Report of the Supervisory Board | Fresenius share
recommendation of the Audit Committee, the Supervisory The Company’s Nomination Committee met three times in whom had previously been members of the Supervisory
Board proposed to the 2021 Annual General Meeting that 2021. It dealt in particular with preparations for the election Board, were elected as employee representatives on the
PricewaterhouseCoopers GmbH Wirtschaftsprüfungsgesell of the Supervisory Board in May 2021. European Works Council.
schaft, Frankfurt am Main, be elected as auditors of the The Joint Committee is responsible for approving cer- At its constituent meeting on May 21, 2021, the Super-
annual financial statements and auditors of the consolidated tain important transactions of Fresenius SE & Co. KGaA and visory Board elected Mr. Wolfgang Kirsch as Chairman of the
financial statements for 2021 and as auditors for any review certain legal transactions between the Company and the Supervisory Board of Fresenius SE & Co. KGaA. Mr Kirsch
of interim financial information within the meaning of Sec- Else Kröner-Fresenius-Stiftung. In 2021, no transactions succeeds Dr. Gerd Krick, who did not stand for re-election at
tion 115 (7) of the German Securities Trading Act (WpHG) were carried out that required its approval. Accordingly, the the end of the election period and therefore retired from
that is prepared before the 2021 Annual General Meeting. Joint Committee did not meet in 2021. the Supervisory Board of Fresenius SE & Co. KGaA at the end
The Audit Committee also dealt with the following There is no Mediation Committee because the Supervi- of the Annual General Meeting on May 21, 2021. At the
items in detail: sory Board of Fresenius SE & Co. KGaA does not appoint the proposal of the shareholder representatives, Mr. Michael
Management Board members of Fresenius Management SE. Diekmann, and at the proposal of the employee represen
▶ the 2021 quarterly reports, For more information about the committees, their com- tatives, Ms. Grit Genster, were elected as Deputy Chair
▶ assessment of the quality of the audit, position, and their work methods, please refer to the Corpo- persons of the Supervisory Board. At the same meeting,
▶ monitoring reports on progress of acquisitions, rate Governance Declaration on pages 219 and 230 and Ms. Grit Genster, Ms. Hauke Stars, Mr. Wolfgang Kirsch,
▶ compliance and internal audit, page 394 of the Annual Report. Mr. Konrad Kölbl, and Mr. Klaus-Peter Müller were elected
▶ review of the risk management system, the internal as members of the Audit Committee. Mr. Klaus-Peter Müller
control system, and the internal auditing system, and PERSONNEL was elected Chairman of the Audit Committee. Further-
▶ approval of non-audit services by Pricewaterhouse- With the Annual General Meeting of Fresenius SE & Co. KGaA more, at the Supervisory Board meeting on May 21, 2021,
Coopers GmbH Wirtschaftsprüfungsgesellschaft, Frank- on May 21, 2021, the term of office of all members of the Mr. Michael Diekmann, Mr. Wolfgang Kirsch, and Mr.
furt am Main. Company’s Supervisory Board ended. Klaus-Peter Müller were elected as members of the Nomi-
The six shareholder representatives were re-elected at nation Committee and Mr. Wolfgang Kirsch as its Chair-
The Chairman of the Audit Committee reported regularly in the Annual General Meeting on May 21, 2021. Mr. Wolf- man. By resolution of the Annual General Meeting of May 21,
each subsequent Supervisory Board meeting on the work gang Kirsch was elected to the 12-member committee for 2021, Ms. Hauke Stars and Mr. Michael Diekmann were
of the committee. the first time. Prof. D. Michael Albrecht, Mr. Michael Diek- appointed members of the Supervisory Board of the Com-
Fresenius | Annual Report 2021
Represented by the Chairman of the Audit Committee, mann, Prof. Iris Löw-Friedrich, Mr. Klaus-Peter Müller, and pany in the Joint Committee. The general partner Fresenius
there is a regular dialog between the Supervisory Board and Ms. Hauke Stars were all re-elected. Ms. Stephanie Balling, Management SE delegated Mr. Wolfgang Kirsch and
the Audit Committee, on the one hand, and the auditor, Mr. Bernd Behlert, Ms. Grit Genster, Ms. Frauke Lehmann, Dr. Dieter Schenk as members of the Joint Committee and
on the other, even outside of meetings. Mr. Konrad Kölbl, and Mr. Oscar Romero de Paco, all of
32
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board Report of the Supervisory Board | Fresenius share
appointed Dr. Dieter Schenk as Chairman of the Joint The annual financial statement, management report, and The Supervisory Board concurs with the general partner’s
Committee. In appreciation and recognition of his decades Group management report of the Company were prepared proposal on the 2021 profit distribution, according to which
of meritorious service to Fresenius, Dr. Gerd Krick was in accordance with the accounting regulations of the Ger- the shareholders may choose to receive the dividend, which
appointed Honorary Chairman of the Supervisory Board of man Commercial Code (HGB), and the consolidated financial has been increased to €0.92, either in cash or partly in the
Fresenius SE & Co. KGaA. statements of the Company were prepared in accordance form of shares of the Company.
The composition of the Management Board of the gen- with IFRS , as applicable in the EU , and the supplementary The Supervisory Board would like to thank the members
eral partner Fresenius Management SE also changed in the provisions of commercial law applicable in accordance with of the Management Board of the general partner and all
past financial year. As of April 12, 2021, Mr. Michael Sen Article 315e of the HGB . The auditors issued their unquali- employees for their achievements over the past financial
was appointed as a member of the Management Board of fied audit opinion for these statements. year.
Fresenius Management SE for the business segment The financial statements, the consolidated financial state-
Fresenius Kabi. He follows Mr. Mats Henriksson, who left ments, the management reports, and the auditor’s reports
the Company on March 16, 2021. were submitted to each member of the Company’s Supervi- Bad Homburg v. d. H., March 17, 2022
sory Board within the required time. The auditor reported
FINANCIAL STATEMENTS AND CONSOLIDATED on the main results of their audits at the meetings on The Supervisory Board of Fresenius SE & Co. KGaA
FINANCIAL STATEMENTS March 16 and 17, 2022. The auditor found no weaknesses in
PricewaterhouseCoopers GmbH Wirtschaftsprüfungs- the risk management system or the internal control system
gesellschaft, Frankfurt am Main, audited the annual finan- with regard to the accounting process. At these meetings,
cial statements and the management report as well as the first the Audit Committee and then the Supervisory Board
consolidated financial statements and the Group manage- discussed in detail all the documents submitted and the Wolfgang Kirsch
ment report of the Company for 2021. The firm was results of the audit presented by the auditors. Chairman
elected as auditor in accordance with a resolution passed The Audit Committee and the Supervisory Board
at the Annual General Meeting of Fresenius SE & Co. KGaA approved the auditor’s findings. Independent reviews by
on May 21, 2021, and was subsequently commissioned by the Audit Committee and the Supervisory Board raised no
the Supervisory Board. The auditor attended all meetings objections to the Company’s financial statements and man-
of the Supervisory Board and all meetings and conference agement report or the consolidated financial statements and
Fresenius | Annual Report 2021
calls of the Audit Committee. the Group management report. At its meeting on March 17,
2022, the Supervisory Board approved the financial state-
ments and management reports presented by the general
partner and the statements contained therein with respect
to future development.
33
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board | Report of the Supervisory Board F
resenius share
FRESENIUS SHARE. In 2021, the Fresenius share
price continued to be impacted by the effects
of the COVID -19 pandemic. Despite the challenges
faced during the year, we propose the 29th con-
secutive dividend increase.
STOCK MARKETS AND DEVELOPMENT the health care sector (Dow Jones STOXX © Europe 600 compared to the previous year (2020: 2,085,926). In the
OF THE FRESENIUS SHARE Health Care) increased by 23%. The leading U.S. indices United States, Fresenius has a Sponsored Level I American
The COVID-19 pandemic continued to negatively impact the performed as follows: the S & P 500 and the Dow Jones Depositary Receipt (ADR) program. In this program, four
global economy in 2021. Although it largely recovered Industrial Average both increased, by 27% and 20%, respec- Fresenius ADRs correspond to one Fresenius share.
during the year, supply shortages, rising inflation, and the tively.
spread of further variants of COVID-19 are affecting short- The closing price for the Fresenius share on December CAPITAL STRUCTURE
term growth prospects. Capital markets and global invest- 31, 2021, was € 35.40 and thus 6% below the closing price The total number of issued shares at the end of 2021 was
ment levels remained broadly stable, benefiting from govern- of 2020. During the course of the year, the lowest price 558,502,143 (December 31, 2020: 557,540,909 shares).
ment stimulus measures and favorable financing conditions. was recorded on December 3 at € 33.45, and the highest on The increase is due to the exercise of options in accordance
Vaccination progress is expected to reduce the impact of August 18 at € 47.44. At https://www.fresenius.com/share- with stock option plans. Information on stock option plans
the pandemic, but uncertainties remain regarding the global price-center you can find an interactive chart tool for graph- can be found on pages 369 to 380 of the Notes to this Annual
Fresenius | Annual Report 2021
economic development. ical display and further analysis of the shares. You can also Report.
The DAX, Germany’s most important stock market baro find out how the Fresenius share has performed compared
meter, increased by 16%. The Dow Jones STOXX© Europe to the shares of competitors.
600 ended the year with an increase of 22%. In this index, The market capitalization of Fresenius was € 19.8 billion
as of December 31, 2021. The average daily trading volume
on Xetra decreased by 33% to 1,405,536 Fresenius shares
34
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board | Report of the Supervisory Board F
resenius share
INVESTOR RELATIONS RELATIVE SHARE PRICE PERFORMANCE 2017 – 2021 ABSOLUTE SHARE PRICE PERFORMANCE 2021
Our investor relations are in accordance with the transpar- FRESENIUS SHARE VS. DAX FRESENIUS SHARE IN €
ency rules of the German Corporate Governance Code. We % €
communicate comprehensively, promptly, and openly with 150 112 60.00
60,00
private and institutional investors, as well as financial ana- 55.00
55,00
125 93
lysts. The equal treatment of all market actors is very impor- 50.00
50,00
tant to us. 100 75
45.00
45,00
We also maintained our intense dialog with the capital
markets in 2021. Since the beginning of the COVID -19 pan- 75 56 40.00
40,00
demic and the worldwide travel restrictions, Fresenius has 35.00
35,00
50 37
presented itself in major financial markets exclusively virtu-
30.00
30,00
ally, via telephone and video conferences.
25 19
We continued our contacts with institutional investors 25.00
25,00
and analysts at 30 international investor conferences, 7 road- 0 0 20.00
20,00
shows, and in numerous one-on-one meetings. We Dec. 2016 Dec. 2017 Dec. 2018 Dec. 2019 Dec. 2020 Dec. 2021 Dec. 20 Feb. 21 Apr. 21 June 21 Aug. 21 Oct. 21 Dec. 21
also organized CEO calls and virtual field trips with banks, Fresenius share in % DAX in % Fresenius high and low in € Fresenius share Monthly price range
giving investors and analysts the opportunity to discuss
matters with the Management Board. We continued to com-
municate with private investors, in particular via the Inter-
net. In addition, we participated in three virtual private KEY DATA OF THE FRESENIUS SHARE
shareholder events in 2021. 2021 2020 2019 2018 2017
At www.fresenius.com/events-and-presentations our pri- Number of shares 558,502,143 557,540,909 557,379,979 556,225,154 554,710,473
vate shareholders can follow live webcasts of the confer- Stock exchange quotation 1 in €
ence calls and can make use of the continuously increasing High 47.44 50.32 52.42 70.94 79.65
range of information offered on our website and social media Low 33.45 25.66 40.74 38.99 60.58
Year-end quotation 35.40 37.84 50.18 42.38 65.07
channels on Twitter and LinkedIn.
Market capitalization 2 in million € 19,771 21,097 27,969 23,573 36,095
The Fresenius investor relations team was recognized in
Total dividend distribution in million € 513.8 3 490.6 468.0 445.0 416.0
the results of the 2021 All-Europe Executive Team Survey, Dividend per share in € 0.92 3 0.88 0.84 0.80 0.75
Fresenius | Annual Report 2021
a broad survey conducted by the Institutional Investor mag- Earnings per share in € 4 3.35 3.22 3.37 3.37 3.28
azine, which asked more than 1,500 investors and analysts 1
etra closing price on the Frankfurt Stock Exchange
X
as well as over 600 financial services companies about vari- 2
Total number of ordinary shares multiplied by the respective Xetra year-end quotation on the Frankfurt Stock Exchange
3
Proposal
ous aspects of good investor relations. On this occasion, the 4
Net income attributable to shareholders of Fresenius SE & Co. KGaA; before special items
Fresenius investor relations team was honored, once again,
as the best in the MedTech & Services sector in Europe.
35
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Letter to our shareholders | Management Board | Report of the Supervisory Board F
resenius share
DEVELOPMENT OF DIVIDENDS IN € DIVIDEND SHAREHOLDER STRUCTURE BY REGION
0.92
Despite COVID-19, Fresenius’ business developed well over-
0.88
0.84 all in 2021. For the 29th consecutive year, we are proposing Other regions 3%
0.80
to our shareholders to increase the dividend – by 5% per
0.75 Not identified 4%
share, to € 0.92 (2020: € 0.88). For the first time, we are offer-
ing the possibility of claiming a scrip dividend. The pro- United Kingdom 11%
Germany 43%
0.62
posed dividend distribution to the shareholders of Fresenius
Rest of Europe 16%
0.55 SE & Co. KGaA will be € 514 million, equivalent to 28% of
Group net income. Based on the proposed dividend and the
United States 23%
0.42
0.44 closing price at the end of 2021, the dividend yield is 2.6%.
0.37
SHAREHOLDER STRUCTURE
The Else Kröner-Fresenius-Stiftung was the largest share-
SHAREHOLDER STRUCTURE BY INVESTORS
holder of Fresenius SE & Co. KGaA, with 26.6% of the shares.
According to notifications pursuant to the German Securi-
Not identified 4%
ties Trading Act (WpHG), BlackRock, Inc. held below 5%
and Harris Associates L.P. above 3% of the shares. For fur- Retail holdings 8%
2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 1 ther information on notifications, please visit www.
fresenius.com/shareholder-structure. Else Kröner- Institutional
1
Proposal Fresenius-Stiftung 27% investors 61%
As of December 31, 2021, a shareholder survey identi-
fied the ownership of about 96% of our subscribed capital.
In addition, the Fresenius investor relations team won the A total of over 600 institutional investors held about 330
special prize for the best digital communication in the DAX million shares or 61% (2020: 60%) of the subscribed capi-
at this year’s Investors’ Darling initiative from Manager tal; 48.1 million (2020: 46.1 million) shares were identified
Magazin. as retail holdings. Unchanged from the previous year, the ANALYST RECOMMENDATIONS
If you would like to contact us or find out about our 2022 10 largest investors held about 20% of the share capital.
financial calendar, please take a look at the last page of Our shares were mostly held by investors in Germany, the
this Annual Report. For additional information visit us at United States, and the United Kingdom.
Fresenius | Annual Report 2021
www.fresenius.com/investors.
ANALYST RECOMMENDATIONS Equal-weight / Hold /
Neutral 44% Buy / Outperform /
The recommendations published by financial analysts are Overweight 56%
an important guide for institutional and private investors
when making investment decisions. According to our sur-
vey, as of February 18, 2021, we were rated with 10 “buy”
and 8 “hold” recommendations.
36
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
GROUP MANAGEMENT REPORT
38 Fundamental information about the 59 Economic report 87 Overall assessment of the business
Group 59 Health care industry situation
38 The Group’s business model 60 The dialysis market
39 Important markets and competitive position 61 The market for generic IV drugs, biopharmaceuticals,
clinical nutrition, infusion therapy, and medical devices /
39 External factors 87 Outlook
40 Management and control transfusion technology
87 General and mid-term outlook
41 Capital, shareholders, articles of association 62 The hospital market
89 Future markets
42 Strategy and goals 65 The market for projects and services for hospitals and
89 Health care sector and markets
43 Our core competencies other health care facilities
92 Group sales and earnings
46 Path to accelerated growth 65 Overall business development
93 Sales and earnings by business segment
46 Cost and efficiency program 65 The Management Board’s assessment of the effect
94 Expenses
47 Sustainability program of general economic developments and those in the
94 Cost and efficiency program
48 Corporate performance criteria health care sector for Fresenius as well as business results
94 Liquidity and capital management
51 Research and development and significant factors affecting operating performance
94 Investments
56 Employees 66 Comparison of the actual business results with the forecasts
94 Capital structure
57 Change to the Management Board 69 Results of operations, financial position, assets and liabilities
94 Dividend
57 Changes to the Supervisory Board 69 Results of operations
58 Procurement
71 Earnings structure
58 Quality management 73 Reconciliation Fresenius Group
95 Opportunities and risk report
58 Sustainability 77 Financial position
95 Opportunities management
84 Assets and liabilities
95 Risk management
2
98 Assessment of the overall risk situation
98 Risks affecting the one-year forecast period
Fresenius | Annual Report 2021
99 Risks with effects on our medium-term goals
99 Risk areas
111 Compliance and legal risks
37
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
GROUP MANAGEMENT REPORT. Fresenius makes
important contributions to high-quality and affordable
medical care worldwide. In this way, we are living up to
our social responsibility. Despite the challenges posed
by the COVID-19 pandemic, Fresenius has proven to be
economically resilient. We met our targets, which
improved in the course of the year.
FUNDAMENTAL INFORMATION ABOUT THE ► Fresenius Medical Care offers services and products
for patients with chronic kidney failure. As of Decem-
GROUP
ber 31, 2021, Fresenius Medical Care treated 345,425
THE GROUP’S BUSINESS MODEL patients at 4,171 dialysis clinics. Dialyzers and dialysis
Fresenius is a global health care Group in the legal form of machines are among the most important product lines.
an SE & Co. KGaA (a partnership limited by shares). We of- In addition, Fresenius Medical Care offers dialysis-re-
fer products and services for dialysis, hospitals, and outpa- lated services.
tient medical care. In addition, Fresenius focuses on hospi- ► Fresenius Kabi specializes in products for the therapy
tal operations. We also manage projects and provide ser- and care of critically and chronically ill patients. The
Annual Report 2021
vices for hospitals and other health care facilities world- portfolio includes intravenously administered generic
There were no changes to the Group's business model in
wide. drugs (IV drugs), biosimilar products with a focus on
2021.
The operating business comprises four business seg- oncology and autoimmune diseases, clinical nutrition,
ments, all of which are legally independent entities and and infusion therapies. In addition, the company is also
have a decentralized structure, managed by the operating a supplier of medical devices and products for transfu-
Fresenius
parent company Fresenius SE & Co. KGaA. sion technology.
38
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
► Fresenius Helios is Europe’s leading private hospital IMPORTANT MARKETS AND COMPETITIVE POSITION Fresenius Vamed is a global company with no direct com-
operator. Under the holding Helios Health, the com- Fresenius operates in more than 90 countries through its petitors covering a comparably comprehensive portfolio of
pany includes Helios Germany, Helios Spain subsidiaries. The main markets are Europe with 45% and projects, services, and total operational management over
(Quirónsalud) and the Eugin Group. At the end of North America with 38% of sales, respectively. the entire life cycle of health care facilities. In Central Eu-
2021, Helios Germany operated a total of 90 hospitals, Fresenius Medical Care holds the leading position rope, the company is one of the leading private providers of
around 130 outpatient clinics, and 6 prevention cen- worldwide in dialysis care as it serves about 9% of all dial- rehabilitation services. As a result, Fresenius Vamed has a
ters. In Spain, Quirónsalud operated 49 hospitals, 88 ysis patients, as well as in dialysis products, with a market unique selling proposition of its own. Depending on the
outpatient centers, and around 300 occupational risk share of about 36%. business segment, the company competes with international
prevention centers at the end of 2021. In addition, Helios Fresenius Kabi aims to make a significant contribution companies and consortia, as well as with local providers.
Spain is active in Latin America with 7 hospitals as well to therapy and care of critically and chronically ill patients
as a provider of medical diagnostics. The Eugin Group’s with products and services. In this area of care in particu- EXTERNAL FACTORS
network comprises 33 clinics and an additional 39 sites lar, the need for high-quality, modern, and affordable ther- The COVID-19 pandemic has a significant impact on the
across 10 countries on 3 continents. Eugin offers a apies is growing as the proportion of chronic diseases con- economic environment of the Fresenius Group. We demon-
wide spectrum of state-of-the-art services in the field tinues to increase. strated our special responsibility as part of the health care
of fertility treatments. Fresenius Kabi is one of the leading companies in Eu- system even under the difficult circumstances of the
► Fresenius Vamed manages projects and provides ser- rope for large parts of its product portfolio and has signifi- COVID-19 pandemic. With our products, services, and ther-
vices for hospitals as well as other health care facilities cant market shares in the growth markets of Asia-Pacific apies, we have made many important contributions to high-
worldwide and is a leading post-acute care provider in and Latin America. Furthermore, Fresenius Kabi is one of quality and affordable health care worldwide during the
Central Europe. The portfolio ranges along the entire the leading companies in the field of generic IV drugs both COVID-19 pandemic. Despite partial government compen-
value chain from project development, planning, and in the U.S. market and in Europe. We intend to further sation, COVID-19 had an overall strong negative effect on
turnkey construction, via maintenance and technical strengthen and expand these market positions in the future. the 2021 financial figures in many of the Group’s important
management, to total operational management. The Further information on the market position of Fresenius markets.
services are aimed at various areas of health care, Kabi can be found in the market description on page 61 f. Despite the challenges posed by the COVID-19 pan-
ranging from prevention and acute care to rehabilita- Fresenius Helios is Europe’s leading private hospital demic, Fresenius has shown economic resilience. Our com-
tion and nursing. operator. Helios Germany and Helios Spain are the largest pany’s business development has proven to be compara-
private hospital operators in their respective home markets. tively stable and largely independent of economic cycles.
Fresenius has an international sales network and maintains The Eugin Group is a leading international provider in the Our diversification into four business segments and our
more than 90 production sites. Large production sites are field of fertility services. global focus give the Group additional stability. For detailed
Annual Report 2021
located in the United States, China, Japan, Germany, and information on our markets, please see pages 59 ff. We re-
Sweden. port on the impact of the COVID-19 pandemic on our busi-
ness performance and on changes in reimbursement prac-
tices in the hospital business, respectively, on pages 62 ff.
Fresenius
39
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
The legal framework for the operating business of the Fresenius Management SE is wholly owned by Else Kröner- statements, and performs the other functions assigned to it
Fresenius Group remained essentially unchanged in 2021. Fresenius-Stiftung. The KGaA has a two-tier management by law and the Company’s articles of association. It is in-
Fluctuating exchange rates, particularly between the system --- management and control are strictly separated. volved in corporate planning and strategy, and in all matters
U.S. dollar and the euro, have an effect on the income The general partner, represented by its Management of fundamental importance for the Company. The Supervi-
statement and the balance sheet. In 2021, the average an- Board, conducts the business and represents the Company sory Board of Fresenius SE & Co. KGaA has six shareholder
nual exchange rate between the U.S. dollar and the euro of in dealings with third parties. The Management Board gen- representatives and six employee representatives. A Nomi-
1.18 was above the 2020 rate of 1.14, and therefore had a erally has seven members. According to the Management nation Committee of the Supervisory Board of Fresenius SE
negative currency translation effect on the income state- Board’s rules of procedure, each member is accountable & Co. KGaA has been instituted for election proposals for
ment. Details of this can be found in the statement of com- for his or her own area of responsibility. However, the the shareholder representatives. Its activities are aligned
prehensive income on page 277. members have joint responsibility for the management of with the provisions of law and the Corporate Governance
Furthermore, there were negative currency translation the Group. In addition to the Supervisory Board of Fresenius Code. The shareholder representatives are elected by the
effects in fiscal year 2021 from the appreciation of Latin SE & Co. KGaA, Fresenius Management SE has its own Annual General Meeting of Fresenius SE & Co. KGaA.
American currencies, in particular the Argentine peso and Supervisory Board. The Management Board is required to The European works council elects the employee repre-
the Brazilian real, against the euro. report to the Supervisory Board of Fresenius Management sentatives to the Supervisory Board of Fresenius SE & Co.
While the balance sheet total increased by 8 %, the in- SE regularly, in particular on its corporate policy and strat- KGaA.
crease in constant currency was only 4 %, inn particular egies. In addition, the Management Board reports on busi- The Supervisory Board must meet at least twice per
due to the exchange rate changes (from 1.23 U.S. dollars ness profitability, current operations, and any other matters calendar half-year. The Supervisory Board of Fresenius SE
on December 31, 2020, to 1.13 U.S. dollars on December that could be of significance for the Company’s profitability & Co. KGaA has two permanent committees: the Audit
31, 2021) and liquidity. The Supervisory Board of Fresenius Manage- Committee, consisting of five members, and the Nomina-
In 2021, the Fresenius Group was involved in various le- ment SE also advises and supervises the Management tion Committee, consisting of three members. The mem-
gal disputes resulting from business operations. Although it Board in its management of the Company. It is prohibited bers of the committees are listed on page 394 of this An-
is not possible to predict the outcome of these disputes, from managing the Company directly. However, the Man- nual Report. The Company’s annual corporate governance
none is expected to have a significant adverse impact on agement Board’s rules of procedure require it to obtain the declaration pursuant to Section 315d and Section 289f of
the assets and liabilities, financial position, and results of approval of the Supervisory Board of Fresenius Manage- the German Commercial Code (HGB) describes the proce-
operations of the Group. Further information regarding le- ment SE for specific activities. dures of the Supervisory Board’s committees on page 225 f.
gal matters can be found on pages 342 to 347 of the Notes. The members of the Management Board are appointed The declaration can also be found on the website
We carefully monitor and evaluate country-specific po- and dismissed by the Supervisory Board of Fresenius Man- www.fresenius.com/corporate-governance.
litical, legal, and financial conditions. This also applies to agement SE. Appointment and dismissal is in accordance The description of both the compensation system and
Annual Report 2021
the potential impact on our business that could result from with Article 39 of the SE Regulation1. The articles of associ- individual amounts paid to the Management Board and Su-
inflation risks. ation of Fresenius Management SE also provide that deputy pervisory Board of Fresenius Management SE, and the Su-
members of the Management Board may be appointed. pervisory Board of Fresenius SE & Co. KGaA, are included
MANAGEMENT AND CONTROL The Supervisory Board of Fresenius SE & Co. KGaA in the Compensation Report on pages 234 ff. of this Annual
In the legal form of a KGaA, the Company’s corporate bod- advises and supervises the management of the Company’s Report.
Fresenius
ies are the Annual General Meeting, the Supervisory Board, business by the general partner, reviews and approves the
and the general partner, Fresenius Management SE. annual financial statements and the consolidated financial
1
Council Regulation (EC) No. 2157/2001 of October 8, 2001 on the Statute for a European Company (SE) (SE Regulation - SE-Reg) 40
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
CAPITAL, SHAREHOLDERS, ARTICLES OF the 2008 Stock Option Plan, the holders of these sub- Company had not utilized these authorizations as of De-
ASSOCIATION scription rights exercise their rights, and the Company cember 31, 2021.
The subscribed capital of Fresenius SE & Co. KGaA does not use its own shares to service the subscription As the largest shareholder, Else Kröner-Fresenius-
amounted to 558,502,143 ordinary shares as of December rights or does not exercise its right to make payment Stiftung, Bad Homburg, Germany, informed the Company
31, 2021 (December 31, 2020: 557,540,909). in cash. on December 30, 2021, that it held 148,685,702 ordinary
The shares of Fresenius SE & Co. KGaA are non-par- ► The general partner is authorized, with the approval of shares of Fresenius SE & Co. KGaA. This corresponds to an
value bearer shares. Each share represents €1.00 of the the Supervisory Board, until May 17, 2023, to issue op- equity interest of 26.6% as of December 31, 2021.
capital stock. Shareholders’ rights are regulated by the Ger- tion bearer bonds and / or convertible bearer bonds, Amendments to the articles of association are made
man Stock Corporation Act (AktG --- Aktiengesetz). once or several times, for a total nominal amount of up in accordance with Section 278 (3) and Section 179 (2) of
Fresenius Management SE, as general partner, is au- to €2.5 billion. To fulfill the granted subscription the German Stock Corporation Act (AktG) in conjunction
thorized, subject to the consent of the Supervisory Board of rights, the subscribed capital of Fresenius SE & Co. with Article 17 (3) of the articles of association of Fresenius
Fresenius SE & Co. KGaA: to increase the subscribed capital KGaA was increased conditionally by up to SE & Co. KGaA. Unless mandatory legal provisions require
of Fresenius SE & Co. KGaA by a total amount of up to €125 €48,971,202.00 through issuance of new bearer ordi- otherwise, amendments to the articles of association re-
million, until May 17, 2023, through a single issuance or nary shares (Conditional Capital III). quire a simple majority of the subscribed capital repre-
multiple issuance of new bearer ordinary shares against The conditional capital increase shall only be im- sented in the resolution. If the voting results in a tie, a motion
cash contributions and / or contributions in kind (Author- plemented to the extent that the holders of convertible is deemed rejected. Furthermore, in accordance with Sec-
ized Capital I). In principle, the shareholders shall be bonds issued for cash, or of warrants from option tion 285 (2) sentence 1 of the German Stock Corporation
granted a subscription right. In certain cases, however, the bonds issued for cash, exercise their conversion or op- Act (AktG), amendments to the articles of association re-
right of subscription can be excluded. tion rights and as long as no other forms of settlement quire the consent of the general partner, Fresenius Man-
In addition, there are the following Conditional Capitals are used. agement SE. The Supervisory Board is entitled to make
according to the articles of association of May 21, 2021: ► The share capital is conditionally increased by up to such amendments to the articles of association that only
€23,786,091.00 by the issuance of new ordinary bearer concern their wording without a resolution of the Annual
► The subscribed capital is conditionally increased by up shares (Conditional Capital IV). The conditional capi- General Meeting.
to €4,735,083.00 through the issuance of new bearer tal increase will only be implemented to the extent that Under certain circumstances, a change of control
ordinary shares (Conditional Capital I). The condi- subscription rights have been, or will be, issued in ac- would impact our major long-term financing agreements,
tional capital increase will only be executed to the ex- cordance with the Stock Option Program 2013 and the which contain customary change of control provisions that
tent that convertible bonds for ordinary shares have holders of subscription rights exercise their rights, and grant creditors the right to request early repayments of out-
been issued under the 2003 Stock Option Plan and the the Company does not grant its own shares to satisfy standing amounts in case of a change of control. The ma-
Annual Report 2021
holders of these convertible bonds exercise their con- the subscription rights. jority of our financing arrangements, in particular our
version rights. bonds placed in the capital markets, however, require that
► The subscribed capital is conditionally increased by up The Company is authorized, until May 17, 2023, to pur- the change of control is followed by a decline or a with-
to €3,452,937.00 through the issuance of new bearer chase and use its own shares up to a maximum amount of drawal of the Company’s rating or that of the respective fi-
ordinary shares (Conditional Capital II). The condi- 10% of the subscribed capital. In addition, when purchas- nancing instruments.
Fresenius
tional capital increase will only be executed to the ex- ing its own shares, the Company is authorized to use equity
tent that subscription rights have been issued under derivatives with possible exclusion of any tender right. The
41
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
STRATEGY AND GOALS
Demographic change is posing fundamental challenges to
societies worldwide. Not only are people living longer, but
the pace of population aging is also increasing signifi-
cantly. As a result, the social and health care systems of
many countries are coming under increasing pressure. As
the average age of the population increases, so does the
number of chronically and critically ill patients.¹ This rep-
resents a major global challenge for the public health sys-
tem. A longer life, however, also offers opportunities for in-
dividuals and societies. The extent to which these opportu-
nities can be leveraged depends heavily on one factor:
health.
Our purpose is to offer ‘‘Ever better medicine for ever
more people’’. In line with this purpose, Fresenius develops
innovative, affordable, and profitable medical solutions for
the megatrends of health and demographics. What drives
us to achieve top performance every day is our mission: we
improve people’s lives by providing high-quality and afford-
able health care. Consequently, Fresenius’ business deci-
sions are guided by this mission. Our goal is to expand
Fresenius’ position as a leading global provider of prod-
ucts, services, and therapies for critically and chronically ill
people. At the same time, we want to grow profitably and We had expected small and mid-sized acquisitions to addi- Furthermore, we now expect that small and mid-sized ac-
use our capital efficiently. tionally increase the CAGR for both sales and net income quisitions will add less than 1% point to both CAGRs.
We have set ourselves clear medium-term goals. The by approximately 1%-point. For Fresenius, economic success is not an end in itself,
targets announced in February 2019 stated that based on In February 2019, when we originally communicated but a means that enables us to continue investing in better
the key financial figures for 2019, average annual organic our medium-term targets, no one has foreseen a global medicine.
Annual Report 2021
sales growth (CAGR) for the period 2020 to 2023 is expected pandemic and the related knock-on effects such as in- We have lived up to our special responsibility as part of
in the range of 4% to 7%. Net income2, 3 is expected to creased inflationary pressure. Hence, we have to refine our the health care system, even under the difficult circum-
grow organically at a CAGR in a range of 5% to 9% in the expectations based on the financial results for fiscal years stances of the current COVID-19 pandemic. With our prod-
period 2020 to 2023. 2020 and 2021: we now expect to achieve a sales CAGR at ucts, services, and therapies, we have made many important
the bottom to middle of the range and the bottom of the contributions worldwide.
Fresenius
range for the net income CAGR.
1
WHO 2021: ‘‘Ageing and health’’
2
Net income attributable to the shareholders of Fresenius SE & Co. KGaA
3
Before special items 42
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Our dialysis clinics and hospitals, for example, have taken OUR STRATEGIC FOCUS OUR CORE COMPETENCIES
extensive measures to ensure that patients continuously re- Fresenius invests in and manages a diversified portfolio of QUALITY
ceive the best possible care. For essential drugs used for health care businesses that create value. With our four All business segments make an overall contribution to in-
COVID-19 patients, we have committed ourselves to keep- business segments we focus on a defined number of health creasing the quality and efficiency of health care.
ing prices stable --- despite a significant increase in de- care areas. We continuously develop our business areas Fresenius Medical Care ensures patient health and
mand. and strive to assume leading positions in the respective product safety by providing a safe environment in its clinics.
In our view, a significant adjustment of our strategy due health care markets and segments. We have defined strate- Fresenius Medical Care considers the quality and safety of
to the COVID-19 pandemic is not necessary. On the con- gic priorities to strengthen our position as the leading its products and services to be the foundation of its success.
trary, our good economic development in 2021 confirms global provider of products, services, and therapies for crit- Fresenius Kabi’s corporate philosophy ‘‘caring for life’’
our strategy. COVID-19 will even accelerate the implemen- ically and chronically ill patients: expresses the company’s commitment to improving the
tation of some strategic goals, such as the further expan- quality of life of its patients. The quality and safety of its
sion of digital services. Through various digital solutions, ► Profit from megatrends: gearing businesses towards products and services is thus of paramount importance to
e.g., telemedicine services, we were able to address pa- the megatrends health, demographic change, and digi- Fresenius Kabi.
tients’ concerns about becoming infected in hospital and talization in health care Fresenius Helios hospitals are characterized by high
provide them with targeted advice (see also separate Group ► Create value: sustainable value creation by allocating standards of treatment quality, hygiene standards, patient
Non-financial Report1 p. 147 ff.). capital to profitable growth areas safety, and quality of care.
► Act responsibly: responsible and sustainable corpo- Fresenius Vamed bases its quality processes on clearly
rate governance as part of our corporate culture defined and generally established standards.
► Foster collaboration: targeted fostering of intra-Group
cooperation to leverage synergies
Annual Report 2021
Fresenius
1
The separate Group Non-financial Report is not part of the audited Group Management Report.
This also applies to all other references in the Group Management Report.
43
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
INNOVATION Fresenius Kabi focuses its research and development activi- The Helios patient portal is also to be introduced at all clin-
Fresenius’ goal is to continue building on its strength in ties on products for the therapy and care of critically and ics (see also separate Group Non-financial Report p. 147 f.).
technology, its competence and quality in patient care, and chronically ill patients. With our products we want to sup- Moreover, Fresenius Helios is also focusing on health apps
its ability to manufacture cost-effectively. Developing prod- port medical advancements in acute and post-acute care for the chronically ill. As a result of the COVID-19 pandemic,
ucts and systems that provide a high level of safety and and improve patients’ quality of life. We are also committed telemedical applications are increasingly in demand ‒ more
user-friendliness and enable tailoring to individual patient to providing access to high-quality, state-of-the-art thera- than 8,900 video consultations were booked by patients in
needs is an inherent part of our strategy of sustainable and pies for an increasing number of people worldwide. Our 2021. The company will continue to expand this service in
profitable growth. We will continue to develop ever more development expertise covers all relevant components such its health care facilities and offer it on a shared platform.
effective products and treatment methods for critically and as drug raw materials, pharmaceutical formulations, pri- Medical consultations are already being conducted via
chronically ill patients in order to offer best-in-class medi- mary packaging, medical technologies for the application video. Numerous facilities already offer such video consul-
cal standards. Digitalization is playing an increasingly im- of drugs and infusions, as well as production technology. In tations on a regular basis (see separate Group Non-finan-
portant role --- whether it is in health care facilities or in the area of biosimilars, we have specialized in the develop- cial Report p. 147 f.). Moreover, Fresenius Helios is driving
production. It drives innovative technologies and treatment ment of products for the treatment of oncological and auto- forward initiatives focused on occupational medicine for
concepts and can contribute to solving numerous chal- immune diseases, making affordable treatments accessible company employees, as well as prevention programs.
lenges in the health care system (see separate Group Non- for even more patients. Fresenius Vamed’s goal is to realize further projects in
financial Report p. 141 ff.). Fresenius Helios’ goal is to foster knowledge sharing integrated health care services and to support health care
Fresenius Medical Care will focus on creating the future across its international hospital network and use innovation systems more efficiently. In addition, state-of-the-art stand-
of health care for chronically and critically ill patients to develop ever better health care services and therapies ards such as the use of Building Information Modeling
across the renal care continuum and critical care solutions. for its patients. In order to comprehensively drive forward (BIM) in the construction of health care facilities, new con-
Fresenius Medical Care also strives to identify new oppor- digitalization, the company is focusing on the further ex- cepts for operational management through the application
tunities in value-added technologies and approaches on an pansion of the IT infrastructure in the hospitals and the of innovative technologies, and digitalization measures
ongoing basis, for example through the Fresenius Medical online patient portal, which accompanies our patients be- contribute to the improvement of medical care as well as to
Care Ventures fund, which invests in start-ups and early- fore, during, and after their stay in hospital. In Germany, the relief of medical professionals.
stage companies in the health care industry. Helios has set itself clear goals: by the end of 2022, addi-
tional medical data such as nursing care documentation
and medication should be available in the digital patient file
at all clinics.
Annual Report 2021
Fresenius
44
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
IMPROVE PROFITABILITY DRIVE INTERNATIONALIZATION With 90 hospitals, Fresenius Helios operates in nearly all of
Fresenius is committed to continuously improving Group Fresenius’ goal is to ensure and expand its long-term posi- Germany. Building on this, Fresenius Helios is now in a po-
profitability and capital efficiency. For example, our finan- tion as a leading international provider of products, ser- sition to develop new patient care models. To benefit from
cial medium-term goals foresee that over the coming years vices, and therapies in the health care industry. To this end, the trend towards outpatient treatment, Helios Germany
we will increase net income1, 2 more strongly than sales and to geographically expand our business, we plan to has been expanding outpatient service offerings. Helios
(see page 92). grow organically as well as through selective small to me- Spain has attractive growth opportunities through the ex-
To contain costs, we initiated a cost and efficiency pro- dium-sized acquisitions, complementing our existing port- pansion and construction of hospitals, and potential for fur-
gram in 2021 and achieved initial cost savings. The folio. We are constantly seeking new above-average growth ther consolidation in the highly fragmented private hospital
measures to sustainably increase profitability and opera- opportunities in developing as well as in emerging coun- market in Spain. Fresenius Helios will exploit upcoming op-
tional excellence are targeted to lead to cost savings of at tries. Our aim is to strengthen our activities in these re- portunities for cross-border synergies in areas such as la-
least €150 million p.a. after taxes and minority interest in gions and successively introduce further products from our boratory services and joint purchasing. The cross-border
2023, with some further potential to increase thereafter. portfolio into these markets. exchange of experience and knowledge is creating the eco-
Further information on the cost and efficiency program and Fresenius Medical Care is the worldwide leader in dialy- nomic prerequisites for the further internationalization of
the Fresenius Group’s strategic roadmap can be found on sis, with a strong market position in the United States. Fu- our hospital business. In the field of fertility services, the
page 46. ture opportunities in dialysis will arise from the further company intends to grow organically and through acquisi-
By focusing on our operating cash flow and employing global expansion of dialysis services products. tions.
efficient working capital management, we are expanding Fresenius Kabi is the market leader in infusion therapy Fresenius Vamed plans to further strengthen its posi-
our scope for investment and improving our balance sheet in Europe and Latin America. tion as a global specialist for projects and services for hos-
ratios. We also aim to optimize our weighted average cost In clinical nutrition therapy, Fresenius Kabi is market pitals and other health care facilities. In Central Europe,
of capital (WACC). To this end, we are focusing on a bal- leader in Europe as well as in the key markets in Asia- Fresenius Vamed is one of the leading providers of rehabili-
anced mix of equity and debt and striving to achieve a net Pacific (including China); in Latin America, Fresenius Kabi tation services. Furthermore, the collaboration with Fresenius
debt / EBITDA3 ratio within a range of 3.0× to 3.5×. is one of the three leading providers of clinical nutrition. Helios has been further intensified. This applies, for exam-
In the area of IV generic drugs, Fresenius Kabi is one of ple, to technical services and purchasing, where both com-
the leading companies in the U.S. market. In the biosimi- panies are cooperating on selected products.
lars product segment, Fresenius Kabi started with launches
of its first biosimilar product, Idacio, in Europe in 2019. In
2021, the company continued to launch Idacio in several
European countries and has received marketing authoriza-
Annual Report 2021
tion in selected countries in Latin America and Asia-Pacific,
as well as in Israel and Canada. In addition, Fresenius Kabi
is one of the leading suppliers in the field of transfusion
technology and medical devices.
Fresenius
Statements on market position according to company research
1
Net income attributable to the shareholders of Fresenius SE & Co. KGaA
2
Before special items
3
Both net debt and EBITDA calculated at LTM average exchange rates; before special items, pro forma closed acquisitions / divestitures.
For pro forma acquisitions, the missing pro forma EBITDA for the full 12 months is included.
For divestments, the EBITDA contribution of the last 12 months is deducted. 45
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
EMPLOYEES PATH TO ACCELERATED GROWTH COST AND EFFICIENCY PROGRAM
The commitment of our more than 300,000 employees Fresenius has defined a strategic path to pursue acceler- In 2021, Fresenius initiated a cost and efficiency program.
worldwide is key for the success and sustained growth of ated profitable growth and hence to strengthen the Group First initiatives have already been successfully imple-
Fresenius. We firmly believe in a culture of diversity, as we and each of its business segments by tapping new sources mented. This has led to initial cost savings of ~€20 million1
are convinced that different perspectives, opinions, experi- of capital and prioritizing segment capital allocation. All and one-time expenses of ~€80 million1 in fiscal year 2021.
ences, and values enable Fresenius to continue successfully our stakeholders continue to benefit from the advantages of The program was initiated in early 2021 and aims to
growing as a global health care company. To tackle the up- the Group’s current structure, which offers stability further safeguard the medium-term targets and sustainably
coming challenges, attracting new employees is key for the through diversification as well as efficiency through econo- enhance profitability.
growth of our company. We regularly participate in recruit- mies of scale, access to attractive debt financing and tax Given the good progress, especially driven by the accel-
ing events and career fairs to attract new talent, and invite savings. erated implementation of initiatives, Fresenius significantly
our management to meet future Fresenius employees at the All of Fresenius’ business segments have excellent mar- increases its savings target and now expects cost savings of
‘‘Meet the Board’’ career day. In the past two years, these ket positions and ample meaningful growth opportunities. at least €150 million p.a. after tax and minority interest in
events were held virtually or in compliance with special hy- Properly balancing the objectives of all our stakeholder 2023. Initially, more than €100 million p.a. after tax and
giene measures in accordance with the general conditions. groups requires an even more targeted approach to capital minority interest were projected. For the years thereafter, a
Not only do we try to attract new talent, but also do every- allocation. While Fresenius continues to believe in the vir- further significant increase in sustainable cost savings is
thing we can to retain and develop our employees over the tues of vertical integration, The Company is keen to gradu- expected. The savings will be achieved by all four business
long term. We offer a variety of flexible working-time mod- ally re-balance the relative weights of its products and ser- segments and the corporate center.
els and incentive programs to ensure that our long-term vice businesses. Fresenius anticipates that achieving these sustainable
needs for highly qualified employees are met. Furthermore, Primarily based on its superior profitability and excel- efficiency improvements will require up-front expenses of
we offer our employees opportunities to develop their ca- lent growth prospects, Fresenius Kabi is defined as top pri- more than €200 million in 2022 and further expenses of
reers in an international and dynamic environment. ority. With respect to Fresenius Medical Care, which has around €100 million in 2023, in each case after taxes and
been particularly hard hit by the pandemic, the transfor- minority interest. No further significant expenses are ex-
mation program FME25 is expected to result in ever im- pected thereafter. In line with previous practice, these ex-
proving profitability and accelerated growth, driving im- penses are classified as special items (see also reconcilia-
proved valuation for Fresenius’ controlling stake. For tion tables on page 74 to 76).
Fresenius Helios and Fresenius Vamed, smaller inorganic
growth opportunities will continue to be financed from
Fresenius Group funds. For larger growth opportunities,
Annual Report 2021
Fresenius is open to value-enhancing external equity in-
vestments the level of these business segments. An equity
increase on Group level would then be redundant and is
hence not foreseen.
By setting this course, Fresenius will accelerate the
Fresenius
growth of each of our business segments for the benefit of
all stakeholders.
1
Refers to net income attributable to shareholders of Fresenius SE & Co. KGaA 46
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
FME25 The focus will be on further developing the portfolio to cap- SUSTAINABILITY PROGRAM
Fresenius Medical Care announced details of the FME25 italize on key market and industry trends in order to cap- For Fresenius, sustainability is an integral part of its busi-
program on November 2, 2021. With a significantly simpli- ture future growth opportunities. In addition, the company ness model. The company is working to establish global
fied future structure of two global operating segments --- will more actively go after growth opportunities in the vari- sustainability standards and continuously improve its own
Care Enablement and Care Delivery --- the company orients ous regions with increased focus, especially once the pan- sustainability performance. To this end, Fresenius contin-
its operating model along the relevant future value drivers. demic normalizes. ued to drive forward its ESG (Environment, Social, Govern-
Based on the implementation of the new global operat- In parallel, Fresenius Kabi will continue to build resili- ance) initiatives in the fiscal year.
ing model, Fresenius Medical Care assumes to reduce its ence in its volume-driven IV business. Fresenius has set a climate target for the Group comple-
annual cost base by €500 million by the end of 2025. Furthermore, Fresenius Kabi will improve its global com- menting its existing sustainability targets and programs.
Around 50% of these savings are expected to be real- petitiveness and the effectiveness of its organization; a first The company aims to be climate neutral by 2040 and to re-
ized by 2023. Around 80% of the anticipated one-time in- step is the introduction of a business-oriented instead of a duce 50 % of absolute scope 1 and scope 2 emissions by
vestments in FME25, amounting to approximately €450‒ regional organization. 2030 compared to 2020 levels. Fresenius will continuously
500 million, are expected to be made by the end of 2023. In the new organizational structure, the business units assess scope 3 emission impacts for inclusion in our targets.
The investments will be treated as a special item. The Com- and the regions will be given more accountability to sup- The Fresenius Group Sustainability Board (GSB) held
pany thus expects to reach positive net savings by the end port Fresenius Kabi’s growth targets. At the same time, the six meetings to discuss the implementation of regulatory
of 2023. interfaces within the company will be streamlined to foster requirements, in particular the EU taxonomy and the Due
collaboration. The new organization was implemented as of Diligence Act, as well as Sustainable Finance. Furthermore,
VISION 2026 January 2022. sustainability was introduced as a non-financial perfor-
Fresenius Kabi has developed a strategic plan to transform mance target in the Management Board compensation sys-
the company for the next decade and to better capture new NEW GLOBAL IT ORGANIZATION tem in 2021. In July 2021, Fresenius took a further step to-
growth opportunities. Given the sustainable growth poten- Fresenius Digital Technology reached a milestone on the ward integrating sustainability into all aspects of its busi-
tial and the company’s already strong market position, path to becoming a modern, global IT organization in 2021. ness activities by launching its first sustainability-oriented
Fresenius Kabi will continue to focus on products and ser- With efficient processes and harmonized IT services, it will financing instrument. In November 2021, we were again in-
vices for critically and chronically ill patients. Within this optimally support the business segments and their strate- cluded in the Dow Jones Sustainability Index (DJSI Europe).
clear direction, Fresenius Kabi has defined three growth gies. The aim of the comprehensive transformation process Further information on our sustainability program can
vectors: is to simplify the technology landscape, communication, be found in the separate Non-financial Group Report start-
and collaboration within the Group. At the same time, it will ing on page 114 and in the Compensation Report starting
► the broadening of our biopharmaceutical offering, increase the efficiency of IT services and make them more on page 234.
Annual Report 2021
► further roll-out of clinical nutrition, cost-efficient.
► expansion in the MedTech area.
Fresenius
47
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
CORPORATE PERFORMANCE CRITERIA
The Management Board makes operational and strategic
management decisions based on our Group-wide perfor-
mance indicators for growth, profitability, liquidity, capital
efficiency, and capital management. The most important fi-
nancial performance indicators for us are explained below
and a definition is provided in the glossary of financial
terms on pages 399 to 401. There were no changes in the
financial performance indicators compared to 2020. There
were also no changes in the financial performance indica-
tors of the Fresenius Group due to COVID-19.
The key figures for the financial performance indicators
for 2022 of the Group and the business segments can be Hence, we have to refine our expectations based on the fi- In February 2019, when we originally communicated our
found in the outlook on pages 92 f. nancial results for fiscal years 2020 and 2021: we now ex- medium-term targets, no one has foreseen a global pan-
pect to achieve a sales CAGR at the bottom to middle of the demic and the related knock-on effects such as increased
GROWTH range. Furthermore, we now expect that small and mid- inflationary pressure. Hence, we have to refine our expec-
In line with our growth strategy, sales growth (in constant sized acquisitions will add less than 1% point to the sales tations based on the financial results for fiscal years 2020
currency) of the Group and, in our business segments, or- CAGR (see outlook, page 92). and 2021: we now expect to achieve the bottom of the
ganic sales growth in particular are of central importance. range for the net income CAGR. Furthermore, we now ex-
Fresenius has set itself medium-term growth targets. The PROFITABILITY pect that small and mid-sized acquisitions will add less than
targets announced in February 2019 stated that based on We use earnings before interest and taxes (EBIT) and EBIT 1% point to the net income CAGR. (see outlook, page 92).
the key financial figures for 2019, average annual organic growth (in constant currency) to measure the profitability
sales growth (CAGR) for the period 2020 to 2023 is ex- of the business segments. At Group level, we primarily use
pected in the range of 4% to 7%. We had expected small net income and its currency-adjusted growth. To facilitate
and mid-sized acquisitions to additionally increase the comparison of operating performance across several peri-
CAGR by approximately 1% point. ods, we adjust the earnings figures for special items where
In February 2019, when we originally communicated appropriate. Fresenius has set itself medium-term growth
our medium-term targets, no one has foreseen a global
Annual Report 2021
targets. The targets announced in February 2019 stated
pandemic and the related knock-on effects such as in- that based on the key financial figures for 2019, net in-
creased inflationary pressure. come1,2 is expected to grow organically at a CAGR in a
range of 5% to 9% in the period 2020 to 2023. We had ex-
pected small and mid-sized acquisitions to additionally in-
crease the CAGR by approximately 1% point.
Fresenius
1
Net income attributable to the shareholders of Fresenius SE & Co. KGaA
2
Before special items 48
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
LIQUIDITY According to the management assessment, the Group is INVESTMENT AND ACQUISITION PROCESS
Within the Group, cash flow margin is used as the main li- therefore able to use debt to finance its growth to a greater Our investments and acquisitions are carried out using a
quidity indicator (see outlook, page 94). In order to further extent than companies in other industries. Our self-im- detailed coordination and evaluation process. As a first
optimize the contributions of our business segments to op- posed target corridor for the leverage ratio is 3.0× to 3.5×. step, the Management Board sets the Group’s investment
erating cash flow, we also use the additional performance targets and the budget based on investment proposals. In
indicators DSO1 (days sales outstanding) and SOI1 (scope of NON-FINANCIAL PERFORMANCE TARGETS the next step, the respective business segments and the in-
inventory). These show the amount of receivables and in- In 2021, sustainability was introduced as a non-financial ternal Acquisition & Investment Council (AIC) determine
ventories in relation to the sales and costs of the services performance target in the Management Board compensa- the proposed projects and measures, taking into account
rendered during the past reporting period. tion system. The Supervisory Board of Fresenius Manage- the overall strategy, the total investment budget, and the
Further information on our cash management system ment SE has set three ESG targets for each of the five ESG required and potential return on investment. We evaluate
can be found in the Opportunities and Risk Report on focus areas of quality, employees, innovation, compliance, investment projects based on commonly used methods,
pages 108 ff. and the environment for the years 2021 and 2022. These such as internal rate of return (IRR) and net present value
are derived from the company’s materiality analysis and are (NPV). Within the framework of the due diligence process,
CAPITAL EFFICIENCY measured qualitatively using a proprietary ESG scoring opportunities and risks associated with the potential acqui-
We work as profitably and efficiently as possible with the methodology. With the ESG targets, the company creates a sition target are analyzed and assessed. To this end, we re-
capital provided to us by shareholders and lenders. In order basis for ESG performance measurement by establishing view the business model, the key financial figures and tax
to manage this, we primarily calculate the return on in- the ESG target and strategy as well as transparent key per- issues, and the resulting company valuation. In addition,
vested capital (ROIC)2 and the return on operating assets formance indicators (KPIs) for performance management in we comprehensively analyze the market and competitive
(ROOA)2 (see outlook, page 94). An overview of the return future years. Further information on our sustainability pro- environment, the regulatory framework and the legal as-
ratios by segment can be found in the Group Management gram can be found in the separate Group Non-financial Re- pects. The audit also covers various issues relating to com-
Report on page 86. port starting on page 114 and in the Compensation Report pliance, production, research and development, quality, in-
starting on page 234. formation technology, human resources, and the environ-
CAPITAL MANAGEMENT ment. Based on investment volume, a project is submitted
We use the ratio of net debt and EBITDA as the key param- for approval to the executive committees or respective
eter for managing the capital structure. This measure indi- managements of the business segments, to the Manage-
cates the degree to which a company is able to meet its ment Board of Fresenius Management SE, and / or its Su-
payment obligations. Our business segments usually hold pervisory Board.
leading positions in growing and mostly non-cyclical mar-
Annual Report 2021
kets. Since the majority of our customers are of high credit You can find more details on our key performance indica-
quality, they generate mainly stable, predictable cash flows. tors in our interactive tool3 on our website at
www.fresenius.com/interactive-tool.
Fresenius
1
Does not reflect a core performance indicator
2
For a detailed calculation of ROIC and ROOA please see page 401.
3
Does not reflect a core performance indicator 49
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
GROUP1
Targets 20212 2021 2020 2019 2018 2017
Sales growth (in constant currency) Mid single-digit percentage growth 5% 5% 6% 6% 16%
Around top-end of low single-digit percentage
Net income3 growth (in constant currency) growth 5% -3% 0% 7% 21%
Liquidity and capital management
Cash flow margin 10% to 12% 13.5% 18.1% 12.0% / 9.9%4 11.2% 11.6 %
Net debt / EBITDA5 Around the top-end of 3.0× to 3.5×6 3.51x 3.44x 3.61× / 3.14×4 2.71× 2.84×
Capital efficiency
Decrease by 40 to 70 basis points
Return on invested capital (ROIC)7 compared to 2020 level 5.9% 6.5% 6.7% / 7.4%4 8.3% 8.0%
Decrease by 50 to 100 basis points
Return on operating assets (ROOA)7 compared to 2020 level 6.5% 7.3% 7.6% / 8.2%4 9.0% 9.4%
BUSINESS SEGMENTS1
Targets 20212 2021 2020 2019 2018 2017
Fresenius Medical Care
Expecting to be at the lower end
of the guidance range of low-to-mid single-digit per-
Sales growth (in constant currency) centage growth 2% 5% 5% 4% 9%
Expecting to be at the lower end
of the guidance range of high-teens to
Net income growth8, 9 (in constant currency) mid-twenties percentage decline -23% 12% -2% 4% 7%
Fresenius Kabi
Sales growth (organic) Low-to-mid single-digit percentage growth 4% 4% 4% 7% 7%
Around the top end of
EBIT growth (in constant currency) the low single-digit percentage guidance range 7% -6% 3% 2% 8%
Fresenius Helios
Sales growth (organic) Mid single-digit percentage growth 7% 4% 5% 3% 4%
EBIT growth (in constant currency) High single-digit percentage growth 10% 0% -4% 0% 54%
Fresenius Vamed
Sales growth (organic) Mid-to-high single-digit percentage growth 11% -8% 16% 16% 6%
EBIT growth (in constant currency) High double-digit € million amount €101 million €29 million 19% 45% 10%
Annual Report 2021
1
Growth rates are based on the assumptions of the respective annual forecasts and are adjusted for special items and, if applicable, other effects affecting the underlying growth
(adjustments to new accounting standards, acquisitions/divestments, acquisition costs, or cost-saving programs).
Fresenius
2
Including expected COVID-19 effects (updated November 2021)
3
Net income attributable to shareholders of Fresenius SE & Co. KGaA
4
Excluding IFRS 16 effect
5
Both net debt and EBITDA calculated at LTM average exchange rates; before special items, pro forma closed acquisitions / divestitures
6
Around the top-end of the self-imposed target range of 3.0× to 3.5×; excluding further potential acquisitions
7
Before special items, pro forma acquisitions
8
Net income attributable to shareholders of Fresenius Medical Care AG & Co. KGaA
9
Special items are effects (when consolidated at the Fresenius Group: special items), that are unusual in nature and were not foreseeable or not foreseeable
in size or impact at the time of giving guidance. 50
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
RESEARCH AND DEVELOPMENT R & D EXPENSES BY SEGMENT1 FRESENIUS MEDICAL CARE
Product and process development and the improvement of Our aim is to continuously improve our patients’ quality of
therapies are at the core of our growth strategy. Fresenius life and their treatment. Our intention is therefore to drive
focuses its R & D efforts on its core competencies in the fol- the development of new products through to market launch
Fresenius
lowing areas: Medical Care 27% and to expand our extensive portfolio of innovation pro-
jects. These focus on technologies in our core business as
Fresenius Kabi 73%
► Dialysis well as related areas of strategic interest.
► Generic IV drugs We intend to deliver innovative, competitive products
► Biosimilars 2021: €818 million and further strengthen our focus on developing countries.
► Infusion and nutrition therapies In addition to research and development activities
1
► Medical devices Before expenses related to the Fresenius cost and efficiency program and revaluations of con- within our company, we collaborate with external partners
tingent biosimilars purchase price liabilities
with the aim of building a comprehensive innovation and
Apart from new products, we are concentrating on develop- As of December 31, 2021, there were 3,656 employees in technology network. These partners include numerous aca-
ing optimized or completely new therapies, treatment research and development (2020: 3,565). Of that number, demic institutions, such as research institutes at prestig-
methods, and services. 1,236 were employed at Fresenius Medical Care (2020: ious universities in the United States. Another is the Renal
Research services provided by third parties are mainly 1,262) and 2,366 at Fresenius Kabi (2020: 2,288). Research Institute (RRI) in New York. This subsidiary of
used by Fresenius Kabi, especially in the field of biosimi- Our main research sites are in Europe, the United Fresenius Medical Care North America is a renowned insti-
lars. Detailed figures are provided on page 310. States, and India. Product-related development activities tution in the field of clinical research into all aspects of
are also carried out in China. chronic kidney failure. Together, we are working on funda-
Research and development expenses1 were €818 mil- mental issues relating to renal therapies. We are also in-
lion (2020: €748 million), approximately 7.5% of our prod- creasingly collaborating with start-ups and early-stage
uct sales (2020: 7.2%). companies with the objective of promoting innovation and
enabling access to the latest technologies.
KEY FIGURES RESEARCH AND DEVELOPMENT The COVID-19 pandemic had no major influence on our
2021 2020 2019 2018 2017
R & D activities. In 2021, we continued with our research
R & D expenses, € in millions1 818 748 677 649 538 and development work.
as % of product sales1, 2 7.5% 7.2% 6.8% 6.7% 5.7%
R & D employees 3,656 3,565 3,412 3,042 2,772
Annual Report 2021
1
2021: Before expenses related to the Fresenius cost and efficiency program and
revaluations of contingent biosimilars purchase price liabilities
2020, 2019, and 2018: Revaluations of biosimilars contingent purchase price liabilities
2
2021, 2019, and 2018 excluding impairment losses from capitalized in-process R & D
activities
Fresenius
1
Before expenses related to the Fresenius cost and efficiency program and revaluations of contingent biosimilars purchase price liabilities 51
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
The new FX CorAL dialyzer was officially presented at the contribution to the success of the treatment and the inter- In the area of generic IV drugs, we are continuously work-
virtual ERA-EDTA Congress (European Renal Association- action between medicine and technology is highly im- ing on the extension of our product portfolio. What matters
European Dialysis and Transplant Association Congress) in portant. most to us here is that we launch new generic drug formu-
June 2021. The FX CorAL was developed with a focus on We consider it our task to develop products that help to lations directly after the patents of the branded products
clinical performance and hemo-compatibility, both im- support medical advancements in acute and post-acute expire. For example, in the reporting year, we launched the
portant factors in patient-oriented dialysis. The dialyzer is care and improve patients’ quality of life. At the same time, cancer drug pemetrexed 25 mg/ml concentrate for the
based on the innovative Helixone hydro® membrane, our products are intended to enable an increasing number preparation of an infusion solution in Europe on June 1,
which forms a hydrous film on the inner membrane sur- of people worldwide to have access to high-quality, modern therefore bringing it onto the market two weeks before the
face. This reduces protein adsorption, resulting in a weak- therapies. patent expired, based on a patent agreement with the origi-
ened immune response and high selective permeability of Chronic diseases are on the increase worldwide; more nal manufacturer. We also introduced the foscarnet sodium
the membrane. The aim here is to reduce the side effects of and more people need access to high-quality therapies. In injection in the United States; when it was launched in Feb-
dialysis treatment. The multiFiltratePRO is a highly innova- the care of critically ill patients, the requirements for suc- ruary 2021, our product was the only generic for the origi-
tive platform for continuous renal replacement therapy. It cessful treatment are becoming ever higher. The demand nator product Foscavir on the market. Foscarnet is mainly
offers advanced features such as renal replacement therapy for effective therapies in conjunction with intelligent medi- used to treat immunosuppressed patients. In addition, we
incorporating proven regional Ci-Ca® citrate anticoagula- cal technology applications and devices will continue to are working on the continuous improvement of IV drugs al-
tion and therapeutic plasma exchange. The multiFiltrate- rise in the future. We want to be the preferred point of con- ready on the market. For example, we are developing IV
PRO has received emergency approval in the United States tact for doctors and nursing staff in the care of critically drugs with new formulations and dosage forms, as well as
and was launched in China and several South American and chronically ill patients. For this purpose, Fresenius improved primary packaging. In 2021, we had more than
countries in 2020, so it now has a broad base in the market. Kabi Vision 2026 was developed during the reporting year 100 active projects in the area of generics. We focus,
In 2022, we aim to grow further and implement optimiza- and adopted in the fourth quarter of 2021. With Vision among other things, on complex formulations such as ac-
tion measures based on the significant increase in the num- 2026, we have defined a clear direction for Fresenius Kabi tive ingredients in liposomal¹ solutions and product im-
ber of devices on the market and increased sales; the devel- with three growth paths: the broadening of our biopharma- provements that bring added value to both medical staff
opment of the corresponding measures was driven forward ceutical range, the further development and global intro- and patients.
in 2021 and is now almost complete. duction of our clinical nutrition products, and expansion in Thus, we develop ready-to-use products that are espe-
the area of MedTech. In the volume-driven IV business, we cially convenient and safe and help to prevent application
FRESENIUS KABI will continue to expand our resilience. Our future develop- errors in day-to-day medical care. These include ready-to-
Fresenius Kabi’s research and development activities con- ment work will be geared toward this. use solutions in our freeflex infusion bags, the cost-effec-
centrate on products for the therapy and care of critically Our development expertise includes all the related tive KabiPac infusion bottle and pre-filled syringes. Drugs
Annual Report 2021
and chronically ill patients. Our products are used where components, such as the drug raw material, the pharma- with pre-filled syringes are simpler and safer to use than
the patient is most at risk: in emergency medicine, inten- ceutical formulation, the primary packaging, the medical traditional applications. In the reporting year, for example,
sive care, special care, and in those who need to be treated device needed for application of drugs and infusions, and we introduced fentanyl in a pre-filled syringe in the United
in hospital or as an outpatient for a longer period of time. the production technology. In the area of biosimilars, we States.
In these patient groups, every single step is essential for have specialized in the development of products in the ar-
Fresenius
the success of the therapy. Products make a crucial eas of autoimmune diseases and oncology.
1
Liposomes are small vesicles consisting of a lipid bilayer and an aqueous core and are used to transport active substances in the body.
52
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
In the area of biosimilars, we have a pipeline of molecules Since its introduction in 2019, we have launched the prod- MSB 114563 is a biosimilar candidate of tocilizumab used
at various stages of development focused on autoimmune uct in numerous countries within Europe, Latin America, in various indications such as rheumatoid arthritis. The
diseases and oncology. A biosimilar is a biological product and Asia-Pacific, as well as in Israel and Canada. In the re- clinical trial for MSB 11456, conducted with healthy volun-
that is very similar to another approved biological product porting year, we worked on further marketing authoriza- teers, reached its primary endpoint in 2019 and demon-
called a ‘‘reference product’’. The biosimilar product corre- tions. strated bioequivalence for all pharmacokinetic parameters.
sponds to the reference product in terms of efficacy and The clinical development of MSB 114552, a biosimilar In the reporting year, we were able to successfully com-
safety. Since the existence of biosimilars, more and more candidate of pegfilgrastim, has been successfully com- plete our next development step for the market launch. Our
patients have been treated with biopharmaceutical drugs. pleted and marketing authorization applications are cur- biosimilar candidate MSB11456 showed positive results in
For many, biopharmaceutical therapy means a completely rently being reviewed by the European Medicines Agency two consecutive phase I studies and successfully achieved
new life. Not only are more people being treated with bio- (EMA) and the U.S. Food and Drug Administration (FDA) to primary and secondary endpoints. In both studies, subcuta-
pharmaceuticals, but waiting times for them have also been obtain approval for market launch. MSB 11455 is a mole- neous and intravenous formulations were used to cover the
significantly reduced in recent years. cule that stimulates the growth of certain white blood cells. two different dosage forms. The bioequivalence, safety, and
We apply the same high quality standards to our bio- These blood cells are essential for fighting infections, immunogenicity of the biosimilar candidate of tocilizumab
similar products during development and preparation as which are a common side effect in cancer patients receiv- compared to its reference product were examined.
are required for the reference product. With our biosimilars, ing chemotherapy. Approval for U.S. market launch re- The first phase I study, a randomized, double-blind,
we offer more patients worldwide access to affordable, quires the FDA to conduct inspections at the European pro- parallel-group study to determine the pharmacokinetics,
high-quality medicines. duction sites for MSB 11455. In the reporting year, the FDA pharmacodynamics, safety, tolerability, and immunogenic-
Our research and development center for biosimilars is informed Fresenius Kabi that it was postponing the com- ity of MSB11456 met all primary and secondary endpoints
based in Eysins, Switzerland, where new products for the pletion of its review process, as COVID-19-related re- following a single subcutaneous injection in healthy volun-
treatment of autoimmune and oncological diseases are de- strictions are delaying FDA inspections across the world. teers. The pharmacokinetic equivalence of MSB11456 with
veloped in state-of-the-art development and research labor- As a result, the FDA has also postponed its authorization the U.S. reference product4 and the EU reference drug5
atories. decision until the inspections can be carried out and com- was demonstrated successfully. The clinical study con-
Our first biosimilar is Idacio1, an adalimumab biosimilar pleted. firmed the similarity of MSB11456 with the U.S. reference
that can be used in chronic inflammatory diseases such as product4 and the EU reference drug5 at the pharmacody-
rheumatoid arthritis, Crohn’s disease and psoriasis (skin namic level. No significant differences in safety and immu-
disease). nogenicity were found between the three treatment groups
(MSB11456, U.S. reference product4, and EU reference
drug5).
Annual Report 2021
Fresenius
1
Idacio is a biosimilar of Humira® and has not yet been approved by all relevant health authorities. Humira® (adalimumab) is a registered trademark of AbbVie Biotechnology Ltd.
2
MSB 11455 is a biosimilar candidate of Neulasta® and has not yet been approved by the relevant health authorities. Neulasta® (pegfilgrastim) is a registered trademark of Amgen Inc.
3
MSB 11456 is a tocilizumab biosimilar candidate of Actemra®/RoActemra® and has not yet been approved by the relevant health authorities. Actemra®/RoActemra® (tocilizumab) are registered
trademarks of Chugai Seiyaku Kabushiki Kaisha.
4
U.S. reference product Actemra®.
5
EU reference product RoActemra®. 53
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
In the second phase I study, all primary and secondary end- In the parenteral nutrition product segment, we focus our In the reporting year, we continued the funding program
points were also achieved and the pharmacokinetic equiva- research and development on products that make a signifi- and awarded another research prize at the ESPEN interna-
lence of MSB11456 and the U.S. reference product1 was cant contribution to improving clinical treatment and the tional congress on nutrition in September 2021.
successfully demonstrated. This clinical study was also a nutritional condition of patients and on innovative contain- In 2021, we also continued development work on paren-
randomized, double-blind, parallel-group study to investi- ers such as our multi-chamber bags that are safer and more teral products. We are concentrating on formulations that
gate the pharmacokinetics, safety, immunogenicity, and convenient in everyday use. are tailored to the needs of individual patient groups. In ad-
tolerability of MSB11456 compared to its U.S. reference In the reporting year, we completed our EuroPN study dition to our global development projects, we are also
product1 following a single intravenous infusion in healthy and presented the first results to health care professionals working on parenteral nutrition products for specific mar-
volunteers. No significant differences in safety and immu- at international scientific congresses. The study examined kets such as the United States, China, and Europe.
nogenicity were found between the two treatment groups clinical nutritional practice in more than 1,000 critically ill One focus area is on the use of fish oil in parenteral nutri-
(MSB11456 and U.S. reference product1). patients in Europe. EuroPN is currently the largest longitu- tion. Parenteral nutrition containing fish oil has numerous
In 2020, we also launched a global phase III study to dinal study conducted that examines the effects of nutri- beneficial effects on important biological functions, includ-
compare the efficacy, safety, tolerability, and immunogen- tional targets on the success of treatment of critically ill pa- ing the modulation of the immune and inflammatory re-
icity of our biosimilar candidate of tocilizumab, tients who have been treated in an intensive care unit for sponse. The use of fish oil in parenteral nutrition products
MSB 11456, with the EU reference product in patients with more than five days. The results are due to be published in helps to improve clinical outcomes such as infection rates,
moderately to severely active rheumatoid arthritis. The in- 2022. sepsis rates, and the duration of stays in the ICU and in
clusion of patients from several European countries in this In addition to our own development, Fresenius Kabi hospital in general.
study was completed in 2021. also supports external development projects that contribute In the area of enteral nutrition, we are focusing our re-
Clinical nutrition provides care for patients who cannot to improving the nutritional care of critically ill patients and search and development activities on product concepts that
nourish themselves normally or sufficiently. This includes, surgery patients. In 2019, we initiated the funding program support therapeutic compliance and thus the success of
for example, patients in intensive care and those who are ‘‘Jumpstart’’. With this program, we support the research therapy.
seriously or chronically ill. Early and correct intervention work of young scientists and doctors in clinics in the area In particular, the flavor of enteral products is known to
can help prevent malnutrition and its consequences. of parenteral nutrition. An independent jury, consisting of be a critical parameter in ensuring the acceptance of the
Malnutrition is a common indication in hospitalized pa- internationally renowned scientists in the area of clinical products and compliance with the nutritional therapy. For
tients: studies carried out in hospitals in Europe show that nutrition, is responsible for selecting the fellows and years, we have been working continuously to develop prod-
one in four patients in the hospital suffers from malnutri- awarding the research prize. ucts with a wide variety of flavors to offer the users varia-
tion or is at risk of malnutrition. The clinical significance of tions and thus provide them with the best possible support
malnutrition results from a less favorable prognosis in to complete the necessary nutritional therapy. Another fo-
Annual Report 2021
terms of morbidity and mortality. Further consequences cus of our work is on the development of products with an
can be a longer stay in hospital and higher treatment costs. increased calorie and protein concentration. This way, we
Fresenius
1
U.S. reference product Actemra®.
54
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
make it easier for the user to take in the necessary amount In the future, we want to benefit from this trend and are al- developments for the automated washing and concentration
of nutrients in small volumes. In addition to global product ready focusing on the continuous development of our soft- of cell concentrates. These products are used in CAR T-cell¹
developments, we are continuing to work on product devel- ware solutions to increase the efficiency and clinical out- and similar cell therapies. In 2021, we started preparations
opments for specific market requirements. The main focus come for our customers. for the market launch of the CUE1 cell processing system.
here is on products for markets with high growth potential, In the reporting year, we continued to develop the Vigi- This device has been specifically developed for smaller fill-
such as for Taiwan and Korea in Asia-Pacific and Brazil in lant Software Suite, a software solution for our Agilia family ing quantities and end-use applications in the area of cell
Latin America. of infusion pumps in hospitals. As a comprehensive, server- therapy and will complement our LOVO1 cell processing
In the area of infusion solutions, we are continuously based therapy information system, it combines the central system, which is already available on the market. We will
working on new primary containers and containers that monitoring of our pumps (Vigilant Sentinel), the central ad- start the launch of CUE in 2022.
have already been introduced with the aim of increasing ef- ministration of the drug databases required for the patient In the area of extracorporeal photopheresis (ECP), we
ficiency and safety in everyday hospital life and facilitating (Vigilant Mastermed), comprehensive quality reporting continue to focus on the introduction of the Amicus Blue
their use. In the reporting year, we began introducing our (Vigilant Insight), and a standardized IT interface applica- system and the associated Phelix light box in Europe, as
optimized freeflex+ infusion bag with needle-free injection tion (Vigilant Bridge). In addition to further development, well as on the further development of an ECP application
port. The aim of this product is to help reduce the risk of we are also pushing ahead with the international market method, which only requires one vascular access. In this
potential injuries in daily hospital life. Furthermore, we are launch through further language versions, regulatory work, therapy method, certain blood cells outside the body are
continuously working on expanding our product range, and support for the installation of the devices in hospitals. treated with ultraviolet light (phototherapy). This method is
which we want to introduce globally. We are also develop- We also continued the development work on a new infu- used to treat various immunological diseases, including to
ing products that will allow us to further tap into the U.S. sion management system in the reporting year. This system kill malignant immune cells (lymphocytes) outside the
market by means of local production. features a modern operating system and will enable new body.
In the area of medical devices, we focus on developing therapy and treatment procedures in the intensive care unit Another focus area is the continuous further develop-
new products as well as on further developing our existing and operating room. ment of our devices and the corresponding data manage-
portfolio. This industry in particular is characterized by With regard to disposable medical products, the focus ment software. This includes the transfusion technology de-
technological innovations. Digitalization is a more crucial was on developing components that increase the safety and vices for plasma (Aurora Xi/optimized Nomogram Soft-
factor here than in any of our other product segments. De- simplicity of use of the products and enable therapy with ware), blood processing (Compoguard), and platelets
vices not only have to be continuously developed in terms new drugs. (AmiCORE/COM tec advanced).
of their application, but they also have to increasingly be In research and development in the area of transfusion
embedded in the IT system landscape of hospitals, blood technology, we are working intensively on products for use
donation centers, and plasma centers. in cell therapy. Our focus is on product
Annual Report 2021
Fresenius
1
For more information, see the glossary on page 397. 55
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
EMPLOYEES EMPLOYEES BY REGION
The knowledge, experience, and commitment of our employ-
ees are critical to our success. For this reason, Fresenius Asia-Pacific 9%
values a culture of diversity. The interplay of a wide range
Latin America
of views, opinions, cultural backgrounds, experiences, and and other regions 10%
Europe 57%
values enables us to successfully exploit our potential as a (thereof Germany 31%)
global company.
North America 24%
The number of employees increased by 2% to 316,078
employees at the end of 2021. Personnel expenses for the
2021: 316,078
Fresenius Group were €15,610 million in 2021 (2020:
€15,128 million), equivalent to 41.6% of sales (2020:
41.7%). NUMBER OF EMPLOYEES
Personnel expenses are above the previous year’s
% of total
level. Personnel expenses per employee, based on the aver- Change as of
Dec. 31, 2021 Dec. 31, 2020 Dec. 31, 2019 2021 / 2020 Dec. 31, 2021
age number of employees, were €49.8 thousand (2020:
Fresenius Medical Care 130,251 133,129 128,300 -2% 41%
€49.5 thousand) and €50.5 thousand in constant currency. Fresenius Kabi 41,397 40,519 39,627 2% 13%
In Germany, Fresenius companies have signed tariff agree- Fresenius Helios 123,484 116,952 106,377 6% 39%
ments with IG BCE, Marburger Bund, and ver.di (labor Fresenius Vamed 19,721 19,414 18,592 2% 6%
Corporate / Other 1,225 1,255 1,238 -2% 1%
union for services). There were no significant structural Total 316,078 311,269 294,134 2% 100%
changes to compensation or employment agreements in
2021.
PERSONNEL EXPENDITURE
€ in millions 2021 2020 2019
Fresenius Medical Care 6,962 7,068 6,800
Fresenius Kabi 1,907 1,809 1,754
Fresenius Helios 5,707 5,270 4,878
Fresenius Vamed 866 815 774
Annual Report 2021
Corporate / Others 168 166 149
Total 15,610 15,128 14,355
Fresenius
56
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
HUMAN RESOURCES MANAGEMENT Plan (LTIP 2018) is a good indication of the share of women at the Annual General Meeting in May. He is chairing the
We are constantly adapting our human resources tools to in management positions. According to this, the ratio of Audit Committee for a further year.
meet new requirements arising from demographics, the women among the more than 1,800 top executives in- The Annual General Meeting of Fresenius Management
transformation to a service economy, the shortage of skilled creased to 32.6% as at December 31, 2021 (Dec. 31, 2020: SE elected Susanne Zeidler (60), Chief Financial Officer of
workers, and employees’ desire to better balance family 31.6% of 1,700 top executives). Deutsche Beteiligungs AG (DBAG) since November 2012,
and career. For example, we offer flexible working hours. You can visit our multiple-award-winning careers portal and Dr. Frank Appel (59), Chief Executive Officer of
Further information can be found in our separate Group at www.career.fresenius.com. Further information on em- Deutsche Post DHL Group since February 2008, to the Su-
Non-financial Report on pages 154 ff. ployment management can be found in our separate Group pervisory Board of Fresenius Management SE.
Non-financial Report on pages 154 ff. Hauke Stars resigned from her office as a member of
EMPLOYEE RECRUITMENT AND PERSONNEL the Supervisory Board with effect to the end of January 31,
DEVELOPMENT CHANGE TO THE MANAGEMENT BOARD 2022, and therefore left the Supervisory Board of the Com-
In order to ensure that our long-term needs for highly qual- Michael Sen (52) became the new Chief Executive Officer pany before the regular end of her term of appointment.
ified employees are met, and to recruit new employees, we of Fresenius Kabi AG. The Supervisory Board of Fresenius Susanne Zeidler succeeds Hauke Stars and was appointed
make use of online personnel marketing, regularly partici- Management SE unanimously appointed him to the Man- as a member of the Supervisory Board by court order until
pate in recruiting events and careers fairs, and organize agement Board of Fresenius as of April 12, 2021. He suc- the end of the Annual General Meeting in 2022.
our own recruiting events. In addition, we try to encourage ceeded Mats Henriksson (53), who left the company due to The CVs of the members of the Supervisory Board and
long-term retention with attractive development programs. different views on Fresenius Kabi’s future direction. the Management Board can be found on our website at
The approaches and measures for employee recruit- https://www.fresenius.com/Corporate-Management.
ment and personnel development in the business segments CHANGES TO THE SUPERVISORY BOARD
are based on the market requirements of each segment. Dr. Gerd Krick (82) left the Supervisory Boards of Fresenius
They are coordinated, developed, and realized inde- Management SE and the listed Fresenius SE & Co. KGaA
pendently for each business segment. At Fresenius, qualifi- when his term ended at the close of the Annual General
cations and experience are the only things that matter in Meeting in May 2021.
the selection of personnel. Consequently, at Fresenius we Wolfgang Kirsch (65), a member of the Supervisory
have the aspiration that women and men with comparable Board of Fresenius Management SE since January 1, 2020,
qualifications will continue to have the same career oppor- took over from him as Chairman of both Supervisory
tunities. The proportion of female employees in the Frese- Boards.
nius Group increased slightly to 69% as at December 31, In recognition and deep appreciation of his long dec-
Annual Report 2021
2021 (Dec. 31, 2020: 68%). The proportion of females in ades of accomplishment and invaluable work on behalf of
services or care is traditionally higher than in the area of Fresenius, Dr. Krick was named Honorary Chairman of
production. This is reflected in the proportion of female both Supervisory Boards.
employees in our business segments: Our business seg- Klaus-Peter Müller (76) stepped down from the Supervi-
ment Fresenius Helios has with 74% the highest propor- sory Board of Fresenius Management SE at the end of his
Fresenius
tion of female employees among the Group. The number of term in May 2021. At the listed Fresenius SE & Co. KGaA,
female participants in the Group-wide Long Term Incentive Klaus-Peter Müller was reelected to the Supervisory Board
57
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
PROCUREMENT COST OF MATERIAL BY BUSINESS SEGMENT 1 SUSTAINABILITY
In 2021, the cost of raw materials and supplies and of pur- We orient our activities within the Fresenius Group to
Fresenius Vamed 10%
chased components and services was €8,820 million (2020: longterm goals, and thus ensure that our work is aligned
€8,804 million). An efficient value chain is important for Fresenius Helios 23%
to the needs of patients and employees, as well as share-
our profitability. In an environment characterized by ongo- Fresenius Medical Care 42% holders and business partners, in a sustainable manner.
ing cost-containment pressure from health insurers, as well Our responsibility as a health care Group goes beyond
as price pressure, security and quality of supply play an im- our business operations. It is our mission to constantly im-
Fresenius Kabi 26%
portant role. Within each business segment of the Frese- prove our performance in the areas of environmental pro-
nius Group, procurement processes are coordinated cen- 2021: €8,820 million tection, occupational health and technical safety, and prod-
trally, enabling us to bundle similar requirements, negoti- 1
uct responsibility and logistics, and to comply with legal re-
Before consolidation
ate global framework agreements, constantly monitor mar- quirements.
ket and price trends, and ensure the safety and quality of Further information on our sustainability management
materials. QUALITY MANAGEMENT can be found in our separate Group Non-financial Report
Further information on supply chain at Fresenius can be The quality of our products, services, and therapies is the on pages 114 ff. of our Annual Report.
found in our Opportunities and Risk Report on page 106 f. basis for optimal medical care.
and in our separate Group Non-financial Report on pages All processes are subject to the highest quality and
197 ff. of our Annual Report. safety standards, for the benefit of the patients and to pro-
tect our employees. Our quality management has the fol-
lowing three main objectives:
COST OF MATERIALS AND SUPPLIES AND PURCHASED
COMPONENTS ► to identify value-enhancing processes oriented toward
efficiency and the needs of our customers
► to monitor and manage these processes on the basis of
€ in millions 2021 2020
performance indicators
Cost of raw materials and supplies 7,629 7,342
Write-downs of raw materials, supplies, and ► to improve procedures
purchased components 0 0
Cost of purchased components and services 1,191 1,462
Further information on quality management at Fresenius
Total 8,820 8,804
can be found in our Opportunities and Risk Report on page
Annual Report 2021
105 f. as well as our separate Group Non-financial Report
on page 127 of our Annual Report.
Fresenius
58
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
ECONOMIC REPORT
HEALTH CARE INDUSTRY At the same time, the cost of health care is rising and Health care structures are being reviewed and cost-cutting
The health care sector is one of the world’s largest indus- claiming an ever-increasing share of national income. potential identified in order to contain the steadily rising
tries and we are convinced that it shows excellent growth Health care spending averaged 9.7% of GDP in the OECD health care expenditures. However, such measures cannot
opportunities. countries in 2020 (2019: 8.8%)1. compensate for the cost pressure. Market-based elements
The United States had the highest per capita spending are increasingly being introduced into the health care sys-
The main growth factors are: with US$10,9492 (2018: US$10,528). Germany ranked tem to create incentives for cost- and qualityconscious be-
fourth among the OECD countries with US$6,5182 (2018: havior. Overall treatment costs will be reduced through im-
► rising medical needs deriving from aging populations, US$6,291). In Germany, 85% of health spending was proved quality standards.
► the growing number of chronically ill and multimorbid funded by public sources in 2020, above the average of In addition, ever-greater importance is being placed on
patients, 76% in the OECD countries. Most of the OECD countries disease prevention and innovative reimbursement models
► stronger demand for innovative products and thera- have enjoyed large gains in life expectancy over the past linked to treatment quality standards.
pies, decades, thanks to improved living standards, public health
► advances in medical technology, interventions, and progress in medical care. In 2019, aver- Our most important markets developed as follows:
► the growing health consciousness, which increases the age life expectancy in the OECD countries was 81.0 years2
demand for health care services and facilities, and (2018: 80.7).
► the increasing demand for digital health services for
patients.
HEALTH CARE SPENDING AS % OF GDP
In the emerging countries, additional drivers are: in % 2020 2010 2000 1990 1980 1970
USA 16.8 16.3 12.5 11.2 8.2 6.2
► expanding availability and correspondingly greater de- France 12.4 11.2 9.6 8.0 6.8 5.2
mand for basic health care, and Germany 12.5 11.1 9.9 8.0 8.1 5.7
Switzerland 11.3 9.9 9.1 7.6 6.4 4.8
► increasing national incomes and hence higher spend- Spain 9.0 9.1 6.8 6.1 5.0 3.1
ing on health care. China 5.1 4.4 4.5 --- --- ---
Annual Report 2021
Source: The latest available data from OECD Health Data refers to 2020, as no more recent data
has been published; database for USA, Switzerland, and Spain 2019
and China 2018.
Fresenius
1
OECD Health Data
2
The latest available data from OECD Health Data refers to 2019, as no more recent data has been published. 59
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
THE DIALYSIS MARKET Dialysis Services Dialysis products
In 2021, the global dialysis market (products and services) In 2021, the global dialysis care market (including renal In 2021, the global dialysis products market was worth
was worth approximately €79 billion. pharmaceuticals) was worth around €64 billion. around €15 billion.
Worldwide, approximately 4.7 million patients with About 9% of worldwide dialysis patients were treated Fresenius Medical Care is the leading provider of dialy-
chronic renal failure were treated in 2021. Of these pa- by Fresenius Medical Care. With 4,171 dialysis clinics and sis products in the world, with a market share of 36%.
tients, around 3.8 million received dialysis treatments and more than 345,000 dialysis patients in around 50 countries, Fresenius Medical Care is the leading supplier world-
about 890,000 were living with a transplanted kidney. Fresenius Medical Care operates by far the largest and wide of hemodialysis products, with a market share of
About 89% were treated with hemodialysis, 11% with per- most international network of clinics for the treatment of 42%, and has a market share of approximately 16% in the
itoneal dialysis. dialysis patients. In the United States, Fresenius Medical worldwide market of products for peritoneal dialysis.
The major growth driver is the growing number of pa- Care treated approximately 37% of dialysis patients in Severe COVID-19 cases often cause acute kidney fail-
tients suffering from diabetes and high blood pressure, two 2021. The market for dialysis care in the United States is al- ure, which has significantly increased worldwide demand
diseases that often precede the onset of chronic kidney fail- ready highly consolidated. for dialysis solutions needed to conduct acute dialysis.
ure. The number of dialysis patients worldwide increased Outside the United States, the market for dialysis care is
by around 2% in 2021. much more fragmented. Here, Fresenius Medical Care Renal care continuum, critical care solutions, and
Due to the COVID-19 pandemic, Fresenius Medical competes mainly with clinic chains, independent clinics, complementary assets
Care already reported increased mortality among patients and with clinics that are affiliated with hospitals. With our strategy 2025, we intend to achieve the next
in 2020. As a result of the global spread of the delta variant, Dialysis reimbursement systems differ from country to level and provide health care for chronically and critically
COVID-19-related excess mortality increased again in the country and often vary even within individual countries. ill patients across the entire renal care continuum. We
second half of 2021. This results in a total excess mortality The public health care programs, the Centers for Medicare aim to use our innovative, high-quality products and ser-
of approximately 30,000 patients since the start of the pan- & Medicaid Services (CMS), cover the medical services for vices to offer sustainable solutions at a reliable cost. To
demic. the majority of all dialysis patients in the United States. achieve this, we will concentrate on three key areas: the
The prevalence rate, which is the number of people To be able to continue care for patients during the renal care continuum, critical care solutions, and comple-
with terminal kidney failure treated per million population, COVID-19 pandemic, Fresenius Medical Care implemented mentary assets.
differs widely from region to region. The significant diver- a number of measures, both operational and financial, to Fresenius Medical Care aims to implement new renal
gence in prevalence rates is due, on the one hand, to differ- maintain an adequate workforce, protect patients and em- care models by applying state-of-the-art digital tools to give
ences in age demographics, incidence of renal risk factors, ployees through expanded personal protective equipment our business a major boost in terms of personalized dialysis
genetic predisposition, and cultural habit, such as nutrition. protocols, and cover expenses related to surge capacity for and therapeutic innovations. Fresenius Medical Care also
On the other hand, access to dialysis treatment is still lim- dialysis patients suspected of having or confirmed to have intends to treat more patients in their homes by offering
Annual Report 2021
ited in many countries. A great many individuals with ter- COVID-19. holistic home care.
minal kidney failure do not receive treatment and are there-
fore not included in the prevalence statistics.
Fresenius
Market data on the dialysis market based on company's own surveys 60
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
In addition, Fresenius Medical Care’s value-based care A reasonable estimate of the market volume of the renal The market for biopharmaceuticals from the therapeutic
models create medical value while ensuring that care re- care continuum, critical care solutions, and complementary areas of oncology and autoimmune diseases addressed by
mains affordable and will incorporate kidney transplants in assets is not possible due to the large number of different Fresenius Kabi grew by approximately 6% to around €51
future. To achieve this, Fresenius Medical Care builds sus- services. The spectrum of our value-based care services billion in 2021. Today, more than one in three new drug ap-
tainable partnerships with payors worldwide to support the may vary across countries and regions, depending on the provals is a biopharmaceutical and significant growth of
transition from a fee-for-service to a pay-for-performance particular reimbursement system or market specifics. this global market, including biosimilars, is expected in the
system. In addition, Fresenius Medical Care Ventures next few years and decades.
GmbH therefore makes strategic investments in start-ups to THE MARKET FOR GENERIC IV DRUGS, In 2021, the global market for clinical nutrition was
gain access to new technologies in our core and comple- BIOPHARMACEUTICALS, CLINICAL NUTRITION, worth about €10 billion. In Europe, this market grew by
mentary businesses, as well as new therapy approaches. INFUSION THERAPY, AND MEDICAL DEVICES / about 3%. Growth rates in emerging market regions were
The number of patients requiring continuous renal re- TRANSFUSION TECHNOLOGY1 higher. In Latin America, the market for clinical nutrition
placement therapy to treat acute renal failure is set to rise The global market for generic IV drugs, biopharmaceuti- grew by around 10%. Similarly strong growth of around
to more than 1.6 million p.a. by 2030. Over the next few cals, nutrition and infusion therapies, and medical de- 9% was realized in the Africa region. The market for clini-
years, we will leverage our competence in the business of vices/transfusion technology was worth about €114 billion cal nutrition in Asia-Pacific increased by about 5%.
critical care solutions to address a variety of health chal- in 2021. There is growth potential in clinical nutrition worldwide,
lenges. We can also use our expertise in the area of extra- Of this amount, around €42 billion2 was attributable to because nutrition therapies are often not yet sufficiently
corporeal blood treatment for acute renal failure to treat the global market for generic IV drugs. Fresenius Kabi was used in patient care, although studies have proven their
acute heart and lung failure. We are also planning innova- able to enter additional segments of the global addressable medical and economic benefits. In cases of health- or age-
tive solutions for multi-organ support to benefit from the market due to targeted investments and the expansion of induced nutritional deficiencies, for example, the admin-
growing critical care market. our product portfolio in the areas of complex formulations, istration of clinical nutrition can reduce hospital costs
Creating additional medical value while cutting costs re- liposomal solutions, and prefilled syringes, among others. through shorter stays.
quires complementary assets and solutions. We have The global market for generic IV drugs generated low In the market for clinical nutrition, Fresenius Kabi is
reached some important milestones and gained many in- double-digit growth as it recovered from the 2020 market one of the leading suppliers worldwide. Fresenius Kabi is
sights into how to coordinate patients more efficiently. We downturn as a result of the COVID-19 outbreak. the global market leader in the parenteral nutrition product
will continue to leverage our core competencies through Competitors of Fresenius Kabi in the market for generic segment and intends to expand this position through prod-
partnerships, investments, and acquisitions. IV drugs include Pfizer, Sanofi, Sandoz, Viatris, and Hikma. ucts, offers, and services with high differentiation potential.
In the enteral nutrition product segment, the company is a
leader in Europe, Latin America, and China.
Annual Report 2021
Fresenius
1
Market data is based on company research and refers to the markets relevant for Fresenius Kabi. This is subject to annual volatility due to currency fluctuations and patent expiries of original drugs
in the IV drug market, among other things.
2
As in the previous year, the market definition also includes sales of off-patent products. 61
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
The company intends to focus its enteral nutrition offerings product range will be developed regionally and thus be THE HOSPITAL MARKET1
more strongly than before on the regions where its product available in more countries. In the medical devices seg- The market volume for acute care hospitals in Germany in
and service offerings have not yet or hardly been repre- ment, Fresenius Kabi ranks among the leading suppliers 2019 was around €111 billion2, as defined by total costs
sented and launch them there. With the existing range and worldwide. (gross). Personnel costs accounted for around 61% of this
newly developed products as well as the entry into new dis- Competitors in the market for medical devices include total and material costs for 37%, each of which increased
tribution channels, Fresenius Kabi will serve the patient Baxter, B. Braun, Becton Dickinson, and ICU Medical. by around 6%.
needs of the future. The market for transfusion technology grew by around With a share of sales of around 6%3, Helios Germany is
In parenteral nutrition, competitors include Baxter, 6% to 7% to around €3.5 billion compared with a weak the leading company in the German market for acute care
B. Braun, JW Pharma, and Kelun Pharmaceuticals. In the previous year. Although blood and plasma donations recov- hospitals. The company’s hospitals compete primarily with
market for enteral nutrition, Fresenius Kabi competes with, ered slightly compared to the previous year and demand individual hospitals or local and regional hospital associa-
among other companies, Abbott, Nestlé, and Danone. for blood bags and plasma disposable products is on the tions. The main private competitors are Asklepios Kliniken,
The market for infusion therapies was worth about €5 rise again, they have not yet returned to the levels seen be- Sana Kliniken, and Rhön-Klinikum.
billion in 2021, growing by 5%. In 2021, there was an in- fore the COVID-19 pandemic, even in 2021. The need for The COVID-19 pandemic had a significant impact on
creased demand for standard solutions in Asia-Pacific. In autotransfusion treatments has decreased further com- the number of inpatient treatments in German hospitals in
Europe, the infusion therapies market grew slightly, while pared to the previous year due to operations still being 2020. A total of 16.4 million admissions were treated,
business in the United States remained stable. Fresenius postponed. The pandemic continued to have a slightly posi- around 13% fewer patients than in the previous year.
Kabi is the market leader in infusion therapies in Europe tive impact on the demand for convalescent plasma. A po- The economic situation of German hospitals overall im-
and Latin America. tential therapy option for some COVID-19 patients is based proved in 2020 compared with the previous year. While the
Competitors in the market for infusion therapies include on the use of plasma (blood component) in patients who pandemic led to significantly fewer admissions, the hospi-
B. Braun and Baxter. have recovered. This process is made possible by devices tals received some financial support to partially compen-
The market for medical devices in 2021 was slightly from our portfolio such as Alyx. In transfusion technology, sate for the negative effects of COVID-19. Expectations for
above the previous year’s level, at around €4 billion. In the Fresenius Kabi is one of the world’s leading companies. 2021, however, are significantly more negative: around
medical devices market, the growth drivers are primarily Competitors in the market for transfusion technology 60% of hospitals expect to record losses in 2021. 23%
IT-based solutions that focus on application safety and in- include Terumo, Haemonetics, and Macopharma. project to break even and just 17% expect to be able to
creased therapy efficiency. In the future, Fresenius Kabi generate a profit for the year. The main reason for the
will focus on the continuous further development of its worsening economic situation is the COVID-19-related rev-
product range and, in doing so, take into account the in- enue loss among hospitals.
creasing proportion of software in the field of medical de-
Annual Report 2021
vices and its areas of application. In addition, the MedTech
Fresenius
1
In each case, the most recent market data available refers to the year 2019 as no more recent data has been published: German Federal Statistical Office, 2019 data; German Hospital Institute (DKI),
Krankenhaus Barometer 2021
2
The market is defined by total costs of the German acute care hospitals (gross), less academic research and teaching.
3
Measured by 2021 sales in relation to gross total costs of acute care hospitals minus scientific research and teaching in Germany (latest available data: Federal Statistical Office, 2019 data)
62
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
In addition to the often difficult economic and financial sit- For the first phase of the COVID-19 pandemic until the end
HOSPITAL BEDS BY OPERATOR
uation, there is an enormous need for capital expenditure of September 2020, what was referred to as the German
due to medical and technological advances, higher quality law to ease the financial burden on hospitals (‘‘Kranken- Private hospitals 19%
requirements, and necessary building renovations, as well haus Rettungsschirm‘‘) was passed as an instrument of eco-
as investments in digitalization and increasing sustainabil- nomic support for hospitals. Among other things, the law Public hospitals 48%
ity efforts1. Moreover, the federal states have in the past provided for a compensation lump sum for each bed kept Independent non-profit
hospitals 33%
failed to meet their statutory obligation to provide sufficient free per day of occupancy. In various follow-up regulations,
financial resources. The German Hospital Institute (DKI) es- the conditions for the financial assistance were adjusted
2019: 494,326
timates that the annual investment requirement at German until they expired mid of June 2021. In addition, a full-year
hospitals is over €6 billion. This is more than two times the offset was implemented to compensate for COVID-19-related
investment funding currently being provided by the federal revenue shortfalls (Corona compensation). The reference Digitalization in hospitals in Germany is to be driven for-
states. figure is the hospital-specific revenue from 2019. Due to ward with the Hospital Future Act (‘‘Krankenhauszukun-
What is known as the change in value figure is crucial the sharp rise in COVID-19 infection levels and hospital ad- ftsgesetz’’). For example, nationwide standards will be in-
for the increase in reimbursement for hospital treatments. missions in the fall of 2021, those hospitals that kept beds troduced to better interlink the health care system and to
It is used to compensate for rising costs in the hospital free for the treatment of COVID-19 patients or that were further improve patient care. Funding is being provided for
market, particularly with regard to personnel and material heavily burdened due to the interregional transfers of ICU investments in modern emergency room capacities and
costs. The change in value figure is redetermined each year patients within what was referred to as the ‘‘Kleeblatt- digital infrastructure, e.g., patient portals, electronic docu-
for the following year. For 2021, it was 2.53% (2020: system’’ again received compensation payments starting in mentation of nursing and treatment services, digital medi-
3.66%). November. cation management, IT security measures, and cross-sector
telemedical network structures.
KEY FIGURES FOR INPATIENT CARE IN GERMANY In 2021, the electronic patient file (ePA) was introduced
Change on a mandatory basis. This also creates an obligation for
2019 2018 2017 2010 2000 2019 / 2018
hospitals to become connected to the telematics infrastruc-
Hospitals 1,914 1,925 1,942 2,064 2,242 0%
ture (TI), which is intended to standardize and simplify the
Beds 494,326 498,192 497,182 502,749 559,651 -1%
Length of stay (days) 7.2 7.2 7.3 7.9 9.7 0% exchange of data between players in the health care sys-
Number of admissions (millions) 19.41 19.39 19.44 18.03 17.26 0% tem. Hospitals must store patient-related data digitally or
Average costs per admission in €1 5,926 5,615 5,439 4,432 3,216 6% make it available via the ePA.
Annual Report 2021
1
Total costs, gross
Source: German Federal Statistical Office, 2019 data
Fresenius
1
Roland Berger, Krankenhausstudie 2021
63
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
In 2021, the minimum level for nursing staff in the care- The private hospital market in Spain had a volume of The COVID-19 crisis has also accelerated the use of tele-
intensive units introduced in 2019 was expanded to include around €16 billion1 in 2020. medicine in Spain, leading to an increase in video consul-
internal medicine, general surgery, pediatrics, and pediat- Helios Spain is the market leader with a market share of tations. This trend will continue as, among other things,
ric intensive care. Previously, the minimum level for nurs- around 12% in the private hospital market in terms of medical care can be improved and greater efficiency cre-
ing staff already applied in the areas of geriatrics, intensive sales. Helios Spain competes with a large number of stand ated in the health care system in this way.
care, cardiology, trauma surgery, cardiac surgery, neurol- alone private hospitals as well as with smaller hospital The global market for fertility services was worth
ogy, early neurological rehabilitation, and neurology / chains such as HM Hospitales, Hospiten, Vithas, Ribera about €9 billion in 2020. Market growth is driven by demo-
stroke unit wards. Salud, Hospitales Sanitas, and HLA, among other chains. graphic and health trends as well as changing lifestyles.
Due to the regulations of the Act to Strengthen Nurs- After high infection rates and health care overload, es- Notable scientific advances in this field have led to higher
ing Staff (‘‘Pflegepersonalstärkungsgesetz’’), since 2020, pecially in the first half of 2020, the epidemiological situa- success rates and less strain for patients. The global market
nursing costs have been deducted from the standardized tion in Spain improved and almost approached pre-pan- for fertility services is highly fragmented, representing an
base rates and the costs for direct nursing patient care are demic normality in 2021. In particular, high vaccination attractive opportunity for consolidation.
instead fully reimbursed by the health insurance companies readiness and a well-organized vaccination structure with
via separate care budgets at costs. In December 2020, the large vaccination centers allowed the country to achieve a
German Hospital Federation (DKG) and the German Associ- vaccination rate close to 80%, one of the highest in Eu-
ation of Statutory Health Insurance Funds (GKV-SV) con- rope2. As a result, hospitals recorded significantly fewer se-
cluded a new agreement on the separation of nursing staff vere COVID-19 cases and the number of COVID-19 inten-
costs for 2021 (‘‘Pflegepersonalabgrenzungsverein- sive care patients decreased significantly. Hospital opera-
barung’’). Following various amendment agreements, a tions continued to return to normal with increased safety
narrower definition (interpretation) of nursing staff costs measures. Even the rising incidences at the end of the year
went into effect for the full year 2021. In July 2021, the leg- did not lead to constraints in patient care, and very few
islator created the foundation for nursing budgets for 2020 elective treatments were canceled.
to also be negotiated according to the new regulations Reimbursement for COVID-19 patients in 2021 re-
(‘‘Gesundheitsversorgungsweiterentwicklungsgesetz --- mained largely unchanged from 2020. The treatment is
GVWG’’). Only those hospitals that had concluded a written generally negotiated bilaterally according to existing con-
agreement on the care budget before the GVWG came into tracts, tariffs, and regulations between the private hospital
force are exempt from the new regulations. operators and the private health insurers or the relevant
government authorities.
Annual Report 2021
Fresenius
1
Market data based on company research and refers to the addressable market of Quirónsalud. Market definition includes both inpatient and outpatient health care services. It includes neither
public-private partnership (PPP) nor occupational risk prevention centers (ORP). The market definition may differ from the definition in other contexts (e.g., regulatory definitions).
64
2
The Lancet, News, Volume 9, Issue 12, E120, December 2021
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
THE MARKET FOR PROJECTS AND SERVICES economic and political conditions. In markets with estab- OVERALL BUSINESS DEVELOPMENT
FOR HOSPITALS AND lished health care systems and mounting cost pressure, the
OTHER HEALTH CARE FACILITIES challenge for health care facilities is to increase their effi- THE MANAGEMENT BOARD’S ASSESSMENT OF THE
The global market for projects and services for hospitals ciency. Here, demand is especially high for sustainable EFFECT OF GENERAL ECONOMIC DEVELOPMENTS
and other health care facilities was heavily impacted by the planning and energy-efficient construction, optimized hos- AND THOSE IN THE HEALTH CARE SECTOR FOR
COVID-19 pandemic throughout 2021. pital processes, and the outsourcing of medical-technical FRESENIUS AS WELL AS BUSINESS RESULTS AND
The general conditions for hospital planning and con- support services to external specialists. This enables hospi- SIGNIFICANT FACTORS AFFECTING OPERATING
struction projects were again challenging and character- tals to concentrate on their core competency − treating pa- PERFORMANCE
ized by supply bottlenecks, extraordinary cost increases, tients. We have demonstrated our special responsibility as part of
and travel and quarantine restrictions. Due to long-stand- In addition to offering services for health care facilities the health care system, even under the difficult circum-
ing project partnerships and a high level of competence worldwide, Fresenius Vamed itself is active as a leading stances of the current COVID-19 pandemic. With our prod-
and experience, Fresenius Vamed was able to meet these post-acute care provider in Central Europe, especially in ucts, services, and therapies, we have made many im-
challenges. Germany, Austria, Switzerland, and the Czech Republic. In portant contributions to high-quality and affordable medi-
The service business also faces challenges regarding emerging markets, the focus is on building and developing cal care worldwide. In this way, we stand by the side of our
the safety of employees and patients in the context of the health care infrastructure and improving the level of health patients --- and live up to our social responsibility. For ex-
COVID-19 pandemic. Capacity restrictions and lower de- care. ample, our dialysis clinics and hospitals took extensive
mand for rehabilitation services due to postponed elective Fresenius Vamed is a global company with no direct measures to ensure that patients received the best possible
surgeries played a smaller role in 2021 than last year. De- competitors covering a comparably comprehensive portfo- care throughout. Despite partial government compensation,
mand for reliable management of medical technology and lio of projects, services, and total operational management the COVID-19 pandemic had an overall negative effect on
high-end health care services remains robust. over the entire life cycle of health care facilities. As a result, the 2021 fiscal year figures, in many of the Group’s key
The market for projects and services for hospitals and Fresenius Vamed has a unique selling proposition of its markets.
other health care facilities is very fragmented. Therefore, own. Depending on the business segment, the company The global economy had only an insignificant overall
an overall market size cannot be determined. The market is competes with international companies and consortia, as impact on our industry in 2021. Over the course of the
country-specific and depends, to a large extent, on factors well as with local providers. year, we experienced increased cost inflation effects, in-
such as public health care policies, government regulation, cluding rising raw material and transport prices, higher en-
and levels of privatization, as well as demographics and ergy costs, bottlenecks in the supply chains, and higher
price levels for medical products to protect our employees
and patients (e.g., protective clothing, medical masks).
Annual Report 2021
Fresenius
65
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
The Management Board is of the opinion that Fresenius COMPARISON OF THE ACTUAL BUSINESS RESULTS Sales in 2021 grew by 5% in constant currency, thus in line
has proven to be stable and resilient in the face of the enor- WITH THE FORECASTS with expectations. Excluding estimated COVID-19 effects3,
mous challenges in 2021 and our significant contributions Our assumption that demand for our products, services, the Fresenius Group would have achieved currency-adjusted
to the fight against and containment of the COVID-19 pan- and therapies would remain strong in 2021 was confirmed. sales growth of 5% to 6% in 2021.
demic. However, the COVID-19 pandemic had impacts on individ- Currency-adjusted net income2 before special items in-
This has particularly benefited our patients, whom we ual product categories and services. creased by 5% in 2021, thus above our expectations. Ex-
have been able to continue to care for reliably despite the The overview on page 68 shows how the outlook for the cluding estimated COVID-19 effects3, the Fresenius Group
challenges posed by the pandemic. We achieved the Group and the business segments has developed in 2021. would have achieved a currency-adjusted net income2
Group’s improved sales and earnings targets for the year Following a strong Q2/2021 and given the progress of growth before special items of 6% to 10%.
2021. Hence, the Management Board is of the opinion that the Group-wide cost and efficiency program, through Fresenius invested €2,032 million in property, plant
2021 was a successful year for the Fresenius Group from a which initial savings were already achieved in 2021, Frese- and equipment (2020: €2,398 million). At 5.4%, the in-
financial perspective. nius raised its earnings outlook for 2021 in July 2021. vestments in property, plant and equipment are below the
Fresenius Medical Care’s sales decreased by 1% (in- Negative COVID-19 effects then intensified in Q3/2021 prior-year level of 6.6% and below the target of around
creased by 2% in constant currency) to €17,619 million compared to the previous quarter due to the significant in- 6% as a percentage of sales. Overall, the Fresenius Group
(2020: €17,859 million). Net income1 attributable to share- crease in excess mortality among Fresenius Medical Care was able to continue its investment programs, despite the
holders of Fresenius Medical Care decreased by 25% patients. Nevertheless, in November 2021, following good pandemic, to a large extent.
(23% in constant currency) to €1,018 million (2020: financial performance in Q3/2021 and given the progress Operating cash flow was €5,078 million and thus sig-
€1,359 million). made in the Group-wide cost and efficiency program, the nificantly below the previous year’s figure due to substan-
Fresenius Kabi achieved organic sales growth of 4%. outlook for Group sales was raised and the outlook for tial advance payments for Medicare patients under the
EBIT1 increased by 5% (7% in constant currency) to Group net income1,2 improved. CARES Act and tax deferrals in North America in 2020
€1,153 million (2020: €1,205 million). We achieved our raised or improved guidance for (2020: €6,549 million). The cash flow margin was 13.5%
The organic sales growth of Fresenius Helios was 7%. Group sales and net income1,2 including expected COVID- (2020: 18.1%) and therefore above expectations. We had
EBIT1 increased by 10% (10% in constant currency) to 19 effects. expected to achieve a cash flow margin between 10% and
€1,127 million (2020: €1,025 million). 12%.
The organic sales development of Fresenius Vamed was
11%. EBIT1 increased to €101 million (2020: €29 million).
Annual Report 2021
Fresenius
1
Before special items
2
Net income attributable to the shareholders of Fresenius SE & Co. KGaA
3
An overview on the effect of COVID-19 is provided on page 67.
For a detailed overview of special items please see the reconciliation tables on pages 74 --- 76. 66
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Group net debt / EBITDA was 3.511 (December 31, 2020: Estimated COVID-19 effects
3.444), hence in line with our expectations. We had ex- The Fresenius Group was affected by the impact of the
pected the leverage ratio at the end of 2021 to be around COVID-19 pandemic. In an environment with direct, but
the upper end of the self-imposed target corridor of 3.0× to also many indirect effects of COVID-19, it is not possible to
3.5×. Due to negative COVID-19 effects on EBITDA, in par- provide precise information on the financial impact on the
ticular the increased excess mortality of dialysis patients consolidated income statement. This applies in particular to
and the associated lower earnings contributions from the impact of lost revenues and the associated reductions in
Fresenius Medical Care the leverage ratio increased in profitability. Therefore, the table below shows manage-
comparison to prior year. ment’s best estimates.
Group ROIC was 5.9%2 (2020: 6.5%2), and Group
ROOA was 6.5%2 (2020: 7.3%2), thus both ratios were
broadly in line with expectations. We had anticipated that ESTIMATED COVID-19 EFFECTS
ROIC would be 40 to 70 basis points and ROOA 50 to 100
basis points below the 2020 level. The change is mainly Reported growth rate Estimated growth rate
driven by by lower EBIT and NOPAT as well higher opating in constant currency Estimated in constant currency
including COVID-19 COVID-19 impact excluding COVID-19
assets and slightly higher invested capital. effects in constant currency effects
€ in millions 2021 2020 2021 2020 2021 2020
Sales 5% 5% 0% to -1% -2% to -3% 5% to 6% 7% to 8%
Net income (before special items)1 5% -3% -1% to -5% -5% to -9% 6% to 10% 2% to 6%
1
Net income attributable to the shareholders of Fresenius SE & Co. KGaA
Annual Report 2021
Fresenius
1
Both net debt and EBITDA calculated at average exchange rates; before special items, pro forma closed acquisitions/divestitures
2
Before special items
For a detailed overview of special items please see the reconciliation tables on pages 74 --- 76.
67
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
ACHIEVED GROUP TARGETS 2021
Guidance Guidance
Guidance 2021, adjustment / adjustment /
published update, update, Achieved in
February 2021 published July 2021 published November 2021 2021
Group1
Sales Low-to-mid single-digit Mid single-digit
(growth, in constant currency) percentage growth percentage growth 5%
Around top-end of
Net income2 At least Low single-digit low single-digit
(growth, in constant currency) broadly stable percentage growth perentage growth 5%
Fresenius Medical Care3
Sales Low-to-mid single-digit Confirmed; expected to be at the
(growth, in constant currency) percentage growth lower end of the guidance range 2%
Net income4 High-teens to mid-twenties Confirmed; expected to be at the
(growth, in constant currency) percentage decline lower end of the guidance range -23%
Fresenius Kabi1
Sales Low-to-mid single-digit
(growth, organic) percentage growth 4%
Around top end of
EBIT Stable-to-low single-digit Low single-digit low single-digit
(growth, in constant currency) percentage growth percentage growth percentage guidance range 7%
Fresenius Helios1
Sales Low-to-mid single-digit Mid single-digit
(growth, organic) percentage growth percentage growth 7%
EBIT Mid-to-high single-digit High single-digit
(growth, in constant currency) percentage growth percentage growth 10%
Fresenius Vamed1
Sales Mid-to-high single-digit
(growth, organic) percentage growth 11%
High double-digit
EBIT € million amount €101 million
Annual Report 2021
Fresenius
1
Before special items
2
Net income attributable to the shareholders of Fresenius SE & Co. KGaA
3
Targets are based on 2020 results excluding goodwill and brand name impairment in the Latin America segment of €195 million. The targets include the expected impact of COVID-19, are in constant
currency and exclude special items. Special items include costs related to FME25 as well as other effects that are unusual in nature and were not foreseeable at the time the outlook was prepared, or
whose magnitude or impact was not foreseeable.
4
Net income attributable to the shareholders of Fresenius Medical Care AG & Co. KGaA
For a detailed overview of special items please see the reconciliation tables on pages 74 --- 76. 68
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
RESULTS OF OPERATIONS, FINANCIAL SALES BY REGION
POSITION, ASSETS AND LIABILITIES Currency
translation Constant cur- Organic % of total
€ in millions 2021 2020 Growth effects rency growth sales growth Acquisitions Divestitures sales
RESULTS OF OPERATIONS North America 14,363 14,801 -3% -3% 0% -1% 1% 0% 38%
Sales Europe 16,888 15,813 7% 0% 7% 5% 2% 0% 45%
Asia-Pacific 3,938 3,705 6% 0% 6% 6% 0% 0% 11%
Group sales increased by 3% (5% in constant currency) to
Latin America 1,830 1,566 17% -11% 28% 24% 4% 0% 5%
€37,520 million (2020: €36,277 million). The impact of the Africa 501 392 28% 3% 25% 25% 0% 0% 1%
COVID-19 pandemic had a negative effect1 of an estimated Total 37,520 36,277 3% -2% 5% 4% 1% 0% 100%
0 to -1 percentage points on currency-adjusted sales
growth. Currency translation effects had a negative impact
SALES BY BUSINESS SEGMENT2
of 2%. These resulted in particular from the appreciation
Currency
of the U.S. dollar and various Latin American currencies, translation Constant cur- Organic % of total
mainly the Brazilian real and the Argentine peso, against € in millions 2021 2020 Growth effects rency growth growth Acquisitions Divestitures sales
Fresenius
the euro. Medical Care 17,619 17,859 -1% -3% 2% 1% 1% 0% 47%
In detail, the sales performance of the business seg- Fresenius Kabi 7,193 6,976 3% -1% 4% 4% 0% 0% 19%
ments2 was as follows: Fresenius Helios 10,891 9,818 11% 0% 11% 7% 4% 0% 29%
Fresenius Vamed 2,297 2,068 11% 0% 11% 11% 0% 0% 5%
Total 37,520 36,277 3% -2% 5% 4% 1% 0% 100%
► Sales of Fresenius Medical Care decreased by 1% (in-
creased by 2% in constant currency) to €17,619 mil-
lion (2020: €17,859 million). Organic sales growth was ORDER INTAKE AND ORDER BACKLOG FRESENIUS VAMED
1%. Currency translation effects lowered sales by 3%.
The sales decline was mainly driven by negative ex- € in millions 2021 2020 2019 2018 2017
change rate effects, partially offset by organic growth, Order intake 1,290 1,010 1,314 1,227 1,096
which was achieved despite COVID-19 and a lower re- Order backlog (December 31) 3,473 3,055 2,865 2,420 2,147
imbursement for calcimimetics, as well as higher con-
tributions from acquisitions. Higher sales of machines
for chronic treatment, home hemodialysis products
and renal pharmaceuticals were offset by a negative
Annual Report 2021
exchange rate effect and lower sales of products for
acute care treatments.
Fresenius
1
An overview of the effect of COVID-19 is provided on page 67.
2
The following description of sales relates to the respective external sales of the business segments. Consolidation effects and corporate entities are not taken into account.
Therefore, aggregation to total Group sales is not possible. 69
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
► Fresenius Kabi increased sales by 3% (by 4%1) to ► Fresenius Helios increased sales by 11% (11%1) to ► Fresenius Vamed increased sales by 11% (11%1) to
€7,193 million (2020: €6,976 million). Organic sales €10,891 million (2020: €9,818 million). Organic sales €2,297 million (2020: €2,068 million). Sales in the pro-
growth was 4%. Negative currency translation effects growth was 7%. Acquisitions contributed a total of 4% ject business increased by 13% to €717 million (2020:
(1%) were mainly related to the devaluation of the U.S. to sales growth. The Eugin Group contributed €133 €633 million). In the project business, there were de-
dollar, the Argentine peso, and the Brazilian real million to sales in 2021, with first-time consolidation as lays due to travel restrictions, restricted supply chains,
against the euro. We recorded continued demand for of April 1, 2021. Fresenius Helios’ sales in 2021 contin- and interrupted project execution, which also impacted
essential medicines and medical devices for the treat- ued to be negatively impacted by a lower number of sales. Sales in the service business grew by 10% to
ment of COVID-19 patients particularly in the United elective treatments due to COVID-19. €1,580 million (2020: €1,435 million).
States and Europe, partially offset by fewer elective Helios Germany’s sales increased by 6% to €6,733 Fresenius Vamed’s services business showed a
treatments. In North America, supply constraints for million (2020: €6,340 million). The acquisitions of the positive development in high-end services and a recov-
individual products due to temporary production de- Malteser Hospitals and the DRK (German Red Cross) ery of case numbers in the rehabilitation business in
lays as well as increased competitive pressure put an Kliniken Nordhessen contributed 4% to sales growth. 2021. The technical services business was robust. Or-
additional strain on sales. In Asia-Pacific, we recorded Organic sales growth of 2% was positively influenced der intake in the project business increased by 28% to
strong growth, mainly due to the continuing normali- by regular price increases for flat rates per case (DRG) €1,290 million (2020: €1,010 million). Fresenius Va-
zation of the number of elective treatments in China in Germany and a positive case mix. Overall, Helios med increased its order backlog by 14% to €3,473
and a sustained recovery in other Asian markets. In the Germany recorded a decline in case numbers of 2% on million (December 31, 2020: €3,055 million).
course of the year, growth in China slowed down due an annual basis. The follow-up regulation to the Act on Fresenius Vamed is the only business segment
to initial negative price effects from successful partici- Economic Relief for Hospitals, which was in force until within the Fresenius Group whose business is also sig-
pation in VBP (volume-based procurement) tenders. the end of May 2021, was able to mitigate part of the nificantly influenced by order intake and order backlog.
negative effects.
Helios Spain increased sales by 16% (17%1) to
€4,021 million (2020: €3,475 million). Organic sales
growth was 15%. The increase was driven by sus-
tained high demand for treatment as well as for occu-
pational health care services. Hospitals in Latin Amer-
ica performed well. They contributed 4% to sales
growth in constant currency.
Annual Report 2021
Fresenius
1
In constant currency 70
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
EARNINGS STRUCTURE GROUP RETURN RATIOS
In 2021, Group net income1 before special items in- in % 2021 2020 2019 2018 2017
creased by 4% (5% in constant currency) to €1,867 million EBITDA margin1 18.3 19.7 20.1 18.1 18.5
(2020: €1,796 million). COVID-19 had an estimated effect of EBIT margin1 11.3 12.7 13.2 13.6 14.3
-1 to -5 percentage points on Group net income growth. In Return on sales (before taxes and noncontrolling interests)1 10.0 10.9 11.2 11.9 12.3
2021, earnings per share1 before special items increased
by 4% (5% in constant currency) to €3.35 (2020: €3.22). 1
Before special items
The weighted average number of shares was 558.1 million.
Reported Group net income1 increased by 7% (8% in STATEMENT OF INCOME (SUMMARY)
constant currency) to €1,818 million (2020: €1,707 million).
€ in millions 2021 2020 Growth
Reported earnings per share1 increased by 7% (8% in
Sales 37,520 36,277 3%
constant currency) to €3.26 (2020: €3.06). Cost of goods sold -27,209 -25,961 -5%
Group EBITDA before special items decreased by 4% Gross profit 10,311 10,316 0%
(-2% in constant currency) to €6,854 million (2020: €7,132 Selling, general and administrative expenses -5,453 -5,430 0%
Other operating income and expenses 105 250 -58%
million). Group EBITDA reported was €6,825 million
Research and development expenses -805 -751 -7%
(2020: €7,100 million). Operating income (EBIT) 4,158 4,385 -5%
Group EBIT before special items decreased by 8% Financial result -506 -659 23%
Income before income taxes 3,652 3,726 -2%
(-6% in constant currency) to €4,252 million (2020: €4,612
Income taxes -833 -903 8%
million). Group EBIT reported decreased by 5% (-3% in Net income 2,819 2,823 0%
constant currency) to €4,158 million (2020: €4,385 million). Noncontrolling interests 1,001 1,116 -10%
Net income attributable to Fresenius SE & Co. KGaA1,2 1,867 1,796 4%
Net income attributable to Fresenius SE & Co. KGaA1 1,818 1,707 7%
Earnings per ordinary share in €1,2 3.35 3.22 4%
Fully diluted earnings per ordinary share in €1,2 3.35 3.22 4%
Earnings per ordinary share in €1 3.26 3.06 7%
Fully diluted earnings per ordinary share in €1 3.26 3.06 7%
Average number of shares 558,061,878 557,451,759 0%
EBITDA2 6,854 7,132 -4%
Depreciation and amortization2 -2,602 -2,520 -3%
EBIT2 4,252 4,612 -8%
Annual Report 2021
EBITDA margin2 18.3% 19.7%
EBIT margin2 11.3% 12.7%
1
Net income attributable to the shareholders of Fresenius SE & Co. KGaA
2
Before special items
Fresenius
1
Net income attributable to the shareholders of Fresenius SE & Co. KGaA
For a detailed overview of special items please see the reconciliation tables on pages 74---76. 71
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
EBIT development by business segment was as follows: ► The EBIT1 of Fresenius Helios increased by 10% Development of other major items
(10% in constant currency) to €1,127 million (2020: in the statement of income
The presentation of the business segments’ earnings devel- €1,025 million). The EBIT1 margin was 10.3% (2020: Group gross profit remained on the prior year’s level at
opment is provided before special items. The special items 10.4%). The increase was mainly driven by a good de- €10,311 million (2020: €10,316 million, increased by 2%
are reported in the Corporate / Other segment. velopment of elective treatments. This was partly offset in constant currency). The gross margin decreased to
by higher costs for personnel, personal protective 27.5% (2020: 28.4%). The cost of sales increased by 5%
► Fresenius Medical Care’s EBIT1 decreased in constant equipment, and selected medical products. The Eugin to €27,209 million (2020: €25,961 million). Cost of sales as
currency by 21% to €1,915 million (2020: €2,499 mil- Group contributed €19 million to operating earnings a percentage of Group sales increased to 72.5% (2020:
lion). This was mainly due to adverse COVID-19-re- (EBIT) in fiscal year 2021, with first-time consolidation 71.6%).
lated net effects, inflationary materials cost increases, effective April 1, 2021. Selling, general, and administrative expenses con-
higher personnel expense, and the remeasurement ef- The EBIT1 of Helios Germany increased by 2% to sisted primarily of personnel costs, marketing and distribu-
fect on the fair value of investments. These effects €613 million (2020: €602 million). The EBIT1 margin tion costs, and depreciation and amortization. These ex-
were slightly mitigated by an improved U.S. payor mix, was 9.1% (2020: 9.5%). penses including other operating income and expenses, in-
in particular due to an increased number of patients The EBIT of Helios Spain increased by 22% (24% creased by 3% to -€5,348 million (2020: -€5,180 million),
with Medicare Advantage coverage. The EBIT margin1 in constant currency) to €514 million (2020: €420 mil- mainly due to the rise in personnel costs and acquisitions.
decreased to 10.9% (2020: 14.0%). EBIT reported de- lion). The EBIT margin was 12.8% (2020: 12.1%). Selling, general, and administrative expenses as a percent-
creased by 17% in constant currency to €1,852 million Good organic sales growth led to improved fixed-cost age of Group sales was 14.3% and remained on the prior
(2020: €2,304 million), and the EBIT margin was coverage. The hospital acquisitions in Colombia also year’s level (2020: 14.3%). R & D expenses increased by
10.5% (2020: 12.9%). contributed to growth. 7% to €805 million (2020: €751 million). The increase re-
► Fresenius Kabi’s EBIT1 increased by 5% (7% in con- ► The EBIT1 of Fresenius Vamed increased by 248% sulted from higher expenses at Fresenius Medical Care and
stant currency) to €1,153 million (20201: €1,095 mil- (248% in constant currency) to €101 million (2020: Fresenius Kabi.
lion). The increase in constant currency was driven pri- €29 million). The EBIT margin1 was 4.4% (2020: Depreciation and amortization was €2,602 million1
marily by emerging markets and the business in Eu- 1.4%). The increase was mainly the result of the weak (2020: €2,520 million1). The ratio as a percentage of sales
rope. The increase in constant currency was supported prior-year basis, which was adversely affected by was 6.9%1 (2020: 6.9%1). Group personnel costs in-
by COVID-19-related demand and good peformances COVID-19 effects due to foregone or postponed elec- creased to €15,610 million (2020: €15,128 million). The
in the emerging markets and in Europe. The EBIT de- tive treatments combined with higher costs for exten- personnel cost ratio was 41.6% (2020: 41.7%).
velopment was negatively impacted by competitive sive measures to combat the pandemic.
price pressure in North America and initial negative
Annual Report 2021
price effects following successful participation in the
volume based procurement (VBP) tender process in
China. The EBIT margin1 was 16.0% (2020: 15.7%).
Fresenius
1
Before special items
For a detailed overview of special items please see the reconciliation tables on pages 74---76. 72
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
The Group financial result before special items improved RECONCILIATION FRESENIUS GROUP
to -€504 million (2020: -€654 million), mainly driven by To present the underlying operational business perfor-
successful refinancing activities and ongoing favorable mance and in order to compare the results with the scope
market conditions. The Group financial result reported of the guidance provided for fiscal year 2021, key figures
was -€506 million (2020: -€659 million). are presented before special items.
The Group tax rate before special items was 22.6% Net income 2021 includes special items from expenses
(2020: 23.1%) and thus in line with expectations. The related to the Group-wide cost and efficiency program, re-
Group tax rate reported was 22.8% (2020: 24.2%). valuations of contingent biosimilars purchase price liabili-
Noncontrolling interests before special items were ties and costs for the FME25 program at Fresenius Medical
-€1,033 million (2020: -€1,248 million), of which 91% Care (FMC). Net income 2020 includes special items from
were attributable to the noncontrolling interests in goodwill impairment at Fresenius Medical Care in Latin
Fresenius Medical Care. America and revaluations of contingent biosimilars pur-
chase price liabilities.
The special items shown within the reconciliation tables
are reported in the Corporate segment.
Annual Report 2021
Fresenius
73
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Reconciliation Fresenius Group
Growth rate
in constant
€ in millions 2021 2020 Growth rate currency
Sales reported 37,520 36,277 3% 5%
EBIT reported (after special items) 4,158 4,385 -5% -3%
Revaluations of biosimilars contingent purchase price liabilities -49 32
Impairment of Goodwill at FMC Latin America - 195
Expenses associated with the Fresenius cost and efficiency program 143 -
EBIT (before special items) 4,252 4,612 -8% -6%
Net interest reported (after special items) -506 -659 23% 22%
Revaluations of biosimilars contingent purchase price liabilities 2 5
Net interest (before special items) -504 -654 23% 22%
Income taxes reported (after special items) -833 -903 8% 6%
Revaluations of biosimilars contingent purchase price liabilities 14 -11
Expenses associated with the Fresenius cost and efficiency program -29 -
Income taxes (before special items) -848 -914 7% 6%
Noncontrolling interests reported (after special items) -1,001 -1,116 10% 8%
Impairment of Goodwill at FMC Latin America - -132
Expenses associated with the Fresenius cost and efficiency program -32 -
Noncontrolling interests (before special items) -1,033 -1,248 17% 15%
Net income reported (after special items)1 1,818 1,707 7% 8%
Revaluations of biosimilars contingent purchase price liabilities -33 26
Impairment of Goodwill at FMC Latin America - 63
Expenses associated with the Fresenius cost and efficiency program 82 -
Net income (before special items)1 1,867 1,796 4% 5%
Annual Report 2021
Fresenius
1
Net income attributable to shareholders of Fresenius SE & Co. KGaA 74
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Reconciliation business segments
FRESENIUS MEDICAL CARE — RECONCILIATION ACCORDING TO FRESENIUS MEDICAL CARE
Growth rate
in constant
€ in millions 2021 2020 Growth rate currency
Sales reported 17,619 17,859 -1% 2%
EBIT reported (after special items) 1,852 2,304 -20% -17%
Impairment of Goodwill at FMC Latin America - 195
Costs related to FME25 program 63 -
EBIT (before special items) 1,915 2,499 -23% -21%
Net income reported (after special items)1 969 1,164 -17% -14%
Impairment of Goodwill at FMC Latin America - 195
Costs related to FME25 program 49 -
Net income (before special items)1 1,018 1,359 -25% -23%
Annual Report 2021
Fresenius
1
Net income attributable to Fresenius Medical Care AG & Co. KGaA 75
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Reconciliation business segments
FRESENIUS KABI
Growth rate
in constant
€ in millions 2021 2020 Growth rate currency
Sales reported 7,193 6,976 3% 4%
Revaluations of biosimilars contingent purchase price liabilities -49 32
Expenses associated with the Fresenius cost and efficiency program 58 -
EBIT (before special items) 1,153 1,095 5% 7%
FRESENIUS HELIOS
Growth rate
in constant
€ in millions 2021 2020 Growth rate currency
Sales reported 10,891 9,818 11% 11%
Expenses associated with the Fresenius cost and efficiency program 10 -
EBIT (before special items) 1,127 1,025 10% 10%
FRESENIUS VAMED
Growth rate
in constant
€ in millions 2021 2020 Growth rate currency
Sales reported 2,297 2,068 11% 11%
Expenses associated with the Fresenius cost and efficiency program 0 -
EBIT (before special items) 101 29 -- --
Annual Report 2021
Fresenius
76
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
FINANCIAL POSITION Short-term financing requirements are covered by issu- FINANCING MIX OF THE FRESENIUS GROUP1
ances under the commercial paper programs of Fresenius
Equity-neutral
Financial management policies and goals SE & Co. KGaA and Fresenius Medical Care AG & Co. KGaA convertible bonds 2%
The financing strategy of the Fresenius Group has the fol- of €1.5 billion each and by bilateral credit lines. The Frese- Schuldschein loans
6%
lowing main objectives: nius Medical Care accounts receivable securitization pro- Commercial paper 7%
gram offers additional financing options. The syndicated Other financial
Bonds 54%
► Ensuring financial flexibility credit facilities of Fresenius SE & Co. KGaA and Fresenius liabilities 7%
► Limiting refinancing risks Medical Care AG & Co. KGaA signed in July 2021, each of
Lease liabilities 24%
► Optimizing the weighted average cost of capital €2 billion, serve as back-up lines and were undrawn as of
December 31, 2021. Dec. 31, 2021: €27,155 million
Assuring financial flexibility is key to the financing strategy Another main objective of the Fresenius Group’s financ- 1
The syndicated revolving credit facility of Fresenius SE & Co. KGaA and Fresenius Medical Care
of the Fresenius Group. An adequate liquidity headroom ing strategy is to optimize the weighted average cost of AG & Co. KGaA in the amount of €2 billion each were undrawn as of December 31, 2021 and
are therefore not included in the chart.
maintains our financial flexibility. Our refinancing risks are capital by employing a balanced mix of equity and debt.
limited due to a balanced maturity profile that is character- Due to the Company’s diversification within the health care
ized by a broad spread of maturities with a high proportion sector and the strong market positions of the business seg- Overall, there was no significant change in our financing
of medium- and long-term financing up to 2033. In the se- ments in global, growing, and non-cyclical markets, pre- strategy in 2021. The average maturity of our majorfinanc-
lection of financing instruments we take into account cri- dictable and sustainable cash flows are generated. These ing instruments (excluding leasing) as of December 31,
teria such as market capacity, investor diversification, fund- allow for a reasonable proportion of debt. Measures to 2021 was 4.5 years and the average cost of interest was
ing flexibility, credit conditions, cost of capital, and the ex- strengthen the equity base may also be considered in ex- 1.6%. In line with the Group’s structure, financing for
isting maturity profile. We also take into account the cur- ceptional cases to ensure long-term growth, for example to Fresenius Medical Care and the rest of the Fresenius Group
rencies in which our income and cash flows are generated. finance a major acquisition. is conducted separately. There are no joint financing facili-
Our main medium- and long-term financing instruments ties and no mutual guarantees. The Fresenius Kabi, Frese-
are bonds, as shown in the adjacent chart. Bonds denomi- nius Helios, and Fresenius Vamed business segments are
nated in euros are issued under our €12.5-billion Debt Is- financed primarily through Fresenius SE & Co. KGaA, in or-
suance Program. Fresenius Medical Care AG & Co. KGaA der to avoid any structural subordination.
has a €10 billion Debt Issuance Program. Other important
long-term financing instruments include Schuldschein
loans, bilateral loans, and an equity-neutral convertible
Annual Report 2021
bond, as well as leases (according to IFRS 16).
Fresenius
77
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Financing For short-term financing needs, Fresenius SE & Co. KGaA MATURITY PROFILE OF THE FRESENIUS GROUP
Fresenius meets its financing needs through a combination and Fresenius Medical Care AG & Co. KGaA maintain bilat- FINANCING FACILITIES1, 2
of operating cash flows generated in the business segments eral credit lines and commercial paper programs. Under
€ in millions
and short-, mid-, and long-term debt. Important financing each of the commercial paper programs, short-term notes 3000
instruments include bonds, Schuldschein loans, bank loans, of up to €1.5 billion can be issued. As of December 31,
convertible bonds, commercial paper programs, and an ac- 2021, €1,056 million of Fresenius SE & Co. KGaA’s com- 2500
counts receivable securitization program. In addition, our mercial paper program were utilized. The commercial paper
2000
financing mix includes lease liabilities in accordance with program of Fresenius Medical Care AG & Co. KGaA was
IFRS 16. Financing activities in the past fiscal year were utilized in the amount of €715 million. In addition, both 1500
mainly carried out to refinance existing financial liabilities Groups can conclude short-term bilateral credit lines as
and to optimize financing costs. needed. 1000
Fresenius SE & Co. KGaA and Fresenius Medical Care The committed bilateral credit lines, that were entered
500
AG & Co. KGaA have Debt Issuance Programs, under which into in 2020 in light of the COVID-19-related general uncer-
bonds of up to €12.5 billion (Fresenius SE) and up to €10 tainties, have expired and have not been extended. 0
2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033
billion (Fresenius Medical Care) can be issued in different Detailed information on the Fresenius Group’s financing
currencies and maturities. The syndicated credit facilities can be found on pages 325 to 332 of the Notes. Further in- 1
As of December 31, 2021, and based on utilization of major financing instruments,
excl. Commercial Paper
serve as back-up lines and were undrawn as of December formation on financing measures in 2022 is included in the 2
Fresenius’ €372 million Schuldschein loan due in January 2022 and Fresenius Medical Care’s
US$700 million bonds also due in January 2022 were redeemed at maturity.
31, 2021. Outlook section on page 94.
FINANCIAL POSITION – FIVE-YEAR OVERVIEW
in Mio. € 2021 2020 2019 2018 2017
Operating Cashflow 5,078 6,549 4,263 3,742 3,937
as % of sales 13.5 18.1 12.0 11.2 11.6
Working Capital1 8,690 8,104 8,812 7,721 7,771
as % of sales 23.2 22.3 24.9 23.0 22.9
Investments in property, plant and equipment, net -2,017 2,366 2,433 2,077 1,705
Cash flow before acquisitions and dividends 3,061 4,183 1,830 1,665 2,232
as % of sales 8.2 11.5 5.2 5.0 6.6
Annual Report 2021
Fresenius
78
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Corporate rating Cash inflow from financing activities is generated from the Cash flow analysis
The credit quality of Fresenius is assessed and regularly re- use of various short-term financing instruments. To this Operating cash flow decreased by 22% to €5,078 million
viewed by the leading rating agencies Moody’s, Standard & end, we issue commercial paper and draw on bilateral bank (2020: €6,549 million), with a margin of 13.5% (2020:
Poor’s, and Fitch. Fresenius is rated investment grade by credit lines. Short-term liquidity requirements can also be 18.1%). The cash flow development was mainly due to U.S.
all three rating agencies. There were no rating changes in covered by the Fresenius Medical Care accounts receivable government assistance and prepayments under the Corona-
2021. securitization program. Medium- and long-term financing virus Aid, Relief, and Economic Security Act (CARES Act) at
is provided mainly by bonds, Schuldschein loans, bilateral Fresenius Medical Care in the United States.
RATING OF FRESENIUS SE & CO. KGAA credit lines, an equity-neutral convertible bond, and leases. Cash provided by operating activities exceeded fi-
Dec. 31, 2021 Dec. 31, 2020
Fresenius is convinced that its existing credit facilities and nancing needs from investment activities before acquisi-
Standard & Poor’s inflows from further debt financing, as well as the operat- tions, with cash outflows for capital expenditures amount-
Corporate Credit Rating BBB BBB ing cash flows and additional sources of short-term fund- ing to €2,047 million and cash inflows from disposals of
Outlook stable stable ing, are sufficient to meet the Group’s foreseeable liquidity noncurrent assets of €30 million (2020: €2,406 million and
Moody’s
Corporate Credit Rating Baa3 Baa3
needs. €40 million, respectively).
Outlook stable stable Cash flow before acquisitions and dividends was
Fitch Dividend €3,061 million (2020: €4,183 million). This was sufficient to
Corporate Credit Rating BBB- BBB-
The general partner and the Supervisory Board will pro- finance the Group dividends of €1,068 million.
Outlook stable stable
pose a dividend increase to the Annual General Meeting for Group dividends consisted of dividend payments of
the 29th consecutive year. Despite the challenging year, €491 million to the shareholders of Fresenius SE & Co.
this is intended to maintain dividend continuity. KGaA, payments of €392 million by Fresenius Medical Care
Effect of off-balance-sheet financing instruments
For 2021, a dividend of €0.92 per share is proposed to its shareholders, and dividends paid to third parties of
on our financial position and liabilities
(2020: €0.88 per share). This is an increase of 5%. The to- €311 million (primarily relating to Fresenius Medical Care).
Fresenius is not involved in any off-balance-sheet transac-
tal dividend distribution would then also increase by about These payments were partially offset by the dividend of
tions that are likely to have a significant impact on its finan-
5% to €514 million (2020: €491 million). €126 million that Fresenius SE & Co. KGaA received as a
cial position, results of operations, liquidity, investments,
The Management Board will propose a scrip dividend to shareholder of Fresenius Medical Care.
assets and liabilities, or capitalization at present or in the
the Supervisory Board. The Company wants to give its
future.
shareholders the opportunity to opt to receive a portion of
the dividend (‘‘Dividend Option Portion’’) in Company
Liquidity analysis
shares. The remaining portion of the dividend (‘‘Dividend
Annual Report 2021
In general, key sources of liquidity are operating cash flows
Base Portion’’) will always be paid in cash, to ensure that a
and cash inflow from financing activities including short-,
shareholder does not have to raise any new cash in order to
mid-, and long-term debt. Cash flow from operations is in-
fulfill a possible tax liability with regard to the dividend. In
fluenced by the profitability of the business of Fresenius
doing so, Fresenius is giving its shareholders an easy and
and by net working capital, especially accounts receivable.
simple way of re-investing their dividend in the Company
Fresenius
and strengthening the liquidity for the purpose of further
growth financing.
79
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
The cash outflow for acquisitions was €800 million, mainly
for acquisitions at Fresenius Medical Care and Fresenius
Helios. Cash flow after acquisitions and dividends was
€1,193 million (2020: €2,478 million). Overall, cash used
for financing activities was €384 million, (2020 cash used
for financing activities: €2,057 million). Cash and cash
equivalents increased by €927 million to €2,764 million as
of December 31, 2021 (December 31, 2020: €1,837 million).
Cash and cash equivalents were positively influenced by
currency translation effects of €118 million (2020: negative
effect of €238 million).
Working capital increased by 7% to €8,690 million,
mainly due due to advance payments received from Medi-
Care at Fresenius Medical Care and tax deferrals in North
America as a result of COVID-19.
CASH FLOW STATEMENT (SUMMARY)
€ in millions 2021 2020 Growth Margin 2021 Margin 2020
Net income 2,819 2,823 0%
Depreciation and amortization 2,667 2,715 -2%
Change in working capital and others -408 1,011 -140%
Operating cash flow 5,078 6,549 -22% 13.5% 18.1%
Capital expenditure, net -2,017 -2,366 15%
Cash flow before acquisitions and dividends 3,061 4,183 -27% 8.2% 11.5%
Cash used for acquisitions/proceeds from divestitures -800 -645 -24%
Dividends paid -1,068 -1,060 -1%
Free cash flow after acquisitions and dividends 1,193 2,478 -52%
Annual Report 2021
Cash provided by / used for financing activities -384 -2,057 81%
Effect of exchange rates on change in cash and
cash equivalents 118 -238 150%
Net change in cash and cash equivalents 927 183 --
Fresenius
80
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Investments and acquisitions INVESTMENTS BY REGION INVESTMENTS, ACQUISITIONS, OPERATING
In 2021, the Fresenius Group provided €3,117 million CASH FLOW, DEPRECIATION AND AMORTIZATION
Other regions 5% IN € MILLIONS – FIVE-YEAR OVERVIEW 1
(2020: €3,300 million) for investments and acquisitions. In-
vestments in property, plant and equipment decreased to Asia-Pacific 7% 6,852
6,549
€2,032 million (2020: €2,398 million). At 5.4% of reported
sales (2020: 6.6%), this was below the depreciation level1 North America 31%
Europe 57%
5,078
of €2,602 million. A total of €1,085 million was invested in
4,263
acquisitions (2020: €902 million). Of the total capital ex- 3,937
2021: €2,032 million 3,742
penditure in 2021, 65% was invested in property, plant and
equipment and 35% was spent on acquisitions. 2,623 2,520
2,463 2,398
INVESTMENTS AND ACQUISITIONS 2,163 2,602
The cash outflow for acquisitions is primarily related to
1,828 2,416 2,032
the following business segments: € in millions 2021 2020 Change
1,494 1,085
902
Acquisitions 1,085 902 20% 1,437
1,086
Investment in property,
► Fresenius Medical Care’s acquisition spending was plant and equipment 2,032 2,398 -15%
mainly related to the acquisition of dialysis clinics. thereof maintenance 58% 49% 2017 2018 2019 2020 2021
► Fresenius Kabi’s acquisition spending was mainly for thereof expansion 42% 51% Depreciation and amortization Acquisitions
Investment in property, Investments Operating cash flow
already-planned acquisition-related milestone pay- plant and equipment
ments relating to the acquisition of the biosimilars as % of sales 5.4% 6.6%
business from Merck KGaA. Total investments and
acquisitions 3,117 3,300 -6%
► Fresenius Helios’ acquisition spending was mainly for
the acquisition of the Eugin Group. Further acquisition
INVESTMENTS / ACQUISITIONS
expenses related to subsequent purchase price pay-
BY BUSINESS SEGMENT
ments for the Malteser-Klinik in Duisburg, Germany,
Thereof property,
and the acquisition of the DRK-Kliniken Nordhessen in plant and Thereof
€ in millions 2021 2020 equipment acquisitions Change % of total
Kassel, Germany.
Fresenius Medical Care 1,482 1,459 854 628 2% 47%
Fresenius Kabi 533 718 532 1 -26% 17%
Fresenius Helios 1,021 1,000 568 453 2% 33%
Fresenius Vamed 81 101 80 1 -20% 3%
Annual Report 2021
Corporate / Other 0 22 -2 2 -100% 0%
Total 3,117 3,300 2,032 1,085 -6% 100%
Fresenius
1
Before special items
For a detailed overview of special items please see the reconciliation tables on pages 74 ---76. 81
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Acquisitions at Fresenius Helios Together with the existing Helios hospital in Warburg, The acquisition is another important step to strengthen
In December 2020, Fresenius Helios announced the acqui- North Rhine-Westphalia, a regional medical cluster shall be Fresenius Helios’ presence in the growing and consolidat-
sition of the Eugin Group, one of the leading international formed and expanded over the next few years. ing health care services markets in Latin America.
fertility Groups. The Eugin Group has been consolidated The acquisition was completed on September 27, 2021. The transaction is expected to close in the first quarter
since April 1, 2021. The Eugin Group contributed €133 mil- DRK Kliniken Nordhessen has been consolidated since of 2022, pending anti-trust clearance from the Colombian
lion to sales and €19 million to the operating income (EBIT) September 30, 2021. The purchase price amounts to €1 authorities. Fresenius Helios expects the acquisition to be
of the Fresenius Group in 2021, with the first-time consoli- and also includes the assumption of debts and the securing accretive to Fresenius’ Group net income as early as fiscal
dation as of April 1, 2021. of liquidity for current operations and for future invest- year 2022.
Eugin’s network comprises 33 clinics and an additional ments.
39 sites across 10 countries on 3 continents and offers a On November 22, 2021, Quirónsalud, Spain’s largest The main investments in property, plant and equipment
wide spectrum of state-of-the-art services in the field of fer- private hospital operator, owned by Fresenius Helios, an- were as follows:
tility treatments. The United States, Spain, Brazil, Italy, and nounced the acquisition of the specialty hospitals Centro
Sweden are the Eugin Group’s largest markets. The com- Oncológico de Antioquia (COA) and Clínica Clofán. The ► modernization of existing, and equipping of new, dialysis
pany also operates clinics in Denmark, Argentina, Colom- clinics, located in Colombia’s second largest city, Medellín, clinics at Fresenius Medical Care.
bia, and Latvia. will become part of Quirónsalud’s existing health care net- ► optimization and expansion of production facilities for
With the acquisition of the Eugin Group, Fresenius He- work in the country, which already comprises 6 hospitals Fresenius Medical Care and for Fresenius Kabi.
lios has become a leading player in this dynamic growing and 10 diagnostic centers. ► new building and modernization of hospitals at Fresenius
market and has established a strong basis for further ex- COA is specialized in the diagnosis and treatment of Helios. The most significant individual projects were,
pansion. cancer. It has 75 beds, 4 operating rooms, and specialized among other locations, hospitals in Wiesbaden, Duis-
The purchase price is based on a valuation of €430 mil- centers for nuclear medicine, radiotherapy, and bone mar- burg, Wuppertal, Niederberg and investments in IT in-
lion, including non-controlling interests acquired and finan- row transplants. frastructure.
cial liabilities of around €80 million. The non-controlling Clínica Clofán is the second largest ophthalmic center
interests are held by the respective senior physicians. in the city, with 10 operating rooms and further dedicated Investments in property, plant and equipment of €277 mil-
As of January 1, 2022, the Eugin Group will form a new, facilities for treating even severe ophthalmic diseases and lion will be made in 2022, to continue with major ongoing
separate business and reporting unit within Fresenius performing complex procedures. Both clinics offer state-of- investment projects on the reporting date. These are in-
Helios, Helios Fertility, alongside Helios Germany and the-art medical standards and technology to their patients vestment obligations mainly for investments to expand and
Helios Spain. and are regarded as leading medical facilities with highly optimize production facilities for Fresenius Medical Care
On September 2, 2021, Fresenius Helios announced the renowned physicians. Together, they generate sales of and Fresenius Kabi. These projects will be financed from
Annual Report 2021
acquisition of the DRK (German Red Cross) Kliniken around €30 million. operating cash flow.
Nordhessen. The clinics in Kassel with sites in Kassel-
Wehlheiden and Kaufungen with a total of 433 beds as well
as an associated outpatient center (MVZ) generated sales
of around €87 million in 2020. The DRK-Schwesternschaft
Fresenius
remains a co-partner.
82
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Investment program at Fresenius Kabi In Austria, we continued to expand our production and lo- Our Haina plant in the Dominican Republic is the central
Fresenius Kabi has a global network of production centers. gistics site in Graz. With capital expenditure of around manufacturing facility for disposable products in the field
We manufacture our products in our plants and, at some €110 million, we will continue to expand this site in the of apheresis and cell therapy. Driven by the high market
sites, we also produce pharmaceutical raw materials. With next few years. demand for plasma products and cell therapies, we have
our investments we aim, among other things, to continu- The plant manufactures sterile drugs such as intrave- gradually expanded the plant in recent years. In the plasma
ously modernize and automate as well as increase the com- nously administered drugs and large-volume products for collection business, in addition to disposable products for
petitiveness of the plants at a consistently high level of parenteral nutrition; the site also specializes in complex our Aurora plasmapheresis system, the disposable products
quality. At the same time, we are responding to the in- process requirements and innovative technologies. The fo- of the successor system, Aurora Xi, are also produced in
creased demand for our products, for example, by expand- cus is on freeze-drying and systems for filling and packag- Haina. We are also currently in the process of relocating
ing our sites. ing glass bottles and prefilled syringes. The demand for the production of disposable products for autotransfusion
In the United States, Fresenius Kabi continued its extensive prefilled syringes is increasing, as they offer significant ad- to Haina.
investment program at the manufacturing sites. In 2021, vantages in everyday clinical life thanks to their fast and In order to continue to meet the growing market de-
we made progress with our investment program and con- safe application. mand for these disposable products, we will be expanding
tinued equipping our plants with the latest technologies for In the manufacturing plant, the mobile preparatory area our manufacturing plant in the coming years with highly
the production of pharmaceutical products. Fresenius Kabi will be enlarged, freeze-drying (lyophilization) expanded, automated production facilities and clean-room capacities.
will continue its investment program in the United States in and new filling systems implemented. The completion of In total, we will invest more than €65 million in the Haina
the coming years. the expansion work is planned for 2023. In 2021, we inau- plant by 2024.
Due to the demand for enteral products in China, we gurated the new packaging building at our logistics site in
are expanding our production capacity there. In 2021, we Werndorf, near Graz.
continued work on a new production building on our cam- In France, we began with the modernization of the plant
pus in Wuxi. In the future, we will be producing enteral nu- at our Louviers production site. Over the next two years, a
trition products there that have the status of Foods for Spe- new building comprising an area of 3,300 square meters
cial Medical Purposes. Fresenius Kabi will also be expand- will be set up in the production facilities for freeflex infu-
ing its research and development activities for enteral nu- sion bags. This also allows the European production net-
trition at the Wuxi site. work to be optimized as a whole. In total, we will be invest-
ing €35 million in the modernization.
Annual Report 2021
Fresenius
83
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
ASSETS AND LIABILITIES BALANCE SHEET OVERVIEW
Asset and liability structure € in millions Dec. 31, 2021 Dec. 31, 2020 Growth
The Group’s total assets increased by 8% (4% in constant ASSETS
currency) to €71,962 million (Dec. 31, 2020: €66,646 mil- Current assets 17,461 15,772 11%
lion). The increase is mainly due to currency translation ef- thereof trade accounts receivables 7,045 6,937 2%
thereof inventories 4,218 3,945 7%
fects, acquisitons as well as the expansion of business activ- thereof cash and cash equivalents 2,764 1,837 50%
ities. Inflation had no significant impact on the assets of Non-current assets 54,501 50,874 7%
Fresenius in 2021. thereof property, plant and equipment 12,569 11,912 6%
thereof goodwill and other intangible assets 32,775 30,335 8%
Current assets increased by 11% (8% in constant cur-
thereof right-of-use-assets 6,014 5,691 6%
rency) to €17,461 million (Dec. 31, 2020: €15,772 million). Total assets 71,962 66,646 8%
Within current assets, trade accounts receivable and other
receivables increased by 2% to €7,045 million (Dec. 31, LIABILITIES AND SHAREHOLDERS' EQUITY
Liabilities 42,674 40,623 5%
2020: €6,937 million). At 70 days, average days sales out- thereof trade accounts payable 2,039 1,816 12%
standing was below the previous year’s level (71 days). thereof accruals and other short-term liabilities 10,594 9,913 7%
Inventories increased by 7% to €4,218 million (Dec. thereof debt 27,155 25,913 5%
thereof lease liabilities 6,590 6,188 6%
31, 2020: €3,945 million). The scope of inventory in 2021
Noncontrolling interests 10,290 9,074 13%
was 63 days (Dec. 31, 2020: 62 days). The ratio of invento- Total Fresenius SE & Co. KGaA shareholders' equity 18,998 16,949 12%
ries to total assets was 5.9% and remained on the prior Total shareholders' equity 29,288 26,023 13%
year’s level (Dec. 31, 2020: 5.9%). Total liabilities and shareholders' equity 71,962 66,646 8%
Non-current assets increased by 7% (3% in constant
currency) to €54,501 million (Dec. 31, 2020: €50,874 mil-
lion). The increase due to acquisitions and new rights of ASSETS AND LIABILITIES – FIVE-YEAR OVERVIEW
use under leases was offset mainly by depreciation and
€ in millions 2021 2020 2019 2018 2017
amortization. The goodwill and intangible assets in the
Total assets 71,962 66,646 67,006 56,703 53,133
amount of €32,775 million (Dec. 31, 2020: €30,335 million) Shareholders’ equity1 29,288 26,023 26,580 25,008 21,720
has proven sustainable. The increase is mainly due to cur- as % of total assets1 41% 39% 40% 44% 41%
rency translation effects as well as acquisitons at Fresenius Shareholders’ equity1 / non-current assets, in % 54% 51% 51% 60% 54%
Debt 27,155 25,913 27,258 18,984 19,042
Medical Care and Fresenius Helios. The addition to the
Annual Report 2021
as % of total assets 38% 39% 41% 33% 36%
goodwill from acquisitions was €1,065 million in fiscal year Gearing1 in % 83% 93% 96% 65% 80%
2021. 1
Including noncontrolling interests
Fresenius
84
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
Shareholders’ equity increased by 13% (7% in constant Group debt increased by 5% (2% in constant currency) to It is important to take into account that approximately 64%
currency) to €29,288 million (Dec. 31, 2020: €26,023 mil- €27,155 million (Dec. 31, 2020: €25,913 million). Its rela- of the goodwill is attributable to the strategically significant
lion). The increase is due to currency translation effects as tive weight in the balance sheet was 38% (Dec. 31, 2020: acquisitions of
well as the good net income development. Group net in- 39%). Approximately 31% of the Group’s debt is denomi-
come attributable to Fresenius SE & Co. KGaA increased nated in U.S. dollars. Liabilities due in less than one year ► National Medical Care in 1996,
shareholders’ equity by €1,818 million. The equity ratio were €4,772 million (Dec. 31, 2020: €3,670 million), while ► Renal Care Group and HELIOS Kliniken in 2006,
was 40.7% (Dec. 31, 2020: 39.0%). liabilities due in more than one year were €22,383 million ► APP Pharmaceuticals in 2008,
The liabilities and equity side of the balance sheet (Dec. 31, 2020: €22,243 million). ► Liberty Dialysis Holdings in 2012,
shows a solid financing structure. Total shareholders’ eq- Group net debt increased by 1% (-1% in constant cur- ► Hospitals of Rhön-Klinikum AG in 2014,
uity, including noncontrolling interests, covers 54% of rency) to €24,391 million (Dec. 31, 2020: €24,076 million). ► Quirónsalud and the biosimilars business in 2017,
non-current assets (Dec. 31, 2020: 51%). Shareholders’ eq- The net debt to equity ratio including noncontrolling inter- ► NxStage in 2019, as well as
uity, noncontrolling interests, and long-term liabilities ests (gearing) is 83% (Dec. 31, 2020: 93%). ► Eugin Group in 2021.
cover all non-current assets and 57% of inventories. The return on equity after taxes1 (equity attributable to
Long-term liabilities increased by 1% (decreased by shareholders of Fresenius SE & Co. KGaA) was 9.8% (Dec. Those have significantly strengthened the competitive posi-
2% in constant currency) to €27,612 million (Dec. 31, 31, 2020: 10.6%). The return on total assets after taxes and tion of the Fresenius Group.
2020: €27,407 million). Short-term liabilities increased by before noncontrolling interests1 was 4.0% (2020: 4.6%). In 2021, the Fresenius Group’s return on invested capi-
14% (11% in constant currency) to €15,062 million (Dec. Group ROIC was 5.9%2 (2020: 6.5% 2). Group ROOA tal (ROIC) exceeded our cost of capital. The WACC
31, 2020: €13,216 million). was 6.5%2 (2020: 7.3%2). Estimated COVID-19 effects had (weighted average cost of capital) of Fresenius Medical
The Group has neither provisions nor accruals that are a negative impact of 90 basis points on ROIC and 100 basis Care was 4.57%; the WACC of the other business segments
of major significance as individual items. Other provisions points on ROOA. Within the position invested capital, the was 5.43%.
and accruals result mainly from provisions for self-insur- goodwill of €28.9 billion had a significant effect on the cal-
ance programs, for personnel expenses, for warranties and culation of ROIC.
claims, and for litigation and other legal risks.
Annual Report 2021
Fresenius
1
Before special items
2
Before special items; pro forma acquisitions / divestitures
For a detailed overview of special items and adjustments please see the reconciliation tables on pages 74---76. 85
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group Economic report | Overall assessment of the business situation | Outlook | Opportunities and risk report
FIVE-YEAR OVERVIEW FINANCING KEY FIGURES1,2
Dec. 31, 2021 Dec. 31, 2020 Dec. 31, 2019 Dec. 31, 2018 Dec. 31, 2017
Debt / EBITDA 4.0 3.6 3.8 3.2 3.1
Net debt / EBITDA3 3.5 3.4 3.6 2.7 2.8
Net debt / EBITDA4 3.6 3.4 3.6 2.7 2.8
EBITDA / financial result 13.6 10.9 9.9 10.6 9.6
1
Before special items
2
For pro forma acquisitions, the missing pro forma EBITDA for the full 12 months is included.
For divestments, the EBITDA contribution of the last 12 months is deducted.
3
At LTM average exchange rates for both net debt and EBITDA
4
Net debt at year-end exchange rate; EBITDA at LTM average exchange rates
ROIC AND ROOA BY BUSINESS SEGMENTS
ROIC ROOA
in % 2021 2020 2021 2020
Fresenius Medical Care1,2 5.2 6.6 6.2 8.2
Fresenius Kabi1,2 9.0 8.5 8.8 9.2
Fresenius Helios1,2 5.2 5.0 5.9 5.7
Fresenius Vamed2 4.5 1.4 4.3 1.3
Group1,2 5.9 6.5 6.5 7.3
1
Pro forma acquisitions
2
Before special items
Currency and interest risk contracts
The nominal value of all foreign currency hedging contracts
was €2,917 million as of December 31, 2021. These con-
tracts had a fair value of -€27 million. The nominal value of
interest rate hedging contracts was €482 thousand. These
contracts had a fair value of around -€12 thousand. Please
Annual Report 2021
see the Opportunities and Risk Report on page 108 f. and
the Notes on pages 361 to 362 for further information.
Fresenius
86
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report Overall assessment of the business situation Outlook | Opportunities and risk report
OVERALL ASSESSMENT OF THE BUSINESS Despite the challenges posed by the COVID-19 pandemic, care, will even be accelerated by the COVID-19 pandemic,
the Management Board continues to assess the business and we believe that we are very well positioned as a Group
SITUATION
outlook of the Fresenius Group as positive at the time of to benefit from this in the coming years.
COVID-19 will continue to impact Fresenius’ operations in preparing the Group Management Report. We continue to We are continuously striving to optimize our costs, to
2022. The extent of the impact on the Group is partly de- see steadily growing demand for our products, services, adjust our capacities, and to improve our product mix, as
pendent on the vaccination coverage in Fresenius’ relevant and therapies worldwide. well as to expand our products and services business.
markets and the potential evolution of new virus mutants. (Further information on the cost and efficiency program is
Fresenius expects COVID-19 case numbers to decline OUTLOOK provided on page 46).
from spring 2022 onwards and consequently, the number We also plan to expand our biosimilars product portfo-
of elective treatments and staff availability to improve. This Group Management Report contains forward-looking lio. We expect these efforts to increase our earnings in the
These assumptions are subject to considerable uncertainty. statements, including statements on future sales, expenses, coming years. In addition, good growth opportunities for
Fresenius closely monitors the development of COVID- and investments, as well as potential changes in the health Fresenius are, above all, presented by the following factors:
19 case numbers and the associated various containment care sector, our competitive environment, and our financial
measures enacted in the Company’s relevant markets. A situation. These statements were made on the basis of the ► The sustained growth of the markets in which we
possible significant deterioration of the situation associated expectations and assessments of the Management Board operate: Fresenius still sees very good opportunities to
with further containment measures that could have a signif- regarding events that could affect the Company in the fu- benefit from the growing health care needs arising
icant and direct impact on the health care sector without ture, and on the basis of our mid-term planning. Such for- from aging populations, with their growing demand for
any appropriate compensation is not reflected in the ward-looking statements are subject, as a matter of course, comprehensive care, and technical advances, but
Group’s FY/22 guidance. to risks, uncertainties, assumptions, and other factors, so driven also by the still-insufficient access to health care
Headwinds from cost inflation are reflected. However, that the actual results, including the financial position and in the developing and emerging countries. There are
Fresenius expects no significant acceleration of inflation ef- profitability of Fresenius, could therefore differ materially --- above average growth opportunities for us not only in
fects and supply chain challenges versus current environ- positively or negatively --- from those expressly or implicitly the markets of Asia-Pacific and Latin America, but also
ment. In its FY/22 forecast, the Management Board as- assumed or described in these statements. For further in- in Africa. Efficient health care systems with appropri-
sumes an unchanged corporate tax rate in the United formation, please see our Opportunities and Risk Report on ate reimbursement structures will evolve over time in
States. Furthermore, the assumptions for Fresenius Medi- pages 95 ff. these countries, as economic conditions improve. We
cal Care's 2022 guidance are also fully applicable to the will strengthen our activities in these regions and in-
Fresenius Group's 2022 guidance. GENERAL AND MID-TERM OUTLOOK troduce further products from our portfolio into these
Despite the challenges posed by the COVID-19 pandemic, markets successively.
Annual Report 2021
the Management Board considers the Fresenius Group’s ► The expansion of our regional presence: Fresenius
prospects for the coming years to be positive due to the in- Medical Care expects excellent growth opportunities in
creasing global demand for our products, services, and the field of dialysis in the Asia-Pacific region.
therapies. Some trends, such as the digitalization of health
Fresenius
87
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation Outlook | Opportunities and risk report
The fast growing markets in Asia-Pacific, Latin Amer- offers additional growth opportunities. In addition, In addition, Fresenius Kabi is developing new dosage
ica, and Africa especially offer further potential to Fresenius Helios is seizing growth opportunities in forms for its products. In the area of biosimilars,
strengthen our market position of Fresenius Kabi. They Latin America through acquisitions to exploit potential Fresenius Kabi specializes in the development of
offer excellent mid-term growth opportunities in infu- in the private hospital market. Helios is also expanding products for the treatment of autoimmune diseases
sion and nutrition therapies, IV drugs, and medical de- its business in the field of fertility services, thus com- and use in oncology and has a pipeline of molecules at
vices. We plan to further roll out additional products plementing its range of services. various stages of development.
and therapies from our existing portfolio in countries Fresenius Vamed is driving the expansion of high- Fresenius Helios is expanding its fertility services
where we do not yet offer a comprehensive range or end services such as the management of medical de- business segment to complement its range of innova-
are not yet represented. vices, sterile services, operational technology, and IT tive therapies.
Fresenius Helios sees good opportunities for fur- development. Helios Germany and Spain, as well as Fresenius
ther international growth, including in Latin America. ► The broadening of our products business: at Frese- Vamed are developing innovative business areas such
Here, Helios Spain is already represented in Colombia nius Medical Care, we see the planned expansion of as digital offerings. For example, health apps such as
and Peru. the core business with dialysis products as a growth Curalie are being developed. Curalie is a platform and
► The broadening of our services business: there are driver. app for digital health programs according to scientific
significant growth opportunities for Fresenius Medical At Fresenius Kabi, we plan to expand our IV drugs standards, e.g. for people with chronic diseases such
Care in the field of dialysis treatment as soon as a product business. We develop generic drug formula- as diabetes mellitus or heart failure. With Curalie,
country opens up to private dialysis providers or allows tions that are ready to launch at the time of market for- these patients can manage their illness digitally and re-
public and private providers to cooperate, for instance mation, directly after the patents of the branded prod- ceive important information and tips for a healthier
in public-private partnerships. Whether and in what ucts expire. We also develop new formulations for non- life.
form private companies can offer dialysis treatment de- patented drugs. Furthermore, we develop ready-to-use ► Selective acquisitions: besides retaining organic sales
pends on the health care system and the legal frame- products that are especially convenient and safe, in- growth as the basis for our business, we will continue
work of the respective country. cluding, for example, pre-filled syringes and ready-to- to utilize opportunities to grow by making small and
Fresenius Helios has an extensive nationwide hos- use solutions in our freeflex infusion bags. Further- mid-sized acquisitions that expand our product portfo-
pital network in Germany and Spain. Based on this more, we plan to expand our biosimilars product port- lio and strengthen our regional presence.
platform, Fresenius Helios aims to develop and offer folio.
innovative, integrated care offerings. In addition, Helios ► Digitalization and the development of innovative We are also exploiting any opportunities within our opera-
Germany is expanding outpatient services. Patient care products and therapies: these will create the potential tions for cost management and efficiency enhancement
should be further improved through the exchange of to further expand our market position in the regions. measures. These include plans for cost-efficient production
Annual Report 2021
knowledge and experience (best practice) between He- In addition to innovation, best-in-class quality, reli- and a further-optimized procurement process. Further-
lios Germany and Helios Spain. Growth opportunities ability, and the convenience of our products and thera- more, we can use digital technologies to speed up central
in Spain arise from expansion and construction of hos- pies are key factors here. This will provide growth po- administrative processes and increase their efficiency.
pitals, and further consolidation potential in the highly tential for Fresenius Medical Care.
fragmented Spanish private hospital market. The close
Fresenius
integration of Helios Spain’s facilities for occupational
risk prevention within the Spanish hospital network
88
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation Outlook | Opportunities and risk report
The outlook takes account of all events known at the time Fresenius Kabi plans to introduce products already offered medical advances and the large number of diseases that are
the annual financial statements were prepared that could outside the United States into that country as well. It also still difficult to cure --- or are incurable --- are expected to re-
influence our operating performance in 2022 and beyond. aims to further roll out its product portfolio internationally, main growth drivers.
Significant risks are discussed in the Opportunities and especially in the fast-growing markets of Asia-Pacific and In the emerging countries, the availability of basic
Risk Report. As in the past, we will do our utmost to Latin America. Market share is to be expanded further health care and the demand for high-quality medical treat-
achieve and --- if possible --- exceed our targets. through the launch of new products in the field of IV drugs ment are increasing. As per-capita income increases, indi-
and medical devices for infusion therapy and clinical nutri- viduals increasingly have to cope with the illnesses associ-
FUTURE MARKETS tion. In the biosimilars business, we are developing addi- ated with lifestyle diseases.
We expect the consolidation process to continue among tional products focusing on autoimmune diseases and on- On the other hand, experts estimate that further finan-
competitors in our markets in Europe, Asia-Pacific, and cology, which will be introduced to the market over the cial constraints in the public sector could result in more
Latin America. Consequently, we expect that there will be next few years. pricing pressure and a slowdown in revenue for companies
opportunities for us to penetrate new markets, both by ex- With its broad hospital network across Germany, in the health care industry. Some countries are experienc-
panding our regional presence and by extending our prod- Fresenius Helios is able to develop new patient care mod- ing significant financing problems in the health care sector
uct portfolio. els. In addition, Helios Germany is expanding outpatient due to the strained public finance situation. Especially in
New markets will open up as Fresenius Medical Care and digital services. The increasing number of privately in- the industrialized countries, increased pressure to encour-
successively rolls out its product and services portfolio, es- sured patients is opening up opportunities for Helios Spain. age saving can be expected as health care costs constitute
pecially in emerging countries. Value-based care models Fresenius Helios also sees good opportunities for further a large portion of the budget.
enable Fresenius Medical Care to create medical value international growth in Latin America, among other loca- It will be increasingly important for companies in the
while ensuring that care remains affordable. The aim is to tions. Furthermore, the activities in the fertility services of- health care sector to increase patient benefit, to improve
build sustainable partnerships with payors worldwide to fer further growth opportunities. treatment quality, and to offer preventive therapies. In ad-
support the transition from a fee-for-service to a pay-for- Fresenius Vamed expects both the project and service dition, especially those products and therapies that are not
performance system. Fresenius Medical Care is committed business to continue to grow due to the need for life cycle only medically but also economically advantageous will be
to aligning its business activities for further sustainable, and PPP projects. Furthermore, the company intends to ex- of increasing importance.
profitable growth by investing in future growth markets in pand its position through follow-up contracts with existing
its product and service businesses. Based on its strategic customers and to enter new target markets. In addition, THE DIALYSIS MARKET
business planning, Fresenius Medical Care has set a new Fresenius Vamed plans to further strengthen its leading po- The global dialysis market is expected to grow in a range of
ambitious target for the expansion of home dialysis: By sition as a post-acute care provider in Central Europe. 2% to 7% at constant exchange rates in 2022.
2025, the Company aims to perform 25% of all treatments The number of dialysis patients worldwide is expected to
Annual Report 2021
in the U.S. at home. HEALTH CARE SECTOR AND MARKETS rise, depending on further developments of the global
The health care sector is considered to be widely independ- COVID-19 pandemic, by approximately 5% in 2022, alt-
ent of economic cycles. The demand, especially for lifesav- hough significant regional differences will remain. For the
ing and life-sustaining products and services, is expected United States, Japan, and the countries of Central and
to increase irrespective of the COVID-19 pandemic and Western Europe, where prevalence is already relatively
Fresenius
mortality among dialysis patients, given that they are medi- high, we forecast below-average patient growth in the
cally needed and the population is aging. Moreover,
Company research 89
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation Outlook | Opportunities and risk report
region. In emerging markets, we expect growth rates to be originator drugs going off-patent, as well as by original off- In 2022, the medical devices market should experience
even higher. patent products that are offered at steady prices due to a growth of 1% to 3%. In many countries, we continue to
Excess mortality of dialysis patients due to the COVID- unique selling proposition. The patent expiries of some see strong demand in the infusion technology segment with
19 pandemic is continuing in 2022 and is expected to have high-revenue IV drugs in 2022 suggest extraordinary mar- more nationally resilient positions even after COVID-19. In
a significant adverse effect on treatment volumes and addi- ket growth for the year. A factor working in the opposite di- addition, the infusion pumps already placed in recent years
tional COVID-19 related costs. The further development rection is the price erosion of original drugs now off-patent will increase the demand for dedicated infusion sets.
significantly depends on the adoption and speed of the roll- and generic drugs that are already on the market. In transfusion technology, we expect to see growth of
out of vaccinations to our worldwide patient population. It is forecast that, in 2022, the market for biopharma- 5% to 6%. In the product segments, we expect plasma to
Overall, factors such as aging populations and the ceuticals relevant for Fresenius Kabi will grow by 4% to grow by between 8% and 9%. In particular, the demand
growing number of people suffering from diabetes and hy- 6% on the basis of units sold and by 3% to 5% on the ba- for plasma-derived products, such as intravenously admin-
pertension, which are ailments often preceding terminal sis of sales. istered immunoglobulins, is on the rise worldwide, driven
kidney failure, are contributing toward continued growth of We expect the market for clinical nutrition to continue by the fact that more and more people have access to high-
the dialysis markets. The life expectancy of dialysis patients to grow at the same level as the previous year in 2022. quality health care and that plasma products are used more
is also rising thanks to ongoing advances in treatment qual- Growth prospects are supported by increasing awareness widely. In cell therapy, we expect to see growth of up to
ity and the rising standard of living, especially in the of the need for early clinical nutrition, which is also re- 15%. In this therapy, the patient’s own immune cells are
emerging countries. flected in the latest guidelines. In addition, the practice of taken, processed in the laboratory, and returned to the pa-
Further information is provided on pages 60 ff. of the mandatory screening for malnutrition² is on the rise. We tient via an infusion. Especially in cancer immune therapy,
Group Management Report. see additional potential in the continuing high proportion we are seeing an increase in the use of cell therapies.
of malnourished people who do not yet have access to nu-
THE MARKET FOR GENERIC IV DRUGS, trition therapies. Considerable potential continues to be
BIOPHARMACEUTICALS, NUTRITION AND INFUSION projected in Latin America and Africa with growth rates of
THERAPIES, MEDICAL DEVICES, AND TRANSFUSION 5% to 7% in individual regions.
TECHNOLOGY1 We expect the market for infusion therapies in Europe
The market for generic IV drugs is expected to grow in the to be slightly above the level of the previous year in 2022.
high single-digit range worldwide in 2022. The demand for While the market for blood volume substitutes is expected
generic IV drugs is likely to grow because of their signifi- to remain relatively stable, the standard solutions business
cantly lower price in comparison to the price of originator is expected to grow slightly in Europe in 2022. Outside
drugs. The growth dynamic will continue to be driven by Europe, we expect the infusion therapies market to be
Annual Report 2021
around 1% to 3% above the previous year’s level, with
Latin America likely to grow at mid single-digit rates.
Fresenius
1
Market data refers to Fresenius Kabi’s addressable markets. Those are subject to annual volatility due to currency fluctuations and patent expiries of original drugs in the IV drug market,
among other things. Percentage increase based on market value (price × volume). Depending on the further development of the COVID-19 pandemic in 2021, the market growth of single product
segments could change.
2
Sources: New ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. 2019 38(1):10-47; by Volkert D, Beck AM, Cederholm T, Cruz-Jentoft A, Goisser S, Hooper L, et al.;
latest implemented e.g., in Portugal: ‘‘National Policy for effective screening implementation‘‘, Directorate General of Health DGS 90
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation Outlook | Opportunities and risk report
THE HOSPITAL MARKET1 Hospitals’ results of operations could further worsen, as cost savings, for example in purchasing. RWI expects the
We assume there will be a stagnation or decline in inpa- the COVID-19-related support measures are expected to be COVID-19 pandemic to further accelerate the trend towards
tient hospital admissions in the future, in particular as a re- largely discontinued in 2022 and the fundamental chal- more collaboration.
sult of the increasing number of outpatient treatments, as lenges in the German hospital market remain unchanged. The agreement on the separation of nursing staff costs
well as the increasing acceptance and use of digital health In addition to inadequate income from current business, (‘‘Pflegepersonalabgrenzungsvereinbarung’’), which has
offerings. the need for capital expenditure continues to grow, while been in force since 2021, will remain in force until further
What is known as the change in value figure is crucial government subsidies are decreasing. Hospitals can only notice.
for the increase in reimbursement for hospital treatments close this gap to a limited extent on their own. In addition, the regulations on the binding minimum
in Germany. For 2022, it was set at 2.32%. In addition, the With regard to the financial support of hospitals in Ger- level for nursing staff will apply again in 2022. These reg-
hospital funding system provides for various increases and many, a surcharge for patients with COVID-19 has been in- ulations apply to nursing staff in hospitals in the following
reductions for acute hospitals. For additional services troduced. The surcharge applies to patients who test posi- areas: geriatrics, intensive care, cardiology, trauma sur-
agreed in advance with the health insurance companies, tive for COVID-19 on admission and who are admitted in gery, cardiac surgery, neurology, neurology / stroke unit,
hospitals have to accept what is known as the fixed-cost de- the period from November 1, 2021 to March 20, 2022. Fur- and early neurological rehabilitation, as well as internal
gression discount of up to 35%. The exact amount of the thermore, the legal amendment regulates an ordinance au- medicine, general surgery, pediatrics, and pediatric inten-
discount is negotiated between the hospitals and the health thorization for the Ministry of Health (‘‘BMG’’). The BMG sive care medicine. For the year 2022, the minimum level
insurance companies. can thus issue regulations on COVID-19-related revenue for nursing staff has been extended to the area of orthope-
In order to factor medical outcomes into the remunera- shortfalls by statutory order, i.e., without the approval of dics, gynecology and obstetrics. Binding minimum levels
tion, the Federal Joint Committee defines quality indicators. the parliament of federal state governments (‘‘Bundesrat’’). for nursing staff could also be introduced in other areas of
The specific financial terms and details are being worked The full-year Corona compensation has been extended for hospitals. However, there is currently no timetable for the
out in a consistent overall fashion. However, we do not ex- 2022. Although the details have not yet been agreed, it is implementation of these further regulations. In the coalition
pect any adverse effects from this since the Helios Group is likely that the 2021 schemes will be continued. agreement, the new German government agreed to intro-
well prepared for quality-based remuneration thanks to its Further measures to provide financial support to hospi- duce a defined measurement of the staffing levels accord-
clear focus on quality and transparency of medical out- tals in Germany in 2022 are not planned. The renewed ing to the hospitals’ need (Pflegepersonalregelung 2.0 or
comes. rapid increase in incidence rates, combined with a vaccina- PPR 2.0).
The future expectations for 2022 among German hos- tion rate that is still insufficient, may make it necessary to We expect the private hospital market in Spain to con-
pitals with respect to their economic situation are clearly extend the current regulation. It remains to be seen what tinue to grow by 2% to 3% in 2022. The continuing increase
negative: according to the Krankenhaus Barometer 2021 concrete measures the new German government will take. in the number of privately insured patients should also open
survey by the German Hospital Institute (DKI), only a fifth The Rheinisch-Westfälisches Institut für Wirtschafts- up opportunities for private operators in the future.
Annual Report 2021
(21%) of hospitals expect their economic situation to im- forschung (RWI) forecasts that more hospitals will respond Relevant indicators, for example nationwide health care
prove in 2022, whereas 50% expect it to worsen. to economic pressures by joining together into networks spending and bed density, indicate the further market de-
and bundling their services. The affiliated hospitals benefit velopment potential in the Spanish health care system com-
from synergy effects, including the possibility of generating pared with other EU countries.
Fresenius
1
In each case, most recent market data available refers to the year 2018 as no more recent data has been published: German Federal Statistical Office, 2018 data
Sources: Company research; German Hospital Institute (DKI), Krankenhaus Barometer 2020, Roland Berger Krankenhausstudie 2020, McKinsey & Company, eHealth Monitor 2020 91
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation Outlook | Opportunities and risk report
This also provides opportunities for the establishment of In the Central European markets with established health GROUP SALES AND EARNINGS
new hospitals. In addition, the highly fragmented private care systems, we expect solid growth and a continued rise Based on the anticipated positive contributions from the
Spanish hospital market offers further consolidation poten- in demand. This is due to demographic developments and cost and efficiency program as well as the attractive growth
tial. an increasing need for investment and modernization in opportunities across all business segments, Fresenius ex-
Key for the future viability of hospitals will increasingly public health care facilities that has also become apparent pects Group earnings growth to meaningfully accelerate
be the degree of digitalization. Interconnectivity and the as a result of the COVID-19 pandemic. Demand is particu- until 2023. The company hence confirms its medium-term
use of digital solutions open up new opportunities to make larly strong for services, i.e., the maintenance and repair of targets set in 2019 despite the ongoing challenges posed
processes safer and more efficient, and thus to break new medical and hospital technology, facility management, by COVID-19. At the same time, Fresenius specifies its ex-
ground in patient care. The integration of telemedicine and technical or overall operational management, and the opti- pectations and now anticipates Group organic sales growth
digital health applications in the inpatient setting could also mization of infrastructural processes --- especially within the to reach the bottom to middle of the targeted 4% to 7%
significantly expand hospital services in the future. framework of public-private partnership models. Additional compounded annual growth rate (CAGR) and Group or-
We expect the trend toward digitalization in health growth opportunities arise from the fact that public institu- ganic net income1,2 growth to be at the bottom end of the
care to continue and generally increase in importance. The tions are increasingly outsourcing non-medical services to 5% to 9% CAGR during 2020 to 2023. Due to the COVID-19
COVID-19 crisis has provided a decisive push, particularly private service providers due to increasing efficiency pres- pandemic, Fresenius now expects small and medium-sized
with regard to interest in and use of telemedicine. Experts sure. In addition, an expansion of the range of post-acute acquisitions to contribute an incremental CAGR of less than
assume that as people become more accustomed to the services in Europe is expected. 1% to both sales and net income growth.
new tools, acceptance of digital healthcare applications and In the emerging markets, we anticipate an overall dy-
services will increase on a broad scale and that the future namic development. Growth in markets such as Africa, GROUP FINANCIAL MEDIUM-TERM TARGETS
of medical care will be a hybrid mix of digital and personal Latin America, and southeast Asia will initially be driven by CAGR 2020 --- 20231
treatment. the demand for efficient, needs-oriented medical care. In Organic Bottom to middle of
The global market for fertility services is expected to China and the Middle East, growth will be driven by the de- sales growth the range of 4% --- 7%
Organic At the bottom of
grow between 10% and 15% in 2022, depending on the velopment of infrastructure and the creation of new care net income growth2 the range of 5% --- 9%
market, due to an anticipated pent-up demand brought services, as well as research and training facilities.
about by COVID-19, as well as demographic and health Further opportunities arise from the progress of digital- 1
Before special items
trends and changing lifestyles. ization. It is important to systematically exploit the oppor- 2
Net income attributable to shareholders of Fresenius SE & Co. KGaA
tunities it offers, for example in the establishment and op-
THE MARKET FOR PROJECTS AND SERVICES FOR eration of ‘‘virtual hospitals’’. These can make a decisive
HOSPITALS AND OTHER HEALTH CARE FACILITIES contribution to making state-of-the-art technology and
Annual Report 2021
For 2022, we expect a slight increase in demand for pro- medical expertise available at adequate cost. This goes
jects and services for hospitals and other health care facili- hand in hand with networking between health care systems
ties worldwide, depending on the further course of the at different levels of development in order to facilitate ac-
COVID-19 pandemic. cess to high-quality health care services for broad sections
of the population.
Fresenius
1
Before special items
2
Net income attributable to shareholders of Fresenius SE & Co. KGaA 92
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation Outlook | Opportunities and risk report
COVID-19 will continue to impact Fresenius’ operations in ► COVID-19 related accumulated excess mortality is as- SALES AND EARNINGS BY BUSINESS SEGMENT
2022. The extent of the impact on the Group is to a large sumed to impact operating income (EBIT) by €100 mil- In 2022, we expect sales and earnings development in our
degree dependent on the vaccination coverage in Frese- lion compared to the level of 2021 business segments as shown in the table below:
nius’ relevant markets and the potential evolution of new ► COVID-19 related staff shortages are anticipated not to
virus mutants. cause significant disruptions in production, distribu- FINANCIAL TARGETS BY BUSINESS SEGMENT 2022
Fresenius closely monitors the development of COVID-19 tion and dialysis operations Targets 20221 Fiscal year 20212
case numbers and the associated various containment ► Macro-economic inflation and supply chain costs to Fresenius Medical Care 3
measures enacted in the Company’s relevant markets. impact operating income (EBIT) by €50 million Low-to-mid
Sales growth single-digit
Fresenius expects COVID-19 case numbers to decline from ► Labor costs for 2022 are expected to be around €100 (in constant currency) percentage growth €17,619 m
spring 2022 onwards and consequently the number of elec- million in excess of the 3% base wage inflation as- Low-to-mid
tive treatments and staff availability to improve. A possible sumption Net income4 growth single-digit
(in constant currency) percentage growth €1,018 m
significant deterioration of the situation associated with ► Any potential further government support is assumed to Fresenius Kabi
further containment measures that could have a significant be applied to manage the unprecedented labor market Sales growth Low single-digit
(organic) percentage growth €7,193 m
and direct impact on the health care sector without any ap- situation to manage cost in excess of the above labor
Decline in
propriate compensation is not reflected in the Group’s costs assumption. high single- to
FY/22 guidance. ► FME25 savings are expected to contribute €40 to €70 EBIT growth low double-digit
(in constant currency) percentage range €1,153 m
Headwinds from cost inflation are reflected. However, million to operating income (EBIT) Fresenius Helios
Fresenius expects no significant acceleration of inflation ef- ► Remeasurement effects on the fair value of investments Sales growth Low-to-mid single-digit
(organic) percentage growth €10,891 m
fects and supply chain challenges versus current environ- are expected to be volatile but neutral on a full year basis
EBIT growth Mid single-digit
ment. In its FY/22 forecast, the Management Board as- (in constant currency) percentage growth €1,127 m
sumes an unchanged corporate tax rate in the United All of these assumptions are subject to considerable uncer- Fresenius Vamed
High single- to
States. tainty. Sales growth low double-digit
Furthermore, the following assumptions for Fresenius (organic) percentage growth €2,297 m
Medical Care's FY/22 guidance are also fully applicable to GROUP FINANCIAL TARGETS 2022 Returning to absolute
pre-COVID levels
the Fresenius Group's FY/22 guidance: Targets 20221 Fiscal year 20212
EBIT (2019: € 134 m) €101 m
Sales growth Mid single-digit
(in constant currency) percentage growth €37,520 m 1
Before special items, including expected COVID-19 effects
Net income3 growth Low single-digit 2
Before special items, including COVID-19 effects
Annual Report 2021
3
(in constant currency) percentage growth €1,867 m These targets are based on the 2021 results excluding the costs related to FME25 of €49 mil-
lion (for Net Income). They are based on the outlined assumptions, in constant currency and
Continue profit-driven Proposal exclude special items. Special items include further costs related to FME25 and other effects
Dividend dividend policy + 5% per share that are unusual in nature and have not been foreseeable or not foreseeable in size or impact at
the time of giving guidance.
4
Net income attributable to shareholders of Fresenius Medical Care AG & Co. KGaA
1
Before special items, including expected COVID-19 effects
2
Before special items, including COVID-19 effects
3
Net income attributable to shareholders of Fresenius SE & Co. KGaA
Fresenius
93
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation Outlook | Opportunities and risk report
EXPENSES LIQUIDITY AND CAPITAL MANAGEMENT At Fresenius Helios, we will primarily invest in the new
For 2022, we do not expect selling, general, and adminis- For 2022, we expect an operating cash flow margin in the buildings, and in the modernizing and equipping of existing
trative expenses (before special items) as a percentage of range of 10% to 12%. hospitals, newly acquired hospitals, and outpatient centers.
consolidated net sales to change significantly compared to In addition, undrawn credit lines under syndicated or Fresenius Vamed primarily invests in modernization as
2021 (2021: 14.1%). bilateral credit facilities from banks provide us with a suffi- well as equipment for existing post-acute care facilities.
cient financial headroom. With a share of around 60%, Europe is the regional fo-
COST AND EFFICIENCY PROGRAM Financing activities in 2022 are largely geared to refi- cus of investment in the planning period. Around 30% of
In 2021, Fresenius initiated a Group-wide cost and effi- nancing existing financial liabilities maturing in 2022 and the investments are planned for North America and around
ciency program to ensure that the medium-term targets set 2023. 10% for Asia-Pacific, Latin America, and Africa. About
before the pandemic are achieved and to sustainably in- Without further acquisitions, Fresenius projects an im- 30% of total funds will be invested in Germany.
crease profitability. These initiatives are expected to con- provement of the net debt / EBITDA1 ratio (December 31, For 2022, we assume that the return on operating as-
sist of operational excellence and cost-saving measures, 2021: 3,51×) into the self-imposed target corridor of 3.0 × sets (ROOA 2021: 6.5%) and the return on invested capital
targeted strengthening of future growth areas, and portfo- to 3.5 × by the end of 2022. (ROIC 2021: 5.9%) will remain on prior year level.
lio optimizations. There are no significant changes in the financing strat-
Given the good progress, especially driven by the accel- egy planned for 2022. CAPITAL STRUCTURE
erated implementation of initiatives, Fresenius significantly For 2022, we do not expect the equity ratio to change sig-
increases its savings target and now expects cost savings of INVESTMENTS nificantly compared to 2021 (2021: 41%). Furthermore, we
at least €150 million p.a. after tax and minority interest in In 2022, we expect to invest about 6% of sales in property, expect debt in relation to total assets to remain around the
2023. Initially, more than €100 million p.a. after tax and plant and equipment. About 45% of the capital expenditure prior year s level (2021: 38%).
minority interest were projected. For the years thereafter, a planned will be invested at Fresenius Medical Care, about
further significant increase in sustainable cost savings is 23% at Fresenius Kabi, and around 27% at Fresenius He- DIVIDEND
expected. The savings will be achieved by all four business lios. At Fresenius Medical Care, investments will primarily The dividend increases provided by Fresenius in the last 28
segments and the corporate center. be used for the expansion of production capacity, optimiz- years show impressive continuity. Our dividend policy aims
Fresenius anticipates that achieving these sustainable ing production costs, and the establishment of new dialysis to align dividends with earnings-per-share growth (before
efficiency improvements will require up-front expenses of clinics. special items). The payout ratio is expected to be in the
more than €200 million in 2022 and further expenses of Fresenius Kabi will primarily invest in expanding and range of approximately 20% to 25%. Fresenius intends to
around €100 million in 2023, in each case after taxes and maintaining production facilities, as well as in introducing increase the dividend for 2022.
minority interest. No further significant expenses are ex- new manufacturing technologies.
Annual Report 2021
pected thereafter. In line with previous practice, these ex-
penses are classified as special items.
Fresenius
1
At LTM average exchange rates for both net debt and EBITDA; pro forma closed acquisitions/divestitures; excluding further potential acquisitions; before special items 94
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
OPPORTUNITIES AND RISK REPORT business segments. As part of our strategic and operational The Management Board is responsible for the quality and
budgeting process, we identify and analyze short-, me- effectiveness of our risk management and internal control
We will continue to take advantage of the wide-ranging op- dium-, and long-term opportunities and risks. We discuss system. It is regularly monitored by the Supervisory
portunities for sustainable growth and expansion that the opportunities in the Outlook section starting on page 87. Board’s Audit Committee as well as audited by the Internal
health care market offers to the Fresenius Group. Audit department. The findings from these audits are used
At the same time, the Fresenius Group is exposed to a RISK MANAGEMENT to continuously advance our risk management and internal
number of risks when undertaking these activities due to FRESENIUS RISK MANAGEMENT SYSTEM control system.
the complexity and the dynamics of its business. These Risk management is a continuous process. The aim of risk The structure of the Fresenius risk management and in-
risks are inevitable consequences of entrepreneurial activ- management is to identify potential risks as early as possi- ternal control system is based on the internationally recog-
ity, because opportunities can only be exploited when ble in order to assess their impact on business and, if nec- nized framework for corporate risk management, the ‘‘En-
there is a willingness to take risks. essary, to take appropriate countermeasures. The ability to terprise Risk Management ‒ Integrated Framework’’ from
As a provider of products and services for the, to a large identify, assess, and manage risks that put the achievement the Committee of Sponsoring Organizations of the Tread-
extent, severely and chronically ill, we are relatively inde- of our business goals at risk is an important element of way Commission (COSO) and on the ‘‘Three Lines of De-
pendent of economic cycles. The diversification into four sound corporate governance. The Fresenius risk manage- fense’’ model of the Institute of Internal Auditors (IAA). The
business segments, which operate in different segments of ment and internal control system is therefore closely linked ‘‘Three Lines of Defense’’ model distinguishes between
the health care market, and the global footprint further to its corporate strategy. It explicitly takes into account all three essential roles within the risk management and inter-
minimize the Group’s risk profile. Our many years of expe- types of risk, including non-financial risks associated with nal control system as well as within the general governance
rience, as well as our regularly leading market position, our business activities or our business relationships, prod- system: While the ‘‘First Line of Defense’’ acts as a direct,
serve as a solid basis for achieving a realistic assessment of ucts, and services. In the reporting period, for example, we active participant in the risk management and internal con-
opportunities and risks. analyzed potential non-financial risks in the areas of cli- trol process, the ‘‘Second Line of Defense’’ at entity, seg-
mate change and water shortages. In both areas we identi- ment, and Group level and the ‘‘Third Line of Defense’’ in
OPPORTUNITIES MANAGEMENT fied no risks threatening to our business model. the form of the Internal Audit function each represent an
Managing opportunities is an ongoing, integral part of We consider short-, medium-, and long-term risks. For independent monitoring and quality assurance function in
corporate activity. To be successful over the long term, we example, we consider a period of 10 years and beyond the Fresenius Group’s governance system. The ‘‘Second
consolidate and improve on what we have already achieved when analyzing product development, investment and ac- Line of Defense’’ also sets guidelines and minimum re-
and create new opportunities. The Fresenius Group and its quisition decisions. Opportunities are not recorded in the quirements for the Group. On the basis of these guidelines,
business segments are organized and managed in a way risk management system. Group-wide standards are established and documented for
that enables us to identify and analyze trends, require- Due to the constantly changing external and internal re- the risk management and internal control system.
Annual Report 2021
ments, and opportunities in our often fragmented markets, quirements and environment, our risk management and in- In addition, the core principles of the risk culture and of
and to focus our actions accordingly. We maintain regular ternal control system is being continuously developed. In the risk strategy are defined and integrated into the busi-
contact and dialog with research groups and scientific insti- the past fiscal year, for example, the risk management and ness processes.
tutions to explore new prospects, and keep a close watch internal control systems were linked even more closely.
on markets and competitors in order to identify opportuni- The completeness and validity of the risk information
Fresenius
ties. Within the Group, opportunities and synergies can be within our risk management approach was also strength-
exploited through continuous communication involving the ened by applying a newly defined concept for analyzing our
exchange of information and know-how between the risk-bearing capacity and our aggregated risk position.
95
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
The organization and responsibilities of the risk manage-
ment process and process control are defined as follows:
► The business segments and their operational business
units are responsible for identifying, assessing, and
managing risks.
► The managers of each organizational unit are required
to report any relevant changes in the risk profile to the
Management Board without delay.
► A dedicated Risk Management function at Group level
defines standards valid for the entire Group and sup-
ports and monitors risk management and internal con-
trol system structures and processes. Specialized sub-
departments have been set up within this Group func-
tion.
► The Group function is supplemented by risk manage-
ment functions at segment or entity level. The tasks
and responsibilities between the different organiza-
tional levels are clearly defined and documented.
► A Risk Steering Committee chaired by the Member of
the Management Board for Human Resources (Labor
Relations Director), Risk Management, and Legal is an
advisory body that discusses internal and external de- ► The Supervisory Board’s Audit Committee monitors In addition to risk reporting, regular financial reporting to
velopments regarding the risk management and inter- the quality and effectiveness of the risk management management is an important tool for managing and con-
nal control system. In addition, the Risk Steering Com- and internal control system. trolling risks. Detailed monthly and quarterly reports are
mittee advises on significant risks and prepares deci- used to identify and analyze deviations of actual versus
sion proposals for the Fresenius Management Board. The risk situation is evaluated regularly and compared with planned business development. In addition, the risk man-
The Management Board of the Fresenius Group has specified requirements using standardized processes. If rel- agement and internal control system includes organiza-
Annual Report 2021
the overall responsibility for effective risk management evant changes to the risk profile or new risks arise between tional processes and safeguards, as well as internal con-
and regularly discusses the current risk situation. the regular reporting cycles, these are recorded and evalu- trols and audits incorporated in our business processes,
Within the Fresenius Group Management Board, the ated as part of ad hoc reporting process. Should negative which help us to identify significant risks at an early stage
Member of the Management Board for Human Re- trends arise, we can then take countermeasures at an early and to counteract them.
sources (Labor Relations Director), Risk Management, stage.
Fresenius
and Legal is responsible for the risk management and
internal control system, as well as their organization.
96
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
RISK ASSESSMENT AND CAPACITY TO BEAR RISK As part of this process, the potential impact on our busi- integrating the various management systems into the inter-
Fresenius uses standardized processes to assess risks. ness, financial position, and operational result is usually as- nal control system in a holistic manner.
These include both quantitative and qualitative valuation sessed on a three-point basis, namely the impact in the The risk management and internal control system is
methods. The assessment of a risk takes into account its best-case, the realistic, and the worst-case scenario. regularly reviewed by the Management Board, the Supervi-
likelihood of occurrence, its potential impact on our busi- The risk matrix on page 98 shows the significant risks sory Board’s Audit Committee, and the Internal Audit de-
ness, financial position, and operational result, and the time that could lead to deviations from the expected business partment. Moreover, the external auditor reviews whether
horizon. Fresenius assesses the potential impact on the re- performance within the one-year forecast period. Since the the monitoring system set up by the Management Board is
sults of operations on the basis of the key figure EBIT-at- past fiscal year, significant risks have been categorized suitable for the early identification of risks that would jeop-
risk. The risks are presented taking into account already in- within this four-tier risk matrix taking into account the like- ardize the continued existence of the Company.
itiated and implemented countermeasures (net assessment lihood of occurrence and the potential impact on our busi- Fresenius has ensured that the organizational structure
of risks). Risks are evaluated for a period of 12 months in ness, financial position, and operational result. and systems for identifying, assessing, and controlling
order to assess the impact of the risk situation on the one- On the basis of the quantitative risk assessment, the risks, and for developing countermeasures, are designed
year forecast for the Fresenius Group. In addition, potential overall risk position is determined at Group level by means appropriately and that they are properly functional. How-
risks with an impact on the medium-term plan are analyzed of a Monte-Carlo Simulation. This involves taking correla- ever, there can be no absolute certainty that this will enable
and estimated. tions and dependencies between risks into account. The us to fully identify and manage all risks.
Fresenius categorizes the likelihood of occurrence of a calculated overall risk position is compared to the Group’s
risk as follows: risk-bearing capacity. The risk-bearing capacity represents Internal financial reporting controls
the maximum acceptable level of risks beyond which the Fresenius employs numerous measures and internal con-
Probability Classification continued existence of the Fresenius Group could be jeop- trols to ensure that accounting processes are reliable and
Almost certain ≥ 90%
ardized. Fresenius determines its risk-bearing capacity on that financial reporting is correct, including the preparation
Probable ≥ 50 to < 90%
Possible ≥ 10 to < 50% the basis of selected key balance sheet figures, such as the of annual financial statements, consolidated financial state-
Unlikely < 10% liquidity reserve, and rating-related key figures of the ments, and management reports in compliance with appli-
Group, such as the leverage ratio. The overall risk position cable regulations and principles. Our four-tier reporting
is fully covered by the risk-bearing capacity of the Frese- process especially promotes intensive discussion and en-
The following overview shows how the potential impact on
nius Group. sures control of the financial results. At each reporting level,
our business, financial position, and operational result is
i.e.,
classified:
INTERNAL CONTROL SYSTEM AS PART OF THE RISK
MANAGEMENT SYSTEM ► the local entity,
Annual Report 2021
Potential impact Classification
The internal control system is an important part of Frese- ► the region,
Severe Significant negative impact
Significant Considerable negative impact nius’ risk management. In addition to internal controls with ► the business segment, and
Moderate Moderate negative impact regard to the financial reporting, it includes control objec- ► the Group,
Low Low negative impact
tives for further critical processes, such as quality manage-
ment and patient safety, cybersecurity and data protection, financial data and key figures are reported, discussed, and
Fresenius
and sustainability. Fresenius has documented relevant criti- compared with the prior-year figures, budget, and latest
cal control objectives in a Group-wide framework, forecast on a monthly basis.
97
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
In addition, all parameters, assumptions, and estimates that ASSESSMENT OF THE OVERALL RISK
are of relevance for the externally reported Group and seg- SITUATION
ment results are discussed intensively with the department The established risk management and internal control sys-
responsible for preparing the Group’s consolidated finan- tem is fundamental for assessing the overall risk position of
cial statements. These matters are also reviewed and dis- the Fresenius Group. Potential risks for Fresenius include
cussed quarterly by the Supervisory Board’s Audit Com- factors beyond our direct control. These also include the
mittee. macroeconomic development, which we constantly moni-
Control mechanisms, such as automated and manual tor. They also include factors immediately within our con-
reconciliation processes, are further precautions put in trol, such as operating risks, which we anticipate at as early
place to ensure that financial reporting is reliable and that a stage as possible and to which we react with appropriate
transactions are correctly accounted for. All consolidated countermeasures, as required.
entities report according to Group-wide standards, which In synopsis, there are currently no recognizable risks
are determined at the head office. These are regularly ad- that appear to present a long-term and significant threat to
justed to allow for changes made to the accounting regula- the Fresenius Group’s business, financial position, and op-
tions. The consolidation proposals are supported by the IT erational result.
system. In this context, internal Group balances, among We have created organizational structures that provide
other things, are reconciled in a comprehensive manner. all the conditions needed to rapidly alert us to possible risk
To prevent abuse, we take care to maintain a strict separa- situations and enable us to take suitable countermeasures.
tion of functions. Monitoring and assessments carried out
by management also help to ensure that risks with a direct RISKS AFFECTING THE ONE-YEAR FORECAST
impact on financial reporting are identified and that con- PERIOD
trols are in place to minimize them. Moreover, changes in The chart besides shows the significant risks that could
accounting principles are closely monitored and employees lead to deviations from the expected business performance
Compared with the previous year, the matrix was expanded
involved in financial reporting are instructed regularly and within the one-year forecast period. to four instead of three dimensions for probability of occur-
comprehensively. External experts and specialists are en-
rence and potential impact. Based on our quantitative anal-
gaged if necessary. The Treasury, Tax, Controlling, and Le-
ysis, risks relating to competition and innovation, as well as
gal departments are involved in supporting the preparation loss of receivables and data privacy, were newly included.
of the financial statements. Finally, the information pro-
Annual Report 2021
In addition, the potential impact of IT and cybersecurity
vided is verified once more by the department responsible
risks and procurement risks has been increased. The poten-
for preparing the consolidated financial statements. tial impact of compliance risks, risks relating to the regula-
Fresenius Medical Care is also subject to the controls of
tory environment, and currency and interest rate risks de-
Section 404 of the Sarbanes-Oxley Act.
creased.
Fresenius
98
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
RISKS WITH EFFECTS ON OUR MEDIUM-TERM Moreover, Fresenius is affected only to a small extent by Negative effects on our business could be caused, for ex-
GOALS general economic fluctuations. We expect demand for our ample, by a continued or increasing higher excess mortal-
Fundamentally, all the risk areas and risks listed in the Risk life-saving and life-sustaining products and services to con- ity among our dialysis patients, and by restrictions on the
Report could lead to us failing to achieve our medium-term tinue to grow. business activities of our suppliers, customers, and our-
goals. We believe the following will be of particular signifi- Furthermore, Fresenius is striving for balanced distribution selves, including our personnel, resulting from regulatory
cance in this respect: of its business in the main global regions and between es- requirements, orders, and conditions at regional, national,
tablished and emerging markets. The risk situation for each or international level. The unavailability of critical staff, in-
► Risks relating to the quality, safety, and effectiveness business segment depends in particular on the develop- creased costs, for example from protective measures in our
of our products and services (see Operating risks, page ment of their respective relevant markets. Country-specific dialysis clinics, hospitals, and production sites, and a sig-
104 ff.); political, legal, and financial conditions are therefore moni- nificant diversion of public health funding away from our
► Risks arising from the financing of health care systems tored and evaluated carefully, particularly in the current products and services to address the COVID-19 pandemic
and potential changes to reimbursement systems (see macroeconomic environment. This applies, for example, to could also negatively impact our business. Additionally, in-
Risks in the health care sector, page 101 ff.); countries with budget problems as a result of their debt flationary cost increases may have an unfavorable effect on
► Risks arising from the regulatory environment and burden, in particular with regard to our accounts receivable. our business, especially if the prices for our products and
compliance with laws and regulations (see General This also applies to any initiatives taken by govern- services remain unchanged or do not adequately track
economic risks and risks in the general operating ments with regard to potential changes to current health against cost increases.
framework, page 99 ff.); care programs. In response to the COVID-19 pandemic, various govern-
► Risks arising from the medium- and long-term effects And this holds true in particular for current develop- ments in regions in which we operate have launched eco-
of the COVID-19 pandemic, such as changes in de- ments related to the COVID-19 pandemic. nomic support programs to address the impact of the pan-
mand and cost base (see Risks related to the COVID-19 demic on businesses and to support health care providers
pandemic, page 99 ff.); RISKS RELATED TO THE COVID-19 PANDEMIC and patients. For example, the Coronavirus Aid, Relief, and
► Risks relating to information technology and cyber se- The rapid spread of the COVID-19 pandemic and the Economic Security Act (CARES Act) was passed in the
curity (see Risks relating to information technology measures taken to contain it have led to a significant deteri- United States to mitigate the negative financial impacts of
and cyber security, page 110 f.). oration in economic conditions worldwide, and financial the COVID-19 pandemic, including on the health care sec-
markets have been significantly impacted. This develop- tor. Additional funds provided under the CARES Act, as
RISK AREAS ment also had a negative impact on our business, financial well as other COVID-19-related assistance funds, are
OVERALL ECONOMIC RISKS AND RISKS DUE TO THE position, and operational results in the fiscal year 2021. We providing some financial support to our businesses.
OPERATING FRAMEWORK anticipate further negative effects on our business, financial
Annual Report 2021
At present, despite the COVID-19 pandemic, no trends in position and operational results in 2022. The COVID-19
the global economy present a going-concern risk to the pandemic may also continue to have a negative impact on
Fresenius Group. Depending on how the pandemic devel- our financial position, liquidity, and the recoverability of
ops, we expect the global economy to continue to recover our assets, including goodwill. The pandemic poses signifi-
in the fiscal year 2022. cant risks to the health of our patients, as well as to our
Fresenius
supply chains, our production, the sale of our products, and
the provision of our services.
99
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
For example, the 2% cut in Medicare benefits was sus- The COVID-19 pandemic had a different impact on our hos- In addition, travel restrictions had a significant negative im-
pended several times from May 2020 to March 2022, Medi- pitals in Germany, Spain, and Latin America, as well as on pact on the number of international (private) patients in
care reimbursements were paid more quickly and in ad- the Eugin fertility clinics. Germany and Spain. Overall, this may continue to have a
vance, and grants were approved to cover costs and miti- The impact of the pandemic varied depending on the negative impact on our net assets, financial position, and
gate revenue losses related to the Covid 19 pandemic. In outbreak in the different regions and the respective virus results of operations. We expect the negative effects of the
addition, companies in which we have less than 100% variant. Helios Germany was severely affected in the first COVID-19 pandemic to continue in the fiscal year 2022.
ownership received financial assistance from the U.S. De- quarter of 2021 due to the pronounced third wave of Fresenius Vamed also experienced and continues to ex-
partment of Health and Human Services in the fourth quar- COVID-19. Due to the high number of COVID-19 cases, perience significant delays and additional costs due to the
ter of 2021 (Provider Relief Fund Phase 4). elective treatments had to be postponed in some hospitals. COVID-19 pandemic in its project business as a result of
However, these measures may not fully offset losses As a result of the heavy COVID-19 burden, the rescue pack- travel restrictions, interrupted supply chains, delayed pro-
and increased costs. And while many of these measures are age for hospitals was extended by the German Federal Min- ject execution, and imposed construction stops.
only in effect for the duration of the public health emer- istry of Health (‘‘BMG’’) until June 15, 2021. The extent of the impacts described on all business seg-
gency, it is possible that some of these temporary measures The ‘‘Ordinance on the Regulation of Further Measures ments of the Fresenius Group depends on the progress of
could result in long-term changes that could affect, in par- for the Economic Safeguarding of Hospitals’’ enables a full- the vaccination campaigns as well as the duration of the
ticular, Fresenius Medical Care’s business, financial posi- year compensation for hospitals, for which 98% of the rev- COVID-19 pandemic and the measures required to contain
tion, and operational results in ways that cannot be quanti- enues of the year 2019 were used as a benchmark. 85% of it. In particular, the emerging variants of the virus increase
fied or predicted at this time. the hospitals' revenue shortfall was eventually refinanced in uncertainty about how the pandemic will continue to de-
Fresenius Medical Care experienced increased mortal- 2021. However, the negative impact of the pandemic could velop.
ity rates among dialysis patients compared to the historical not be fully offset in some hospitals by the rescue package We have continued to demonstrate our particular re-
average, which could continue to have a material adverse and reimbursements for COVID-19 in Germany. In Spain, sponsibility as part of the health care system during the
effect on our operational result in 2022 and beyond. Dialy- the third wave was milder compared to the previous ones challenging time of the current COVID-19 pandemic. For
sis patients typically have comorbidities, which has led and and opened up some opportunities such as coronavirus example, our dialysis clinics and hospitals have taken ex-
could continue to lead to an increased need for inpatient testing for the occupational health sector. tensive measures to ensure that patients receive the most
care for these patients. In addition, it appears that COVID-19 In addition, COVID-19 pandemic measures, such as the seamless care possible. Fresenius Kabi has responded to
has led to an increase in individuals with acute renal fail- minimum distance of 1.5 meters between hospital beds for the significantly increased global demand for important
ure. We expect to face continued staffing shortages as well infection control, continued in 2021 and will remain in drugs and infusion technology to treat COVID-19 patients,
as additional staffing costs to meet the increased demand place in 2022. particularly for sedative drugs such as propofol, analgesics,
for dialysis treatments and to provide equipment and our and infusion pumps. We have thus maximized the supply
Annual Report 2021
medical staff for emergency treatments, such as in hospi- using all the appropriate manufacturing capacities dedi-
tals. cated to these important products.
Fresenius
100
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
RISKS IN THE HEALTH CARE SECTOR Changes in legislation or reimbursement practices, such as Through value- and risk-based agreements and risk care
Risks related to changes in the health care market are of those relating to the End-Stage Renal Disease (ESRD) Pro- programs, Fresenius Medical Care assumes the risk of both
major importance to the Fresenius Group. The main risks spective Payment System (PPS), physician and clinical la- medical and administrative costs for certain patients in re-
are the financing of health care systems and the corre- boratory fee schedules, and the billing system for ambula- turn for fixed periodic payments or set benchmark targets
sponding reimbursement systems, as well as the develop- tory surgical clinics, could affect both the level of Medicare from governmental and commercial insurers:
ment of new products and therapies. and Medicaid reimbursement for services and the level of
insurance coverage. ► The CMS Comprehensive ESRD Care Model allows di-
Financing of health care systems and A reduction in reimbursement rates, reimbursed ser- alysis providers and physicians to form ESRD Seamless
reimbursement systems vices or changes in standards, regulations and government Care Organizations (ESCOs) that seek to deliver better
In our extensively regulated business environment, funding in countries in which we operate could adversely health outcomes for ESRD patients with chronic kidney
changes in the law --- also with respect to reimbursement affect our revenue and profitability and have a material ad- failure while lowering the CMS’ costs. ESCOs that
of costs --- can have a major impact on our business success. verse effect on our business, financial position and opera- achieve the program’s minimum quality requirements
National insurance systems are financed in very differ- tional result. and generate reductions in treatment costs for the
ent ways. For example, health care systems in Europe and Based on the ‘‘Budget Control Act’’ of 2011, reimburse- CMS above certain threshold values will receive a
in the British Commonwealth countries are generally based ment by Medicare for dialysis treatment is provided under share of the cost savings. However, ESCOs are also
on one of two financing models: Systems with a mandatory a prospective payment system (PPS), which bundles par- obliged to share the risk of cost increases and to reim-
employer and employee contribution and systems predomi- ticular products and services into one reimbursement rate. burse the CMS for some of these increases. This model
nantly financed through taxes. Due to pressure to reduce health care costs, increases in ended March 31, 2021.
In the Asia-Pacific region, universal health care (UHC) the reimbursement rate by the U.S. government have been ► The treatment choices model for patients with chronic
is at different stages of implementation, so reimbursement limited. kidney failure (‘‘ESRD Treatment Choices Model’’ ---
mechanisms can vary significantly from country to country As part of the PPS, our dialysis clinics in the United ETC model) launched on January 1, 2021. This is a
(and even from province to province and city to city). In States participate in the Quality Improvement Program mandatory model that provides financial incentives for
Latin America, health care systems are funded by public or (QIP). Medicare reimbursement benefits can be reduced by home dialysis treatments and transplants. This model
private payers, or a combination of both. Due to the high up to 2% based on the previous year’s benefits if clinics do is scheduled to be in place from January 2021 to June
percentage of Group sales that the U.S. market accounts not meet the quality standards of the QIP. Underlying qual- 2026. The ETC model consists of two partial reim-
for, changes to the state reimbursement system, such as ity measures are reviewed, extended, and amended annu- bursement programs: first, it includes increases in the
reimbursements for dialysis treatments, can be particularly ally by the CMS. A material failure by Fresenius Medical three-year reimbursement offset for home dialysis
significant for our business. For example, in 2021, approxi- Care to achieve the minimum client quality standards under treatments, and second, it includes a performance-
Annual Report 2021
mately 27% of Fresenius Medical Care’s global sales were the QIP could materially and adversely affect our business, based reimbursement offset for all dialysis claims. The
attributable to reimbursements from the U.S. federal health financial condition, and results of operations. model applies both positive and negative payment ad-
care benefit programs the Centers of Medicare and Medi- justments to claims submitted by physicians and dialy-
caid Services (CMS). sis facilities for dialysis patients. It applies to dialysis
facilities and physicians in certain randomly selected
Fresenius
geographic regions. About 35% of Fresenius Medical
Care’s U.S. dialysis clinics are participating in the
model.
101
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
► Voluntary Medicare reimbursement models, such as Inadequate pricing of products or an unsuitable cost esti- In 2017, the U.S. administration announced its decision to
Comprehensive Kidney Care Contracting (CKCC), are mate for the service portfolio for beneficiaries and ineffec- end subsidies, known as cost-sharing reduction (CSR) pay-
designed to provide financial incentives for health care tive cost management may have a material adverse effect ments, to health insurance companies to help pay out-of-
providers in the area of chronic kidney disease and on our financial position, net assets, and operational re- pocket costs of low-income Americans. Some private insur-
transplants. Health care providers can take on financial sults. ers have stated that they will need much higher premiums
risks to varying degrees by forming a Kidney Care En- Fresenius Medical Care mitigated the impact of the PPS and may withdraw from the insurance exchanges created
tity (KCE). This entity assumes responsibility for the and the additional above-referenced reimbursement mod- under the Affordable Care Act if the subsidies were elimi-
overall cost and quality of care for Medicare patients els by two broad measures: nated. It is not possible to predict the outcome of ongoing
with stage 4 and 5 chronic kidney failure and Medicare litigation on this matter. As a result, significant increases in
patients with end-stage renal disease. The implementa- ► First, Fresenius Medical Care works with medical di- insurance premiums and a reduction in the availability of
tion period for the CKCC model began on October 15, rectors and treating physicians to generate options for insurance through such insurance exchanges established
2020, on a no-risk basis, and we began participation in efficiency increases consistent with QIP and good clini- by the ACA could reduce the number of Fresenius Medical
the first performance year of the CKCC model on Janu- cal practice and negotiates cost savings on the pur- Care’s privately insured patients and shift such patients to
ary 1, 2022, at which time each participating entity chasing of pharmaceuticals. Medicare and Medicaid. Because Medicare and Medicaid
starts to assume financial risk. We do not yet know ► Second, Fresenius Medical Care introduces new initia- reimbursement rates are generally lower than the reim-
whether we and our partners will be able to deliver tives in order to achieve efficiency increases and better bursement rates paid by private insurers, a shift of privately
better health outcomes while lowering CMS’ costs. patient outcomes by increasing care upon initiation of insured patients to Medicare and Medicaid could have a
► In addition, Fresenius Medical Care has entered into dialysis, increasing the percentage of patients using material adverse impact on the results of operations of
per capita sub-capitations and risk-based and value- home dialysis, and generating additional cost reduc- Fresenius Medical Care.
based agreements with certain insurers to provide tions in its clinics. Further requirements for dialysis clinics and changes in
health care to private and Medicare Advantage patients reimbursement from government and private insurers for
with end-stage renal disease. These agreements pro- The previous U.S. government had announced its intention our entire product and service portfolio in the United States
vide for the establishment of a basic amount per pa- to make significant changes to existing health care pro- could have a material adverse effect on our business and
tient per month. If we provide complete care at costs grams, including new remuneration models to promote operating results. For example, the ballot initiatives intro-
below the basic amount, we retain the difference. earlier detection and treatment of kidney disease, as well as duced at the state level could result in further regulation of
However, if the costs of complete care exceed the increasing home dialysis and transplants. Efforts to repeal clinic staffing requirements, state inspection requirements,
basic amount, we may be obliged to pay the difference or replace the ‘‘Affordable Care Act’’ (ACA) have not been and a cap on private insurer margins. Such additional state
to the insurer. successful and the current U.S. administration has an- regulations would increase the cost of operating dialysis
Annual Report 2021
nounced its intention to continue and expand ACA. In addi- clinics and create additional costs. This could have a mate-
tion, options to restructure the Medicare program in the di- rial adverse effect on our business in the affected states.
rection of a defined-contribution, ‘‘premium support’’
model and to shift Medicaid funding to a block grant or per
capita arrangement, with greater flexibility for the states,
Fresenius
are also being considered.
102
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
A portion of dialysis treatments in the United States is re- In addition, the health care insurance industry is experienc- The allocation of nursing staff to the nursing budget was
imbursed by private insurance companies and managed ing continuing consolidation among insurers and pharmacy adjusted to the current definitions of ’’nursing specialist’’
care organizations, with reimbursements generally higher benefit managers, including increasing buyer power and and ’’nursing assistant’’ or ’’other professions’’ in the Nurs-
than the reimbursements provided by the government impacts on referral streams. This may have an adverse im- ing Staff Lower Limits Ordinance (PpUGV).
health care program. As a result, payments from private pact on our ability to negotiate favorable coverage terms For the 2021 nursing budget, the personnel costs of the
health insurers contribute a significant portion to Fresenius and commercially reasonable rates with such insurers. We following occupational groups were fully included in the
Medical Care’s profits. In 2021, approximately 40% of monitor the relationships with private health insurance nursing budget: Nursing professionals and nursing assis-
Fresenius Medical Care’s sales from health care services in companies continuously and try to hedge the business tants (nursing assistant, physician assistant, anesthesia
the North American segment were attributable to private through long-term contracts to maintain profitability. technical assistant, emergency paramedic, or nursing and
health insurance companies. If these organizations in the Changes in reimbursement from government and private geriatric care assistant).
United States manage to push through a reduction in the insurers for our entire product and service portfolio in the The digital or technical measures that reduce or sup-
reimbursements, or the share of reimbursements by private United States could have a material adverse effect on our port nursing activities were included in the nursing budget
health insurers decreases, it would significantly reduce the business and operating results. (4 es total nursing budget).
sales revenues and operating earnings for the products and The same applies to the hospital market in Germany, In the German market, Helios Germany sees a general
services of Fresenius Medical Care. Beginning January 1, where the DRG (Diagnosis-Related Groups) system is in- trend towards outpatient treatment, which could lead to
2021, all ESRD patients will be eligible to enroll in Medi- tended to increase the efficiency of hospitals while reduc- lower growth in the number of inpatient cases. In response
care Advantage plans for the first time. As a result, formerly ing health care spending. Patients are largely assigned to to this trend, Helios Germany is expanding outpatient ser-
privately insured patients may opt for Medi-care Advantage hospitals by the public health and pension insurers. It is vices offerings in a separate division. If Helios Germany
plans, which generally provide lower reimbursement pay- therefore important for Helios Germany that the contracts does not succeed in sustainably adapting its business
ments than private payers. between its hospitals and the insurers and health care insti- model through suitable measures, this could lead to a de-
A portion of Fresenius Medical Care’s patients who are tutions are maintained. We not only monitor legislative cline in the number of cases and have a material adverse
currently covered by private insurers may elect to transition changes intensively, but also work together with govern- effect on our business and results of operations.
to government-funded reimbursement programs that reim- mental health care institutions. Quirónsalud, our private chain of clinics in Spain, oper-
burse us at lower rates for our services if efforts to restrict As part of the Nursing Staff Strengthening Act (PpSG), ates hospitals through PPP contracts (public-private part-
or eliminate the charitable funding of patient insurance nursing costs were removed from the flat rates per case nership), among other methods. These are part of the pub-
premiums are successful. (DRG) from 2020 and the costs of patient-centered care lic health system in Spain. The company has thus been
were fully reimbursed by the health insurance funds via given responsibility in certain areas of health care for the
separate nursing budgets. As early as 2021, every addi- citizens of Spain with statutory health insurance. Quirónsalud
Annual Report 2021
tional or increased bedside nursing position was fully re- receives compensation for its services in the form of a per
financed by the payers and the inclusion criteria of the capita lump sum or remuneration for the specific service
nursing budget were changed. rendered.
As negotiations with the payers on the care budgets for
2020 and 2021 have largely not yet been concluded, this
Fresenius
poses a potential risk to Fresenius Group’s business, finan-
cial position, and result.
103
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
If Quirónsalud were to lose the concession to operate hos- Operating risks ► Compensation of medical personnel and financial ar-
pitals with PPP contracts or renegotiations with public or Our operational business around the world is exposed to a rangements with physicians and establishments that
private insurance companies resulted in worse conditions number of risks and extensive government regulation, arrange patient referrals;
for doing so, or if hospitals are not able to compensate for which include, among others: ► Access to collection, publication, use, and security of
lower reimbursement rates by cutting costs, this could have health-related information and other protected data;
a material adverse effect on our net assets, financial posi- ► The quality, safety, and efficacy of medical and phar- ► Limitation of our ability to make acquisitions or certain
tion, and results of operations. maceutical products, supplies, and therapies; investments and the conditions for transactions of this
Reductions in health care spending could also nega- ► The operation and licensing of hospitals, other health nature.
tively affect the pricing of Fresenius Kabi products. care facilities, manufacturing facilities, and laboratories;
Changes in the law, the reimbursement method, and the ► The planning, construction, equipping, and manage- If Fresenius fails to comply with laws or regulations, this
health care programs could affect the scope of payments ment of pharmaceutical and medical-technological may give rise to a number of consequences, including mon-
for services, as well as the scope of insurance coverage and production facilities; etary penalties, increased compliance costs, exclusion from
the product business. This could have a significant adverse ► The planning, construction, equipping and manage- governmental reimbursement programs, or a complete or
impact on our business operations as well as net assets, fi- ment of health care facilities; partial curtailment of our authorization to conduct busi-
nancial position, and results of operations. Generally, our ► Permits from public authorities and monitoring of clini- ness, any of which could have a material adverse effect on
aim is to counter such possible regulatory risks through en- cal and non-clinical research and development activities; our business reputation, net assets, financial condition, or
hanced performance and cost reductions. ► Product approvals and regulatory approvals for new results of operations. Significant risks of operations for the
products and product modifications; Fresenius Group are described in the following sections.
Development of new products and therapies ► Audits and reviews by enforcement authorities of com-
The introduction of new products and services, or the de- pliance with applicable pharmaceutical legislation;
velopment of advanced technologies by competitors, could ► Compliance with due diligence obligations, warranty
render one or more of our products and services less com- obligations, and product liability regulations;
petitive or even obsolete, and thus have a significant nega- ► The accurate reporting of and billing for reimburse-
tive impact on future sales, the prices of products, and our ments by government and private insurers;
range of services. This includes the introduction of generic ► Discounting reimbursable pharmaceutical and medical
or patented drugs by competitors, which may have an im- device products and reporting drug prices to govern-
pact on sales and operational results. Cooperation with ment agencies;
medical doctors and scientists allows us to identify and ► The labeling and designation of pharmaceutical prod-
Annual Report 2021
support relevant technological innovations. This means we ucts and their marketing;
are always able to keep abreast of current developments in ► Attracting qualified personnel;
alternative treatment methods so that we are able to evalu-
ate and, if necessary, adjust our corporate strategy.
Fresenius
104
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
Production, products, and services Global safety officers react promptly as soon as Fresenius Providing medical services in our hospitals, rehabilitation
Compliance with product specifications and manufactur- becomes aware of a quality-related issue. They initiate and clinics, and dialysis clinics is generally subject to inherent
ing regulations is ensured by our quality management sys- coordinate necessary actions on a global level, such as risks. For example, disruptions to processes, also due to
tems, which are structured in accordance with the interna- product recalls. With its early warning system, Fresenius causes such as natural disasters or technical failures, in-
tionally recognized quality standards ISO 9001 and ISO evaluates any quality-related information from various risk volve risks for patients and the clinic. In addition, there are
13485 and take into account relevant international and na- areas to identify risks at an early stage and take corrective operational risks, for example regarding hygiene. We coun-
tional regulations. We implement them by means of inter- and preventive actions. For this purpose, Fresenius Kabi teract these risks with strict operating procedures, contin-
nal standards such as quality and work procedure manuals. uses databases in which complaints and side effects are ual personnel training, and patient-oriented work proce-
Regular internal and external audits are carried out at the logged, internal and external audits, and key performance dures. At Fresenius Helios, for example, a structured hy-
Group’s production sites, distribution companies, and dial- indicators used for internal control purposes and the opti- giene management system is in place to ensure that infec-
ysis clinics to check compliance. This covers all require- mization of quality processes. In this way, safety profiles of tions within the hospital are avoided and their spread pre-
ments and regulations, from management and administra- the products can be created and evaluated worldwide. vented as quickly as possible. Furthermore, we are con-
tion to production and clinical services, right through to pa- Product recalls, for example, are initiated as a risk-minimiz- stantly striving to improve the standard of patient treatment
tient satisfaction. ing measure in cooperation with the responsible regulatory through our quality management systems.
Our production facilities comply with the Good Manufactur- authority; at the same time, the cause of the recall is ana- Performance risks associated with Fresenius Vamed’s
ing Practice (GMP) requirements of the markets they sup- lyzed thoroughly. Corrective action may be taken to avoid project business are countered through professional pro-
ply. Our facilities are audited by local public health authori- the circumstances that led to the recall occurring again in ject management and control and with a proven system tai-
ties such as the U.S. Food and Drug Administration (FDA) the future. lored to each business activity for identifying, evaluating,
or the European Medicines Agency (EMA) and other au- In addition, changes made to requirements and regula- and minimizing these risks. This system consists of organi-
thorities. If an authority identifies any deficiencies, Frese- tions by regulatory authorities, such as those affecting our zational measures, such as standards for pricing in risks
nius will immediately take comprehensive and appropriate production processes, can lead to lower production vol- when preparing quotations. Risks are assessed even before
rectifying measures. umes during any transitional period or jeopardize produc- accepting orders and are subsequently updated during reg-
Non-compliance with the requirements of these authori- tion. ular project controlling. To avert the risk of default, the sys-
ties in our production facilities or at our suppliers could Production could also be adversely affected by events tem also includes financial measures, such as checking cre-
lead to regulatory actions, such as warning letters, product such as natural disasters, infrastructure disruptions, regula- ditworthiness and, as a rule, safeguarding through prepay-
recalls, production interruptions, monetary sanctions, or tory rulings, supply disruptions, such as of raw materials, ments, letters of credit, and secured credits.
delays in new product approvals. Any of these regulatory or technical failures. To minimize these risks, stocks are Further information about our quality management pro-
actions could adversely affect our business reputation and built up, for example to bridge any gaps in the event of cesses can be found in the separate Group Non-financial
Annual Report 2021
our ability to generate sales and result in significant ex- short-term problems. Report from page 127 onward.
penses. Potential risks arising from the start-up of new produc-
tion sites or the introduction of new technologies are coun-
tered through careful planning, regular analysis, and con-
tinual progress reviews.
Fresenius
105
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
Procurement affect the future pricing and sale of our products and ser- Similar developments with regard to price pressure in the
In the procurement sector, potential risks arise mainly from vices. tender business and increasing competition and price re-
price increases or the lack of availability of raw materials Growing competition, among other things induced by ductions are affecting our business in all major markets in
and goods, as we saw in the wake of the COVID-19 pan- the recovery of some notable competitors, in particular in Asia. In China, two Fresenius Kabi products were success-
demic in the 2021 fiscal year. We counter these risks by ap- the U.S. market for generic IV drugs after halts to produc- ful in winning National Volume based Procurement (NVBP)
propriately selecting and working together with our suppli- tion, may continue to materially affect the pricing and sale negotiations. As a result, there will be a significant decline
ers, through long-term framework agreements in certain of our products and services. In addition, the introduction in prices. Further expansion of NVBP and Provincial Vol-
purchasing segments, and by bundling volumes within the of generic or patented drugs by competitors may have an ume based Procurement (PVBP) is expected with one or
Group. impact on the sales and operational results of our products. two rounds annually over the next three years. Based on
We counter the risk of poor-quality purchased raw ma- Generally, the health care sector is characterized by the directive from the Chinese State Council, drug price re-
terials, semi-finished products, and components mainly by pricing pressure (including from tenders), competition, and duction will continue to be one of the major measures to
requiring our suppliers to meet strict quality standards. efforts to contain costs. These factors could result in lower further contain health care costs in a market in which vol-
This includes a structured qualification process, which sales and adversely affect our business, financial position, umes are steadily growing. This development could have a
comprises audits, document and advance sample inspec- and operational results. negative impact on our sales, financial position, and opera-
tions, as well as regular quality controls of deliveries. We In the United States, almost all Fresenius Kabi injecta- tional results if Fresenius Kabi is not successful in offset-
only purchase high-quality products with proven safety and ble pharmaceutical products are sold to customers through ting these price reductions, for example through cost sav-
suitability from qualified suppliers that conform to our arrangements with group purchasing organizations (GPOs) ings and efficiency gains in production.
specifications and standards. and distributors. The GPOs also have purchasing agree- To ensure our permanent competitiveness, we work
Evaluating our risks and our management measures, we ments with other manufacturers, and the bidding process closely together with physicians and scientists. Important
also take into account new regulatory requirements and le- for products is highly competitive. In the fourth quarter technological and pharmaceutical innovations are intended
gal conditions, such as the Act on Corporate Due Diligence 2021, one of the largest GPOs in the United States issued a to be quickly identified and further developed, if necessary
Obligations in Supply Chains, which will be effective in request-for-proposal for bids for a significant portion of also by adapting our business strategy. Moreover, we se-
Germany in 2023. their pharmaceutical contracts. These new contracts are cure our competitiveness by ongoing analyzes of our market
Further information about our supply chains and our ap- expected to be effective in mid-2022. environment as well as the regulatory framework. The mar-
proach to the protection of human rights can be found in the If Fresenius Kabi is not successful in maintaining its ex- ket activity, especially our competitors’ products and newly
separate Group Non-financial Report from page 194 onward. isting contracts or if new contracts are concluded on less launched dialysis-related products are thoroughly monitored.
favorable terms, this could have an adverse effect on our The cooperation between the various technical, medical
Competition operational results. and academic institutions within our company also ensures
Annual Report 2021
We face numerous competitors in both our health care ser- our competitiveness, which is finally further enhanced by
vices business and dialysis products business, some of our consequent conduction of programs devoted to cost
which may possess substantial financial, marketing or re- saving and efficiency increase.
search and development resources. Competition from new
and existing competitors and especially new competitive
Fresenius
developments and innovations in technology, pharmaceuti-
cals and care delivery models could materially adversely
106
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
Referrals from doctors Personnel Furthermore, we offer young academic talent the oppor-
Our hospitals, rehabilitation clinics, and dialysis clinics are Fresenius addresses potential shortages of qualified per- tunity to gain initial practical experience and to establish
dependent on patients selecting them for their medical sonnel through appropriate employer branding measures, contacts within our company in the context of internships
treatment. To a large extent, patients rely on the recom- as well as recruitment, upskilling, and retention of qualified and working student positions before or during their stud-
mendation of their attending physician. Physicians make staff. ies or in the context of their final papers.
their recommendations based on various factors, including In order to increase the awareness and attractiveness of Depending on the customer and market structure, our
the quality of the medical treatment and the competence of the Fresenius Group, our employer branding relies on a business segments place very different demands on con-
the hospital staff, as well as the distance to the hospital and mix of marketing to universities, in-house events (such as cepts and measures for personnel development. We
the availability of appointments for treatment. If we are un- the Fresenius Career Day ‘‘Meet the Board’’ involving our strengthen employee loyalty to our company by offering
able to meet these criteria, physicians may recommend top management), and digital employer branding (such as our employees attractive development opportunities and
fewer or no patients at all to our clinics. In addition, by expanding our career website and our presence on so- fringe benefits and variable compensation and working-
Fresenius Helios could receive fewer referrals from doc- cial media channels). time models. In addition, we promote international and in-
tors’ practices because they increasingly perceive Fresenius To ensure a sustainable supply of qualified staff, we of- terdisciplinary cooperation.
Helios’ outpatient services as competition or because they fer, for example, targeted programs for young academic By using target-group-specific measures, Fresenius ad-
no longer take rehabilitation clinics with a certain medical talent with subsequent retention programs, as well as com- dresses the overall shortage of specialized hospital person-
focus into account when making their choice. These factors prehensive apprenticeships for students who just gradu- nel. We thereby aim to recruit qualified and dedicated per-
could result in lower sales and adversely affect our busi- ated high school. sonnel, thus ensuring our high standard of treatment quality.
ness, financial position, and operational results. With more than 6,305 apprentices and dual students, Greater employee absenteeism and longer recruiting
Fresenius is one of the biggest training companies in Ger- cycles as an effect from the COVID-19 pandemic further
Payment defaults many. Fresenius offers 42 apprenticeships and 29 study contribute to the experienced shortages in personnel. Addi-
As a rule, we assess the creditworthiness of new customers programs throughout Germany. The number of our appren- tionally, evolving guidelines and requirements regarding
in order to limit the risk of late payment and defaults by ticeships and study program offerings was further ex- vaccine mandates for our employees may have an impact
customers. We also conduct follow-up assessments and re- panded nationwide in 2021. on our ability to attract and retain qualified clinical personnel.
view credit lines on an ongoing basis. We monitor receiva- We provide information about our apprenticeship and Since January 1, 2019, the German hospital market has
bles outstanding from existing customers, and assess the study program offerings on our career website, as well as also been subject to the Ordinance on the Minimum Re-
risk of default. This particularly applies to countries with at our respective training locations through various market- quirements for Nursing Personnel in Hospitals (PpUGV).
budgetary problems and countries exposed to political ing activities and vocational orientation offers (such as the
risks. In 2021, we again worked on the status of our receiv- career guidance app Aivy, vocational information days, and
Annual Report 2021
ables, by taking measures such as factoring. the Night of Apprenticeship). In June 2021, a virtual train-
ing fair was held for the second time, which is integrated
into the careers website. We offer this fair format on a reg-
ular basis since 2020.
Fresenius
107
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
This ordinance stipulates minimum staffing levels for nurs- speculative purposes. Transactions are carried out within translation risks are not hedged. A sensitivity analysis
ing personnel in certain areas of the hospital. Further statu- the limits approved by the Board of Management, which shows that a one percent change in the exchange rate of
tory regulations on minimum personnel levels in additional are set depending on the counterparty's rating. Further in- the U.S. dollar to the euro would have an annualized effect
hospital departments with beds may further intensify com- formation about how the currency risk and interest rate risk of around €130 million on Group sales, around €20 million
petition for qualified nursing staff. are managed can be found in the Notes on page 361 on- on EBIT, and around €6 million on Group net income.
Helios Germany is therefore working intensively on ad- ward. As a globally active company, we have production facili-
ditional measures to make it particularly attractive as an Our foreign exchange risk management is based on a ties in all the main currency areas. In the service busi-
employer for nursing staff. These include the compatibility policy approved by the Management Board that defines the nesses, our revenue and cost base largely coincide. The
of family and career (e.g., through childcare facilities at targets, organization, and handling of the risk management Fresenius Group uses a Cash-Flow-at-Risk (CFaR) model in
hospital sites or the option of part-time work), attractive processes. In particular, the policy assigns responsibilities order to estimate and quantify such transaction risks from
further and advanced training opportunities, occupational for the determination of currency risks, the execution of foreign currencies. The foreign currency cash flows that
health management, and career opportunities. hedging transactions, and the regular risk management re- are reasonably expected to occur within the following 12
At present, the Spanish hospital market is also experi- porting. These responsibilities are coordinated with the de- months, less any hedges, form the basis for the analysis of
encing a shortage of qualified nursing staff. As a result of cision-making structures in the residual business processes the currency risk. As of December 31, 2021, the Fresenius
the COVID-19 pandemic and the associated additional need of the Group. Decisions on the use of derivative financial Group cash flow at risk was €44 million, i.e., with a proba-
for nursing staff, public hospitals have hired more nurses at instruments in interest rate management are made in bility of 95%, a potential loss in relation to the forecast for-
more attractive terms than before. Quirónsalud is undertak- close consultation with the Management Board. Transac- eign exchange cash flows of the next 12 months will not be
ing various measures such as online campaigns and other tions using derivatives are carried out by the Group Treas- higher than €44 million.
employer branding measures to attract new employees. In ury of the Fresenius Group --- apart from a few exceptions Further information about financial risks can be found
addition, long-term security in the workplace and attractive in order to adhere to foreign currency regulations. These in the Notes on page 361 onward.
working conditions, for example, should help to retain ex- transactions are subject to stringent internal controls. This
isting employees. policy ensures that the Management Board is fully informed Recoverability of assets
Further information about our measures for recruiting, of all significant risks and current hedging activities. Financial risks that could arise from acquisitions and in-
developing, and retaining qualified personnel can be found The Fresenius Group is protected, to a large extent, vestments in property, plant and equipment, and in intangi-
in our separate Group Non-financial Report from page 154 against currency risks and interest rate risks. As of De- ble assets are assessed through careful and in-depth re-
onward. cember 31, 2021, approximately 78% of the Fresenius views assisted by external consulting firms. The intangible
Group’s debt was protected against increases in interest assets, including goodwill, product rights, trade names,
FINANCIAL RISKS rates either by fixed-rate financing arrangements or by in- and management contracts, contribute a considerable part
Annual Report 2021
Currency and interest rate risks terest rate hedges; accordingly, around 22% is subject to to the total assets of the Fresenius Group.
The global focus of our operations exposes us to a variety an interest rate risk. A sensitivity analysis shows that a rise
of currency risks. In addition, the financing of the business of 0.5 percentage points in the reference interest rates rele-
can expose us to certain interest rate risks. We use deriva- vant for Fresenius would have an impact of approximately
tive financial instruments, among other things, to minimize 0.8% on Group net income. As a global company, Fresenius
Fresenius
these risks. However, we limit ourselves to non-exchange- is exposed to translation effects. The exchange rate of the
traded, marketable instruments, used exclusively to hedge U.S. dollar to the euro is of particular importance because
our underlying transactions and not for trading or of our extensive operations in the United States. Currency
108
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
Currency devaluations, adverse changes in general interest Debt and liquidity Inflation risks
rates and deteriorating economic conditions, including in- As of December 31, 2021, the Fresenius Group’s financial As an international company, Fresenius is exposed to vary-
flationary price developments in various markets combined liabilities including leases under IFRS 16 were €27,155 mil- ing inflation rates and price developments. We also oper-
with deteriorating country credit ratings, increase the risk lion. The debt could, among other things, limit the Com- ate in high-inflation countries such as Argentina and Leba-
of goodwill impairment, which may lead to a partial or pany’s ability to pay dividends, arrange refinancing of fi- non. Due to inflation in Argentina and Lebanon, our subsid-
complete write-down of the goodwill or brand name of the nancial liabilities, or implement the corporate strategy. If iaries there apply IAS 29, Financial Reporting in Hyperin-
affected cash-generating unit or negatively impact our in- Fresenius’ credit rating or the conditions on the relevant fi- flationary Economies.
vestments and external partnerships. nancial markets deteriorate significantly, financing risks Inflation-related cost increases could have an adverse
Goodwill and other intangible assets with an indefinite could arise for Fresenius. We reduce these risks through effect on our business, particularly if prices for our prod-
useful life carried in the Group’s consolidated balance early refinancing as well as a high proportion of mid- and ucts and services remain unchanged or cannot be adjusted
sheet are tested for impairment each year. Further infor- long-term funding with a balanced maturity profile. sufficiently to reflect increased costs.
mation can be found in the Notes on page 293 onward. Some of our financing agreements that were concluded
before the year 2017 contain covenants requiring us to RISKS ASSOCIATED WITH RESEARCH
Taxes and duties comply with certain financial ratios. These covenants are AND DEVELOPMENT AND PRODUCT APPROVAL
As a global corporation, Fresenius is subject to numerous currently suspended due to the investment grade rating of The development of new products and therapies always
tax laws and regulations. Risks arising therefrom are identi- the Fresenius Group. A deterioration of the rating may carries the risk that the ultimate goal might not be
fied and evaluated on an ongoing basis. The Fresenius therefore also lead to the currently suspended covenants in achieved, or it might take longer than planned. This is par-
Group’s companies are subject to regular tax audits. Any some financing agreements becoming active again. Non- ticularly true for our biosimilar products from Fresenius
changes in tax regulations or adjustments resulting from compliance with these covenants could then result in a de- Kabi. The development of biosimilar products entails addi-
tax audits and additional duties, import levies, and trade fault and acceleration of the debt under the respective tional risks, such as significant development costs and the
barriers could lead to higher taxes and duties. agreements. We counteract this risk by taking the perfor- still-developing regulatory and approval processes. Regula-
Similarly, tax and trade law reforms, in particular the OECD mance indicators relevant for our investment grade rating tory approval of new products requires comprehensive,
initiatives for the reallocation of taxation rights and the in- into account in our Group planning and continuously moni- cost-intensive preclinical and clinical studies. Furthermore,
troduction of a global minimum tax, as well as a potential toring their development. This enables us to take counter- there is a risk that regulatory authorities either do not
U.S. tax reform, may increase our tax and duty burden. measures at an early stage. grant, or delay, product approval, or withdraw an existing
Additional information about conditions and maturities approval.
can be found on page 325 of the Notes and on page 78 of In addition, adverse effects of our products that may be
the Group Management Report. discovered after regulatory approval or registration may
Annual Report 2021
lead to a partial or complete withdrawal from the market,
due either to legal or regulatory actions or our voluntary
decision to stop marketing a product.
Fresenius
109
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
For example, following feedback from the European Medi- RISKS FROM ACQUISITIONS INFORMATION TECHNOLOGY AND CYBERSECURITY
cines Agency (EMA), risk mitigation measures for HES The acquisition and integration of companies carries risks RISKS
products from Fresenius Kabi (controlled dispensing of hy- that can adversely affect the net assets, financial position, Technological innovations promise new therapeutic ap-
droxyethyl starch (HES) medicines to accredited hospitals, and results of operations of Fresenius. Acquisition pro- proaches in the treatment of diseases, not least because in-
training and letters to health care professionals and warn- cesses often include closing conditions, including but not formation technology (IT) applications and digital compo-
ings on packaging) were initiated in 2019. Based on the re- limited to antitrust clearance, fulfillment of assurances and nents offer the potential to relieve medical staff and make
sults of a study examining the routine use of HES in ac- warranties, and adherence to laws and regulations. Non- health care more efficient. Fresenius is also using digital
credited clinics, the effectiveness of the interventions will compliance with such closing conditions by either party to product solutions to enter new markets. At the same time,
be evaluated. an acquisition could lead to litigation between the parties we are taking into account the risks associated with digital-
Follow-up studies as well as similar measures could or with others and thus claims against Fresenius. ization.
also be taken by authorities in non-EU countries. For exam- Following an acquisition, the acquired company’s struc- The Company's processes are growing ever more com-
ple, two regulatory studies are currently underway to evalu- ture must be integrated while clarifying legal questions and plex as a result of the Fresenius Group’s steady growth and
ate the long-term safety and efficacy of our HES products contractual obligations. Marketing, patient services, and lo- increasing internationalization. Correspondingly, the de-
in surgical and trauma patients. As soon as the results of gistics must also be unified. During the integration phase, pendence on information and communication technolo-
these studies are available, they will be evaluated by the there is the risk that key managers will leave the company gies and on the IT systems used to structure procedures
European authorities. and that both the course of ongoing business processes and --- increasingly --- harmonize them internationally, is in-
The Fresenius Group spreads its risk widely by conduct- and relationships with customers and employees will be tensifying. A failure of these IT systems could temporarily
ing development activities in various product segments. We harmed. In addition, change-of-control clauses may be lead to an interruption of other parts of our business and
also counteract risks from research and development pro- claimed. The integration process may prove more difficult thus cause serious damage.
jects by regularly analyzing and assessing development or require more time and resources than expected. Risks Due to the increased integration of IT systems, the inte-
trends and examining the progress of research projects. can arise from the operations of the newly acquired com- gration of digital components and applications into medical
Furthermore, we strictly comply with the legal regulations pany that Fresenius regarded as insignificant or was una- technology products and services and the use of technolo-
for clinical and chemical-pharmaceutical research and de- ware of. An acquisition may also prove to be less beneficial gies, such as cloud computing, within our business pro-
velopment. than initially expected. Future acquisitions may be a strain cesses, there is the possibility that cyber incidents may
With IV drugs, it is also crucial that new products are on the finances and management of our business. Moreo- compromise the confidentiality, integrity, or availability of
continually brought to the market in a timely manner. ver, as a consequence of an acquisition, Fresenius may be- our information assets and systems. Risks to information
Therefore, we monitor the development of new products on come directly or indirectly liable towards third parties, or security, cyber security, and the stability of IT systems also
the basis of detailed project plans and focus on achieving claims against third parties may turn out to be non-assertable. increase if we fail to keep our information assets and sys-
Annual Report 2021
specific milestones. In this way, we can take countermeas- We counter risks from acquisitions by means of structured, tems at the cutting edge of technology and security.
ures if defined targets are called into question. detailed due diligence prior to deciding to go ahead with The disclosure of sensitive data or non-compliance
Both Fresenius Medical Care and Fresenius Kabi are the acquisition and by means of detailed integration plans, with data protection laws, regulations, and standards
exposed to typical patent-related risks. These include insuf- as well as with a dedicated integration and project manage- could damage our competitive position, our reputation, and
ficient protection by patents of the technologies and prod- ment process afterward so that countermeasures can be in- the entire company. In addition, Fresenius or one of the
Fresenius
ucts we develop, which could enable competitors to copy itiated in good time if there are deviations from the ex- Group companies could be subject to a significant fine in
our products without having to bear comparable develop- pected development. the event of a data protection breach. To comply with all le-
ment costs. gal requirements, we have implemented comprehensive
110
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
data protection management systems, which provide the The results of these semi-annual cyber risk assessments are COMPLIANCE AND LEGAL RISKS
appropriate technical and organizational measures and presented to the Cybersecurity Board, which includes all COMPLIANCE RISKS
controls for the protection of personal data. cybersecurity officers from the business units. On this ba- Fresenius is subject to comprehensive government regula-
In 2017, the Management Board of Fresenius Manage- sis, the GCSO continuously derives risk-based measures to tion and control in nearly all countries. In addition, Fresenius
ment SE adopted the Cybersecurity Approach, Roadmap further mitigate cyber risks and enables the Group-wide ex- must comply with general rules of law, which differ from
and Execution (CARE). Since 2018, CARE has served as a change of knowledge and best practices. While our primary country to country. There could be far-reaching legal reper-
cybersecurity program that bundles cybersecurity initia- goal is to prevent the materialization of cyber risks, we cussions or reputation damage should Fresenius fail to
tives and strengthens our resilience to protect and defend have established monitoring mechanisms to detect and ad- comply with these laws or regulations.
against cyber attacks. In 2020, the Management Board of dress cyber threats at an early stage in order to limit the We must comply in particular with rules and regulations
Fresenius Management SE enacted a Group-wide Cyberse- impact of security incidents on business operations. that monitor the safety and effectiveness of our medical
curity Policy. This policy defines the objectives as well as We are guided in this process by internationally recog- products and services. Corruption is a core risk area across
the organizational and operational structure for the man- nized standards for information security such as the all business segments. Antitrust law, data protection,
agement of cybersecurity in the Fresenius Group, inte- ISO/IEC 27000 series, ISO/IEC 62443, KRITIS, or the NIST money laundering, sanctions, and the upholding of human
grated into CARE. Cybersecurity Framework. The central IT infrastructure, as rights are further significant risk areas. It is therefore of
To sustainably protect the Group’s added value, we well as critical infrastructures in the medical sector, among particular importance to us that our compliance programs
have introduced tailored frameworks for our cybersecurity other things, have ISO/IEC 27001 certification. and guidelines are strictly adhered to. Through compli-
risk domains that define the security architectures, con- We will continue to invest in cybersecurity and expand ance, we aim to meet our own expectations and those of
cepts and requirements. Further information about our cy- our capabilities to make us more resilient to the threat our partners, and to orient our business activities to gener-
bersecurity strategy, organization, and measures is set out posed by cyberattacks on our systems and digital products ally accepted standards and local laws and regulations.
in our separate Group Non-financial Report on page 149 and services. At Fresenius, risk-oriented compliance management
onward. systems are implemented in each business segment. These
In addition, the Group Cybersecurity Office (GCSO) con- systems take into account the markets in which the respec-
ducts a business-oriented assessment of strategic cyberse- tive business segment operates and are tailored to the spe-
curity risks along the value chain in collaboration with the cific requirements of the business segment. Furthermore,
business units. The Group’s cyber risks are related to the we at Fresenius assess compliance risks using
business activities of the respective business sectors: In the a standardized methodology.
product business, they are closely linked to the disruption
of production or logistics processes and the theft of intel-
Annual Report 2021
lectual property; in our health care facilities, they relate to
patients and their health care information and operated
medical devices.
Fresenius
111
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
Each business segment has appointed a Chief Compliance The core element of data protection is the secure and law- In addition, the individual data protection management sys-
Officer to oversee the development, implementation, and ful processing of personal data in accordance with these tems also include appropriate control measures in order to
monitoring of the compliance management system of the regulatory requirements. In addition to patient data, this adequately check compliance with regulatory and internal
relevant business segment and to check progress made in also includes the personal data of employees as well as that requirements.
this regard. In line with their organizational and business of contractual partners and other persons. Further information about our data protection organiza-
structure, the business segments have established compli- Risk areas include compliance with data protection tions and data protection management systems can be
ance responsibilities at the respective organizational levels. principles, information obligations, data subjects’ rights, found in the Group Non-financial Report on page 188 on-
The Corporate Compliance department of Fresenius risk analysis regulations, and the documentation of data ward.
SE & Co. KGaA supports the compliance officers in each processing activities, as well as ensuring secure data pro-
business segment with standardized tools, processes, and cessing, including the establishment of an appropriate level Legal risks
methods, and reports to the Chief Compliance Officer of of data protection in (inter)national data transfers. Risks arising in connection with litigation or official pro-
Fresenius SE & Co. KGaA. To comply with legal requirements, Fresenius has im- ceedings are continuously identified, assessed, and --- above
Our compliance programs set binding rules of conduct plemented comprehensive data protection management a relevant set materiality threshold, where applicable --- re-
for our employees. We believe that we have taken adequate systems, which provide the appropriate technical and or- ported within the Group. Companies in the health care in-
measures to ensure that national and international rules are ganizational measures and controls for the protection of dustry are regularly exposed to claims or actions for breach
observed and complied with. Nevertheless, even when a personal data. Fresenius SE & Co. KGaA and all business of their duties of due care, product liability, breach of war-
comprehensive compliance program is in place, individual segments maintain data protection organizations in accord- ranty obligations, patent infringements, treatment errors,
cases of misconduct by individual employees or contractual ance with their organizational and business structures. This and other claims. This can result in high claims for dam-
partners cannot be ruled out, which could cause damage to includes independent data protection officers reporting to ages and substantial costs for legal defense, regardless of
the Company. the respective company’s management. The dependence whether a claim is actually justified. This applies in particu-
Further information about our compliance management on data protection and IT security/cybersecurity resulting lar to disputes and proceedings in the United States, where
systems can be found in the Group Non-financial Report on from increasing internationalization is also taken into ac- legal defense costs and claims for damages can be excep-
page 182 onward. count by the data protection organizations by ensuring col- tionally high. If legal matters or official proceedings are de-
laboration with the respective departments is as close as cided against Fresenius, it may also no longer be possible
Data protection possible. to insure risks of this kind in the future, or it may no longer
Fresenius’ business activities are also subject to data pro- The business segments have implemented processes be possible to insure such risks under appropriate condi-
tection regulatory requirements. This includes compliance and standards based on their organizational and business tions.
with the General Data Protection Regulation (GDPR) as well structures that also provide internal guidelines for pro-
Annual Report 2021
as compliance with other country-specific data protection cessing personal data in a secure and appropriate manner.
regulations. Breaches of these regulations or of the GDPR
can result in substantial fines, damage to reputation, and
loss of trust.
Fresenius
112
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Fundamental information about the Group | Economic report | Overall assessment of the business situation | Outlook Opportunities and risk report
The Fresenius Group is involved in several legal matters More detailed information about environmental manage-
and official proceedings arising from the ordinary course of ment at Fresenius and about assistance in the event of nat-
its business. However, although the outcome cannot always ural disasters and other crises can be found in the Group
be reliably predicted, we do not currently expect any signif- Non-financial Report from page 114 onward.
icant adverse effect on our net assets, financial position,
and results of operations arising from the legal matters and Insurance
proceedings currently pending. In its risk management, Fresenius uses the option to trans-
Such legal matters and administrative proceedings that fer certain risks to external insurers. Fresenius Versicher-
may have a significant negative impact on the net assets, fi- ungsvermittlungs-GmbH is the Fresenius Group’s insur-
nancial position, and results of operations of Fresenius are ance department, which is organized as a captive insurance
set out on pages 340 to 342 in the Notes. broker, and ensures appropriate insurance cover for large
parts of the Group. Other sub-groups ensure adequate in-
OTHER RISKS surance coverage through their own departments. The aim
Our international orientation also gives rise to the following is to protect the Company’s employees and assets against
risks, which could have an adverse effect on our business possible hazards within the risk management process by
and thus on our financial position and operational results: procuring insurance coverage that is appropriate to the
risks. To this end, we purchase adequate coverage, taking
► Political, social, or economic instability, especially in into account the cost-benefit ratio. For example, Fresenius
developing and emerging countries; has all-risk insurance against property damage and loss of
► Civil unrest, war, or the outbreak of diseases, such as earnings due to, for example, fire, storms, water, earth-
pandemics, e.g. the coronavirus pandemic; quakes, and other natural hazards, product liability insur-
► Environmental risks; ance, insurance for volunteers and patients in clinical trials,
► Natural disasters, terrorist attacks, and other unfore- hospital liability insurance, environmental liability insur-
seen events; ance and environmental damage insurance, and directors’
► Different labor law conditions and difficulties in meet- and officers’ insurance.
ing the global demand for qualified personnel;
► Different and less stable regulations protecting intel-
lectual property;
Annual Report 2021
► Delays in the transport and delivery of our products.
Fresenius
113
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
SEPARATE
GROUP NON-FINANCIAL REPORT
115 Strategy and management 141 Digital transformation and innovation 216 Report profile
116 The business model 141 Digitalization and innovation
116 Our value chain 149 Cybersecurity
116 Sustainability risks 217 Limited assurance report of the
117 Our sustainability goals and programs
independent auditor
118 Our sustainability organization 154 Employees
119 Our materiality analysis 154 Working conditions, recruitment and employee participation
120 Stakeholder and partnerships 165 Employee development
120 EU taxonomy 169 Occupational health and safety
121 Well-being of the patient 178 Diversity
121 Access to health care and medicine 178 Diversity and equal opportunities
127 Patient and product safety
182 Compliance and integrity
182 Compliance
188 Data protection
194 Human rights
197 Supply chain
3
199 Environment
Fresenius | Annual Report 2021
199 Environmental management
205 Water management
208 Waste and recycling management
211 Climate protection – Energy and emissions
114
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
SEPARATE GROUP NON-FINANCIAL REPORT.
We are committed to responsible and sustainable
management as part of our corporate culture
and day-to-day business practice. We place great
importance on fulfilling our legal and ethical
responsibility as a company. Only by doing so can
we be perceived as a trustworthy and reliable
p artner in the health care sector.
STRATEGY AND MANAGEMENT care, we have significantly increased the number of inten- In our Code of Conduct, we commit to integrity in dealing
sive care beds and ventilation stations. The dialysis centers with our business associates as well as to socially responsi-
As a health care Group with more than 300,000 employees, also continued to provide safe treatments, even for kidney ble behavior and transparent communication. The Fresenius
Fresenius plays an important role in society. For more than patients infected with COVID-19. We have consistently Code of Conduct defines basic principles that apply to all
100 years, our mission has been to preserve life, promote ensured the supply of our vital medicines, medical devices, employees and the management of the Fresenius Group. It
health, and improve patients’ quality of life – as defined in and services for critically and chronically ill patients. also sets out the framework for the relevant regulations of
our company objective – ever better medicine for ever more For Fresenius, economic success is not an end in itself, the individual business segments, and defines our respective
people. The importance of modern and functional health but a means of continuously contributing to medical prog- activity areas. Further information can be found in the
care for society again became particularly clear in 2021. ress. The patient’s well-being always comes first. It is our Compliance and Integrity section on pages 182 ff.
Fresenius | Annual Report 2021
Our employees worldwide have continued to work tirelessly point of reference for all business decisions. The common
and under sometimes difficult pandemic conditions – in goal of all business segments is to improve health care qual-
clinics, dialysis centers, factories, and logistics. In acute ity and efficiency. We aim to provide innovative solutions
and work proactively to enable a growing number of people
to have access to high-quality, affordable medicine.
115
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
trategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
S
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
▶ We
take responsibility for our patients’ well-being and THE BUSINESS MODEL initiate quality and safety controls for raw materials and
are committed to the highest quality in our products, Fresenius is a global health care Group and one of the leaders procurement goods. Supply reliability and quality of care play
treatments, and services. in its respective markets. The Fresenius Group comprises an important role in an environment characterized by ongo-
▶ We
want to do the right thing and comply with all four independently operating business segments managed ing cost-saving efforts by health care providers and by
applicable rules and laws. In addition to legal require- by Fresenius SE & Co. KGaA: Fresenius Medical Care is the price pressure in the markets. We therefore constantly opti-
ments, we adhere to high ethical standards and rules of world’s leading provider of products and services for individ- mize our purchasing processes, standardize procurement
good corporate governance. uals with renal diseases based on publicly reported revenue materials, identify new sources of supply, and negotiate the
▶ We
largely owe our success and growth to the commit- and the number of patients. Fresenius Kabi provides lifesaving best possible price deals. Maintaining high flexibility while
ment of our more than 300,000 employees worldwide. medicines, medical devices, and services for the critically meeting our strict quality and safety standards is crucial.
Our aim is therefore to be perceived as an attractive and chronically ill. Fresenius Helios is Europe’s largest private A broad portfolio of suppliers reduces potential procure-
employer to acquire talent, retain employees, and allow hospital chain, with clinics in Germany, Spain, and Latin ment or raw material shortages in both the product and ser-
them to further develop their skills. America. Fresenius Vamed specializes in health care facil- vice business.
▶ We
think and act long-term in our business decisions. ities projects and service business. The Group Management Additional information is included in the section Pro-
We protect nature as the basis of life and treat resources Report on pages 38 ff. contains additional information on curement on page 58 of the Group Management Report.
with care. the Group’s business model and ownership structures, on
▶ We
are committed to respecting human rights as defined legal and economic factors, as well as key sales markets SUSTAINABILITY RISKS
by international standards, such as the Declaration of and competitive positions. The identification and assessment of potential sustainability
Human Rights of the United Nations. risks (non-financial risks) initially takes place at both the
OUR VALUE CHAIN Group level and in the four business segments via the exist-
We analyze the impact of our actions with the help of the Fresenius has an international distribution network and ing risk management system. Sustainability risks are
United Nations’ 17 Sustainable Development Goals (SDGs). operates more than 90 production facilities. The largest of assessed that are already covered by the existing risk cata-
A particular focus is on the goals of good health and these are located in the United States, China, Germany, logs and risk reporting of the Fresenius Group. In an addi-
well-being (SDG 3), high-quality education (SDG 4), and Japan, and Sweden. In the Fresenius Group, all purchasing tional step, potential sustainability risks are discussed on a
decent work and economic growth (SDG 8). We also align processes are controlled by central coordination points in quarterly basis at Group level by the corporate functions
our sustainable actions closely to the United Nations Global the business segments. Competence teams bundle the needs, Risk Management & Internal Control System, Business Integ-
Compact and the sustainability requirements of the capital conclude framework contracts, and continuously monitor rity and Investor Relations & Sustainability of Fresenius
market. Further information is available on our website. current market and price trends. They also coordinate global SE & Co. KGaA, and supplemented if necessary. In the future,
procurement for individual production sites or clinics and
Fresenius | Annual Report 2021
116
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
we intend to record and assess sustainability risks across OUR SUSTAINABILITY GOALS AND PROGRAMS also part of the compensation system for the members of the
the Group in a more harmonized approach together with We pursue specific sustainability approaches at the level of company’s Management Board. Fresenius Medical Care’s
financial, legal, and compliance risks. This will enable us to the four business segments and Fresenius SE & Co. KGaA. Global Sustainability Program reflects the increasing
achieve an integrated view of our impact on the issues The business segments build their own sustainability pro- requirements for sustainability management as well as the
(inside-out perspective) on the one hand and the impact of grams and regularly review how they can further develop company’s commitment to continuously improving its per-
the issues on Fresenius (outside-in) on the other. This and optimize them. formance. It defines global targets for eight focus areas in the
allows us to assess their short-, medium- or long-term finan- In May 2021, the Fresenius Annual General Meeting period between 2020 and 2022. Fresenius Medical Care
cial impacts as well as their impacts on society and the approved a new compensation system for the members of selected these areas based on the results of the company’s
environment. In the area of human rights, we have already the Management Board of Fresenius Management SE. In materiality analysis, which identifies the most relevant sus-
started to do this. Further details are provided in the the context of short-term variable compensation, ESG (Envi- tainability topics for its business. The focus areas are the
Human rights chapter on pages 194 ff. ronmental, Social, and Governance) targets have an influ- responsibility towards the patients as well as the employees,
In the reporting period, we analyzed potential sustain- ence on compensation for the first time in this system, with anti-bribery and anti-corruption, data protection and privacy,
ability risks in the areas of climate change and water scar- a weighting of 15%. The focus of the ESG targets is on the human and labor rights, sustainable supply, environment,
city. We did not identify any material risks to our business key sustainability topics identified by Fresenius in the mate- and occupational health and safety. The program’s objective
model in either area. Overall, we did not identify any riality analysis: quality / patient well-being, innovation and- is to establish common global standards, goals, respon
material non-financial risks, taking into account risk mitigat- digital transformation, employees and diversity, environment, sibilities, and key performance indicators to monitor sus-
ing measures (net risk assessment), related to our own and compliance and integrity. With the identification of tainability performance.
business activities, business relationships, products, or ser- key performance indicators (KPIs) and the definition of com- In February 2022, the Management Board of Fresenius
vices that are very likely to have an adverse effect on the prehensive management concepts, the company will create Management SE has implemented a climate target, comple-
non-financial aspects mentioned above or on our business a basis to make the sustainability performance of the busi- menting the existing sustainability goals and programs for
operations. The Group Management Report on pages 95 ff. ness segments measurable. The identified key performance the Fresenius Group. Fresenius Group aims to achieve cli-
contains further information on opportunities and risks as indicators are intended to facilitate target setting and mea- mate neutrality by 2040 and to reduce 50% of absolute
well as a detailed presentation of risk management. surement in the long term and also to be incorporated into scope 1 and scope 2 emissions by 2030 compared to 2020.
the long-term variable compensation of the company’s We will continuously assess scope 3 emission impacts for
executives. inclusion in our targets. Further information on our environ-
In the reporting year, the members of the Executive Board mental management and emissions within our business
achieved the ESG targets. A detailed presentation can be segments and the Group are provided on pages 199 ff. as
found in the Compensation Report on pages 234 ff. The ESG well as pages 211 ff. of this Group Non-financial Report.
Fresenius | Annual Report 2021
methodology for determining target achievement is avail-
able on the website of Fresenius SE & Co. KGaA.
For Fresenius Medical Care, the target achievement of the
company’s Global Sustainability Program is used, which is
117
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
OUR SUSTAINABILITY ORGANIZATION FRESENIUS GROUP SUSTAINABILITY ORGANIZATION
Sustainability at Fresenius is the responsibility of the CEO
of Fresenius Management SE, as shown in the overview
aside. Fresenius Management SE is the general partner of Group Sustainability Board Group Management Board Supervisory Board
(GSB)
Fresenius SE & Co. KGaA. The Group Management Board is supported by
Chair: Stephan Sturm – CEO Stephan Sturm – CEO audit firm
regularly informed about sustainability issues by the Investor
Relations & Sustainability department of Fresenius SE & Co. Information exchange and progress report Management control Audit
KGaA. The Management Board and the Supervisory Board
review the progress and the results of the sustainability Group
sustainability strategy
management, which are then published in the separate Group Investor Relations &
facilitates Group-wide
Non-financial Report. The Supervisory Board is supported collaboration
Sustainability
Reporting
in this process by the auditor’s limited assurance engage-
coordinates and supports
ment. The Audit Committee has a special role in reviewing sustainability officers
the Group Non-financial Report. The Supervisory Board as
a whole is responsible for monitoring the Company’s sus-
tainability performance.
Investor Relations & Sustainability coordinates the imple-
mentation of sustainability guidelines and standards at
operational level and is responsible for the non-financial
reporting of the Fresenius Group. Business Integrity (for-
merly Corporate Compliance) is responsible for our Code of guidelines and management concepts relating to these sus- Medical Care is the Sustainability Decision Board. Headed
Conduct and manages issues relating to human rights, tainability topics. The business segments have also defined by the CEO, it is responsible for integrating sustainability
supply chain, and compliance. Data protection and Cyber- departments and responsible persons – often in the form of into the company’s strategy and business. Together with the
security are independent areas of responsibility. The sustainability officers who coordinate all sustainability issues Sustainability Decision Board, the Management Board
departments and functions at Fresenius SE & Co. KGaA level within the business segment. Fresenius Medical Care is decides on strategic initiatives. In the reporting year, a mem-
support the business segments in the development of itself a stock-listed company and has therefore established ber of the Supervisory Board was appointed to the position
its own sustainability governance structure. Sustainability of Lead Independent Director. Her responsibilities include
is also an integral part of the Management Board there. The addressing matters relating to ESG aspects of the company.
Fresenius | Annual Report 2021
highest governing body for sustainability issues at Fresenius
118
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
THE GROUP SUSTAINABILITY BOARD MATERIAL CLUSTERS AND TOPICS IN ACCORDANCE WITH GERMAN COMMERCIAL CODE (HGB) SECT. 289C (3)
The Group Sustainability Board (GSB) is composed of those
responsible for sustainability at Group level and in the busi-
ness segments and is scheduled to meet every two months. Social matters Employee matters Combating corruption Human rights Environmental matters
and bribery
The Board discusses the future sustainability strategy of the
Fresenius Group. The overall goal of the GSB is to identify
the most important sustainability issues for the Group and
Well-being of the patient Employees Compliance & Integrity Diversity Environment
to strengthen intra-Group cooperation.
In 2021, six GSB meetings were held under the leader- Access to health care Working conditions, recruit-
Compliance
Diversity and
Water management
and medicine ment & employee participation equal opportunities
ship of CEO Stephan Sturm. That year, the GSB focused on
the implementation of the EU taxonomy, and the exchange Patient & Product safety
Employee
Data protection Compliance & Integrity
Waste and recycling
development management
of best practices, and the implementation of the ESG targets
of the Management Board of Fresenius Management SE. Digital Transformation Occupational health
Human Rights Climate protection
& Innovation and safety
OUR MATERIALITY ANALYSIS Digitalization
& Innovation
Since 2017, we have been identifying the material topics
for the Fresenius Group in a comprehensive materiality Cybersecurity
analysis. This is carried out every two to three years, depend-
ing on possible changes in the corporate structure and the Supply Chain
operating business performance. In addition, we review the
material topics annually to ensure that they are up to date. Material aspects according to HGB Material cluster Material topic
Material are those aspects that are relevant for understand-
ing Fresenius’ business performance, results of operations,
and position, as well as for understanding the effects of its We conducted our last comprehensive materiality analysis However, the content of individual topics and topic clusters
business activities on the non-financial aspects. in the 2020 reporting year. The multi-stage analysis process was further deepened in the reporting year, such as the
in accordance with HGB and GRI is described in the topic Clinical Study Management. The structure of the chap-
Fresenius Sustainability Report 2020. In 2021, we checked ters in this report reflects the main topic clusters. The vari-
the actuality of the analysis by means of an environment ous individual topics are assigned to the chapters according
Fresenius | Annual Report 2021
analysis. to their prioritization, and their management approach is
described according to the requirements of GRI and the Ger-
MATERIALITY ANALYSIS RESULTS man Commercial Code (HGB).
The review of the materiality analysis in the reporting year
did not indicate any changes in the 6 material non-financial
topic clusters and 15 individual topics compared to the
previous year.
119
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
STAKEHOLDERS AND PARTNERSHIPS facilitate sustainable investment, and amending Regulation ensure a complete and unambiguous reconciliation to the
Fresenius is involved in a diverse network of stakeholder (EU) 2019/2088 (EU Taxonomy Regulation). The application corresponding items in the annual financial statements and
groups. We gain valuable insights from this exchange, which and results of the other conformity criteria and environ- to avoid double counting.
we use to continuously develop our quality and sustain- mental objectives will be reported in future.
ability management as well as our reporting procedures. As a global health care group with products and services Turnover
Our main stakeholders are: for dialysis, hospital and outpatient care, our core business Total turnover for the fiscal year 2021 forms the denominator
activities are not covered by the Delegated Regulation EU of the turnover KPI and can be taken from the consolidated
▶ Patients 2021 / 2139 and Annex I (Substantial Contribution to Climate income statement on page 278 (equals our sales figure).
▶ Employees Change Mitigation) as well as Annex II (Substantial Contribu- The EU Taxonomy-eligible turnover in 2021 (1%) relates to
▶ Providers tion to Climate Change Adaptation) and are therefore not external sales generated by Fresenius Vamed in the project
▶ Private shareholders, institutional investors, analysts, considered EU Taxonomy-eligible. This is reflected in the low business (according to IFRS 15), which are incurred in con-
and rating agencies EU Taxonomy-eligible share of our turnover. However, our nection with the construction and renovation of new hospi-
▶ Political institutions and external organizations, e.g., investments in existing and new building infrastructure rep- tal buildings (Annex I: economic activity 7.1 and 7.2). For the
in the fields of health care and patient care resent the EU Taxonomy-eligible Capex share. Our operat- reporting year 2021, no further economic activities are
▶ Suppliers or other business partners ing expenses (Opex) do not include any significant EU Tax- applicable.
▶ In their non-financial reports, Fresenius Medical Care, onomy-eligible share.
Helios Germany and Helios Spain also include lists of Capex
the stakeholder groups that are specific to their respec- EU TAXONOMY KPIS 2021 The amounts used to calculate the Capex KPI (denominator)
tive business activities: for example, Fresenius EU Taxonomy- EU Taxonomy-non- are based on the capital expenditures reported in the con-
KPI eligible shares 2021 eligible shares 2021
Medical Care includes representatives from academia, solidated financial statements resulting from additions in the
Turnover 1% 99%
among others, while Fresenius Helios considers trade fiscal year to property, plant and equipment (IAS 16) and
Capex 49% 51%
unions. other intangible assets (IAS 38) excluding goodwill. In addi-
Opex 0% 100%
tion, the EU Taxonomy KPI takes into account right-of-use
EU TAXONOMY assets (IFRS 16) and additions from business combinations.
For the fiscal year 2021, we are reporting the EU Taxono- In order to determine the EU Taxonomy-eligible compo- This information can be found in the notes to the con
my-eligibility of our economic activities for the environ- nents, we compared the descriptions of economic activities solidated financial statements on pages 317, 319 and 349.
mental objectives of climate change mitigation and adapta- from Annex I and Annex II with our products and services, For the identification of the EU taxonomy-eligible share
tion for the first time. This is conducted in accordance with investment expenditures and expenses. For this purpose, (numerator), the above-mentioned line items were matched
Fresenius | Annual Report 2021
the mandatory disclosures required by Regulation (EU) further information on the three KPIs has been discussed, with the descriptions of economic activities from Annex I
2020 / 852 of 18 June 2020 on establishing a framework to collected and consolidated at the business segment level in and Annex II. After analyzing the Capex definitions of the
a multi-stage process. The determination of the EU Taxon- EU Taxonomy Regulation, we determined only the Capex
omy KPIs was based on our financial reporting system to
120
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
associated with the purchase of products and services from WELL-BEING OF THE PATIENT Our products are often used to treat people who are suffer-
a Taxonomy-eligible economic activity as applicable. This ing from serious or chronic diseases. Our task is to ensure
covers the main capital expenditure projects of the business Rising life expectancy and the growing global population the safety and quality of our products and services and to
segments. The EU Taxonomy-eligible Capex share 2021 make access to high-quality medical care increasingly meet the highest safety and quality standards for all pro-
(49%) relates to investments of all business segments in new important. Fresenius is committed to providing access to cesses and therapies. Information on our health care markets
construction and renovation of buildings, such as clinics or health care and medicine to as many people as possible can be found on pages 59 ff. of the Group Management
production facilities (Annex I: economic activities 7.1 and worldwide. Report 2021.
7.2). Our range of products and services includes a compre-
ACCESS TO HEALTH CARE AND MEDICINE hensive network of hospitals, modern dialysis procedures and
Opex Every year we assume responsibility for the well-being of post-acute care – such as rehabilitation – and high-quality
The amounts used to calculate the Opex KPI (denominator) millions of patients. We offer lifesaving and life-sustaining drugs and medical products. Our portfolio also includes dig-
are based on the direct costs of research and development products and therapies. In their development, we take into ital health services, advanced therapies, and the expansion
reported in the consolidated financial statements (Notes account different social and regulatory requirements and of primary care in emerging and developing countries.
page 310) and the costs of short-term leases (Notes page adapt them to different health care systems. This enables The main focus is on the quality of our products and of the
349). In addition, the cost of maintenance and repair was us to meet the growing global demand for innovative, high- medical care we provide our patients.
analyzed for all business segments from the local ERP sys- quality therapies. In 2021, we had more than 90 own pro- In 2021, access to health care and medicine was again
tems. For the identification of the EU Taxonomy-eligible duction sites and operated in more than 90 countries with hampered by the COVID-19 pandemic. In these challenging
share (numerator), the above-mentioned line items were own subsidiaries. Numerous national and international times, we have taken on our special responsibility as part
matched with the descriptions of economic activities from research projects and studies are carried out in our business of the healthcare system with extensive measures, which we
Annex I and Annex II. After analyzing the Opex definitions segments. In this way, we investigate and develop new already started in 2020. Further information can be found
of the EU Taxonomy Regulation, we determined only the treatment standards, improve current standards, for example on pages 125 ff. of this report.
Opex associated with the purchase of products and services by studying the side effects of pharmaceuticals by biologi-
from a taxonomy-eligible economic activity as applicable. cal sex or age group, and facilitate best practice exchange of OUR APPROACH
We did not identify any significant Taxonomy-eligible com- our health care professionals. Further, in our hospitals in Fresenius’ long-term goal is to further develop the compa-
ponents in our operating expenses that are directly attrib Spain and Germany, various approval studies for pharmaceu- ny’s position as one of the leading international providers of
utable to relevant economic activities within the meaning of ticals are conducted. We report in detail on our clinical health care products and services. In recent years, we have
the EU Taxonomy. The main expenditures for the mainte- study management in the Digital transformation and innova- expanded our company along our value chain – increasing
nance of our building infrastructure are capitalized and are tion chapter, see pages 142 f. of this Group Non-financial the global availability of our products and services.
Fresenius | Annual Report 2021
thus reflected in the EU Taxonomy-eligible Capex share. Report.
121
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
The constant development of our products and services care systems in developing countries. The business seg- generics and biosimilars products, Fresenius Kabi provides
allows us to take advantage of growth opportunities. We ment aims to increase the number of patients on home access to modern, high-quality, and affordable therapies for
guarantee our patients high-quality, comprehensive health dialysis and has improved the digital offering to make it eas- patients. Generics and biosimilars are cost-effective alter-
care with our products and in our own facilities, allowing ier for patients to access its services. Additionally, the natives to originator drugs. They help to lower the price of
them to benefit from medical progress. development of renal care infrastructure is an important part treatments and thus reduce the burden on healthcare sys-
Our core business focuses on ensuring that as many peo- of the company’s strategy. This includes continuing tems, e.g., in the United States or in Europe. Further infor-
ple as possible worldwide are able to participate in this to expand its network of dialysis clinics, for example. mation is provided in the Group Management Report 2021
progress. We consider health equity in our efforts to increase Fresenius Medical Care also has processes in place that allow on pages 52 ff.
access to care worldwide and to support the development of patients’ treatment to continue during crisis and emer-
sustainable health care systems. This means striving to make gency situations. Fresenius Helios
treatment and health education available to those in need, Home dialysis allows Fresenius Medical Care to expand Fresenius Helios’ acute care hospitals, outpatient clinics
irrespective of age, income distribution, race or ethnicity, or the health care capacity, increasing the number of patients and other health care facilities offer the full range of medical
education. that can be treated by a dialysis clinic. In addition, by facili- services. Our international hospital network enables
This ambition is also reflected in our commitment to tating treatment for patients living in more remote regions, Fresenius Helios to transfer knowledge between health care
society. the business segment aims to widen its geographical reach systems in Germany, Spain and Latin America with regard
and reduce patient travel. to affordable health care of high-quality, and with very high
Fresenius Medical Care standards of service and patient experience. In 2021, this
Fresenius Medical Care recognizes the importance of Fresenius Kabi international network enabled an intensive knowledge
improving access to health care and is working to provide Fresenius Kabi is committed to improving patients’ quality exchange on the treatment of COVID-19 patients in order to
affordable treatment to a growing number of patients of life. The business segment’s product portfolio targets improve treatment outcomes.
worldwide. The business segment’s Global Medical Office critically and chronically ill patients. It comprises a compre-
leadership team frequently discusses how to best manage hensive range of I.V. generic drugs, infusion therapies and Fresenius Vamed
this topic as part of the medical strategy. The focus is on both clinical nutrition products as well as the devices for adminis- Fresenius Vamed is active worldwide in the planning and
improving access to care and level-of-care outcomes. tering these products. In the field of biosimilars, Fresenius construction of healthcare buildings with the aim of serving
Fresenius Medical Care considers, for example, barriers to Kabi focuses on autoimmune diseases and oncology. Within patient health and improving access to healthcare services.
access such as cost and ease of travel to the dialysis clinics, transfusion medicine and cell therapies, the business seg-
lack of education on kidney disease, and unsustainable health ment offers products for collection of blood components and
extracorporeal therapies. With its comprehensive range of
Fresenius | Annual Report 2021
122
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Fresenius Vamed also provides operational management performing over 15% of treatments in the United States in Fresenius Kabi wants to be the preferred partner for physi-
services for acute and post-acute care facilities, prevention a home setting by 2022. This goal was achieved in the third cians and caregivers responsible for the treatment of criti-
centers, and elderly care homes, as well as technical services quarter of 2021 and the business segment set a new target cally and chronically ill patients. To this end, the Fresenius
with a focus on building, construction, and medical tech- in 2022. Globally, the number of its home dialysis patients Kabi Vision 2026 has been developed in the reporting year
nology, sterile goods supply, information and communication increased by about 10,000. In the United States alone, and adopted in the fourth quarter of 2021. Through Vision
technology, and infrastructure and business services. This Fresenius Medical Care educated more than 56,000 people 2026 the business segment has defined an overarching
enables Fresenius Vamed to provide access to high-quality living with chronic kidney disease or end-stage kidney direction for Fresenius Kabi with three well-defined growth
medical care for a growing number of people. disease about home dialysis options in 2021. The business vectors: broaden its biopharmaceutical offering, develop-
Patient safety is directly dependent on the quality of segment did this with the support of more than 180 kidney ment and global roll out clinical nutrition, expand in Med-
the treatments, care, or products used and indirectly on the care experts. Tech, and build resilience in its volume-driven I.V. business.
provision of operational management services. Fresenius Information on Vision 2026 is provided on page 47 of the
Vamed’s main goal is to give people around the world access Fresenius Kabi Group Management Report.
to health care services at all levels of care. The business segment further adapted its activities to the Fresenius Kabi is constantly expanding its product range
requirements of the COVID-19 pandemic in the reporting to provide high-quality and affordable health care to more
PROGRESS AND MEASURES 2021 year. Numerous elective or less time-critical treatments were patients. The business segment is expanding product avail-
again postponed in the hospital setting. Fresenius Kabi ability in established markets as well as in new and emerg-
Product and service portfolio thus stepped up its efforts to secure the supply of healthcare ing markets and has launched new products in 2021.
There were no significant changes in the Fresenius Group’s facilities with drugs and medical devices for treatment of
product and service portfolio in the reporting year 2021. intensive care and COVID-19 patients. In addition, the busi- Fresenius Helios
Under the influence of the ongoing COVID-19 pandemic, the ness segment has adapted its activities, e.g., in distribution, In 2021, Fresenius Helios closed the acquisition of the fer-
primary objective was to ensure patient care and access to to the respective specifications in place to control the tility service provider Eugin Group. Following closing of the
our products, services and health care facilities. spread of infection in the various countries. Through acquisition, the company has been consolidated in the
numerous webinars and online offerings, Fresenius Kabi has financial reporting since April 1, 2021, and will be integrated
Fresenius Medical Care worked to educate healthcare professionals and patients into the non-financial reporting as of 2022. Further infor-
In 2021, Fresenius Medical Care provided home therapy to with training and education on relevant topics such as inflam- mation on Eugin Group is included in the Fresenius Group
more than 54,000 peritoneal and hemodialysis patients matory diseases, and clinical nutrition in the care of criti- Annual Report on page 82. In 2021, the business segment
globally. In 2017, the business segment set itself the goal of cally and chronically ill patients, cancer patients or chronic conducted further strategic portfolio adjustments, which are
kidney disease patients. also described in the Group Annual Report 2021, see page
Fresenius | Annual Report 2021
82 of the Group Management Report.
123
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
The improvement of therapeutic measures based on clinical Patient support in crisis and emergency situations Furthermore, the business segment regularly tests the
studies outcomes and the increasing use of telemedical As a health care Group, we have to be crisis-proof and emergency response procedures to assess service safety
services are explained in detail in the chapter Digital Trans- respond flexibly in all areas: it is our task to enable unre- and continues to donate funds, dialysis machines, and
formation and Innovation on pages 141 ff. of this report. stricted access to our services and seamless care for medical supplies to organizations that require support.
patients even under difficult conditions. To ensure this, we
Fresenius Vamed have established high-performance as well as resilient Fresenius Kabi
Fresenius Vamed is one of the leading private providers of emergency systems and programs in our business segments. Fresenius Kabi has a crisis team for emergency situations
post-acute care in Central Europe, thus strengthening which is summoned immediately after an event that could
access to the relevant services, especially in the rehabilita- Fresenius Medical Care lead to a crisis occurs. The crisis team comprises members
tion segment. In 2021, outpatient rehabilitation services Fresenius Medical Care’s goal is to continue to provide of the Management Board, key staff units, and other rele-
were expanded. The outpatient offerings are easy to access access to health care under difficult circumstances, for exam- vant functions of the business segment and initiates neces-
and enable in-service utilization of medically necessary ple in the case of a health crisis or natural disaster. The sary measures, coordinates the company’s activities, and
rehabilitation services. Existing facilities were expanded by business segment has dialysis clinics in many regions of the monitors the measures initiated. Crisis situations are consid-
therapeutic offers for additional indications. After numer- world with diverse geographic, social, and economic condi- ered to be unforeseen events that may, e.g., have an impact
ous rehabilitation facilities were temporarily closed in 2020 tions, serving a vulnerable population of patients who need on the company or the public. During the COVID-19 pan-
due to the COVID-19 pandemic, business operations were regular dialysis treatment multiple times a week. To allow the demic, the crisis team met to coordinate measures to ensure
largely uninterrupted in 2021. In order to ensure safe access business segment to continue treating its patients in extreme the supply of vital medicines to patients.
to our health care services for our patients and employees conditions, it has developed an emergency response system
in the wake of the COVID-19 pandemic, comprehensive pre- comprising regional disaster response teams. These teams Fresenius Helios
vention concepts were drawn up based on regulatory pro- seek to ensure that treatments continue under difficult cir- In the hospital sector, there are legal requirements for how
visions, and measures were implemented and adapted in line cumstances. For example, in February 2021, a team assisted care is to be organized in the event of an emergency.
with epidemiological developments. In addition, a Corona- patients affected by extreme weather in Texas that caused a Therefore, hospitals and health care facilities have dedicated
virus Crisis Team, which meets regularly, has been installed water shortage. More than 160 of the business segment’s emergency plans to respond immediately to incidents that
to check the validity and application of existing preventive dialysis clinics were forced to temporarily close as a result, might be critical for patients. These encompass, among oth-
measures. affecting about 5,000 patients. The disaster response teams ers, evacuation plans, emergency systems in case of inter-
brought in generators and water tankers to assist in getting
clinics operational. Additionally, Fresenius Medical Care
provided hospitals with dialysis equipment and supplies to
Fresenius | Annual Report 2021
help manage the surge of patients seeking treatment.
124
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
ruption of power or water supply, or plans to respond to vide facilities that were particularly affected with additional that patients have a high risk of complications should they
impacts on local infrastructure, like flooding. Emergency protective equipment. In 2021, the VAMED clinic Hagen-Am- contract the virus. Patients and staff entering dialysis clinics
power generators ensure that operations or vital therapies, brock was affected by the extreme weather situation in are screened for the virus and given personal protective
such as artificial respiration, can continue even in the event Germany. Our emergency plans were activated, and the local equipment. Fresenius Medical Care also encouraged patients
of a power failure. In 2021, incidents occurred in Germany infrastructure was secured, for example by emergency to get vaccinated. In addition, Fresenius Medical Care has
and Spain, such as extreme weather events, that impacted power generators and submersible pumps. The care of our set up isolation centers and treated more than 17,000
the respective local hospital infrastructure and patient care. patients was thus ensured. In our other regions affected by patients infected with COVID-19 in North America.
Patients were not harmed by these events. Incidents were extreme weather situations, no clinic operation was To broaden the contribution to the fight against COVID-19,
assessed, together with the local authorities, and necessary impacted. the business segment donated € 250,000 to UNICEF to sup-
evacuation measures or remediation measures were imple- port its vaccination initiative in about 140 countries. UNICEF
mented. Health care delivery during the will put this money towards measures aimed at protecting
COVID-19 pandemic teachers and medical workers against the COVID-19 virus.
Fresenius Vamed The COVID-19 pandemic again posed continued extraordinary This in turn should support the care and education of chil-
At Fresenius Vamed, a structured crisis management system challenges to the global health care system in 2021. For dren impacted by the pandemic. The business segment pro-
takes immediate effect in critical situations. It comprises Fresenius as a health care Group and as a company with vided hundreds of acute dialysis devices and further sup-
the Management Board, key staff units, and the management many employees and a great deal of patient contact, pan- plies to hospitals for emergency treatment.
teams of the lead companies. The crisis team meets as demic protection and prevention is essential. Emergency Despite the increased safety measures, it was able to
soon as an incident becomes known and initiates all neces- management plays a key role in this: it enables us to main- continue producing and delivering life-saving products, even
sary measures. Like Fresenius Helios, Fresenius Vamed’s tain the care of all patients in our health care facilities and when operations and supply chains were hampered by
facilities have emergency and outage concepts and crisis ensure the supply of medicines. Based on the legal require- global restrictions.
communication plans in place, which have been drawn ments and regulatory recommendations for the COVID-19
up together with the local emergency units. Beyond that, pandemic, our business segments implemented measures in Fresenius Kabi
Fresenius Vamed ensures all necessary prerequisites to response: Demand for some of Fresenius Kabi’s drugs and medical
ensure the safety of systems and infrastructure, not only for devices has increased significantly due to the COVID-19 pan-
its own facilities but also for those hospitals, for which the Fresenius Medical Care demic. For example, the business segment saw an increased
company provides facility management services. These mea- In 2021, the fallout from the COVID-19 pandemic continued demand for its infusion pumps and respective disposables in
sures have increased the speed of response to individual to present the business segment with extraordinary chal- 2021 and an ongoing high demand for clinical nutrition.
COVID-19-related incidents and thus made it possible to pro- lenges. These were exacerbated by the fact that acute kidney
Fresenius | Annual Report 2021
injury is common in critically ill COVID-19 patients, and
125
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Fresenius Kabi reacted to this demand early, using all Fresenius Helios At our hospitals in Spain and Latin America, more than
suitable capacities to increase production volume for these Measures taken at our Fresenius Helios’ hospitals in 2021 20,000 patients have been hospitalized in 2021. The mortal-
products. In addition, Fresenius Kabi’s crisis team, which were carried out in close, continuous consultation with the ity rate was 12% in 2021.
was set up at the beginning of the pandemic, is continuously respective crisis team at Group level and the crisis teams The use of social media to educate and inform about
coordinating the efficient manufacturing and supply of or task forces of the clinics as well as the central and local COVID-19 has been successful in Germany and Spain. For the
essential drugs needed for the management of critically ill hospital hygiene departments. As of March 2021, the German sites, Helios published messages on the pandemic,
COVID-19 patients. Fresenius Kabi continued its activities in numbers of intensively managed COVID-19 patients in the testing procedures and vaccinations, which were widely
response to the ongoing COVID-19 pandemic and adapted Helios hospitals dropped significantly and a return to nor- shared. Helios Spain uses its social media channel to provide
them to the changing environment. The focus in the report- mal operations was initiated. By mid-2021, elective proce- written information or videos on the most urgent questions,
ing year, in view of the volatility of the procurement mar- dures were suspended only in isolated cases, depending like hygiene, vaccines, or even the impact on family life, as
kets, was on supply capability in order to ensure the supply on the utilization of the respective intensive care unit by well as information regarding the impact on hospitals
of vital medicines and medical devices for patients. The COVID-19 patients. In what was referred to as the fourth appointments and the availability of COVID-19 tests in our
business segment closely monitored the availability of mate- wave, the number of COVID-19 patients again increased centers. Our dedicated hotlines were well received by the
rials required for the manufacture of products to ensure the noticeably from October 2021, with recognizable hotspots general public, and we again received a high number of calls.
best possible availability, e.g., through increased inventories in the German states of Saxony and Bavaria. Here, elective
as applicable or higher safety stocks for selected raw operations had to be postponed again in isolated cases. Fresenius Vamed
materials essential for the production of products, as well Since June 2021, the number of COVID-19 patients in our Ger- For all managed and owned health care facilities, Fresenius
as ongoing alternative supplier qualifications. In 2021, man clinics has been published on the website of the busi- Vamed created catalogs of measures in which the pandemic
Fresenius Kabi was able to mitigate supply bottlenecks for ness segment (German language). Further information is pro- experiences in Austria, Germany, the Czech Republic, the
sourced products and avoided significant effects on the vided regarding the intensive care capacity and treatment United Kingdom, and Switzerland were collected; these cata-
supply of vital drugs and medical devices to patients. of the patients. logs are updated regularly. As a result, our health care
In the reporting year, it was possible to draw on the facilities were able to remain open, subject to the respective
experience gained in 2020 and adjust staffing and structural regulatory requirements. The experience gained will con-
capacity depending on the pandemic situation. At Helios tinue to be incorporated into risk management in the future
Germany, for example, the number of intensive care beds and will help Fresenius Vamed to continuously improve its
was increased again to over 1,300 at the start of the fourth processes and actions. Furthermore, a 24 / 7 information
wave in fall 2021, following a comparatively relaxed overall hotline as well as comprehensive and continuously updated
situation in the summer. Helios Germany cared for about
Fresenius | Annual Report 2021
30,000 patients with a COVID-19 infection in 2021, more than
8,000 of whom required intensive care. About 5,000 patients
died in our hospitals with or due to a COVID-19 infection.
126
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
information on the Fresenius Vamed intranet “Corona Info- provided through dedicated communication channels, for By offering regular training on a global, regional, and local
center” are available to Fresenius Vamed staff. In Germany example websites, and trained experts from our business level, Fresenius Kabi ensures that employees are aware of all
and Austria, a small number of COVID-19 cases occurred in segments. aspects of the quality management system that are relevant
the nursing facilities, except for two facilities in Germany, We have established sophisticated and efficient pro- for their daily work. For more information on quality manage-
where larger numbers of COVID-19 cases were reported. cesses in all business segments that are fully geared ment training at Fresenius Kabi, see the Employee Develop-
The prevention measures, such as the 3G rule, testing toward the safety of our patients. In the area of quality ment section starting on page 168.
offers for residents and employees, mandatory masks, management, we monitor, manage, and improve these Helios Germany has three simulation and emergency
access restrictions, etc., have been and are being imple- processes with performance indicators. Each individual busi- facilities in Erfurt, Krefeld and Hildesheim. Among other
mented accordingly or adapted to the situation. ness segment adapts its quality management system and things, surgical procedures or crisis scenarios in the operat-
Please refer to the Notes to the Consolidated Financial sets priorities according to its respective business model. ing room are trained here. In addition, such training
Statements on pages 312 f. for further information on assis- Our quality management systems meet and are based on var- courses take place in the clinics directly. In the fields of emer-
tance programs provided by various governments in the ious standards or are adapted to them. International stan- gency medicine, anesthesia, intensive care medicine, and
form of reimbursement payments and funding in connection dards such as ISO (International Organization for Standard- obstetrics, decisions on the content and number of partici-
with the COVID-19 pandemic. ization) and GMP (Good Manufacturing Practice) are pants in the mandatory training courses are based on reso-
particularly important for our production facilities. Our hos- lutions of the respective specialist groups. Helios Spain con-
PATIENT AND PRODUCT SAFETY pitals and health care facilities measure the quality of tinuously provides training on patient safety, on its quality
patient care using various indicators. Each of the four busi- management systems and on topics that are essential in hos-
OUR APPROACH ness segments is subject to specific regulatory require- pital routine. In 2021, 14 sessions or courses were con-
At Fresenius, our aspiration is: Ever better medicine for ments and standards, depending on the business activity ducted in the hospital network. The exchange of knowledge
ever more people. In order to provide patients with the best and the market. among the hospital network has been promoted through
possible care, we offer them medical treatments and prod- We use different applications to check our quality man- inter-hospital clinical sessions that now cover several medical
ucts that meet our strict requirements for quality and safety. agement systems, depending on the business segment and fields such as gynecology and obstetrics, pediatrics, and
It is essential for the safety and well-being of our patients business activity. We use externally provided IT systems as internal medicine. In addition, clinical sessions have been
that we appropriately label our products, describe our ser- well as self-developed applications. All units are subject to held on several patient safety topics: best patient safety
vices in a transparent manner, and provide all relevant regular external and internal audits. Peer reviews in hospi- practices in the surgical block, preventing adverse events in
information to patients or their relatives in our health care tals are carried out if the internal quality targets are not met. the insertion and management of venous access, patient
facilities. For health care professionals, relevant informa- We report on the evaluation and outcome of audits for falls prevention, medical record and informed consent com-
tion on pharmaceutical products or medical equipment is each business segment. pletion requirements, transforming the patient safety cul-
Fresenius | Annual Report 2021
Training courses for our employees, which are an essen- ture of the hospital through the Joint Commission Interna-
tial part of guaranteeing the safety of our patients and tional accreditation process, and evidence-based safety
products, are an important component of our quality man- improvement practices.
agement systems.
127
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Fresenius Vamed’s quality management officers also regu- In addition, the business segments have developed their In 2021, further locations were added to ISO 9001. Due to
larly conduct legally required training courses and quality own comprehensive guidelines. Furthermore, they have the COVID-19 pandemic, certifications at Helios Spain
management training courses. In addition, Fresenius Vamed voluntarily committed to complying with a wide range of planned for the 2020 reporting year were started in the first
plans and conducts in-person and online training courses industry obligations and international standards. quarter of 2021 and successfully finalized in March 2021.
on a wide range of topics. The Fresenius Group quality management approach is
Further information on employee training can be found Certifications and commitment controlled by internal specialists or dedicated functions
in the Employee Development chapter on pages 165 ff. Our commitment to patients’ health and well-being in the within the business segments. Relevant data is reviewed reg-
business segments is reviewed and certified by external ularly, for example daily. If deviations occur, our specialists
Organization and responsibilities partners or regulatory bodies. We are continuously expand- initiate root cause analyses or peer reviews; they evaluate
All Fresenius employees must ensure that the applicable ing the number of sites certified to ISO 9001 standard, deviations and, if necessary, determine corrective or pre-
quality and safety regulations are always applied in their applicable international acknowledged care or hospital stan- ventive actions. Regular internal audits and self-inspections,
areas of responsibility. The employees in the production dards or quality standards provided for centers of expertise at least annually, often at higher frequencies, support data
facilities, outpatient centers, and hospitals have a special for certain areas of treatment. Not all locations have the same verification and management approaches, for certified and
obligation to exercise due care. The organizational structures scope of certifications. However, at the very least they non-certified entities. Thus, we ensure that patient health
are adapted to the requirements of the individual business adhere to internal quality standards, which are subject to activities comply with internal guidelines and regulatory pro-
segments. applicable regulatory provisions. visions. The overarching ambition is to improve the effi-
ciency and coverage of our quality management systems
Policies and regulations Quality principles or standards applied in addition to the and, ultimately, the credibility of the procedures and sys-
All four business segments comply with the applicable laws internationally acknowledged ISO 9001 are, among others, tems in place.
within the framework of quality management. This includes Following a risk-based approach, Fresenius Medical Care
the EU legislation on the Registration, Evaluation, Authoriza- ▶ the
methodology of the Initiative for Quality Medicine carries out internal audits at least once a year at each of its
tion and Restriction of Chemicals (REACH), the Restriction (IQM), the model EFQM, the standards of the Joint production sites. The business segment assesses its quality
of Hazardous Substances (RoHS), the Medical Device Regu- Commission International (JCI), and the Spanish UNE, management systems against internal and regulatory stan-
lation (MDR), and the Code of Federal Regulations (CFR) of for health care facilities, and dards. Internal quality audits at the local sites help the busi-
the U.S. Food and Drug Administration (FDA), among others. ▶ Good
Manufacturing Practice (GMP), Good Distribution ness segment determine the effectiveness of these systems.
Practice (GDP), Guideline on Good Pharmacovigilance The consolidated quality management system is certified
Practices (GVP), Medical Device Regulation (MEDDEV; according to ISO 9001 and ISO 13485. Fresenius Medical
MDR), the Code of Federal Regulations (CFR) of the U.S. Care also completed the Medical Device Single Audit Pro-
Fresenius | Annual Report 2021
Food and Drug Administration (FDA), and the ISO 13485 gram (MDSAP) for this system. The production sites are
quality management standard for medical devices in our
production business of Fresenius Medical Care and
Fresenius Kabi.
128
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
subject to regular external quality audits and reviews in tions conducted in 2021 will be included in the certification Evaluation
accordance with local requirements. Audits are carried out in 2022. 33% of the hospitals are additionally certified With regard to patient health and safety in all business
according to the Good Manufacturing Practice (GMP), the under the quality standard UNE 179003. In 2021, 4 further segments, breaches or violations that lead to deviations from
Current Good Manufacturing Practice (cGMP), ISO 9001, hospitals were awarded the international certification UNE internal management provisions have to be evaluated.
ISO 13485, or MDSAP. In 2021, 74% of the production sites 179003, a total of 16 hospitals for the reporting year (2020: Resulting corrective and preventive actions aim to ensure
managed by the Global Manufacturing, Quality, and Supply 12; 24%). 11 hospitals are also already certified to UNE our patients’ health and safety. Information on the identifica-
division were certified to ISO 9001 / 13485. 179006, the standard for infection control (2020: 8). In addi- tion of deviations and examples of possible deviations can be
Fresenius Kabi’s quality management system is orga- tion, we have 12 assisted reproduction units certified with found in the following reporting on the business segments.
nized in accordance with the ISO 9001 standard and is UNE 179007.
binding for all organizations of the business segment. Com- In 2021, two further hospitals were included in the JCI FRESENIUS MEDICAL CARE
pliance with the standard is reviewed by TÜV Süd in annual certification. In total, five hospitals (including clinics in Patient well-being is top priority. As part of the business
audits at a global level and covers 102 Fresenius Kabi orga- Latin America) are accredited with JCI and four hospitals segment’s commitment to delivering safe, high-quality care
nizations through a matrix certification; further organiza- with the European Foundation for Quality Management to patients with chronic illnesses, it continually monitors
tions hold local ISO 9001 certificates. In addition, numerous (EFQM) standards. Fundación Jiménez Díaz was the first hos- the performance of its products and services. The focus is
manufacturing plants are also certified according to pital in the world to receive the EFQM Global award. The on quality, safety, accessibility, and patient experience.
ISO 13485 for medical devices as well as GMP. hospital has obtained more than 750 points, which also gives Fresenius Medical Care makes further improvements where
Helios Germany applies the German Inpatient Quality it the EFQM 7 Stars seal, the highest score for this stan- necessary, keeping in mind the goal to expand access to
Indicator (G-IQI) management system in all German clinics. dard. high-quality health care. The business segment invests in
Newly acquired entities are integrated into this manage- Fresenius Vamed aligns its internal processes to estab- innovations and new technologies, and leverage insights
ment system from the start of the acquisition. Further certi- lished quality standards such as ISO 9001, the sector-specific from scientific research and collaboration with partners.
fications encompass the acknowledgment as centers of standard EN15224 for quality management in health care, Fresenius Medical Care develops, produces and delivers a
medical expertise, e.g., for oncology, diabetes, endopros- and ISO 13485, as well as the EFQM standards. In addition, broad range of products for treating kidney disease. With
thetics, or others. Fresenius Vamed has certified several health care facilities its network of production sites around the world, the com-
Helios Spain gears its quality management toward the according to international standards such as JCI, ISO, or the pany controls the procurement, production, distribution,
requirements of recognized international quality standards. German QMS-REHA (BAR). All inpatient rehabilitation facili- and supply of renal and multi-organ therapy products. The
All hospitals and centers are certified according to ISO ties in Germany must be certified in accordance with a pro-
Standard 9001 and continued to be certified according to the cedure recognized by the Federal Association for Rehabilita-
Spanish Association for Standardization, UNE. New acquisi- tion (Bundesarbeitsgemeinschaft für Rehabilitation e.V.
Fresenius | Annual Report 2021
– BAR). All certifications form the basis for the continuous
improvement of the processes at Fresenius Vamed.
129
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
business segment manages quality and safety in its product In 2021, a chapter on medical strategy and quality manage- Our ambitions
business over the entire product life cycle, from design and ment was included in this policy. Responsibility for inte- Fresenius Medical Care has set itself the goal of implement-
development, to operation and application. grating the policy into operations lies with senior medical ing a global quality management system by 2024. Addi-
leadership and the interdisciplinary patient care teams in tionally, the IT tool for audit management has already been
Organization and responsibilities each of the regions. harmonized globally, and the company plans to introduce a
The Global Medical Office drives the medical strategy and The Global Quality Policy outlines the company’s com- global electronic training system by 2024.
coordinates activities related to the advancement of medical mitment to product and service quality. The policy also Fresenius Medical Care has defined its first global KPI
science and patient care. It is part of the business seg- covers the obligation to comply with relevant regulations, for quality of care – the global hospitalization rate. It mea-
ment’s network that promotes scientific and medical progress and maintain environmentally sound and efficient opera- sures the length of time a patient spends in hospital.
worldwide. The Global Medical Office is led by the Global tions. It is the basis for regional quality manuals and further Fresenius Medical Care is also planning to develop a
Chief Medical Officer who is also a member of the Manage- policies covering responsibilities, training, risk assess- quality index focusing on the most relevant quality indicators
ment Board of Fresenius Medical Care. Key findings of the ments, and audits. The Management Board is regularly to reflect improvements and achievements related to global
Global Medical Office are reviewed by dedicated commit- informed about the global quality performance. patient care.
tees. They are published on a regular basis and shared Over the past few years, Fresenius Medical Care has Having recently achieved the internal NPS target,
with the medical community. merged the quality management systems in Europe, Middle the business segment is now aiming for a NPS score of
The Global Research and Development and the Global East, and Africa, Latin America, and Asia-Pacific. at least 70.
Manufacturing, Quality, and Supply divisions are responsible
for the product business of Fresenius Medical Care. The Patient information Progress and measures 2021
functions report directly to the Management Board of the Fresenius Medical Care treats patients across the full spec- Fresenius Medical Care works with external organizations
company. trum of chronic kidney disease. The company believes listen- to facilitate scientific progress and explore new ways of
ing to their therapy preferences is critical. The company improving quality of care. In 2021, the business segment
Internal rules of conduct and guidelines aims to give patients an informed choice and provide treat- was involved in more than 60 key partnerships with aca-
Fresenius Medical Care’s commitment to continuously ment options that best fit their circumstances. Home dialysis demia, research institutes, and peers. Focus areas included
improve the quality of care is included in their Code of Ethics provides patients with the opportunity for greater indepen- cardio-protection, personalized and precise medicine,
and Business Conduct. The Global Patient Care Policy out- dence and control over their time and health outcomes. public health, and the impact of COVID-19 on vulnerable
lines the principles, responsibilities, and processes related patient populations.
to patient experience surveys and grievance mechanisms.
Fresenius | Annual Report 2021
130
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Evaluation Patient satisfaction In addition to the NPS, Fresenius Medical Care also tracks
During the COVID-19 pandemic, Fresenius Medical Care has As part of the global patient experience program, Fresenius survey coverage and response rates. In 2021, a global cover-
worked to keep the clinical care environment as stable as Medical Care aims to conduct patient experience surveys at age rate of 91% was achieved, in line with the target of 75%
possible and deliver a high quality of care. Further informa- least every two years. The business segment uses the infor- or above. In 2021, the response rate was 75%.
tion is provided on the company’s website, see the Sus- mation collected to evaluate the services provided by its
tainability section. dialysis clinics and implement global improvement pro- Patient grievance processes
cesses. Fresenius Medical Care’s goal is to establish mea- In addition to the experience survey, Fresenius Medical Care
Quality analyses sures that enable more personalized care and improve the provides patients and their representatives with other
Fresenius Medical Care continually measures and assesses quality of services. Based on the results of the 2020 survey, feedback channels. They can use these to make any sugges-
the quality of care provided in its dialysis clinics based on in 2021 the business segment sharpened its focus on tions or raise concerns, anonymously if they wish. Channels
generally recognized quality standards and international improving patient education, individualized patient care, and include dedicated hotlines and email addresses, complaint
guidelines. These include those of the global nonprofit service excellence. For example, the business segment and suggestion boxes, and a feedback form on the company
Kidney Disease: Improving Global Outcomes, the Kidney developed patient education material to help clinic staff website. The business segment is committed to resolving any
Disease Outcomes Quality Initiative, and European Renal better inform their patients about health-related topics. issues in a timely manner.
Best Practice. The business segment also considers indus- Fresenius Medical Care measures patient experience In the reporting year, the company received 24,449
try-specific clinical benchmarks and its own quality tar- and customer loyalty using the Net Promoter Score (NPS). patient reports through local feedback channels.
gets. The NPS reflects patients’ overall satisfaction with the ser- The business segment’s policies allow patients to report
Additionally, Fresenius Medical Care evaluates a set of vices. In 2021, the NPS was 71, compared with 67 in 2020. grievances without fear of reprisal or denial of services. In
medical indicators on an ongoing basis to measure the The increase can be attributed to comprehensive local most regions, concerns that are dealt with on the spot are not
quality of care provided in its dialysis clinics. The global hos- improvement measures, such as those mentioned in the considered grievances. Fresenius Medical Care provides
pitalization rate measures the length of time a patient paragraph above. In line with the mission to provide a training to support staff in following patient grievance guide-
spends in hospital. In 2021, the global hospitalization rate future worth living for the patients, the business segment lines.
was 10.7 days per patient. This is an important indicator, is continuously working toward improving patients’ experi-
given hospitalization has a significant impact on a patient’s ence. As part of the NPS calculations, the percentage of
quality of life. It also reflects the business segment’s impact patients is measured that would recommend Fresenius
on the respective health care system, which is especially rel- Medical Care. In the reporting year, 78% of the patients
evant during the ongoing pandemic. Other quality of care answered in the survey that they would highly recommend
KPIs are currently measured on a regional level as Fresenius the services.
Fresenius | Annual Report 2021
Medical Care continues to harmonize these criteria.
131
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Handling product complaints targets an average global audit score not exceeding 1.0 to INTEGRATED QUALITY MANAGEMENT FRESENIUS KABI
Post-market surveillance is an integral part of quality man- maintain the effectiveness of its quality management sys-
agement. It is essential that products and services are effec- tems and certifications. All audit findings are documented
tive and reliable, and pose as low a risk as possible to and escalated depending on their criticality and are used to
patients. Standards for planning, conducting, and monitor- determine and implement appropriate corrective and pre-
Integrated quality management system ISO 9001
ing clinical studies help to enhance product quality and ventive measures.
safety and improve patients’ health. Should any issue arise
concerning the safety of our products, Fresenius Medical FRESENIUS KABI
Product-specific standards and norms,
Care takes corrective action. This could include publishing Fresenius Kabi’s corporate philosophy “caring for life”
Occupational health and safety
further information and data on the product after market describes the company’s commitment to improving the qual-
Environmental management
e.g., GxP, ISO 13485, MDR
introduction, or product recall. ity of life of its patients. The quality and safety of its prod-
Applicable legislation
Energy management
Fresenius Medical Care strives to comply with legal and ucts and services is therefore of paramount importance to
regulatory requirements in monitoring the adverse effects the business segment. An important goal of the quality
of drugs – also called pharmacovigilance – and medical management at Fresenius Kabi is to monitor the applicability,
ISO 14001
ISO 50001
ISO 45001
devices. The business segment collects and reviews adverse efficacy, and safety of products and services, as well as the
events and product complaints. The company has incorpo- success of therapies, and their continuous improvement. To
Active
rated the topic of reporting adverse events and product com- ensure this, the company has established an integrated Pharmaceuticals Nutritionals pharmaceutical Medical devices Others
ingredients
plaints in its Code of Ethics and Business Conduct. quality management system, a monitoring and reporting sys-
tem, and product risk management.
Audits Fresenius Kabi has global standard operating procedures
Fresenius Medical Care has defined key performance indica- as well as a quality management manual that includes,
tors to monitor its quality objectives and prevent adverse among other things, the company’s quality policy, which also Organization and responsibilities
events. The company discloses the audit score, which indi- applies to all sites. The business segment uses a global At Fresenius Kabi, the globally responsible quality managers
cates the ratio of major and critical findings to the number electronic quality management system, KabiTrack, based on report directly to the respective member of the Manage-
of external audits. In 2021, more than 50 certification audits the Trackwise® software, for event and change control of ment Board. The members of the Management Board are
were performed at productions sites that are managed by quality management processes. The system supports the directly responsible for quality management. They attend
the Global Manufacturing, Quality, and Supply division. The local implementation of centrally defined processes as quality oversight meetings and receive quality reports on a
audit score was 0.1 (2020: 0.2). Fresenius Medical Care well as global oversight. regular basis.
Fresenius | Annual Report 2021
132
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Policies and regulations Product risk management The products of Fresenius Kabi are also subject to certain
Fresenius Kabi has defined the following principles for its Global safety officers react promptly and appropriately to labeling requirements. The labeling of the products is
quality management: potential quality-related issues. They initiate and coordinate checked as part of the regular pharmacovigilance activities
necessary actions, such as product recalls, on a global level. – e.g., compliance with laws relating to side effects of
▶ Clear assignment of responsibilities With its early-warning system, Fresenius Kabi evaluates any medicinal products – and updated if necessary. For example,
▶ Qualification and continuous training of employees quality-related information from various risk areas to iden- product labeling is updated if competent authorities, e.g.,
▶ Monitoring of product and patient safety tify risks early and take corrective and preventive actions. the Pharmacovigilance Risk Assessment Committee (PRAC)
▶ Transparent and documented processes and procedures Information is obtained from databases for complaints and of the European Medicines Agency (EMA), publish relevant
▶ Fulfillment of regulatory compliance side effects, internal and external audits, and from key per- information. The dedicated function at Fresenius Kabi uses
▶ Continuous improvement formance indicators used for internal control and optimiza- an electronic management system for product labeling or
▶ Checking of quality management effectiveness tion of quality processes. With these systems, Fresenius Kabi any printed packaging material to manage the information
can evaluate the safety profile of any of its products at a necessary for labeling and to ensure correctness. The
Monitoring and reporting systems global level continuously. requirements of the European Falsified Medicines Directive
Fresenius Kabi interacts with patients, users, and custom- Product recalls, for example, are initiated as a risk- or the U.S. Drug Supply Chain Security Act (DSCSA) lead
ers in the provision of products and services, and monitors the minimizing measure in cooperation with the responsible the way in this context. Fresenius Kabi takes into account
applicability, effectiveness and safety of its products on the regulatory authority. At the same time, the cause of the their specifications and has introduced appropriate pro-
market. Further, the business segment monitors and evalu- recall is analyzed. Where necessary, corrective measures cesses for serialization, testing, and traceability for the rel-
ates relevant information and feedback on the products, are taken to prevent the cause of the recall in the future. evant products. Further information on transparency in
services, and therapies during their use. Fresenius Kabi has health care can be found on page 185 f. of this report, section
set up monitoring and reporting systems, e.g. a vigilance Labeling and product information Compliance.
system, and a product risk management system covering all Fresenius Kabi’s products are classified, e.g., as pharma- With the help of its vigilance activities, Fresenius Kabi
regions worldwide, in order to be informed and deal with ceuticals, nutritional products, active pharmaceutical ingre- ensures that the patients’ safety of its products is always
product quality and patient safety issues in a timely manner. dients, or medical devices, based on global and national guaranteed: In this way, the company can identify any
These early-warning systems are designed in such a way regulations and standards. The marketing of these products changes in the benefit risk ratio of its products at an early
that trained complaints and safety officers worldwide record is subject to various laws and regulations to ensure com- stage and reacts in a timely manner. Fresenius Kabi’s Cor-
complaints and side effects in IT systems and forward the plete and fact-based product information. Fresenius Kabi porate Safety Officer is responsible for the global vigilance
respective information to experts for review. has a global policy and global standard operating proce-
dures for its product information to ensure that it is in accor-
Fresenius | Annual Report 2021
dance with applicable laws and regulations and that the
product information is correct, accurate, and not misleading.
133
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
system. This function ensures that the company can respond Progress and measures 2021 in accordance with the applicable regulations and
quickly to safety-relevant events. Fresenius Kabi promptly In the reporting year, the management approach and gover- therefore strives to report 100% of the Individualized
informs its customers and the public about matters concern- nance structure of Fresenius Kabi remained as reported in Case Safety Reports (ICSRs) to the authorities in time.
ing product and patient safety; this may be done directly 2020. Progress focused on implementing the requirements of For 2021, the worldwide compliance rate was 99.6%
or through appropriate public relations, if applicable. the EU Medical Devices Directive (MDR), which has been (2020: 99.9%). In Europe, in 2021 99.6% (2020:
The new requirements for medical devices as a result of in force since 2021. 99.5%) of all adverse reactions were reported to the
the Medical Device Directive (MDR) issued by the EU in European Medicines Agency (EMA) in due time.
2017 came into force on May 26, 2021. Thus, the focus on Evaluation ▶ In addition, Fresenius Kabi regularly evaluates the benefit
patient safety was significantly tightened for all medical Fresenius Kabi assesses the health and safety impacts of all risk ratio of its products based on safety-related infor-
devices on the European market, including the requirements significant product and service categories. Further, Fresenius mation from various sources (e.g., adverse event reports,
for respective vigilance systems. Fresenius Kabi has Kabi aims to assess products for improvement potential. medical literature). The results of these analyses are
adapted its processes in accordance with the new regulation. Further information is provided in the R & D section in Group submitted to authorities as periodic safety reports.
For example, Fresenius Kabi integrated the shortened Management Report on pages 52 ff.. Fresenius Kabi aims to submit all periodic safety reports
reporting timelines to the responsible authorities into its worldwide to authorities in due time. For 2021, the
internal processes. Vigilance system compliance rate was 98.9% (2020: 99.6%). In Europe,
The monitoring of adverse reactions or events (side effects) 98.8% of all periodic safety reports were submitted in
Our ambitions associated with the use of medicinal products is referred to due time to the EMA in 2021 (2020: 98.6%).
At Fresenius Kabi, the application of the highest possible as pharmacovigilance (drug safety). The statutory pharma- ▶ According to regulatory requirements, Fresenius Kabi, as
quality and safety standards, the efficacy of products and ser- covigilance commitments relate to our medicinal products for a pharmaceutical company, is obliged to describe its
vices, and the adherence to regulatory assessment and human use. Similar regulations exist for medical devices. vigilance system in a Pharmacovigilance System Master
compliance requirements, are essential conditions to sup- Fresenius Kabi has established various standard operating File (PSMF). Fresenius Kabi uses a global database to
port the business segment’s goal: to ensure its long-term procedures for the continuous monitoring of the bene- collect and evaluate vigilance data on a quarterly basis
success. Fresenius Kabi continuously promotes a quality fit-risk ratio of its own products and assesses their success- from all local marketing and sales units for the PSMF.
and safety culture and aims to ensure compliance with ful implementation based on specific indicators. The goal is to receive timely data from all marketing and
increasing regulatory requirements and expectations of reg- sales units worldwide. This is documented in the com-
ulatory bodies in an effective manner. ▶ Fresenius Kabi collects and assesses reports about indi- pany’s vigilance system. For 2021, the compliance rate
vidual side effects and reports them to health authorities was 100% (2020: 100%).
worldwide in accordance with regulatory requirements.
Fresenius | Annual Report 2021
The business segment claims to submit all safety reports
134
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
In addition to the timely evaluation and reporting of single Good Manufacturing Practices (GMP) by the U.S. Food and FRESENIUS HELIOS
side effects to authorities, cumulative evaluations on side Drug Administration (FDA), the Australian Therapeutic Helios Germany has developed a quality management system
effects are carried out to guarantee the safety of our products Goods Administration (TGA), Canada Health, European regu- based on three pillars: Measure, Publish, Improve, used by
(signal detection). These include important events, e.g., latory authorities, and Quality System audits from TÜV around 500 hospitals in Germany and Switzerland. This qual-
reports about side effects with a fatal outcome to evaluate if Süd (notifying body for ISO 9001). ity management system is based on administrative data
new information is available about a known side effect (routine data) from patient treatments: the hospitals docu-
profile or a new side effect of a product leading to a changed AUDITS AND INSPECTIONS ment each treatment step for later billing with the health
risk profile. No such information became known in the 2021 2020 2019 insurance companies. This routine data shows whether the
reporting year about side effects of the business segment’s Internal audits 58 42 60 healing process took longer than expected, and whether
products. External audits and inspections 94 59 64 complications or even a death occurred. It also indicates
whether a treatment took a normal course; if mistakes were
Audits and inspections made, they are reviewed in specific audit procedures (peer
Fresenius Kabi regularly conducts internal quality audits to Based on the respective observations, an audit and inspection reviews). Defined quality indicators (German Inpatient Qual-
ensure the effectiveness of the quality management system score is calculated. The score is calculated by addition of ity Indicators – G-IQI) are used to measure and monitor the
and compliance with internal and external standards and the number of critical and major observations identified quality of medical outcomes, which are published. This data
requirements. The suppliers related to product manufactur- during GMP inspections by the authorities mentioned allows patients to see, among other things, how often cer-
ing are subject to a qualification process based on the rele- above and the number of non-conformities identified during tain treatments are performed in Fresenius Helios hospitals.
vance of the delivered material or service. Also, the supplier’s TÜV Süd ISO 9001 audits, divided by the overall number of It also gives patients important information on the doctors’
qualification and their recertification is regularly audited. inspections and audits; critical observations, if any, or certi- experience and routine and helps inform their own decisions
Inspections by regulatory authorities and audits by indepen- fication status withdrawal are weighted with a multiplier about their treatment. Thanks to its quality and risk man-
dent organizations and customers are performed along the compared to major observations. The audit and inspection agement, Helios Germany can continuously monitor key qual-
entire value chain at Fresenius Kabi. Fresenius Kabi promptly score was 1.9 in 2021 (2020: 1.3) 1. Observations have ity parameters and, if necessary, take countermeasures at
takes steps to deal with any weaknesses or deficiencies been and will be addressed by corrective and preventive an early stage.
discovered during inspections. actions (CAPAs) and effectiveness checks have been and In Spain, Fresenius Helios implemented the IQI method-
The external audits and inspections in the reporting will be defined. The observations neither impacted the GMP ology at the end of 2017 in all its hospitals. Since then, 45
year comprised a total of 30 inspections (2020: 21) regarding certification nor the ISO 9001 certificate. indicators have been systematically monitored, first on a
In 2021, no events with a material adverse impact were quarterly basis, and since 2021 on a monthly basis.
recorded that conflict with our quality management goals.
Fresenius | Annual Report 2021
1
For the calculation of the audit and inspection score, Fresenius Kabi takes into account all information on findings from audits and inspections received by
the company before December 31, 2021. 135
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Organization and responsibilities Policies and regulations consumption, and training physicians as antibiotic stew-
At Fresenius Helios, the medical director has direct respon- Helios Germany has built on the numerous measures intro- ardship (ABS) specialists. The implementation of and com-
sibility for patient and product safety and a Patient Safety duced in the past, to increase patient safety. Two checklists pliance with hospital hygiene measures in the clinics is
Officer position has also been created. Helios Germany’s cen- are mandatory for all surgeries in Fresenius Helios’ clinics. accompanied and monitored by our specially trained staff –
tral medical services and medical specialist groups help to The “PRÄ” checklist assesses the risks associated with the hygiene specialist nurses, hospital hygienists and hygiene
implement appropriate measures. The leading physicians in surgery before it takes place. The second checklist, “PERI ”, officers. The Helios Group hygiene regulation is binding for
various fields from all Fresenius Helios hospitals in Ger- helps to avoid treatment errors immediately before, during, all employees in all clinics. It is based on the evidence-based
many come together to form specialist groups. They ensure and immediately after the surgical procedure. recommendations of the Robert Koch Institute (RKI) and
that the knowledge of their medical specialty is anchored in Since 2020, these measures have been supplemented by prescribes, among other things, hand disinfection – espe-
all hospitals and represent their respective medical fields increased hygiene requirements due to the COVID-19 pan- cially before and after contact with patients – for physi-
internally and externally. They also advise and decide on the demic. For this purpose, the existing hygiene concepts have cians, nurses, medical staff, and other personnel, in accor-
introduction of standard processes, sensible innovations, been adapted to the changed regulatory provisions. dance with the guidelines of the World Health Organization
campaigns, and the introduction of medical products. In 2021, the Corporate Patient Safety Committee at Helios (WHO).
In Spain, the organization has been reinforced with the Spain continued to develop and implement clinical best The clinics monitor their hygiene status continuously and
creation of a new Corporate Operations department, practices. The committee consists of members from various transparently: every six months, Fresenius Helios publishes
focused on improvements in the provision of therapies and hospitals, including clinics in Latin America. The commit- figures for each clinic on the occurrence of the three most
health services and the design and marketing of new tee has remained active throughout the pandemic, not only important multi-resistant and infection-relevant pathogens.
digital products in the ambulatory setting. The Corporate Risk advising the hospitals on COVID-19 management, but also The reporting for 2021 is delayed to the first half of 2022 due
unit has also been created in order to improve risk man- developing new strategic patient safety protocols and updat- to the impacts caused by COVID-19.
agement in the company. ing them in 2021. The existing Patient Safety Strategy In 2020, Helios Spain started encouraging all hospitals to
Helios Germany and Helios Spain’s specialist groups developed by this committee will be updated in 2022. It is appoint a medical officer to manage infection control and
exchange ideas and information on specific topics. For exam- based on principles such as those of the World Health prevention measures. In 2021, 50% of the hospitals had an
ple, the German hospitals benefit from Helios Spain’s Organization (WHO) and the JCI. epidemiologist to manage infection prevention and control
close networking of outpatient and inpatient care – and can within the hospital. Other hospitals had at least one profes-
take advantage of these experiences. Hygiene management in hospitals sional specialized in infection control from other specialties
The aim of Fresenius Helios’ hygiene management system is (internal medicine, intensive care) who manages this area.
to avoid infections within the hospital and to quickly pre-
vent them from spreading when they do occur. Hygiene man-
Fresenius | Annual Report 2021
agement focuses on close monitoring of infections and
pathogens, regular hygiene training for hospital staff, for
example on correct hand disinfection, monitoring antibiotic
136
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Patient information The IQI methodology will be extended to the clinics in Latin Evaluation of the quality of outcomes
Fresenius Helios provides information to its patients within America. In addition to the implemention of the necessary For Fresenius Helios, the quality of medical outcomes is key.
its hospitals about the patient admission process with the medical and patient data base, the medical documentation Helios Germany has defined specific targets for 47 (2020:
help of the treatment contract, as well as special information will be improved to gather the data relevant to calculate the 45) key quality indicators, including, for example, the fre-
documents and privacy statements. The therapeutic objective IQI development. quency of interventions and their results. Helios Germany’s
is discussed with patients during admission and discharge As an additional tool for improving patient safety, the results are expected to be better than the German average.
discussions with the treating physicians. Fresenius Helios Corporate Committee on medical liability claims has been The year 2021 was as the previous year exceptional for
communicates via an online magazine, social media, its reorganized so that medical directors of the hospitals can hospitals and was dominated for long periods by the pan-
website, and in its communication campaigns for the inter- now participate, in order to improve the healthcare risk man- demic and the treatment of COVID-19 patients.
ested public. In addition, information events on specific agement in the hospital network. In Germany, Helios achieved a total of 43 of its 47 Group
medical topics are held in all hospitals (known as patient A specific policy to enhance the early diagnosis of sepsis targets in 2021. This corresponds to a quality target
academies). Further details on transparency in health care was launched in 2021 at our Spanish hospitals. Also, to achievement of 91% (2020: 89%). In 2021, there were
can be found on pages 185 f. of this report, section “Com- assist in its deployment, two training videos have been devel- around 17% less patients in the clinics than in the pre-
pliance”. oped using real cases of patients with sepsis, to reinforce COVID-19 year 2019. Many patients stayed at home at the
the key points that have to be taken into account in order to beginning of 2021, because of the nationwide restrictions
Our ambitions quickly identify this time-dependent pathology. and the cancellation of surgeries in hospitals in spring. In the
Helios sets company goals to measure the quality of treat- second quarter, the number of patients started to increase
ment in its hospitals, using the E-IQI methodology in Spain Evaluation again at our German locations.
and the G-IQI methodology in Germany. Each hospital treat- Fresenius Helios assesses the health and safety impacts of Helios Spain has introduced quality indicators that corre-
ment (case) is evaluated by making use of comparative mea- all significant treatment or service categories for improve- spond to Germany’s G-IQI. The results are also compared
surements, with the benchmark being the German national ment potential. with the goals of the IQM network. Each hospital publishes its
average as calculated by the Federal Statistical Office or com- In order to ensure that all physicians working at a hospi- results quarterly, and since 2021 monthly, in a central IT
parable national benchmarks in Spain. The target is in each tal in Spain perform clinical acts for which they have system. This allows individual hospitals to check whether
case to be better than the national average for the respective demonstrated competence, a model has been defined to val- they deviate from the standards set.
indication. Further quality targets in our hospitals in Spain idate these competencies and accredit the professional to The competence gained through the research into
relate to patient satisfaction and are measured via the NPS, perform the corresponding acts and procedures. This model COVID-19 and the improved diagnostics related to the infec-
among other methods. has been included in a corporate policy that also defines tion also led to an improvement in the overall treatment in
the monitoring of physicians´ complication rates through the our Spanish hospitals. Earlier diagnosis, better knowledge of
Fresenius | Annual Report 2021
Progress and measures 2021 minimum basic dataset (MBDS). its management and the impact of vaccination, have resulted
In the reporting year, the management approach and the in less virulence of the illness, less use of intensive care
governance structure of Fresenius Helios remained mainly
as reported in 2020.
137
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
beds and a lower mortality rate. Thus, throughout 2021, the HELIOS QUALITY INDICATORS
mortality rate of those hospitalized by COVID-19 in Spain
has fallen to 11% compared to 15% in 2020, which reached Germany 2021 2020 2019 2018 2017
Key indicators, total > 1,500 > 1,500 > 1,500 > 1,500 > 1,500
17% in the first wave in spring 2020.
G-IQI-targets 47 45 46 46 45
Helios Germany uses reporting and learning systems for
Targets achieved 91% 89% 96% 89% 98%
critical events and near-misses of patients in all hospitals Peer reviews 7 8 60 55 69
(Critical Incident Reporting System – CIRS). In 2021, a total of
Further information (German language only):https://www.helios-gesundheit.de/qualitaet/
576 events were reported in Germany (2020: 458), which
were evaluated at the respective clinic level. The central con-
solidation and analysis of the CIRS data was further rolled
out in 2021. In this way, risks relevant for the overall business Patient satisfaction measurement goal is to continuously improve the NPS results. The global
segment are identified and remediation measures imple- and grievance processes NPS score has increased over recent years. until the start of
mented. The business segment uses the Helios Service Monitor to the pandemic
At Helios Spain the clinics report patient safety incidents measure the satisfaction of inpatients in its German hospi-
including near misses. In 2021, a total of 8,480 incidents tal locations once a week. Employees conduct short inter- NET PROMOTER SCORE (NPS) SPAIN
were reported in 2021 (2020: 4,897). At Helios Spain we views on care and service. The information is collected anon- 2021 2020 2019
actively encourage the reporting of incidents, including ymously. The management of the hospital and other Global NPS 49.9 54.1 54.6
hazardous (or “unsafe”) conditions and near misses, as a authorized persons receive the monthly survey results. This Total reports 534,930 361,800 426,061
way of promoting patient safety. makes it possible for necessary improvements to be intro-
In the interests of transparent error management, duced quickly. In addition, Helios Germany publishes the
In 2021, Helios Spain identified high demand for outpatient
Fresenius Helios handles and settles its liability cases itself results of patient surveys, further data on medical treat-
consultation that is heavily penalizing NPS results, as the
as far as possible instead of handing them over to an ment quality, and hygiene figures on its corporate website
demand from patients is higher than the capacity for consul-
insurer. As a result, we analyze these cases intensively and www.helios-gesundheit.de, see Qualität bei Helios (German
tations and number of doctors in our clinics. The patients
learn from them. In addition, Helios Germany developed a language only).
expressed their dissatisfaction through low results. The con-
tool for use in 2021 that automatically queries preventive In Spain, Fresenius Helios uses the net promoter score
straints were increased through the lack of professional
measures, which, in the event of a confirmed treatment (NPS) to get specific feedback from patients who have been
staff, impacting the availability of services.
error, will initiate a central review of the usefulness of the treated as inpatients, outpatients, or in emergencies. 48
Further information can be found in the chapter
respective preventive measures. hours after a hospital stay, an e-mail is sent to patients ask-
Employees in the section “Evaluation” on pages 162 ff. of
Fresenius | Annual Report 2021
ing if they would recommend the hospital and its services.
this report.
The results are analyzed centrally for Helios Spain and at a
hospital level by type of treatment and treatment area. The
138
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Peer reviews quality of the structure, process, and outcomes from the The quality assurance officers can thus ensure that employ-
Helios Germany analyzes the cases – including treatments insurers, e.g., as part of the quality assurance of the German ees comply with their obligation to exercise due care.
and medical routines – in hospitals that fail to meet individ- pension insurance or the statutory health insurance provid- Fresenius Vamed informs its employees about its under-
ual quality targets, in order to identify and implement ers. In all Fresenius Vamed health care facilities, patients standing of quality early in the initial training and intro-
improvements. Particularly important are the specific audit receive relevant information material and patient training ductory events. Guidelines are communicated to and docu-
procedures in the medical and nursing sectors, and the to ensure long-term treatment success. Reporting systems mented for the relevant areas and departments in writing
peer reviews – expert discussions of cases. In Germany, for complaints are also available in some health care facili- (e.g. via work instructions from the respective management).
specially trained physicians from the hospitals of Helios ties. In Fresenius Vamed’s project business, the lead compa- The VAMED International Medical Board (IMB) ensures
Germany and from the IQM network cooperate in the peer nies establish guidelines for all subsidiaries, which are the exchange of information between Fresenius Vamed phy-
review, and question statistical abnormalities. Their reviewed in annual audits. sicians from Austria, Germany, the Czech Republic, Switzer-
insights are translated into concrete recommendations for 10 fully inpatient facilities at 6 locations provide care for land and the United Arab Emirates. Within Fresenius Vamed,
action in the hospital with the aim of increasing patient people in need of care in care grades 1 to 5. The range of medical specialist groups and executive conferences coor-
safety. In 2021, Helios Germany conducted a total of 7 peer care and support includes basic care and medical treatment dinate on quality and safety.
reviews (2020: 8), due to the impact of the COVID-19 pan- care, social care, day-structuring measures, and additional
demic and the resulting restrictions on hospital operations. care for people with a considerable need for general supervi- Policies and regulations
Due to the pandemic, Helios Spain was able to perform sion and care (dementia patients), as well as specialized Fresenius Vamed sets ethical standards through its mission
only 4 peer reviews online by the end of 2021 (2020: 2). care for people with severe neurological illnesses, with psy- statement as well as through its Code of Conduct, the Clinical
Internally, ISO 9001 audits were conducted at all Helios chiatric or geriatric psychiatric illnesses, and for people Code of Conduct, and the Code of Conduct for Business
clinics in Spain. with addictive disorders. In addition to full inpatient long- Partners. Fresenius Vamed’s internal guidelines are based
term care, all nursing facilities also offer short-term and on regulatory requirements established throughout Europe,
FRESENIUS VAMED respite care. e.g. for rehabilitation. In elderly care, Fresenius Vamed fol-
In post-acute care, elderly care and project management, all lows the renowned salutogenesis methodological concept.
processes are regularly checked for their suitability and Organization and responsibilities In addition to the statutory requirements and the require-
adapted, if necessary. In accordance with the Federal Asso- In order to raise awareness of quality requirements among ments of the insurers, Fresenius Vamed also adheres to
ciation for Rehabilitation (BAR) guidelines, Fresenius employees, Fresenius Vamed employs staff for quality and international standards such as ISO and EFQM, expert stan-
Vamed implements all relevant measures to increase patient risk management. These employees report directly to man- dards, and medical guidelines. All internal guidelines are
safety at its post-acute care facilities – including patient agement. Quality assurance officers carry out training regularly reviewed and updated as necessary. Employees can
surveys, complaint management, and regular internal audits courses in the various segments, thus integrating all employ- obtain information on the guidelines via the intranet.
Fresenius | Annual Report 2021
of all segments. The company receives feedback on the ees in the quality management systems of their facilities.
139
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management W
ell-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Hygiene management in rehabilitation Patient information Evaluation
and nursing care Fresenius Vamed provides information to its patients in Fresenius Vamed assesses the health and safety impacts
One of Fresenius Vamed’s tasks with regard to hygiene in different ways – for example, in the patient information folder of all significant product, treatment, and service categories
rehabilitation clinics and nursing facilities is to ensure the or in the treatment contract, and via information brochures, for improvement potential.
highest possible protection for everyone – without restrict- privacy statements, the house rules, and the mission state-
ing individual rehabilitation. Protecting patients from infec- ment. Welcome lectures and training sessions are also Personalized and individually tailored
tious diseases during their stay is a top priority. Newly offered. The website is available as a source of information rehabilitation goals
established health care facilities follow systematic guidelines before arrival. The goal of therapy is usually discussed and Fresenius Vamed uses modern, resource-oriented
from day one to prevent infections breaking out or spread- evaluated with patients during admission and discharge dis- approaches, such as the ICF concept (International Classifica-
ing. Clearly defined procedures are followed and compliance cussions. tion of Functioning, Disability and Health) or the comput-
with hygiene regulations is strictly controlled. Since Fresenius Vamed is also active as an accredited er-based evaluation system CHES (Computer-Based Health
Fresenius Vamed’s hygiene standards in Germany are inspection body (ISO 17020) and as a manufacturer of Evaluation System). This enables patients to achieve the
based on the recommendations of the RKI’s KRINKO (Com- medical gas supply systems (RL93 / 42 EEC), the business best possible, evidence-based functional improvement to
mission for Hospital Hygiene and Infection Prevention). segment is subject to both a labeling obligation and an increase activity and participation in all areas of life, even
These recommendations take into account all legal require- information obligation in accordance with RL93 / 42 EEC and after severe illness.
ments for hygiene. In the German facilities, the central MPG and / or ISO 13485. The accreditation authority uses In addition, the findings on treatment quality are pub-
Head of Hygiene coordinates the hygiene specialists and external audits, for example, to check whether appropriate lished, for example by Fresenius Vamed Germany on the
establishes overarching standards, together with the Chief provisions exist and whether regulatory or normative website Qualitaetskliniken.de. This allows patients to find
Medical Officer. One of the most important hygiene measures requirements are complied with. out about key quality parameters of the various clinics
is hand disinfection. Fresenius Vamed follows the guide- before they are admitted.
lines of the WHO in this regard. Hygiene specialists, doctors, Our ambitions
and nurses with special hygiene responsibilities imple- Fresenius Vamed defines its quality goals annually with the Measurement of patient satisfaction
ment hospital hygiene measures. In Austria, the Federal Hos- aid of additional key performance indicators. The findings and grievance processes
pitals Act forms the basis for the management of hygiene from complaint, case, and risk management are also incorpo- Fresenius Vamed measures patient satisfaction in its health
plans, hygiene inspections, the use of hygiene specialists, rated. The goals are reviewed regularly. care facilities in a continuous and structured process. The
and doctors with special hygiene responsibilities. In the evaluation is conducted on a weekly and a monthly basis.
course of the COVID-19 pandemic, hygiene inspections in the Progress and measures 2021 The company collects data, evaluates it internally, and
facilities were intensified. Hand hygiene and the correct In the reporting year, the management approach and the implements appropriate measures, if necessary. Patient sur-
Fresenius | Annual Report 2021
wearing of protective equipment were continuously governance structure of Fresenius Vamed remained as veys are conducted while the patient is in the clinic, as well
addressed. reported in 2020. Progress was focused on the safeguard-
ing and application of hygiene and safety protocols and
on adapting those to regulatory provisions.
140
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
as after their rehabilitation; in some clinics both approaches DIGITAL TRANSFORMATION munication between doctors, easier access to health infor-
are established. In this way, the clinics receive comprehen- AND INNOVATION mation, and improved diagnosis and treatment options.
sive feedback with regard to patient satisfaction. Furthermore, shorter waiting times, cost savings through
Fresenius Vamed uses reporting systems for critical improved efficiency, and an increase in the quality of health
events and near-misses in its health care facilities, i. e., the DIGITALIZATION AND INNOVATION care are expected as positive effects of digitalization in medi-
electronic CIRS (Critical Incident Reporting System). Critical Digitalization plays an increasingly important role for cine.
incidents can be reported anonymously there. The reports are Fresenius – whether in health care facilities, in direct contact Important indicators for Fresenius’ digital offering are the
processed by a dedicated committee. In addition, Fresenius with patients, or in production. It is a driving force behind answers to the question of what people specifically want:
Vamed uses systems for suggestions for improvement, mate- the implementation of innovative technologies and treatment the introduction of digital medical records, the expansion of
rial vigilance (material safety), and pharmacovigilance concepts and can help us to find solutions to many chal- telemedicine services, and the use of patient data for diag-
(drug safety). Thanks to these systems, a timely and appro- lenges in the health care sector and help unlock trapped nosis are considered desirable by a large part of the popula-
priate response to potential sources of danger or com- value. For us, the focus is on the opportunities offered by tion in Germany, Spain, and the United States. Around
plaints can be made, aligned with our internal quality stan- digital solutions. Through innovative, safe, and user-friendly one-third of the population in each of these three countries
dards. products and systems, we can further improve the quality also consider it desirable that more and more personal
and efficiency of treatments. health data be recorded by means of apps, smartwatches, and
Audits and recertification fitness bracelets.
To ensure adherence to quality standards, Fresenius Vamed Digitalization as an opportunity in health care
also performs regular internal audits as well as external Fresenius has been pressing ahead with digitalization initia- OUR APPROACH
recertifications. This is done in the certified health care com- tives in its business segments for many years. On the one Our markets are changing rapidly; this is particularly true
panies as well as in the other facilities of Fresenius Vamed. hand, these initiatives are aimed at getting closer to patients with regard to digital trends in health care, which have been
Quality management audits are carried out there once a year and better integrating them into preventive care and thera- further accelerated by COVID-19. We are seeing increas-
in accordance with the ISO regulations. Internal audits are pies. On the other hand, numerous applications help medical ing demand from patients, health insurance companies, and
carried out systematically and cover all business segments, professionals to achieve even better treatment results even health care institutions for new digital services along the
and at a minimum, those topics that are required by the more efficiently and safely. entire value chain. Patients want remote treatment and on-de-
certified standards – i. e., all quality management processes. This is in line with the results of a representative poll mand health care services. Data-driven decision-making is
Besides ISO certifications, audits are conducted by the conducted for Fresenius by the polling organization becoming increasingly important, for example in predictive
external regulatory bodies, listed on page 128 of this Group Allensbach Institut für Demoskopie in Germany, Spain, and maintenance of dialysis machines and analysis of patient
Non-financial Report. the United States. According to a large part of the respon- data. At the same time, cybersecurity risks have made us
Fresenius | Annual Report 2021
dents, the increase in digitalization offers opportunities for aware of the need for standardized and resilient IT infra-
the health care system. People associate digitalization structures.
with a whole range of positive effects, above all easier com-
141
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
In order to drive digitalization and innovation at Fresenius, All new or improved products and services are subject to CLINICAL RESEARCH AND INNOVATIVE
we take different approaches in the four business segments internal quality requirements as well as external regulations TREATMENT MANAGEMENT
– from independent R & D strategies to active innovation and regulatory requirements. In the case of digital devel-
management, as described in the Group Management Report opments, we pay particular attention to the requirements of Fresenius Medical Care
on pages 51 ff.. We also involve external partners such as the European Union (EU)’s General Data Protection Regu- Fresenius Medical Care’s Global Medical Office aims to
research institutions and start-up companies in this work. lation (GDPR); for more information see the “Data Protection“ enhance its patient-focused care delivery business model.
One of our priorities is developing innovative products section on page 188 of this report. We also observe Euro- This function, led by the Global Chief Medical Officer on
that not only meet stringent quality requirements, but also pean directives such as the EU Medical Devices Regulation Fresenius Medical Care’s Management Board, aims to
affordability requirements. In doing so, we are responding (MDR) in the medical technology sector. We address possi- achieve the best clinical outcomes for patients, their fami-
to the growing demand worldwide for high-quality yet ble risks such as hacker attacks on sensitive data and sys- lies, and the payor community. This office is tasked with
cost-effective products and outcome-based services. tems, by implementing comprehensive cybersecurity con- evaluating coordinated data from clinical science research
Many of our stakeholders, especially our patients and our cepts, as described in the “Cybersecurity” section on pages and medical practice. This includes facilitating cooperation
employees, are directly affected by the changes resulting 149 ff. and knowledge transfer across the entire network of
from the advance of digitalization. Our R & D activities are Fresenius Medical Care. More information can be found in
closely linked to digitalization and are an integral part of Group-wide IT transformation the Annual Medical Report, which is available online.
our growth strategy. Our aim here is to improve products and In 2021, Fresenius began implementing a new, Group-wide The business segment continuously engages in the
processes as well as to develop innovative therapies and IT program to strengthen cooperation in the IT area and research and development of innovative products and
integrated health care services; however, we do not conduct increase value creation in the Group. All organizations of the enhanced therapies. For example, it facilitates clinical trials,
fundamental research. Fresenius Group have participated in the development of which are a crucial step in developing new treatments.
Our products and therapies are designed to help promote the program and are accompanying the transformation pro- Fresenius Medical Care is also further exploring non-inter-
human health. Benefits and risks must be carefully evalu- cess in the Global IT Board. ventional methods by means of mathematic modeling and
ated. Whether it is in clinical approval studies or in clinical We want to further develop our IT in such a way that it virtual clinical trial simulations. The research and develop-
research projects, the Fresenius Group wants to create supports existing business models and enables the develop- ment activities follow regulatory guidance for clinical
opportunities to improve the quality of treatment, especially ment of new ones. Our vision is to digitally transform research practices. Additionally, they are conducted in com-
in the area of critical illnesses and chronic diseases. Fresenius for improved patient care and a successful future pliance with ethical standards. In a global statement,
for our Group. Fresenius Medical Care outlined the principles with which the
business segment commits to advancing health care and
Fresenius | Annual Report 2021
142
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
managing related risk, as well as advocating for patient university scientific institutions to do so. For some products, ticipants and validity of the study data are considered the
rights, patient well-being, and animal welfare. The business clinical studies sponsored by Fresenius Kabi must meet reg- most important criteria. No clinical trials are conducted with-
segment plans to make this publicly available in 2022. It is ulatory approval requirements. In addition, further studies out a positive vote by the responsible ethics committee
of importance, that research partners follow similar bioethics are conducted regarding patient safety, in order to gain new and approval from the respective competent authority, where
guidelines as the company itself. medical-scientific insights or comparative clinical studies required.
The business segment’s Frenova Renal Research division with other products available on the market. The clinical When selecting study participants, Fresenius Kabi also
provides research services to third parties and has also studies sponsored by Fresenius Kabi are always carried out takes diversity into account concerning the population
started enrolling patients in a new initiative to develop the in accordance with strict legal requirements, including, for group for which a product in question is intended. Fresenius
largest renal-focused genomic registry in the world. It example, the guidelines of the International Council of Har- Kabi does not conduct studies without a prior positive
aims to enroll over 100,000 patients by 2025. This new reg- monisation of Technical Requirements for Pharmaceuticals benefit / risk assessment. Furthermore, safety events occur-
istry will contain genetic data from chronic kidney disease for Human Use (ICH), of Good Clinical Practice (GCP), and of ring during a clinical study are constantly monitored and
patients worldwide and help researchers improve their under- the relevant pharmaceutical regulatory authorities such as evaluated. Study participants are fully informed prior to the
standing of kidney disease. the U.S. Food and Drug Administration (FDA), the European start of the study and are enrolled only with their consent.
Medicines Agency (EMA), the Declaration of Helsinki, and Internally, clinical studies are documented in a central data-
Fresenius Kabi the EU General Data Protection Regulation. Fresenius Kabi base and the results are published in accordance with the
At Fresenius Kabi, the knowledge and expertise from experts sponsors studies for registration in close cooperation with applicable regulations.
in clinical nutrition, pharmaceuticals, and medical devices various CROs, scientists, and physicians and supports inves-
are embedded in research and innovation projects with the tigator-initiated trials. These studies pursue the goal of Fresenius Helios
goal of improving patients’ health and quality of life. As a generating new scientific knowledge that is significant for Fresenius Helios conducts clinical trials at many sites to pro-
manufacturer of generic drugs, clinical nutrition products, patient care using approved and new products. mote innovation processes in clinical treatment, medica-
and infusion and transfusion therapies, as well as biosimi- Fresenius Kabi has a Chief Medical Officer and a Global tion, and interdisciplinary exchange. The business segment’s
lars and medical devices used to administer these products, Trial Committee that reviews, evaluates, and approves innovative strength in clinical study management strongly
Fresenius Kabi conducts clinical studies by commissioning clinical trials before they begin. Responsibility for clinical influences its future success in therapy and inpatient treat-
qualified external contract research organizations (CROs) and study management is aligned with Fresenius Kabi’s product ment. Among other things, studies are conducted to deter-
groups and is anchored in the divisional organizations.
Compliance with the applicable regulations and guidelines
prior to, during, and after clinical studies is ensured by a
risk-based auditing program. Here, safety of the study par-
Fresenius | Annual Report 2021
143
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
mine how effective and safe medicines are and whether whether with patient data, by participating in clinical drug patients for various acute conditions (myocardial infarc-
medical devices are suitable for approval in accordance with and medical device studies, or by developing new apps. tion, mental disorders, major tumor surgery) during the
internationally applicable ethical and scientific standards, Before a clinical research project takes place in a clinic, it is pandemic.
such as Good Clinical Practice or the Declaration of Helsinki ensured, for the protection of the participating patients,
of the World Medical Association. In addition, the division that scientific, ethical, and legal requirements are met and Progress and measures in 2021
encourages its employees to engage in scientific and techno- that the project complies with Fresenius Helios’ guidelines Under the Horizon 2020 research program of the European
logical research activities. The aim is for them to develop and quality standards. These requirements are listed in the Union, the Helios Leipzig Heart Institute is coordinating
personally and use their findings to enhance the well-being Helios Group Regulation Research and Science. This PROFID, a large international research project on prediction
of patients. Group regulation also specifies the framework conditions and prevention of sudden cardiac death after myocardial
Projects funded by public grants are also being carried within which Helios specifically promotes research proj- infarction. The project started in January 2020, is scheduled
out at the German Helios hospitals – supported by the Inno- ects of its own employees that are expected to have a high for five years, and brings together more than 20 top part-
vation Fund of the Joint Federal Committee (G-BA), the Ger- level of benefit for patients. ners from 12 European countries including key academic
man Federal Ministry of Education and Research (BMBF), or A total of 48 hospitals or integrated health care facili- institutions, the European Society of Cardiology, public
ministries of further German federal states, among others. ties are involved in at least one research project. The respec- health insurance bodies, health economic experts, and
These projects serve the benefit of both Helios’ employees tive Helios clinics or facilities in question employ what are patient organizations. The Fresenius entities involved are
and patients; they mostly focus on the development of new referred to as investigators and study assistants – specially the Helios Leipzig Heart Center and Helios Spain. The
therapies, care, and treatment pathways. In cooperation with trained staff such as biologists, chemists, or natural scien- assessment of risk factors for sudden cardiac death is based
manufacturers, the focus is also on testing specially designed tists with doctorates, but also nurses. They determine on-site on machine-learning approach using approximately one
patient rooms (e.g., for dementia patients) or assessing new the costs associated with a study and the benefits to million patient datasets. The findings will be subsequently
technologies in the sterilization of medical equipment. patients and to Fresenius Helios. In addition, the HCRI sup- validated in two international clinical trials that are cur-
Helios Germany provides data on severe acute respiratory ports the research clinics of Helios Germany along with rently the largest clinical trials worldwide in the field of car-
infections (ICOSARI) to the Robert Koch Institute (RKI) in employees in studies initiated by the clinics themselves diac devices.
order to monitor the appearance of influenza virus and coro- (known as investigator-initiated studies, IITs).
navirus in hospitals. HCRI, as the central office with experts in regulatory prin- Evaluation
ciples and methodology and in contract management, is In 2021, a total of 424 studies were conducted in the Helios
Clinical research projects supported by the Central Data Protection Service and has clinics in Germany, the majority of those with the goal to
In Germany, the Helios Center for Research and Innovation been conducting the central study review since 2019. More improve therapies for patients. For example, under the lead-
(HCRI) is the point of contact for all employees of Helios information on data protection can be found in the respective ership of Helios ENDO-Klinik Hamburg, an international
Fresenius | Annual Report 2021
clinics and its subsidiaries who want to conduct research – section on pages 188 ff. of this Group Non-financial Report. group of experts from over 40 countries developed guide-
In the wake of the COVID-19 pandemic, Helios-wide anal- lines and algorithms under which a safe return to normal
yses based on routine data were conducted several times; operations and the performance of elective orthopedic sur-
they substantiated, for example, the changed number of
144
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
gery was possible. The study results were publicated in Progress and measures in 2021 Africa, Asia-Pacific, and Latin America. Combined, these
spring 2021. ▶ Telehealth care apps had more than 26,000 active users in December
Further, Helios Germany conducted 34 COVID-19-related In North America, Fresenius Medical Care has estab- 2021. The business segment use digital platforms in more
studies in its clinics. lished telehealth platforms aimed at giving extra support than 20 countries to overcome the challenges presented
to patients on home dialysis. For example, the cloud- by COVID-19. In the United States, Fresenius Medical Care
Fresenius Vamed based solutions for home dialysis are designed to keep recorded over 410,000 remote visits between patients,
At Fresenius Vamed’s Institute for Gender Medicine, all patients connected to their care teams, with better care teams, and physicians by the end of 2021.
health issues that lead to an extension of the healthy years access to recent treatment data. By making this data more
of life and to the improvement of quality of life are easily accessible to clinicians, care teams can resolve Fresenius Kabi
researched, with a particular focus on gender-specific aspects treatment issues earlier and reduce hospitalization. For As a global health care company that offers lifesaving medi-
with regard to individualized medicine. These research the peritoneal dialysis patient education experience cines and technologies for infusion, transfusion, and clinical
activities encompass prevention, acute care, rehabilitation, app, the business segment was awarded two Bronze nutrition, digitalization and innovation are of great impor-
and nursing. Awards for Excellence in Technology by the research and tance to Fresenius Kabi. The digitalization of processes is a
analyst firm Brandon Hall Group. cornerstone in the development of innovations and an
DIGITALIZATION AND INNOVATION IN THE important aspect in effective care for critically and chron-
BUSINESS SEGMENTS ▶ Digital product innovations ically ill patients, as well as compliance with regulatory
The business segment has expanded its digital options requirements. Fresenius Kabi develops devices and applica-
Fresenius Medical Care to facilitate better access to information for the patients tions in various medical fields to support its customers’
Digitalization plays an important role for both health care ser- under its care. The digital platforms enable virtual con- ongoing digitalization. Devices not only have to be optimized
vices and products. The business segment continually tact, which has, for example, reduced the risk of infection in their core functions but increasingly need to be embed-
develops products and digital services that improve access for patients and staff during the pandemic. Keeping ded into the IT systems of hospitals, clinics, and plasma cen-
to health care, which has become more critical during the patients and care teams connected and giving them ters. Fresenius Kabi wants to benefit from this trend and
pandemic. access to recent treatment data is vital for continuously will focus on the constant development of its portfolio, while
Fresenius Medical Care’s Global Research and Develop- improving medical outcomes, user experience, and the
ment division manages the global research and develop- effectiveness of care. The business segment has two
ment activities related to product engineering. The Global main platforms, that are provided via apps. One is used
Medical Office is responsible for the clinical digitalization predominantly in North America and the other is
strategies and the use of digital clinical data for research and accessible across more than 20 countries in Europe,
Fresenius | Annual Report 2021
operations. The basis of this commitment to continuous
innovation is articulated in the Code of Ethics and Business
Conduct.
145
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
acknowledging the increasing role of software in medical Product innovation ▶ Digital product innovations and digital applications
technology and its application area. This is part of the In product development, Fresenius Kabi’s expertise includes Digital applications can help to ensure patient safety and
Fresenius Kabi Vision 2026, which was developed in 2021 all related components, such as the raw material for regulatory compliance. For example, Fresenius Kabi
and adopted in the fourth quarter. drugs, the pharmaceutical formulation, the primary packag- introduced radio frequency identification (RFID) technol-
In order to take even greater advantage of the opportu ing, the devices needed for application of drugs and infu- ogy, known as smart labels, for drugs in the United
nities of digital transformation and to develop digital busi- sions, and the related production technology. In the field of States in 2020. The smart label enables hospitals to auto-
ness models, Fresenius Kabi has started to realign its IT biosimilars, Fresenius Kabi focuses on autoimmune dis- matically identify, locate, and manage their inventories.
organization as part of the Group-wide IT program. The dig- eases and oncology. More information on R & D can be found Following the successful launch of the first RFID-labeled
ital transformation is thus to be driven forward and the in the Group Management Report from page 51 onwards. product in the United States, two more products with
value contribution of digital applications for the company The business segment has standard operating procedures smart labels were launched there in 2021.
and customers increased. The business segment is increas- for the development and design of products and for the
ingly using intelligent automation and artificial intelligence cybersecurity of its devices; for more information see the With digital technical services, Fresenius Kabi helps improve
to improve business processes in administrative functions. “Cybersecurity” section on pages 149 ff. The responsibility the efficiency of processes in hospitals and care facilities.
In production and quality management, Fresenius Kabi is for innovation and development is anchored in the divisional Digital technical service applications accelerate maintenance
using digital platforms to implement process control sys- organizations of the company. Fresenius Kabi constantly and can reduce the downtime of medical devices due to
tems, monitor plant efficiency, and manage data and support addresses the advancement of scientific findings. Employees maintenance work. In this context, Fresenius Kabi aims to
workflows in laboratories. This also enables the business work together in cross-organizational and cross-functional offer its solutions to its customers in as many countries
segment to access data to analyze and automate decision- teams to develop innovative solutions for medical needs. around the world as possible.
making processes. Digital solutions are constantly being In compliance with data protection regulations, Fresenius
developed along the entire value chain to make internal work Progress and measures in 2021 Kabi is also working to use the data generated by the apps
processes more efficient and simpler. ▶ Digital transformation to improve patient care. For example, the aim is to identify
At Fresenius Kabi, responsibility for digitalization is Fresenius Kabi started to implement the business seg- potential risks for patients and improve the decisions made
anchored in the central, divisional, and regional organiza- ment’s new governance structure as part of the Group- by patients or health care professionals.
tions; steering responsibility lies with the Fresenius Kabi wide IT program for digital transformation in 2021.
IT Executive Board, which is chaired by the responsible Fresenius Kabi has thus had an integrated IT organization
member of the Management Board and the head of the global for business-specific applications and IT services since
IT department. Other relevant functions are also repre- October 2021 and in this way aligns them even more
sented on this board. closely with the requirements of the business model
Fresenius | Annual Report 2021
and its customers and patients.
146
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Fresenius Helios Each of the three pillars has key figures to indicate progress able and to read up on the risks associated with an exam-
Digitalization is key for Fresenius Helios to ensure the sus- in digitalization and its acceptance, and collects data, for ination. Prior to a procedure, patients can also sign a consent
tainability of its hospitals and outpatient facilities, and to example on the number of patients making use of digital form electronically via the portal.
improve the quality of health care and the service provided medical consultations, the number of electronic prescrip-
to patients. tions issued by employees, and the number of invoices auto- Electronic patient file (EPF)
Since 2020, the business segment has used a newly devel- matically generated. The data is evaluated on a monthly A digital patient file with doctor’s letters, findings, and com-
oped process for managing digitalization projects in Germany basis and enables comparison of the state of evolution of plete clinical imaging is available at the majority of work-
via the Helios Digitalization Board (Helios DIGI) to manage digitalization in the various hospitals in Spain. stations in the clinics; this creates added value for both treat-
and centrally evaluate proposals for digitalization projects. ment providers and patients. By 2022, other medical data
Proposals are collected in the clinics and outpatient facili- The Helios patient portal such as nursing documentation and medication will also be
ties of Helios Germany and in the Fresenius Group and then Fresenius Helios started introducing a patient portal at its available in the digital patient file at Fresenius Helios. In
rated. The Board decides on the approval of project pro- clinics in 2019. Patients can now access treatment documents about half of the Helios clinics, integrated software solutions
posals. All digitalization projects, including rejected project such as diagnoses, book appointments online, or attend already issue warnings of possible interactions with other
ideas, are published in the “Helios.Digital” project data- video consultations at 50 German clinics, around the clock drugs, which increases patient safety.
base via the intranet “myHelios”. and from home. The portal can be accessed via the web- In general, this makes many processes more efficient
Helios Spain’s IT and process strategy aims to further sites of the respective clinics. In 2021, the patient portal and improves medical quality. The expansion of the Germa-
improve digital patient interaction such as video conferencing recorded 130,000 registered users, 300,000 documents ny-wide telematics infrastructure, ordered by the govern-
and chats, where patients can present their medical his- exchanged via the portal and nearly 85,000 online appoint- ment, into which the electronic patient file will be integrated
tory, protocols, and automated tests for specific diagnoses. To ments. in the future, focuses on improving the quality of care and
ensure that the IT strategy is gradually implemented, the Many users already access Helios Spain’s patient portal. the efficiency of care and administrative processes. This proj-
business segment has introduced a competence model called Nearly all Spanish hospitals are connected. The hospitals ect aims to modernize the technical infrastructure in the
Digital Stars at Spanish hospitals. This model is based on benefit from a central data repository and improved data German health care system up until 2025.
three pillars: Digital Customer (patients), Digital Professional transmission and coordination. Via the digital portal, E-medication is one planned aspect of the telematics
(employees), and Digital Organization (administration). patients of Helios Spain can track the progress of their own infrastructure. It will enable electronic prescriptions to be
clinical treatments and view recommended therapeutic transmitted digitally to parties outside the hospital – e.g.,
measures. They have direct access to 3D radiological images medical practices and pharmacies – and to be uniquely
and can contact their responsible specialists and interact assigned and tracked. Patients can make their own decisions
via web formats. In addition, it is possible to digitally on the distribution of information.
Fresenius | Annual Report 2021
request an appointment for most of the examinations avail-
147
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
In Spain, the electronic patient file contains discharge papers, Progress and measures in 2021 In 2021, Fresenius Medical Care started the process of fur-
issued by medical or nursing staff, along with medication In 2021, the management approach and the governance ther integrating specific environmental criteria in its research
information and prescriptions. Thanks to this paperless pro- structure of the digitalization strategic business unit of and development activities. The business segment is also
cess, patients can go directly to the pharmacy with their Fresenius Vamed remained as reported in 2020. Progress working to include sustainability topics in the early stages of
smartphone. Prior to an appointment at the hospital, they fill focused on various digitalization projects and initiatives innovation projects.
out a form online and then receive notifications and direc- in the areas of high-end services, overall operations man- Fresenius Kabi continuously reviews its progress in the
tions. At the clinic they are navigated directly to the treatment agement, and project management. area of digitalization. In 2021, the business segment reviewed
room via the app. the structure of its IT organization. Responsibility for busi-
OUR AMBITIONS ness-specific IT applications and services for medical profes-
Fresenius Vamed The Fresenius Group diligently works on expanding its com- sionals and patients are thus anchored directly in the busi-
Fresenius Vamed has established digitalization as a strategic petencies and developing new areas of business in order ness segment and decisions are accelerated. In this regard,
business area with the aim of implementing digitalization to offer digital solutions to the challenges faced by the health Fresenius Kabi intends to make even greater use of artifi-
initiatives and projects, coordinating digitalization activities care sector. cial intelligence applications and to exploit the possibilities
within the Vamed Group, driving digital innovation, and The four business segments take different, segment-spe- of analyzing digital information for the benefit of the com-
generating new digital solutions and services. Among other cific, approaches to the area of digitalization and innova- pany and its customers.
things, Fresenius Vamed is developing patient services for tion. In the care of critically ill patients, the demands on treat- In 2021, no critical events with a significant impact on
digital assistance systems that support ambient assisted liv- ment success are becoming ever higher. The demand for the safety of study participants or compliance with the appli-
ing (AAL) and digital rehabilitation services. In the project effective therapies together with intelligent medical applica- cable requirements and standards became known.
business, Fresenius Vamed has long used complex virtual tions and devices will rise steadily. In the hospital sector, Helios Germany measures the
models (Building Information Modeling - BIM) in the plan- degree of digitalization using the EMRAM Score from the ser-
ning and operation of health care facilities, which enable to EVALUATION vice provider HIMSS Analytics. EMRAM is an eight stage
simulate and optimize the entire life cycle (planning, All business segments have their own approach to digitaliza- (0 – 7) model that provides transparency on a hospital’s
design, construction, operation, and maintenance) of a health tion and innovation and are currently developing key per- degree of digitalized processes. A fully digitalized hospital
care facility. Additionally, Fresenius Vamed is also under- formance indicators (KPIs). As a material aspect, digitalization would reach stage 7, while a hospital at stage 0 would use
taking internal digitalization projects in the areas of project and innovation is also included in the variable remunera- paper-based documentation in all departments. The results
business, high-end services, and general operations man- tion of the Group Management Board. Further information for 2021 will be available in the first quarter of 2022.
agement. The management of the digitalization strategic is included on page 234 ff. of the Annual Report 2021, see
business unit regularly reports to the Management Board the Compensation Report.
Fresenius | Annual Report 2021
on progress.
148
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Fresenius Vamed regularly reviews its management CYBERSECURITY incident. Overall, eight sub-programs have been set up to
approach using standard controlling processes. In addition, meet the primary objectives of the respective clusters in all
the digitalization strategic business area collects data and OUR APPROACH risk domains:
regularly reports on the status of the respective initiatives and At the Fresenius Group, we pursue a holistic approach for the
projects in the business segment. Fresenius Vamed uses management of cybersecurity. We bring cybersecurity and Critical
▶ Asset Protection: Protection for the most critical
common trend and innovation studies, e.g., Gartner Hype- business decision-makers in the Group together to develop assets that are of highest value to the Group
Cycle, and in 2021 also the results of the Allensbach study, a joint approach aligned with our strategic goals. We base Baseline Security: Defining and implementing minimum
▶
to formulate and evaluate strategies for digitalization in the our strategy on cyber-risk analyses and the security require- cybersecurity standards
health care market. Local publications and trend analyses ments of our four business segments. This approach is Cyber Defense: Detecting and responding to cybersecu-
▶
are also taken into account. In 2021, the business segment reflected in all Group security policies. rity incidents in a timely manner to limit the business
increased the use of telehealth solutions and mobile apps. In 2017, the Management Board of Fresenius Manage- impact
Overall, the digitalization of processes was driven forward ment SE initiated the Cybersecurity Approach, Roadmap Governance, and Risk & Organization: Establishing a
▶
throughout the Fresenius Group in 2021. and Execution (CARE). Since 2018, CARE has represented the foundation for effective cybersecurity governance
Group’s cybersecurity program, which bundles initiatives
to strengthen our resilience in preventing and defending The Opportunities and Risk Report contains further informa-
against cyber attacks. In 2020, the Management Board of tion on cybersecurity at Fresenius in 2021, on page 110 f.
Fresenius Management SE enacted a Group-wide Cyberse-
curity Policy that defines the objectives, structure, and Certification and commitment
operational organization for cybersecurity governance across Cybersecurity insurance policies are in place at business seg-
the Fresenius Group, embedded in CARE. ment level, where deemed suitable for risk transfer. In addi-
To manage Group-wide cybersecurity and associated tion, there are certifications such as ISO / IEC 27001 at Group
risks, we have determined five risk domains. These are man- and business segment level. In addition, to complement
aged by the respective Risk Domain Managers – at corpo- the governance structure for risk minimization and to further
rate level and in the four business segments. Facilitated by hedge risks, the conclusion of a global cybersecurity insur-
the Group Cybersecurity Office (GCSO), the managers ance will continue to be evaluated at Group level.
appoint Special Interest Groups (SIGs) that define cybersecu-
rity requirements and coordinate risk management activi-
ties. The managers promote the use of best practices and the
Fresenius | Annual Report 2021
exchange of expertise and knowledge across all cybersecu-
rity risk domains.
The CARE program is structured along these risk domains
across four cybersecurity clusters to ensure that our digital
environment stays robust and recovers quickly in case of an
149
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Organization and responsibilities CYBERSECURITY ORGANIZATION
The organizational structure
The CFO on the Fresenius Group Management Board over- Fresenius Management Board
sees cybersecurity governance and receives direct reporting
from the Group Head of Cybersecurity. The position of the Cybersecurity Board
Fresenius Group Head
of Cybersecurity
Group Head of Cybersecurity, who acts as Group-wide Chief
Information Security Officer (CISO), has overall responsibil-
ity for the governance of cybersecurity within the Fresenius
Group and leads the Group Cybersecurity Office (GCSO).
He defines the Group-wide cybersecurity strategy and coor-
dinates this strategy with the respective cybersecurity Corporate Head of Business Segment Business Segment Business Segment Business Segment
Cybersecurity Head of Cybersecurity Head of Cybersecurity Head of Cybersecurity Head of Cybersecurity
heads in order to ensure an aligned approach across all busi-
ness segments.
Risk Domain Managers Risk Domain Managers Risk Domain Managers Risk Domain Managers Risk Domain Managers
In the four business segments, the respective Business
Segment Heads of Cybersecurity (Segment CISO) are respon- Steering of Risk Domains
sible for the activities in the respective business segments.
Group Cybersecurity Office (GCSO)
At Fresenius SE & Co. KGaA level, the Corporate Head of Cyber Led by Group Head of Cybersecurity
security is responsible for the individual corporate func- Cybersecurity Cyber Defense & Cyber Risk & Product Security & Cyber Culture & Cyber Program
Governance & Assurance Analytics Economics Architecture Training Management
tions.
The GCSO enables and manages cybersecurity within
the Fresenius Group. It ensures that relevant cybersecurity
activities are organized and implemented at the business rity & Architecture, Cyber Defense & Analytics, Cyber Cul- Cybersecurity, the Corporate Head of Cybersecurity, and
segment level, monitored, and coordinated from a Group per- ture & Training, and Cyber Program Management. all Business Segment Heads of Cybersecurity. It ensures the
spective. Where necessary, the business segments are At the operational level, the four business segments are exchange of information on Group-wide cybersecurity mat-
advised and supported in their activities. responsible for their cybersecurity management. The busi- ters between the business segments and Group functions,
The GCSO is divided into six functions: Cyber Gover- ness segments establish and report on strategic objectives defines criteria for evaluating and monitoring the develop-
nance & Assurance, Cyber Risk & Economics, Products Secu- and strategies for addressing risks. The objectives are based ment of cybersecurity across the Group, and reviews the
Fresenius | Annual Report 2021
on the Group-wide cybersecurity strategy and are autono- progress and results of cybersecurity measures and initia-
mously defined by the Business Segment Heads of Cyberse- tives. The Cybersecurity Board also monitors the adoption
curity, who are responsible for implementation. and implementation of the Group-wide cybersecurity policies.
In addition, the cross-divisional Cybersecurity Board
meets on a bi-monthly basis. It consists of the Group Head of
150
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
The individuals responsible for cybersecurity usually have dation for cybersecurity in all business segments and Group a targeted, risk-based, and cost-effective manner. The Cyber-
many years of experience in cybersecurity management, functions. Within this framework, we define confidentiality, security Board annually develops Group-wide and busi-
extensive knowledge, and appropriate professional certifica- integrity, and availability as our key objectives for protecting ness-unit-specific operational objectives and measures to
tions. digital information, technologies, and systems across our safeguard the confidentiality, integrity, and availability of
risk domains. It was approved by the Management Board of our digital information – and to continuously enhance the
The reporting structures Fresenius Management SE and the management committees cybersecurity of our IT, manufacturing, and health facility
The CFO of the Fresenius Group, as a member of the Man- of the four business segments. environments ,as well as our medical devices. These are coor-
agement Board of Fresenius Management SE, is informed The Cybersecurity Policy is based on the Fresenius Code dinated via the Group Head of Cybersecurity and are sub-
about cybersecurity-related topics on a weekly basis by the of Conduct and follows internationally recognized standards mitted to the CARE Steering Committee, which is established
Group Head of Cybersecurity, and as required. The Group and best practices, such as the Charter of Trust. It defines the at Management Board level and meets on a quarterly
Head of Cybersecurity reports quarterly to the Management overarching policy and organizational structure for cyber- basis.
Board of Fresenius Management SE and at least annually to security governance in the Fresenius Group. The underlying
the Supervisory Board. The Chief Financial Officers of the Risk Domain Policies specify the framework, processes, PROGRESS AND MEASURES IN 2021
business segments, and for Fresenius Vamed the member and roles and responsibilities for each risk domain to attain
of the Management Board responsible for the service busi- the overarching objectives of protecting the confidentiality, CARE Program
ness, meet on a quarterly basis in the CARE Steering Com- integrity, and availability of Fresenius’ digital information in Throughout the reporting period, the various CARE sub-pro-
mittee to organize regular reporting and to steer the cyber- a holistic manner. grams have been established to fulfil our ambition of
security initiatives across the business segments. The four business segments also have specific minimum increasing the maturity level of our cybersecurity capabili-
The Business Segment Heads of Cybersecurity inform the security standards, which take into account specific regula- ties, strengthening our resilience against cyber attacks,
respective members of the CARE Steering Committee and tory requirements or local legislation. Minimum security stan- and constantly addressing our cyber risks. Selected progress
additionally report on cybersecurity matters to their Manage- dards already established in the four business segments in line with the CARE program structure is outlined below:
ment Boards at least on a bi-annual basis. The Risk Domain are leveraged as Group-wide standards where appropriate.
Managers report to their respective Heads of Cybersecurity. ▶ ybersecurity Baseline Measure Implementation
C
In addition, the Data Protection, Enterprise Risk Manage- Our ambitions (CBMI): implementation of enhanced cybersecurity base-
ment, and Compliance departments regularly exchange infor- The objective of our cybersecurity program CARE, which line measures, such as endpoint detection and response
mation on matters relating to cybersecurity. covers all risk domains, is to increase the maturity level of (EDR) solutions, strengthened authentication mechanisms
our cybersecurity capabilities, strengthen our resilience for critical areas
Guidelines and regulations towards cyber attacks, and continuously reduce our cyber
Fresenius | Annual Report 2021
Our Cybersecurity Policy Framework consists of a set of risks. We evaluate the ever-changing threat landscape,
policies, requirements, and procedures. It forms the foun- define minimum security standards for our cyber risk
domains, and implement appropriate security measures in
151
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Cyber
▶ Training & Awareness (CTAP): extending the We continuously derive our cybersecurity measures from manner and limit the actual business impact of security inci-
reach of the Group-wide training and awareness platform; the bi-annual cyber risk evaluations in order to effectively dents. Recurring analyses and defense processes are auto-
conducting various training and phishing campaigns; mitigate our risks. mated in order to react even more efficiently. Incidents are
establishing the cybersecurity awareness brand (“Cyber We are currently in the process of designing a cyberse- thoroughly investigated to derive additional measures to
Aware”) and associated materials such as posters, vid- curity metrics system that will enhance transparency regard- improve our overall security.
eos, and merchandise articles ing the overall cyber risk situation of Fresenius. To this
Cyber Defense: aligning incident response procedures;
▶ end, we defined an initial set of metrics (e.g., what we refer Training
implementing the “Fresenius Virtual Cyber Defense to as crown jewels with critical weak points, average In 2019, we launched the Cybersecurity Training & Awareness
Center” and the “Fresenius Intelligence Office”; extend- phishing simulation click rate, mean time required to resolve Program (CTAP). The goal is to establish a cyber culture at
ing monitoring visibility to enable early detection and incidents), which in future are to be collected across all Fresenius, enabling our employees to learn about cybersecu-
fast response the Group’s cybersecurity environments. This will help us to rity risks and how to deal with them, and to develop the
Governance, Risk & Organization: implementing a
▶ understand how well prepared and resilient we are to pre- habits to protect themselves against cyber attacks. In addition
cybersecurity governance structure; assessing cybersecu- vent (stay robust) and recover (recover quickly) from a cyber to mandatory training on data protection and information
rity capability maturities; defining a cybersecurity risk attack. In the next step, the system design will be gradu- security, CTAP offers various courses, games, videos, and
management framework; conducting several cyber risk ally rolled out to complement the existing cybersecurity gov- other cybersecurity learning content, such as the digital
insurance dialogs to evaluate cyber risk transfer ernance structure. CTAP learning platform. We regularly simulate phishing
Our Risk Report contains extensive information on the attacks to monitor the effectiveness of the training and to pro-
Risk analysis effects of cyber risks on risk management; see page 110 f. vide users with information on an appropriate response if
In accordance with the newly established Group-wide of our Annual Report 2021. phishing is suspected. We calculate a personal risk score for
Cybersecurity Risk Management Framework, the GCSO – employees based on their behavior in phishing tests and
together with the business segments – conducts a busi- Security concept the number of cybersecurity training sessions they have com-
ness-driven evaluation of the strategic cybersecurity risks To protect the Group’s value generation, we have developed pleted. All CTAP activities are tailored toward Fresenius’
along Fresenius’ value chains. The cyber risks of the Group tailored frameworks for our five cybersecurity risk domains specific risks and are available in several languages. The suc-
are attributed to the business activities of the respective busi- that define the security architectures, concepts, and require- cess of the CTAP activities is measured using predefined
ness segments. While the cyber risks in the product busi- ments. We have been implementing the frameworks suc- success criteria.
ness are closely related to interruptions to manufacturing or cessively since 2021. The respective preventive, detective and
logistic processes, as well as theft of intellectual property, corrective measures are prioritized and implemented
the risks in our health care facilities are related to patients, through our CARE program to effectively reduce risk. While
Fresenius | Annual Report 2021
their health information, and the medical devices used. our main objective is to prevent cyber risks from material-
izing, we can detect cyber threats at an early stage through
various monitoring solutions in order to respond in a timely
152
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient D
igital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
In addition, we constantly inform our employees through Reporting paths Audits and monitoring
various channels about current cyber risks and new types of If Fresenius employees suspect cyber threats, they can The Internal Audit departments carry out independent
cyber threats. We also organize a Cybersecurity Awareness contact [email protected], [email protected], audits to improve the effectiveness of our risk management,
Month in October each year. In October 2021, various webi- or any cybersecurity employee. To improve reporting effi- internal control, and governance processes in all areas of
nars were conducted, with a focus on the cyber threats ciency, suspicious mails may be reported through the “Phish the company. Cybersecurity aspects are taken into account
posed by the still high number of employees working from Alert Button”, which performs an automated analysis and in the risked-based annual planning and audit execution.
home. Further, webinars for employees’ children were involves the Cyber Emergency Response Team (CERT), if The results of the audits are analyzed by the Cybersecurity
offered as “cyber junior training”. We are convinced that chil- required. Our CERT investigates possible threats and inci- Group function and are incorporated into the ongoing
dren and young teenagers have a comparably high need dents in our IT, manufacturing, and health facility environ- improvement of existing cybersecurity activities.
for cyber awareness, especially in view of the increased use ments, as well as suspected violations. If a malicious phish- Furthermore, independent auditors conduct regular and
of remote learning during the COVID-19 pandemic. ing attempt is detected, the sender is blocked and the security comprehensive security assessments (e.g., penetration
The phishing tests conducted in 2020 and 2021 showed protocols adapted accordingly. tests, security reviews of critical systems) and certification
that the intensive training activities positively influenced audits (e.g., ISO 27001, HDS). Results from audits or other
our employees’ security awareness. Therefore, the level of EVALUATION monitoring activities are evaluated if internal processes have
difficulty was raised. The phishing rate initially deteriorated We established our Fresenius Group cybersecurity gover- to be adjusted. Additionally, we work with management
and improved again in the course of the year, thanks to fur- nance structure in 2020 and further improved it in 2021: part consultancies and auditing companies to review and improve
ther training sessions. We inform the respective employees of the further development and improvement of our cyber- our cybersecurity processes. For security reasons, we can-
individually and directly about the results in their personal security governance is the definition and reporting of KPIs, not make any statements about specific review processes.
dashboard. Further information is provided at Group level e.g., the total number of breaches, along with substanti-
on our intranet. ated classification by severity. We are diligently working to
further mature our KPI reporting system for the Fresenius
Group. In the meantime, we abstain from reporting any KPIs
externally, either in total or by risk domain. The increase
in reporting transparency must always be in compliance with
our risk prevention activities. Information from our exter-
nal reporting must not lead to targeted attacks on our infra-
structure.
Fresenius | Annual Report 2021
153
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
EMPLOYEES WORKING CONDITIONS, RECRUITMENT, Recruitment and candidate communication
AND EMPLOYEE PARTICIPATION In order to meet our future demand for qualified specialists,
The commitment of our more than 300,000 employees world- we use a variety of different tools to recruit staff. We monitor
wide forms the basis of our success. Their achievements, OUR APPROACH our working environment and competitive surroundings
skills, and dedication help our business segments to hold closely to identify potential. Furthermore, we use digital per-
leading positions in their respective markets. Working conditions sonnel marketing, organize our own recruitment events,
As an international health care Group, we create various and present the company at career fairs. In recent years, we
Reporting in this chapter encompasses three categories that incentives for employees, depending on the country and loca- have significantly broadened our range of personnel mar-
we deem essential: tion. These include flexible working time models and the keting activities and expanded our global careers website.
chance to participate in the company’s success via variable In 2021, the market research institute Potentialpark named
▶ Working conditions, recruitment, and employee compensation models. Benefits for full-time employees of Fresenius the German company with the best online offering
participation the organization are also provided proportionally to part-time for applicants for the tenth consecutive year.
▶ Employee development employees. In Germany, for example, benefits can be based
▶ Occupational health and safety on joint agreements between management and works coun- Employee retention
cils. We describe our variable compensation models in A variety of initiatives ensure that employees are retained
Further, diversity has been identified as material to our detail on pages 369 ff. of the Notes. effectively. Fresenius offers various benefit components on
company, and is therefore presented on pages 178 ff. of this The collaboration with unions and works councils in a corporate and business segment level. These encompass,
report. various countries globally is explained on pages 155 f. In the for example, employee benefit programs, profit-sharing
The importance we attach to personnel issues is also case of working time models, challenges remain with bonuses, pension plans, compensatory time accounts, and
expressed in our structure: the Group Management Board regard to an employee’s function or the local markets. Fur- tariff-based future payments. Not all elements are imple-
member responsible for Human Resources (Labor Rela- ther information is included in the business segments’ mented equally within the Fresenius Group, but can, how-
tions Director), Risk Management and Legal is responsible reporting. ever, be accompanied by local benefits depending on the
for the interests of employees. The business models of In recent years, we have established various dialog for- market and employee requirements and regulatory provi-
each of our four business segments set different operational mats to strengthen communication between management sions.
requirements for the management of key matters. In the and employees – both at Group level and in the individual
following section, we will therefore report on both Group- business segments. This allows the Management Board to
wide and segment-specific personnel concepts and mea- provide employees with information on important issues per-
sures. sonally. In addition, we promote our feedback culture and
Fresenius | Annual Report 2021
constructive exchange of ideas.
154
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Employee participation about 78% of our employees are covered by collective bar- Dialog at European level
gaining agreements. In some European countries, Fresenius Fresenius SE & Co. KGaA has a European Works Council
Exchange with employee representatives is subject to industry-related collective agreements, e.g., comprising 19 employee representatives from 12 countries
Trust and cooperation between management, employees, in France, which are binding by law due to the industry to as of December 31, 2021. These individuals come from
and employee representatives is well established at Fresenius which we are affiliated. Where this is not the case, coun- the EU and EEA (European Economic Area) member states
and is an integral part of our corporate culture. An open try-specific collective bargaining agreements can be negoti- in which Fresenius employs personnel.
and ongoing dialog between management and employee ated with local trade unions or comparable social partners. The EWC is responsible for the participation of
representatives, as well as unions, is important to us. On a global base, about 50% 1 of our employees are cov- Fresenius employees in cross-border measures, insofar as
Fresenius acts responsibly toward its employees. This is ered by collective bargaining agreements. these have a significant impact on the interests of Fresenius
detailed in our commitment to respect the international In European countries, workplace representation bodies personnel and affect at least two countries within their
standards mentioned in our Code of Conduct and our are organized according to national law. The business area of responsibility, such as the relocation or closure of
Human Rights Statement. Fresenius SE & Co. KGaA respects segments have overall responsibility for dealing with local companies or collective redundancies. For example, the
freedom of association and recognizes the right to collec- employee representatives and trade unions at country or management informs and consults with the EWC on the
tive bargaining. Employees have the right to join or not to site level. Our discussions with these representatives focus structure and economic and financial situation of the Group,
join a union in accordance with local laws. We do not toler- on local and regional circumstances. Together with the its anticipated growth, employment situation, investments,
ate discrimination based on trade union membership and employee representatives, we aim to find tailored solutions organizational changes, and the introduction of new work
act accordingly. We are committed to an open and solu- to the challenges in the different locations. Further infor- and production processes. The EWC meets once a year,
tion-oriented dialog between employees and their repre- mation is included in the business segment sections; see while its executive committee convenes three times a year,
sentatives, and our management within the relevant legal pages 156 ff. partially in hybrid form due to the COVID-19 pandemic. In
and operational frameworks. For more information, see Fresenius has reached an agreement with the European 2021, the new elections and appointments to the EWC took
pages 194 ff. in the chapter on Human Rights. Works Council (EWC), making provisions for a structured place as planned. In preparation for the constituent EWC
Employees liaise with their supervisors, but they can dialog with the international trade union associations; meet- meeting, an extraordinary meeting of the executive commit-
also turn to their human resources or compliance officers, as ings are subsequently held once a year between represen tee (GFA) was held in hybrid form. The EWC was reconsti-
well as to the works council, their union representatives, tatives of the four business segments, the employee repre- tuted in April 2021. The European trade union federations
or other employee representatives for assistance. In Europe, sentatives of the Supervisory Board, and representatives IndustriALL and the European Federation of Public Service
of the international trade union associations. Unions (EPSU) attend the meetings at the invitation of the
EWC.
Fresenius | Annual Report 2021
1
Based on about 91% of Fresenius Group total employees. 155
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
The focus topics of the EWC in the past fiscal year were Organization and responsibilities Recruitment
projects in the Group’s business segments for reorganization, The business segment uses its Global People Strategy as a When it comes to hiring talented staff, Fresenius Medical
e.g., in the area of global human resources management, framework for its activities. Fresenius Medical Care’s global Care faces increasingly strong competition. As a result, the
the digital transformation, the Group-wide cost and efficiency HR function – which is responsible for defining and imple- business segment is working to continuously improve its
program, and compliance matters relating to the Group’s menting the Global People Strategy – reports to Fresenius employer brand. The company aims to remain an attractive
human rights declaration. Another focus area was the impact Medical Care’s CEO. This function provides and manages employer and recruit, engage, and retain excellent employ-
of the COVID-19 pandemic on Fresenius’ employees. To the relevant standards, policies, and processes in accordance ees. In 2021, Fresenius Medical Care started to set various
this end, an exchange of information took place on the situa- with the evolving requirements of the employees and the internal targets to help itself achieve this aim. These relate
tion in the individual countries. Against the backdrop of business. The Global People Strategy has four priorities: (1) to, for example, employee engagement, survey participation,
the COVID-19 pandemic, the prolongation of the agreement engage employees; (2) make the right capabilities avail- and voluntary turnover.
on the digital performance of tasks was reached with the able to support the business goals; (3) continuously advance
EWC. the organization; and (4) foster excellent people practices. Dialog and feedback formats
At its annual meeting, the EWC entered into a dialog with In line with these priorities, the business segment contin- Fresenius Medical Care’s primary objective of its employee
the Management Boards of Fresenius Vamed, Fresenius ually develops and improves the Human Resources (HR) engagement activities is, to give every employee the opportu-
Kabi, and the management of Fresenius Digital Technology policies and guidelines that steer the global activities. In nity to provide feedback and engage with the company in
(formerly Fresenius Netcare). 2021, the business segment established new global an ongoing and open dialog. In doing so, the business seg-
The EWC elected six employee representatives to the employee guidelines on a broad range of topics such as ment hopes to create an attractive work environment, and
Supervisory Board of Fresenius SE & Co. KGaA, including at employee engagement, talent management practices, and to boost the employees’ commitment and performance.
least one representative of the trade unions. inclusion and diversity. Fresenius Medical Care wants to encourage them to contrib-
Fresenius Medical Care also regularly completes audits of ute to the company mission and vision. The global employee
Fresenius Medical Care its employee-related activities. In 2021, more than 20% of engagement survey is a tool that helps the business segment
Fresenius Medical Care’s employees have always been key to internal audits had an HR focus. do this. Fresenius Medical Care conducts one full employee
its success. It is important for the business segment to con- engagement survey every two years and “pulse checks” in
tinuously hire and retain the best people for the job, inspire Employee retention the years between. Through the survey, the company identi-
them to stay with Fresenius Medical Care long term, and Fresenius Medical Care has an established organizational fies strengths, as well as opportunities to improve the work-
support their development during their employment. This and talent review process, which identifies high-performing
helps to create an attractive, fair, and trusting work envi- and high-potential talent among the top leaders of the
ronment for all employees. business segment. This process allows identified employees
Fresenius | Annual Report 2021
to be assisted in building their readiness to tackle future
challenges and take on more responsibility.
156
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
ing environment. The results are used to initiate global and ees with COVID-19-related pay and incentives, as well as Fresenius Kabi uses social networks to address potential
local measures, with the aim of increasing engagement other resources to help them overcome financial challenges candidates with the close involvement of the communications
levels in the long term. In 2021, Fresenius Medical Care con- and to support their overall well-being. department. In the past fiscal year, Fresenius Kabi was able
ducted a global engagement survey. Almost 90,000 employ- In 2021, Fresenius Medical Care continued to roll out its to fill vacancies as planned. The company continuously works
ees worldwide responded, reflecting a participation rate of global HR compliance framework, which sets out its prin- to offer its employees a modern working environment.
74% – up from 68% in the last full survey in 2019. The ciples and defines how the business segment applies them in
latest survey revealed that 56% of employees who partici- its HR processes. Employees received training on the frame- Organization and responsibilities
pated are actively engaged – the same rate as in 2019. work, and the roll-out was accompanied by supporting mate- Fresenius Kabi has a Center of Expertise for Talent, Leader-
This was despite the challenging environment created by the rials to help employees understand what is expected of them. ship and Organizational Development (CoE TLO), including
COVID-19 pandemic. The employee engagement score is In Germany, where the business segment is headquar- Talent Acquisition & Employer Branding and Diversity,
based on three aspects: how many employees would speak tered, Fresenius Medical Care concluded seven agreements Equity & Inclusion in the global human resources department,
positively about Fresenius Medical Care, how many intend with the works councils in 2021. These agreements cov- which reports directly to the head of global human resources.
to stay at Fresenius Medical Care, and how many feel moti- ered topics such as mobile working, expense reimbursement, The CoE TLO aims to further develop talent acquisition,
vated to perform at Fresenius Medical Care. In 2021, the COVID-19-related issues, and the HR information system. personnel and organizational development, and talent man-
business segment trained about 10,000 managers on how to Other agreements with local works councils related to site- agement, and to strengthen a company-wide learning cul-
read and act upon the results from the global engagement specific workplace matters were finalized. ture and corresponding structures and offers for promoting
survey. talent at Fresenius Kabi.
Fresenius Kabi
Progress and measures in 2021 Fresenius Kabi aims to be perceived as an attractive employer Policies and regulations
The COVID-19 pandemic continued to present the business around the world in order to attract qualified and motivated As the basis for the shared understanding of collaboration,
segment with health care challenges throughout 2021. talent to the company. It is particularly important to under- Fresenius Kabi has defined company values that have been
Fresenius Medical Care has introduced various measures to stand regional and local characteristics of the markets and introduced worldwide. These company values are anchored
protect and support its employees during this health crisis. to take these into account when addressing talents based on in both the Code of Conduct and the Quality Management
For example, Fresenius Medical Care increased employee job profiles. Fresenius Kabi is continuously developing its Handbook. They are embodied in the corporate environment,
opportunities for flexible working, created new opportuni- processes for recruiting employees further and fosters the and employees maintain a culture of cooperation across
ties for virtual learning, and continued to adapt the organiza- collaboration between the human resources departments national borders, as well as functions and hierarchies.
tion to the requirements of a virtual environment. In the and the divisions. In 2021, Fresenius Kabi continued to carry
United States, Fresenius Medical Care provided its employ- out application and selection processes partially in virtual
Fresenius | Annual Report 2021
form due to the ongoing COVID-19 pandemic. In addition,
157
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Recruitment For the first time, Fresenius Kabi conducted a global Progress and measures in 2021
Fresenius Kabi set up a Recruiting Center in 2021 to fill employee survey in 2021. In order to achieve a high level of In 2021, the newly established Recruiting Center focused
vacant or new positions in the central functions and the participation, the business segment decided to conduct an on improving the recruitment of new employees in the central
Transfusion and Cell Therapies division in Germany, which open survey accompanied by an internal communication functions of Fresenius Kabi and the Transfusion and Cell
is part of the CoE TLO. The departments are supported campaign. The focus was on respectful leadership culture Therapies division in Germany. Further progress focused on
throughout the process by the Recruiting Center’s team of and collaboration, trust and integrity, and agility within the conducting the first global employee survey for Fresenius
experts in the search for and selection of suitable candi- business segment. More than 70% of employees partici- Kabi to gain important insights into employee satisfaction
dates. In this way, Fresenius Kabi aims to define individual pated in the global employee survey. Initial significant and retention.
requirements for vacant positions to improve the recruiting insights were gained with important information for global Fresenius Kabi developed the Fresenius Kabi Vision 2026
process. The team of experts also draws on a network and human resources and the top management: the responses in the reporting year and adopted it in the fourth quarter of
talent pool of candidates, who are also given a central show differences both regionally and in the business units. 2021. Vision 2026 entails a cultural change. Fresenius Kabi
point of contact for all questions relating to the recruiting Fresenius Kabi sees very high levels of positive feedback in wants to advance its company culture together with its
process. Asia and South America as well as in the Transfusion and Cell employees – in relation to how employees work together, what
In the region North America, the process of recruiting Therapies division, for example. In addition, the close and values the company stands for, and how it makes decisions.
personnel and introducing new employees to the company cooperative collaboration within the company’s own team Further information on Vision 2026 can be found on page 47
can be carried out completely virtually, thanks to the adap- was also emphasized, with a satisfaction rate of above of the Group Management Report.
tion of existing IT systems. 90%. The evaluation of the survey will be finalized in 2022.
Fresenius Kabi also uses regional employee surveys to Fresenius Helios
Dialog and feedback formats sustainably increase employee satisfaction, gain valuable Unlike many other industries, hospitals need to work around
Fresenius Kabi attaches great importance to dialog with insights into business processes, and increase loyalty to the the clock, 365 days a year to ensure patients are cared for.
employees across hierarchical levels. Due to the pandemic, business segment. The business segment conducted a sur- Against this background, flexible working hours therefore
dialog and feedback formats could only be conducted vey in Switzerland, in 2021, in which approximately 90% of pose certain challenges and require the revision of existing
online in 2021. To support dialog between management and employees participated. About 70% of employees took part concepts and the introduction of new ones. Further, Helios
employees, video messages from the CEO on relevant topics in another employee survey in the United Kingdom. Fresenius offers its employees the opportunity to work part-time.
were published on the global intranet, for example. In addi- Kabi is currently further evaluating the results to take them
tion, digital formats were used to foster the exchange into account in the future development of employee-related
between the CEO of Fresenius Kabi and top executives. cultural company initiatives. Once the evaluation has been
concluded in 2022, further measures will be derived.
Fresenius | Annual Report 2021
158
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Helios Germany also has to deal with a specific challenge Helios Spain aims to further expand its position as a leading vides transparency for all clinics on the most relevant KPIs
posed by Germany’s Ordinance on the Minimum Require- private provider of health care services in Spain. To do so, and enables best-practice sharing on how to improve person-
ments for Nursing Personnel in Hospitals (PpUGV), which it needs to attract new employees, retain them, and develop nel management in our Spanish hospitals.
has increased the need for nursing personnel, of whom there them further. Along with this, the business segment partici-
is a shortage on the labor market in some areas. The search pated in various online recruitment sites in 2021 and started Policies and regulations
for employees focuses on the following fields of action: train- to promote its main vacancies through social media cam- All Fresenius Helios hospitals apply collective agreements,
ing of qualified personnel internally, advertising for skilled paigns. The quality of Helios Spain as an employer was con- including those in Germany, which are linked to the Helios
workers, and searching the international labor market. Helios firmed by various external rankings in the course of 2021; Group collective agreement, the collective agreement for
Germany participates in government-led campaigns to the business segment is one of the 50 best companies to work public service (TVöD), or company-specific collective agree-
recruit personnel on the international labor market, as well as for in Spain according to Forbes Magazine, for example. ments. In Germany, all Fresenius Helios hospitals are sub-
supporting people who have qualified as nurses abroad in ject to the current Working Time Act, which in some cases
their applications or in their searches for language schools. Organization and responsibilities provides for wage reopener clauses for supplementary tariff
Many international nursing professionals have completed At Helios Germany, the Central Service for Personnel Recruit- regulations. The Works Constitution Act, which grants the
academic training at universities. These forms of vocational ment and Development is responsible for creating and works councils co-determination rights and control, also
training are mainly aimed at complex medical activities and implementing measures and strategies for the operating units has a regulatory effect. The framework with regard to work-
an often strongly cooperative collaboration in medical teams. within the clinics to attract, train and develop personnel. ing hours for the individual companies is regularly agreed
The German vocational training system is a generalist The Central Personnel Management and Collective Bargain- by the respective company parties onsite.
training, which enables its participants to care for people of ing Service is responsible for structuring working condi- In its human resources policy, Fresenius Spain states
all ages. Specialization is possible during and after voca- tions under collective agreements and improving the service that the company’s success depends to a large extent on its
tional training. Bringing together the strengths of both train- for employees. employees. The guideline also defines the objectives of
ing systems is a great advantage and offers an opportunity The central function People & Organization of Helios human resources work; these include transparent internal
to advance the overall quality of medical care in the hospitals. Spain is responsible for collective agreement management communication and the development of a program for the
In Spain, prospective nurses complete their training at a and negotiation as well as ensuring that wages are in com- ongoing training of employees.
university. Later, they can specialize through a specific pliance with applicable regulations. From Spain’s headquar- In Spain, all workers are covered by collective agreements
program – choosing between occupational health nursing, ters, the function participates in all collective bargaining set by law, which set out their basic rights, such as pay
family and community health, obstetrics and gynecology, processes through the corporate labor relations department. and working hours. The agreements thus ensure attractive
geriatrics, pediatrics, and mental health. Helios Spain has Helios Spain has a company-wide dashboard to manage, working conditions and market-oriented remuneration for
established partnerships with universities to provide class- evaluate, and improve the most important personnel KPIs. workers and are negotiated with their legal representatives.
Fresenius | Annual Report 2021
room training for these professionals and to raise its The dashboard is available to all clinics and enables them to There are two different collective bargaining variants at the
attractiveness for potential candidates. conduct benchmark comparisons. Thus, the company pro-
159
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
sites in Latin America: In Peru, there is only one collective Induction of new employees In order to better understand employee satisfaction, espe-
agreement; it applies to all employees regardless of the In the last few years, Helios Germany further developed and cially under the influence of the ongoing COVID-19 pandemic,
union to which they belong. In Colombia, on the other hand, standardized the processes used for induction of new an employee survey was conducted in Spain in January
negotiations take place at the local level. In clinics with a employees and new managers. The aim is to reduce early 2021. The participation rate was about 40% of the applicable
collective agreement, it applies only to union members. turnover to a minimum. In 2021, new measures were employees. More than 21,000 were invited to respond to
established in the first clinics, such as the appointment of an the survey. The participation rate was impacted by the high
Flexible working conditions and digitalization onboarding mentor, structured familiarization concepts, working intensity in our clinics due to COVID-19, as well as
In 2021, Helios Germany further continued digitalization in and feedback discussions during the probationary period. the high fluctuation rate in the first year of service among our
the HR area and transferred about 28% of the companies’ New managers participate in a three-stage program within employees in Spain. The results were announced to all
personnel files to the digital HR management system at the two years of taking up their posts. A key component of this employees. According to the results, the employees would
end of the year. All HR processes are to be digitalized by the process is the integration of employees from abroad. This like to strengthen mututal recognition promote the contri-
end of 2022. includes language courses and programs to familiarize them bution of ideas, and cope better with difficult situations in the
In addition, Helios Germany is developing new working quickly with the day-to-day work processes in German future. As a result, employees had the opportunity to sub-
time models, especially for the medical service, but also for hospitals, as well as supporting measures for social integra- mit suggestions for improvement in a competition. Helios
nursing and administration. To this end, workshops and tion together with local employees. Spain immediately began to implement the measures
meetings of working groups with the aforementioned occupa- Helios Spain uses digital onboarding. By doing so, the derived from the best ideas in regional action plans, which
tional groups took place in 2021. The working time models business segment ensures that standards set for the induction are to be continued into 2022.
developed from the findings are presented to personnel and of new employees are uniform. For instance, the onboard- Employees in Spain who decide to leave the company
clinic managers so that they can test them and put them into ing includes information on the company and its values as likewise have the opportunity to state reasons for their
practice in the facilities. well as general and job-specific training. To ensure suc- departure in a coordinated interview. These interviews are
Working hours during the officially ordered lockdown cessful integration, a survey is conducted with new employ- IT based, automatically conducted and documented.
periods, with no or only limited childcare, were also less fixed ees both in the first week and after three months. They can
than before. Mobile working was also made possible in also sign up for a mentor program and receive individual sup- Progress and measures in 2021
2021 for employees whose work does not require direct con- port early in their careers. In 2021, the management approach and the governance
tact with patients. structure of Fresenius Helios remained as reported in 2020.
Dialog and feedback formats Progress focused on digitalization and creating flexible
Helios Germany offers annual appraisal interviews to all working models against the background of the pandemic,
employees. From these employee discussions, and from other and on measures to retain employees.
Fresenius | Annual Report 2021
dialog formats, it became evident how important it is for
employees in the nursing division that well-functioning, inte-
grated teams are maintained.
160
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
In 2021, Helios Spain defined and implemented an internal In Austria, the management of Fresenius Vamed and the Dialog and feedback formats
mobility policy with the aim of publishing all vacancies in human resources managers of the rehabilitation and care Appraisal interviews are an essential part of Fresenius
the employee portal on the intranet with the goal of retaining facilities actively participate in the respective collective Vamed’s management culture. In addition to essential
employees within the clinic Group. In doing so, the busi- bargaining negotiations in order to ensure the best justifi- insights and measures for further successful cooperation,
ness unit highlights opportunities and career paths to profes- able conditions for the employees and the company. the necessary training and further education requirements
sionals who want to develop further, while making an Where collective agreements are applicable, these are also result from the detailed discussions. These are summa-
important contribution to retaining talent. overpaid in most locations. In addition, market-specific sala- rized in a training plan, on the basis of which the correspond-
In addition, Helios Spain is planning a project on perfor- ries are evaluated on a regularly basis. ing training and continuing education program is drawn
mance management and sustained feedback for middle up. This ranges from specialist training in the health care
management. The implementation is initially planned for Policies and regulations sector and personality-building seminars to customized
specific centers and scheduled for the beginning of 2022. Fresenius Vamed has put detailed guidelines and standards language training and IT seminars.
in place regarding working conditions and working hours.
Fresenius Vamed Compliance with these requirements is constantly monitored. Progress and measures in 2021
Fair working conditions are part of Fresenius Vamed’s mis- In 2021, new regulations were adopted because of the In 2021, the management approach and the governance
sion statement. Fresenius Vamed’s corporate culture is COVID-19 pandemic, e.g., for working from home, for hygiene structure of Fresenius Vamed remained as reported in 2020.
characterized by the diversity of unique people, open dialog, at the workplace, and for business trips. Progress focused on the design of working conditions in
mutual appreciation, respect, caring, clear goals, and the context of the COVID-19 pandemic.
decisive leadership. The company values, strategies, and Flexible working conditions and digitalization
goals should manifest themselves through open, intensive, Digitalization and flexibilization continued to accompany Our ambitions
and direct communication. The Fresenius Vamed business Fresenius Vamed in all areas of ongoing human resources The four business segments pursue segment-specific ambi-
model is very broad in nature, which places special work and communication in 2021. In the Czech Republic, tions in the areas of working conditions, recruitment, and
demands on the recruitment of personnel. The recruiting pro- for example, the business segment worked on the develop- employee participation. We want to build on the position of
cess is tailored to the individual requirements of the indi- ment of an app to make communication between the our business segments as drivers of innovation in the
vidual positions. respective management and employees who do not work at health care sector. Our aim in doing so is to attract new
the actual workplace faster and more direct. In order to be employees who contribute to the company’s success
Organization and responsibilities able to access information on the move in future, the Austrian through their willingness to perform, their expertise, their
Human resources work at Fresenius Vamed’s entities is man- parent companies have also developed an app for their experience, and their willingness to work together as a
aged by the business segment’s Human Resources divi- employees. This can be used to access the contents of the team.
Fresenius | Annual Report 2021
sion. Since the general conditions in the individual countries intranet and, for example, certain training courses.
in which Fresenius Vamed is active are highly diverse, the
division ensures that those responsible in the various coun-
tries are actively involved.
161
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
EVALUATION EMPLOYEES (HEADCOUNT) BY BUSINESS SEGMENT
At the end of the 2021 fiscal year, the Fresenius Group had 2021 2020 2019 2018 2017
316,078 employees. This was 4,809 or 2% more than in the Fresenius Medical Care 130,251 133,129 128,300 120,328 121,245
previous year (December 31, 2020: 311,269). In terms of FTE Fresenius Kabi 41,397 40,519 39,627 37,843 36,380
Fresenius Helios 123,484 116,952 106,377 100,144 105,927
(full-time equivalents), this also represented a 1% increase
Fresenius Vamed 19,721 19,414 18,592 17,299 8,667
at the Fresenius Group. Acquisitions in the business segments
Corporate / Other 1,225 1,255 1,238 1,136 1,030
Fresenius Medical Care and Fresenius Helios contributed Total as of Dec. 31 316,078 311,269 294,134 276,250 273,249
1% to the increase in employees, while the total number of
employees decreased at Fresenius Medical Care.
The regional distribution is as follows: about 31% of
employees are employed in Germany, 26% in the rest of EMPLOYEES (FTE) BY BUSINESS SEGMENT
Europe, and 24% in North America. 2021 2020 2019 2018 2017
Fresenius Medical Care 122,909 125,364 120,659 112,658 114,000
Our distribution of employees by function remained
Fresenius Kabi 39,579 39,032 38,264 36,423 34,923
largely unchanged in 2021: About 14% of the workforce was
Fresenius Helios 1 101,652 96,899 88,057 82,522 85,577
employed in the production sector, and 71% in the services Fresenius Vamed 15,730 15,364 14,770 13,665 7,215
sector. Our personnel structure was thus stable in terms of Corporate / Other 1,141 1,166 1,154 1,060 969
development. The high proportion of service personnel is Total (FTE) as of Dec. 31 281,011 277,822 262,904 246,329 243,913
mainly due to the large number of nurses in our health care 1
FTE: For Helios Kliniken Germany, the number of employees converted to the full collectively agreed working time on monthly average (Vollkräfte)
facilities.
The rate of new hires 1, 2 in relation to the overall number
of employees in each business segment is evidence of our EMPLOYEES (HEADCOUNT) BY REGION
2021 2020 2019 2018 2017
efforts within recruitment. The length of service 1 within the
Europe 180,122 174,835 165,862 158,939 154,172
Group can vary with acquisitions in the business segments.
thereof Germany 98,754 96,915 91,014 88,086 86,613
In 2021, the average was 8.3 years and remained close to the
Europe excl. Germany 81,368 77,920 74,848 70,853 67,559
previous year’s level of 8.2 years. North America 76,740 75,837 74,894 72,672 75,083
In 2021, the proportion of employees who voluntarily Asia-Pacific 27,145 27,805 27,457 25,575 24,381
left 1, 3 the company increased to 12.8% (2020: 9.8%). Main Latin America 30,192 30,871 23,998 17,610 17,709
reasons for this development were the uncertainty in the Africa 1,879 1,921 1,923 1,954 1,904
Fresenius | Annual Report 2021
labor market associated with the COVID-19 pandemic, stress- Total as at Dec. 31 316,078 311,269 294,134 276,750 273,249
1
Fresenius Medical Care’s 2017 data reflects country data representing 96% of all employees. Helios Germany’s data for 2017 includes the post-acute care business in Germany.
Fresenius Vamed’s data for 2017 also includes temporary staff and, as of 2018, the German post-acute care business transferred from Fresenius Helios to Fresenius Vamed. The data from Helios Spain
contains the hospitals in Latin America as of 2020. Data does not include the recently acquired company Eugin, yet.
2
Calculated as the number of external hires in a business segment within the reporting period, relative to the number of employees at year-end.
3
Calculated as the number of employees who left the organization voluntarily in relation to the number of employees at the end of the year. 162
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
ful labor conditions in the health care sector and thus an NEW HIRES 1, 2
increase in early turnover as well as people leaving the indus- in % 2021 2020 2019 2018 2017
try. We explain this development in detail in our business Fresenius Medical Care 23.7 23.1 24.7 21.7 n. a.
segments and measures taken to correspond to this situation Fresenius Kabi 17.1 13.5 17.1 16.9 19.8
on pages 165 ff. of the Group Non-financial Report, section Helios Germany 18.8 14.3 15.4 16.0 19.8
“employee development”. Helios Spain 29.0 25.5 20.1 27.6 n. a.
Fresenius Vamed 18.4 18.4 17.8 22.5 11.0
The average age of Group employees was 41.6 years
Corporate / Other 11.0 6.1 11.2 12.5 9.7
(2020: 41.7 years). The majority (55%) of our employees are
between 30 and 50 years of age. We aim to maintain a
well-balanced age structure within our Group. The distribu-
tion reflects the demand for a high proportion of skilled AVERAGE LENGTH OF SERVICE 1
and experienced employees in our business segments. in years 2021 2020 2019 2018 2017
Fresenius Medical Care 7.6 7.3 6.8 7.1 7.0
Fresenius Medical Care Fresenius Kabi 7.9 7.9 8.6 7.5 7.4
After declining to 11.9% in 2020, Fresenius Medical Care’s Helios Germany 10.3 10.3 10.6 10.8 10.5
voluntary turnover rate rose to 16.5% in 2021. This increase Helios Spain 7.7 8.0 8.4 8.2 n. a.
Fresenius Vamed 7.8 7.7 6.9 7.8 6.1
reflects an increasingly competitive labor market, especially
Corporate / Other 7.8 7.5 7.3 7.3 7.6
in clinics and the manufacturing business. To counteract this
Total 8.3 8.2 8.1 8.2 8.1
increase, the business segment implemented several mea-
sures. These include various measures to help managers
and HR professionals to help improve employee retention.
The average tenure of employees increased from 7.3 years VOLUNTARY TURNOVER 1, 3
in 2020 to 7.6 years in 2021. in % 2021 2020 2019 2018 2017
Fresenius Medical Care 16.5 11.9 14.3 13.2 12.2
Fresenius Kabi 11.3 7.1 9.2 9.4 11.3
Helios Germany 9.5 8.3 9.1 6.9 6.0
Helios Spain 11.0 9.8 7.6 3.8 n. a.
Fresenius Vamed 9.3 7.8 7.6 9.5 8.0
Fresenius | Annual Report 2021
Corporate / Other 3.5 1.7 3.5 3.8 2.7
Total 12.8 9.8 11.0 9.8 9.9
1
Fresenius Medical Care’s 2017 data reflects country data representing 96% of all employees. Helios Germany’s data for 2017 includes the post-acute care business in Germany.
Fresenius Vamed’s data for 2017 also includes temporary staff and, as of 2018, the German post-acute care business transferred from Fresenius Helios to Fresenius Vamed. The data from Helios Spain
contains the hospitals in Latin America as of 2020. Data does not include the recently acquired company Eugin, yet.
2
Calculated as the number of external hires in a business segment within the reporting period, relative to the number of employees at year-end.
3
Calculated as the number of employees who left the organization voluntarily in relation to the number of employees at the end of the year 163
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Fresenius Kabi AVERAGE AGE 1
Total employees at Fresenius Kabi increased slightly in the 2021 2020 2019 2018 2017
reporting year. The external hires as well as the voluntary Fresenius Medical Care 42.1 41.7 40.8 40.8 41.7
turnover were marked by the constraints for personnel in the Fresenius Kabi 39.2 39.9 38.7 38.4 38.5
health care market, a development which we also experi- Helios Germany 42.2 42.2 42.5 42.6 42.7
enced in the other business segments. Helios Spain 40.4 40.5 41.0 40.0 n. a.
Fresenius Vamed 44.3 44.0 41.2 43.6 43.0
Corporate / Other 39.7 39.3 39.1 38.9 39.2
Fresenius Helios
Total 41.6 41.7 41.0 41.0 41.5
The total number of employees increased in the reporting
year at Fresenius Helios. Employee retention measures
were initiated early and thus, we were able to respond to the
impacts on the labor market, caused by the pandemic. The
voluntary turnover only slightly increased to 10.3% (2020: job adjustments amounted to around 3% and were carried Fresenius Vamed
9.0%). At Helios Germany, the rate was at 9.5% below the out by not filling vacant positions or letting fixed-term At Fresenius Vamed, the number of employees increased
rate at Helios Spain with 11.0%. employment contracts expire. The adjustments in the by 2%. The turnover was impacted by COVID-19 and the
In view of the renewed decline in the number of cases by medical services were conducted without redundancies. change in work-life-balance aspirations of employees in
around 16% in the reporting year compared with the pre- administrative functions. Further, employees in health care
COVID-19 year 2019, Helios Germany made moderate adjust- facilities faced increasing.
ments to positions in the medical service in 2021. These
AGE STRUCTURE 1
2021 2020 2019 2018 2017
Between Between Between Between Between
Dec. 31 Below 30 30 und 50 Above 50 Below 30 30 and 50 Above 50 Below 30 30 and 50 Above 50 Below 30 30 and 50 Above 50 Below 30 30 and 50 Above 50
Fresenius Medical Care 16% 58% 26% 17% 58% 25% 18% 56% 26% 16% 57% 27% 18% 56% 26%
Fresenius Kabi 21% 60% 19% 22% 61% 17% 23% 60% 17% 23% 60% 17% 25% 59% 16%
Fresenius | Annual Report 2021
Helios Germany 20% 47% 33% 20% 48% 32% 19% 48% 33% 18% 49% 33% 19% 49% 32%
Helios Spain 21% 59% 20% 18% 60% 22% 17% 61% 22% 18% 62% 20% n. a. n. a. n. a.
Fresenius Vamed 16% 47% 37% 15% 49% 36% 16% 50% 34% 15% 50% 35% 18% 54% 28%
Corporate / Other 25% 51% 24% 25% 53% 22% 24% 54% 22% 25% 54% 21% 24% 55% 21%
Total 19% 55% 26% 19% 55% 26% 19% 55% 26% 18% 55% 27% 19% 55% 26%
1
Fresenius Medical Care’s 2017 data reflects country data representing 96% of all employees. Helios Germany’s data for 2017 includes the post-acute care business in Germany.
Fresenius Vamed’s data for 2017 also includes temporary staff and, as of 2018, the German post-acute care business transferred from Fresenius Helios to Fresenius Vamed. The data from Helios Spain
contains the hospitals in Latin America as of 2020. Data does not include the recently acquired company Eugin, yet. 164
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
EMPLOYEE DEVELOPMENT for the first time. The classic direct entry route aside, and Fresenius Vamed also offer needs-based e-learning
Fresenius also offers graduates trainee programs for further and document the training activities in their own learning
OUR APPROACH professional orientation. management systems.
We offer our employees the opportunity to develop profes-
sionally in a dynamic international environment. Our four Fresenius Training Compendium Digitalization of the training offered
business segments use different concepts and measures for The training compendium of Fresenius SE & Co. KGaA lists all In the reporting year, we continued to advance the digitaliza-
personnel development – depending on their own cus- of the training opportunities available to our employees. tion of Fresenius’ development and training offerings.
tomer and market structures. They constantly adapt their This includes programs for communication and presentation, Numerous training measures as well as compulsory training
approaches to current trends and requirements. In addition self-management, and project management, as well as took place as webinars or e-learning courses. Among other
to Group-wide mandatory training courses on the respective specific learning content depending on the job profile of the things, this enabled fast, up-to-date, precise training, espe-
Codes of Conduct, there are mandatory training courses on target group of employees. cially in the area of hygiene, which is particularly important
quality management, environmental management, and occu- during the ongoing COVID-19 pandemic. The organization of
pational health and safety in the business segments. Digitali- Fresenius Learning Center digital learning opportunities took place mainly on the
zation is also playing an increasingly important role in the In addition to the training compendium, we offer training already existing or newly implemented learning platforms.
daily work done by our employees, which we explain in the courses in the Fresenius Learning Center (FLC) learning man- Further information is provided in the following descrip-
following. Segment-specific talent management and individ- agement system. Depending on the subject, these training tions of the business segments.
ual further training offerings for employees and managers programs consist of one or more modules. Most of these
are our other personnel development measures. involve some e-learning – for example webinars – as well as FRESENIUS MEDICAL CARE
classroom training; reading materials are also offered to Fresenius Medical Care is committed to supporting the
Vocational training different target groups. Employees in Germany who do not learning and development of employees around the world.
Vocational training is very important to us. This is why we have their own computer or laptop, or who do not have a In this context, the business segment provides learning
offer applicants many opportunities to start their career quiet work environment, can take the training courses they opportunities to all employees irrespective of their location
pathways in our company. In 2021, more than 6,300 young need at specially set up learning locations. Fresenius Helios or position in the business segment. Learning platforms
people were doing dual vocational training and/or dual
study at our locations in Germany. Across the Group, we
offered more than 43 posts requiring formal training and
29 dual degree programs. Compared to the 2020 training TRAINEES AND TRAINING RATIO FOR GERMANY
year, the Group’s range of training opportunities was 2021 2020 2019 2018 2017
Fresenius | Annual Report 2021
expanded once again. The dual study program in General Trainees 1 6,305 5,985 4,952 4,354 4,019
Industrial Engineering, Digital Transformation, and the Training ratio 6.38 6.18 5.44 4.94 4.64
training program for Digitalization Management were offered 1
Includes vocational training and university students
165
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
allow employees to pursue their career goals and interests in All employees who are directly involved in the manufactur- the responsible organizations within Fresenius Kabi. Feed-
a self-directed manner. ing, testing, and distribution of our products, as well as back from employees and executives is also taken into
employees who work in a supporting role (e.g., technical account.
Organization and responsibilities maintenance, IT) receive mandatory training in job-related
Individual learning needs are identified through development good manufacturing, control, and distribution practice and Progress and measures in 2021
and career discussions that are often part of a performance in occupational health and safety and environmental pro- In 2021, numerous learning modules were rolled out, for
management process. Since 2019, the business segment has tection. example the module on the Code of Conduct, which was
intensified efforts to train managers and employees in how In addition, occupational health and safety and environ- supplemented by a chapter on human rights, or a training
they can contribute to these career conversations. Online mental and energy management training is conducted at all module on “Fair Competition – Acting in Accordance with
resources are provided such as webinars and virtual class- certified sites. Further training supplements this and serves Antitrust Law”. Mandatory training was increasingly con-
room trainings. to support the introduction, further development, and ducted online. The range of mandatory online modules was
improvement of the corresponding management systems and also expanded. Fresenius Kabi documented training activ-
Progress and measures in 2021 measures. ities in more than 50 countries, with more than 30,000
The business segment expanded its digital learning platform As part of talent management, postings to other countries employees trained in 2021 in the most relevant internal learn-
globally in third-quarter 2021. Since then, more than 16,000 are also used to promote professional and personal devel- ing management systems. The online training on back-
employees have participated in training via this platform. In opment. These comprise both long- and short-term postings, ground, behavior, and preventive measures relating to the
addition, the company provided certain employee groups which also contribute to meeting specific staffing needs. In pandemic was continued in 2021 in various languages.
with specific training. The top 450 leaders were offered lead- addition, Fresenius Kabi supports the development of digital
ership resilience training via virtual classroom events, as competencies, for example in connection with making work FRESENIUS HELIOS
well as training in employee engagement strategies. New more flexible, such as mobile work by its employees, through Employee training and development activities help Fresenius
leaders also received courses on employee development. further training programs. Helios achieve its four strategic business objectives: to offer
The global performance and development platform for the best service, to be a leader in medicine, to do sustainable
leaders, which was introduced in 2020, was made available Organization and responsibilities business, and to expand on its market position. These will
to all employees. The CoE TLO reports directly to the head of the global Human enable Fresenius Helios to further improve with regard to
Resources department. In 2021, it was assigned worldwide medical quality and to position itself as an attractive
FRESENIUS KABI responsibility for managing Fresenius Kabi’s learning activ- employer at the same time. Training budgets, along with reg-
Fresenius Kabi has global, regional, and local structures for ities. In this way, the business segment aims to offer more ular employee and career interviews, are therefore firmly
training and developing employees. Employees are trained individualized and extended training activities. Training is anchored in Fresenius Helios’ corporate culture.
Fresenius | Annual Report 2021
and qualified according to their functions and responsibili- mainly offered decentrally, to provide training opportunities
ties. Mandatory global training for employees is carried out quickly and in accordance with the respective requirements.
internally. This includes, for example, training on the Code of The personnel development measures are evaluated by
Conduct.
166
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
However, Fresenius Helios has also been faced with medical school is taught and more than 400 medical staff are Progress and measures in 2021
increased competition in the human resources sector, also fully trained each year. In our two nursing schools, we Due to the pandemic, a large number of training courses
due to new regulatory requirements in line with the lower cover classroom and hands-on training as well as vocational were again switched to digital formats in 2021. This included
thresholds for nursing. The demand for skilled workers has training; for example, we qualify students as Imaging training content for nurses, for example, as well as content
continued to increase over the past few years, especially in Technicians for Diagnosis and Nuclear Medicine and Tech- from the career programs and wherever it was methodically
the nursing sector in our relevant markets of Spain and Ger- nicians in Radiation Therapy and Dosimetry. and didactically appropriate. Helios Spain started the devel-
many. For this reason, Fresenius Helios intends to acquire Fresenius Helios now uses digital work tools across the opment of a new training platform in 2021. The goal is for
a large proportion of the necessary nursing personnel board in all areas of basic and advanced training and educa- more than 90% of Spanish training to be offered via
through in-company training at its 34 training centers in Ger- tion. Learning content is organized using what is known as e-learning.
many. the Helios knowledge account – a digital education manage- Helios Spain is in the process of accrediting new univer-
In Spain, the business segment focuses on cooperations ment system – and learning scenarios implemented via sity hospitals for medical degrees and nursing schools. The
with universities. In contrast to Germany, where nurses e-learning and online seminars. company also has its own master’s degree programs based
receive vocational education and training, Spanish nurses are on the needs of our own nursing and medical professionals
educated at universities, as described on page 159. The Organization and responsibilities and of the professionals we need in order to seize opportuni-
business segment is also tackling the continuing challenge In 2020, Helios Germany merged the two departments of ties in the health care markets. The master’s degree in Emer-
posed by the shortage of skilled workers in the medical Digital Knowledge Media and Academy / Talent Management gency Care for Doctors, for example, was launched in 2021.
sector. One example is the structured talent pools of senior under the new Central Service Recruitment and Develop- This is aimed at professionalizing our emergency physicians
doctors that Helios Germany is building. ment. and attracting external professionals.
All professional groups at the hospital can learn, train, Helios Spain has created a central department that In 2021, for the first time, the business segment partnered
and further develop their expertise at the Helios Academy brings together different talent and employee areas: Talent in Spain with the IESE Business School to run an advanced
and the Fresenius Helios training centers in Germany, to Acquisition and Management, Internal Communications healthcare management program. Its aim is to provide train-
develop professional and personal competencies. Fresenius and Employer Brand, Apprenticeship, and the Universidad ing in modern and efficient hospital management and in
Helios also offers its employees trainee and assistant pro- Corporativa, a corporate training academy. The aim is to leadership skills – and to transform care models and services
grams, for example, and builds up competence profiles for attract the best professionals and create an optimized work- as well as clinical research, for this purpose. In 2021, 60
clinic management. place. With the launch of the Universidad Corporativa, an professionals participated. Comprehensive assessments,
In Spain, more than 5,000 students are trained annually advisory board was also established, which includes a num- including 360-degree feedback interviews and feedback
by our experts; they acquire practical skills during their ber of company and divisional directors. It is responsible
undergraduate and postgraduate training. We also have eight for aligning and promoting the training with the strategic
Fresenius | Annual Report 2021
university hospitals where classroom-based content of a goals of the company.
167
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
sessions, were conducted with all participants to create indi- larly in the area of hygiene. Fresenius Vamed has also digi- EVALUATION
vidual development and training plans. A second in-depth talized essential and mandatory training and further educa-
assessment is planned for the first half of 2022 so that nec- tion activities. The same applies for the monitoring of the Fresenius Medical Care
essary improvement measures can be implemented. participation within a defined period as well as e.g. success- Fresenius Medical Care is in the process of assessing the
fully carried out exams which are digitally recorded and industry standard for average training hours undertaken per
FRESENIUS VAMED evaluated. employee annually, and plans to meet or achieve this stan-
The expertise and project experience of its employees plays All employees are free to use their own Fresenius Vamed dard, if it has not already done so, by the end of 2024.
an important role in the success of Fresenius Vamed in view Academy. Their courses and training cover not only specific
of the heterogeneous nature of its activities in the high-end professional issues, but also topics such as personal devel- Fresenius Kabi
service business, overall operations management, and opment and leadership, interpersonal skills, and method- For training of employees in production on quality manage-
project management. It is therefore extremely important for ological expertise. Various knowledge platforms, such as the ment an average of almost 26 hours was spent per employee
the business segment to promote the further development International Medical Board (IMB), also pool the know-how of in 2021. The quality management training for employees
of its employees in a targeted manner. Key for Fresenius about 1,200 health care professionals working for Fresenius from 2019 and 2020 has been renewed and additionally sup-
Vamed’s personnel management are individually adapted Vamed. The content of the program has not changed sig- plemented by quality trainings for new employees.
personnel development measures and a comprehensive, nificantly over the course of the COVID-19 pandemic, with a
needs-oriented training offering, which is very diverse in certain number of courses and events being digitalized and AVERAGE HOURS OF TRAINING PER YEAR PER EMPLOYEE IN
nature due to the complex structure of the business segment. some classroom seminars postponed to later dates. PRODUCTION 1 REGARDING QUALITY
As part of its strategic personnel planning, Fresenius
2021 2020
Vamed identifies young employees with particular potential Organization and responsibilities Production (training hours / average) 25.93 20.06
and promotes their individual development. This is done via Fresenius Vamed’s Human Resources management team, Number of employees included
trainee programs and in the VAMED Human Capital Manage- together with the responsible business segments and the in the calculation (FTE) 23,700 21,800
ment (HCM) Program, which prepares employees with Management Board, develop and implement measures to The production area comprises the following employee groups: operation / manufacturing, qua-
1
lity control, quality assurance, maintenance / technical support and warehouse.
potential to take on leadership and specialist roles. promote and train employees and new talents.
Fresenius Vamed is increasingly using digital elements
such as e-learning to design new training offerings. Employ- Progress and measures in 2021
ees can access a pool of knowledge via various knowledge In 2021, the management approach to training and develop-
platforms. In addition, Fresenius Vamed has the option of ment and the governance structure of Fresenius Vamed
developing and rolling out micro-learning modules inde- remained as reported in 2020. In the area of employee devel-
Fresenius | Annual Report 2021
pendently. These short training modules are largely available opment, progress also focused on dealing with the chal-
online, and have enabled fast, up-to-date, precise training lenges of the COVID-19 pandemic.
and education on applicable COVID-19 regulations, particu-
168
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
The business segment uses an IT-based annual talent review In 2021, Helios Germany held a total of 221 training sessions OCCUPATIONAL HEALTH AND SAFETY
for dialog and feedback on performance, competencies, in the fields of emergency medicine, anesthesia, intensive
and development potential for upper management levels and care medicine, and obstetrics at its simulation and emergency OUR APPROACH
to strengthen the exchange between employees and their facilities, thus training a total of 1,756 physicians and Ensuring the health and safety of our employees is an essen-
superiors on the individual development planning. On this nurses. tial part of our corporate responsibility. The Fresenius Code
basis, Fresenius Kabi identifies, evaluates, and develops Fresenius Helios had dedicated targets in Spain and Ger- of Conduct states that we must take the necessary measures
executives and talents in all regions, divisions, and central many with regard to annual investments in the training to protect our employees and to prevent work-related acci-
functions worldwide. The Talent Review, which was con- and education of employees. In view of the ongoing digitali- dents. All four business segments focus on preventive mea-
ceptually revised in 2020, was implemented in 2021. It is now zation and increased use of e-learning, whether this target sures and on the individual responsibility of employees
fully automated and supported by an IT system, to better must be adjusted is currently being examined. An adjustment when it comes to occupational health and safety. The occu-
assist managers and employees. Furthermore, evaluation and will be made in fiscal year 2022 at the earliest. pational safety concepts are adapted to the specific business
analysis of results have been made more efficient for the Fresenius Helios continued the development of training models of the four business segments. These focus on occu-
global Human Resources department. portfolio management, the aim of which is to evaluate and pational health and safety within production, as well as
market employee training and further education options and occupational health management for health care facility or
Fresenius Helios services more effectively – internally and externally. administrative employees. The aim of all the measures is
In the reporting year, Fresenius Helios again recorded, com- not only to protect employees, but also to ensure the health
pared to the pre-pandemic times, significantly higher use of Fresenius Vamed and safety of patients. All Fresenius business segments
online conference tools and digital learning platforms in both Fresenius Vamed continually evaluates its own vocational continually record data on occupational health and safety in
Germany and Spain. Fresenius Helios utilizes annual feed- training and development programs; where necessary, the line with regulatory requirements.
back meetings to discuss topics relating to training and edu- business segment develops and implements adaptation or During the ongoing COVID-19 pandemic in 2021, the
cation. The business segment also analyzes the effective- improvement measures. safety and health of our employees, their families, and the
ness of its digital offerings and programs for employees. It Fresenius Vamed also continually optimizes its human communities in which we work were again the focus of our
carries out qualitative evaluations and reviews the recorded resources development processes through additional digita- response activities. In early 2021, our clinics in Germany and
usage statistics, results of outcome measurements (e.g., fill- lization. Spain started with the implementation of a vaccination cam-
ing vacancies after development programs), and participa- paign which was expanded to our administrative offices. With
tion rates. regard to hygiene in particular, we had to take special mea-
sures. At times, our employees also had to face restrictions,
e.g., by wearing personal protective equipment (PPE), or
Fresenius | Annual Report 2021
carry out additional work, for instance in the case of neces-
sary admission controls. A major challenge for us in this
169
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
regard was developing individual protection concepts, mea- local entities are applied, and define specifications such as Fresenius Medical Care
sures, and working regulations that allow us to continue all company-wide guidelines for the business segments. Rele- Some of the production sites and dialysis clinics of Fresenius
operational and administrative activities. Depending on the vant data is reported regularly, for example on a monthly or Medical Care are certified according to international health
evolution of the incidence rates and changes in regulatory quarterly basis, to identify deviations. If deviations occur, our and safety standards. These include ISO 45001 in Europe,
provisions, it was necessary to promptly adapt our protection specialists initiate root cause analysis and evaluation, and Middle East, and Africa, Latin America, and Asia-Pacific,
concepts and guidelines and to communicate these to the corrective or preventive actions are implemented where nec- and the Australian Council on Healthcare Standards (ACHS) in
employees. This also meant equipping our employees with essary. Regular internal audits, partly annually, support the Asia-Pacific. In addition to external audits by relevant
suitable protective material. verification of data and management approaches, for entities authorities, internal reviews and audits are conducted to
In our clinics, we have intensified infection control both certified in accordance with ISO 45001 and without monitor compliance with corresponding regulations, poli-
practices that were already in place in order to protect both certification. Thus, we ensure that internal guidelines and cies, and procedures. The business segment is working on
our patients and our staff. regulatory provisions are complied with. harmonizing the management concepts for occupational
In the production facilities, we introduced strict hygiene No Group results are available for occupational health and health and safety as part of its Global Sustainability Program.
measures in 2020, such as disinfection and distancing. safety in fiscal year 2021. Although no effects can yet be
Since March 2020, a large number of our employees in reported at Group level, we report on the measures initiated Fresenius Kabi
administrative functions have been working from home to in the reporting year and related progress in the business A global management system in accordance with the interna-
avoid infection. segments. tional ISO 45001 standard supports occupational health and
There has been continuous and direct communication safety at Fresenius Kabi. The global management handbook
with the employees of all sites and companies ever since the Certifications and commitment and standard operating procedures provide global manage-
beginning of the pandemic. The specially established crisis Our commitment in the business segments regarding OHS is ment requirements for the certified organizations’ local man-
teams communicated the hygiene and medical requirements supported, monitored, and certified by external partners or agement. The management system covers all employees as
as part of regular communication in the Group, taking into regulatory bodies. The overarching ambition of the manage- well as temporary workers at certified sites. The certified enti-
account the respective local official regulations and country- ment system according to ISO 45001 – which replaces the ties set local targets to enhance the occupational health and
specific ordinances and laws. OHSAS 18001 standard – is to improve occupational health safety management. The local management reviews it at least
Occupational Health and Safety (OHS) is decentrally orga- and safety management and ensure the effectiveness of once a year with regard to its continued suitability, appro-
nized within the Fresenius Group. The business segments existing procedures and systems. To drive this forward, we priateness, effectiveness, and potential for improvement.
have internal specialists and dedicated functions that ensure are consistently expanding the number of entities certified Global internal audits ensure implementation of the manage-
that the respective guidelines and requirements for the with this management system standard. Audits performed by ment system. Furthermore, it is audited on an annual basis
other external bodies are scheduled with the local manage- and certified by TÜV Rheinland.
Fresenius | Annual Report 2021
ment.
170
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
At Fresenius Kabi, 30 organizations are certified according to Reporting systems including near misses in the reporting of occupational
the ISO 45001 standard 1. The company is working on rolling All four business segments have notification systems for acci- accidents. These can be taken into account in the analysis
out the certification globally according ISO 45001 to all dents at work. of occupational health and safety.
manufacturing plants by 2023 2. Fresenius Kabi aims to At Fresenius Medical Care responsibility for occupa- Fresenius Helios uses a Critical Incident Reporting
improve occupational health and safety processes and align tional health and safety lies with regional and local manage- System (CIRS) for critical incidents and near misses at all hos-
them with internationally recognized standards. In 2021, ment. This structure allows the company to comply with pitals. This is anonymous, can be used in all areas of a hos-
nine additional manufacturing plants were included in the different regulatory and legal requirements, and to report pital site, and primarily serves the preventive protection of
ISO 45001 certification of Fresenius Kabi. incidents to authorities based on local specifications. Rep- both patients and employees. The reporting system can be
resentatives at local level collect relevant data and report it to used to make preventive corrections in processes and work-
Fresenius Helios regional representatives. The management regularly reviews flows and thus eliminate risks from everyday work. Further
Helios Kliniken in Germany have local approaches to occu- this information. information can be found on page 138 of this report.
pational safety and occupational medicine that comply with Fresenius Kabi organizations document all accidents If an accident occurs in a clinic, a defined process must
regulatory requirements. worldwide – for both its own employees and temporary work- be followed in order for the person affected to have recourse
Helios Spain works continuously to ensure the safety ers. Occupational accidents are categorized according to against the accident insurance organization: the person
and health of its employees. With the implementation of SAP at their severity and reported to the responsible central OHS involved in the accident reports the event to the responsible
all its hospitals in Spain, Helios Spain changed the manage- function and other relevant functions of the business seg- function depending on the local organizational structure,
ment of occupational health and safety from local systems to ment depending on their severity. For example, work-related e.g., the human resources department. The clinic must then
a single company-wide system. Based on ISO 45001 (for- accidents that result in at least one day of absence must be file a report with the accident insurance organization within
merly OHSAS 18001) and Spanish regulatory provisions, all reported within two working days to the central OHS function; a specified period.
hospitals are required to report occupational health and other, less severe accidents without or with less than one At all Fresenius Vamed sites, reporting procedures are
safety incidents along with their cause, lost time, illnesses day of absence are reported on a quarterly basis. All reported in place to identify and prevent work-related injuries. In
and absenteeism as well as other KPIs in a tool. The local accidents are investigated, and the results are documented Austria these are, for example, the reporting of occupational
management, which is responsible for ensuring that regula- in respective reports. Additionally, in 2021 Fresenius Kabi accidents and near-accidents and preventive workplace
tory requirements for occupational health and safety are started to include first-aid cases and unsafe situations evaluation. All work-related accidents and all events that
met, is guided by a handbook and standard operating pro- almost lead to an accident are documented locally. In addi-
cedures (SOPs). A central department for corporate ill- tion, the human resources department reports all accidents
health prevention coordinates all activities and the reporting. with lost days to the accident insurance, in accordance with
country-specific requirements.
Fresenius | Annual Report 2021
1
The standard OHSAS 18001 has been replaced by the international standard ISO 45001. The business segment concluded the transition in 2021.
2
The implementation will be concluded at all manufacturing plants of Fresenius Kabi in 2023. The certification issuance from the individual certification
companies may extend into the following year. 171
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Training overall performance: the total recordable injury frequency pational Health and Safety Policy, which outlines the key
Fresenius SE & Co. KGaA and all four business segments con- rate and lost time injury frequency rate. In certain seg- principles. The policy was approved by the Management
duct regular occupational health and safety training to ments of the regional businesses, the business segments has Board of Fresenius Medical Care.
prevent incidents in their fields of operation. In our clinics, already defined targets for incident rates, safety training, Fresenius Medical Care strives to prevent work-related
employee health and safety training courses cover topics or the monitoring of occupational health and safety perfor- accidents and hazards to protect employees and contrac-
such as the safe use of sharps and disposables, and hand mance. The business segment plans to set global targets tors. The business segment tracks and analyzes accidents and
hygiene as well as infection control, and prevention of for occupational health and safety by 2023. injuries at local and regional levels, identifies their root
emergencies and their control. Health and safety training pro- Fresenius Kabi wants to continue the improvement of its causes, and takes corrective action.
vided in our production sites focuses, for instance, on occupational health and safety management. The ambition
hand hygiene, the safe handling of work equipment, hazard- of the business segment is to prevent all work-related acci- Training
ous chemicals, and emergency prevention and response. dents and improve workplace safety. To achieve this, To prevent incidents and increase awareness, Fresenius
Fresenius Kabi holds, for instance, monthly training sessions Fresenius Kabi is developing appropriate occupational health Medical Care provides health and safety training. Employee
on work-related risks. For example, training sessions were and safety programs and measures with local managers. training courses in the dialysis clinics cover, for example,
held with occupational health and safety managers in 2021 The introduction of a system for the comprehensive the safe use of sharps and disposables, hand hygiene, infec-
on emergency preparedness, OHS committees according recording of occupational accidents at all German Helios tion prevention, and emergency management. Training
to ISO 45001, behavioral safety and general safety aspects in hospitals is planned for 2022. In future, key figures such as provided at the production sites focuses on, among other top-
the handling and storing of chemicals. Fresenius Vamed the lost time injury frequency rate (LTIFR) are also to be col- ics, the safe handling of work equipment and chemicals,
offers employees in Austria a separate e-learning module on lected. To this end, Fresenius Helios is closely cooperating and emergency prevention and response. In the United States
employee protection. with the German accident insurance institutions and inter- alone, more than 48,000 employees completed health and
nal managers. In the future, Helios Germany will also col- safety training in 2021.
Our ambitions lect data for preventive health and safety at work purposes.
Occupational health and safety is highly relevant for the Fresenius Vamed currently collects relevant key figures Progress and measures in 2021
Fresenius Group. The aim is to define a Group-wide KPI that locally that may result from occupational accidents. In the As part of the Global Sustainability Program, Fresenius
will serve as a long-term performance indicator and be future, changes in occupational health management will also Medical Care began a global risk assessment in 2021. The
reported. Further details can be found in the Compensation be evaluated to an increasing extent. company identified the biggest physical risks as injuries
Report on pages 234 ff. of the Annual Report 2021. from needlesticks, slips, trips, and falls. The business seg-
Our business segments manage their occupational health FRESENIUS MEDICAL CARE ment is working to identify and prioritize high-risk areas
and safety measures in line with segment-specific ambitions. Fresenius Medical Care is committed to providing a safe
Fresenius | Annual Report 2021
Fresenius Medical Care plans to include further global and healthy work environment for its employees and contrac-
indicators in the internal reporting from 2023 to reflect tors. In 2021, the company established a new global Occu-
172
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
and plans to develop specific risk mitigation measures in the ▶ provision of appropriate information, training, and Responsibility for occupational health and safety manage-
coming years. It has also piloted an initiative in the produc- instruction to employees and all persons at our locations, ment lies with the divisional and local organizations; global
tion sites in Europe, Middle East, and Africa. This initiative ▶ ensuring and supporting continuous improvement, management responsibility lies with the central organization,
aims to facilitate the sharing of information concerning ▶ preventing work-related injuries, illnesses, and other which reports to the responsible member of Fresenius
significant accidents, near misses, and occupational health incidents, e.g., implementing technical protection mea- Kabi’s Management Board.
and safety best practices. sures, Fresenius Kabi has implemented standard operating pro-
Fresenius Medical Care also offered COVID-19 vaccina- ▶ performing hazard and risk assessments for all routine cedures (SOPs) and further instructions as well as guidelines
tions to its employees at various locations. and non-routine activities, to provide a global framework for occupational health and
▶ complying with applicable legal requirements and other safety. A management handbook and additional SOPs provide
Evaluation occupational health and safety requirements, a consistent framework for the local occupational health
No work-related fatalities were reported between 2019 and ▶ providing and ensuring the continuous safe operation of and safety management of ISO 45001-certified organizations.
2021. In the reporting year, the business segment is reporting facilities, machinery, and equipment,
on work-related fatalities for the first time. ▶ safe handling, use, storage, and proper disposal of haz- Progress and measures in 2021
ardous substances. In 2021, the management approach and the governance
FRESENIUS KABI structure of Fresenius Kabi remained as reported in 2020.
The safety of employees at their workplace is Fresenius Experts in the central OHS function analyze and evaluate Progress focused on the transition of sites certified accord-
Kabi’s central concern. The aim is to prevent all work-related occupational health and safety programs, working proce- ing to OHSAS 18001 to the international standard ISO 45001,
accidents. Fresenius Kabi’s occupational health and safety dures, risks, and objectives, and facilitate exchange of and implementation of the ISO 45001 management system
guidelines focus on the following principles: information about occupational health and safety through- at additional manufacturing plants to further improve occupa-
out the company. Risk assessment is an important part of tional health and safety management. Furthermore, the
▶ implementing the necessary measures to ensure the occupational health and safety management. Based on the exchange of occupational health and safety management
health and safety of employees, outcomes of risk assessment, occupational health and practices has been facilitated internally.
safety measures are developed and implemented locally.
This is supplemented by a notification system, in which
work-related incidents and accidents are reported and ana-
lyzed. In addition, regular training on work-related risks,
procedures, and precautionary measures is provided at all
sites.
Fresenius | Annual Report 2021
173
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Evaluation LOST TIME INJURY FREQUENCY RATE 1 on production output. Precautionary and hygiene measures
Fresenius Kabi performs global internal audits at its organi- to protect employees and limit the impact of COVID-19
zations to confirm compliance with applicable requirements Fresenius Kabi 2021 2020 2019 2018 developed and implemented in 2020 have been continued to
and identify potential improvements. As necessary, the com- LTIFR 2.4 2.3 2.6 3.1 be monitored and stringently maintained in 2021. Further-
pany develops measures to exploit this potential together more, COVID-19 had no impact on the further roll-out of the
with local responsible persons. Due to the COVID-19 pan- ISO 45001 management system in 2021 and did not affect
demic, most audits continued to be conducted digitally in The occupational health and safety report provides informa- OHS performance of the business segment.
2021. Quarterly virtual meetings took place with representa- tion about, for example, LTIFR, LTISR, the severity of the
tives from the organizations to exchange learning points occurred injuries, the type of accidents and the identified root FRESENIUS HELIOS
about work-related accidents and their future prevention. causes. Fresenius Helios hospitals have risk assessments for the indi-
Occupational accidents are categorized according to In December 2021, a serious fire occurred at a produc- vidual workplaces and maintain lists of hazardous sub-
their severity and are investigated by means of a standard tion site in China, resulting in the deaths of five employees stances. As a preventive measure, Fresenius Helios conducts
investigation template. Furthermore, local management and one other person being hospitalized. An investigation of occupational health and safety inspections of areas of the
assesses the investigation reports to decide whether technical the incident and the cause of the fire was initiated immedi- hospitals to detect potential risks. The main risk areas are
improvements, additional working equipment or instruc- ately. The business segment will adopt measures to address identified via accident reports or information from employ-
tions, or further training are required to avoid reoccurrence the incident and its potential or actual consequences, and to ees and undergo rigorous assessment. As part of a risk
in future and to improve occupational health and safety for prevent future occurrences, based on the review results by assessment, these are then analyzed.
employees. the business segment and local authorities. In Germany, clinic experts use the S-T-O-P principle
Fresenius Kabi calculates the LTIFR 1 from the data it col- In addition, the company recorded one serious work-re- (substitution, technical, organizational, and personal mea-
lects and uses this as an indicator to measure performance; lated accident, which was attributable to insufficient risk sures). Fresenius Helios then reviews the implementation
the LTIFR deteriorated by about 4% compared to the previous assessment. This has prompted additional preventive mea- process and its effectiveness. The procedure used is the
year due to an incident at a production site in China. sures at the respective site, e.g., training and reassessment equivalent of a classic PDCA loop – plan, do, check, act – for
Fresenius Kabi also considers the lost time injury severity of hazards and risks connected with the respective work continuous improvement. In coordination groups, for
rate (LTISR) 2 in the analysis. Occupational health and safety activities. In 2021, Fresenius Kabi saw only a limited number example for mental health risk assessments, specialized
reports are submitted to the Management Board and other of COVID-19 cases at its facilities, with no significant impact employees work together with managers to develop
relevant functions of Fresenius Kabi on a quarterly basis. cross-functional measures. Similar procedures can be found
for example in occupational health management and occu-
pational reintegration management. The business segment
Fresenius | Annual Report 2021
is currently reviewing whether to introduce an integrated
management system for occupational health and safety in
Germany.
1
LTIFR: Number of work-related accidents resulting in at least one day of absence from work in relation to 1,000,000 working hours.
2
LTISR: Number of days absent due to work-related accidents in relation to 1,000,000 working hours. 174
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Helios Spain strives to develop an exemplary culture within Helios Spain has a management system for health and An integral part of Helios Spain’s OHS management system is
health care provision, in order to avoid occupational health safety at work that has been coordinated with the health and training in the prevention of occupational risks. For each of
risks and promote healthy habits among its workforce. This safety committees and approved by management. It has the professions practiced at Helios Spain, there is a special
is also implemented in the company’s policy on workplace undergone the legally required audits in Spain, as well as course dealing with the risks and associated preventive
safety, which is applicable at all company levels and loca- internal audits and certifications. The implementation and measures. Each year, the division also identifies additional
tions. Helios Spain has standardized occupational health monitoring of the OHS system is taken care of by specially training needs for risk prevention in the workplace. In addi-
and safety across the Group’s hospitals and companies and authorized employees. tion, courses and exercises are held on emergency measures.
developed a company-wide training platform for specific Since 2021, the OHS system has included a process for
workplace-related risks. Various KPIs, including absenteeism, continuously identifying hazards and deficiencies, assess- Organization and responsibilities
occupational illness, and work-related injuries, are consoli- ing risks for incidents, and determining measures for control, The senior management team of Fresenius Helios, the Helios
dated for all hospitals on a monthly basis in a single standard- correction or mitigation, and prevention,and improvement. Occupational Health business segment as well as the Helios
ized system and are evaluated. Based on this, measures are It complies with applicable legal requirements for risk assess- segment Infrastructure have the task of coordinating occupa-
then taken to reduce absenteeism and prevent accidents at ment and the implementation of necessary controls. This tional health and safety in Germany.
work. process includes all employees who perform or have access In terms of organization, the Helios Occupational Safety
As a hospital operator, Fresenius Helios implements in to routine and non-routine activities in Helios Spain work- segment is assigned to the area of Authorized Officers & Envi-
Germany occupational medicine measures primarily with places. All current and planned workplaces, procedures, ronmental Management in the Infrastructure business seg-
own medical personnel. At numerous locations, Helios Ger- (OHS) processes, and tasks located or performed at the ment. It was founded in 2019 and currently looks after about
many supplies occupational health services to external com- centers, as well as their design, are assessed – as are human two-thirds of all the employees in the business segment, in
panies. The safety-related support of the clinics is ensured factors such as personal behavior. Also covered are (the addition to Fresenius Vamed and Xenios, a Fresenius Medical
specifically by highly qualified personnel. design of) infrastructure, equipment, and materials in the Care company.
In Spain, the range of services encompasses about 300 workplace, whether provided by Helios Spain or by third Helios Occupational Safety within the segment Infrastruc-
institutions that provide occupational health management. parties. The process also includes hazards that arise in the ture and its engineers are responsible for almost all Helios
Via these prevention centers, around five million employees immediate vicinity of the workplace from work-related clinics and their subsidiaries (e.g., cleaning, logistics, or
are examined annually in cooperation with companies. activities under the control of the business unit, as well as catering). They look after all aspects of health and safety at
those that exist outside the workplace but potentially affect work for Fresenius Helios’ employees, as well as the employ-
the safety and health of its employees. ees of Fresenius Helios subsidiaries, ensuring coordination is
carried out in close collaboration with the supervisory
authorities on a daily basis.
Fresenius | Annual Report 2021
175
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
The Helios Occupational Health business segment in Ger- tember 2021 at the Park Hospital in Leipzig, aims to committee. Based on this, Fresenius Helios takes measures
many also has an Occupational and Organizational Psychol- develop and establish unified occupational medicine and to reduce absenteeism and prevent occupational accidents.
ogy department. occupational safety standards, and improve internal and In addition to the figures resulting from accident reporting,
At local level, the members of the Occupational Health external interface management. In addition, a pilot project on-site local audits in particular serve to monitor the effec-
and Safety Committee take a targeted approach to monitor- was launched in October 2021 to expand the existing tiveness of risk evaluations and local occupational safety and
ing the various aspects of occupational safety and health range of occupational health services to include digital ser- health management approaches.
promotion. The meetings held by the Occupational Health vices such as online consultations. Helios Spain collects data for preventive occupational
and Safety Committee meet the legal requirements set for safety on a monthly basis. The division has defined key
composition and number of participants. In addition, special- Evaluation figures to document absenteeism and accident rates, as well
ist personnel and managers in special steering groups at Qualified occupational health and safety specialists and as the status of compliance with important legal require-
the hospital sites work on dealing with specific areas, such occupational physicians examine whether the requirements ments at employee level. Each location in Spain reports on a
as occupational health management. for occupational health and safety are met at Fresenius monthly basis on the development of the key figures. At
At Helios Spain, the OHS system defines the functions, Helios in Germany. In addition, the requirements are regu- Helios Spain, there are dashboards for monthly monitoring of
roles, and responsibilities for health and safety in the work- larly reviewed by supervisors from the BGW. Various audits, absenteeism, occupational accidents, and general illness.
place. sometimes internal, of Fresenius Helios in Germany enable The development of the indicators is assessed, and in case of
Helios Germany follows the legal requirements and takes consistent analysis of existing procedures, validation of deviations, the business unit implements optimizing proj-
all necessary measures to comply with them. At local level, processes, and effective optimization of the occupational ects to reduce absenteeism.
we work closely with the relevant accident insurance institu- health and safety management already in place. Experts In 2021, a fire occurred in a ward at a hospital site in
tions in the interests of our employees. Preventive mea- from the field of occupational health and safety, and Germany. The night services on duty in all departments eva-
sures to maintain occupational health and safety standards hygiene, monitor jointly the management of occupational cuated patients in accordance with the emergency and fire
are a priority. health and safety based on regulatory provisions. They are protection plans. Three patient fatalities were reported in the
The Fresenius Helios policy on workplace safety in constantly cooperating across segments and developing context of the fire. No employees were harmed. The hospi-
Spain promotes safe behavior among its workforce; it applies improvement processes. tal management, the hospital pastoral care and the psycho-
at all levels of work and at all locations in Spain. Helios Germany documents accidents locally and logical service took care for patients and employees. The
assesses the potential for associated risk, with a specific hospital staff is prepared for such crisis situations through
Progress and measures in 2021 assessment carried out on-site; this is then discussed and annual mandatory training. The remediation work is still
Since 2021, Helios Germany has been involved in a project assessed together with the relevant supervisory authorities. ongoing and will be completed in the course of spring 2022.
of the responsible professional German association Institution Time management reports, which document absences
Fresenius | Annual Report 2021
for Statutory Accident Insurance and Prevention in Health and absenteeism and their development are recorded and
and Welfare Services (BGW). This initiative, launched in Sep- evaluated locally in hospitals. Further, accident figures
are evaluated at each meeting of the local health and safety
176
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
FRESENIUS VAMED Risk management is a fixed component in the area of occu- In the Czech Republic, there are not only safety officers, but
The health and safety of employees is firmly embedded in our pational health and safety and has also been taken into also a legally required categorization of work into safety
company’s culture and the Fresenius Vamed mission state- account as such in the organizational structure. In Austria, levels. This categorization is performed by in-house respon-
ment. All employees, and in most instances patients and cus- for example, a certified risk manager and auditor was sible persons. The categories determine what protective
tomers too, are covered by the company’s holistic approach appointed to ensure competence in this area. Further, the clothing the employer must provide for the respective work-
to occupational health and safety. Due to the diverse range respective workplace-specific risks were identified, ana- place and the scope of occupational health examinations of
of services and the different responsibilities involved, the lyzed, evaluated, and reduced to an acceptable level by the respective employee.
implementation process is organized in very different ways means of targeted measures in the process organization; this
throughout the business segment – nationally and interna- was carried out in close coordination with the divisional Progress and measures in 2021
tionally. In the area of occupational health and safety, all loca- managers. With regard to COVID-19, specific attention was In 2021, the management approach and the governance
tions are subject to the respective local laws and regula- paid to reducing risks relating to infection as well as the structure of Fresenius Vamed remained as reported in 2020.
tions. Compliance with these regulations is also ensured at physical and mental stress involved in dealing with the over- Progress focused on health protection during the COVID-19
local level. all situation. Corresponding documentation was provided pandemic.
Due to the decentralized organizational structure of in the safety and health protection documents. Wherever logistically possible, COVID-19 testing was
Fresenius Vamed, a range of different legal and internal In Austria, the safety center of VAMED Technical Services offered to employees free of charge on site, and vaccinations
guidelines play a significant role in occupational health and employs several safety specialists. This center is responsi- were provided centrally by the facilities. Masks, protective
safety. The Code of Conduct covers administration and the ble for the safety-related support of Fresenius Vamed’s oper- equipment, and adequate disinfection facilities were pro-
area of technical services, while the Clinical Code of Conduct ations. In order to maintain and further develop their com- vided. Maintaining minimum distances in the office was
regulates the area of health care and medical personnel. To petence, all safety specialists are subject to a focus-specific supported by a rotation system and working from home.
prevent work-related injuries and occupational accidents, all training program adapted to the respective needs of the In some facilities, more psychological support was offered
new employees receive safety training at the very begin- organization. In addition, the manager of the safety center is and bonuses were paid to employees in direct contact with
ning of their employment. certified as quality, safety, risk, and environmental manager patients for the particular stress they experienced during the
and as lead auditor. pandemic.
Switzerland has its own safety officers who are responsi-
ble for occupational safety and data protection. In addition,
there is a dedicated CIRS Circle: this is a committee of repre-
sentatives from different areas, who analyze critical and
near-critical situations, in order to develop and implement
Fresenius | Annual Report 2021
solutions.
177
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Evaluation DIVERSITY with the results of the investigation. Depending on the type
All Fresenius Vamed locations are subject to regular occupa- and severity of misconduct, sanctions such as actions under
tional health and safety inspections. At Fresenius Vamed, DIVERSITY AND EQUAL OPPORTUNITIES employment, civil, or criminal law can be imposed. After
work-related incidents must not only be reported, but they finishing the investigation, measures that prevent future mis-
also trigger an audit of existing work processes and of any OUR APPROACH conduct, or at least make it more difficult, are implemented.
proposed changes and the implementation thereof. Corre- At Fresenius we support equal opportunities for all and con- If business segments have implemented additional, specific
sponding internal guidelines are available. The aim is to sciously oppose discrimination of all kinds. No one may be reporting channels, these are described in this chapter.
minimize risks and prevent the recurrence of hazards. discriminated against on the basis of skin color, ancestry,
Therefore, all incidents are subject to a structured evaluation faith, political views, age, gender, ethnicity, nationality, Diversity lived in the business segments
by means of a root cause analysis including the corre- cultural background, sexual orientation, physical condition, Fresenius promotes international and interdisciplinary
sponding improvement measures. These are prioritized in appearance, or other personal characteristics. We work in cooperation as well as diversity in our business segments and
terms of technical, organizational and personnel criteria. an atmosphere of mutual respect. Our dealings with each regions. The diversity of our markets and locations is also
The effectiveness of the measures is validated on site by the other are open, fair, and appreciative. We do not tolerate reflected in the workforce of the four business segments. In
responsible local safety specialists. To ensure a holistically insults, humiliation, or harassment. Our managers have a our home market in Germany, we have employees of around
structured approach, a standard operating procedure has special responsibility in this respect and act as role models. 140 nationalities. All business segments attach great impor-
been implemented. These values and our aspirations with regard to diversity are tance to equal opportunities for all employees in the work-
In 2021, an evaluation of mental stress in the workplace laid down in the Fresenius Code of Conduct, which is bind- place as well as in the application, selection, and develop-
was carried out by an external provider. The lead companies ing for all employees. This code makes our stance clear, i.e., ment procedures. In order to integrate equal opportunities
at the headquarters participated in the evaluation, which to support equal opportunities for all. This lays the founda- in all processes and workflows, the business segments
set out to derive further findings for improved working con- tion of our cooperation and corporate culture. Further infor- develop diversity concepts that are adapted to the require-
ditions. The results are expected to be available at the mation on our approach to equal opportunities is provided ments of their respective business models and regions.
beginning of 2022. Based on the results, measures will be in the “Human rights” section, see pages 194 ff. of the
developed going forward. Group Non-financial Report. Employees with disabilities
The Fresenius Group also employs people with disabilities,
Dealing with incidents of discrimination severe disabilities, and other limitations. The spectrum not
Information about violations of the principles of the Fresenius only includes people in wheelchairs or with mental disabili-
Code of Conduct and other possible misconduct can be
reported via various notification systems – anonymously, if
Fresenius | Annual Report 2021
necessary, as described in the Compliance chapter, on page
185, and on page 188 in this report. All information is care-
fully examined and appropriate action taken in accordance
178
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
ties. Survival of cancer, or diabetes, rheumatism, depres- Medical Care is working on improving the complaint han- mon interests. In the United States alone, Fresenius Medical
sion, back problems, or cardiovascular disease can also be dling practices and to establish globally consistent pro- Care has 14 ERGs dedicated to different employee inter-
the cause of a disability or impairment. cesses. ests and aspects of diversity.
Fresenius is committed to the inclusion of severely dis- In 2021, Fresenius Medical Care built on its past efforts
abled people. We want to enable our employees to apply to foster a diverse and inclusive workplace, and to raise Fresenius Kabi
their knowledge and skills as fully as possible. In doing so, awareness of the benefits the company believes such an Fresenius Kabi emphasizes equal opportunities for all
the respective local legal requirements must be imple- environment brings. The business segment further devel- employees in their daily work as well as in recruiting, applica-
mented. As these differ significantly in some cases, manage- oped global inclusion and diversity initiatives. For instance, tion, and development processes. Numerous projects are
ment is decentralized and local. For example, severely dis- it held an inclusion workshop for the Management Board. placed in an intercultural environment. Transnational teams
abled employees in Germany are entitled to a workplace In addition, an Asia-Pacific Women’s Leadership Initiative are working on solutions to the manifold challenges in the
suitable for the disabled, part-time work if the disability was launched in 2021 as a catalyst to continue driving health care sector. The company values of Fresenius Kabi –
requires shorter working hours, special protection against inclusion and diversity among the 13,000-strong work- customer focus, quality, integrity, collaboration, creativity,
dismissal, and additional leave. force in the region. passion and commitment – form the basis for the day-to-day
Fresenius Medical Care also established a main contact actions of all Fresenius Kabi employees. The company val-
Fresenius Medical Care for Diversity, Equity, and Inclusion (DE & I) in North America, ues of Fresenius Kabi underline the importance of respectful
Fresenius Medical Care’s commitment to inclusion and diver- who is focused on supporting the advancement of the key collaboration between all employees and are part of its
sity is incorporated in its Code of Ethics and Business objectives in this area in alignment with the global inclusion Code of Conduct.
Conduct. The business segment introduced a guideline stip- and diversity work. She is supported by both the busi- Fresenius Kabi has a Center of Expertise Talent, Leader-
ulating that the interview round for senior-level positions ness segment’s DE & I Executive Committee and its DE & I ship, and Organizational Development (CoE TLO), which
should, where possible, include at least one qualified candi- Council. Together these form a diverse group of employ- reports directly to the head of the Global Human Resources
date from an underrepresented group. The objective is to ees who provide input on the business segment’s continued department. The CoE TLO is tasked with anchoring diversity
increase diversity levels in the company, taking global ambi- efforts to build a more trusting and inclusive culture. and inclusion in the organization and supporting the regional
tions and local environments into account. Fresenius Medical Care intends to further strengthen and divisional human resources functions in their activities
Various channels are available to employees, patients, inclusion and diversity beyond gender diversity over the next with a global framework.
and third parties to report potential violation of human or few years. For example, the business segment plans to Fresenius Kabi has guidelines and reporting systems for
workplace rights, laws, or company policies. Based on an increase the focus on ethnic diversity in the future. To sup- reports of potential violations of the principles defined in
analysis of its grievance mechanisms in 2020, Fresenius port these efforts, the company plans to help establish new the Fresenius Kabi Code of Conduct. Employees can report
employee resource groups (ERGs) across the regions. These
Fresenius | Annual Report 2021
groups refer to employees who meet based on shared com-
179
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
possible violations of the principles to their supervisors, overarching measures. In the hospitals, the clinic manage- Each clinic of Helios Spain employs an equal opportunities
their human resources department, or the compliance depart- ment is responsible for implementing the diversity con- officer, who is specially trained and exercises an advisory
ment, for example via e-mail. An online platform also offers cepts. function for the respective management. In addition, the
the possibility of anonymously reporting violations of corpo- In the fourth quarter of 2021, Helios Germany signed the equality plan is monitored by a central committee compris-
rate principles to the company in various languages. Charter of Diversity (Charta der Vielfalt) – an employer initia- ing members from the management and employee represen-
In the reporting year, the management approach and the tive for diversity in the workplace. Underpinning this com- tatives, who report on the implementation and development
governance structure of Fresenius Kabi remained as mitment, the business unit is developing tools to strengthen status at the locations. Specific action plans are also drawn
reported in 2020. Progress focused on further embedding diversity in all dimensions. The Helios intranet makes infor- up to ensure inclusion and equal opportunities for all employ-
diversity management in the business segment. The mation, internal and external networks, and examples of best ees in our clinics and health care facilities.
COVID-19 pandemic had no impact on Fresenius Kabi’s diver- practice transparently available to employees. At Helios Spain, incidents involving discrimination can
sity management in 2021. Incidents involving discrimination are processed via the be reported via the Human Resources department, the
In 2021, Fresenius Kabi established a diversity, equity, clinic management in cooperation with the human resources intranet and the employee portal. In addition, sexual and
and inclusion (DEI) department as well as a Steering Commit- managers and, depending on the severity of the incident, gender-based harassment can be recorded via a dedicated
tee for the region North America. Activities there focused escalated to regional or central level. As a rule, in the event complaint protocol. Three reports were received in 2021.
on building competencies for diversity- and equity-friendly of incidents of discrimination, a crisis management team Those related to own employees were investigated inter-
and inclusive behavior and developing regional DEI con- is deployed to advise on the specific procedure to be used on nally by the labor relations department. Two reports were
cepts for Fresenius Kabi employees. a case-by-case basis. solved and not further substantiated. One report is still
Helios Spain commits to a diverse corporate culture in its under investigation.
Fresenius Helios Code of Conduct. The management is committed to using
At Fresenius Helios, the aspiration to be non-discriminatory gender equality tools – for example, through integrative lan- Integration of international nursing staff
and provide equal opportunities extends equally to employ- guage and training, or in procedures such as personnel To support its foreign employees, in particular foreign nurses,
ees, business partners, and patients. In Germany, it is also selection processes and internal promotions, as well as in Helios Germany began to train staff as integration manag-
anchored in Helios’ vision and mission, which were finalized cases of sexual harassment or gender discrimination. ers in 2020. In the course of the year, 40 integration manag-
in 2021, and in its six guiding principles: the guiding prin- Helios Spain is currently in the process of negotiating equal- ers who were either still undergoing or had already com-
ciple “Working together” emphasizes how valuable human ity plans for all locations in the hospital group. This kind pleted training supported nurses who had come to us from
diversity is – for example in nursing or medical teams at of equality plan respects the European directives and the
the clinics. national rules in Spain on equal opportunities and wage
At Helios Germany, the Director of Human Resources transparency between men and women, and also guarantees
Fresenius | Annual Report 2021
has overall responsibility for diversity. A separate diversity non-discrimination in the workplace. Negotiations with
working group was set up in 2021 to design and implement trade unions on these equality plans took place during 2020
and 2021.
180
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
abroad when they arrived in Germany, helping them to deal section “Reporting channels”, of this Group Non-financial is reflected in the proportion of female employees in our
with authorities and providing support in other situations. Report. business segments: Our business segment Fresenius Helios
The aim here is to help with social and cultural integration, Fresenius Vamed has developed concepts for the integra- has with 74% the highest proportion of female employees
as well as aiding professional and linguistic integration. tion of foreign nursing staff. among the Group. The number of female participants in the
This is supported and complemented by local initiatives at Group-wide Long Term Incentive Plan (LTIP 2018) is a good
each hospital location. OUR AMBITIONS indication of the share of women in management positions.
Promoting diversity and inclusion at all levels of the company According to this, the ratio of women among the more than
Fresenius Vamed is a priority at Fresenius. The Fresenius Group Manage- 1,800 top executives increased to 32.6% as at December 31,
Fresenius Vamed focuses, among other things, on address- ment Board welcomes the activities within the business seg- 2021 (Dec. 31, 2020: 31.6% of 1,700 top executives).
ing diversity in the effective promotion of young talent and ments to further building on this diversity in future and At Fresenius Medical Care, as of December 31, 2021,
the management of succession planning. In the area of train- benefiting from it more widely. women accounted for 69% of the total workforce and 26% of
ing and development in particular, the diversity of employees In the past, the Management Board of Fresenius had positions in the first two management levels. Gender diver-
is taken into account and, for example, online training is already set targets for the proportion of women in the two sity in the business segment’s main governance bodies and at
offered in various languages. management levels directly below the Management Board. management level has remained stable over the past two
At Fresenius Vamed, a diversity and gender representa- For more information, please refer to our Corporate Gover- years. In 2020, the Management Board of Fresenius Medical
tive oversees equality issues. nance Report on pages 232 f. of the Annual Report 2021. Care defined a new target of 22% for the share of women
Suspected cases of discrimination or violations of diver- in the first management level below the Management Board
sity provisions are reported to and investigated by the Com- EVALUATION and 32% in the second management level. The business
pliance Organization. Various reporting channels through The proportion of female employees in the Fresenius Group segment aims to achieve these targets by 2025. In 2021, the
which possible compliance cases can be reported are avail- increased slightly to 69% as at December 31, 2021 (Dec. definition of the two management levels below the Manage-
able to Fresenius Vamed employees for reporting sus- 31, 2020: 68%). The proportion of females in services or care ment Board for which targets were set was also adjusted in
pected cases of discrimination, as explained on page 185, is traditionally higher than in the area of production. This this context.
FEMALE EMPLOYEES
Dec. 31 2021 2020 2019 2018 2017
Fresenius Medical Care 69% 69% 69% 69% 69%
Fresenius Kabi 51% 50% 50% 50% 51%
Fresenius | Annual Report 2021
Fresenius Helios 74% 75% 75% 75% 76%
Fresenius Vamed 62% 62% 63% 64% 56%
Corporate / Other 40% 38% 39% 39% 39%
Total 69% 68% 68% 68% 68%
181
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
COMPLIANCE AND INTEGRITY responsibility and reliability form the core of our under- The design and implementation of our compliance manage-
standing of compliance. Thereby, we design all our measures ment systems are based on international regulations and
COMPLIANCE in such a way that they prevent compliance violations. guidelines, such as the ISO standards on the set-up of compli-
For Fresenius, compliance means doing the right thing. Our As stated in our Fresenius Code of Conduct, we are fully ance management systems and applicable audit standards
ethical values are based on more than just regulatory committed to adhering to statutory regulations, internal of the IDW (PS 980). When implementing measures, we take
requirements, which means that we not only act in accor- guidelines, and voluntary commitments, as well as acting in into account the respective national or international legal
dance with the law, but also according to applicable sector accordance with ethical standards. Violations are not to be frameworks.
codices, our internal guidelines and values. For our employ- tolerated. If a violation is detected, we perform an investiga-
ees, this is the foundation of all our activities. For our busi- tion, initiate the necessary remediation measures, and Organization and responsibilities
ness partners and suppliers, it is the standard Fresenius sets impose sanctions if applicable. In addition, incidents prompt
for cooperation. In this way, we want to help ensure that us to anchor ethical and compliant behavior even more Involvement of the Management Board
everyone can rely on us as a partner of trust and integrity. firmly in our corporate culture, as well as to further sharpen Responsibility for compliance within the Fresenius Group lies
Our risk-based compliance management systems are our compliance programs and prevention mechanisms in with the Management Board and has been assigned to the
aligned with the business of each of our business segments. order to prevent future violations. board member responsible for Human Resources, Risk Man-
Our key ambition is to prevent corruption and bribery in In all four business segments and at Fresenius agement and Legal of Fresenius Management SE. The
our business environment. Beyond that, prohibiting violations SE & Co. KGaA, we have set up dedicated risk-oriented com- Management Board member assumed the function of Chief
of antitrust law, data protection regulations, trade restric- pliance management systems. These are based on three Compliance Officer of Fresenius SE & Co. KGaA until Dec. 31,
tions, and anti-money-laundering laws, preventing the financ- pillars: prevention, detection and response. Our compliance 2021. As of Jan. 1, 2022, the new Group function Risk & Integ-
ing of terrorism, and protecting human rights are also key measures are primarily aimed at using preventive mea- rity was established, encompassing the areas Risk Man-
areas, which we address with dedicated compliance mea- sures to avoid compliance violations. Key preventive mea- agement & ICS (Internal Control System), Business Integrity
sures. sures include comprehensive risk identification and risk (formerly Corporate Compliance) and Data Protection. The
assessment, appropriate and comprehensive policies and pro- Head of Business Integrity has assumed the functions and
OUR APPROACH cesses, regular training, and ongoing consultation. We also responsibilities of the Group Chief Compliance Officer of
At Fresenius, we strongly believe that compliance protects carry out internal controls to identify possible compliance Fresenius Group. He has a direct reporting line to the Mem-
what is most important to us: the well-being of the patients violations and ensure that we act in accordance with the ber of the Management Board, responsible for Human
we care for. Compliance is firmly anchored in our corporate rules. Resources, Risk Management and Legal.
culture and guides us in our everyday work. Integrity, In our four business segments, Chief Compliance Officers
and in some instances Compliance Committees develop
Fresenius | Annual Report 2021
and monitor the respective compliance management system.
These functions report to the respective management of
the business segment.
182
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
The organizational structure of the Compliance Management System, as well as important compliance report, which provides a comprehensive over-
The business segments have established their own compli- compliance initiatives and relevant compliance risk areas. view of all Corporate Compliance initiatives. The Supervisory
ance organizations, which are based on the business organi- The members of the committee also discuss severe compli- Boards of both Fresenius SE & Co. KGaA and Fresenius Man-
zation. This includes respective Corporate Compliance ance cases and their remediation. All four business seg- agement SE are regularly informed about progress of com-
departments, which develop global compliance initiatives for ments report annually to the CSC on the progress of their pliance measures, at least once a year, most recently in
their business segment and support their respective com- compliance management systems. The meetings of the CSC December 2021. The business segments have established
pliance officers. More than 400 employees throughout the take place every six to eight weeks. In 2021, eight meetings individual reporting lines to their respective management.
Group are responsible for compliance tasks and support took place – due to the COVID-19 pandemic, most of them The management teams of the business segments receive
Fresenius managers and employees in all compliance-related virtually. regular reports on compliance by their Compliance Offi-
matters. cers.
Best practice exchanges and compliance Despite the differences in business and risk profile in
Corporate Compliance department expert panels each business segment, we strive to uniformly evaluate the
of Fresenius SE & Co. KGaA To ensure ethical conduct, we continually review our busi- design of the compliance management systems. In 2021,
The Corporate Compliance department of Fresenius ness practices and exchange on best practices with our com- aspects of the effectiveness of compliance measures were
SE & Co. KGaA sets minimum standards for the compliance pliance colleagues worldwide. Despite the travel restric- also surveyed after the Corporate Compliance department
management systems, especially for those compliance risks tions that remained in place in 2021, regular exchanges in of Fresenius SE & Co. KGaA reviewed the maturity of the com-
that are relevant to all business segments. The department cross-divisional expert panels continued to take place within pliance measures of the business segments and Fresenius
supports the compliance officers in the four business seg- virtual meetings. Areas of collaboration included antitrust and SE & Co. KGaA for all compliance risk areas by using the
ments with standardized management tools, processes and foreign trade law, as well as anti-money laundering, whis- Compliance Management System Reporting methodology
methods, and develops overarching compliance initiatives tleblower protection, and cross-border investigations. in the previous year. The results were presented to the
with them. Compliance Steering Committee as well as the Management
Reporting structure Board and Supervisory Board. This assessment will be
Compliance Steering Committee The Chief Compliance Officer of Fresenius SE & Co. KGaA is continued on a regular basis.
The Compliance Steering Committee (CSC) is the central informed about initiatives driven by the Corporate Compli-
advisory body of Fresenius SE & Co. KGaA for Corporate Com- ance department on a weekly basis. Compliance case reports Guidelines and regulations
pliance matters. The CSC is composed of the Chief Compli- of medium severity for the corporate segment are reported The Fresenius Code of Conduct forms the framework for
ance Officer, the Chief Financial Officer, and the heads of the to the Chief Compliance Officer immediately. The Manage- all rules applicable in the Fresenius Group. The Code of Con-
Legal, Internal Audit, and Corporate Compliance depart- ment Board of Fresenius Management SE receives reports duct lays out the principles of conduct for all employees,
Fresenius | Annual Report 2021
ments. If necessary, representatives of other governance on the corporate compliance management system’s status including managers at all levels and members of the Man-
departments attend the meetings of the CSC. The Compli- and selected initiatives regularly, at least twice a year. The agement Board. The Code is aligned with international
ance Steering Committee discusses the further development Corporate Compliance department also prepares an annual regulations, as explained on page 182, and was adopted by
183
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
the Management Board of Fresenius Management SE. In Risk assessment The Codes of Conduct of the Fresenius Group are publicly
addition, the four business segments have implemented their By using standardized methods, we regularly record, analyze, accessible, for more information see chapter Supply chain,
own Codes of Conduct, which reflect the Fresenius Code of and evaluate compliance risks in each business segment starting on page 197.
Conduct principles and are adapted to the individual charac- and at Fresenius SE & Co. KGaA. These risk assessments cover
teristics of each business segment. The Code of Conduct over 20 risk groups depending on the business segment. Business partner and investment due diligence
is available to all employees and is also available on the Inter- Once a year, the compliance responsibles exchange informa- All business segments and Fresenius SE & Co. KGaA conduct
net. Guidelines, organizational directives, and process tion on key findings from the respective risk assessments. risk-based due diligence on business partners before entering
descriptions supplement and further define the rules of the In addition to core compliance risks such as bribery and cor- into a business relationship. In each business segment, the
Code of Conduct. ruption, antitrust violations, money laundering, terrorism business partners to be screened are selected on a risk-based
These are our principles, which are also defined in the financing, data protection violations, trade restrictions, and basis according to defined criteria. A risk profile of the part-
Fresenius Code of Conduct: human rights violations, the risk assessment also includes ner is drawn up and targeted measures are initiated: accord-
other significant business risks such as information security, ingly, the compliance contract clauses are based on the
Quality environmental and occupational safety, quality assurance, partner’s risk profile to prevent corrupt actions. We also
▶ Ensuring
quality of products and services. and the protection of intellectual property, where the respon- reserve the right to terminate the contract in the event of
sibility lies with other functions. misconduct. If we suspect misconduct on the part of a busi-
Integrity ness partner, we take additional measures which, depend-
▶ Acting
fair in competition Dealing with third parties ing on the severity of the misconduct, may include audits or
▶ Dealing
properly with third parties Our Code of Conduct and the related guidelines for Fresenius certifications.
▶ Handling
conflicts of interest transparently Group employees also regulate our relations with business Whenever we decide on potential acquisitions and invest-
▶ Acting
in exemplary fashion partners and suppliers. We expect them to comply with appli- ments, we take compliance risks into account in due dili-
cable laws and standards as well as ethical standards of gence measures, among other things via the Acquisition and
Responsibility conduct in daily business and have specified this in our Investment Council (AIC), which reviews planned acquisi-
▶ Protecting
data Fresenius Code of Conduct for Business Partners. Our tions and investments in a defined process for Fresenius
▶ Protecting
company property ambitions to avoid corruption and bribery are laid down in Kabi, Fresenius Helios, Fresenius Vamed and Fresenius
▶ Handling
company information confidentially our Codes of Conduct. Among other topics, the Codes SE & Co. KGaA. Every acquisition and investment proposal sub-
▶ Living
social responsibility explicitly prohibit corruption and bribery and oblige our part- mitted to the Management Board must first be discussed,
ners to comply with relevant national and international reviewed, and evaluated by the AIC. The AIC is made up of
Reliability anti-corruption laws. In addition to risk-based business part- managers from various functions, including Compliance. If
Fresenius | Annual Report 2021
▶ Creating
transparency in accounting, reporting, and ner due diligence, we inform our business partners about necessary, we initiate safeguarding measures and include, for
communication with the public these requirements before entering a business relationship. example, compliance declarations and guarantees in the
184
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
contracts. Following an acquisition, we integrate the new goods. These measures include anti-money-laundering telephone or online via whistleblower systems and e-mail
company into our compliance management systems as guidelines, specific topic-related risk analyses, internal con- addresses set up specifically for this purpose. All business
quickly as possible. trols such as the prohibition of certain cash payments, and segments have established appropriate mechanisms. The
auditing processes for relevant transactions. We have whistleblower systems of Fresenius SE & Co. KGaA, Fresenius
Financial transactions anchored the implemented controls in our guidelines and Medical Care, Fresenius Kabi and Fresenius Vamed are
We have implemented dedicated controls for cash transac- conduct training on them. available via the corporate websites not only to employees,
tions and banking transactions, such as the dual-control but also to third parties, e.g., customers, suppliers, and
principle. We also monitor cash transactions that exceed a Trade restrictions other partners, in a total of more than 30 languages
certain threshold. In this way, we want to ensure that all To provide people worldwide with access to lifesaving medi-
financial transactions are correctly accounted for, authorized, cine and medical equipment we also supply products to Transparency in the health care sector
and processed. Thanks to automated processes, we can countries that are subject to trade restrictions. It is particu- In the health care sector, transparency is of major importance
identify compliance risks at an early stage. Evaluations of larly important to us to comply with all currently applicable with regard to business conduct, patient information and
compliance with threshold values as well as other verifica- legal provisions, e.g., with regard to sanctions or export con- quality of care. More information can be found on pages
tion processes for supplier master data in affected business trols. To this end, we have introduced various measures in 127 ff. in the Well-being of the patient chapter, section
segments also provide valuable guidance. the business segments concerned, such as monitoring pro- “Patient and product safety”.
This year, the reinforcement and refinement of the Group- cesses and special IT system checks for deliveries that are Fresenius Group companies have to adhere to laws and
wide guidelines on cash and banking transactions was a subject to import or export restrictions. The measures depend our ethical principles that
major project across all business segments. In addition to fur- on the specific risk in the country concerned. We aim to
ther controls for payments, the new regulations mainly ensure that we can comply with all applicable sanctions and ▶ require us to track and report publicly payments made
relate to controls to prevent money laundering. These Group- requirements for export controls, even in the event of short- to health care professionals and organizations;
wide guidelines also provide guiding principles for the term changes in legislation. ▶ require us to issue written notification or approval and
subsidiary policies. to disclose the purpose and scope of the interaction
Reporting channels between a Fresenius Group entity and health care pro-
Money laundering If Fresenius employees suspect misconduct, e.g., violations fessionals, such as in health care facilities;
Based on the risk profiles of our business segments, we have of laws, regulations or internal guidelines, they can contact ▶ require us to publicly disclose data pursued in clinical
established measures to address money-laundering risks their supervisors or the responsible compliance officers and trials as well as disclose to patients the information
in the Fresenius Group as part of the implementation of the report the possible compliance incident. They can also gathered in patient studies. This is linked to the public
requirements of the Money Laundering Act for traders in report potential compliance incidents anonymously, e.g., by right to transparency regarding data used to approve
Fresenius | Annual Report 2021
185
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
new medicines, as well as provisions to adhere to rele- PROGRESS AND MEASURES 2021 registration, or manual registration by compliance depart-
vant data protection standards; for more information see ments, human resources, or managers. To promote a
chapter Data protection, pages 188 ff.; Risk assessment risk-conscious and value-oriented corporate culture, we train
▶ require transparency in pricing and reimbursement pro- In 2020, the business segments expanded the risk assess- executives using a dialog-based approach.
cedures for pharmaceutical products. ment to include bottom-up information, which they continued Fresenius Kabi focused on the topic of antitrust and the
to carry out in 2021. Fresenius Kabi already introduced this development of an e-learning program to combat money
We are committed to respecting the codes and principles approach in 2019 and continued this in the 2021 reporting laundering and terrorism financing. Furthermore, Fresenius
associated with membership of various associations. In addi- year. Fresenius Helios, on the other hand, will implement Kabi introduced entertaining and easy-to-understand video
tion, we disclose all donations to health care professionals bottom-up risk assessments in 2022. After introducing a har- training in series format on various compliance topics, in
in our business segments, in accordance with the publication monized IT tool, we made further adjustments to regulatory addition to the mandatory training courses.
requirements applicable to us. requirements and adapted existing risk processes in 2021. In the reporting year, Helios Spain began preparing
This way, we ensure an improved Group-wide compliance additional training courses for the risks identified in the com-
Our goals risk reporting. pliance risk assessment, in addition to the existing training
Our goal is to integrate our comprehensive understanding of courses on the Code of Conduct.
compliance into our daily business. The aim is to prevent Compliance training Workshops on the prevention of corruption and on the
violations, continuously improve our compliance manage- Compliance training is a high priority for Fresenius. All U.S. Foreign Corrupt Practices Act (FCPA) were held at
ment systems, and to further evolve a “living compliance employees are offered training on compliance issues, cover- Fresenius Vamed.
culture” Group-wide. Exchange on best practices from our ing basic topics such as our Code of Conduct and corporate Furthermore, in addition to the mandatory training
business segments plays a key role here. Each year, all guidelines, as well as specific topics such as anti-corruption, courses, entertaining and easy-to-understand video training
business segments develop operational goals and measures antitrust law, anti-money-laundering, data protection, and courses in series format on various compliance topics and
to further strengthen their compliance management sys- information security. the subject of information security, further information on
tems. These are coordinated by the compliance responsibles To convey the content in a targeted manner, we rely on pages 149 ff. in the chapter Digital transformation and
and presented to the Compliance Steering Committee. individual concepts tailored to the respective department and innovation, were introduced in several areas of the Group.
employees. We use various formats such as in-house train-
ing, live webinars, on-demand video training, and traditional Continuing development of the business partner
online training. Participation in essential basic training, due diligence
such as on the Code of Conduct, is mandatory. Fresenius Medical Care enhanced its global internal audit
Employees are prompted and reminded to participate in activities by improving the resources and focusing on
Fresenius | Annual Report 2021
mandatory training courses, for example with automatic anti-corruption in high-risk areas. More than 80% of inter-
186
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
nal audits included a compliance focus. Prior to entering vider for business partner data showing potential red flags. tions with third parties. These guidelines replace older regu-
new business relationships, and as part of its continuous For medium- and higher-risk business partners, the RPA lations, e.g., on dealing with healthcare professionals and
monitoring of existing business relationships, the company solution delivers the result of another dedicated sanctions list organizations and on conflicts of interest, and bring these
assesses third parties for compliance risks. In 2021, the check. The associated guidelines and training courses are rules together in a uniform document.
business segment assessed and approved 29,000 third par- currently being revised. Fresenius Kabi has also updated its Helios Germany updated its anti-corruption policy in
ties. In addition, Fresenius Medical Care has implemented anti-money-laundering and counter-terrorist-financing pol- 2021 and adapted it to current requirements. The focus here
their third-party training approach at global level. In the icy to reflect the current legal situation and the first national was on the experience gained during implementation, as
scope of the business segment´s training third parties refer to risk analysis. well as adaptation to the current framework conditions. At
those in the sales channel. These include distributors, Helios Spain launched a more comprehensive project in Helios Spain, new anti-corruption guidelines were drawn
re-sellers, wholesalers, commercial, or sales agents. They the reporting year that will lead to business partner due up in the reporting year, covering topics such as participation
also refer to any other third party involved in the sales of diligence for every supplier or business partner in the divi- in congresses, travel and representation expenses, and
the products that potentially interact with government offi- sion in the future. Further information can be found in the donations. Training on these guidelines is in preparation.
cials or health care professionals for sales of the products. Supply chain chapter on page 199.
The business segment also continued to conduct anti-corrup- Fresenius Vamed has established a risk-based business EVALUATION
tion-related audits of third-party business partners. partner due diligence as part of the continuing develop-
Fresenius Medical Care undertook 17 audits, exceeding its ment of business partner audits. In addition, guidelines for Audits and inspections
target to complete 15 in the reporting year. the prevention of corruption have been introduced. The Internal Audit departments conduct independent audits
Fresenius Kabi improved its systems and processes in to improve the effectiveness of the risk management, control
the area of business partner screening in 2021. For example, Dealing with conflicts of interest and governance processes at Fresenius SE & Co. KGaA and
what is known as robot-assisted process automation (RPA) At Fresenius SE & Co. KGaA, we support our employees in deal- in the Group companies of the business segments. This was
is now used to provide further background information on ing responsibly with conflicts of interest. We provide rele- also done in 2021, taking into account risk-based measures
business partners. Since its launch in April 2021, the RPA vant internal policies, and guidelines, as well as answers to of the compliance organizations such as policies and proce-
solution has automatically provided the persons responsible the most frequent questions, on the intranet. Training and dures as well as their implementation. If weaknesses are
for the due diligence with a report for each business part- regular updates complement the activities at the Group level identified, Internal Audit monitors the implementation of
ner due diligence carried out using our system. This report and within the business segments. Our Corporate Compli- remediation actions taken by the respective management.
contains Internet search results against certain search ance department is also available as a contact partner for all The audit engagement results are analyzed by the compli-
terms and a current search report from our third-party pro- questions. ance organizations and are incorporated into the continu-
Fresenius Kabi introduced a comprehensive, global ous improvement of existing measures.
Fresenius | Annual Report 2021
anti-bribery and anti-corruption policy during 2021 that sets
out clear rules and principles for avoiding bribery and cor-
ruption within the company and in connection with interac-
187
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
At Helios Germany, adherence to the business segment’s MESSAGES BY INPUT CHANNEL DATA PROTECTION
transparency regulations is monitored on a random basis in As a globally operating company, we process the personal
regular transparency reviews. With the Compliance Cockpit, Personal report
data of, among others, our patients, employees, customers,
Fresenius Kabi has a tool that provides managers of each (incl. Direct calls) 5% suppliers, and other business partners. Careful handling of
subsidiary with an annual overview of compliance-relevant the data provided to us is of great importance for Fresenius.
E-Mail / Letter 17% Hotline (phone) 29%
key parameters based on external and internal indicators. To meet this responsibility, we are continuously developing
Fresenius Kabi reviews these key parameters annually and our data protection measures.
defines monitoring measures for those subsidiaries with an Other 23%
increased risk profile. Fresenius Kabi also conducts regular OUR APPROACH
Web-based system 26%
reviews of compliance initiatives in the form of workshops. Fresenius is committed to the right to informational self-de-
Fresenius Kabi’s compliance organization organized vari- termination and the privacy of all individuals from whom we
ous international workshops again in 2021. The workshops receive and process data in the course of our business. This
not only served as intensive training for local employees, Dealing with possible compliance violations also includes the processing of personal data by third parties
but also enabled compliance officers to review and, if neces- We take all potential compliance violations seriously. An ini- on our behalf. The Fresenius Code of Conduct forms the
sary, improve their understanding of compliance, the effec- tial assessment focuses on the plausibility and possible framework of our daily actions. A key component of this is
tiveness of local implementation of internal guidelines, and severity level of the potential violation. We take every case of the Group’s commitment to handling personal data respon-
the development and improvement of central compliance possible misconduct as an opportunity to review our corpo- sibly. Data protection is thus a core task for us at Fresenius.
initiatives. rate processes for improvements. The severity of the compli- To meet new requirements or to accommodate new tech-
ance violation determines who is responsible for further nologies, we are constantly developing our data protection
Reports in 2021 investigation. If necessary, a dedicated team takes over the management systems. The operational tasks of data pro-
In 2021, a total of 2,119 compliance reports¹ were received investigation, which may include internal professionals or tection management are managed by the functional depart-
via the reporting channels. They were collected via different external support. Measures are implemented in a timely man- ments. In these tasks they are supported by processes of
input channels as shown in the graph. ner by the responsible management in close cooperation our Data Protection Management System. In certain areas,
The compliance reports were assigned to the following with the responsible compliance officers. Depending on the our Compliance Management System provides additional
topic groups, among others: Business Integrity including type and severity of the misconduct, disciplinary sanctions support, such as through general risk assessments or the
Anti-Corruption (105 reports), Data Protection (659 reports), or remedies under civil or criminal law may be imposed. After investigation of potential data privacy violations.
and Human Resources / Workplace (1,040 reports). completion of the investigation, we implement measures to
prevent similar misconduct in the future. Further information
Fresenius | Annual Report 2021
pursuant to § 289c (3) No. 6 HGB on the Non-Prosecution
Agreement of Fresenius Medical Care can be found in the
Notes to the Consolidated Financial Statements.
1
For Fresenius Medical Care in North America, the hotline system was used for multiple reporting purposes: In addition to the reporting of compliance
concerns, reports can also be made on patient care and safety. These patient-related cases were not included in the Group-wide number of compliance reports. 188
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
We continuously work to ensure that all processing of per- specified in each case, in accordance with legal require- Fresenius Medical Care developed a number of standard
sonal data that we hold meets the requirements of the EU ments. We also require third parties with whom data is operating procedures allowing for individuals whose personal
General Data Protection Regulation (EU-GDPR) and other shared for specified purposes to comply with our policies. data the business segment holds to exercise their rights as
national and international data protection regulations. All business segments and Fresenius SE & Co. KGaA safe- data subjects.
guard the rights of data subjects by adequately informing With these solutions, Fresenius Medical Care supports
Risk assessment them of their rights and by having established processes data subjects in exercising their rights to access, rectifica-
We regularly assess risks related to data protection and and tools in place to ensure that requests are answered in a tion, restriction, objection, portability, and deletion of their
IT security in every business segment and at Fresenius timely manner. Fresenius informs data subjects – whether personal data in a timely manner. The business segment
SE & Co. KGaA, using standardized methods in a top-down employees or external parties – about the processing, e.g., complies with requests for deletion in accordance with legal
approach. All business segments and Fresenius SE & Co. KGaA collecting and storing, of their data. We inform employees requirements.
record their data processing activities in central IT applica- of any amendments to the data protection information.
tions or systems and subject them to a data protection review, We have also implemented technical and organizational Reporting systems
including a risk assessment. For this purpose, we organize measures, including appropriate measures that serve to At Fresenius SE & Co. KGaA, we have a zero-tolerance policy
business processes in such a way as to integrate data pro- safeguard the rights of data subjects in accordance with the regarding data protection violations. External parties and all
tection into the design of new, or amended, data process- GDPR. We provide data subjects with an uncomplicated employees of the Fresenius Group may raise concerns
ing activities as early as possible. Among other things, this way to find out what personal data we process about them. regarding data protection via the existing whistleblowing sys-
enables us to implement the data protection principles Fresenius SE & Co. KGaA and Fresenius Kabi have developed tems or dedicated e-mail addresses. We investigate and
and incorporate the technical and organizational measures easily accessible technical solutions with which data subjects evaluate all reported indications of potential infringements as
in processing that are necessary to meet the legal require- can address their inquiries to the companies. The requests quickly as possible and, where necessary, question and
ments, e.g., from the GDPR, and to minimize potential risks. are evaluated and responded to at both corporate and local adjust our corporate processes. When required, we report
The introduction of new or modified IT systems is subject level. Fresenius Kabi, for example, monitors the receipt of privacy breaches to the authorities and inform those
to standardized review processes to examine the implemen- requests centrally, although the collection of and responses affected promptly and in accordance with legal requirements.
tation of data protection and IT security requirements. regarding all requested information may also be carried The data protection organizations of the business segments
out locally if deemed necessary. This takes place in the local and of Fresenius SE & Co. KGaA conduct their own audits and
Data subject rights language with the assistance of local data protection advi- document possible violations. Information on data protec-
Fresenius SE & Co. KGaA and all business segments respect sors. tion notifications received can be found in the Compliance
and protect the rights of all persons whose data is pro- Helios Spain processes requests from data subjects in chapter on page 188.
cessed. Personal data is processed for the legal purposes accordance with the requirements for hospitals and is sup-
Fresenius | Annual Report 2021
ported by central Data Protection Officers. A technical solu-
tion for submitting data requests is to be implemented at
Helios Spain in 2022.
189
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
International data transfer Protection Board and of the national authorities and their Training
As a globally operating company, we give high priority to committees, are closely monitored and taken into account We train employees on current requirements and threats in
ensuring an appropriate level of data protection in all inter- in risk assessments and when concluding contracts. The connection with data protection and data security. To this
national data transfers as defined by the GDPR and all other internally published templates are adapted without delay. end, we use an extensive range of e-learning courses, face-
international legal requirements relating to data transfer. When data is processed in countries outside the EU by to-face training, and other training measures. We supple-
Thus, Fresenius SE & Co. KGaA and Fresenius Kabi have sub- third parties, the contractor is subjected to a careful review ment general training with training measures for specific
mitted what are known as Binding Corporate Rules (BCRs), and measures are taken to ensure compliance with privacy employee groups. In this way, we ensure that employees
i.e., mandatory internal company guidelines, to the respon- regulations. entrusted with processing data are informed about the cur-
sible data protection authorities for review and approval As part of Fresenius Medical Care´s international business rent legal situation and the corresponding internal require-
and are preparing their internal implementation. BCRs help operations, the business segment may transfer personal ments.
the participating companies to establish a uniform level of data to third parties that undertake business activities on its We inform new employees about the appropriate handling of
data protection aligned with the standards of the GDPR and behalf or within the Fresenius Group. The business seg- sensitive data and oblige them to maintain confidentiality.
contribute to the lawful processing of personal data inter- ment expects these third parties to meet applicable laws, the Newly hired employees at Fresenius SE & Co. KGaA, Fresenius
nationally. In accordance with the EU-GDPR or other legal business segment´s own standards of conduct, and to com- Kabi, and Fresenius Helios also receive online mandatory
safeguards and contracts, the business segments and ply with the information security and privacy policies. instruction in data protection within a specified period. Each
Fresenius SE & Co. KGaA only transfer data to third countries Fresenius Medical Care prioritizes the protection of data in company at Fresenius Kabi and Fresenius SE & Co. KGaA
outside the European Union on the basis of an adequacy all transfers, in line with the EU General Data Protection Reg- must provide evidence regarding the instruction of employ-
decision of the European Commission, recognized certifica- ulation (GDPR) and other international data transfer laws. ees in data protection at least every two years. At Helios
tions, or other legal safeguards. To this end, in addition to New developments concerning international data transfers Germany, each company must train all employees in data
commercial contracts, we also enter into specific supplemen- have been assessed internally. Fresenius Medical Care con- protection at least once every two years. Fresenius Vamed
tary data processing agreements with data recipients. In siders the results of these assessments in its new guidance organizes an annual e-learning course, which is obligatory for
these, we also make use of the current EU model clauses, and its process for engaging with third parties based out- employees. In-depth training sessions are also held on an
which were last issued by the European Commission in side of the European Economic Area. Corresponding training ad-hoc basis. The mandatory e-learning course and the
June 2021. The latest developments in the area of interna- has been developed and rolled out to relevant employees. re-certifications of the Data Protection Officers were carried
tional data transfer, such as the European Court of Justice out in 2021.
ruling in the Schrems II case on the Privacy Shield and the
corresponding recommendations of the European Data
Fresenius | Annual Report 2021
190
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
Organization and responsibilities Helios Spain, for example, has set up data protection com- Guidelines and regulations
mittees at the hospital level. Data protection is a joint task of all employees of the
Organizational structure Fresenius Medical Care has a network of local country Fresenius Group. At the core of this is the joint commitment
Fresenius SE & Co. KGaA and all business segments maintain and sub-regional Privacy Liasons, who liaise between country of all business segments and Fresenius SE & Co. KGaA to
data protection organizations in line with their organiza- management and the regional privacy leads to ensure com- data protection, as specified in their Codes of Conduct. In the
tional and business structure. These include independent pliance with local law and implementation of the Code of Eth- Fresenius Code of Conduct, we clearly commit ourselves
Data Protection Officers, who report to the management of ics and Business Conduct which also defines the privacy to the careful handling of data and the right to informational
the respective companies. All data protection organizations, standards and guides the business segment´s approach to self-determination: we undertake to respect the rights and
separated according to functions, have both advisory and protecting personal information. privacy of all persons from whom we collect or receive data.
controlling functions, which complement each other in their In total, more than 300 employees at Fresenius are This also applies to suppliers and business partners. For
tasks. The data protection organizations support the man- entrusted with data protection tasks. instance, Fresenius Kabi obligates its suppliers to handle data
agement and specialist departments of the assigned compa- The Data Protection Officers from the business segments carefully by means of a Code of Conduct.
nies in operational data protection issues and in complying and Fresenius SE & Co. KGaA regularly exchange information All business segments and Fresenius SE & Co. KGaA have
with and monitoring the applicable data protection require- on best practices and initiatives, including at Group Coordi- also drawn up policies for data protection and the handling of
ments. The respective Data Protection Officers are responsi- nation Meetings and conferences, jours fixes, and other personal data. The data protection policies are comple-
ble for monitoring compliance with these requirements. They formats. In 2021, all events took place purely virtually. mented by further guidelines, standards, or standard operat-
are the contact persons for national and international super- ing procedures. These support the employees in imple-
visory authorities and are supported by competent data pro- Involvement of the Management Board and reporting menting GDPR requirements and other relevant local laws and
tection advisors and coordinators. Depending on the busi- Overall responsibility for data protection at the level of the regulations in their areas of responsibility.
ness segment, the data protection advisors are organized Fresenius Group lies with the Management Board member
centrally, regionally or locally. responsible for Human Resources, Risk Management and PROGRESS AND MEASURES IN 2021
Fresenius Kabi lists the contact details of the local data Legal of Fresenius Management SE. The Data Protection Offi- In 2021, at Fresenius SE & Co. KGaA and within the business
protection advisors appointed by the site manager on its cer of Fresenius SE & Co. KGaA reports directly to this Man- segments, data protection was further developed with a view
intranet, together with the relevant country and site. They agement Board member. to global operational activities. Our measures therefore
support the data protection officer, for example in the local In addition, data protection is a regular topic for the focused on the development of new training content and the
language, in any communication with the local data protec- Compliance Steering Committee, which includes the Man- implementation of existing training concepts, as well as on
tion authority, in inquiries from employees, and in the agement Board member for Human Resources, Risk Man- the expansion of audit concepts to take regulatory changes
implementation of internal processes. agement, Legal and Compliance of Fresenius Management
Fresenius | Annual Report 2021
SE. The Data Protection Officers responsible for the four
business segments report regularly to the respective man-
agement.
191
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
into account. There was also a focus on data protection At Fresenius Kabi, a risk assessment of data processing vacy-compliant design of hospital information systems (e.g.,
measures in connection with the increasing use of virtual activities in an application is performed in several stages on access logging and auditing for improper access, both inde-
health offerings. the basis of templates developed for this purpose. The appli- pendently and on an ad hoc basis). Many measures were also
cation will be further developed so that future risk assess- necessary at Fresenius Helios as a result of COVID-19, e.g.,
Risk management ments will no longer be performed in separate templates, in relation to vaccination and surveying of the vaccination sta-
Fresenius SE & Co. KGaA further developed its data protec- but within the application. Data privacy impact assessments tus of employees. This required close coordination with the
tion management system in 2021. In addition to the ongoing are performed on an ongoing basis; in the future, the pro- relevant authorities.
development of the already-existing process for efficient cess will be an integral part of the application for recording Helios Spain has continued to implement data protection
investigation of potential breaches of data protection, this data processing activities. To ensure structured and effi- impact assessments and has expanded them to include
also included the expansion and implementation of the cient processing of notifications on data protection incidents additional indicators for information security or technological
data protection audit concept. In order to implement the risk- and potential data protection violations, Fresenius Kabi has risks.
based approach, the data protection risk assessments of implemented internal guidelines; these are accompanied by a Fresenius Vamed has progress in data protection man-
data processing activities are also constantly optimized and technical solution with which notifications on data protec- agement evaluated and documented annually by an external
implemented. In 2021, significant further developments tion incidents can be recorded by local data protection advi- law firm. In 2021, the business segment focused in particu-
took place in the areas of data deletion and international data sors on the basis of a notification by employees. The techni- lar on updating directories and revising the deletion con-
transfer. cal applications for conducting and documenting, recording, cept for its processing activities.
Fresenius SE & Co. KGaA has implemented guidelines for and processing data subject inquiries were further devel-
the creation and implementation of deletion concepts. The oped. A report developed for this purpose provides informa- Training
requirements of the European Data Protection Board were tion on the number, type, and processing status of data In 2021, Fresenius SE & Co. KGaA developed a new data pro-
implemented in the course of a revision of contracts and of privacy incidents and data privacy inquiries. tection training program consisting of various modules,
the additional risk assessment in connection with this. The Helios Germany strengthened various instruments of the which will be rolled out in 2022. In addition to a comprehen-
use and implementation of specific applications for the future data protection management system in 2021. Additional sive module on data protection, this also includes explicit
performance of the data protection risk assessment also materials such as checklists for auditing processing activities, training on the applicable data protection guidelines.
played a key role in the ongoing developments. In order to e.g., were made available to the sites, the Helios audit con- Since 2021, Fresenius Medical Care included privacy
further strengthen risk management, new e-learning units cept was updated, and the notification processes for auditing awareness in its mandatory Code of Ethics and Business
on data protection and on the BCRs are currently being devel- new processing activities were revised centrally and locally Conduct training. The business segment offers a range of
oped at Fresenius SE & Co. KGaA. A further focal point was due to the implementation of the Helios Digitization Board e-learning opportunities and classroom training courses
the permissible processing of personal data in connection (DIGI Board). In 2021, the focus was on, e.g., the adoption
Fresenius | Annual Report 2021
with COVID-19 measures. of Helios Group regulations on data privacy, the further devel-
opment of auditing processes, and the continued data-pri-
192
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
and combines general training with targeted measures for Helios Germany has added a new online training course on reviews are used to continuously develop our data protec-
specific employee groups. In 2021, the business segment data protection and FlexWork to its existing training portfolio tion processes. Helios Germany’s audit concept, for exam-
offered more than 60 training classes on data privacy to its in response to new work requirements. Helios Spain intro- ple, stipulates that each company is to be reviewed regu-
employees and contractors around the world. Training in duced company-wide data protection training in 2021. In 21 larly – at least once a year – in the course of internal audits
North America is aligned with HIPAA (Health Insurance Por- clinics, face-to-face training was also conducted during the and supplemented by a central, annual risk analysis (on
tability and Accountability Act of 1996) requirements. In pandemic. January 31 of each year for the previous fiscal year) with
the European Union, it covers GDPR requirements. In 2021, In 2021, employees at Fresenius Vamed participated in regard to data protection.
Fresenius Medical Care launched an awareness campaign data protection e-learning courses. Furthermore, 48 people Helios Spain’s audit concept requires all hospitals to be
as part of its first International Privacy Day celebrations. This received an initial or re-certification as Data Protection Offi- audited every second year. This is performed as an internal
involved the introduction of a privacy website in countries cers. audit conducted by the company’s data protection team and
in Europe, Middle East, and Africa, as well as Latin America, an external law firm. Every year without an on-site audit, a
and Asia-Pacific. EVALUATION self-audit checklist is distributed by the data protection team
In the reporting year, Fresenius Kabi completely revised and filled out by the hospitals.
its training on data protection and information security in Audits and monitoring Fresenius Kabi conducts data protection audits on the
the form of an e-learning course and divided it thematically To ensure compliance with data protection regulations, sev- basis of an internal process by the Data Protection Officer and
into individual modules. The training content was expanded eral governance functions in the Group perform regular records the results of data protection audits performed in
to include how to deal with data protection incidents and pos- checks with different focuses in all business segments. The tabular form. The Internal Audit departments carry out inde-
sible data protection violations as well as a separate module Internal Audit departments carry out independent audits to pendent audits to improve the effectiveness of risk manage-
on Binding Corporate Rules (BCRs). The training was rolled improve the effectiveness of risk management, control and ment, control and governance processes in all business seg-
out globally as an e-learning course in the final quarter of the governance processes in all business segments. Aspects of ments. In this context, aspects of data protection are also
reporting year. Data privacy advisors and compliance employ- data protection are also taken into account on a risk basis. taken into account on a risk-based approach. Thematically
ees were also trained in dealing with data privacy incidents. The data protection related results of the audits are ana- identical deviations are grouped and communicated as
Training on data privacy clauses in contracts, data privacy lyzed by the respective data protection officers and are incor- preventive measures. The measures resulting from audit devi-
agreements, conducting a risk assessment, or handling data porated into the continuous improvement of existing mea- ations are also documented and the status updated by the
subject inquiries were developed as accompanying training sures of the respective business segment. All business respective local data protection advisors. The progress of the
measures. A question and answer page on the intranet pro- segments and Fresenius SE & Co. KGaA have defined corre- implementation of measures resulting from audit deviations
vides information on individual questions with references to sponding audit concepts for this purpose. is regularly reviewed.
further information, contacts and internal company applica- In addition, data protection controls are an integral part
Fresenius | Annual Report 2021
tions. of various internal control frameworks in the business seg-
ments. Findings on potential improvements from audits and
193
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
HUMAN RIGHTS OUR APPROACH damentals, risk analysis, measures and integration, reporting,
Human rights are universal. As a global health care company, Fresenius is committed to respecting and upholding human and grievance mechanisms.
Fresenius views the respect for human rights as an integral rights. We underline this commitment with a Group-wide In 2019, we identified and defined human rights topics
part of our responsibility. We are committed to meeting the Human Rights Statement, which the Management Board that are of particular importance for the Group in a compre-
regulatory requirements and social expectations of due dili- adopted in 2018. The statement is based on the United hensive project involving all business segments. They include
gence for the respect of human rights. Nations (UN) Universal Declaration of Human Rights and the access to health care, working conditions in the supply
Medical care for patients and the well-being of our more International Labour Organization (ILO) Declaration on Fun- chain, and preventing discrimination and promoting equal
than 300,000 employees are among the most important damental Principles and Rights at Work. It covers human opportunities. Our business activities and relationships can
engagement areas of our human rights due diligence. We are rights issues that are of particular importance to our Group, have impacts on human rights in these areas. In addition, the
aware that respecting human rights extends beyond our which include prohibiting exploitative and illegal child labor business segments work on potential issues specific to their
own company operations and core business. We consider or forced labor, preventing discrimination, promoting equal business, such as potential environmental impacts related to
human rights issues when selecting and cooperating with opportunities, and creating safe working conditions. production. This analysis forms the basis for identifying
our suppliers and business partners, both in procurement The publication of the statement also marked the starting potential human rights violations and gives us the opportu-
and in sales and distribution. We are working to increase point for our Human Rights Program, which establishes nity to develop necessary measures. In 2020, a Group-wide
the transparency of our supply chains. The knowledge gained preventive measures helping Fresenius to prevent or reduce methodology for human rights risk analysis was initiated to
by doing so helps us to ensure secure supplies while reduc- human rights risks in its business processes and includes identify and prevent or mitigate human rights violations at
ing human rights risks in the procurement of important raw human rights risks in our Group-wide risk management. The an early stage – and to then define further measures in the
materials and supplies, as shown on page 197 f. measures of the Human Rights Program are closely aligned business segments.
with the UN Guiding Principles on Business and Human
Rights and build on its five elements: establishment of fun- Organization and responsibilities
Human Rights Council
In 2019, Fresenius established a Human Rights Council to
drive the implementation and development of our Human
MILESTONES OF THE HUMAN RIGHTS PROGRAM
Rights Program at the Group level. It is composed of repre-
sentatives of the four business segments and Fresenius
Group-wide project identification Group-wide methodology for Business-specific and individual measures are SE & Co. KGaA. The approximately 20 members of the Human
of human rights topics human rights risk assessment implemented in the business segments
Rights Council are active in various functions within the
Fresenius | Annual Report 2021
Group, including compliance, legal, sustainability, communi-
cation, purchasing, human resources, and medicine. The
Human Rights Foundation Human Methodology for assessment
Statement Rights Council of grievance mechanisms committee meets quarterly and promotes information
194
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
exchange on current human rights topics across the business position ourselves in the Human Rights Statement are HUMAN RIGHTS PROGRAM
segments. The participants discuss Group-wide initiatives available online on our corporate website fresenius.com/
and present new concepts and methods. In 2021, the Human compliance.
Rights Council met four times.
In the Human Rights Statement, we position ourselves on the Foundation Risk Assessment
Addressing human rights in the business segments following topics:
In each of Fresenius’ four business segments, various depart-
ments are responsible for planning and implementing ▶ Creating
safe working conditions
human rights activities within their business segments and ▶ Preventing
discrimination and promoting equal oppor-
supply chains. Supported by Compliance Management tunities
Complaint Mechanism Measures & Integration
Systems (CMS), they carry out training within the Group on ▶ Protecting
personal data
specific human rights issues and provide information on ▶ Prohibiting
exploitative and illegal child labor or forced
how employees can react to and report any misconduct. labor
▶ Respect
the right to freedom of association and collec-
Guidelines and regulations tive agreements Reporting
▶ Considering
our impact on the environment
Fresenius Human Rights Statement ▶ Assuming
responsibility along the supply chain
Our Human Rights Statement is a commitment by Fresenius
SE & Co. KGaA and its business segments. In addition, Human Rights Program Chain Due Diligence Act, which comes into force in Ger-
Fresenius Medical Care has adopted its Human Rights, Work- We respect and support human rights as defined in interna- many in 2023, into the ongoing development process and
place Rights and Labor and Employment Principles. The tional standards, e.g., the UN Universal Declaration of Human adapt our measures where necessary.
human rights statements supplement the Codes of Conduct of Rights and the ILO Declaration on Fundamental Principles
the business segments and their underlying human rights and Rights at Work. Our actions are based on the UN Guiding Complaint mechanisms and reporting channels
commitments. The Human Rights Statement can or should be Principles on Business and Human Rights, which were Employees of all business segments and of Fresenius
regularly updated as new insights arise or new essential established in Germany through the National Action Plan for SE & Co. KGaA can raise their concerns directly with their man-
issues need to be added. Details on the topics on which we Business and Human Rights (NAP) and the CSR reporting agers. Employees and external stakeholders may also use
obligation. The measures of our Human Rights Program – dedicated complaint management systems to provide infor-
which we are continuously developing, as the graphic mation or use designated e-mail addresses to draw atten-
Fresenius | Annual Report 2021
shows – are based on these principles. We incorporate new tion to possible human rights violations or other violations.
requirements and legal frameworks, such as the Supply We provide information on these systems in the Compli-
ance chapter, page 185. We strive to continuously improve
195
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
our processes and further optimize the complaint mecha- Our goals Human rights training
nisms. Based on the requirements of the UN Guiding Prin- Our primary goal is to establish and continually develop In 2021, Fresenius Medical Care included information on
ciples on Business and Human Rights and the European appropriate human rights measures for Fresenius to prevent, human rights in its mandatory Code of Ethics and Business
Union Directive on the protection of whistleblowers and their end, or minimize the possible negative human rights impact Conduct training, as well as in its Global Supplier Code of
implementation in national law, we developed specific crite- of our business activities and supply chain. Conduct training. The business segment´s aim is to raise
ria for complaint mechanisms or procedures. Based on these awareness of this topic among employees.
criteria, an assessment has shown that the reporting sys- PROGRESS AND MEASURES 2021 In 2020, Fresenius Kabi supplemented the e-learning
tem of Fresenius SE & Co. KGaA meets these requirements. The To protect human rights, along with other measures, new training on the Fresenius Kabi Code of Conduct with a chap-
business segments observe the developments in this area guidelines were developed by individual business segments ter on human rights. The supplementary human rights
and adapt their processes as needed, based on these criteria. in the reporting year, which are accompanied by training module was successfully rolled out in 2021 as part of the
We are committed to protecting persons reporting com- courses. mandatory e-learning on the Fresenius Kabi Code of Con-
plaints in different ways. Reports can be made anonymously, duct. Employees are familiarized with the content of the
where legally permitted. Incoming reports are treated confi- Risk management and assessment human rights statement and the company’s positions on
dentially as described in the respective guidelines. Ombuds The Fresenius Group has identified human rights issues and illegal child or forced labor, discrimination and equal oppor-
panels also exist at Fresenius SE & Co. KGaA, Fresenius Vamed, fields of action in all business segments that are particu- tunity, safe working conditions, the right of freedom of
and Fresenius Kabi. These carry out preliminary assessments larly relevant to our value chains. In doing so, we consider association and collective bargaining, protecting personal
of reports received and initiate risk-appropriate investiga- various factors, including business models of the business data, the influence on the environment, and responsibility
tions of reports on a case-by-case basis. Employees are also segments, and current public debates and regulatory devel- in the supply chain.
informed about the possibility of reporting potential viola- opments such as National Action Plans (NAPs) for Business Helios Germany trained its purchasing staff in the report-
tions through externally accessible websites. Our reporting and Human Rights. ing year on the topics covered by the recently introduced
channels are also accessible to supplier employees and Based on these topics, we further introduced our Human Supplier Code of Conduct. In addition to requirements relat-
other third parties. Fresenius Medical Care has an anti-retal- Rights Risk Assessment methodology in individual business ing to environmental protection and human rights, it also
iation policy in place. segments in the reporting year 2021. This methodology takes includes further requirements, e.g., animal welfare and labor
If we find substantiated concerns or violations of laws and into account the severity of the potential human rights risks, standards that will be required of suppliers and business
policies, we take appropriate measures. We use the results such as the impact on the people affected and the possibility partners in the future.
of internal reviews and reports to review our business pro- of restoring the situation, as well as the likelihood of a Helios Spain has developed a comprehensive program
cesses and implement corrective or improvement measures potential human rights violation. Human rights risks have that focuses on people. The program also reflects the con-
where necessary. This information is also very useful for our been integrated into Group-wide risk management in 2021. tent of the Code of Conduct, in which the company empha-
Fresenius | Annual Report 2021
risk assessments and the Group-wide risk management. sizes the importance of respectful behavior, a commitment
196
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
to equal opportunities and freedom from discrimination, and SUPPLY CHAIN duced at the end of 2021. The codes include details on the
respect for the compatibility of family and career. In the regulation of child and forced labor, and fair working and
future, this content will be trained with additional focus top- OUR APPROACH employment conditions such as working hours and wages.
ics such as human rights, social responsibility, and the We expect our suppliers and business partners to comply
environment. The ambition is to train all persons responsible with our and equivalent ethical, social, ecological, and human PROGRESS AND MEASURES 2021
for these topics who are assigned to the individual hospitals rights standards. To this end, they are expected to intro-
and companies of Helios Spain. However, the training courses duce processes to ensure compliance with applicable stan- Supplier evaluation
are also open to all employees who wish to further train their dards. The requirements for our direct suppliers, service Transparency in the supply chain is important to identify and
knowledge in this area. providers, and other partners are set out in Codes of Conduct address human rights risks. In the reporting year, our global
for Business Partners and Suppliers and corresponding procurement activities demonstrated their reliability – despite
EVALUATION contractual clauses. If we suspect that rules of conduct have the particularly volatile procurement market situation in
In the reporting year, we received information on potential been or are being violated, we react accordingly. Depend- 2021. The business segments’ individual measures are pro-
human rights violations via the existing reporting channels. ing on how serious the misconduct is, we may, e.g., introduce vided below; additional information on procurement activities
Further information on the reporting channels ca be found additional control measures, such as audits, and request can be found in the Group Management Report on page 58.
in the chapter Compliance on page 185 and page 188. We additional written confirmations from suppliers and business
evaluated these and determined that our management partners. Fresenius Medical Care
approach at Group level has proven itself; thus, no adjust- Fresenius Medical Care’s Global Supplier Code of Conduct
ments have been made compared to the management Guidelines and regulations specifies its expectations of suppliers in terms of sustainable
approach in 2020. However, progress and measures in the Our Codes of Conduct for Business Partners and Suppliers business practices, covering topics such as integrity and
business segments certainly relate to changes in the take into account the respective business models of the ethics, human rights and labor conditions, quality, occupa-
respective governance structure or the improvement of exist- business segments. The Codes of Conduct are used in pur- tional health and safety, and environmental protection. It
ing reporting systems. chasing contracts and contracts with other business part- forms the basis of their contractual relationships with suppli-
ners, e.g., distributors and sales representatives – as annexes ers. Fresenius Medical Care continues to incorporate the
or references. Fresenius Medical Care has embedded its requirements of the Global Supplier Code of Conduct into
expectations in its Global Supplier Code of Conduct. supplier contracts and has updated all relevant procure-
Fresenius SE & Co. KGaA, Fresenius Kabi, and Fresenius ment guidelines across the regions to include a reference to
Vamed have set out their requirements in Codes of Con- this document. In 2021, the business segment also devel-
duct for Business Partners and Suppliers. Fresenius Helios oped an onboarding process for suppliers to inform them of
Fresenius | Annual Report 2021
defines its expectations of business partners in the respec- the sustainability requirements. This includes procedures
tive contracts and in the Code of Conduct for Suppliers intro-
197
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile | Limited assurance report of the independent auditor
to manage situations where suppliers do not wish to or are low-up action. In addition, Fresenius Medical Care continued suppliers had been evaluated against ESG criteria. The inter-
unable to adhere to these requirements. to screen social media for negative reports regarding its nally set ambition was thus achieved. The ESG performance
In the reporting year, various employees in Procurement, suppliers’ business conduct related to sustainability. In 2021, of the majority of suppliers was confirmed by the assessment.
as well those working in Legal, Finance, and Compliance, the business segment screened 100% of its most important Strategic suppliers with a low ESG assessment score have
participated in internal training courses on the Global Sup- suppliers based on relevant spend. been requested in 2021 to take measures to improve their
plier Code of Conduct. Additionally, in 2021, Fresenius performance.
Medical Care developed a global e-learning course on sus- Fresenius Kabi In view of the volatility on the procurement markets in the
tainable supplier management, with the goal of reaching Fresenius Kabi has identified strategic suppliers that the reporting year, Fresenius Kabi closely monitored the avail-
procurement staff in all countries by the end of 2022. It has business segment monitors closely because of their impor- ability of materials required for the manufacture of products
also developed an internal process to manage supplier feed- tance to the business; this is managed by Fresenius Kabi’s and ensured the best possible availability, for example by
back, which will be rolled out in 2022. global strategic purchasing organizations. increasing inventory levels as applicable and continuing to
In the context of its Global Sustainability Program, Based on defined processes, Fresenius Kabi classifies certify alternative suppliers. Thus, in the reporting year
Fresenius Medical Care launched an initiative to evaluate strategic suppliers according to their risk and evaluates 2021, Fresenius Kabi was able to mitigate supply bottlenecks
suppliers based on sustainability risks. This helps to cluster them regularly. The business segment also conducts sup- for sourced products and avoided significant effects on the
suppliers according to these risks, which allows it to monitor plier audits. supply of vital drugs and medical devices to patients.
them more closely and take the required action when nec- Since 2019, Fresenius Kabi has assessed the aspects of
essary. In 2021, Fresenius Medical Care further developed its occupational health and safety, environment, human rights, Fresenius Helios
risk assessment procedures, taking into consideration the business ethics, and sustainable procurement of relevant¹ At Fresenius Helios in Germany, the purchasing department
requirements of the new German Act on Corporate Due Dili- strategic suppliers, which has been further continued in regularly evaluates strategically important suppliers accord-
gence Obligations in Supply Chains, which will come into 2021. This enables Fresenius Kabi to identify suppliers’ ing to standardized criteria and processes. In 2021, the sup-
force in 2023. As part of this initiative, Fresenius Medical ESG performance (Environment, Social, Governance). Sub- plier evaluation for the years 2020 and 2021 was carried out
Care will ask critical suppliers to provide information about sequently, suppliers can be requested to implement appro- on 204 suppliers with a procurement volume of around €1.03
their sustainability performance via, for instance, a self-as- priate measures to reduce their ESG risks. Fresenius Kabi is billion. Criteria include the quality of processes, IT infra-
sessment form. Fresenius Medical Care will use this infor- supported in its supplier evaluation by an external service structure, and the quality of operational and strategic collabo-
mation to identify suppliers that do not fully comply with its provider that provides ESG assessments for global supply ration.
sustainability standards so it can initiate appropriate fol- chains. In addition, the business segment continued to In addition to this focus, further environmental and
work on integrating supplier assessments based on ESG crite- social aspects, as required by the German Supply Chain Due
ria into supplier processes in the reporting year 2021. At
Fresenius | Annual Report 2021
the end of 2021, more than 70% of the relevant strategic
1
Suppliers of APIs, excipients, primary packaging materials, energy, disposal services, filters, granulates, lab consumables, secondary and tertiary
packaging, strategic components, clinical studies, medical devices components. 198
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
Diligence Act as of 2023, were assessed. In 2021, on this transparency and quality in various procurement areas – ENVIRONMENT
basis, the potential human rights risk areas defined in 2020 such as the evaluation of food safety, pharmaceuticals, con-
were further evaluated and divided into specific risk groups. struction and other work, and equipment. In the reporting As a health care Group, Fresenius feels a responsibility to
Helios Germany’s purchasing department will also take year, Helios Spain thus launched an extensive analysis of protect the environment and use natural resources carefully
this Group-wide, uniform risk assessment on the topic of direct suppliers to the central purchasing department, the because only a healthy environment can be a home for
human rights into account for the further evaluation of its construction and equipment department, and the quality healthy people. It is important to avoid possible negative
suppliers in order to ensure early identification of potential department. Further implementation of the project is planned effects on the environment and health. To this end, we
risks. Helios Germany also introduced a Code of Conduct for for the next two years at Helios Spain. Here, the framework identify and evaluate potential hazards and take the neces-
Suppliers at the end of 2021, which will be an integral part audited in 2021 is to be extended to the other suppliers, as sary measures to protect the environment. In our Group-
of all contracts in the future. On this basis, the company will well as the purchasing processes of the clinics and health wide materiality analysis, we identified the following topics
consequently demand the inclusion of further, predomi- centers. for our internal environmental management strategy as
nantly ecological and social, aspects in the future. particularly relevant to our core business:
Fresenius Helios in Spain has developed a procedure for Fresenius Vamed
the general evaluation of all suppliers, elaborating different Fresenius Vamed already introduced a Code of Conduct for ▶ Water management
supplier categories and detailed criteria for analysis and eval- Business Partners in 2017, which was revised in 2020 and ▶ Waste and recycling management
uation for the different categories. To implement the sup- further rolled out in the reporting year. A key component is ▶ Climate protection – energy and emissions
plier evaluation, software is used that allows traceability of Fresenius Vamed’s expectation of its business partners to
the different actors involved in all phases of the evaluation comply with human rights, environmental protection, and ENVIRONMENTAL MANAGEMENT
process. Part of this project is a validation process to ensure sustainability. We aim to develop an integrated environmental approach for
that suppliers are aware of and accept the Code of Conduct. With the further development of the business partner due the Fresenius Group and foster a balanced view across all
The processes established with this project are intended to diligence, Fresenius Vamed has also introduced correspond- functions with regard to relevant environmental aspects. In its
improve supplier selection through a standardized, compre- ing guidelines, through which a risk-based audit of all busi- business operations, the Fresenius Group is subject to
hensive evaluation. For this purpose, a modular questionnaire ness partners is regulated. numerous guidelines and regulatory requirements that must
was developed. It includes, among others, general, finan- be applied and complied with at all times. We integrate
cial, qualitative, social, and environmental aspects of suppli- national requirements into our internal guidelines, which are
ers, criminal incidents, and implementation of compliance, defined in ISO-based or ISO-oriented management systems.
data protection, and cybersecurity. The objective is to ensure
OUR APPROACH
Fresenius | Annual Report 2021
We aim to analyze our impact on the material environmental
aspects in both the manufacturing and services areas, as
the risks of financial or reputational costs linked to environ-
mental litigation are expected to increase. Also, reducing
in-process material is essential for many industries affected
199
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
by growing natural resource scarcity. Dedicated monitoring CERTIFICATIONS AND COMMITMENT guidelines. Due to the COVID-19 pandemic, audits in 2021
of natural resource consumption and waste-generating activ- The environmental commitment of our business segments is took place virtually. In total, 25% of the production sites
ities can lead to lower costs and, in some cases, new busi- reviewed or certified by external partners and regulatory are certified according to ISO 14001 standard and 5% of the
ness opportunities. This is why we assess trends and adapt bodies. We are continuously expanding the number of sites production sites have ISO 50001 certifications.
our activities if deemed essential to support the sustainable, certified to ISO 14001. In 2021, further entities were added The environmental management of Fresenius Medical
long-term growth of our business. We report on our progress on a Group level. Information on the various standards is pro- Care is described in this section; for energy management and
and measures in 2021 on page 203 f. Information on risks vided for each business segment in this chapter. emissions see page 211 f.
can be found in the Group Annual Report 2021 in the Oppor- The environmental management approach of the
tunities and Risk Report on pages 95 ff. Fresenius Group is controlled by internal specialists or ded- Fresenius Kabi
On a business segment level, the environmental manage- icated functions within the business segments. Relevant Fresenius Kabi has a matrix certification for both its global
ment strategy is aligned to the respective business models. data is reported regularly, e.g., on a monthly basis, to iden- environmental management system and the energy manage-
Since the requirements in our business segments differ, envi- tify deviations. If deviations occur, our specialists initiate a ment system; both systems are audited annually and certi-
ronmental management is decentralized. The common root cause analysis which is evaluated, and corrective or pre- fied by TÜV Rheinland. Fresenius Kabi continuously monitors
foundation of environmental management approaches in our ventive actions are implemented where necessary. Regular certified organizations to ensure that they comply with the
business segments is the ISO 14001 standard. All segments internal audits, partially annually, support the verification of standard process guidelines that are binding for them. To this
have implemented local, regional, or global management sys- data and management approaches, both for certified and end, globally appointed auditors conduct regular internal
tems to take into account the respective business models non-certified entities. In this way, we ensure that activities to audits of the organizations. Fresenius Kabi is working to
and adapt processes accordingly. The dedicated functions of protect the environment are in accordance with internal implement the environmental management system according
the business segments monitor and control the environ- guidelines and regulatory provisions. The overarching ambi- to the international standard ISO 14001 and the energy man-
mental impact of their operations. They analyze environmen- tion is to improve efficiency and coverage of our manage- agement system according to ISO 50001 at all manufacturing
tally relevant vulnerabilities, develop suitable standard pro- ment systems, so as to ensure the effectiveness of the proce- plants worldwide by 2026 1. To achieve the goal of imple-
cedures, and implement appropriate measures. They support dures and systems in place. menting the management systems, the business segment has
their certified local entities in effective, directed environ- drawn up an ambitious implementation plan and is working
mental goal-setting, monitoring these goals as well as devel- Fresenius Medical Care systematically on its realization. By expanding the coverage
oping and implementing mandatory guidelines for all enti- Production sites, distribution centers, laboratories, and dial- of the management systems, Fresenius Kabi aims to contin-
ties. ysis clinics are subject to internal and external audits. This uously improve its environmental and energy performance.
involves checking their compliance with environmental laws 40 Fresenius Kabi organizations are currently certified
and regulations, certification requirements, and internal according to ISO 14001, and 3 additional manufacturing
Fresenius | Annual Report 2021
1
Implementation will be concluded at all Fresenius Kabi manufacturing plants in 2026. The certification issuance from the individual certification
companies may extend into the following year. 200
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
plants were certified in 2021. Further, 22 organizations ENVIRONMENTAL MANAGEMENT IN THE In 2021, Fresenius Medical Care rolled out a new digital tool
are certified according to ISO 50001, and 4 additional manu- BUSINESS SEGMENTS at its production sites to improve the data quality and effi-
facturing plants were included in the certification in 2021. ciency of its eco-reporting. At the dialysis clinics in Asia-Pa-
Information on the environmental management of Fresenius Fresenius Medical Care cific, Fresenius Medical Care introduced the eco-reporting
Kabi can be found on page 202; for energy management As a large international company, Fresenius Medical Care software that is already being used in dialysis clinics in the
and emissions see page 212. recognizes its responsibility to protect the environment and Europe, Middle East, and Africa region, and in Latin Amer-
use natural resources carefully. Therefore, the business ica. Manufacturing and clinic staff received the necessary
Fresenius Helios segment tracks and analyzes environmental data generated training on these new solutions.
Fresenius Helios started the introduction of an environmen- by the dialysis clinics and production sites worldwide,
tal management system in accordance with ISO 14001 in including energy and water consumption levels. This helps Life cycle assessments
Germany in 2020 and continued this process in 2021. The the company to manage resources more effectively. Eco-re- To help understand the environmental impact of its prod-
certification of all Helios clinics is to be covered by matrix porting across regions and functions is facilitated by specific ucts, Fresenius Medical Care also conducts simplified prod-
certification in the coming years. tools. uct life cycle assessments (Screening LCA) for selected
Implementation of the energy management system in Responsibility for environmental management is shared products. These assessments identify the life cycle phase with
accordance with ISO 50001 was completed at all Fresenius between global and regional functions. The Global Manufac- the highest impact, and the processes and materials needed
Helios sites in Germany by the end of 2020. The clinics of turing, Quality, and Supply division is accountable for sus- to focus on to improve the eco-performance of the products
Helios Germany were audited up to the end of 2019 accord- tainable operations in the production business. Responsibil- and services. Based on international guidelines and the
ing to the EDL-G in compliance with DIN EN 16247. With ity for environmental protection in dialysis clinics lies with requirements of ISO 14001 and IEC 60601-1-9 standards,
the introduction of the energy management system according the respective management in the regions. In 2021, the com- Fresenius Medical Care calculates the environmental
to ISO 50001 in 2020, the EDL-G will continue to be oper- pany also set up a network of environmental experts to reg- impact caused during each individual stage of a product’s life
ated seamlessly. ularly exchange information and work together on environ- cycle. The IEC 60601-1-9 standard applies to efforts to
At Helios Spain, two further hospitals were certified mental deliverables at a global level. This is an important step reduce the adverse environmental impact of medical electri-
according to ISO 14001 in 2021. The total number is now 42 toward establishing global governance, with the aim of driv- cal equipment. Screening LCAs were used to assess most of
hospitals. The number of hospitals certified to ISO 50001 ing strategic environmental initiatives across the whole orga- the active medical device product lines and are gradually
increased by 1 to a total of 7. nization. being extended to disposables. In addition, the business
Fresenius Medical Care monitors national and interna- segment has conducted detailed comparative product life
Fresenius Vamed tional regulations concerning environmental issues on an cycle assessments for important disposables. These follow
In 2021, at Fresenius Vamed no new certifications according ongoing basis so that internal policies, and manuals are up the structure and requirements of ISO 14040 / 44 standards
Fresenius | Annual Report 2021
to ISO 14001 or ISO 50001 were performed. The number to date. The business segment has established internal and compare the eco-performance of several of the acid
of facilities with appropriate certifications was unchanged, environmental standards, which are complemented with concentrates and dialyzers.
with 7 facilities certified to ISO 14001 and 76 certified to external certifications if it adds value.
ISO 50001.
201
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
Fresenius Kabi Manufacturing sites must identify environmental protection Fresenius Kabi has implemented mandatory environmental
The focus of the environmental management system at measures associated with environmental aspects of their guidelines worldwide, which provide the framework for envi-
Fresenius Kabi is to improve environmental performance and activities and services. This can relate to emissions into air, ronmental protection in all Fresenius Kabi’s organizations.
prevent environmental incidents. Key opportunities are, water, or soil, consumption of natural resources and raw The guidelines include general principles on how to address
e.g., reducing energy and water usage, as well as wastewa- materials, waste and wastewater, packaging, transport, or and prevent environmental risks, as well as how to prevent
ter, waste, and emissions, in relation to production activi- other local environmental impacts. Environmental impacts environmental incidents. Fresenius Kabi also expects careful
ties. of organizations are evaluated and, where necessary, environ- and responsible handling of nature and its resources from
A manual for the respective management system and mental protection measures are implemented and reviewed its suppliers; this is set out in the Suppliers’ Code of Conduct.
standard operating procedures provide the certified units with for effectiveness. In addition, using internal audits, Fresenius
the framework for their local environmental or energy man- Kabi identifies further improvement opportunities and devel- Fresenius Helios
agement system. ops appropriate measures with locally responsible managers The environment has a direct impact on health. As a hospital
The local management reviews the environmental manage- to tap that potential. During an audit, a review is conducted operator, Fresenius Helios therefore feels a responsibility
ment system at least annually to ensure continued compli- as to how environmental aspects have been evaluated by the to protect the climate and the environment. With its environ-
ance with the applicable requirements and effectiveness of respective organization and whether objectives have been mental management strategy, the business segment works
the systems, and to identify potential for improvement. set for significant environmental aspects. Objectives and to reduce the environmental impact of hospital operations. It
These local reviews are consolidated, analyzed, and evaluated respective measures are reviewed by the auditor during is the aim of Fresenius Helios to control energy consump-
on an annual basis by Fresenius Kabi’s global EHS (Envi- inspection tours or on the basis of monitoring records. This tion, raise employee awareness of the environment, and with
ronment, Health, and Safety) function. Appropriate corrective is carried out at certified sites in particular. In addition, these measures, to improve the ecological sustainability
measures will be initiated if deviations from the require- internal audits cover preparedness for emergencies including performance of its hospitals in the long term.
ments of the ISO 14001 or ISO 50001 management systems heavy weather events, floods, earthquakes, or hurricanes, In Germany, the Infrastructure business unit is responsi-
are identified. Based on the local management reviews, the depending on relevance or location. The frequency of global ble for the energy and environmental management strategy
global EHS function presents a global management review to internal audits depends on audit observations from previ- of Fresenius Helios hospitals. It supports hospitals in the cen-
the responsible members of Fresenius Kabi’s Management ous audits, environmental incidents, certification status, or tral purchasing of products or services and in sharing best
Board and other relevant functions of the business segment. the evaluation of the management review and can vary practice procedures, among others. The business unit reports
In addition, the global EHS function reports on a quarterly between one and four years. Global internal audits are con- directly to the Chief Operating Officer (COO) of the parent
basis about Fresenius Kabi’s environmental and energy per- ducted by the global EHS department. Due to the ongoing company Helios Health.
formance with selected indicators and provides an update COVID-19 pandemic in 2021, most audits have been con-
on the implementation of the ISO 14001 and ISO 50001 man- ducted remotely.
Fresenius | Annual Report 2021
agement systems.
202
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
In Spain, environmental management is part of operational OUR AMBITIONS clear targets have been in place to reduce electricity and gas
management and is carried out by the Quality Management Each business segment has its own approach to environmen- consumption in all hospitals. Furthermore, in 2021 the
department and by the local environmental management tal management. We are currently developing key perfor- business unit set itself comprehensive goals to raise environ-
committees of the hospitals. In addition, these interdisciplin- mance indicators (KPIs) at Group level to measure our envi- mental awareness, improve energy use, and document CO2
ary working groups develop and promote environmental ronmental performance and the impact of Scope 3 emissions, emissions in all hospitals. The infrastructure of the hospitals
guidelines and support the hospitals in their implementation. as environmental management is a key aspect of the vari- is to be analyzed, with a view to increasing their own gen-
The guidelines serve to raise environmental awareness and able compensation of the Board of Management. For more eration of energy and improving their equipment.
tackle climate change through optimized energy use. In addi- information, please refer to page 234 of the Annual Report Helios Spain’s hospitals operate an energy management
tion, the management policy, which applies to Helios Spain 2021, section “Compensation Report”. Further, in February system; seven of these hospitals are ISO 50001-certified and
as a whole, contains the following obligations: to protect and 2022, the Management Board implemented a climate target are working on annual improvements to achieve energy sav-
preserve the environment, to promote environmental ini- for the Fresenius Group. Details are provided on page 117 ings.
tiatives, to apply environmental protection and conservation of the Group Non-financial Report. Fresenius Vamed continues to strive to evaluate its strat-
measures, and to comply with the applicable requirements. Fresenius Medical Care set new climate targets in Jan- egy on the basis of sustainability criteria and to identify
uary 2022. performance indicators that will serve long-term strategic
Fresenius Vamed Fresenius Kabi constantly works to improve its environ- development.
Fresenius Vamed continuously monitors national and inter- mental management and reduce negative impacts on the
national regulations on environmental and climate protec- environment. Certified organizations set local targets to con- PROGRESS AND MEASURES IN 2021
tion. Internal principles, guidelines, and standard operating stantly improve their environmental and energy perfor- In 2021, the Fresenius Group initiated various measures and
procedures are updated as necessary. The division also mance. projects with a view to establishing an integrated environ-
expects its suppliers to treat the environment and natural Fresenius Helios is evaluating the extent to which the mental approach. In February 2022, the Group climate target
resources with care and responsibility; this is set out in the share of renewable energies relative to total energy require- was approved. Further information is included on page 117
Code of Conduct for Business Partners. As part of the ESG ments can be increased at the German clinic sites. The of the Group Non-financial Report.
component of variable Management Board compensation business segment is also exploring opportunities to increase In addition, our business segments achieved progress
and together with the relevant Fresenius corporate functions, the proportion of energy generated in-house. In this way, on which we report in the following.
the responsibilities and processes for the environmental it is continuously increasing its own energy generation
area of Fresenius Vamed were collected and recorded in an quota through combined heat and power plants. Nine new Fresenius Medical Care
internal process documentation in 2021. combined heat and power plants were installed at Helios In 2021, the business segment launched a Global Environ-
Germany in 2021. mental Policy, which was approved by the Management
Fresenius | Annual Report 2021
At Helios Spain, a defined percentage of annual invest- Board of Fresenius Medical Care. It provides a framework for
ments is targeted at improving environmental and energy environmental management at a global level and will serve
performance through projects. The business segment has set as a basis for developing improvement targets. It addresses
itself ambitious overarching goals and defines the environ-
mental targets for each hospital locally each year. Since 2020,
203
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
how Fresenius Medical Care manages and monitors envi- Fresenius Helios Fresenius Medical Care
ronmental impact. It also acts as a framework for other poli- In addition to the centrally managed energy efficiency proj- At Fresenius Medical Care’s production sites, the business
cies and manuals. In addition, the company introduced ects, some Helios hospitals are also implementing site-spe- segment is involved in local environmental projects that are
manuals and guidelines for global data and reporting envi- cific projects to improve their energy and environmental per- reported as part of the global Green & Lean initiative. This
ronmental indicators related to energy, greenhouse gas formance. initiative enables best practices to be shared across the orga-
(GHG) emissions, and water. These include guidelines on how At Helios Spain, the stronger integration of environmen- nization. The objective is to reduce emissions, promote the
to report information using the new digital eco-reporting tal management at Group level is supported by specific tar- efficient use of natural resources, and increase recycling
tool. Furthermore, Fresenius Medical Care has included infor- gets set by the hospitals’ management in 2021. Furthermore, rates. By the end of 2021, more than 100 projects were
mation on environmental standards in the mandatory since 2015, the business unit has been part of the Clúster reported. They aimed at, for example, improving proceses
employee training on the Code of Ethics and Business Con- de Cambio Climático alliance, organized by Forética, a lead- and recycling. As a result of these projects, per year the
duct. ing corporate network for sustainability and corporate company expects to save more than 20,000 MWh of energy
The company regularly identifies and evaluates environ- responsibility in Spain and Latin America. The alliance meets (0.8% of its total energy consumption), prevent nearly
mental risks as part of its enterprise risk management. In three times a year to discuss a specific topic with experts 5,500 t of CO2 equivalent emissions (0.7% of its total Scope
2021, Fresenius Medical Care used Task Force on Climate-re- and authorities, to evaluate the best climate-related practices 1 and 2 emissions), save more than 220,000 m³ of water
lated Financial Disclosures (TCFD) standards as guidelines in the private sector, and to promote exchange and trans- (0.5% of its total water consumption), and recycle or reuse
in this process for the first time. Additional risk examples parency between companies. roughly 700 t of waste.
were added to the risk catalog and specific assessments
were performed, for example concerning water stress and Fresenius Vamed Fresenius Kabi
climate change vulnerability. As part of the ESG component of variable Management Board In 2021, Fresenius Kabi, e.g., conducted a global internal
compensation, Fresenius Vamed reviewed and recorded audit at one entity in which employees were randomly cho-
Fresenius Kabi responsibilities and processes, and defined strategies on the sen and interviewed about their awareness of the environ-
In 2021, Fresenius Kabi progressed with the roll-out of the core topics of energy and water in 2021. Detailed contents mental policy, environmental objectives, and the entity’s
environmental management system at the designated manu- and derived measures of these various developments can be environmental management representative. It was found that
facturing plants. The global EHS function supports the local expected to be reported in 2022. awareness of these aspects in the respective entity showed
organizations in preparing and implementing the manage- potential for improvement. As a result, corrective and preven-
ment system and certification according to ISO 14001. EVALUATION tive actions were initiated, such as more frequent employee
In addition, in 2021, the business segment began to take Internal and external audits are used to identify potential for communication to raise awareness.
sustainability criteria into account in decision-making pro- improvement at both local and global level and to take mea-
Fresenius | Annual Report 2021
cesses for new projects, such as the development of products sures to continuously improve environmental performance.
or capacity expansions.
204
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
The headquarters of Fresenius Kabi are audited annually this scarce and vital resource responsibly. We work with lines provide transparency within the business segments.
by TÜV Rheinland with regard to ISO 14001 environmental management systems and control systems globally to ensure The local government is informed of any detected critical
management certification. In 2021, no observations were that water quality meets internal and external regulatory deviations from local drinking water provisions.
detected, confirming that the environmental management requirements so it can be used safely during production, in
system is in line with the requirements of ISO 14001. The processes, and in our health care facilities. The health of Fresenius Medical Care
ongoing COVID-19 pandemic had no impact on the roll-out of our patients and employees must be protected. The aim of Large volumes of water are required both in production sites
the environmental management system according to our water management is therefore not only to ensure the and in dialysis clinics – dialysis requires a significant quan-
ISO 14001 in 2021. highest quality and sufficient availability of freshwater but tity. It is critical that the water Fresenius Medical Care uses
also to avoid unnecessary polluting the sources from which for dialysis is of high quality, which is why the company gen-
Fresenius Helios we obtain water or into which we discharge our wastewater. erally uses municipal water that is treated further in its dial-
Helios Germany conducts internal and external energy Water withdrawal for the Fresenius Group has been sur- ysis clinics.
audits at the hospital sites. As part of the monitoring process, veyed annually since 2016 as a part of non-financial report-
the respective personnel is sensitized to potential savings ing. Progress and measures in 2021
and increasing energy efficiency as well as related measures. In 2020, Fresenius Medical Care assessed water stress at
The effects on energy efficiency are regularly monitored OUR APPROACH production sites. This determined that 7% of sites are in
and evaluated within the energy management system. This Fresenius continuously reviews national and international areas defined as locations with an extremely high risk of
process is part of the continuous improvement according regulations on water management. This ensures that internal water stress. Water stress is a situation when the demand for
to the requirements of ISO 50001. principles, guidelines, and standard operating procedures water surpasses the available amount during a certain
Helios Spain achieved the targets set for 2021 and are always up to date or often go beyond regulatory require- time, or when poor quality restricts its use. In 2021, the busi-
expanded the existing matrix certification of ISO 14001 to fur- ments, e.g., within the framework of global management ness segment followed up on the results of this assessment
ther hospitals. In addition to the local ISO 14001 certifica- handbooks. Depending on the operating activity, either envi- in various ways. For instance, it conducted interviews with
tion targets, the goal was to include all sites in Spain into the ronmental or hygiene experts ensure that internal guide- teams at selected sites in areas with an extremely high risk
ISO 14001 certification. lines and external regulations are adhered to. of water stress to raise awareness of the issue and to assess
At our clinics and hospitals, most of the water withdrawal the need for potential remedial measures. The company
WATER MANAGEMENT is from municipal water supplies. We have implemented expanded the scope of its water stress assessment to include
For decades, water consumption has been increasing applicable risk management procedures that come into action the majority of its dialysis clinics. Fresenius Medical Care
worldwide and water shortages are occurring in more and if impurities are detected or if the quality of water is not used the World Resource Institute’s Aqueduct tool to collect
more regions. We too need water both at our production compliant with standards set. Further, dedicated reporting the data. According to the results, 12% of included dialysis
Fresenius | Annual Report 2021
plants and in our health care facilities. We therefore handle clinics are in areas defined as locations with an extremely
205
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
high risk of water stress. Additionally, Fresenius Medical Fresenius Kabi is in the process of implementing the Com- can be used to determine discharge concentration targets
Care has started to analyze water stress scenarios for 2030 mon Antibiotic Manufacturing Framework (CAMF) of the for antibiotics that are not expected to cause environmental
and 2040. The company aims to complete the assessment AMR Industry Alliance. According to the CAMF requirements, effects.
by the end of 2022, and plans to integrate the findings into wastewater contaminated with antibiotic residues should
its risk management. not be discharged untreated. In 2021, the business segment Fresenius Helios
started to establish corresponding processes and measures As a hospital operator, the availability and quality of water is
Fresenius Kabi at the relevant sites that produce antibiotics. These processes extremely important to Fresenius Helios, in all countries
Water is primarily used in production at Fresenius Kabi, and measures complement the existing internal standards and at all sites. The focus of water management at the Helios
e.g., for cooling or in sanitary facilities, and is discharged and procedures. clinics lies on ensuring an uninterrupted supply of water of
as wastewater. Some manufacturing sites are reusing Water availability at Fresenius Kabi’s production sites is consistently high quality and on preventing microbiological
water, e.g., by using condensate water from installed air han- important to ensure business continuity. The business seg- contamination. The use of water as a resource in health care
dling units or in steam condensate recovery systems. The ment analyzes the water situation using the World Resources facilities is subject to strict legal requirements both in Ger-
business segment also uses water for its products, e.g., for Institute’s Aqueduct Water Risk Atlas, which contains infor- many and in Spain. Rainwater, for instance, can only be
infusion solutions such as sodium chloride. The water used mation on current and future water risks at specific locations. used in areas that are not critical for patient safety. Compli-
for this purpose must meet stringent quality requirements to Fresenius Kabi has identified manufacturing sites that are ance with the respective applicable regulatory requirements,
ensure product quality and patient safety. Fresenius Kabi’s in areas with extremely high or high risk of water scarcity. At e.g., the Drinking Water Ordinance (TrinkwV) in Germany,
global environmental standard operating procedures and these sites, efficient water management is especially import- has top priority. In order not to endanger patients, employ-
working instructions include instructions for the responsi- ant to ensure water availability for production and to prevent ees, or other people at any time, water management is closely
ble handling of water, including the control of wastewater. negative impact on the local water situation as far as possi- linked to hygiene management.
Each of Fresenius Kabi’s manufacturing sites is required to ble. The company’s own guidelines and specifications deter-
evaluate its environmental impact, e.g., from water usage mine the hospital-specific procedures. Further internal
and wastewater. Water management measures consider a Progress and measures in 2021 requirements regarding drinking water quality apply. These
reduction in water and wastewater volumes, and monitor the In 2021, the management approach and the governance must be implemented in all German and Spanish facilities.
quality and authorized withdrawal of water and discharge of structure of Fresenius Kabi remained as reported in 2020. For these reasons, Helios does not reuse water or use gray
wastewater. Progress focused on the introduction of CAMF at the antibi- water – i. e., treated water from showers or washbasins.
Water discharges are locally managed at the sites in otic-producing manufacturing plants and the evaluation of
accordance with applicable local regulations. Water dis- methods for treating wastewater as well as the introduction of
charge by quantity is regularly reported to global EHS in systems to control Predicted No-Effect Concentrations
Fresenius | Annual Report 2021
accordance with internal standards and guidelines. (PNEC) as defined by the AMR Industry Alliance. PNEC values
206
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
For the discharge of wastewater, Helios Spain and Helios Fresenius Vamed are rehabilitation clinics with therapy pools, municipal water supply, while about 8% was sourced from
Germany must comply with strict regional and local legal e.g., in the orthopedics department, and facilities that ster- groundwater and 1% from surface water. In the hospital
requirements, which are monitored within the respective ilize used medical instruments. and rehabilitation sector in particular, water is sourced from
wastewater treatment plants. Deviations are reported directly Fresenius Vamed uses local management systems, pro- the municipal water supply. This is due to the strict hygiene
to the hospital concerned and forwarded to all responsible cess owners, and operating procedures to ensure that the regulations and high demands on water quality in health care
departments through established reporting chains. After eval- respective local guidelines on water and wastewater are facilities.
uating an incident, Fresenius Helios aims to ensure that the strictly adhered to. The internal principles, guidelines, and In 2021, the reported water withdrawal at Fresenius
requirements are met in future. This is enabled through mea- standard operating procedures are adapted to the applica- Medical Care decreased by 1% compared with 2020. This
sures like technical improvements or changes to processes ble regulatory requirements. was because mainly due to efficiency measures at various
and additional training. Due to the material significance of fresh water use for production sites and lower production volumes. The business
compliance with hygiene measures and thus patient safety, segment is working to develop global water-related targets
Progress and measures in 2021 no significant reductions in water consumption are made. in addition to those it already has at regional level. It plans to
In 2021, the management approach and governance struc- In the long term, the business segment aims to achieve con- define these global targets by the end of 2022.
ture in the water management area of Fresenius Helios stant water consumption. Secondary use of water is not Fresenius Kabi continued to improve its water manage-
remained as reported in the previous year. considered an urgent priority in view of the hygiene issues ment in 2021. Methods used to improve the treatment and
Helios Spain set a target in 2021 to optimize water con- to be observed. discharge of antibiotic-contaminated water at the relevant
sumption in the clinics. sites have been identified. Appropriate measurement meth-
Progress and measures in 2021 ods and processes will be implemented at some sites to bet-
Fresenius Vamed In 2021, the management approach and governance struc- ter avoid potential negative impacts of antibiotic-contami-
For Fresenius Vamed, a sufficient supply of fresh water for ture in the water management area of Fresenius Vamed nated wastewater. In addition, the business segment has used
patient well-being and hygiene is a key element in the plan- remained as reported in the previous year. Progress focused the results of the analysis of water-stressed areas at its pro-
ning, construction, and operation of health care facilities. on the internal preparation of the process documentation in duction sites to align water management efficiently and sus-
The health care facilities built by Fresenius Vamed use con- alignment with the ESG component of the variable compen- tainably to the local situation.
struction and sanitation technology that enables optimal sation for the Fresenius Group Management Board. Water withdrawal at the business segment was 10.1
water management – adapted to local regulations. At the million m3 in 2021 (2020: 9.7 million m3). In 2021, several
same time, intelligent water management must under no EVALUATION 1 projects to reduce water withdrawal were implemented at
circumstances undermine hygiene measures or jeopardize manufacturing plants of Fresenius Kabi. Water-saving proj-
the well-being of patients. The largest freshwater users at In 2021, Fresenius withdrew a total of 56.4 million m3 of ects in 2021 included, e.g., the use of recycled water for
Fresenius | Annual Report 2021
water (2020: 56.2 million m3). Over the last three years, a rel- boilers, efficient water usage in cooling towers or reduction
ative reduction in water withdrawal was achieved, both in
relation to sales and to FTE. Around 91% came from the
1
Fresenius Medical Care figures include energy consumption and water withdrawal at production sites, as well as electricity consumption and water withdrawal at dialysis centers. Emissions include
scope 1 and 2 emissions of production sites and Scope 2 emissions of in-center treatments in dialysis clinics. The data from Fresenius Helios encompasses as of 2018 all hospitals in Spain and the cli-
nics in Latin America as of 2020. Fresenius Vamed’s data includes all fully consolidated health care facilities and service entities, and, as of 2018, the German post-acute care business transferred from
Fresenius Helios to Fresenius Vamed. Newly acquired companies are included in the second year of consolidation, at the latest. If data of the business segments is not available in time, it is extrapola-
ted on the basis of existing data. An adjustment will be made in the next report. Prior-year information was adjusted to conform to the current year’s presentation. Due to rounding, individual numbers
and percentages presented in this report may not precisely reflect the absolute figures. 207
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
of water consumption in restrooms. Further, the COVID-19 WATER WITHDRAWAL F RESENIUS GROUP 1
pandemic had an impact on water performance in some
m 3 in millions 2021 2020 2019 2018 2017
countries, due to additional cleaning activities, as well as
Fresenius Medical Care 41.4 41.7 43.2 42.1 n.a.
more employees working remotely, among other factors.
Fresenius Kabi 10.1 9.7 9.5 9.7 9.8
In addition, water performance at some sites was affected by Fresenius Helios 4.0 4.1 3.8 3.7 3.2
ongoing expansion measures or regulatory validation pro- Fresenius Vamed 0.8 0.8 0.7 0.7 0.3
cesses, e.g., testing new production lines for quality require- Total 56.4 56.2 57.3 56.2 n.a.
ments.
Fresenius Helios had not set any water management tar-
FRESENIUS GROUP 1 RELATIVE WATER WITHDRAWAL
gets for 2021 to reduce water consumption specifically.
Water withdrawal at the business segment was 4.0 million m3 in m 3 2021 2020 2019 2018
in 2021 (2020: 4.1 million m3). Water withdrawal depends Water withdrawal / € 1 million sales 1,502 1,549 1,612 1,676
on the number of patients treated in hospitals and in 2020 Water withdrawal / FTE 201.8 203.1 218.7 228.2
and 2021 on the increased demand for sterilization and
hygiene in the hospital setting.
In the business segment Fresenius Vamed, water with-
drawal increased slightly compared to the previous year. WASTE AND RECYCLING MANAGEMENT OUR APPROACH
In 2020, the post-acute clinics were closed due to regulatory Natural resources are becoming increasingly scarce all over For Fresenius as a health care Group, professional, safe waste
provisions to limit the impact of the COVID-19 pandemic. the world. We can only operate sustainably if we use the disposal goes hand in hand with the requirements of hygiene
In 2021, only two German tourism facilities, Ostsee Resort raw materials available to us efficiently. This also includes the and sterility in production processes and treatments in hospi-
Damp and Allgäu Resort Bad Grönenbach, were temporar- responsible handling of waste – because it contains valuable tals. Our approach extends from the selection of suitable dis-
ily affected. The regular course of business of most facilities resources that can be returned to production. Through sys- posal containers to cleaning and sterilization procedures and
led to an increase in total water withdrawal. tematic waste management, we aim to reduce our material the occupational safety of our employees in the disposal of
consumption and minimize the amount of waste produced. In hazardous, e.g., infectious, waste.
the health sector, strict hygiene requirements apply to the The handling of waste in the health sector is strictly regu-
materials used and to the safe disposal of hazardous waste. lated. Fundamentally, waste must not pose a danger to our
With clear internal guidelines and comprehensive controls, patients, our employees, or the environment. Our production
we ensure that these are complied with. processes and our treatments in health care facilities must
Fresenius | Annual Report 2021
be hygienic and sterile at all times. All business segments
1
Fresenius Medical Care figures include energy consumption and water withdrawal at production sites, as well as electricity consumption and water withdrawal at dialysis centers. Emissions include
scope 1 and 2 emissions of production sites and Scope 2 emissions of in-center treatments in dialysis clinics. The data from Fresenius Helios encompasses as of 2018 all hospitals in Spain and the cli-
nics in Latin America as of 2020. Fresenius Vamed’s data includes all fully consolidated health care facilities and service entities, and, as of 2018, the German post-acute care business transferred from
Fresenius Helios to Fresenius Vamed. Newly acquired companies are included in the second year of consolidation, at the latest. If data of the business segments is not available in time, it is extrapola-
ted on the basis of existing data. An adjustment will be made in the next report. Prior-year information was adjusted to conform to the current year’s presentation. Due to rounding, individual numbers
and percentages presented in this report may not precisely reflect the absolute figures. 208
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
must always dispose of their waste professionally and safely. to defining reduction targets. As part of this, in 2021 the of waste in accordance with the applicable local regula-
As the business models of our business segments are differ- company introduced new measures to improve waste data tions. In general, local EHS managers or dedicated waste
ent, Fresenius conducts waste management on a decentral- collection processes at four pilot production sites. Fresenius managers are responsible for waste management at the
ized basis. The four business segments are responsible for Medical Care plans to roll these measures out to all sites at respective organizations. Where necessary, local training
assessing individual risks and, where necessary, establishing the beginning of 2022. Additionally, the business segment is courses on waste management are conducted. Regular audits
internal guidelines for dealing with waste. The business assessing opportunities at its sites for stepping up the recy- of the commissioned waste disposal companies are con-
segments provide training to their employees and carry out cling or reuse of resources. ducted by the local organizations to ensure compliance with
checks to ensure that the standards contained therein are the applicable regulations.
adhered to. Fresenius Kabi As part of the ISO 14001 requirements, certified organi-
Waste at Fresenius Kabi is mainly generated as a byprod- zations evaluate processes that significantly contribute to the
Fresenius Medical Care uct of production processes or packaging material of the generation of waste as well as identifying potential for
Waste is managed on a local and regional level, allowing product containers in hospitals, private households, or nurs- improvement. The business segment also considers the con-
Fresenius Medical Care to adhere to all applicable laws and ing homes. This includes both non-hazardous and hazard- servation of resources and options for recycling or reuse of
regulations. The business segment has ongoing waste ini- ous waste, i. e. solvents, cytostatics, or antibiotics. the generated waste. Based on the evaluation, measures are
tiatives that help to reduce its environmental footprint. For The business segment’s global environmental standard implemented to reduce waste or increase the recycling
instance, the Reusable Sharps Container Program in the operating procedures include global requirements for waste rate.
United States enables Fresenius Medical Care to reuse each management. The instructions constitute a global frame- If the design of a product is under the control of an
container up to 600 times, thereby reducing the amount of work for the business segment’s waste management and set ISO 14001-certified organization, as part of the life cycle per-
plastic ending up in landfill. Thanks to this program, in 2021, minimum requirements for Fresenius Kabi’s own facilities. spective, the design phase of the product must take envi-
the business segment has reused more than 1.2 million As part of waste management, the business segment has ronmental aspects into account. The influence of the orga-
containers, diverting more than 1,000 t of plastic waste from established a sequence for the measures to be taken: nization on pharmaceutical products can be limited due to
landfill and preventing more than 400 t of carbon emissions. waste prevention, preparation for reuse, recycling, other the importance of patient safety and product quality
recovery, in particular energy recovery and backfilling, requirements.
Progress and measures in 2021 and disposal of the resulting waste. The measures taken must Furthermore, in 2021 the business segment began to take
In 2021, Fresenius Medical Care continued to analyze the always be in compliance with applicable laws and regula- sustainability criteria into account in decision-making pro-
waste streams of its production sites and dialysis clinics in tions. cesses for new projects, such as the development of products
all regions. In the context of the company’s Global Sustain- Each of Fresenius Kabi’s manufacturing sites is required or capacity expansions. ISO 14001-certified organizations
ability Program, Fresenius Medical Care is planning to to separate its waste according to local regulations and to set local targets for their waste management.
Fresenius | Annual Report 2021
develop a global approach to consolidating waste data and store the waste under consideration of measures to protect
the environment, e.g., to avoid contamination. The local
Fresenius Kabi organizations are responsible for the disposal
209
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
Fresenius Kabi records the waste volumes generated at its The Fresenius Helios facilities are subject to strict regula- Fresenius Vamed
production sites, logistics centers, compounding centers, and tions. In Spain, the Law 22 / 2011 on Waste and Contaminated The waste generated in all of Fresenius Vamed’s business
the further ISO 14001-certified organizations and categorizes Soils applies, for example, which sets out requirements for processes is disposed of in accordance with regional,
them by waste type and disposal method. Plastic waste rep- different types of waste applies. Specially trained staff in the national, and industry-specific regulations. The local manage-
resents the largest portion of classified non-hazardous waste. hospitals are responsible for ensuring that the respective ment of each health care facility is responsible for ensuring
Hazardous waste is, to a large extent, processed and reused requirements are met. In particular, if hospitals in Germany compliance with these guidelines. Reusable waste is pro-
for a different or similar purpose. To a large extent, the inter- generate more than two tons of hazardous waste per calen- cessed in the required recycling processes. Other waste is
nally generated waste is recycled. Non-recyclable hazardous dar year, they must appoint a company waste officer or an disposed of by composting or incineration or is sent to land-
waste is mainly incinerated and a large part if it is led into external waste officer and report this to the responsible fill. For clinical and hazardous waste, the individual facili-
energy recovery. authority. For this purpose, the waste officer requires the rel- ties of Fresenius Vamed cooperate with local disposal compa-
evant expertise, which is regulated in the Closed Substance nies, who ensure that the waste is disposed of in compliance
Progress and measures in 2021 Cycle Waste Management Act (Kreislaufwirtschaftsgesetz) with the law.
In 2021, the management approach and the governance in conjunction with the Ordinance on Waste Management The most important legal basis for waste management in
structure of Fresenius Kabi remained as reported in 2020. Officers (Verordnung für Betriebsbeauftragte für Abfall). Austria is the Waste Management Act (AWG 2002), which is
Progress focused on recovery as well as the control of waste, When disposing of waste, Helios Spain and Helios Germany supplemented in the federal states by state laws to include
e.g., in storage, handling, and waste disposal. must take into account not only the requirements of envi- local aspects, such as the fees to be paid. There are also a
ronmental protection, occupational safety, and infection con- large number of legal provisions under European law. All of
Fresenius Helios trol, but also specific hospital hygiene requirements. Appro- these regulations create the legal framework to ensure an
Fresenius Helios sees waste disposal management as a priate disposal containers and cleaning and sterilization efficient waste management industry in Austria.
process. This begins with waste avoidance and continues procedures must be used. The health care facilities built by Fresenius Vamed use
through to consistent recycling or environmentally friendly construction and sanitation technology that enables optimal
disposal. In hospital operations, the business segment must Progress and measures in 2021 resource management adapted to local regulations. The pro-
always meet strict hygiene requirements: medical instru- In 2021, Helios Germany began to implement or prepare for vision of technical management services is a major business
ments and aids are cleaned and packed separately so that the implementation of the new regulatory requirements of segment of Fresenius Vamed. One focus of our activities is
they can be reused as sterile items. In addition, various the German Packaging Act 2021 (VerpackG). For instance, an to ensure the longevity of technical systems through mainte-
disposable medical products are used. This results in waste, initial concept for reusable packaging in the restaurant and nance and repair.
the professional and safe disposal of which must be guar- catering segment was drawn up.
anteed. Helios Spain is also currently working to reduce single-
Fresenius | Annual Report 2021
use plastic in line with European and Spanish legislation.
Large packs, e.g., with dispensers or dosing aids, are increas-
ingly being used to prevent packaging waste. The busi-
ness unit has also been working with a supplier to improve
the labeling of recyclable primary packaging.
210
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
Progress and measures in 2021 CLIMATE PROTECTION – ENERGY Fresenius constantly invests in new buildings and mod-
In 2021, the decentralized management approach and gover- AND EMISSIONS ernizations that meet the latest energy standards and legal
nance structure in the waste and recycling management Climate change and its effects are also impacting Fresenius: requirements.
area of Fresenius Vamed remained as reported in the previ- in health care facilities we have to prepare for rising tempera-
ous year. tures and the increase in severe weather events in order to Fresenius Medical Care
protect the health of patients at all times. Our production pro- Fresenius Medical Care monitors the energy consumption
EVALUATION cesses and the operation of health care facilities require a at its production sites and the electricity usage in its dialysis
No Group results are available for waste management in fis- high level of energy input. Energy-efficiency measures can clinics. In Europe, Middle East, and Africa, the company has
cal year 2021. Although no effects can yet be reported at lead to short- and long-term cost savings; in addition, set local electricity-related targets.
Group level, we report on the measures initiated in 2021 and through the increased usage of renewable energies, they also Further information on the management approach can be
related progress in the business segments. make an important contribution to climate protection. found on page 201.
Fresenius Kabi’s total waste volume increased in 2021.
Fresenius Kabi is continuously working to increase recy- OUR APPROACH Progress and measures in 2021
cling rates¹ and has been able to make progress on hazard- In energy management and climate protection, our aim is to In 2021, Fresenius Medical Care introduced measures to
ous and non-hazardous waste in order to be able to put go beyond the legal framework to identify ways of minimiz- reduce energy consumption at several of its production sites.
valuable resources to further use. The COVID-19 pandemic ing the impact on the environment and to implement these in For example, the business segment has started piloting an
has increased the generation of waste related to protective our management approaches. In 2021, the divisions energy management system at some of the dialysis clinics in
hygienic measures, although this was partly compensated focused primarily on the topics of efficiency enhancement, the United States that aims to improve energy efficiency by
for by the increased amount of remote work carried out by energy saving, and thus the reduction of CO2 emissions. centralizing the control of energy use. The system is expected
administrative employees. Uninterrupted energy supply is a top priority for to be rolled out in 2022 across some 800 locations. In addi-
In our health care facilities and our clinics, the waste vol- Fresenius in order to ensure patient safety and reliable tion, the business segment implemented various projects as
ume caused by disposables and protective gear has increased production or care. We always examine possible energy- part of its Green and Lean Initiative. For example, the com-
due to COVID-19. Especially in the hospitals, the amount saving measures with the greatest care. The energy pany continued to replace fluorescent lighting with LED light-
of (potentially) infectious waste requiring special disposal management system is geared to the requirements of our ing in selected warehouses and production areas to save
increased. business segments and is certified according to ISO 50001. energy.
We are constantly expanding the number of certified sites. Fresenius Medical Care also assessed the share of renew-
able energy impact within its total electricity consumption.
Fresenius | Annual Report 2021
1
Calculation of the recycling rate has been updated according to the GRI standard 306-4 (2020) for waste by category and disposal method applied as of
2021 for both, 2020 and 2021 data; waste disposed for energy recovery is no longer categorized as recycled waste. 211
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
To do this, the company considered the country-specific Responsibility for energy management lies with the divi- heat generation. In addition, more frequent severe weather
average share of renewables needed to produce electricity. sional and local organizations; global management responsi- events such as heavy rainfall or flooding may pose a threat to
According to this calculation, renewables accounted for bility lies with the central EHS function, which reports to the the health care services of hospitals.
22% of total electricity consumption in 2021, compared with responsible member of Fresenius Kabi’s Management Board. In Germany, the Infrastructure business unit has estab-
21% in 2020. In the United States, the business segment Further information on the management approach can lished a central energy procurement and management sys-
purchased 140,000 MWh worth of Green-e certified Renew- be found on page 202. tem that records the energy consumption of each site. Helios
able Energy Certificates (RECs) in 2021. These correspond Germany uses this system to compare consumption figures
to about 54,000 t of Scope 2 CO2 equivalent and account for Progress and measures in 2021 and to initiate improvement measures. Helios Germany’s own
10.7% of the business segment’s global Scope 2 emissions In 2021, the management approach and governance struc- energy supplier, HKG Energiedienstleistungen GmbH, is
(calculated based on location-specific emission factors). ture of Fresenius Kabi remained as reported in 2020. Prog- responsible for energy procurement.
ress focused on increasing energy efficiency and reducing Various parameters can be monitored via a central portal
Fresenius Kabi CO2 emissions in proportion to the volume of its production – from the price of electricity on the energy market to the
The focus of the energy management system at Fresenius activities. hospitals’ respective energy consumption. In order to monitor
Kabi is on improving energy performance and preventing For energy management, the Global Competence Cluster energy flows more precisely, a measurement concept is
excessive use of energy. Key opportunities are reducing Energy and Water Management, an internal information plat- being implemented at relevant sites. This is an essential com-
energy and emissions in proportion to the volume of produc- form for global exchange, has already produced ideas for ponent to meet the requirements of the ISO 50001 stan-
tion activities. Fresenius Kabi derives its energy mainly improvements. Four energy-saving projects were concluded dard. With its central energy procurement and management
from external providers. This includes the purchase of renew- in 2021. Furthermore, potential exemplary methods for the system, Fresenius Helios can compare the consumption
able energy such as hydropower, solar, or wind power. The intracompany transfer and new projects are currently being values of the clinics, initiate targeted improvement measures,
business segment also generates electricity in its own facil- evaluated. Four projects concluded in 2021 will lead to sav- and share best practices from individual clinics within the
ities and uses, e.g., combined heat and power systems. ings of approximately 241.3 t of CO2 annually; the savings of company.
Fresenius Kabi wants to increase the share of renewable another project will be evaluated in 2022. Helios Spain analyzes its energy management risks and
energy in its overall energy consumption. uses renewable energy sources in some clinics. In order to
Local measurable objectives and energy targets are Fresenius Helios ensure an uninterrupted energy supply at all times, every
derived from the business segment’s global energy policy. As The rising temperatures resulting from climate change are hospital has a mains backup system: in the event of a power
stated on pages 200 f. of the Non-Financial Consolidated also affecting Fresenius Helios’ business operations, espe- outage, this system guarantees a secure supply of electric-
Report, Fresenius Kabi has matrix certification for its global cially in Spain. In recent years, refrigeration technology, ity for the principal energy consumers in the clinics within
energy management system, which is audited annually and which serves to cool technical equipment and hospital rooms,
Fresenius | Annual Report 2021
certified by TÜV Rheinland. has become more important for hospital operations than
212
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
a few seconds. To safeguard this protection, these emer- In 2021, Helios Spain analyzed whether technical installa- EVALUATION 1
gency power systems are inspected and tested regularly, at tions needed to be renewed. The business unit also con- We calculate our Scope 1 and 2 GHG emissions following the
least once a year. ducted a study on the use of solar energy systems. methodology of the Greenhouse Gas Protocol, using the lat-
Electricity and natural gas are purchased centrally at est version from the UK Department for Environment, Food
Helios Spain. The business unit also has an energy manager, Fresenius Vamed and Rural Affairs (DEFRA). We also use the emission factors
who monitors the consumption of all hospitals and provides The respective management teams are responsible for energy of the International Energy Agency (IEA) for electricity con-
corresponding data for evaluation and comparative analyses. and emission management at Fresenius Vamed’s health care sumption. We additionally use these emission factors to cal-
In addition, each hospital reviews and implements specific facilities. The effectiveness of energy management measures culate the indirect emissions from electricity.
energy-saving measures. Seven Helios Spain hospitals use in the certified business segments is assessed by regular Fresenius 1 consumed a total of 5.8 million MWh of energy
thermal solar energy and photovoltaic systems to generate independent audits as part of ISO 50001 certification. In Ger- in 2021, an increase of 6% compared to the previous year;
energy. To generate thermal energy, the division also uses many, this certification was implemented together with the the main energy sources were gas (thereof 97% natural gas)
miniature combined heat and power plants at two hospitals Infrastructure business unit of the Fresenius Helios hospitals. and district heating. When purchasing energy, we consider
and biomass at another hospital. efficiency requirements and changes in demand. We are
Progress and measures in 2021 exploring the possible use of renewable energies and already
Progress and measures in 2021 In 2021, the management approach and governance struc- generate our own electricity at numerous sites. In 2021, the
In order to improve the data situation regarding electricity ture of Fresenius Vamed remained as reported in the previ- share of renewable energy consumption was 2%. Among the
consumption and to comply with the requirements of the Ger- ous year. Progress focused on the ongoing internal prepa- main energy sources, electricity demand is our most mate-
man Renewable Energies Act (EEG), Helios introduced a ration of the process documentation as part of the ESG rial driver of CO2 emissions. Accordingly, Scope 2 emissions
Group-wide measurement and delimitation concept in 2021. component of variable Management Board compensation. are higher than Scope 1 emissions in all business segments.
Corresponding metering technology measures all electric- Furthermore, a pilot project was initiated in order to be In 2021, Fresenius generated a total of 1,524 thousand tons
ity consumption at all hospital locations and distinguishes able to collect data on Scope 3 emissions in the future from of CO2 equivalents (2020: 1,512 thousand tons).
between Helios’ own consumption and that of third parties, industrial activities in Austria, Germany, Switzerland, and At Fresenius Medical Care, total emissions (Scope 1 and
e.g., units rented by flower stores. the Czech Republic. Scope 2) decreased by 1% in 2021 compared with 2020.
The reported Scope 1 emissions increased by 8% in 2021
compared to 2020. This increase is due to more accurate
data reporting and a change in the reporting approach, with
Fresenius | Annual Report 2021
1
Fresenius Medical Care figures include energy consumption and water withdrawal at production sites, as well as electricity consumption and water withdrawal at dialysis centers. Emissions include
scope 1 and 2 emissions of production sites and Scope 2 emissions of in-center treatments in dialysis clinics. The data from Fresenius Helios encompasses as of 2018 all hospitals in Spain and the
clinics in Latin America as of 2020. Fresenius Vamed’s data includes all fully consolidated health care facilities and service entities, and, as of 2018, the German post-acute care business transferred
from Fresenius Helios to Fresenius Vamed. Newly acquired companies are included in the second year of consolidation, at the latest. If data of the business segments is not available in time, it is
extrapolated on the basis of existing data. An adjustment will be made in the next report. Prior-year information was adjusted to conform to the current year’s presentation. Due to rounding, individual
numbers and percentages presented in this report may not precisely reflect the absolute figures. 213
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
the reporting tool now automatically calculating conversions in production, which affected energy performance and GROUP ENERGY CONSUMPTION BY SOURCE
for natural gas. The reported Scope 2 emissions decreased by consequently the generation of emissions. Energy perfor-
5% due to enhanced data reporting as well as lower emis- mance was also affected in 2021 by expansion measures Fossil fuels, excl. gas 2% Renewable energies 2%
sion factors provided by the IEA. Most of the Scope 1 and and regulatory validation processes, e.g., the testing of new
Scope 2 GHG emissions stem from energy consumption. production lines for quality requirements. Purchased heat, steam Gas 47%
Fresenius Medical Care is currently assessing Scope 3 emis- The spread of coronavirus required our Spanish hospi- and cooling 7%
sions that arise from activities or assets that the company tals to increase ventilation, so the energy consumption
does not own or control along its value chain. required for air conditioning increased in some facilities in Electricity 42%
Each year, the headquarters of Fresenius Kabi are 2021.
audited by TÜV Rheinland with regard to the ISO 50001 5.84 MWh in millions
energy management certification. In 2021, no observations
were detected, confirming that the energy management
system is in line with the requirements of ISO 50001. Fur-
ther, Fresenius Kabi successfully achieved the self-imposed
FRESENIUS GROUP 1 ENERGY CONSUMPTION
target for the continuing roll-out of the ISO 50001 energy
management system in accordance with the internal imple- MWh in millions 2021 2020 2019 2018 2017
mentation plan, thus expanding the coverage of the man Fresenius Medical Care 2.61 2.49 2.43 2.38 n. a.
agement system to additional manufacturing plants. The Fresenius Kabi 1.79 1.66 1.64 1.65 1.57
ongoing COVID-19 pandemic had no impact on the roll-out Fresenius Helios 1.24 1.16 1.09 1.14 0.95
of the energy management system according to ISO 50001 Fresenius Vamed 0.19 0.18 0.16 0.17 0.05
Total 5.84 5.47 5.32 5.34 n. a.
in 2021.
In addition, the focus in the past fiscal year was on
increasing energy efficiency and the share of renewable
FRESENIUS GROUP 1 RELATIVE ENERGY CONSUMPTION
energy in total energy consumption. Furthermore, the
COVID-19 pandemic had an impact, e.g., on energy perfor- in MWh 2021 2020 2019 2018
mance in some countries due to the significant energy Energy consumption / € 1 million sales 156 151 150 159
baseload in combination with COVID-19-related fluctuations Energy consumption / FTE 20.9 19.8 20.3 21.7
Fresenius | Annual Report 2021
1
Fresenius Medical Care figures include energy consumption and water withdrawal at production sites, as well as electricity consumption and water withdrawal at dialysis centers. Emissions include
scope 1 and 2 emissions of production sites and Scope 2 emissions of in-center treatments in dialysis clinics. The data from Fresenius Helios encompasses as of 2018 all hospitals in Spain and the
clinics in Latin America as of 2020. Fresenius Vamed’s data includes all fully consolidated health care facilities and service entities, and, as of 2018, the German post-acute care business transferred
from Fresenius Helios to Fresenius Vamed. Newly acquired companies are included in the second year of consolidation, at the latest. If data of the business segments is not available in time, it is
extrapolated on the basis of existing data. An adjustment will be made in the next report. Prior-year information was adjusted to conform to the current year’s presentation. Due to rounding, individual
numbers and percentages presented in this report may not precisely reflect the absolute figures. 214
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity Environment | Report profile | Limited assurance report of the independent auditor
At Fresenius Vamed, operations in 2021 concentrated on FRESENIUS GROUP 1 RELATIVE GHG EMISSIONS SCOPE 1 AND 2
developing the management approach to climate protection
in connection with the ESG component of variable Manage- t CO2 equivalents in thou. 2021 2020 2019 2018
ment Board compensation. Relevant collection and control t CO2 equivalents / € 1 million sales 41 42 42 46
t CO2 equivalents / FTE 5.5 5.5 5.8 6.2
processes were also defined. Furthermore, the business
segment was involved in the diverse discussions at the
Fresenius Group on the definition of a CO2 reduction target. F RESENIUS GROUP 1 GREENHOUSE GAS EMISSIONS (GHG) SCOPE 1 AND 2
As the processes for the above items are still ongoing, no
t CO2 equivalents in thou. 2021 2020 2019 2018 2017
changes in management approaches are to be reported for
Fresenius Medical Care 766 770 775 776 n. a.
2021. With regard to energy consumption, 2021 can be
Scope 1 263 242 227 219 n. a.
considered a return to a normal year at Fresenius Vamed. Scope 2 503 527 547 557 n. a.
After many facilities were closed for longer periods in 2020 Fresenius Kabi 443 417 409 424 422
due to the COVID-19 pandemic, consumption levels in 2021 Scope 1 170 160 169 169 174
returned to the pre-pandemic level. Scope 2 273 256 239 255 248
Fresenius Helios 277 287 284 296 255
Scope 1 122 112 107 114 103
Scope 2 155 175 178 182 152
Fresenius Vamed 39 39 36 38 9
Scope 1 23 21 18 19 3
Scope 2 16 17 18 19 6
Total 1,524 1,512 1,504 1,534 n. a.
Scope 1 578 536 522 521 n. a.
Scope 2 946 976 982 1,013 n. a.
GHG emissions in t CO2 e
Fresenius | Annual Report 2021
1
Fresenius Medical Care figures include energy consumption and water withdrawal at production sites, as well as electricity consumption and water withdrawal at dialysis centers. Emissions include
scope 1 and 2 emissions of production sites and Scope 2 emissions of in-center treatments in dialysis clinics. The data from Fresenius Helios encompasses as of 2018 all hospitals in Spain and the
clinics in Latin America as of 2020. Fresenius Vamed’s data includes all fully consolidated health care facilities and service entities, and, as of 2018, the German post-acute care business transferred
from Fresenius Helios to Fresenius Vamed. Newly acquired companies are included in the second year of consolidation, at the latest. If data of the business segments is not available in time, it is
extrapolated on the basis of existing data. An adjustment will be made in the next report. Prior-year information was adjusted to conform to the current year’s presentation. Due to rounding, individual
numbers and percentages presented in this report may not precisely reflect the absolute figures. 215
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment Report profile | Limited assurance report of the independent auditor
REPORT PROFILE Further, we also report ESG information in accordance with materiality analysis, see pages 110 f. of the Group Non-finan-
We want to inform our stakeholders transparently about our the SASB Index and the Task Force on Climate-related cial Report 2020 for more information. Experts from the
sustainability activities through this report. The report meets Financial Disclosures (TCFD). These additional indices, out- four business segments as well as relevant Group functions
the regulatory requirements for a separate Group Non-fi- side of the Non-financial Report, include information pro- have reviewed and validated the results. In 2021, a review
nancial Report. It was prepared in accordance with Section vided in the audited Group Non-financial report, however, confirmed the identified materials topics as still valid. The
315c in connection with Sections 289c to 289e of the Ger- they were not part of the audit process. content of this separate Group Non-financial Report was
man Commercial Code (HGB). The EU taxonomy disclosures defined in accordance with Sections 289c (2) and (3) HGB
included were prepared in accordance with REGULATION REPORT FRAMEWORK for the principle of dual materiality. The Management
(EU ) 2020 / 852 OF THE EUROPEAN PARLIAMENT AND OF This separate Group Non-financial Report covers the finan- Board has reviewed and approved this report. The contents
THE COUNCIL of 18 June 2020 on the establishment of a cial year (calendar year) 2021 and relates to the Group of the have also been examined by the Supervisory Board
framework to facilitate sustainable investment, and amend- including its four business segments, i. e., all fully consoli- of Fresenius SE & Co. KGaA in accordance with Section 171
ing Regulation (EU) 2019 / 2088 (EU Taxonomy Regulation). dated companies that are subject to the legal or actual (1) of the German Stock Corporation Act (AktG). The Super-
Together with the additional information we offer on our web control of Fresenius SE & Co. KGaA, Bad Homburg, Germany. visory Board made use of the option pursuant to Section
site, it forms our Sustainability Report 2021. For the pre The Notes to the consolidated financial statements in 111 (2) of the German Stock Corporation Act (AktG) to com-
paration of the Group Non-Financial Report, we considered the Annual Report contain further information, see pages mission an external audit by PricewaterhouseCoopers
the Sustainability Code (Deutscher Nachhaltigkeitskodex) 288 ff. Deviations from this reporting framework are marked GmbH Wirtschaftsprufungsgesellschaft.
and the standards of the Global Reporting Initiative (GRI) as in the appropriate place. References to data or information
possible frameworks. Due to our global business activities, outside of the Group Management Report or the Notes are EXTERNAL AUDIT
we decided to use the globally recognized GRI standards as considered further information and are not part of the Auditors PricewaterhouseCoopers GmbH Wirtschafts
a framework.In accordance with Section 289d HGB, Fresenius separate Group Non-financial Report. The report is published prufungsgesellschaft submitted the information in the sepa-
SE & Co. KGaA uses the GRI Standards for the structured annually as a separate Group Non-financial Report and is rate Group Non-financial Report to an audit according to
description of management approaches in accordance with part of the Annual Report. The last separate Group Non-finan- ISAE 3000 (Revised) to obtain limited assurance against the
GRI 103: Management Approach 2016. Furthermore, this cial Report was published in March 2021. relevant legal requirements and issued an independent
report contains a review of the materiality analysis we con- audit certificate.
ducted in 2020 in accordance with GRI 102-46 (determina- DETERMINATION OF THE CONTENTS
tion of report content and topic delimitation) from GRI 102: OF THE REPORT
General Disclosures 2016 and the legal requirements. We base our choice of report content on the GRI standards,
the principles of materiality and the requirements of our
Fresenius | Annual Report 2021
stakeholders, especially the capital market. In addition, the
United Nations’ Sustainable Development Goals (SDGs)
serve as a framework for identifying and aligning our sus-
tainability activities. In 2020, we conducted a comprehensive
216
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile Limited assurance report of the independent auditor
INDEPENDENT PRACTITIONER’S their own interpretation of the wording and terms con- INDEPENDENCE AND QUALITY CONTROL
REPORT ON A LIMITED ASSURANCE tained in the EU Taxonomy Regulation and the Delegated OF THE AUDIT FIRM
Acts adopted thereunder, as set out in section “1 Strategy We have complied with the German professional provi-
ENGAGEMENT ON NON-FINANCIAL and management – EU-Taxonomy” of the Separate Non- sions regarding independence as well as other ethical
REPORTING 1 financial Group Report. requirements.
This responsibility includes the selection and application Our audit firm applies the national legal requirements
To Fresenius SE & Co. KGaA, Bad Homburg of appropriate non-financial reporting methods and making and professional standards – in particular the Professional
assumptions and estimates about individual non-financial Code for German Public Auditors and German Chartered
We have performed a limited assurance engagement on the disclosures of the Group that are reasonable in the circum- Auditors (“Berufssatzung für Wirtschaftsprüfer und vereidigte
Separate Non-financial Group Report of Fresenius SE & Co. stances. Furthermore, the executive directors are respon Buchprüfer“: “BS WP / vBP”) as well as the Standard on
KGaA, Bad Homburg, (hereinafter the “Company”) for the sible for such internal controls as the executive directors Quality Control 1 published by the Institut der Wirtschafts-
period from 1 January to 31 December 2021 (hereinafter the consider necessary to enable the preparation of a Separate prüfer (Institute of Public Auditors in Germany; IDW):
“Separate Non-financial Group Report”). Non-financial Group Report that is free from material mis- Requirements to quality control for audit firms (IDW Qual-
Not subject to our assurance engagement are the exter- statement whether due to fraud or error. itätssicherungsstandard 1: Anforderungen an die Quali
nal sources of documentation or expert opinions mentioned The EU Taxonomy Regulation and the Delegated Acts tätssicherung in der Wirtschaftsprüferpraxis - IDW QS 1) –
in the Separate Non-financial Group Report. issued thereunder contain wording and terms that are still and accordingly maintains a comprehensive system of
subject to considerable interpretation uncertainties and quality control including documented policies and proce-
RESPONSIBILITY OF THE EXECUTIVE for which clarifications have not yet been published in every dures regarding compliance with ethical requirements,
DIRECTORS case. Therefore, the executive directors have disclosed professional standards and applicable legal and regulatory
The executive directors of the Company are responsible for their interpretation of the EU Taxonomy Regulation and the requirements.
the preparation of the Separate Non-financial Group Report Delegated Acts adopted thereunder in section “1 Strategy
in accordance with §§ (Articles) 315c in conjunction with and management – EU-Taxonomy” of the Separate Non- RESPONSIBILITY OF THE ASSURANCE
289c to 289e HGB (“Handelsgesetzbuch”: “German Commer- financial Group Report. They are responsible for the defen- PRACTITIONER
cial Code”) and Article 8 of REGULATION (EU) 2020 / 852 sibility of this interpretation. Due to the immanent risk Our responsibility is to express a conclusion with limited
OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of that indeterminate legal terms may be interpreted differently, assurance on the Separate Non-financial Group Report
18. June 2020 on establishing a framework to facilitate sus- the legal conformity of the interpretation is subject to based on our assurance engagement.
tainable investment and amending Regulation (EU) 2019 / uncertainties. We conducted our assurance engagement in accordance
2088 (hereinafter the “EU Taxonomy Regulation”) and the with International Standard on Assurance Engagements
Fresenius | Annual Report 2021
Delegated Acts adopted thereunder, as well as for making (ISAE) 3000 (Revised): Assurance Engagements other than
Audits or Reviews of Historical Financial Information,
issued by the IAASB. This Standard requires that we plan
1
PricewaterhouseCoopers GmbH has performed a limited assurance engagement on the German version of the separate non-financial group report and issued
an independent practitioner’s report in German language, which is authoritative. The following text is a translation of the independent practitioner’s report. 217
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Strategy and management | Well-being of the patient | Digital transformation and innovation | Employees | Diversity
Compliance & Integrity | Environment | Report profile Limited assurance report of the independent auditor
and perform the assurance engagement to obtain limited ▶ Evaluation of the implementation of central manage- with §§ 315c in conjunction with 289c to 289e HGB and
assurance about whether any matters have come to our ment requirements, processes, and specifications the EU Taxonomy Regulation and the Delegated Acts issued
attention that cause us to believe that the Company’s Sepa- regarding data collection through targeted sample test- thereunder as well as the interpretation by the executive
rate Non-financial Group Report, other than the external ing at selected sites directors disclosed in section “1 Strategy and management
sources of documentation or expert opinions mentioned in ▶ Analytical procedures on selected disclosures in the – EU-Taxonomy” of the Separate Non-financial Group
the Separate Non-financial Group Report, are not prepared, Separate Non-financial Group Report Report. We do not express an assurance opinion on the
in all material respects, in accordance with §§ 315c in con- ▶ Evaluation if the preparation of the ESG targets, which external sources of documentation or expert opinions
junction with 289c to 289e HGB and the EU Taxonomy Reg are part of the Management Board compensation as mentioned in the Separate Non-financial Group Report.
ulation and the Delegated Acts issued thereunder as well as non-financial performance targets, is in line with the
the interpretation by the executive directors disclosed in methodology described in the Compensation Report RESTRICTION OF USE
section “1 Strategy and management – EU -Taxonomy” of ▶ Reconciliation of selected disclosures with the corre- We draw attention to the fact that the assurance engage-
the Separate Non-financial Group Report. sponding data in the consolidated financial statements ment was conducted for the Company’s purposes and that
In a limited assurance engagement the procedures per- and group management report the report is intended solely to inform the Company about
formed are less extensive than in a reasonable assurance ▶ Evaluation of the presentation of the Separate Non- the result of the assurance engagement. Consequently, it may
engagement, and accordingly a substantially lower level of financial Group Report not be suitable for any other purpose than the aforemen-
assurance is obtained. The selection of the assurance ▶ Evaluation of the process to identify taxonomy-eligible tioned. Accordingly, the report is not intended to be used by
procedures is subject to the professional judgement of the economic activities and the corresponding disclosures third parties for making (financial) decisions based on it.
assurance practitioner. in the Separate Non-financial Group Report Our responsibility is to the Company. We do not accept any
▶ Inquiries on the relevance of climate-risks responsibility to third parties. Our assurance opinion is not
In the course of our assurance engagement, we have, modified in this respect.
amongst other things, performed the following assurance In determining the disclosures in accordance with Article 8
procedures and other activities: of the EU Taxonomy Regulation, the executive directors Frankfurt am Main, February 21, 2022
are required to interpret undefined legal terms. Due to the
▶ Gain an understanding of the structure of the Group’s immanent risk that undefined legal terms may be inter- PricewaterhouseCoopers GmbH
sustainability organisation and stakeholder engagement preted differently, the legal conformity of their interpretation Wirtschaftsprüfungsgesellschaft
▶ Inquiries of the executive directors and relevant employ- and, accordingly, our assurance engagement thereon are
ees involved in the preparation of the Separate Non- subject to uncertainties.
financial Group Report about the preparation process,
Fresenius | Annual Report 2021
about the internal control system relating to this pro- ASSURANCE OPINION [Original German version signed by:]
cess and about disclosures in the Separate Non-financial Based on the assurance procedures performed and evidence
Group Report obtained, nothing has come to our attention that causes us Nicolette Behncke ppa. Mirjam Kolmar
▶ Identification of likely risks of material misstatement in to believe that the Separate Non-financial Group Report of Wirtschaftsprüfer
the Separate Non-financial Group Report the Company for the period from 1 January to 31 December [German Public Auditor]
2021 is not prepared, in all material respects, in accordance
218
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
CORPORATE GOVERNANCE
220 Corporate Governance Declaration 232 Further information on
220 Group management and supervision structure and corporate Corporate Governance
bodies 232 Diversity
226 Objectives for the composition, profile of skills and expertise, 233 Disclosures on directors’ dealings / managers’ transactions
and diversity concept and shareholdings in 2021
229 Relevant disclosures on corporate governance practices 233 Transparency and communication
230 German corporate governance and declaration of conformity 233 Financial accounting and reporting
234 Compensation report
4
Fresenius | Annual Report 2021
219
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
CORPORATE GOVERNANCE DECLARATION.
The Supervisory Board and the Management Board
are committed to responsible management that is
focused on achieving a s ust ainable increase in the
value of the Company. Long-term corporate strate-
gies, solid financial m anagement, strict adherence
to legal and ethical business standards, and trans-
parency in corporate communication are key factors.
In this Corporate Governance Declaration, the Supervisory CORPORATE GOVERNANCE corporate bodies. There have been no changes in the
Board of Fresenius SE & Co. KGaA and the Management DECLARATION Group management and the supervision structure in the
Board of the general partner of Fresenius SE & Co. KGaA, reporting period. The chart on the following page pro-
Fresenius Management SE (Management Board), report on GROUP MANAGEMENT AND SUPERVISION vides an overview of the Group structure.
corporate management pursuant to Sections 289 f and STRUCTURE AND CORPORATE BODIES The articles of association of Fresenius SE & Co. KGaA,
315 d of the German Commercial Code (HGB) and on the cor- which, in addition to legal provisions, further define the
Fresenius | Annual Report 2021
porate governance of the Company pursuant to the Ger- GROUP MANAGEMENT AND responsibilities of the individual corporate bodies, can be
man Corporate Governance Code. The Corporate Governance SUPERVISION STRUCTURE downloaded from our website, see www.fresenius.com/
Declaration is published on our website, see The Company has the legal form of a KGaA (Kommanditge- corporate-governance.
www.fresenius.com/corporate-governance. sellschaft auf Aktien – partnership limited by shares). The
Annual General Meeting, the Supervisory Board, and the
general partner Fresenius Management SE are the legal
220
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
SHAREHOLDERS STRUCTURE OF FRESENIUS SE & CO. KGAA
The shareholders uphold their rights at the Annual Gen-
eral Meeting, where they exercise their voting rights. reduced voting power 1
Else Kröner-Fresenius-Stiftung Free float
Every ordinary share of Fresenius SE & Co. KGaA confers
one vote. None of the shares carry multiple or preferential 100% 27% 73%
voting rights.
We report in detail on our investor relations activities in Annual General Meeting Annual General Meeting
Fresenius Management SE Fresenius SE & Co. KGaA
the section “Fresenius share” on page 35.
elects elects
ANNUAL GENERAL MEETING
Supervisory Board Supervisory Board
Our virtual Annual General Meeting (AGM) was held on Fresenius Management SE Fresenius SE & Co. KGaA
May 21, 2021, in Bad Homburg vor der Höhe. Approxi-
supervises / supervises
mately 73% of the share capital was represented. As in the appoints board management
previous year, in order to protect the health of the share-
Fresenius Management SE manages Fresenius SE & Co. KGaA
holders as well as the employees and external partners (general partner)
involved in the organization, Fresenius took advantage of
the option created by the legislator due to the COVID-19
pandemic to hold the Annual General Meeting virtually. The or selected items no voting power, e.g., election of Supervisory Board of Fresenius SE & Co. KGaA, discharge of general partner and Supervisory Board
F
1
of Fresenius SE & Co. KGaA, election of the auditor
shareholders elected Mr. Wolfgang Kirsch with a majority
of 98% as a new member to the Supervisory Board of
SE & Co. KGaA . The five other shareholder representatives During the AGM, the shareholders approved the proposal sole authority to decide on these matters, especially those
were re-elected in the course of the regular Supervisory made by the general partner and the Supervisory Board that pertain to the supervision of management.
Board elections. Following the Annual General Meeting, the to increase the 2020 dividend by 5% to € 0.88 per ordinary Documents and information on the Annual General
new Supervisory Board elected Mr. Wolfgang Kirsch as share with a majority of more than 99% of the votes cast. Meeting, as well as the voting results, are available on our
its Chairman at its constituent meeting. With a majority of Shareholder majorities of around 99% and 91%, respec- website at www.fresenius.com/annual-general-meeting.
92%, the Annual General Meeting approved a new com- tively, approved the actions of the general partner and the
pensation system for the Management Board of the General Supervisory Board in 2020. MANAGEMENT BOARD AND SUPERVISORY
Partner. With regard to certain subject matters, legally required BOARD PROCEDURES
Fresenius | Annual Report 2021
voting right exclusions exist for the general partner and The responsibilities are distributed as follows in Fresenius
for its sole shareholder, the Else Kröner-Fresenius-Stiftung. SE & Co. KGaA: the Management Board of the general part-
These pertain, for example, to the appointment of the ner is responsible for conducting the business of Fresenius
Supervisory Board of Fresenius SE & Co. KGaA, the approvals SE & Co. KGaA. The Supervisory Board of Fresenius SE & Co.
of the actions of the general partner and the members of KGaA supervises the management of the Company’s busi-
the Supervisory Board, and the selection of the auditor. ness by the general partner.
This guarantees that the remaining shareholders retain the
221
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
General partner – Management and The Group departments Finance, Group Controlling, Inter- is most senior in age. However, Management Board meet-
Supervisory Boards nal Audit, and Tax report to the Chief Financial Officer ings are usually held twice a month. The person chairing the
The general partner, Fresenius Management SE, repre- directly. Further, the Chief Financial Officer coordinates meeting decides the order in which the items on the agenda
sented by its Management Board, manages Fresenius SE & Co. cybersecurity activities at Fresenius. are dealt with and the form in which the voting is con-
KGaA at its own responsibility and conducts its business. Members of the Management Board also lead internal ducted. The Management Board passes its resolutions by a
The Management Board formulates the Company’s strategy, working groups or committees, for example the Compli- simple majority of the votes cast or, outside its meetings,
discusses it with the Supervisory Boards of Fresenius ance Steering Committee or the Group Sustainability Board. by a simple majority of its members, except in cases where
Management SE and Fresenius SE & Co. KGaA, and oversees Further information is included on pages 114 ff. of the mandatory provisions of law impose stricter requirements.
its implementation. Its actions and decisions are aligned Group Non-financial Report. The Chairman of the Management Board has the casting
with the best interests of Fresenius SE & Co. KGaA. The There are no Management Board committees owing to vote if a vote is tied. If the Chairman is incapacitated or
Management Board is committed to increasing the value of Fresenius SE & Co. KGaA’s role as an operating holding com- absent, the motion is deemed rejected if a vote is tied. The
the Company on a sustainable basis. The rules of proce- pany. The Management Board is listed on page 395 of the rules of procedure for the Management Board also govern
dure for the Management Board were established by the Annual Report. the relations between the Management Board and the Super-
Supervisory Board of Fresenius Management SE. They Members of the Management Board are appointed for a visory Board of the general partner, as well as between
define the activities within the board more specifically, espe- maximum period of five years. Following the recommen the general partner and the Supervisory Board of Fresenius
cially with regard to the individual duties and responsi dation of the Code, first-time appointments are for a three- SE & Co. KGaA, and also matters that require approval of
bilities of the members, matters reserved for the full Man- year period. the general partner’s Supervisory Board.
agement Board, and resolutions to be passed by the full Effective April 12, 2021, Mr. Michael Sen was appointed As a European company (SE – Societas Europaea),
Management Board. Chairman of the Management Board of Fresenius Kabi AG Fresenius Management SE has its own Supervisory Board.
The Management Board, in principle, consists of seven and member of the Management Board of Fresenius Man- It consists of six members, and its Chairman is Dr. Gerd
members: the Chairman, the Chief Financial Officer, the agement SE responsible for the business segment Fresenius Krick. The Supervisory Board appoints the members of the
Management Board Member resposible for Human Resources Kabi. He succeeds Mr. Mats Henriksson, who left the Com- Management Board of Fresenius Management SE and
(Labor Relations Director), Risk Management and Legal pany on March 16, 2021. supervises and advises the Management Board in conduct-
and the chief executive officers of the four business seg- By resolution of the Supervisory Board of Fresenius ing business. If necessary, e.g., in order to discuss or
ments. This ensures that the full Management Board is kept Management SE dated May 21, 2021, a standard age limit decide on matters concerning the Management Board, the
constantly informed about important events, plans, devel- was introduced for the Management Board. Since then, Supervisory Board meets without the Management Board.
opments, and measures within the business segments. newly appointed members of the Management Board shall, It has established its own rules of procedure.
According to the rules of procedure, the CEO is responsible as a rule, retire from the Management Board after reaching The Supervisory Board members of Fresenius Manage-
Fresenius | Annual Report 2021
for coordinating the business segments, the general cor the age of 65 at the end of the calendar year. ment SE can be found on page 396 of the Annual Report.
porate policy, and the investment policy. The subject of Group The meetings of the Management Board are convened With the end of the Annual General Meeting on May 21,
sustainability is also directly reported to the CEO. Further as required, but at least once a month, and are chaired by 2021, Dr. Gerd Krick as well as Mr. Klaus-Peter Müller regu-
information on sustainability matters can be found in the the Chairman of the Management Board or, if he is incapac- larly resigned from the Supervisory Board of Fresenius
Group Non-financial Report on pages 114 ff. itated, by the Chief Financial Officer or, if she is also inca-
pacitated, by the Management Board member present who
222
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
Management SE without standing for re-election. In their The Supervisory Board of Fresenius SE & Co. KGaA sory Board were held by rotation. The statutory quotas were
place, Ms. Susanne Zeidler and Dr. Frank Appel were elected The Supervisory Board of Fresenius SE & Co. KGaA super- met prior to these elections and continue to be met.
as new members of the Supervisory Board of Fresenius vises the management of the Company’s business by the By resolution of the Supervisory Board of Fresenius SE &
Management SE. Mr. Wolfgang Kirsch, who had previously general partner Fresenius Management SE. It supervises Co. KGaA on May 21, 2021, a standard age limit was intro-
been a member of the Supervisory Board, succeeds Dr. Gerd business operations to ensure that the Management Board’s duced for the Supervisory Board of Fresenius SE & Co. KGaA.
Krick as the new Chairman of the Supervisory Board of corporate decisions are compliant, suitable, and finan- According to this, the Supervisory Board of Fresenius SE &
Fresenius Management SE in this function. Dr. Gerd Krick cially sound. In addition, the Supervisory Board reviews the Co. KGaA should generally only have members who have not
was appointed Honorary Chairman of the Supervisory Group’s annual financial statements, taking into account yet reached the age of 75 at the time of their election or
Board of Fresenius Management SE in recognition of his the auditor’s reports. Another important part of the Super- appointment. The average age on the Supervisory Board as
outstanding services to the Company. visory Board’s activities is the work conducted within the of December 31, 2021 was around 61 years. All members
The Supervisory Board of Fresenius Management SE committees formed in accordance with the requirements of have served an average of more than five years on the board.
appoints the members of the Management Board of the the German Stock Corporation Act and the recommenda- The competencies and the expert knowledge of all mem-
general partner and also ensures long-term succession plan- tions of the Code. The Management Board of the general part- bers support the discussion and the information exchange
ning. This is based on discussions with members of the ner – Fresenius Management SE – continuously informs within the board. In 2021, the objectives for the composition
Management Board and impressions of other managers the Supervisory Board of the corporate development, plan- and profile of skills and expertise of the Board were met.
gained at the meetings of the Supervisory Boards of ning, and strategy. Further information can be found on pages 226 ff. of the
Fresenius Management SE and Fresenius SE & Co. KGaA. The Supervisory Board of Fresenius SE & Co. KGaA con- Annual Report.
In this way, the Supervisory Board can form an opinion sists of 12 members. The Supervisory Board members can The Supervisory Board of Fresenius SE & Co. KGaA ful-
on potential successors from within the Company. be found on page 393 f. of the Annual Report. Half of its mem- fills its tasks in accordance with the provisions of law, the
bers are elected by the AGM. The proposals for the mem- articles of association of Fresenius SE & Co. KGaA, and its rules
Information on the compensation of the Management bers of the Supervisory Board primarily take account of the of procedure. The Chairman is responsible for coordinating
Board and Supervisory Board of Fresenius Management knowledge, ability, and expert experience required to the activities of the Supervisory Board, chairing the meet-
SE can be found here: perform the tasks. The election proposals provided by the ings, and representing its interests externally. The Super
Supervisory Board will reflect its designated objectives visory Board should convene once each calendar quarter,
▶ ompensation system of the Management Board pur
C as well as its p
rofile of expertise and skills. A Nomination and must convene twice each calendar half-year. The meet-
suant to Section 87a (1), (2) Sentence 1 German Stock Committee has been instituted for election proposals for ings are convened and chaired by the Chairman or, if he is
Corporation Act (AktG) the shareholder representatives. Its activities are aligned incapacitated, by a chairperson named by the Chairman.
at www.fresenius.com/corporate-governance with the provisions of law and the Code. The European The person chairing the meeting decides the order in which
Fresenius | Annual Report 2021
▶ Compensation Report 2021 including the auditor‘s Works Council elects the employee representatives to the items on the agenda are dealt with and the form in
report pursuant to Section 162 AktG the Supervisory Board of Fresenius SE & Co. KGaA. If an which the voting is conducted. Unless other majorities are
at www.fresenius.com/corporate-governance employee representative retires within their term of office, mandatory by law, the Supervisory Board passes its resolu-
the substitute member will become a member of the tions by a simple majority of the votes submitted in the vot-
Supervisory Board. For the Supervisory Board of Fresenius ing. If a vote is tied, the Chairman has the casting vote or,
SE & Co. KGaA, the law requires a quota of at least 30%
women and 30% men. In 2021, elections to the Supervi-
223
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
if he does not take part in the voting, the matter is decided business or personal relationship with the Company, its cor- bers are suitably qualified, keep their professional knowledge
by the vote of the Deputy Chairman, who is a shareholder porate bodies, a controlling shareholder, or a party related up to date, and further develop their judgment and exper-
representative. The shareholder representatives and the to the latter that may give grounds for a material and not tise. They are supported appropriately by the Company in
employee representatives within the Supervisory Board con- merely temporary conflict of interest. This also applies to accordance with the Code. External experts as well as
duct separate meetings on a regular basis. Klaus-Peter Müller, who has been member of the Supervi- experts from the Company continuously provide information
The articles of association of Fresenius SE & Co. KGaA sory Board for more than 13 years. His performance in about important developments, for example about relevant
and the rules of procedure of the Supervisory Board of office demonstrates the necessary critical distance to prop- new laws and precedents, or changes in the IFRS accounting
Fresenius SE & Co. KGaA regulate the details with regard to erly advise and monitor the business conduct of the general and auditing standards. In addition, the Company holds
the Supervisory Board’s election, constitution, term of partner in every respect. an onboarding event for new members of the Supervisory
office, meetings and resolutions, and rights and duties. They The general partner, acting through the Management Board.
are published on our website, see www.fresenius.com/ Board, and the Supervisory Board of Fresenius SE & Co. KGaA The members of the Supervisory Board of Fresenius
corporate-governance. are committed to the interests of the Company. The mem- SE & Co. KGaA can be found on page 393 f. of the Annual
bers of these bodies neither pursue personal interests in the Report. On page 28 f. of the Annual Report, the Supervisory
Information on the Compensation of the Supervisory Board performance of their duties nor grant unjustified advan- Board reports on the main focuses of its activities and those
of Fresenius SE tages to other persons. Any sideline activities or transactions of its committees in 2021.
of the members of the executive bodies with the Company
▶Compensation system of the Supervisory Board of must be disclosed to the Supervisory Board without delay and Supervisory Board self-assessment
Fresenius SE & Co. KGaA in accordance with Section approved by the Supervisory Board. The Supervisory Board The Supervisory Board of Fresenius SE & Co. KGaA carries
113 (3) of the AktG at www.fresenius.com/corporate- of Fresenius SE & Co. KGaA reports to the AGM on any con- out a self-assessment of how effectively it as a whole and its
governance flicts of interest and their treatment. There were no con- committees perform their duties, at least once a year, most
▶C
ompensation Report 2021 including the auditor’s report flicts of interest of Supervisory Board members in the past recently in June 2021.
pursuant to Section 162 AktG at www.fresenius.com/cor- fiscal year. The review is carried out through a company-specific
porate-governance Fresenius publishes information on related parties on questionnaire covering the salient points for a self-evaluation
page 380 of the Annual Report. followed by an open discussion within the full Supervisory
Independence and conflicts of interest Board. The most recent self-assessment showed that the
The Supervisory Board of Fresenius SE & Co. KGaA is of the Supervisory Board training and Supervisory Board, including its committees, assesses its
opinion that all its members are independent. The Supervi- further education measures organization as well as its work as efficient and that it ful-
sory Board shall include what it deems to be an appropriate The members of the Supervisory Board independently fills its tasks effectively.
Fresenius | Annual Report 2021
number of independent members who do not have any take on necessary training and further education measures
required for their tasks. They keep themselves regularly
informed, through internal and external sources, about the
latest requirements with regard to their supervisory activ
ities. The Supervisory Board at all times ensures that its mem-
224
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
Cooperation between the general partner and COMPOSITION AND PROCEDURES OF THE make a preliminary review of the proposal on the allocation
Supervisory Board of Fresenius SE & Co. KGaA S UPERVISORY BOARD COMMITTEES of distributable profits. It also reviews the quarterly reports
Good corporate governance requires trusting and efficient The Supervisory Board of Fresenius SE & Co. KGaA forms before they are published and – following discussions with
cooperation between the Management and the Supervisory two permanent committees from among its members: the the Management Board – engages the auditor for the finan-
Board. The Management Board of the general partner and Audit Committee, consisting of five members, and the cial statements (and concludes the agreement on the audi-
the Supervisory Board of Fresenius SE & Co. KGaA closely Nomination Committee, consisting of three members. The tor’s fees), determines the main focuses of the audit, and
cooperate for the benefit of the Company. Open communi- committee members were elected for the duration of their defines the auditor’s reporting duties in relation to the Super-
cation is essential. The common goal is to sustainably term as a member of the Supervisory Board of Fresenius SE & visory Board of Fresenius SE & Co. KGaA. Other matters
increase the company value in line with the corporate govern Co. KGaA. In accordance with the articles of association of within its remit are to monitor the quality of the audit of the
ance and compliance principles. The Management Board of Fresenius SE & Co. KGaA, only members of the Audit Commit- financial statements and to review the effectiveness of the
the general partner and the Supervisory Board of Fresenius tee receive additional compensation (Section 13 (4)). There internal control system, of the risk management system, of
SE & Co. KGaA coordinate with each other, especially with is no Personnel Committee in the KGaA because the Super- the internal audit system, and of the compliance manage-
regard to the Company’s strategic focus. As the monitoring visory Board of Fresenius SE & Co. KGaA is not responsible ment system.
body, the Supervisory Board of Fresenius SE & Co. KGaA for appointing members of the Management Board of the Since the constituent meeting of the Supervisory Board
also needs to be fully informed about operating performance general partner or for their service contracts. Responsibility on May 21, 2021, the Audit Committee has comprised
and corporate planning, as well as the risk situation, risk for these personnel matters lies with the Supervisory Board Mr. Klaus-Peter Müller (Chairman), Ms. Grit Genster,
management, and compliance. The Management Board of of the general partner. Mr. Wolfgang Kirsch, Mr. Konrad Kölbl, and Ms. Hauke Stars
the general partner provided this information in full and The provisions for the Supervisory Board of Fresenius (until January 31, 2022). Mr. Klaus-Peter Müller is inde-
in compliance with its duties in the reporting period. SE & Co. KGaA apply analogously to the committees. The pendent and has the required expertise in the fields stated
The representatives of the shareholders and of the committees hold meetings as required. The meetings are in Section 100 (5) of the German Stock Corporation Act
employees may prepare the Supervisory Board meetings convened by the committee chairmen. They report during (AktG), as well as specialist knowledge and experience in the
separately, and, if applicable, with members of the Man the following Supervisory Board meeting about the work of application of accounting principles and internal control
agement Board. Pre-meetings of the employee representa- the respective committee. The rules of procedure for the processes. He was re-elected by the Annual General Meet-
tives as well as consultations of the shareholder represen committees are regulated in the rules of procedure of the ing on May 21, 2021 for a one-year term of office. Until
tatives take place on a regular basis. The Supervisory Board Supervisory Board of Fresenius SE & Co. KGaA. Accordingly, the end of the Annual General Meeting on May 21, 2021, the
meets without the Management Board on a regular basis. the committees do not have their own rules of procedure. members of the Audit Committee were Mr. Klaus-Peter
The members of the Supervisory Board’s committees are Müller (Chairman), Ms. Grit Genster, Dr. Gerd Krick, Mr. Kon-
listed on page 393 of the Annual Report. rad Kölbl and Ms. Hauke Stars.
Fresenius | Annual Report 2021
The Audit Committee also examined in detail the non-
Audit Committee audit services rendered additionally by the auditor KPMG AG
The Audit Committee’s function is, among other things, to Wirtschaftsprüfungsgesellschaft, Berlin, as well as Price
prepare the Supervisory Board’s approval of the financial waterhouseCoopers GmbH Wirtschaftsprüfungsgesellschaft,
statements – and the consolidated financial statements – and Frankfurt am Main.
the Supervisory Board’s proposal to the AGM on the appoint-
ment of the auditor for the financial statements, and to
225
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
Nomination Committee consolidated profit are affected by the matter. These include, OBJECTIVES FOR THE COMPOSITION OF THE
The Nomination Committee proposes suitable candidates for example, the divestiture and acquisition of large invest- SUPERVISORY BOARD AND PROFILE OF SKILLS
to the Supervisory Board for the nominations it makes to ments and business units or the divestiture of large busi- AND EXPERTISE FOR THE ENTIRE BOARD
the AGM for the election of Supervisory Board members on ness units from the assets of Fresenius SE & Co. KGaA or a The Supervisory Board of Fresenius SE & Co. KGaA is to be
the shareholders’ side. It consists solely of shareholder wholly owned company. The approval of the Joint Com composed in such a way that its members in entirety have
representatives. In making its proposals, the Nomination mittee is also required for certain legal transactions between the required knowledge, skills, and professional experi-
Committee is guided by the requirements of the Code. Fresenius SE & Co. KGaA or its a ffiliates and the Else Kröner- ences for duly observing the tasks. Thereby, it is necessary
Since the constituent meeting of the Supervisory Board on Fresenius-Stiftung. to differentiate between the requirements for the individ-
May 21, 2021, the members of the Nomination Committee Since the end of the Annual General Meeting on May 21, ual Supervisory Board members and the requirements for the
have been Mr. Wolfgang Kirsch (Chairman), Mr. Michael 2021, the members of the Joint Committee have been composition of the entire Board.
Diekmann and Mr. Klaus-Peter Müller. Until the end of the Mr. Michael Diekmann and Ms. Hauke Stars (until January 31,
Annual General Meeting on May 21, 2021, the members of 2022). In addition, Dr. Dieter Schenk (Chairman) and Wolf- Requirements for the individual
the Nomination Committee were Dr. Gerd Krick (Chairman), gang Kirsch, who were delegated by the General Partner, Supervisory Board members
Michael Diekmann and Klaus-Peter Müller. are members of the Committee. Until the end of the Annual The Supervisory Board members have to be professionally
General Meeting on May 21, 2021, the members of the as well as personally qualified to advise and supervise the
Mediation Committee Joint Committee were Michael Diekmann, Dr. Gerd Krick, Management Board of a globally active health care Group.
Fresenius SE & Co. KGaA does not have a Mediation Com- Klaus-Peter Müller and Dr. Dieter Schenk (Chairman). The
mittee because the provisions of the German Co-Determina- Joint Committee did not meet in the reporting year. Good corporate governance
tion Act that require such a committee do not apply to a Each Supervisory Board member is to have the knowledge
partnership limited by shares and because the Code does OBJECTIVES FOR THE COMPOSITION, of good corporate governance of a capital-market-oriented
not require such a committee either. PROFILE OF SKILLS AND EXPERTISE, company required for duly observing its tasks. This includes
AND DIVERSITY CONCEPT knowledge of the main features of accounting, risk man-
Joint Committee The Supervisory Board of Fresenius SE & Co. KGaA has deter- agement, internal control mechanisms, and of compliance
Pursuant to Sections 13a et seq. of the Articles of Asso mined concrete objectives for its composition and pre- matters.
ciation of Fresenius SE & Co. KGaA, the Supervisory Board of pared a profile of skills and expertise for the entire board.
Fresenius SE & Co. KGaA has formed a Joint Committee Furthermore, it resolved on a diversity concept for itself Sector experience and internationality
together with the Supervisory Board of Fresenius Manage- and the Management Board of Fresenius Management SE. Each Supervisory Board member is to have general knowl-
ment SE. For some matters, which are defined in further edge of the health care sector, as well as a basic under-
Fresenius | Annual Report 2021
detail in Section 13c (1) of the articles of association of standing of the global activities of Fresenius.
Fresenius SE & Co. KGaA, the general partner requires the
approval of the Joint Committee if 40% of the consoli-
dated sales, the consolidated balance sheet total, and the
226
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
Independence Time availability and limit to the numbers Requirements for the entire Board
A minimum of half of the Supervisory Board members and of offices held
a minimum of the half of the shareholder representatives in Each Supervisory Board member is to have sufficient time Sector experience
the Supervisory Board are to be independent within the available for duly observing the office as Supervisory The Supervisory Board in its entirety needs to be familiar
meaning of the German Corporate Governance Code. Inde- Board member and to comply with the limit to the offices with the health care sector. An appropriate number of
pendent in this meaning is someone who does not have held as recommended by the German Corporate Gover- Supervisory Board members are to have in-depth knowl-
a personal or business relationship with the Company, its nance Code. Under the assumption of in the future five edge and / or experience in the important sectors of the
governing bodies, a controlling shareholder, or a com- meetings annually, the expected time expenditure of new Company’s operations:
pany affiliated with such that may cause a substantial and members amounts to approximately 15 to 30 days a year.
not merely temporary conflict of interest. The shareholder This includes the preparation and follow-up of the Super ▶ dialysis products, dialysis services, and Care
structure may be appropriately taken into account. visory Board’s meetings, the review of reports to the Super- Coordination
When assessing independence, in the view of the visory Board, the participation in the Annual General ▶ essential medicines, medical products, and services
Supervisory Board, neither an appointment to the Manage- Meeting, and regular training. Thereby, it is to be considered for the critically and chronically ill
ment Board lapsed for more than two years nor the dura- that the time expenditure also depends on the membership ▶ operation of hospitals
tion of the membership to the Supervisory Board exclude of one or several Supervisory Board committees. ▶ planning, construction, and management of health
the classification as independent per se. care institutions
With regard to the employee representatives, the Age limit and duration limit on the term
independence is not contested by the fact of representing of membership The Supervisory Board is to include an appropriate number
employees nor by the employment relationship. For the activities of the Supervisory Board of Fresenius SE & of members with management experience in the health
Individuals exercising an office in a body of a significant Co. KGaA , a balance between experience and new ways care sector.
competitor of Fresenius or who hold, directly or indirectly, of thinking is important. Therefore, the Supervisory Board of
more than 3% of the voting capital in such are not to be Fresenius SE & Co. KGaA should have a balanced mix of Financial knowledge
a member of the Supervisory Board. experienced and new members. In this way, not only do The Supervisory Board in its entirety needs to have finan-
In cases where a Supervisory Board member is active different perspectives flow into the respective decision- cial knowledge, in particular in the fields of accounting,
for another company having business relationships with making process, but a continuous transfer of knowledge is reporting, and auditing. In the future, at least one member
Fresenius, this activity is described in the section “Legal also promoted. The age limit for members of the Super needs to have expert knowledge in the fields of accounting
relationships with members of the corporate bodies” of the visory Board of Fresenius SE & Co. KGaA is stipulated in its and at least another member needs to have expert knowledge
Annual Report. rules of procedure and is stated in the corporate gover- in the fields of annual auditing.
Fresenius | Annual Report 2021
nance declaration.
Knowledge of relevant legal issues as well as relevant
regulatory and compliance matters
The Supervisory Board in its entirety is to be familiar with
the relevant legal issues, as well as relevant regulatory and
compliance matters.
227
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
Experience in the field of digitalization sides will consider, to the extent possible and until equal Age
The Supervisory Board in its entirety is to have the required representation is achieved, whether the proportion of Finding a balance between expertise and novel approaches
understanding of the requirements of digitalization. women can be increased with qualified female candidates. is important for the Management Board of Fresenius Man-
Please note that the responsibility for electing employee agement SE and the Supervisory Board of Fresenius SE & Co.
Internationality representatives is with the European Works Council. There- KGaA. Therefore, both the Management Board of Fresenius
Fresenius is present in more than 100 countries. Therefore, fore, the Supervisory Board cannot provide a recommen Management SE and the Supervisory Board of F resenius
the Supervisory Board in its entirety is to have knowledge dation. SE & Co. KGaA should have a balanced mix of experienced
and experience in the regions important for Fresenius. The In fiscal year 2021, the Supervisory Board generally met and new members, ensuring that different perspectives are
Supervisory Board is to include an appropriate number of the respective objectives for its composition. Only in one taken into consideration in the decision-making processes
members with, due to their origin or business experience, a individual case was a deviation from recommendation C.5 of and a continuous transfer of knowledge is fostered.
particular relation to the international markets relevant for the German Corporate Governance Code declared. It is
Fresenius. intended to continue to meet the objectives for its own com- Gender
position, which have been adjusted on a selective basis Fresenius believes that a mix of women and men on both
Management experience with effect from March 17, 2022, to this extent. Furthermore, the Management Board of Fresenius Management SE and
The Supervisory Board is to include an appropriate number the current composition of the Supervisory Board was and the Supervisory Board of Fresenius SE & Co. KGaA is desirable.
of members with experience in managing or supervising a is in line with that valid in the financial year and also with the At least 30% of the Supervisory Board are women and at
medium-sized or large company. current profile of skills and expertise. least 30% are men. In general, the participation of women
is a joint responsibility of the shareholder and employee
Diversity and appropriate representation of women DIVERSITY CONCEPT sides. For nominations, both the shareholder and employee
The Supervisory Board is to rely on as different as possible A diversity concept applies for the Management Board sides will consider, to the extent possible and until equal rep-
expert knowledge, skills, and experiences. Therefore, diver- of Fresenius Management SE and the Supervisory Board of resentation is achieved, whether the proportion of women
sity is to be appropriately considered for its composition, Fresenius SE & Co. KGaA. The concept is outlined below. can be increased with qualified female candidates. Please
and when making election proposals, in the Company’s inter- The objectives of the diversity concept, the way in which note that the responsibility for electing employee repre-
est, attention should be paid to ensuring that the candi- they are implemented, and the results achieved in the fiscal sentatives is with the European Works Council. Therefore,
dates’ profiles reasonably complement each other. year are also explained. Diversity enables us to look at mat- the Supervisory Board cannot provide a recommendation.
At least 30% of the Supervisory Board are women and at ters from different perspectives and against the background Besides, qualification is the decisive criterion for filling
least 30% are men. In general, the participation of women of different experiences. Fresenius seeks diversity in the board positions.
is a joint responsibility of the shareholder and employee Management Board of Fresenius Management SE as well as
Fresenius | Annual Report 2021
sides. For nominations, both the shareholder and employee in the Supervisory Board of Fresenius SE & Co. KGaA in
terms of age, gender, education, professional background,
and international experience.
228
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
Professional background International experience of Fresenius SE & Co. KGaA and the Management Board
For each one of the Company’s key business areas, one mem- Fresenius is present in more than 100 countries. Against this of Fresenius Management SE. Overall, the objectives of the
ber of the Management Board of Fresenius Management background, the majority of the members of the Manage- diversity concept continue to be fulfilled.
SE shall have longstanding experience: ment Board of Fresenius Management SE are expected to
have international experience in at least one of the markets RELEVANT DISCLOSURES ON CORPORATE
▶ dialysis products, dialysis services, and Care relevant to Fresenius, based on their background, profes- GOVERNANCE PRACTICES
Coordination sional training, or career. The general partner, represented by its Management Board,
▶ essential medicines, medical devices, and services An appropriate number of members of the Supervisory manages the Company’s business with the due care and
for the critically and chronically ill Board of Fresenius SE & Co. KGaA should also have a special diligence of a prudent and conscientious company director
▶ operation of hospitals connection to international markets relevant to Fresenius in compliance with the provisions of the law, the articles
▶ planning, construction, and management of health as a result of their origin or business experience. of association, the rules of procedure for the Management
care institutions Board, the resolutions passed by the full Management
Implementation of objectives Board, and the Supervisory Board of the general partner.
In addition, one of the members shall have long-standing The implementation of the objectives of the Diversity The basic rules of corporate conduct, partly extending
experience and expertise in finance and one in corporate Concept with regard to the composition of the Management beyond the requirements of law, are defined in the Fresenius
governance, law, and compliance. This takes into account Board of Fresenius Management SE will be reflected by Code of Conduct. It defines the framework of our rules
the special requirements of a capital-market-oriented com- future personnel decisions of the Supervisory Board of and specifies the key principles for our conduct within the
pany. Fresenius Management SE. The Diversity Concept will be Company and in our relations with external partners and
The Supervisory Board of Fresenius SE & Co. KGaA shall reflected in the proposals of candidates by the Supervisory the public. We have published the Fresenius Code of Con-
have a reasonable number of members experienced in Board of Fresenius SE & Co. KGaA to the AGM of the Com- duct on our website at www.fresenius.com/compliance. In
the management or supervision of a medium-sized or large pany. As far as possible, this should be taken into account by addition, all Fresenius business segments have implemented
company. A reasonable number of Supervisory Board the European Works Council in the election of employee their own Codes of Conduct. They cover the specifics of
members should have leadership experience in the health representatives to the Supervisory Board of Fresenius SE & Co. their businesses and reflect the values of the Fresenius Code
care industry. In the previous fiscal year, at least one KGaA. of Conduct.
member of the Supervisory Board had to have expertise in In the past fiscal year, Mr. Wolfgang Kirsch was elected
accounting or auditing. In the future, at least one member to the Supervisory Board of Fresenius SE & Co. KGaA and to COMPLIANCE MANAGEMENT SYSTEMS
must have expertise in the field of accounting and at least one the position of Chairman of this Supervisory Board. In this For Fresenius, compliance means doing the right thing.
other member must have expertise in the field of audting. function, Mr. Wolfgang Kirsch succeeds Dr. Gerd Krick. Because our core ethical values go beyond regulatory
Fresenius | Annual Report 2021
In the past fiscal year, Mr. Michael Sen was appointed to requirements, it means acting not only in accordance with
the Management Board of Fresenius Management SE. He the law, but also with applicable industry codes, internal
succeeds Mr. Mats Henriksson, who retired during the year. policies and our values. Compliance is part of our corpo-
There were no further changes on the Supervisory Board rate culture and, consequently, our daily work.
229
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
Each of our business segments has appointed a Chief Com- ance function or report a potential compliance case anony- The well-being of our patients is important to us. Our risk
pliance Officer, or a dedicated Compliance Committee, mously through whistleblowing systems or dedicated e-mail management and control system, as well as efficiently
responsible for overseeing the development, implementation, addresses. Most whistleblowing systems are open not only designed processes, help to enhance the Company’s perfor-
and monitoring of the Compliance Management System to employees, but also to third parties, such as customers, mance. Our early risk detection system is reviewed as part
(CMS) of the business segment. Furthermore, in line with the suppliers, and other partners, via the corporate website in of the annual audit of the financial statements. The auditor
business structure and organization, the business seg- local languages. assesses whether the monitoring system set up by the
ments have established compliance responsibilities at the Any illegal actions or violations of the rules may harm Management Board is suitable for the early identification of
respective organizational levels. The respective compli- the individual and Fresenius. We do not tolerate non-com risks that could jeopardize the Company’s existence. The
ance organization supports management and employees in pliance. If a violation of applicable regulations is detected, risk management and control systems is regularly reviewed
all compliance-related principles. we will take the necessary actions to remediate the viola- by the Management Board and the Internal Audit depart-
Our Compliance Management Systems are designed tion and prevent any recurrence. We also take all reports as ment. The quality and effectiveness of our risk management
to achieve the implementation of and adherence to our an opportunity to review our company processes for possi- and control system is the responsibility of the Management
rules within the Company. We have implemented risk-based ble improvements. Board and is regularly monitored by the Audit Committee
Compliance Management Systems in all our business seg- Further information on compliance and the Compliance of the Supervisory Board and audited by Internal Auditing.
ments and at Fresenius SE & Co. KGaA’s corporate level. They Management Systems can be found on pages 114 ff. of our Findings from these audits are incorporated into the ongo-
comprise three pillars: Prevent, Detect, and Respond. Group Non-financial Report. ing development of the risk management and control system.
Emphasis is placed on actively preventing any acts of non- Further information can be found in the Report of the
compliance before they occur. Such systems consider the RISK MANAGEMENT AND CONTROL SYSTEM Supervisory Board on page 32 in the Annual Report 2021
markets Fresenius is operating in. They are tailored to the In our view, responsible risk management is a crucial element and on pages 95 ff. of the Management Report.
specific requirements of each business segment. of good corporate governance. Fresenius has a systematic The Internal Audit department supports the Manage-
Essential measures for prevention include comprehen- risk management and control system that allows the Manage- ment Board as an independent function outside the Com
sive risk recording and risk assessment, effective policies as ment Board to identify risks and market trends at an early pany’s day-to-day operations. The department assesses
well as adequate and effective procedures, regular training, stage and to react promptly to relevant changes in our risk internal processes from an objective viewpoint and with the
and continuous advice. Through objective indicators, we profile. It consists of the following elements: necessary distance. Our goal is to create added value for
try to detect potential compliance risks early on. To this Fresenius, and thus to help achieve organizational goals
end, we have implemented tools for early risk detection and ▶ internal control system, through improved internal controls, optimized business
internal control structures, e.g., for cash and bank transac- ▶ early warning system for risks, processes, cost reduction, and efficiency increases. Results
tions, and monitor these measures regularly in workshops ▶ steering of financial, operational, and strategic risks, from internal audits are evaluated both by the business
Fresenius | Annual Report 2021
and internal audits. ▶ quality management systems, segments and by the compliance organization to continu-
We take even potential misconduct seriously. This is why ▶ Compliance Management Systems, ously improve preventive measures, for example to pre-
Fresenius employees who are aware of potential miscon- ▶ reporting on legal risks, and vent corruption.
duct, can contact their superior or the responsible compli- ▶ risk assessment in investment and acquisition Fresenius Medical Care AG & Co. KGaA has its own inter-
processes. nal risk management and control system.
230
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration | Further information on Corporate Governance
GERMAN C
ORPORATE GOVERNANCE AND nance Code” published by the Federal Ministry of Justice 2021, a standard age limit was established for the Super-
DECLARATION OF CONFORMITY and Consumer Protection (Bundesministerium der Justiz und visory Board. Accordingly, the supervisory board shall,
The German Corporate Governance Code aims to provide für Verbraucherschutz) in the official section of the Federal as a rule, only include persons who have not reached the
more transparency for investors with regard to existing Gazette (Bundesanzeiger) in the version of December 16, age of 75 years at the time of their election or appoint-
regulations covering the management and monitoring of 2019 (hereafter the Code) have been met and that the Code ment. The established age limit will be stated in the Cor-
companies. Our value-enhancing strategies, as well as the will also be met in the future. porate Governance Statement in the future.
majority of the guidelines, recommendations, and sugges-
tions for responsible management contained in the Only the following recommendations of the Code have not Code
▶ recommendation C.5:
Code, have been basic components of our activities for many or will not be met as explained in the following: protection against overboarding
years. Extensive information on Corporate Governance Pursuant to Code recommendation C.5, a member of the
can be found on our website at www.fresenius.com/ ▶ Code recommendation B.5: Management Board of a listed company shall not be a
corporate-governance. age limits for the Management Board members member of more than two Supervisory Boards in listed
The Management Board of the general partner of Pursuant to the Code recommendation B.5 an age limit non-group companies or hold comparable positions
Fresenius SE & Co. KGaA, Fresenius Management SE, and is to be specified for members of the Management and shall not chair the Supervisory Board of a listed non-
the Supervisory Board of Fresenius SE & Co. KGaA have Board and disclosed in the Corporate Governance State- group company.
issued the required Declaration of Conformity pursuant ment. Prof. Dr. med. Iris Löw-Friedrich is a member of the
to Section 161 of the AktG and have made it available to Until May 21, 2021 Fresenius had not specified an age Supervisory Board of Fresenius SE & Co. KGaA and has
shareholders on the website of the Company: limit for members of the Management Board. By resolu- now also been elected Chairwoman of the Supervisory
tion of the Supervisory Board of Fresenius Management Board of Evotec SE. She also serves on the Executive
“Declaration by the Management Board of the General SE dated May 21, 2021, a standard age limit was estab- Committee of UCB S.A. as Chief Medical Officer and Exec-
Partner of Fresenius SE & Co. KGaA, Fresenius Management lished for the Management Board. Since then, newly utive Vice President Development and Medical Prac-
SE, and the Supervisory Board of Fresenius SE & Co. KGaA appointed members of the Management Board shall, as tices. Even if this Committee does not formally correspond
on the German Corporate Governance Code pursuant to a rule, retire from the Management Board after reach- to the Management Board of a Stock Corporation or SE,
Section 161 German Stock Corporation Act (Aktien ing the age of 65 at the end of the calendar year. The it is nevertheless comparable with such a Board, so that
gesetz) established age limit will be disclosed in the Corporate a deviation from Code recommendation C.5 is declared
Governance Statement. in this respect on a precautionary basis.
The Management Board of the General Partner of Fresenius Prof. Dr. med. Iris Löw-Friedrich always had sufficient
SE & Co. KGaA, Fresenius Management SE (hereafter the Code
▶ recommendation C.2: time to fulfill her mandate as a member of the Super
Fresenius | Annual Report 2021
Management Board) and the Supervisory Board of Fresenius age limits for the Supervisory Board members visory Board of Fresenius SE & Co. KGaA to the extent
SE & Co. KGaA declare that since the issuance of the pre Pursuant to the Code recommendation C.2 an age limit is required. Prof. Dr. med. Löw-Friedrich plausibly demon-
vious Declaration of Conformity in December 2020 (updated to be specified for members of the Supervisory Board strated that this will continue to be the case in the future.
in March and October 2021), the recommendations of the and disclosed in the Corporate Governance Statement.
“Government Commission on the German Corporate Gover- Until May 21, 2021, Fresenius had not specified an
age limit for Supervisory Board members. By resolution
of the Supervisory Board of the Company dated May 21,
231
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration Further information on Corporate Governance
Code
▶ recommendations G.1 – G.3 and G.6: compensa- The agreement entered into with Mr. Henriksson on FURTHER INFORMATION
tion of the members of the Management Board the occasion of his premature resignation from the ON CORPORATE GOVERNANCE
Fresenius has established a compensation system in line Management Board provides for a severance payment
with the recommendations of the Code with effect from that corresponds to this severance payment cap and DIVERSITY
January 1, 2021. For the previously applicable compen- does not compensate more than the remaining term of The Management Board takes diversity into account when
sation system, a deviation with regard to Code recom- Mr. Henriksson’s service agreement. In addition, the filling executive positions. At Fresenius, the individual’s
mendations G.1 to G.3 and G.6 is declared for the period agreement with Mr. Henriksson provides for certain addi- qualifications are the paramount consideration in all hiring
until the establishment of this compensation system. tional compensation components which exceed the and promotion decisions. This means that women and
entitlements that were agreed in the service agreement men with comparable qualifications and suitability have the
Code
▶ recommendation G.12 and G.13: for the case of Mr. Henriksson’s premature resignation same career opportunities. Fresenius will continue to con
payments upon termination of contract from the Management Board. In particular, Mr. Henriks- sistently act upon this principle – in compliance with the
Pursuant to Code recommendation G.12, if a Manage- son received long-term variable compensation compo- obligations arising from the Act on the Equal Participation
ment Board member’s agreement is terminated, the pay- nents in accordance with the relevant plan conditions of Women and Men in Leadership Positions in the Private
ment of any outstanding variable compensation compo- which, as a result of Mr. Henriksson’s premature resig Sector and the Public Sector (FüPoG I) and the Act to Sup-
nents attributable to the period up to the termination of nation from the Management Board, would have been plement and Amend the Regulations for the Equal Partici-
the agreement shall be made in accordance with the forfeited under the provisions of these plan conditions. pation of Women in Leadership Positions in the Private Sec-
originally agreed targets and comparison parameters and Since these compensation components could qualify tor and the Public Sector (FüPoG II):
in accordance with the due dates or holding periods as addition severance payments, a deviation from Code For the Supervisory Board of Fresenius SE & Co. KGaA,
specified in the agreement. recommendation G.13 sentence 1 is declared in this indi- the law requires a quota of at least 30% women and
On the occasion of Mr. Mats Henriksson’s premature vidual case on a precautionary basis. 30% men. These mandatory quotas were again met by the
resignation from the Management Board it was agreed Supervisory Board elections in 2021.
with Mr. Henriksson that the pro rata short-term variable Fresenius complies with all suggestions of the Code. The legally stipulated targets for the Management Board
compensation for the year 2021 as well as the post- do not apply to Fresenius Management SE or to Fresenius
poned or converted portions of the short-term variable SE & Co. KGaA. Due to its legal form, Fresenius SE & Co. KGaA
compensation of the years 2018, 2019 and 2020 will Bad Homburg v. d. H., December 2021 does not have a Management Board. Fresenius Manage-
already be paid to him prior to the due date. Management Board of the General Partner of ment SE is not listed on the stock exchange and is also not
To that extent, Code recommendation G. 12 was not Fresenius SE & Co. KGaA, of Fresenius Management SE, subject to co-determination.
complied with in this individual case. and Supervisory Board of Fresenius SE & Co. KGaA” In accordance with the legal requirements, the Manage
Fresenius | Annual Report 2021
Pursuant to Code recommendation G.13, any pay- ment Board specifies composition of the two management
ments to a Management Board member on the occasion This declaration and all past declarations are published on levels directly below the Management Board as follows:
of a premature termination of the activity for the Man- our website, see www.fresenius.com/corporate-governance.
agement Board shall not exceed the value of two year’s
compensation (severance payment cap) and shall not
compensate more than the remaining term of the service
agreement.
232
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration Further information on Corporate Governance
The first management level includes all Senior Vice Presi- transactions conducted on their own account relating to the TRANSPARENCY AND COMMUNICATION
dents and Vice Presidents who have an employment con- shares or debt instruments of Fresenius SE & Co. KGaA or Fresenius adheres to all recommendations of the Code.
tract with Fresenius SE & Co. KGaA and who report directly to derivatives or other financial instruments linked thereto. Transparency is guaranteed by continuous communication
to a Member of the Management Board. Through a deci- Managers’ transactions in 2021 are disclosed on our with the public. In that way, we are able to validate and
sion effective January 1, 2021 the Management Board has website at www.fresenius.com/corporate-governance. deepen the trust given to us. Of particular importance to us
set a target, which has to be met by December 31, 2025, and None of the Management or Supervisory Board mem- is the equal treatment of all recipients. To ensure that all
calls for a proportion of women of 30.0% at the first man- bers of the general partner or of the Supervisory Board of market participants receive the same information at the same
agement level. Fresenius SE & Co. KGaA directly or indirectly holds more time, we post all important publications on our website
The second management level includes all Vice Presi- than 1% of the shares issued by Fresenius or any related at www.fresenius.com. We report in detail on investor rela-
dents who have an employment contract with Fresenius financial instruments. tions activities on page 35 of the Annual Report.
SE & Co. KGaA and who report directly to a member of the first The members of the Management and Supervisory
management level. Through the decision effective January 1, Boards of Fresenius Management SE and the members of FINANCIAL ACCOUNTING AND REPORTING
2021, the Management Board has set a target, which has the Supervisory Board of Fresenius SE & Co. KGaA together Fresenius, as a publicly traded company based in a mem-
to be met by December 31, 2025, and calls for a proportion hold 0.14% of the shares of Fresenius SE & Co. KGaA out- ber country of the European Union, has to prepare and
of women of 30.0% at the second management level. standing as of December 31, 2021, in the form of shares or publish its consolidated financial statements, as required,
The Management Board believes that inclusion in the related financial instruments and stock options under the in accordance with International Financial Reporting
company-wide long-term incentive programs is a strong Fresenius SE & Co. KGaA stock option plans. 0.13% are held Standards (IFRS) pursuant to Section 315e of the German
indicator that an individual holds a leading executive posi- by members of the Management Board of Fresenius Man- Commercial Code (HGB).
tion. The proportion of women in this group of our top agement SE, 0.006% by members of the Supervisory Board According to the Audit Regulation (EU) No. 537 / 2014
1,800 executives was approximately 33% as of December 31, of Fresenius Management SE, and 0.005% by members of there is an obligation for regular external rotation of the
2021. the Supervisory Board of Fresenius SE & Co. KGaA. Due to the auditor and the Group auditor. For Fresenius SE & Co. KGaA,
Further information on diversity, as well as personnel fact that some persons are members of both Supervisory such external rotation took place for fiscal year 2020.
development and personnel management, is included in the Boards, the amount of shares or related financial instruments PricewaterhouseCoopers GmbH Wirtschaftsprüfungsgesell
Group Management Report on page 56 ff. and in the Group and stock options held by the Boards of Fresenius SE & schaft, Frankfurt am Main, was elected as auditor for the
Non-financial Report on pages 114 ff. Co. KGaA and Fresenius Management SE in total can be fiscal year 2021 by the Annual General Meeting 2021. The
smaller than the cumulative holdings of the three Boards leading auditor Dr. Bernd Roese, PricewaterhouseCoopers
DISCLOSURES ON DIRECTORS’ as reported herein. GmbH Wirtschaftsprüfungsgesellschaft, Frankfurt am Main,
DEALINGS /MANAGERS’ TRANSACTIONS There were no notifications that the shareholdings of has been responsible for the audit of the consolidated
Fresenius | Annual Report 2021
AND SHAREHOLDINGS IN 2021 members of the Management and Supervisory Boards had financial statements since 2020.
According to the provisions of Art. 19 Market Abuse Regu reached, exceeded, or fallen below the reporting thresholds
lation (MAR) regarding managers’ transactions, persons stipulated in the German Securities Trading Act.
discharging managerial responsibilities, as well as persons
closely associated with them, shall notify the Company of
233
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
COMPENSATION REPORT Fresenius SE & Co. KGaA has published the compensation version of the GCGC. The Supervisory Board of Fresenius
1. INTRODUCTION report on its website (www.fresenius.com/corporate- Management SE therefore intensively addressed the revi-
The compensation report summarizes the main elements of governance). The compensation system of the Manage- sion of the existing compensation system for the Manage-
the compensation system for the members of the Manage- ment Board and the compensation system of the Supervi- ment Board and resolved on December 3, 2020, with effect
ment Board of Fresenius Management SE as the general sory Board are also available on the Company's website from January 1, 2021, the Compensation System 2021+.
partner of Fresenius SE & Co. KGaA and has been prepared (www.fresenius.com/corporate-governance). On May 21, 2021, it was approved by the Annual General
jointly by the Management Board and the Supervisory In accordance with Section 162 (3) AktG, Pricewater- Meeting of Fresenius SE & Co. KGaA with an approval rate
Board of the Company. The contents of the compensation houseCoopers GmbH Wirtschaftsprüfungsgesellschaft has of 92.23%. In addition, a revised compensation system for
report comply with the regulatory requirements of the Ger- formally audited the compensation report. Clear, compre- the Supervisory Board of the Company was approved with
man Stock Corporation Act (AktG) (Section 162 AktG) as hensible, and transparent reporting is of great importance an approval rate of 98.86%.
well as with the recommendations and suggestions of the to both the Management Board and the Supervisory Board Apart from meeting regulatory requirements, the aim
German Corporate Governance Code (GCGC) in the version of the Company. For this reason, Fresenius SE & Co. KGaA of the revision of the compensation system for the Manage-
dated December 16, 2019. In addition to disclosing the voluntarily commissioned PricewaterhouseCoopers GmbH ment Board was to provide even more effective incentives
amount and structure of the compensation, the compen- Wirtschaftsprüfungsgesellschaft with a substantive audit to achieve the goals of the corporate strategy.
sation report sets out how the compensation components of the disclosures in the compensation report, above and The compensation of the Management Board is directly
comply with the relevant compensation system and how beyond the legally required formal review for the presence linked to its performance (pay for performance) and is con-
the compensation promotes the long-term development of of the disclosures. The note regarding the audit is attached siderably aligned with the Company's success through the
the Company. To ensure comprehensive transparency, the to the compensation report. high proportion of variable compensation. Furthermore,
compensation report also contains additional disclosures the Supervisory Board has now also anchored sustainability
and explanations that go considerably beyond the statutory 2. REVIEW OF THE FISCAL YEAR 2021 FROM A targets, also known as ESG --- Environmental, Social, Gov-
requirements. Furthermore, the compensation report COMPENSATION PERSPECTIVE ernance ---, in the compensation of the Management Board.
describes the main elements of Supervisory Board com- In 2020, the regulatory and legal requirements for the com- These cover patient and employee concerns as well as eco-
pensation and discloses their amount. pensation of the Management Board significantly changed logical aspects and allow a holistic view of the Company's
as a result of the Act on the Implementation of the Second success.
Shareholders' Rights Directive (SRD II) and the revised
Annual Report 2021
Fresenius
234
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
The following illustration shows the adjustments and innovations resulting from the Compensation System 2021+ Especially in light of the challenges of the COVID-19 pan-
or planned revisions compared to the previous compensation system (Compensation System 2018): demic, Fresenius has again shown economic resilience in
the fiscal year 2021. Once again, it was confirmed that the
Company’s business development is comparatively stable
and largely independent of economic cycles. Diversification
across four business segments and a global focus give the
Group additional stability. The forecasts, which improved
in the course of the year, were met.
In 2021, the relevant financial targets for the short-term
variable compensation were achieved as follows:
STI 2021 TARGET ACHIEVEMENT
FINANCIAL PERFORMANCE TARGETS
Target
Target value Actual value achievement
€ in millions € in millions in %
Net income
(before special items)
Fresenius Group 1,768 1,799 104.51%
Fresenius Kabi 712 729 105.81%
Fresenius Helios 702 724 107.86%
Fresenius Vamed 65 67 108.26%
Sales
Fresenius Group 36,984 36,781 94.51%
Fresenius Kabi 7,023 6,991 95.36%
Fresenius Helios 10,541 10,911 117.55%
Fresenius Vamed 2,281 2,293 102.72%
Target achievement for non-financial targets (ESG) was
100%.
Annual Report 2021
Fresenius
235
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
The financial and non-financial targets at Group and busi- Management Board with effect as of March 16, 2021, and sustainable development of Fresenius SE & Co. KGaA, and
ness segment level are presented in detail in Section 3.3.2, resigned from his function as member and Chief Executive that it does not exceed the usual compensation without
Variable Components. Officer of the Management Board of Fresenius Kabi AG as special reasons. For this purpose, both external and inter-
At the end of the fiscal year 2021, the measurement of that date, too. Mr. Michael Sen, as the new Chief Execu- nal comparative analyses are carried out. In addition, the
period of the grant 2018 according to the Long Term Incen- tive Officer of the Management Board of Fresenius Kabi total compensation contractually agreed with the individual
tive Plan (LTIP) 2018 expired as well. For the two perfor- AG, has also been appointed to the Management Board of members of the Management Board takes into account the
mance targets, growth rate of adjusted Group net income Fresenius Management SE effective April 12, 2021. interest of the Company to retain the members of the Man-
and relative total shareholder return based on the STOXX agement Board at the Company or to attract new potential
Europe 600 Health Care Index, the target achievement 3. COMPENSATION OF THE MANAGEMENT BOARD talents for the Management Board.
was 0%. 3.1 COMPENSATION GOVERNANCE In order to assess the appropriateness of the compen-
The Supervisory Board of Fresenius Management SE is sation system and the individual compensation of the
LTIP 2018 – GRANT 2018 responsible for determining the compensation of each Management Board members, the Supervisory Board of
TARGET ACHIEVEMENT Management Board member as well as for determining, Fresenius Management SE regularly conducts a review of
Target reviewing, and implementing the compensation system. the respective amount and structure of the compensation
achievement
Target value Actual value in % The Supervisory Board of Fresenius Management SE is by means of a horizontal analysis (external comparative
Average growth of adjusted assisted in this task by its Human Resources Committee, analysis). The respective amount of the total target com-
Group net income (in %) 8% 1.4% 0% which is also responsible for the tasks of a Compensation pensation and the underlying compensation components
Relative total
shareholder return Committee. In the past fiscal year, the Human Resources contractually agreed with the individual Management
(percentile ranking) 50. 13. 0% Committee of Fresenius Management SE was composed of Board members are compared with the compensation
Dr. Gerd Krick (until May 21, 2021), Mr. Wolfgang Kirsch data of other DAX companies.
Fresenius’ goal is to continuously increase the Group’s (since May 21, 2021), Dr. Dieter Schenk, and Mr. Michael When determining the compensation system and the
profitability and capital efficiency. To this end, a cost and Diekmann. The Human Resources Committee makes compensation of the Management Board members, the
efficiency program was launched in the fiscal year 2021, recommendations to the Supervisory Board of Fresenius Supervisory Board of Fresenius Management SE addition-
the design phase of which has already been completed Management SE, which are discussed and --- where neces- ally conducts a vertical review (internal comparative analysis)
and which has already led to initial cost savings. No adjust- sary --- decided on by the Supervisory Board. with respect to the compensation levels of the Company's
ments to strategy and targets due to the COVID-19 pandemic With regard to the requirements of the German Stock employees. For this purpose, the ratios between the aver-
are required. On the contrary, Fresenius sees its strategy Corporation Act and the GCGC, the Supervisory Board of age compensation of the Management Board, the average
confirmed due to the robust economic development in the Fresenius Management SE regularly reviews the appropri- compensation of the senior management of the Company,
Annual Report 2021
fiscal year 2021. The implementation of some strategic goals, ateness and customary practice of the compensation of the and that of the total workforce are determined. Senior man-
such as the further expansion of digital offerings, will even members of the Management Board. In the course of deter- agement is defined as all employees who report to a Man-
be accelerated by the COVID-19 pandemic. mining the amount of the total target compensation, care is agement Board member in a position of Vice President and
Moreover, a change within the Management Board of taken to ensure that the respective compensation is in an above. When conducting the vertical review, the Supervi-
Fresenius Management SE took place in the fiscal year appropriate relationship to the duties and performance of sory Board of Fresenius Management SE also considers the
Fresenius
2021. Mr. Mats Henriksson prematurely resigned from the the Management Board member as well as to the perfor- development of the compensation levels over time.
mance of the Company, that it supports the long-term and
236
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
Most recently in 2020, the Supervisory Board of Fresenius 3.2 OVERVIEW OF THE COMPENSATION SYSTEM effective incentives for the achievement of the strategic
Management SE examined and further developed the com- Principles of the compensation system goals as well as for the long-term value creation of the
pensation system underlying the service agreements due The Compensation System 2021+ for the members of the Company, taking into account the interests of patients,
to the significant changes in regulatory and legal require- Management Board makes a significant contribution to pro- shareholders, employees, and other stakeholders. The
ments resulting from the Act on the Implementation of moting our business strategy and the long-term, sustain- Compensation System 2021+ is based on the following
the Second Shareholders' Rights Directive (Compensation able development of Fresenius SE & Co. KGaA. It provides principles:
System 2021+).
With effect from January 1, 2021, the Compensation
System 2021+ is reflected in the service agreements of all
members of the Management Board. For Mr. Rice Powell,
the Chief Executive Officer of the Management Board of
Fresenius Medical Care Management AG, who is also a
Management Board member of Fresenius Management SE,
the compensation system for the members of the Manage-
ment Board of Fresenius Medical Care Management AG
applies in deviation therefrom.
In general, the Supervisory Board of Fresenius Manage-
ment SE has the right to temporarily deviate from the com-
pensation system if this is necessary in the interest of the
Company’s long-term well-being. In the past fiscal year,
the Supervisory Board of Fresenius Management SE did
not make use of this right.
In addition, under the Compensation System 2021+,
the Supervisory Board of Fresenius Management SE is not
entitled to grant special payments for outstanding perfor-
mance to the Management Board members (also known as
"Ermessenstantieme").
Within the framework of the Compensation System
Annual Report 2021
2021+, a revision of the long-term variable compensation
is planned with effect from the fiscal year 2023. The new
long-term variable compensation --- following consultation
with the Company's stakeholders --- shall be submitted to
the Annual General Meeting 2023 for approval.
Fresenius
237
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
The following illustration shows the compensation components and further design elements of the Compensation To promote the sustainable and long-term development of
System 2021+, which are described in more detail below: the Company, the variable compensation components in
the Compensation System 2021+ are granted predominately
on a long-term basis. Accordingly, the grant value of the
Long-Term Incentive always exceeds the target amount of
the Short-Term Incentive for each fiscal year.
Under the Long-Term Incentive, performance is meas-
ured over a period of four years. The compensation under
the Long-Term Incentive is available to Management Board
members after a period of at least four years.
The general compensation structure of the target direct
compensation (sum of base salary p.a., target Short-Term
Incentive (STI) amount p.a., and grant value under the Long-
Term Incentive (LTI) p.a.) for a full fiscal year consists of
approximately 30% each of the base salary and the Short-
Term Incentive as well as of approximately 40% of the
Long-Term Incentive.
Annual Report 2021
Fresenius
238
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
Consequently, approximately 70% of the target direct com- Board member is higher than the respective Maximum With regard to the total compensation (Maximum Com-
pensation comprises performance-related variable compen- Compensation, the amounts accruing under the Long-Term pensation) contractually agreed with Mr. Rice Powell, the
sation components. The approximately 40% share of the Incentive are reduced accordingly until the Maximum Com- compensation system for the members of the Management
Long-Term Incentive (approximately 57% of the variable pensation is no longer exceeded. Board of Fresenius Medical Care Management AG, which
components) reflects the long-term orientation of the com- The Maximum Compensation in the Compensation was amended with effect as of January 1, 2020, stipulates
pensation structure. System 2021+ is set at €10 million for the Chief Executive a maximum amount of €12 million (or US$13.4 million).
Officer of the Management Board and €6.5 million for all In addition, the caps for short-term and long-term variable
Maximum compensation other Management Board members (except for Mr. Rice compensation provided for in the compensation system
The Compensation System 2021+ provides for an overall Powell). Compliance with the Maximum Compensation is applicable to the members of the Management Board of
annual maximum compensation amount (Maximum Com- reviewed annually. Compliance with the Maximum Com- Fresenius Medical Care Management AG apply to him.
pensation) for each Management Board member. These pensation can only be finally determined once all contrac- The compliance with the Maximum Compensation for the
Maximum Compensation amounts limit the payouts to a tually agreed compensation components of the Compensa- fiscal year 2020 for Mr. Rice Powell can be reviewed for the
Management Board member from the compensation con- tion System 2021+ for a fiscal year have been paid out. first time in 2023 as soon as the vesting period for the long-
tractually agreed for a fiscal year, irrespective of the dates Thus, the Supervisory Board of Fresenius Management SE term variable compensation allocated in 2020 has expired
of the payouts. The Maximum Compensation comprises will review the final payout amount against the background and the amount to be paid out has been determined.
base salary (payment in the fiscal year), the Short-Term of the Maximum Compensation 2021 for the first time in
Incentive (payment in the following fiscal year) and the 2025 after the end of the first measurement period for the 3.3 COMPENSATION COMPONENTS IN DETAIL
Long-Term Incentive (payment according to plan condi- long-term variable compensation under the Compensation 3.3.1 FIXED COMPONENTS
tions in later fiscal years), as well as all other fringe bene- System 2021+. Base salary
fits and compensation (payment in the fiscal year). The pen- The previously applicable compensation system also The base salary, which is usually agreed upon for a full
sion commitment that is part of the fixed compensation provided for limitation possibilities. Since the fiscal year year, is paid in accordance with the local payroll customs
components is also included in the calculation of the Maxi- 2018, the Management Board service agreements of applicable to the respective member of the Management
mum Compensation with the amount of the service cost Fresenius Management SE included an allocation cap Board. For Management Board members in Germany, the
incurred in the fiscal year. The Maximum Compensation (excluding service cost) of €9 million for the Chief Execu- base salary is typically paid in 12 monthly installments.
amount for Management Board members can be below the tive Officer of the Management Board and €6 million for all Mr. Rice Powell usually receives his base salary in biweekly
sum of the potentially achievable payouts from the individ- other Management Board members (except for Mr. Rice installments.
ual compensation components contractually agreed for a Powell). The compliance with the Maximum Compensation
fiscal year. If the calculated payout for a Management also takes place on an annual basis.
Annual Report 2021
Fresenius
239
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
Fringe benefits against them in the course of their service for the Company of 45%. In deviation from this, the Management Board
Fringe benefits are granted based on the individual service and its affiliated Group companies to the extent that such member responsible for the business segment Fresenius
agreements and can basically include: the private use of claims exceed their liability under German law. To cover Vamed is entitled to an increase of 1.2 percentage points
company cars, special payments such as school fees, hous- such obligations, the Company took out Directors´ & for each full year of service as a Management Board mem-
ing, rent, and relocation payments, costs for the operation Officers´ liability insurance, the deductible complying with ber, up to a maximum of 40%.
of security alarm systems, and contributions to pension the requirements of the Stock Corporation Act. The indem-
insurance (with the exception of the pension commitments nification covers the period during which the respective Defined contribution pension commitments
described hereinafter), as well as contributions for accident, member of the Management Board holds office as well as Management Board members appointed to the Manage-
health, and nursing care insurance, other insurance policies, any claims in this regard after termination of the service ment Board as of January 1, 2020 or later, are granted a
and tax equalization compensation due to different tax rates on the Management Board. pension commitment within the framework of a defined
in Germany and, as the case may be, the country in which contribution plan. This is promised at the beginning of the
the Management Board member is personally taxable. Pension commitments service agreement with a waiting period of the first three
Fringe benefits can be of one-time or recurring nature. Defined benefit pension commitments years regarding the granting of benefits. Under such a
In order to attract qualified candidates for the Manage- Management Board members appointed to the Manage- defined contribution plan, the respective Management
ment Board, the Supervisory Board of Fresenius Manage- ment Board prior to January 1, 2020, were granted a con- Board member receives an annual contribution amounting
ment SE may complement the compensation of first-time tractual pension commitment in the form of a defined ben- to 40% of the base salary, which determines the future
Management Board members in an appropriate and efit scheme. Under this defined benefit scheme, pension capital amount. After reaching the retirement age under
market-compliant manner with an entry bonus (sign-on commitments provide for pension and survivor benefits the defined contribution plan, payments can be made either
bonus), e.g., to compensate for forfeited compensation (Hinterbliebenenversorgung) as of the time of conclusively as a one-off payment or optionally in ten annual install-
from previous employment or service agreements. The ending active work or in case of occupational disability or ments. An annuity or pension payment is not provided. The
Supervisory Board of Fresenius Management SE may also incapacity to work (Beruf- oder Erwerbsunfähigkeit). The defined contribution plan may provide for survivors' bene-
grant reimbursements for fees, charges, and other costs in amount of these benefits is calculated by reference to the fits (Hinterbliebenenversorgung) and benefits after the
connection with or related to a change in the regular place amount of the contractually agreed pensionable income occurrence of a full or partial reduction in earning capacity
of work of Management Board members. In the fiscal year of the Management Board member. Until the start of their (Erwerbsminderung). The implementation of the defined
2021, Dr. Sebastian Biedenkopf and Mr. Michael Sen were pension, this is adjusted annually based on the develop- contribution plan is carried out in the form of external
reimbursed for relocation expenses in this context. They ment of the consumer price index (as of January 1, 2022, financing as a defined contribution plan with a reinsurance
also received a rental allowance for a second home for for the first time). The pension amount is calculated as policy. This provides for covering the risks of death and
the first year of their appointment. 30% of the contractually agreed pensionable income and occupational disability as early as the first appointment
Annual Report 2021
Fresenius SE & Co. KGaA furthermore undertook to in- increases by 1.5 percentage points for each full year of ser- period from the start of service and not just starting from
demnify the Management Board members, to the legally vice as a Management Board member, up to a maximum non-forfeiture (after the expiry of three years since the
permitted extent, against any claims that may be asserted start of service).
Fresenius
240
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
3.3.2 VARIABLE COMPONENTS Short-Term Incentive is linked to the achievement of
3.3.2.1 SHORT-TERM INCENTIVE financial and non-financial performance targets, balancing
Overview growth, profitability, and sustainability aspects.
Under the Compensation System 2021+, the Management The respective target amount for the Short-Term Incen-
Board members are entitled to receive a Short-Term Incen- tive (i.e., the amount paid out if the target is reached to
tive, which may result in a cash payment. The Short-Term 100%) is as a percentage of the respective base salary of a
Incentive rewards the Management Board members for the Management Board member individually agreed upon. In
success of the Company in the relevant fiscal year. The case of appointments to the Management Board during a
fiscal year, the respective target amount can be prorated.
Annual Report 2021
Fresenius
241
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
Performance targets Adjustment of the performance targets
The Short-Term Incentive is measured based on the achieve- The financial figures underlying the financial performance
ment of three performance targets: 65% relates to Group targets can be adjusted for certain effects, in particular
or business segment net income (before special items), effects from significant acquisitions, divestments, restruc-
20% to Group or business segment sales, and 15% to turing measures, and changes in accounting principles. In
the achievement of sustainability criteria (ESG targets). addition, the Supervisory Board of Fresenius Management
The financial performance targets reflect the key perfor- SE can also adjust for one-time material special items for
mance indicators of the Company and support the Compa- which the Management Board is not responsible, which
ny's strategy of achieving sustainable and profitable growth. have not been budgeted for and which are therefore not
The non-financial performance targets underline the Com- included in the calculation of the target values.
pany's commitment to implementing its global sustainabil-
ity strategy. Sustainable actions are an integral part of the
corporate strategy and ensure the future viability from a
social and economic perspective.
Annual Report 2021
Fresenius
242
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
In 2021, the Supervisory Board of Fresenius Management SE made an adjustment to the net income regarding the non- Levels of performance measurement
recurring expenses and the initial savings from the cost and efficiency program and the income from revaluation of the In order to further enhance cooperation across the business
contingent biosimilars purchase price liabilities: segments and at the same time incentivize the Management
Board members with respect to their individual responsi-
Fresenius Fresenius Fresenius Fresenius
€ in millions Group Kabi Helios Vamed bilities, some performance targets are measured at Group
Net income, reported level, others at business segment level. For Management
(including special items) 1,818 762 720 67 Board members who are responsible for a business segment
Adjustments:
Expenses associated with the
(Mr. Michael Sen, Dr. Francesco De Meo, and Dr. Ernst
Fresenius cost and efficiency program 82 49 8 --- Wastler), half of the net income and half of sales are based
Savings associated with the on the corresponding key financial figures of the Group and
Fresenius cost and efficiency program -23 -11 -6 ---
Income from revaluation of biosimilars the respective business segment. For Management Board
contingent purchase price liabilities -33 -33 --- --- members with Group responsibilities (Mr. Stephan Sturm,
Currency conversion
(at budget rates) -45 -38 2 ---
Dr. Sebastian Biedenkopf, and Ms. Rachel Empey), net
Net income, adjusted 1,799 729 724 67 income and sales refer to the corresponding key financial
figures of the Group. By measuring the financial perfor-
Sales were adjusted by the Supervisory Board of Fresenius Management SE in the fiscal year 2021 as follows: mance targets at Group as well as on a business segment
level, the financial success of both the individual business
Fresenius Fresenius Fresenius Fresenius
€ in millions Group Kabi Helios Vamed
segments and the Group is reflected.
Sales, reported The achievement of sustainability targets is measured
(including special items) 37,520 7,193 10,891 2,297 at Group level to ensure close cooperation across the Com-
Adjustments:
pany's business segments in the field of sustainability. The
Currency conversion
(at budget rates) -739 -202 20 -4 non-financial performance targets relate to ESG focus
Sales, adjusted 36,781 6,991 10,911 2,293 topics such as quality, employees, innovation, compliance,
and environment. Targets are defined annually for each
ESG focus topic. For the time being, the overall ESG tar-
get achievement is identical for all Management Board
members.
Annual Report 2021
Fresenius
243
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
Performance target setting and determination These were based on the following target achievement The target achievement is deemed to be 0% if the lower
of target achievement curve: threshold is not reached. If the cap is exceeded, the target
Financial performance targets is deemed to have been reached by 150% (cap). If the
At the beginning of fiscal year 2021, the Supervisory Board achieved financial indicators are between the respective
of Fresenius Management SE set concrete target values for values for target achievement of 0% and 100% or 100%
the financial performance targets, taking into account the and 150%, the target achievement is determined by linear
market and competitive environment, the budget, and the interpolation.
strategic growth targets. Non-recurring expenses and initial
savings from the cost and efficiency program could not be
taken into account yet.
After the end of the past fiscal year, the Supervisory
Board of Fresenius Management SE determined whether
and to what extent the financial performance targets had
been achieved.
Financial performance targets for the fiscal year 2021
For the financial performance targets, the Supervisory Board of Fresenius Management SE has set the following lower and
upper thresholds as well as target values at Group and business segment level for the fiscal year 2021. At the end of the
fiscal year 2021, the targets were achieved as follows:
STI 2021 TARGET ACHIEVEMENT
FINANCIAL PERFORMANCE TARGETS
Lower threshold Target value Upper threshold Actual value Target achievement
€ in millions € in millions € in millions € in millions in %
Net income (before special items)
Fresenius Group 1,415 1,768 2,121 1,799 104.51%
Fresenius Kabi 570 712 854 729 105.81%
Fresenius Helios 562 702 842 724 107.86%
Annual Report 2021
Fresenius Vamed 52 65 78 67 108.26%
Sales
Fresenius Group 33,286 36,984 40,682 36,781 94.51%
Fresenius Kabi 6,321 7,023 7,725 6,991 95.36%
Fresenius Helios 9,487 10,541 11,595 10,911 117.55%
Fresenius Vamed 2,053 2,281 2,509 2,293 102.72%
Fresenius
244
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
Non-financial performance targets be achieved; partial achievement (e.g., 0.5 points) is not In the event that all ESG targets in the four business seg-
For the fiscal years 2021 and 2022, the Supervisory Board possible. The resulting 0 to 15 points per business segment ments are met, the overall ESG target achievement for the
of Fresenius Management SE has set three ESG targets will be included in the overall ESG target achievement for fiscal years 2021 and 2022 is limited to 100% (cap); over-
for each of the five ESG focus topics quality, employees, Fresenius SE & Co. KGaA with a weighting of 25% each. achievement is not possible.
innovation, compliance, and environment. These are For Fresenius Medical Care, the target achievement is
derived from the Company's materiality analysis and based on the achievement of targets within the framework Non-financial performance targets for fiscal year 2021
qualitatively measured using a customized ESG scoring of the company's global sustainability program, which is With the ESG targets, the Company creates a basis for ESG
method. This is available on the Company's website also part of the compensation system of the members of performance measurement by establishing an ESG target
(www.fresenius.com/corporate-governance). The ESG the Management Board of the company. The resulting tar- and strategy as well as transparent key performance indica-
targets are identical for all Management Board members get achievement is translated to calculate the overall target tors (KPIs). To this end, for each of the five focus topics, the
except for Mr. Rice Powell. The extent to which the ESG achievement. At Fresenius Medical Care, the global sus- following three ESG targets have been defined, with each
targets are met is determined for the business segments tainability program allows a target achievement between focus topic being measured in a qualitative way using the
Fresenius Kabi, Fresenius Helios, and Fresenius Vamed. 0% and 120%. The target achievement is linearly con- ESG scoring method.
For each of the three ESG targets, a score of 0 or 1 point verted into a target value of 0 to 15 points, with 1% cor-
per focus topic, i.e., a total of 5 points per ESG target, can responding to 0.125 points.
Based on the corporate sustainability strategy, the Supervisory Board specified the following three equally weighted ESG
targets for the fiscal year 2021:
Annual Report 2021
Fresenius
245
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
For the fiscal year 2021, the total target achievement for the non-financial performance targets, which consists of the
equally weighted target achievements for each business segment, was as follows:
STI 2021 TARGET ACHIEVEMENT
NON-FINANCIAL PERFORMANCE TARGETS
Target value Actual value
in points in points
Target 1: Identification of key topics (KPIs)1
Fresenius Kabi 5 5
Fresenius Helios 5 5
Fresenius Vamed 5 5
Target 2: Definition of a comprehensive management approach1
Fresenius Kabi 5 5
Fresenius Helios 5 5
Fresenius Vamed 5 5
Target 3: Presentation and sign-off
Fresenius Kabi 5 5
Fresenius Helios 5 5
Fresenius Vamed 5 5
Overall target achievement
Fresenius Medical Care
(translation from the FME global sustainability program2) 15 15
Fresenius Kabi 15 15
Fresenius Helios 15 15
Fresenius Vamed 15 15
Overall target achievement in points (25% weighting each) 15
Overall target achievement in % 100%
1
For the topic environment, the subobjectives 1 and 2 were concretized for 2021 as follows: 1) improvement of the data quality and transparency, 2) definition of short-term and long-term targets.
2
For Fresenius Medical Care, the target achievement is based on the achievement of targets within the framework of the company's global sustainability program, which is also part of the compensa-
tion system of the members of the Management Board of the company. The resulting target achievement is translated to calculate the overall target achievement. At Fresenius Medical Care, the global
sustainability program allows a target achievement between 0% and 120%. The target achievement is linearly converted into a target value of 0 to 15 points, with 1% corresponding to 0.125 points.
Overall target achievement for fiscal year 2021 final Short-Term Incentive amount will be paid out to the accordance with the corresponding recommendation of the
The degree of the overall target achievement is determined respective Management Board member in cash. Since the GCGC in the version dated December 16, 2019 --- may take
by the weighted arithmetic mean of the respective achieve- overall target achievement for the fiscal years 2021 and into consideration that certain extraordinary economic, tax,
Annual Report 2021
ment of each financial and non-financial target. Multiplying 2022 is capped at 142.5%, the payout amount of the Short- or similar impacts are not related to the performance of the
the degree of respective overall target achievement by the Term Incentive for the fiscal years 2021 and 2022 is also Management Board member. In the fiscal year 2021, the
target amounts of the Short-Term Incentive results in the capped to 142.5% of the respective target amount. Supervisory Board of Fresenius Management SE did not
final Short-Term Incentive amount. Subject to approval by When determining the degree of target achievement, make use of this option.
the Supervisory Board of Fresenius Management SE, the the Supervisory Board of Fresenius Management SE --- in
Fresenius
246
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
For the financial and non-financial performance targets, the following target amounts were set for the members of the Management Board in office as of December 31, 2021, and the
following target achievements were determined for the fiscal year 2021:
STI 2021 OVERALL TARGET ACHIEVEMENT
Weighted
Net income overall target
Target amount (before special items) Sales ESG targets achievement Payout amount
Weighting Target achievement Weighting Target achievement Weighting Target achievement
€ in thousands in % in % in % in % in % in % in % € in thousands
Stephan Sturm 1,600 104.51% 94.51% 100.00% 101.83% 1,629
Dr. Sebastian Biedenkopf 600 65% Group 104.51% 20% Group 94.51% 100.00% 101.83% 611
Rachel Empey 850 104.51% 94.51% 100.00% 101.83% 866
32.5% Group 104.51% 10% Group 94.51%
Dr. Francesco De Meo 1,000 100.00% 105.23% 1,052
32.5% Helios 107.86% 10% Helios 117.55% 15%
32.5% Group 104.51% 10% Group 94.51%
Michael Sen (since April 12, 2021) 755 100.00% 102.34% 773
32.5% Kabi 105.81% 10% Kabi 95.36%
32.5% Group 104.51% 10% Group 94.51%
Dr. Ernst Wastler 850 100.00% 103.87% 883
32.5% Vamed 108.26% 10% Vamed 102.72%
For Mr. Rice Powell, the overall target achievement for the short-term variable compensation for the fiscal year 2021 according to the compensation system applicable to the members of
the Management Board of Fresenius Medical Care Management AG (FME STI 2021) is as follows:
FME STI 2021
OVERALL TARGET ACHIEVEMENT
Net income Revenue Operating income Sustainability Weighted overall target
Target amount (40%) (20%) (20%) (20%) achievement Payout amount
Target achievement Target achievement Target achievement Target achievement
€ in thousands (in %) (in %) (in %) (in %) in % € in thousands
Rice Powell 1,793 72.14% 69.82% 62.29% 120% 79.28% 1,422
Annual Report 2021
Fresenius
247
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
3.3.2.2 LONG-TERM INCENTIVE
Allocation for the fiscal year 2021
Overview
Under the Compensation System 2021+, the Management
Board members are entitled to receive Long-Term Incen-
tives in the form of so-called performance shares with a
measurement period of four years. Performance shares are
virtual cash-settled payment instruments not backed by
equity and are non-certificated. A payout depends on the
achievement of two equally weighted performance targets
and on the development of the share price of the Company.
Grant values
The grant value of the Long-Term Incentive for each Man-
agement Board member is defined by the Supervisory
Board of Fresenius Management SE and corresponds to a
percentage of the base salary, as stipulated in the individ- period of 60 stock exchange trading days prior to the
ual service agreement. respective grant date. The final number of performance
In order to determine the number of performance shares shares depends on the achievement of predefined targets,
to be allocated to the respective Management Board mem- which are set by the Supervisory Board of Fresenius Man-
ber, the respective grant value is divided by the value per agement SE prior to the beginning of the respective mea-
performance share in accordance with IFRS 2 and consid- surement period.
ering the average share price of the Company over a
Annual Report 2021
Fresenius
248
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
For the fiscal year 2021, the allocations under the LTIP 2018 are as follows:
LTIP 2018 – GRANT 2021
Share price
(average 60 trading days Maximum number of possible Maximum possible payout
Grant value before grant) Granted number of performance shares amount (250% grant value)
€ in thousands in € performance shares (200% target achievement) € in thousands
Stephan Sturm 2,765 44.75 61,788 123,576 6,913
Dr. Sebastian Biedenkopf 800 44.75 17,877 35,754 2,000
Dr. Francesco De Meo 1,450 44.75 32,402 64,804 3,625
Rachel Empey 1,300 44.75 29,050 58,100 3,250
Michael Sen (since April 12, 2021) 1,058 44.75 23,633 47,266 2,644
Dr. Ernst Wastler 1,300 44.75 29,050 58,100 3,250
For Mr. Rice Powell, the allocation under the Management Board Long Term Incentive Plan 2020 in accordance with the compensation system applicable for the members of the Man-
agement Board of Fresenius Medical Care Management AG is as follows:
MB LTIP 2020 – GRANT 2021
Share price
(average 30 days Maximum possible payout
Grant value before grant) Granted number of amount (400% grant value)
€ in thousands in € performance shares € in thousands
Rice Powell 2,306 55.12 40,894 9,224
Performance targets
The Long-Term Incentive is measured on the basis of the
achievement of two equally weighted financial performance
targets: adjusted net income growth and relative Total
Shareholder Return (Relative TSR). These performance tar-
gets have been chosen as they reflect the Company's strate-
gic priorities of increasing profitability, long-term sustaina-
Annual Report 2021
ble growth, and the development of the Company's value.
At the same time, they include a relative comparison with
competitors and thus ensure that the interests of share-
holders are adequately taken into account. long-term strategy. In order to ensure that all decision
The performance targets under the Long-Term Incen- makers pursue uniform goals, the Long-Term Incentive for
tive are among the most important key figures of the Com- the Management Board and senior management is deter-
Fresenius
pany and support the implementation of the Company's mined according to uniform targets and a uniform system.
249
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
The adjusted net income growth is calculated at constant The performance target of adjusted net income growth 0%. If the rank is between the 25th and the 50th percen-
exchange rates. The underlying financial figures of the finan- is deemed to have been achieved to 100% if this is at tile, the degree of target achievement is between 0% and
cial performance targets are adjusted for effects defined least 8% p.a. on average over the four-year measurement 100% and if the rank is between the 50th and the 75th per-
in advance, such as the effects of certain acquisitions and period. If the growth rate is 5% p.a. or less, the target centile, the degree of target achievement is between 100%
divestments and changes in IFRS accounting standards, to achievement is 0%. If the growth rate is between 5% p.a. and 200%. Intermediate values are also calculated here by
ensure comparability of these financial figures with respect and 8% p.a., the degree of target achievement is between linear interpolation.
to the operational performance. 0% and 100% and if the growth rate is between 8% p.a. At the end of the respective measurement period, the
and 20% p.a., the degree of target achievement is between Supervisory Board of Fresenius Management SE deter-
Performance target setting and determination 100% and 200%. Intermediate values are calculated by mines the overall target achievement for the granted Long-
of target achievement linear interpolation. Term Incentive. For this purpose, the extent to which the
Prior to the beginning of the respective measurement For the relative TSR target, a 100% target achievement two performance targets have been achieved is determined
period of an allocation, the Supervisory Board of Fresenius is given if the Total Shareholder Return of Fresenius SE & and included with equal weighting in the determination of
Management SE defines target values for each performance Co. KGaA compared to the Total Shareholder Return of the the overall target achievement.
target that lead to a target achievement of 0% (lower thresh- other companies in the STOXX® Europe 600 Health Care The final number of performance shares is determined
old), 100% (target value), and 200% (cap). In setting the Index is at the median of the peer companies over the four- for each Management Board member on the basis of the
target values, the Supervisory Board of Fresenius Manage- year measurement period, i.e., exactly in the middle (50th overall target achievement and can increase or decrease
ment SE considers the strategic growth targets and the percentile) of the ranking. If the rank is equal to or below over the measurement period compared to the number
market as well as the competitive environment. the 25th percentile, the degree of target achievement is at the time of grant. A total loss as well as (at the most)
doubling of the granted performance shares if a 200%
target achievement is reached (cap) is possible. After
the final determination of the overall target achievement,
the final number of performance shares is multiplied by
the average price of the Company's shares over the last
60 stock exchange trading days prior to the end of the
respective measurement period (four years after the date
of the respective grant) plus the sum of the dividends per
share paid in the meantime by Fresenius SE & Co. KGaA, in
order to calculate the corresponding amount for the pay-
Annual Report 2021
ment from the final performance shares. The payout is lim-
ited to 250% of the respective grant value. Payment is also
conditional on the absence of a compliance violation and
the continuation of the service or employment relationship.
Fresenius
250
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
In determining the overall target achievement, the Super- Management SE can correct the calculated overall target Overall target achievement of the LTIP 2018
visory Board of Fresenius Management SE may --- following achievement accordingly, i.e., increase or decrease it. This for the fiscal years 2018 to 2021
the corresponding recommendation of the GCGC in the ver- also applies in the event that capital measures (e.g., capital In the fiscal year 2021, the measurement period of the
sion dated December 16, 2019 --- determine that certain increase, spin-off, or stock splits) are conducted. The Super- grant 2018 ended in accordance with the LTIP 2018.
extraordinary economic, tax, or other effects are to be dis- visory Board of Fresenius Management SE did not make use The average growth of adjusted Group net income for
regarded in full or in part in accordance with the plan con- of this possibility in 2021. the fiscal year 2021 and the previous three years was 1.4%.
ditions. In this case, the Supervisory Board of Fresenius Therefore, a target achievement of 0% was derived. For the
relative TSR, the percentile rank at the end of the four-year
measurement period was 13. Hence, the target achievement
is 0% for the relative TSR, too.
The following table shows the target and actual value as well as the target achievement for the grant 2018 for the two performance targets growth rate of adjusted Group net income and
relative TSR based on the STOXX Europe 600 Health Care index:
LTIP 2018 – GRANT 2018
TARGET ACHIEVEMENT
Target achievement
Lower threshold Target value Upper threshold Actual value (in %)
Average growth of adjusted Group
net income (in %) 5% 8% 20% 1.4% 0%
Relative total shareholder return
(percentile ranking) 25. 50. 75. 13. 0%
Annual Report 2021
Fresenius
251
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
For the Management Board members in office as of December 31, 2021 who received an allocation from the LTIP 2018, the following grant values were determined. Due to the overall
target achievement of 0%, no final performance shares were allocated. Thus, no payment will be made from the grant 2018 in the fiscal year 2022.
LTIP 2018 – GRANT 2018
OVERALL TARGET ACHIEVEMENT
Share price
(average 60 trading days
Grant value before grant) Granted number of Overall target achievement Final number of
€ in thousands in € performance shares (in %) performance shares
Stephan Sturm 2,500 67.45 37,064 0% ---
Dr. Francesco De Meo 1,300 67.45 19,274 0% ---
Rachel Empey 1,300 67.45 19,274 0% ---
Dr. Ernst Wastler 1,300 67.45 19,274 0% ---
Commitments and payouts under the LTIP 2013 the Supervisory Board’s own due discretion, provided that The amount of the cash settlement pursuant to the Phantom
Until the end of the fiscal year 2017, benefits under the generally all Management Board members received the Stock Plan 2013 is based on the volume-weighted average
LTIP 2013 of Fresenius SE & Co. KGaA were allocated as a same amount of stock options and phantom stocks, with the market price of the share of Fresenius SE & Co. KGaA dur-
component with long-term incentive effect, which resulted exception of the Chairman of the Management Board, who ing the three months preceding the exercise date.
in a payout in the fiscal year 2021 and may result in a pay- received double the respective amount of stock options and The respective performance target has been reached if
out in the future. The benefits consisted, on the one hand, phantom stocks. At the time of the grant, the participants the adjusted consolidated net income of the Company (net
of share-based compensation with cash settlement (phan- in LTIP 2013 had the right to choose whether they wished income attributable to the shareholders of the Company)
tom stocks) and, on the other hand, of stock options on the to receive stock options and phantom stocks in a ratio of has increased by a minimum of 8% per year in comparison
basis of the Stock Option Plan 2013 of Fresenius SE & Co. 75 : 25, or in a ratio of 50 : 50. to the previous year within the waiting period, after adjust-
KGaA. Based on the LTIP 2013, both members of the Man- Exercise of the stock options and the phantom stocks ment for foreign currency effects. The performance target
agement Board and other executives were allocated stock allocated under LTIP 2013 of Fresenius SE & Co. KGaA is has also been achieved if the average annual growth rate of
options and phantom stocks. In accordance with the divi- subject to several conditions, such as expiry of a four-year the adjusted consolidated net income of the Company dur-
sion of powers under the Stock Corporation Act, grants waiting period, observance of blackout periods, achieve- ing the four-year waiting period is at least 8%, adjusted for
to members of the Management Board were made by the ment of the specified performance target, and continuance foreign currency effects. If, with respect to one or more of
Supervisory Board of Fresenius Management SE and grants of the service or employment relationship. The vested stock the four reference periods within the waiting period, neither
to other executives were made by the Management Board. options can be exercised within a period of four years. The the adjusted consolidated net income of the Company has
Annual Report 2021
The number of stock options and phantom stocks for Man- vested phantom stocks are settled on March 1 of the year increased by a minimum of 8% per year in comparison to
agement Board members to be granted was determined by following the end of the waiting period. the previous year, after adjustment for foreign currency
effects, nor the average annual growth rate of the adjusted
Fresenius
252
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
consolidated net income of the Company during the four- Payments under the LTIP 2013 for Payments under the LTIP 2013 for
year waiting period is at least 8%, adjusted for foreign cur- fiscal years 2017 to 2020 fiscal years 2016 to 2019
rency effects, the respective granted stock options and In fiscal year 2021, the waiting period of the phantom stocks In the fiscal year 2021, after the end of the vesting period,
phantom stocks are forfeited on a pro rata basis according of grant 2017 under the LTIP 2013 as well as that of the the grant 2016 under the LTIP 2013 and the additional
to the proportion of the performance target that has not additional phantom stocks allocated in 2017 ended. The phantom stocks granted in 2016 were paid out. The follow-
been achieved within the waiting period, i.e., by one fourth, payment will be made in fiscal year 2022 after the end ing targets were achieved for the Company's adjusted Group
by two fourths, by three fourths, or completely. If a mem- of the vesting period. The following target achievement net income performance target:
ber of the Management Board leaves the Company, the resulted from the Company's adjusted Group net income
stock options and phantom stocks are forfeited as a matter performance target: LTIP 2013 – GRANT 2016
of principle. TARGET ACHIEVEMENT
Furthermore, through fiscal year 2017, the then acting LTIP 2013 – GRANT 2017
Target value Actual value
members of the Management Board, with the exception of TARGET ACHIEVEMENT Average annual growth of adjusted Group net
Ms. Rachel Empey and Mr. Rice Powell, were granted an income of the past four years (in %) 8% 9.30%
Target value Actual value
entitlement to further share-based compensation with cash Average annual growth of adjusted Group net
settlement (further phantom stocks) in the equivalent value income of the past four years (in %) 8% 3.80% As the target value of 8% was exceeded on average during
of €100 thousand per Management Board member. With the four-year waiting period, a payout of 100% of the allo-
regard to the performance target and waiting period, the As the target value of 8% during the four-year waiting cated phantom stocks of the grant 2016 was made in 2021.
same conditions that pertain to the phantom stocks allo- period was reached in one year, a payout of 25% of the
cated under LTIP 2013 apply to them. allocated phantom stocks of the grant 2017 will be made
in 2022.
Annual Report 2021
Fresenius
253
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
Payments for Mr. Rice Powell under LTIP 2016 and the New Incentive Bonus Plan 2010 of Fresenius Medical Care
For Mr. Rice Powell, the grant 2017 of the Long Term Incentive Plan 2016 of Fresenius Medical Care was paid out as long-term variable compensation of Fresenius Medical Care
Management AG in 2021:
FME LTIP 2016 – GRANT 2017
OVERALL TARGET ACHIEVEMENT
Fair value Granted number of Overall target achievement Final number of Final share price Payout amount
€ in thousands performance phares in % performance shares in € € in thousands
Rice Powell 1,331 18,063 108% 19,508 69.01 1,302
FME NEW INCENTIVE BONUS PLAN 2010 – GRANT 2017
OVERALL TARGET ACHIEVEMENT SHARE BASED AWARDS
Grant value Granted number of Share price at payout Payout amount
€ in thousands share based awards in € € in thousands
Rice Powell 916 11,138 60.78 677
Annual Report 2021
Fresenius
254
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
Development and status of commitments of further LTIP grants
At the end of the fiscal year 2021, the members of the Management Board held performance shares, phantom stocks, and stock options from different programs from the past.
The following table gives an overview of the outstanding allocated performance shares in the fiscal year 2021:
Grant date fair value Overall target Number of
per performance share Granted number of achievement performance shares
Grant date Vesting date in € performance shares (if final) as of December 31, 2021
Current members of the Management Board
Stephan Sturm
Grant 2018 (LTIP 2018) Sept. 10, 2018 Sept. 10, 2022 2,500 37,064 0% ---
Grant 2019 (LTIP 2018) Sept. 9, 2019 Sept. 9, 2023 2,500 55,115 n.a. 55,115
Grant 2020 (LTIP 2018) Sept. 14, 2020 Sept. 14, 2024 2,500 59,552 n.a. 59,552
Grant 2021 (LTIP 2018) Sept. 13, 2021 Sept. 13, 2025 2,765 61,788 n.a. 61,788
Total 213,519 176,455
Dr. Sebastian Biedenkopf
Grant 2021 (LTIP 2018) Sept. 13, 2021 Sept. 13, 2025 800 17,877 n.a. 17,877
Total 17,877 17,877
Dr. Francesco De Meo
Grant 2018 (LTIP 2018) Sept. 10, 2018 Sept. 10, 2022 1,300 19,274 0% ---
Grant 2019 (LTIP 2018) Sept. 9, 2019 Sept. 9, 2023 1,300 28,660 n.a. 28,660
Grant 2020 (LTIP 2018) Sept. 14, 2020 Sept. 14, 2024 1,300 30,967 n.a. 30,967
Grant 2021 (LTIP 2018) Sept. 13, 2021 Sept. 13, 2025 1,450 32,402 n.a. 32,402
Total 111,303 92,029
Rachel Empey
Grant 2018 (LTIP 2018) Sept. 10, 2018 Sept. 10, 2022 1,300 19,274 0% ---
Grant 2019 (LTIP 2018) Sept. 9, 2019 Sept. 9, 2023 1,300 28,660 n.a. 28,660
Grant 2020 (LTIP 2018) Sept. 14, 2020 Sept. 14, 2024 1,300 30,967 n.a. 30,967
Grant 2021 (LTIP 2018) Sept. 13, 2021 Sept. 13, 2025 1,300 29,050 n.a. 29,050
Total 107,951 88,677
Rice Powell1
Grant 2018 (LTIP 2016) July 30, 2018 July 30, 2022 1,413 17,548 81% 14,214
Grant 2019 (MB LTIP 2019) July 29, 2019 July 29, 2023 1,575 25,127 38% 9,548
Grant 2020 (MB LTIP 2020) Nov. 2, 2020 Nov. 2, 2023 2,170 35,030 n.a. 35,030
Grant 2021 (MB LTIP 2020) March 1, 2021 March 1, 2024 2,231 40,894 n.a. 40,894
Total 118,599 99,686
Annual Report 2021
Michael Sen (since April 12, 2021)
Grant 2021 (LTIP 2018) Sept. 13, 2021 Sept. 13, 2025 1,058 23,633 n.a. 23,633
Total 23,633 23,633
Dr. Ernst Wastler
Grant 2018 (LTIP 2018) Sept. 10, 2018 Sept. 10, 2022 1,300 19,274 0% ---
Grant 2019 (LTIP 2018) Sept. 9, 2019 Sept. 9, 2023 1,300 28,660 n.a. 28,660
Grant 2020 (LTIP 2018) Sept. 14, 2020 Sept. 14, 2024 1,300 30,967 n.a. 30,967
Fresenius
Grant 2021 (LTIP 2018) Sept. 13, 2021 Sept. 13, 2025 1,300 29,050 n.a. 29,050
Total 107,951 88,677
1
Mr. Rice Powell holds performance shares under the programs of Fresenius Medical Care AG & Co. KGaA.
255
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
The following table gives an overview of the outstanding allocated phantom stocks in the fiscal year 2021:
Overall target
Granted number of Grant date fair value achievement Number of phantom stocks
Grant date End of waiting period phantom stocks € in thousands (if final) as of December 31, 2021
Current members of the Management Board
Stephan Sturm
Grant 2017 (LTIP 2013) July 31, 2017 July 31, 2021 10,668 728 25% 2,667
Dr. Francesco De Meo
Grant 2017 (LTIP 2013) July 31, 2017 July 31, 2021 6,067 414 25% 1,517
Rachel Empey
Grant 2017 (LTIP 2013) Dec. 4, 2017 Dec. 4, 2021 1,831 109 25% 458
Dr. Ernst Wastler
Grant 2017 (LTIP 2013) July 31, 2017 July 31, 2021 6,067 414 25% 1,517
The following table gives an overview of the outstanding allocated Share Based Awards of Fresenius Medical Care in the fiscal year 2021:
Number of virtual shares
Grant date Vesting date as of December 31, 2021
Current members of the Management Board
Rice Powell
Grant 2018 March 12, 2019 March 12, 2022 15,003
Grant 2019 March 10, 2020 March 10, 2023 9,913
Total 24,916
Annual Report 2021
Fresenius
256
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
The following table shows the development and the status in 2021 of the stock options allocated in the past:
Stephan Dr. Francesco Rachel Rice Dr. Ernst Total /
Sturm De Meo Empey Powell1 Wastler arithmetic mean2
Options outstanding on January 1, 2021
Number 270,000 196,875 7,031 224,100 219,375 693,281
Average exercise price in € 55.88 58.27 64.69 67.97 52.87 55.70
Options exercised during the fiscal year
Number 45,000 --- --- --- 45,000 90,000
Average exercise price in € 33.10 33.10 33.10
Average stock price in € 39.53 44.00 41.77
Options forfeited during the fiscal year
Number --- --- --- --- --- ---
Average exercise price in €
Options outstanding on December 31, 2021
Number 225,000 196,875 7,031 224,100 174,375 603,281
Average exercise price in € 60.44 58.27 64.69 67.97 57.97 59.07
Average remaining life in years 2.1 1.9 3.9 1.2 1.9 2.0
Range of 36.92 36.92 49,93 36.92 36.92
exercise prices in € to 74.77 to 74.77 64.69 to 76.99 to 74.77 to 74.77
Exercisable options on December 31, 2021
Number 225,000 196,875 7,031 224,100 174,375 603,281
Average exercise price in € 60.44 58.27 64.69 67.97 57.97 59.07
1
Mr. Rice Powell holds stock options under the Fresenius Medical Care AG & Co. KGaA Stock Option Plan 2011.
2
Only stock options of Fresenius SE & Co. KGaA, excluding stock options of Mr. Rice Powell
Annual Report 2021
Fresenius
257
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
The following graph provides an overview of the different allocations (annual grants) under the Long-Term Incentive plans As a result of his exit, no performance shares were allocated
described above and their respective time profiles: to Mr. Mats Henriksson under the LTIP 2018 for the fiscal
year 2021. With regard to the stock options and phantom
stocks already allocated under the LTIP 2013 and the per-
formance shares already allocated under the LTIP 2018, the
respective plan conditions apply, with the exception that
Mr. Mats Henriksson will be treated as if his employment
relationship were to continue until the end of his regular
appointment as a member of the Management Board on
December 31, 2022.
3.4 SHARE OWNERSHIP GUIDELINES Under these guidelines, the Management Board members ownership guidelines continue to apply if the first appoint-
In addition to the Long-Term Incentive, the Compensation are obliged to invest an amount equal to the gross amount ment to the Management Board is for three years and the
System 2021+ provides for share ownership guidelines of an annual base salary in shares of Fresenius SE & Co. Management Board member is not reappointed thereafter.
(SOG) in order to further strengthen the long-term align- KGaA. The Management Board members are obliged to Shares already voluntarily acquired by a member of the
ment with the interests of shareholders and to promote the hold these shares permanently until two years after resig- Management Board since the beginning of the (first) con-
Annual Report 2021
sustainable development of the Group. Furthermore, the nation from the Management Board. For a Management tractual term as a member of the Management Board of
introduction of share ownership guidelines considers inter- Board member, the investment in shares of the Company Fresenius Management SE will be taken into account for
national market practice and the expectations of our share- shall be built up cumulatively from the second year of ser- the fulfillment of the SOG target.
holders. vice onwards at the latest, each year with one quarter of Management Board members can sell their shares at
the gross amount of an annual base salary. The share own- the earliest after the end of the mandatory retention period
Fresenius
ership guideline must be met in full at the latest after the of two years after resignation from the Management Board.
fifth year as a Management Board member. The share
258
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
The following table shows the status of compliance with the share ownership guidelines as of December 31, 2021:
SHARE OWNERSHIP GUIDELINES
Required Status quo End of acquisition phase
in % of the gross amount of
the annual base salary € in thousands € in thousands in % of the SOG target
Stephan Sturm 100% 1,600 401.06 25.07% December 31, 2024
Dr. Francesco De Meo 100% 1,000 250.00 25.00% December 31, 2024
Rachel Empey 100% 850 232.69 27.37% December 31, 2024
Dr. Ernst Wastler 100% 850 215.02 25.30% December 31, 2024
Dr. Sebastian Biedenkopf and Mr. Michael Sen were in Material violations include non-compliance with material 3.6 COMPENSATION-RELATED TRANSACTIONS
their first year of service on the Management Board in provisions of the internal Code of Conduct, grossly negli- 3.6.1 BENEFITS FROM THIRD PARTIES
2021. As previously described, their acquisition phase for gent or unethical conduct, and significant violations of the In the past fiscal year, no benefits were granted or assured
the share ownership guidelines does not begin until the duties of care as defined by Section 93 AktG. In the event to any member of the Management Board by a third party
second year of their service on the Management Board. of incorrect consolidated financial statements, it is possible with regard to their activities as a member of the Manage-
Mr. Mats Henriksson was no longer obliged to acquire to reclaim variable compensation that has already been ment Board. Mr. Rice Powell receives his compensation
and hold shares in Fresenius SE & Co. KGaA due to his paid out if, after payment, it emerges that the audited and exclusively from Fresenius Medical Care in accordance
exit as of March 16, 2021. approved consolidated financial statements on which the with the compensation system applicable to the mem-
In deviation from this, Mr. Rice Powell is required to calculation of the amount to be paid out was based were bers of the Management Board of Fresenius Medical Care
invest in shares of Fresenius Medical Care AG & Co. KGaA incorrect and, on the basis of corrected consolidated finan- Management AG.
as part of the long-term variable compensation provided cial statements, a lower or no payment amount of variable Any compensation granted to Management Board
under the compensation system applicable to the members compensation would have been owed. The obligation of members for Supervisory Board mandates in subsidiaries
of the Management Board of Fresenius Medical Care Man- the Management Board member to pay damages to the of the Fresenius Group is offset against the Management
agement AG effective January 1, 2020. Company pursuant to Section 93 (2) AktG remains unaf- Board member's compensation. If the Supervisory Board of
fected by these provisions. Fresenius Management SE resolves to deduct any compen-
3.5 MALUS/CLAWBACK In the past fiscal year, the supervisory boards of sation, in full or in part, granted to Management Board
Under the Compensation System 2021+, the Supervisory Fresenius Management SE and Fresenius Medical Care members for any activity in supervisory boards outside the
Annual Report 2021
Board of Fresenius Management SE is entitled to withhold Management AG did not withhold or reclaim variable Fresenius Group from the compensation of the Management
(malus) or reclaim (clawback) variable compensation com- compensation components. Board member concerned, this will be made transparent.
ponents in the event of material violations of internal Com-
pany guidelines, statutory and contractual obligations, and
in the event of incorrect consolidated financial statements,
Fresenius
taking into account the particularities of the individual
case.
259
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
3.6.2 COMMITMENTS IN THE EVENT OF Mr. Rice Powell has received a defined benefit pension United States to invest a limited portion of their gross
TERMINATION commitment from Fresenius Medical Care Management income into retirement plans.
Company pension scheme AG. Furthermore, he has acquired non-forfeitable entitle- Dr. Ernst Wastler has a defined benefit pension commit-
As previously described under 3.3.1, there are individual ments from participating in pension plans for employees of ment from VAMED Aktiengesellschaft, Vienna; Fresenius
contractual defined benefit pension commitments for Fresenius Medical Care North America. Moreover, during SE & Co. KGaA has issued a guarantee for the commitment
Mr. Stephan Sturm, Dr. Francesco De Meo, and Ms. Rachel the fiscal year 2021, he participated in the U.S.-based 401(k) thereunder.
Empey based on their service agreements with the general Savings Plan. This plan generally enables employees in the
partner of Fresenius SE & Co. KGaA.
The defined benefit pension commitments for the Management Board members in office as of December 31 of the fiscal year
in accordance with IAS 19 are as follows:
DEFINED BENEFIT PENSION COMMITMENTS
Pension commitment
€ in thousands Pensionable assessment basis As of January 1, 2021 Additions 2021 As of December 31, 2021
Stephan Sturm 1,170 8,716 2,619 11,335
Dr. Francesco De Meo 660 3,709 1,330 5,039
Rachel Empey 630 1,150 915 2,065
Rice Powell --- 14,727 693 15,420
Dr. Ernst Wastler 590 7,226 -325 6,901
Total 35,528 5,232 40,760
Dr. Sebastian Biedenkopf and Mr. Michael Sen have received The Management Board member Mr. Mats Henriksson,
a pension commitment in the form of a defined contribution who resigned as of March 16, 2021, has a defined benefit
pension commitment as described above under 3.3.1. The pension commitment of Fresenius Kabi AG from the time of
2021 insurance contributions and the obligations as of his previous employment with Fresenius Kabi AG. Accord-
December 31, 2021, are as follows: ingly, he has acquired a non-forfeitable right to a company
pension, the amount of which was determined upon his
DEFINED CONTRIBUTION PENSION COMMITMENTS exit. For the determination of the entitlement, the date of
Annual Report 2021
Insurance Commitment as of exit was set as December 31, 2022 (regular end of his ser-
€ in thousands contribution 2021 December 31, 20211
vice on the Management Board). This results in an entitle-
Dr. Sebastian Biedenkopf 240 240
ment to a company pension of €228 thousand p.a. for
Michael Sen
(since April 12, 2021) 302 302 Mr. Mats Henriksson from the age of 63. As of Decem-
Total 542 542 ber 31, 2021, the resulting pension commitment amounts
Fresenius
1
Corresponds to insurance contribution 2021
to €6,496 thousand.
260
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
Severance regulations arising from the sum of the base salary, the target amount Other agreements
The service agreements of the Management Board mem- of the Short-Term Incentive, and the last grant value of In the event of regular termination of his employment,
bers are limited to a maximum of five years in accordance the Long-Term Incentive. Any payments under a post- Dr. Ernst Wastler is entitled to a severance payment based
with Section 84 (1) AktG and provide for a severance pay- contractual non-competition clause are to be offset against on contractual agreements with VAMED Aktiengesellschaft,
ment cap. Accordingly, payments to a Management Board any severance payments and benefits under the Company Vienna. The severance payment stipulates entitlement to a
member in the event of early termination of a Management pension scheme. For Mr. Rice Powell, the compensation payment that depends on the length of service and amounts
Board appointment, including fringe benefits, are limited to amount is half of the annual base salary. to a maximum of one year’s gross compensation (within the
two years of compensation, but not exceeding the compen- meaning of Section 23 of the Austrian Salaried Employees
sation for the remaining term of the service agreement. If Change of control Act). If his service ends due to death, the severance payment
the Company terminates the service agreement for cause The service agreements of the Management Board mem- amounts to only half of the amount. In certain cases, it is
on grounds attributable to the relevant Management Board bers do not contain any provisions in the event of a change waived in the event of premature termination of his service.
member according to Section 626 of the German Civil Code of control. Dr. Wastler's pension entitlement is suspended for the
(BGB), no severance payment will be due. For the calcula- period for which severance payment is granted. With regard
tion of the severance payment cap, the total compensation Continued payments in the event of illness to the severance payment entitlement of Dr. Ernst Wastler,
within the meaning of Section 285 No. 9a HGB of the past All members of the Management Board have individual a severance payment provision of €1,148 thousand (IFRS
fiscal year and the expected total compensation for the fis- contractual commitments for the continuation of their com- DBO (defined benefit obligation)) is in place as of Decem-
cal year in which the termination occurs are used (whereby pensation in the event of sickness for a maximum period ber 31 of the fiscal year. The additions to the pension liabil-
only the fixed compensation components are taken into of 12 months, provided that, after 6 months of sickness- ity in the fiscal year 2021 amounted to -€134 thousand.
account for the calculation of the relevant annual compen- related absence, any insurance benefits that may be paid
sation of Mr. Rice Powell). are to be deducted from such continued compensation. In Commitments for Management Board
the event of death of a member of the Management Board, members terminating their appointment
Post-contractual non-competition clause the surviving dependents will receive three monthly pay- in the fiscal year 2021
A post-contractual non-competition clause has been agreed ments after the month in which the death occurred, at Mr. Mats Henriksson was paid a severance amount of
with all Management Board members for a period of up most, however, until the expiry of the respective service €6,336 thousand as a result of terminating his appointment
to two years. If such a post-contractual non-competition agreement. on March 16, 2021 as part of his termination agreement in
clause becomes applicable, the Management Board mem- March 2021, which also serves as waiting allowance for the
bers may receive compensation for each year of the non- post-contractual non-competition clause from March 17,
competition clause amounting to up to half of the amount 2021 to December 31, 2022.
Annual Report 2021
Fresenius
261
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
3.7 INDIVIDUALIZED DISCLOSURE OF MANAGEMENT BOARD COMPENSATION FOR 2021 AND 2020
In the following tables, the total target compensation of the members of the Management Board set for the fiscal years 2021 and 2020 is individually disclosed. For the short- and
long-term variable compensation, the target or allocation value will be disclosed on the assumption of a 100% target achievement.
TARGET COMPENSATION
Stephan Sturm Dr. Sebastian Biedenkopf Dr. Francesco De Meo
Management Board member,
Chairman of the Management Board responsible for Human Resources (Labor
(since July 1, 2016) Relations), Risk Management and Legal CEO Fresenius Helios
Board member since January 1, 2005 Board member since December 1, 2020 Board member since January 1, 2008
€ in thousands 2021 2020 2021 2020 2021 2020
Base salary 1,600 1,100 600 50 1,000 630
Fringe benefits 69 82 66 4 67 41
Sum fixed compensation 1,669 1,182 666 54 1,067 671
Short-term variable compensation 1,600 1,838 600 --- 1,000 1,388
STI 20201 --- 1,838 --- --- --- 1,388
STI 2021 1,600 --- 600 --- 1,000 ---
Long-term variable compensation 2,765 2,500 800 50 1,450 1,388
Postponed short-term incentive --- --- --- 50 --- 88
Performance shares (LTIP 2018)
Grant 2020 --- 2,500 --- --- --- ---
Grant 2021 2,765 --- 800 --- 1,450 1,300
Sum variable compensation 4,365 4,338 1,400 50 2,450 2,776
Sum fixed and variable compensation 6,034 5,520 2,066 104 3,517 3,447
Service cost 536 541 240 --- 278 391
Total target compensation 6,570 6,061 2,306 104 3,795 3,838
1
For the STI 2020, there are no target values or comparable values for Board members who receive their compensation from Fresenius Management SE.
The STI 2020 was calculated on the basis of bonus curves that were valid for several years. For this reason, the payout from the short-term incentive is stated for the year 2020.
Annual Report 2021
Fresenius
262
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
TARGET COMPENSATION
Rachel Empey Rice Powell Michael Sen
Chief Financial Officer CEO Fresenius Medical Care CEO Fresenius Kabi (since April 12, 2021)
Board member since August 1, 2017 Board member since January 1, 2013 Board member since April 12, 2021
€ in thousands 2021 2020 2021 2020 2021 2020
Base salary 850 704 1,708 1,769 755 ---
Fringe benefits 67 196 315 429 44 ---
Sum fixed compensation 917 900 2,023 2,198 799 ---
Short-term variable compensation 850 799 1,793 1,857 755 ---
STI 20201 --- 799 --- 1,857 --- ---
STI 2021 850 --- 1,793 --- 755 ---
Long-term variable compensation2 1,300 1,300 2,306 2,170 1,058 ---
Postponed short-term incentive --- --- --- --- --- ---
Performance shares (LTIP 2018)
Grant 2020 --- 1,300 --- --- --- ---
Grant 2021 1,300 --- --- --- 1,058 ---
Sum variable compensation 2,150 2,099 4,099 4,027 1,813 ---
Sum fixed and variable compensation 3,067 2,999 6,122 6,225 2,612 ---
Service cost 369 1,150 --- --- 302 ---
Total target compensation 3,436 4,149 6,122 6,225 2,914 ---
1
For the STI 2020, there are no target values or comparable values for Board members who receive their compensation from Fresenius Management SE.
The STI 2020 was calculated on the basis of bonus curves that were valid for several years. For this reason, the payout from the short-term incentive is stated for the year 2020.
2
Mr. Rice Powell was granted share-based payments from the programs of Fresenius Medical Care AG & Co. KGaA as follows:
in 2021: €2,306 thousand from the Management Board Long Term Incentive Plan 2020 grant 2021
in 2020: €2,170 thousand from the Management Board Long Term Incentive Plan 2020 grant 2020
Annual Report 2021
Fresenius
263
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
TARGET COMPENSATION
Dr. Ernst Wastler1
CEO Fresenius Vamed
Board member since January 1, 2008
€ in thousands 2021 2020
Base salary 850 550
Fringe benefits 74 75
Sum fixed compensation 924 625
Short-term variable compensation 850 769
STI 20202 --- 769
STI 2021 850 ---
Long-term variable compensation 1,300 1,300
Postponed short-term incentive --- ---
Performance shares (LTIP 2018)
Grant 2020 --- 1,300
Grant 2021 1,300 ---
Sum variable compensation 2,150 2,069
Sum fixed and variable compensation 3,074 2,694
Service cost 22 189
Total target compensation 3,096 2,883
1
In 2021, Dr. Ernst Wastler received a one-time payment from a direct commitment in the amount of €259,741. In accordance with the service agreement,
this amount was paid in the month in which Dr. Ernst Wastler reached the age of 63.
2
For the STI 2020, there are no target values or comparable values for Board members who receive their compensation from Fresenius Management SE. The STI 2020
was calculated on the basis of bonus curves that were valid for several years. For this reason, the payout from the short-term incentive is stated for the year 2020.
In addition to the target compensation, the compensa- Thus, the compensation awarded and due in the fiscal
tion awarded and due in the fiscal year is disclosed and year 2021 comprises the base salary and fringe benefits
explained in accordance with the requirements of Sec- paid in the fiscal year 2021. The variable compensation is
tion 162 AktG. For the fiscal year 2021, the short- and long- the short-term variable compensation for the fiscal year
term variable compensation is reported in such a way 2021 (payment in fiscal year 2022) and the long-term vari-
that the respective performance has been completed or the able compensation whose measurement period or waiting
vesting period has been fully completed by the end of the period ended in the fiscal year 2021 and whose vesting
fiscal year 2021 and the vesting conditions are met. This conditions have been met.
Annual Report 2021
enables a comprehensive presentation of the connection In addition, the pension expenses (current service cost)
between the business results of the fiscal year 2021 and for the pension commitments incurred in the fiscal year
the resulting compensation. 2021 are disclosed.
Fresenius
264
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
COMPENSATION AWARDED AND DUE
Stephan Sturm Dr. Sebastian Biedenkopf
Chairman of the Management Board Management Board member, responsible for Human Resources
(since July 1, 2016) (Labor Relations), Risk Management and Legal
Board member since January 1, 2005 Board member since December 1, 2020
2021 2020 2021 2020
€ in thousands in % € in thousands in % € in thousands in % € in thousands in %
Base salary 1,600 1,100 600 50
Fringe benefits 69 82 66 4
Total fixed compensation 1,669 46% 1,182 32% 666 52% 54 100%
Short-term incentive 1,629 1,838 611 ---
Long-term incentive 356 633 --- ---
Postponed short-term incentive --- --- --- ---
Phantom stocks (LTIP 2013)
Grant 2015 --- 550 --- ---
Grant 2016 298 --- --- ---
Further phantom stocks
Grant 2015 --- 83 --- ---
Grant 2016 58 --- --- ---
Total variable compensation 1,985 54% 2,471 68% 611 48% ---
Total in accordance with Section 162 (1) sentence 2 no. 1 AktG 3,654 3,653 1,277 54
Service cost 536 541 240 ---
Total including service cost 4,190 4,194 1,517 54
Annual Report 2021
Fresenius
265
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
COMPENSATION AWARDED AND DUE
Dr. Francesco De Meo Rachel Empey
CEO Fresenius Helios Chief Financial Officer
Board member since January 1, 2008 Board member since August 1, 2017
2021 2020 2021 2020
€ in thousands in % € in thousands in % € in thousands in % € in thousands in %
Base salary 1,000 630 850 704
Fringe benefits 67 41 67 196
Total fixed compensation 1,067 43% 671 26% 917 51% 900 53%
Short-term incentive 1,052 1,388 866 799
Long-term incentive 372 506 --- ---
Postponed short-term incentive 115 148 --- ---
Phantom stocks (LTIP 2013)
Grant 2015 --- 275 --- ---
Grant 2016 199 --- --- ---
Further phantom stocks
Grant 2015 --- 83 --- ---
Grant 2016 58 --- --- ---
Total variable compensation 1,424 57% 1,894 74% 866 49% 799 47%
Total in accordance with Section 162 (1) sentence 2 no. 1 AktG 2,491 2,565 1,783 1,699
Service cost 278 391 369 1,150
Total including service cost 2,769 2,956 2,152 2,849
Annual Report 2021
Fresenius
266
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
COMPENSATION AWARDED AND DUE
Rice Powell Michael Sen
CEO Fresenius Medical Care CEO Fresenius Kabi (since April 12, 2021)
Board member since January 1, 2013 Board member since April 12, 2021
2021 2020 2021 2020
€ in thousands in % € in thousands in % € in thousands in % € in thousands in %
Base salary 1,708 1,769 755 ---
Fringe benefits 315 429 44 ---
Total fixed compensation 2,023 37% 2,198 29% 799 51% ---
Short-term incentive 1,422 1,734 773 ---
Long-term incentive1 1,979 3,710 --- ---
Postponed short-term incentive --- --- --- ---
Phantom stocks (LTIP 2013)
Grant 2015 --- --- --- ---
Grant 2016 --- --- --- ---
Further phantom stocks
Grant 2015 --- --- --- ---
Grant 2016 --- --- --- ---
Total variable compensation 3,401 63% 5,444 71% 773 49% ---
Total in accordance with Section 162 (1) sentence 2 no. 1 AktG 5,424 7,642 1,572 ---
Service cost --- --- 302 ---
Total including service cost 5,424 7,642 1,874 ---
1
Mr. Rice Powell received these payments from the share-based compensation plans of Fresenius Medical Care:
in 2021: €677 thousand from the Share Based Award grant 2017, €1,302 thousand from the Long Term Incentive Program 2016 grant 2017
in 2020: €659 thousand from the Share Based Award grant 2016, €748 thousand from the Long Term Incentive Program 2011 --- Phantom Stock Plan 2011 grant 2015, €2,303 thousand from the Long Term Incentive Program 2016 grant 2016
Annual Report 2021
Fresenius
267
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
COMPENSATION AWARDED AND DUE
Dr. Ernst Wastler
CEO Fresenius Vamed
Board member since January 1, 2008
2021 2020
€ in thousands in % € in thousands in %
Base salary 850 550
Fringe benefits1 334 75
Total fixed compensation 1,184 51% 625 31%
Short-term incentive 883 769
Long-term incentive 257 633
Postponed short-term incentive --- ---
Phantom stocks (LTIP 2013)
Grant 2015 --- 550
Grant 2016 199 ---
Further phantom stocks
Grant 2015 --- 83
Grant 2016 58 ---
Total variable compensation 1,140 49% 1,402 69%
Total in accordance with Section 162 (1) sentence 2 no. 1 AktG 2,324 2,027
Service cost 22 189
Total including service cost 2,346 2,216
1
In 2021, the fringe benefits of Dr. Ernst Wastler include a one-time payment from a direct commitment in the amount of €259,741. In accordance with the service agreement,
this amount was paid in the month in which Dr. Ernst Wastler reached the age of 63.
3.8 COMPENSATION OF FORMER MANAGEMENT Mr. Mats Henriksson received fringe benefits on a pro rata non-competition clause applicable after his exit from the
BOARD MEMBERS basis in the form of subsidies for life, pension, health, and Management Board as of June 30, 2020. In addition, con-
For the period from January 1 to March 16, 2021, Mr. Mats accident insurance and private use of a company car in a sulting fees of €16 thousand were paid to Dr. Götz in the
Henriksson was paid on a pro rata basis, in addition to the total amount of €48 thousand, as well as a one-off payment fiscal year 2021.
severance payment explained under 3.6.2, a fixed base of €10 thousand in April 2021 for legal advice in connection Mr. Rainer Baule, member of the Management Board
salary in the amount of €219 thousand and a short-term with his premature exit from the Management Board. In until December 31, 2012, was paid €265 thousand in con-
variable compensation for the fiscal year 2021 (based on total, Mr. Mats Henriksson was paid €1,121 thousand pro nection with his pension commitment.
the target value for the fiscal year 2021) in the amount of rata temporis for the period from January 1 to March 16, Furthermore, in fiscal year 2021, €896 thousand was
Annual Report 2021
€219 thousand. Furthermore, in March 2021, he was paid 2021. Thereof, 25% was fixed and 75% was variable com- paid to three former members of the Management Board
out postponed payments of the previous short-term variable pensation, or, taking into account the severance payment who retired before 2012, mainly as part of pension commit-
compensation for the years 2018 to 2020 in the total amount specified under 3.6.2, Commitments in the event of termi- ments.
of €169 thousand. As part of the long-term variable compen- nation, 89% fixed and 11% variable compensation. For eight former members of the Management Board,
sation, phantom stocks (LTIP 2013) of the 2016 grant in In fiscal year 2021, Dr. Jürgen Götz received a compen- there is a pension obligation in accordance with IAS 19 of
Fresenius
the amount of €456 thousand were paid out to him in fis- sation payment of €605 thousand for the period from Janu- €34,714 thousand in fiscal year 2021.
cal year 2021. In the past fiscal year, among other things, ary 1 to December 31, 2021 due to the post-contractual
268
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
4. COMPENSATION OF THE SUPERVISORY BOARD This aspiration will be met through the revised remunera- 4.2 COMPENSATION SYSTEM
4.1 COMPENSATION GOVERNANCE tion for the members of the Supervisory Board governed The members of the Supervisory Board of the Company are
The Supervisory Board of the Company advises and super- in Section 13 of the articles of association of Fresenius SE & remunerated on the basis of Section 13 of the articles of as-
vises the business activities conducted by the Management Co. KGaA. The material change to the remuneration for the sociation. A resolution on the remuneration of the members
Board of the general partner and performs the other duties Supervisory Board of the Company in comparison with the of the Supervisory Board is passed by the Annual General
assigned to it by law and by the articles of association. It is previous arrangement is that, under the new remuneration Meeting at least every four years on the basis of a proposal
involved in strategy and planning as well as in all matters of arrangement, only fixed remuneration components shall by the general partner and the Supervisory Board. The
fundamental importance for the Company. In view of these be paid. The variable remuneration component previously members of the Supervisory Board of the Company receive
responsible duties, the members of the Supervisory Board governed in Section 13 (2) of the articles of association a fixed remuneration, fringe benefits (consisting of refund
of the Company receive appropriate remuneration that shall lapse. The adjustment is in line with the suggestions of expenses and insurance cover), and, if they perform
also takes sufficient account of the time demands of the of the GCGC in the version dated December 16, 2019. any duties on the Audit Committee of the Supervisory
position of the Supervisory Board member. In addition, a The revised remuneration of the members of the Super- Board of the Company, remuneration for their duties on
Supervisory Board remuneration that is also in line with visory Board was proposed for resolution to the Annual this committee. The relative share of fixed remuneration
the market environment ensures that the Company will General Meeting of the Company on May 21, 2021 with a is always 100%.
continue to attract qualified candidates to its Supervisory corresponding amendment in Section 13 of the articles of As fixed remuneration, each member of the Supervisory
Board in the future. In this way, the fair remuneration of association and approved with an approval rate of 98.86%. Board of the Company, shall receive an amount of €180
the members of the Supervisory Board contributes to pro- The new compensation system has been effective since thousand annually for each full fiscal year, payable after the
moting the business strategy and long-term development January 1, 2021. end of the fiscal year. The Chairman of the Supervisory
of Fresenius SE & Co. KGaA. Board of the Company shall receive two and a half times,
and his deputies one and a half times, the remuneration of
a Supervisory Board member.
Annual Report 2021
Fresenius
269
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
For membership in the Audit Committee of the Supervisory If a member of the Supervisory Board of the Company is Additionally, in his capacity as Chairman of the Supervisory
Board of the Company a member shall receive additional at the same time a member of the Supervisory Board of the Board of Fresenius Management SE until May 21, 2021,
remuneration of €40 thousand for each full fiscal year, while general partner, Fresenius Management SE, and receives Dr. Gerd Krick was reimbursed for the costs of the operation
the Chairman of the Audit Committee shall receive twice remuneration for their services on the Supervisory Board of a security alarm system in the amount of €1 thousand.
this amount. of Fresenius Management SE, the remuneration for their Fresenius Management SE, with the consent of its
If a fiscal year does not encompass a full calendar year, activities as a member of the Supervisory Board of the Supervisory Board, entered into a consultancy agreement
or if a member of the Supervisory Board of the Company is Company shall be reduced by half. The same applies with with Dr. Gerd Krick on July 17, 2021, with a term of three
a member of the Supervisory Board for only a portion of regard to the additional part of the remuneration for the years, to ensure that the comprehensive knowledge and
the fiscal year, the remuneration shall be paid on a pro rata Chairman of the Supervisory Board of the Company, pro- experience of Dr. Gerd Krick regarding the Fresenius Group
temporis basis. This shall apply accordingly to membership vided he is simultaneously the Chairman of the Super- will still be available after his retirement from the Supervi-
of the Audit Committee of the Supervisory Board of the visory Board of Fresenius Management SE; this applies sory Board of the Company and from the Supervisory Board
Company. accordingly to his deputies to the extent they are simulta- of Fresenius Management SE on May 21, 2021. For his con-
The members of the Supervisory Board of the Company neously deputies of the Chairman of the Supervisory Board sulting activities, Dr. Gerd Krick will receive an annual fee
shall be refunded expenses incurred when exercising their of Fresenius Management SE. If a deputy of the Chairman in the amount of €200 thousand plus any applicable value
functions, which also includes any possible applicable of the Supervisory Board of the Company is at the same added tax; within the fiscal year 2021, Dr. Gerd Krick was
value added tax due for payment. Fresenius SE & Co. KGaA time the Chairman of the Supervisory Board of Fresenius paid a pro rata fee in the amount of €100 thousand. Under
shall provide members of its Supervisory Board with insur- Management SE, they shall not receive any additional remu- the terms of the consulting agreement, Dr. Gerd Krick has
ance cover to an appropriate extent for exercising Super- neration for their service as Deputy Chairman of the Super- agreed to a comprehensive non-competition clause.
visory Board activities. As for the Management Board, visory Board of the Company. According to Section 7 of the
Fresenius SE & Co. KGaA has also taken out Directors’ & articles of association of Fresenius SE & Co. KGaA, the remu-
Officers’ liability insurance for the Supervisory Board of neration of the Supervisory Board of Fresenius Manage-
Fresenius Management SE and the Supervisory Board of ment SE will be charged to Fresenius SE & Co. KGaA.
the Company. This insurance covers the legal defense costs
of a member of a representative body in the event of a claim
and, if applicable, any damages to be paid within the scope
of the existing coverage sums.
Annual Report 2021
Fresenius
270
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
4.3 INDIVIDUALIZED DISCLOSURE OF SUPERVISORY BOARD COMPENSATION FOR 2021 AND 2020
The amount of compensation awarded and due for the fulfilment of service in the fiscal years 2021 and 2020, including compensation for committee services for the members of the
Supervisory Board of the Company and Fresenius Management SE (excluding expenses and reimbursements) is as follows:
COMPENSATION OF THE SUPERVISORY BOARD
Fixed compensation Compensation for committee services Total compensation
Fresenius SE & Co. KGaA Fresenius Management SE Fresenius SE & Co. KGaA Fresenius Management SE
€ in thousands 2021 2020 2021 2020 2021 2020 2021 2020 2021 2020
Wolfgang Kirsch 138 --- 238 150 25 --- 25 --- 426 150
Dr. Gerd Krick
(up to May 21, 2021) 88 225 99 225 16 20 16 20 219 490
Michael Diekmann 180 150 120 75 --- --- 20 10 320 235
Grit Genster
(since May 1, 2020) 270 147 --- --- 40 12 --- --- 310 159
Dr. Dieter Schenk --- --- 300 225 --- --- 20 10 320 235
Prof. Dr. med. D. Michael Albrecht 180 150 --- --- --- --- --- --- 180 150
Stefanie Balling 180 150 --- --- --- --- --- --- 180 150
Bernd Behlert 180 150 --- --- --- --- --- --- 180 150
Dr. Heinrich Hiesinger
(since July 1, 2020) --- --- 210 75 --- --- --- --- 210 75
Dr. Frank Appel
(since May 21, 2021) --- --- 129 --- --- --- --- --- 129 ---
Konrad Kölbl 180 150 --- --- 40 20 --- --- 220 170
Frauke Lehmann 180 150 --- --- --- --- --- --- 180 150
Prof. Dr. med. Iris Löw-Friedrich 180 150 --- --- --- --- --- --- 180 150
Klaus-Peter Müller 145 75 47 75 80 40 --- --- 272 190
Oscar Romero De Paco 180 150 --- --- --- --- --- --- 180 150
Hauke Stars 180 150 --- --- 40 20 --- --- 220 170
Susanne Zeidler
(since May 21, 2021) --- --- 129 --- --- --- --- --- 129 ---
Total 2,261 1,797 1,272 825 241 112 81 40 3,855 2,774
Annual Report 2021
Fresenius
271
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
5. COMPARATIVE PRESENTATION OF THE For the comparative presentation of the earnings develop- comparison of the compensation paid in the fiscal year and
COMPENSATION DEVELOPMENT OF THE ment of the Company, Group sales and Group net income the earnings development of the Company in the same fiscal
MANAGEMENT BOARD MEMBERS AND THE (before special items) will be shown, which are key perfor- year is only possible to a limited extent.
SUPERVISORY BOARD MEMBERS IN RELATION mance indicators for the steering of the Group and the vari- The comparative presentation of the development of the
TO THE COMPENSATION OF THE OVERALL able compensation of the Management Board. In addition, compensation of the workforce includes all employees of
WORKFORCE AND TO THE EARNINGS according to the regulatory requirements, net income of the Fresenius Group on a full-time equivalent (FTE) basis.
DEVELOPMENT OF THE COMPANY Fresenius SE & Co. KGaA pursuant to HGB will be presented.
The development of the compensation awarded and due to It should be noted that the compensation data refers
the members of the Management Board and both supervi- to the compensation awarded and due pursuant to Sec-
sory boards according to Section 162 AktG, the earnings tion 162 AktG. This refers to payments made from the
development of the Company, and the development of the Long-Term Incentive to compensation components allo-
average compensation of the workforce will be presented cated in previous fiscal years. Therefore, a meaningful
in the following comparative table for the five-year period
2017 to 2021.
Annual Report 2021
Fresenius
272
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
ANNUAL COMPARISON OF COMPENSATION AWARDED AND DUE
2021 2020 2019 2018 2017
Sales € in millions 37,520 36,277 35,409 33,530 33,886
Annual change in % +3% +2% +6% -1%
Group net income1 € in millions 1,867 1,796 1,879 1,871 1,816
Annual change in % 4% -4% 0% +3%
Net income of Fresenius SE & Co. KGaA pursuant to HGB € in millions 503 603 580 489 548
Annual change in % -17% +4% +19% -11%
Average employee compensation2 € in thousands 45 45 45 44 45
Annual change in % 0% 0% +2% -2%
Current Members of the Management Board
Stephan Sturm € in thousands 3,654 3,653 3,675 4,035 3,362
(Management Board member since January 1, 2005) Annual change in % 0% -1% -9% +20%
Dr. Sebastian Biedenkopf € in thousands 1,277 54 --- --- ---
(Management Board member since December 1, 2020) Annual change in % +2,265% n.a. n.a. n.a.
Dr. Francesco De Meo € in thousands 2,491 2,565 2,719 3,035 2,469
(Management Board member since January 1, 2008) Annual change in % -3% -6% -10% +23%
Rachel Empey € in thousands 1,783 1,699 1,610 1,643 604
(Management Board member since August 1, 2017) Annual change in % +5% +6% -2% +172%
Rice Powell € in thousands 5,424 7,642 4,060 4,082 3,968
(Management Board member since January 1, 2013) Annual change in % -29% +88% -1% +3%
Michael Sen € in thousands 1,572 --- --- --- ---
(Management Board member since April 12, 2021) Annual change in % n.a. n.a. n.a. n.a.
Dr. Ernst Wastler € in thousands 2,324 2,027 2,212 2,497 1,718
(Management Board member since January 1, 2008) Annual change in % +15% -8% -11% +45%
Former Members of the Management Board
Dr. Jürgen Götz € in thousands 621 1,399 2,159 2,446 1,741
(Management Board member until June 30, 2020) Annual change in % -56% -35% -12% +40%
Mats Henriksson € in thousands 7,457 2,726 2,797 3,088 2,108
(Management Board member until March 16, 2021) Annual change in % +174% -3% -9% +46%
Rainer Baule € in thousands 265 265 265 252 252
(Management Board member until December 30, 2012) Annual change in % 0% 0% +5% 0%
1 Before special items
2 Average of wages and salaries of all Group employees on FTE basis
Annual Report 2021
Fresenius
273
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
ANNUAL COMPARISON OF COMPENSATION AWARDED AND DUE
2021 2020 2019 2018 2017
Current Members of the Supervisory Boards
Wolfgang Kirsch € in thousands 426 150 --- --- ---
(Supervisory Board member since January 1, 2020) Annual change in % +184% n.a. n.a. n.a.
Michael Diekmann € in thousands 320 235 315 375 451
(Supervisory Board member since May 20, 2015) Annual change in % +36% -25% -16% -17%
Grit Genster € in thousands 310 159 --- --- ---
(Supervisory Board member since May 1, 2020) Annual change in % +95% n.a. n.a. n.a.
Dr. Dieter Schenk € in thousands 320 235 325 385 461
(Supervisory Board member since March 11, 2010) Annual change in % +36% -28% -16% -16%
Prof. Dr. med. D. Michael Albrecht € in thousands 180 150 240 300 301
(Supervisory Board member since January 28, 2011) Annual change in % +20% -38% -20% 0%
Stefanie Balling € in thousands 180 150 240 300 301
(Supervisory Board member since May 13, 2016) Annual change in % +20% -38% -20% 0%
Bernd Behlert € in thousands 180 150 240 100 ---
(Supervisory Board member since September 1, 2018) Annual change in % +20% -38% +140% n.a.
Dr. Heinrich Hiesinger € in thousands 210 75 --- --- ---
(Supervisory Board member since July 7, 2020) Annual change in % +180% n.a. n.a. n.a.
Dr. Frank Appel € in thousands 129 --- --- --- ---
(Supervisory Board member since May 21, 2021) Annual change in % n.a. n.a. n.a. n.a.
Konrad Kölbl € in thousands 220 170 260 320 311
(Supervisory Board member since July 16, 2007) Annual change in % +29% -35% -19% +3%
Frauke Lehmann € in thousands 180 150 240 300 301
(Supervisory Board member since May 13, 2016) Annual change in % +20% -38% -20% 0%
Prof. Dr. med. Iris Löw-Friedrich € in thousands 180 150 240 300 301
(Supervisory Board member since May 13, 2016) Annual change in % +20% -38% -20% 0%
Klaus-Peter Müller € in thousands 272 190 280 340 320
(Supervisory Board member since May 21, 2008) Annual change in % +43% -32% -18% +6%
Oscar Romero de Paco € in thousands 180 150 240 300 301
(Supervisory Board member since May 13, 2016) Annual change in % +20% -38% -20% 0%
Hauke Stars € in thousands 220 170 260 320 311
(Supervisory Board member since May 13, 2016) Annual change in % +29% -35% -19% +3%
Susanne Zeidler € in thousands 129 --- --- --- ---
(Supervisory Board member since May 21, 2021) Annual change in % n.a. n.a. n.a. n.a.
Annual Report 2021
Former Members of the Supervisory Boards
Dr. Gerd Krick € in thousands 219 490 580 640 632
(Supervisory Board member from May 28, 2003 until May 21, 2021) Annual change in % -55% -16% -9% +1%
Fresenius
274
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
AUDITOR’S REPORT AUDITOR’S RESPONSIBILITIES The objective of this is to plan and perform audit procedures
Our responsibility is to express an opinion on this remuner- that are appropriate in the circumstances, but not for the
TO FRESENIUS SE & CO. KGAA, ation report, including the related disclosures, based on purpose of expressing an opinion on the effectiveness of
BAD HOMBURG V.D.H. our audit. We conducted our audit in accordance with Ger- the company's internal control. An audit also includes eval-
man generally accepted standards for the audit of financial uating the appropriateness of accounting policies used and
We have audited the remuneration report of Fresenius SE & statements promulgated by the Institut der Wirtschaftsprüfer the reasonableness of accounting estimates made by the
Co. KGaA, Bad Homburg v.d.H., for the financial year from (Institute of Public Auditors in Germany) (IDW). Those executive directors and the supervisory board, as well as
January 1 to December 31, 2021including the related dis- standards require that we comply with ethical requirements evaluating the overall presentation of remuneration report
closures, which was prepared to comply with § [Article] and plan and perform the audit to obtain reasonable assur- including the related disclosures.
162 AktG [Aktiengesetz: German Stock Corporation Act]. ance about whether the remuneration report, including the We believe that the audit evidence we have obtained is
related disclosures, is free from material misstatement. sufficient and appropriate to provide a basis for our audit
RESPONSIBILITIES OF THE EXECUTIVE DIRECTORS An audit involves performing procedures to obtain audit opinion.
AND THE SUPERVISORY BOARD evidence about the amounts including the related disclo-
The executive directors and the supervisory board of sures stated in the remuneration report. The procedures AUDIT OPINION
Fresenius SE & Co. KGaA are responsible for the prepara- selected depend on the auditor's judgment. This includes In our opinion, based on the findings of our audit, the remu-
tion of the remuneration report, including the related dis- the assessment of the risks of material misstatement of neration report for the financial year from January 1 to
closures, that complies with the requirements of § 162 the remuneration report including the related disclosures, December 31, 2021, including the related disclosures, com-
AktG. The executive directors and the supervisory board whether due to fraud or error. In making those risk assess- plies in all material respects with the accounting provisions
are also responsible for such internal control as they deter- ments, the auditor considers internal control relevant to of § 162 AktG.
mine is necessary to enable the preparation of a remunera- the preparation of the remuneration report including the
tion report, including the related disclosures, that is free related disclosures.
from material misstatement, whether due to fraud or error.
Annual Report 2021
Fresenius
275
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Corporate Governance Declaration ► Further information on Corporate Governance
REFERENCE TO AN OTHER MATTER --- FORMAL AUDIT RESTRICTION ON USE
OF THE REMUNERATION REPORT ACCORDING TO We issue this auditor’s report on the basis of the engage-
§ 162 AKTG ment agreed with Fresenius SE & Co. KGaA. The audit has
The audit of the content of the remuneration report been performed only for purposes of the company and the
described in this auditor's report includes the formal audit auditor‘s report is solely intended to inform the company as
of the remuneration report required by § 162 Abs. [para- to the results of the audit. Our responsibility for the audit
graph] 3 AktG, including the issuance of a report on this and for our auditor’s report is only towards the company in
audit. As we express an unqualified audit opinion on the accordance with this engagement. The auditor’s report is
content of the remuneration report, this audit opinion in- not intended for any third parties to base any (financial)
cludes that the information required by § 162 Abs. 1 and 2 decisions thereon. We do not assume any responsibility,
AktG has been disclosed in all material respects in the duty of care or liability towards third parties; no third par-
remuneration report. ties are included in the scope of protection of the under-
lying engagement. Section 334 BGB [Bürgerliches
Gesetzbuch: German Civil Code], according to which
objections arising from a contract may also be raised
against third parties, is not waived.
Frankfurt am Main, February 21, 2022
PricewaterhouseCoopers GmbH
Wirtschaftsprüfungsgesellschaft
(Original German Version signed by:)
Dr. Ulrich Störk Dr. Bernd Roese
Wirtschaftsprüfer Wirtschaftsprüfer
Annual Report 2021
(German Public Auditor) (German Public Auditor)
Fresenius
276
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement | Auditor’s report
TABLE OF CONTENTS
CONSOLIDATED FINANCIAL STATEMENTS
278 Consolidated statement of income 285 Consolidated segment reporting
279 Consolidated statement 287 Notes
of comprehensive income 288 General notes
308 Notes on the consolidated statement of income
280 Consolidated statement
314 Notes on the consolidated statement of financial position
of financial position
342 Other notes
281 Consolidated statement of cash flows
283 Consolidated statement 384 Responsibility statement
of changes in equity
385 Auditor’s report
Annual Report 2021
Fresenius
277
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
► Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA
CONSOLIDATED STATEMENT OF INCOME
€ in millions Note 2021 2020
Sales 4 37,520 36,277
Cost of sales -27,209 -25,961
Gross profit 10,311 10,316
Selling expenses -1,059 -1,057
General and administrative expenses 8 -4,394 -4,373
Other operating income 9 381 398
Other operating expenses 9 -276 -148
Research and development expenses 7 -805 -751
Operating income (EBIT) 4,158 4,385
Interest income 10 124 93
Interest expenses 10 -630 -752
Income before income taxes 3,652 3,726
Income taxes 11 -833 -903
Net income 2,819 2,823
Noncontrolling interests 12 1,001 1,116
Net income attributable to shareholders of Fresenius SE & Co. KGaA 1,818 1,707
Earnings per share in € 14 3.26 3.06
Fully diluted earnings per share in € 14 3.26 3.06
The following notes are an integral part of the consolidated financial statements.
Annual Report 2021
Fresenius
278
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income ► Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA
CONSOLIDATED STATEMENT OF COMPREHENSIVE INCOME
€ in millions Note 2021 2020
Net income 2,819 2,823
Other comprehensive income (loss)
Positions which will be reclassified into net income in subsequent years
Foreign currency translation 29, 32 1,475 -2,075
Cash flow hedges 29, 32 -6 5
FVOCI debt instruments -10 30
Income taxes on positions which will be reclassified 29 8 -11
Positions which will not be reclassified into net income in subsequent years
Actuarial gains (losses) on defined benefit pension plans 26, 29 -15 28
Equity method investees - share of OCI -23 58
FVOCI equity investments 32 -28 4
Income taxes on positions which will not be reclassified 29 16 -8
Other comprehensive income (loss), net 1,417 -1,969
Total comprehensive income 4,236 854
Comprehensive income attributable to noncontrolling interests 1,718 92
Comprehensive income attributable to shareholders of Fresenius SE & Co. KGaA 2,518 762
The following notes are an integral part of the consolidated financial statements.
Annual Report 2021
Fresenius
279
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income ► Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA
CONSOLIDATED STATEMENT OF FINANCIAL POSITION
ASSETS LIABILITIES AND SHAREHOLDERS’ EQUITY
as of December 31, € in millions Note 2021 2020 as of December 31, € in millions Note 2021 2020
Cash and cash equivalents 15 2,764 1,837 Trade accounts payable 2,039 1,816
Trade accounts and other receivables, Short-term accounts payable to related parties 92 67
less allowances for expected credit losses 16 7,045 6,937 Short-term provisions and other short-term liabilities 21, 22 7,915 7,330
Accounts receivable from and loans to related parties 147 110 Short-term debt 23 2,841 245
Inventories 17 4,218 3,945 Short-term debt from related parties 8 5
Other current assets 18 3,287 2,943 Current portion of long-term debt 23 473 1,132
I. Total current assets 17,461 15,772 Current portion of lease liabilities 31 832 766
Property, plant and equipment 19 12,569 11,912 Current portion of bonds 24 618 1,522
Right-of-use assets 31 6,014 5,691 Short-term liabilities for income taxes 244 230
Goodwill 20 28,943 26,599 A. Total short-term liabilities 15,062 13,113
Other intangible assets 20 3,831 3,736 Long-term debt, less current portion 23 2,127 4,022
Other non-current assets 18 2,286 2,124 Lease liabilities, less current portion 31 5,758 5,422
Deferred taxes 11 858 812 Bonds, less current portion 24 14,016 12,325
II. Total non-current assets 54,501 50,874 Convertible bonds 25 482 474
Total assets 71,962 66,646 Long-term provisions and other long-term liabilities 21, 22 1,788 2,021
Pension liabilities 26 1,675 1,582
Long-term liabilities for income taxes 251 274
Deferred taxes 11 1,515 1,390
B. Total long-term liabilities 27,612 27,510
I. Total liabilities 42,674 40,623
A. Noncontrolling interests 27 10,290 9,074
Subscribed capital 28 558 557
Capital reserve 28 4,026 3,992
Other reserves 28 14,860 13,535
Accumulated other comprehensive loss 29 -446 -1,135
B. Total Fresenius SE & Co. KGaA shareholders’ equity 18,998 16,949
II. Total shareholders’ equity 29,288 26,023
Annual Report 2021
Total liabilities and shareholders’ equity 71,962 66,646
The following notes are an integral part of the consolidated financial statements.
Fresenius
280
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
► Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA
CONSOLIDATED STATEMENT OF CASH FLOWS
January 1 to December 31, € in millions Note 2021 2020
Operating activities
Net income 2,819 2,823
Adjustments to reconcile net income to cash and
cash equivalents provided by operating activities
Depreciation and amortization 18, 19, 20, 31 2,667 2,715
Change in deferred taxes 11 84 43
Loss / Gain on sale of fixed assets and of investments and divestitures 2 42 -60
Changes in assets and liabilities, net of amounts
from businesses acquired or disposed of
Trade accounts and other receivables 16 87 -26
Inventories 17 -105 -527
Other current and non-current assets 18 -320 -252
Accounts receivable from / payable to related parties -10 13
Trade accounts payable, provisions and
other short-term and long-term liabilities 21, 22 -154 1,819
Liabilities for income taxes -32 1
Net cash provided by operating activities 5,078 6,549
Investing activities
Purchases of property, plant and equipment
and capitalized development costs 19 -2,047 -2,406
Proceeds from sales of property, plant and equipment 30 40
Acquisitions and investments
and purchases of intangible assets 2, 34 -999 -720
Proceeds from sale of investments and divestitures 2 199 75
Net cash used in investing activities -2,817 -3,011
Annual Report 2021
Fresenius
281
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
► Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA
CONSOLIDATED STATEMENT OF CASH FLOWS
January 1 to December 31, € in millions Note 2021 2020
Financing activities
Proceeds from short-term debt 23 3,279 282
Repayments of short-term debt 23 -688 -2,529
Proceeds from long-term debt 23 458 61
Repayments of long-term debt 23 -3,028 -1,438
Repayments of lease liabilities 31 -880 -937
Proceeds from the issuance of bonds 24 2,714 4,577
Repayments of liabilities from bonds 24 -2,253 -937
Repayments of convertible bonds 25 --- -400
Payments for the share buy-back program of Fresenius Medical Care 28 --- -366
Payments for the Accounts Receivable
Facility of Fresenius Medical Care 23 --- -374
Proceeds from the exercise of stock options 36 38 18
Dividends paid -1,068 -1,060
Change in noncontrolling interests, net 27 -24 -14
Net cash used in financing activities -1,452 -3,117
Effect of exchange rate changes on cash and cash equivalents 118 -238
Net increase in cash and cash equivalents 927 183
Cash and cash equivalents at the beginning of the reporting period 15 1,837 1,654
Cash and cash equivalents at the end of the reporting period 15 2,764 1,837
ADDITIONAL INFORMATION ON PAYMENTS
THAT ARE INCLUDED IN NET CASH PROVIDED BY OPERATING ACTIVITIES
January 1 to December 31, € in millions Note 2021 2020
Received interest 94 66
Paid interest -517 -627
Income taxes paid -750 -765
Annual Report 2021
The following notes are an integral part of the consolidated financial statements.
Fresenius
282
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows ► Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA
CONSOLIDATED STATEMENT OF CHANGES IN EQUITY
Subscribed Capital Reserves
Number of Capital Other
ordinary shares Amount Amount reserve reserves
Note in thousand € in thousands € in millions € in millions € in millions
As of December 31, 2019 557,380 557,380 557 3,989 12,422
Proceeds from the exercise of stock options 36 161 161 0 9
Compensation expense related to stock options 36 -6
Dividends paid 28 -468
Purchase of noncontrolling interests 27
Share buy-back program of Fresenius Medical Care AG & Co. KGaA -118
Put option liabilities 22, 32 -8
Comprehensive income (loss)
Net income 1,707
Other comprehensive income (loss)
Cash flow hedges 29, 32
Change of FVOCI equity investments 29, 32
Foreign currency translation 29, 32
Actuarial gains on defined benefit pension plans 26, 29
Fair value changes
Comprehensive income (loss) 1,707
As of December 31, 2020 557,541 557,541 557 3,992 13,535
Proceeds from the exercise of stock options 36 961 961 1 33
Compensation expense related to stock options 36 1
Dividends paid 28 -491
Purchase of noncontrolling interests 27
Put option liabilities 22, 32 -13
Transfer of cumulative gains / losses of equity investments 11
Comprehensive income (loss)
Net income 1,818
Other comprehensive income (loss)
Cash flow hedges 29, 32
Annual Report 2021
Change of FVOCI equity investments 29, 32
Foreign currency translation 29, 32
Actuarial gains / losses on defined benefit pension plans 26, 29
Fair value changes
Comprehensive income (loss) 1,818
As of December 31, 2021 558,502 558,502 558 4,026 14,860
Fresenius
283
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows ► Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA
CONSOLIDATED STATEMENT OF CHANGES IN EQUITY
Accumulated other comprehensive income (loss)
Total Fresenius
SE & Co. KGaA Total
Foreign currency Cash flow Equity Fair value shareholders’ Noncontrolling shareholders’
translation hedges Pensions investments changes equity interests equity
€ in millions € in millions € in millions € in millions € in millions € in millions € in millions € in millions
As of December 31, 2019 294 -65 -429 10 --- 16,778 9,802 26,580
Proceeds from the exercise of stock options 9 9 18
Compensation expense related to stock options -6 0 -6
Dividends paid -468 -592 -1,060
Purchase of noncontrolling interests --- 28 28
Share buy-back program of Fresenius Medical Care AG & Co. KGaA -118 -248 -366
Put option liabilities -8 -17 -25
Comprehensive income (loss)
Net income 1,707 1,116 2,823
Other comprehensive income (loss)
Cash flow hedges 3 3 1 4
Change of FVOCI equity investments -1 -1 4 3
Foreign currency translation -998 5 -993 -1,087 -2,080
Actuarial gains on defined benefit pension plans 19 19 2 21
Fair value changes 27 27 56 83
Comprehensive income (loss) -998 3 24 -1 27 762 92 854
As of December 31, 2020 -704 -62 -405 9 27 16,949 9,074 26,023
Proceeds from the exercise of stock options 34 4 38
Compensation expense related to stock options 1 --- 1
Dividends paid -491 -577 -1,068
Purchase of noncontrolling interests --- 98 98
Put option liabilities -13 -27 -40
Transfer of cumulative gains / losses of equity investments -11 --- --- ---
Comprehensive income (loss)
Net income 1,818 1,001 2,819
Other comprehensive income (loss)
Cash flow hedges -4 -4 0 -4
Annual Report 2021
Change of FVOCI equity investments -40 -40 20 -20
Foreign currency translation 758 0 -7 0 1 752 727 1,479
Actuarial gains / losses on defined benefit pension plans 1 1 -8 -7
Fair value changes -9 -9 -22 -31
Comprehensive income (loss) 758 -4 -6 -40 -8 2,518 1,718 4,236
As of December 31, 2021 54 -66 -411 -42 19 18,998 10,290 29,288
Fresenius
The following notes are an integral part of the consolidated financial statements.
284
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity ► Consolidated segment reporting
Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA
CONSOLIDATED SEGMENT REPORTING
BY BUSINESS SEGMENT Fresenius Medical Care Fresenius Kabi Fresenius Helios Fresenius Vamed Corporate Fresenius Group
€ in millions 2021 1 2020 2 Growth 2021 3 2020 4 Growth 2021 5 2020 Growth 2021 5 2020 Growth 2021 6 2020 7 Growth 2021 2020 Growth
Sales 17,619 17,859 -1% 7,193 6,976 3% 10,891 9,818 11% 2,297 2,068 11% -480 -444 -8% 37,520 36,277 3%
thereof contribution
to consolidated sales 17,570 17,819 -1% 7,126 6,916 3% 10,862 9,798 11% 1,960 1,742 13% 2 2 0% 37,520 36,277 3%
thereof intercompany sales 49 40 23% 67 60 12% 29 20 45% 337 326 3% -482 -446 -8% --- ---
contribution to consolidated sales 47% 49% 19% 19% 29% 27% 5% 5% 0% 0% 100% 100%
EBITDA 3,501 4,090 -14% 1,601 1,490 7% 1,600 1,470 9% 191 113 69% -68 -63 -8% 6,825 7,100 -4%
Depreciation and amortization 1,586 1,591 0% 448 395 13% 473 445 6% 90 84 7% 70 200 -65% 2,667 2,715 -2%
EBIT 1,915 2,499 -23% 1,153 1,095 5% 1,127 1,025 10% 101 29 -- -138 -263 48% 4,158 4,385 -5%
Net interest -280 -368 24% -58 -82 29% -184 -180 -2% -10 -20 50% 26 -9 -- -506 -659 23%
Income taxes -367 -501 27% -259 -239 -8% -199 -171 -16% -20 -4 -- 12 12 0% -833 -903 8%
Net income attributable to shareholders
of Fresenius SE & Co. KGaA 1,018 1,359 -25% 778 730 7% 728 666 9% 67 2 -- -773 -1,050 26% 1,818 1,707 7%
Operating cash flow 2,489 4,233 -41% 1,203 1,143 5% 1,204 1,149 5% 151 78 94% 31 -54 157% 5,078 6,549 -22%
Cash flow before acquisitions and dividends 1,660 3,197 -48% 659 450 46% 637 609 5% 72 2 -- 33 -75 144% 3,061 4,183 -27%
Total assets 34,367 31,689 8% 14,698 13,591 8% 20,891 19,241 9% 2,795 2,716 3% -789 -591 -34% 71,962 66,646 8%
Debt 13,320 12,380 8% 4,159 4,181 -1% 8,059 7,472 8% 721 686 5% 896 1,194 -25% 27,155 25,913 5%
Other operating liabilities 6,199 6,192 0% 3,250 3,225 1% 3,176 2,585 23% 994 933 7% 385 385 0% 14,004 13,320 5%
Capital expenditure, gross 854 1,052 -19% 532 687 -23% 568 541 5% 80 95 -16% -2 23 -109% 2,032 2,398 -15%
Acquisitions, gross / investments 628 407 55% 1 31 -97% 453 459 -1% 1 6 -83% 2 -1 -- 1,085 902 20%
Research and development expenses 221 194 14% 595 553 8% 3 2 50% --- --- -14 2 -- 805 751 7%
Employees (per capita
on balance sheet date) 130,251 133,129 -2% 41,397 40,519 2% 123,484 116,952 6% 19,721 19,414 2% 1,225 1,255 -2% 316,078 311,269 2%
Key figures
EBITDA margin 19.9% 22.9% 22.3% 21.4% 14.7% 15.0% 8.3% 5.5% 18.3%3 19.7%4
EBIT margin 10.9% 14.0% 16.0% 15.7% 10.3% 10.4% 4.4% 1.4% 11.3%3 12.7%8
Depreciation and amortization
Annual Report 2021
in % of sales 9.0% 8.9% 6.2% 5.7% 4.3% 4.5% 3.9% 4.1% 7.1% 7.5%
Operating cash flow in % of sales 14.1% 23.7% 16.7% 16.4% 11.1% 11.7% 6.6% 3.8% 13.5% 18.1%
ROOA 6.2% 8.2% 9.4% 9.2% 5.9% 5.7% 4.3% 1.3% 6.5%9 7.3%10
1
Before costs related to FME25 program
2
Before impairment of goodwill at FMC Latin America
3
Before expenses associated with the Fresenius cost and efficiency program and revaluations of biosimilars contingent purchase price liabilities
4
Before revaluations of biosimilars contingent purchase price liabilities
Fresenius
5
Before expenses associated with the Fresenius cost and efficiency program
6
After expenses associated with the Fresenius cost and efficiency program and revaluations of biosimilars contingent purchase price liabilities
7
After revaluations of biosimilars contingent purchase price liabilities and impairment of goodwill at FMC Latin America
8
Before revaluations of biosimilars contingent purchase price liabilities and impairment of goodwill at FMC Latin America
9
The underlying pro forma EBIT does not include expenses associated with the Fresenius cost and efficiency program and revaluations of biosimilars contingent purchase price liabilities.
10
The underlying pro forma EBIT does not include revaluations of biosimilars contingent purchase price liabilities and impairment of goodwill at FMC Latin America.
The consolidated segment reporting by business segment is an integral part of the notes.
285
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity ► Consolidated segment reporting
Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA
CONSOLIDATED SEGMENT REPORTING
BY REGION
Europe North America Asia-Pacific
€ in millions 2021 2020 Growth 2021 2020 Growth 2021 2020 Growth
Sales 16,888 15,813 7% 14,363 14,801 -3% 3,938 3,705 6%
contribution to consolidated sales 45% 44% 38% 41% 11% 10%
EBIT 873 883 -1% 2,198 2,766 -21% 861 758 14%
Depreciation and amortization 1,073 1,003 7% 1,268 1,235 3% 227 196 16%
Total assets 32,346 29,489 10% 31,787 29,771 7% 5,451 5,018 9%
Capital expenditure, gross 1,154 1,253 -8% 635 861 -26% 141 190 -26%
Acquisitions, gross / investments 401 199 102% 652 262 149% 13 28 -54%
Employees (per capita on balance sheet date) 180,122 174,835 3% 76,740 75,837 1% 27,145 27,805 -2%
Latin America Africa Fresenius Group
€ in millions 2021 2020 Growth 2021 2020 Growth 2021 2020 Growth
Sales 1,830 1,566 17% 501 392 28% 37,520 36,277 3%
contribution to consolidated sales 5% 4% 1% 1% 100% 100%
EBIT 176 -60 -- 50 38 32% 4,158 4,385 -5%
Depreciation and amortization 88 270 -67% 11 11 0% 2,667 2,715 -2%
Total assets 2,082 2,056 1% 296 312 -5% 71,962 66,646 8%
Capital expenditure, gross 86 86 0% 16 8 100% 2,032 2,398 -15%
Acquisitions, gross / investments 18 413 -96% 1 --- 1,085 902 20%
Employees (per capita on balance sheet date) 30,192 30,871 -2% 1,879 1,921 -2% 316,078 311,269 2%
The consolidated segment reporting by region is an integral part of the notes.
Annual Report 2021
Fresenius
286
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
TABLE OF CONTENTS NOTES
288 General notes 314 Notes on the consolidated statement of financial position 342 Other notes
288 1. Principles 314 15. Cash and cash equivalents 342 30. Commitments and contingencies
288 I. Group structure 314 16. Trade accounts and other receivables 349 31. Leases
289 II. Basis of presentation 315 17. Inventories 352 32. Financial instruments
289 III. Summary of significant accounting policies 316 18. Other current and non-current assets 365 33. Information on capital management
303 IV. Critical accounting policies 317 19. Property, plant and equipment 366 34. Supplementary information on the consolidated
306 2. Acquisitions, divestitures and investments 319 20. Goodwill and other intangible assets statement of cash flows
323 21. Provisions 367 35. Notes on the consolidated segment reporting
324 22. Other liabilities 369 36. Share-based compensation plans
308 Notes on the consolidated statement of income 325 23. Debt 380 37. Related party transactions
308 3. Special items 330 24. Bonds 380 38. Subsequent events
308 4. Sales 332 25. Convertible bonds 381 39. Compensation of the Management Board and
310 5. Cost of materials 332 26. Pensions and similar obligations the Supervisory Board
310 6. Personnel expenses 339 27. Noncontrolling interests 382 40. Auditor‘s fees
310 7. Research and development expenses 339 28. Fresenius SE & Co. KGaA shareholders’ equity 382 41. Corporate Governance
310 8. General and administrative expenses 341 29. Other comprehensive income (loss) 383 42. Proposal for the distribution of earnings
310 9. Other operating income and expenses
310 10. Net interest
311 11. Taxes
312 12. Noncontrolling interests
312 13. Impacts of COVID-19 pandemic
313 14. Earnings per share
Annual Report 2021
Fresenius
287
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
GENERAL NOTES (IV drugs), biosimilar products with a focus on oncology (FMC-AG & Co. KGaA) at the end of the fiscal year 2021.
and autoimmune diseases, clinical nutrition, and infusion Fresenius Medical Care Management AG, the general part-
1. PRINCIPLES therapies. In addition, the company is also a supplier of ner of FMC-AG & Co. KGaA, is a wholly owned subsidiary of
medical devices and products for transfusion technology. Fresenius SE & Co. KGaA. Through this structure, Fresenius
I. GROUP STRUCTURE Fresenius Helios is Europe’s leading private hospital SE & Co. KGaA has rights that give Fresenius SE & Co. KGaA
Fresenius is a global health care group with products and operator. Under the holding Helios Health, the company the ability to direct the relevant activities that significantly
services for dialysis, hospitals and outpatient medical care. includes Helios Germany, Helios Spain (Quirónsalud) and affect the earnings of FMC-AG & Co. KGaA. Therefore, FMC-
In addition, the Fresenius Group focuses on hospital opera- the Eugin Group. At the end of 2021, Helios Germany AG & Co. KGaA is fully consolidated in the consolidated
tions and also manages projects and provides services for operated a total of 90 hospitals, around 130 outpatient financial statements of the Fresenius Group.
hospitals and other health care facilities worldwide. Besides clinics, and 6 prevention centers. In Spain, Quirónsalud Fresenius SE & Co. KGaA continued to hold 100% of
the activities of the parent company Fresenius SE & Co. operated 49 hospitals, 88 outpatient centers, and around the management companies of the business segments
KGaA, Bad Homburg v. d. H., Germany, the operating activi- 300 occupational risk prevention centers at the end of 2021. Fresenius Kabi (Fresenius Kabi AG) as well as Fresenius
ties are organized amongst the following legally indepen- In addition, Helios Spain is active in Latin America with Helios and Fresenius Vamed (both held through Fresenius
dent business segments in the fiscal year 2021: 7 hospitals and as a provider of medical diagnostics. The ProServe GmbH) on December 31, 2021. Through Fresenius
Eugin Group’s network comprises 33 clinics and an addi- ProServe GmbH, Fresenius SE & Co. KGaA holds 100% in
► Fresenius Medical Care tional 39 sites across 10 countries on 3 continents. Eugin Helios Kliniken GmbH and Helios Healthcare Spain S.L.
► Fresenius Kabi offers a wide spectrum of state-of-the-art services in the (Quirónsalud), 100% in Helios Fertility Spain S.L.U. and
► Fresenius Helios field of fertility treatments. Helios Healthcare USA, Inc. (Eugin group) as well as a
► Fresenius Vamed Fresenius Vamed manages projects and provides ser- 77% stake in VAMED Aktiengesellschaft. In addition,
vices for hospitals as well as other health care facilities Fresenius SE & Co. KGaA consolidates companies with cor-
Fresenius Medical Care offers services and products for worldwide and is a leading post-acute care provider in porate holding functions regarding real estate, financing
patients with chronic kidney failure. As of December 31, Central Europe. The portfolio ranges along the entire value and insurance, as well as in Fresenius Digital Technology
2021, Fresenius Medical Care treated 345,425 patients at chain --- from project development, planning, and turnkey GmbH which provides intercompany services in the field
4,171 dialysis clinics. Dialyzers and dialysis machines are construction, via maintenance and technical management, of information technology.
among the most important product lines. In addition, to total operational management. The services are aimed The reporting currency and functional currency of the
Fresenius Medical Care offers dialysis-related services. at various areas of health care, ranging from prevention Fresenius Group is the euro. In order to improve the clarity
Fresenius Kabi specializes in products for the therapy and acute care to rehabilitation and nursing. of presentation, amounts are generally presented in million
and care of critically and chronically ill patients. The port- Fresenius SE & Co. KGaA owned 32.21% of the sub- euros. Amounts less than €1 million, after rounding, are
Annual Report 2021
folio includes intravenously administered generic drugs scribed capital of Fresenius Medical Care AG & Co. KGaA marked with ‘‘0’’.
Fresenius
288
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
II. BASIS OF PRESENTATION The general partner of Fresenius SE & Co. KGaA is All intercompany sales, expenses, income, receivables and
Fresenius SE & Co. KGaA, as a stock exchange listed com- Fresenius Management SE. Fresenius Management SE payables are eliminated. Profits and losses on items of
pany with a domicile in a member state of the European prepares its own consolidated financial statements. The property, plant and equipment and inventory acquired from
Union (EU), fulfills its obligation to prepare and publish Else Kröner-Fresenius-Stiftung is the sole shareholder of other Group entities are also eliminated. Deferred tax assets
the consolidated financial statements in accordance with Fresenius Management SE. The shareholder representa- and liabilities are recognized on temporary differences
the International Financial Reporting Standards (IFRS) as tives elect in the Annual General Meeting of Fresenius resulting from consolidation procedures.
adopted by the EU and applying Section 315e of the Ger- Management SE its Supervisory Board. Noncontrolling interests are the portion of equity of
man Commercial Code (HGB). The consolidated financial At February 21, 2022, the Management Board of Group entities not attributable, directly or indirectly, to
statements of Fresenius SE & Co. KGaA at December 31, Fresenius Management SE authorized the consolidated Fresenius SE & Co. KGaA and are recognized at fair value
2021 have been prepared and are published in accordance financial statements for issue and passed it to the Supervi- at the date of first consolidation. Profits and losses attribut-
with the Standards and interpretations in effect on the sory Board of Fresenius SE & Co. KGaA. The Supervisory able to the noncontrolling interests are separately disclosed
reporting date, and endorsed in the EU, as issued by the Board has to review and approve the consolidated finan- in the consolidated statement of income.
International Accounting Standards Board (IASB) and the cial statements. The Fresenius Group writes put options on noncontrol-
IFRS Interpretations Committee (IFRS IC). ling interests, primarily in the segment Fresenius Medical
In order to improve the clarity of presentation, various III. SUMMARY OF SIGNIFICANT ACCOUNTING Care for dialysis clinics in which nephrologists or nephrol-
items are aggregated in the consolidated statement of finan- POLICIES ogy groups own an equity interest. Generally, put options
cial position and in the consolidated statement of income. are valid for an unlimited time and provide for settlement
These items are shown separately in the notes to provide a) Principles of consolidation in cash. As far as the Fresenius Group, as option writer of
useful information to the readers of the consolidated finan- The consolidated financial statements have been prepared existing put options, can be obliged to purchase noncon-
cial statements. using uniform accounting methods. Acquisitions of compa- trolling interests held by third parties, a put option liability
Moreover, the notes include information required by nies are accounted for applying the purchase method. Capi- is recorded in long-term provisions and other long-term
HGB according to Section 315e (1) HGB. The consolidated tal consolidation is performed at the date of acquisition. Ini- liabilities as well as short-term provisions and other short-
financial statements include a management report according tially, all identifiable assets and liabilities of subsidiaries as term liabilities at present value of the redemption amount
to Section 315e HGB in conjunction with Section 315 HGB. well as the noncontrolling interests are recognized at their at the date of the consolidated financial statements. The
The consolidated statement of financial position con- fair values. The cost is then compared with the fair value Fresenius Group, in line with IAS 8, Accounting Policies,
tains all information required to be disclosed by Interna- of the net assets acquired. Any remaining balance is recog- Changes in Accounting Estimates and Errors, paragraph 10,
tional Accounting Standard (IAS) 1, Presentation of Finan- nized as goodwill and is tested at least once a year for
cial Statements, and are in accordance with Accounting impairment.
Annual Report 2021
Interpretation 1 (AIC 1, Balance Sheet Classification accord-
ing to current / non-current distinction in compliance with
IAS 1) classified on the basis of the liquidity of assets and
liabilities following the consolidated statement of financial
position. The consolidated statement of income is classified
Fresenius
using the cost-of-sales accounting format.
289
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
applies the present access method. According to the pre- in Vifor Fresenius Medical Care Renal Pharma Ltd. makes The complete list of the investments of Fresenius SE & Co.
sent access method, noncontrolling interests are further up a large portion of the equity method investees, however KGaA, registered office in 61352 Bad Homburg v. d. H.,
recorded in equity. The initial recognition of the put option it is not individually material to the Fresenius Group. Asso- Else-Kröner-Straße 1, Germany, registered in the Commer-
liability, as well as valuation differences, are recorded in ciates are accounted for using the equity method. Invest- cial Register of the local court in Bad Homburg v. d. H.
equity with no impact to the consolidated statement of ments that are not classified as associated companies are under B11852, will be submitted to the Federal Gazette and
income. recorded at fair value. the companies register as well as published on the website
Fresenius Vamed participates in project entities which of Fresenius SE & Co. KGaA (www.fresenius.com / financial-
b) Composition of the Group are established for long-term defined periods of time and reports-and-presentations).
Besides Fresenius SE & Co. KGaA, the consolidated finan- for the specific purpose of constructing and operating ther- For the fiscal year 2021, the following consolidated
cial statements include all material subsidiaries according mal centers. These project entities are not controlled by German subsidiaries of the Fresenius Group will apply the
to IFRS 10, over which Fresenius SE & Co. KGaA has con- Fresenius Vamed and therefore are not consolidated. The exemption provided in Sections 264 (3) and 264b, respec-
trol. Fresenius SE & Co. KGaA controls an entity if it has project entities generated approximately €113 million in tively, of the German Commercial Code (HGB):
power over the entity. That is, Fresenius SE & Co. KGaA has sales in 2021 (2020: €85 million). The project entities finance
existing rights that give Fresenius SE & Co. KGaA the cur- themselves mainly through debt, profit participation rights Name of the company Registered office
Corporate
rent ability to direct the relevant activities, which are the and investment grants. Assets and liabilities relating to the
Fresenius Digital Technology GmbH Bad Homburg v. d. H.
activities that significantly affect the entity’s return. In addi- project entities are not material. Fresenius Vamed made Fresenius Immobilien-Verwaltungs-
tion, Fresenius SE & Co. KGaA is exposed to, or has rights no payments to the project entities other than contractu- GmbH & Co. Objekt Friedberg KG Bad Homburg v. d. H.
Fresenius Immobilien-Verwaltungs-
to, variable returns from the involvement with the entity and ally stipulated. From today’s perspective and due to the
GmbH & Co. Objekt St. Wendel KG Bad Homburg v. d. H.
Fresenius SE & Co. KGaA has the ability to use its power contractual situation, Fresenius Vamed is not exposed to Fresenius Immobilien-Verwaltungs-
over the entity to affect the amount of Fresenius SE & Co. any material risk of loss from these project entities. GmbH & Co. Objekt Schweinfurt KG Bad Homburg v. d. H.
Fresenius ProServe GmbH Bad Homburg v. d. H.
KGaA’s return. The consolidated financial statements of 2021 included,
FPS Immobilien Verwaltungs
Generally, entities in which Fresenius SE & Co. KGaA, in addition to Fresenius SE & Co. KGaA, 3,159 (2020: 2,856) GmbH & Co. Reichenbach KG Bad Homburg v. d. H.
directly or indirectly, holds more than 20% and less than consolidated companies and 84 (2020: 71) companies were ProServe Krankenhaus Beteiligungs-
gesellschaft mbH & Co. KG München
50% of the voting rights and can exercise a significant accounted for under the equity method. In 2021, there were Fresenius Kabi
influence over their financial and operating policies are no material changes in the scope of consolidated entities, Fresenius HemoCare GmbH Bad Homburg v. d. H.
considered associates. There are no investments in equity except for those mentioned in note 2, Acquisitions, divesti- Fresenius HemoCare
Beteiligungs GmbH Bad Homburg v. d. H.
method investees that are individually material to the tures and investments. Fresenius Kabi AG Bad Homburg v. d. H.
Fresenius Group. Fresenius Medical Care’s investment Fresenius Kabi Deutschland GmbH Bad Homburg v. d. H.
Annual Report 2021
Fresenius Kabi Logistik GmbH Friedberg
MC Medizintechnik GmbH Alzenau
medi1one medical gmbh Waiblingen
Fresenius
290
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Name of the company Registered office Name of the company Registered office c) Classifications
Fresenius Helios Fresenius Helios
Comparative information for certain items have been
Gesundheitsmanagement Helios Kliniken Mansfeld-Südharz GmbH Sangerhausen
Elbe-Fläming GmbH Burg Helios Kliniken Mittelweser GmbH Nienburg / Weser reclassified to conform with current year’s presentation.
Helios Agnes-Karll Krankenhaus GmbH Bad Schwartau Helios Kliniken Taunus GmbH Bad Schwalbach In the business segment Fresenius Medical Care, in
Helios Aukamm-Klinik Wiesbaden GmbH Wiesbaden Helios Klinikum Aue GmbH Aue the consolidated statement of income, gain related to
Helios Bördeklinik GmbH Oschersleben Helios Klinikum Bad Saarow GmbH Bad Saarow
Helios Fachklinik Schleswig GmbH Schleswig divestitures of Care Coordination activities in the amount
Helios Klinikum Berlin-Buch GmbH Berlin
Helios Fachklinik Helios Klinikum Erfurt GmbH Erfurt of €31 million for the year ended December 31, 2020, which
Vogelsang-Gommern GmbH Gommern Helios Klinikum Gifhorn GmbH Gifhorn was previously presented separately, has been included
Helios Fachkliniken Helios Klinikum Gotha GmbH Gotha
Hildburghausen GmbH Hildburghausen within other operating income.
Helios Klinikum Hildesheim GmbH Hildesheim
Helios Frankenwaldklinik
Helios Klinikum Meiningen GmbH Meiningen Furthermore, in the business segment Fresenius Medical
Kronach GmbH Kronach
Helios Klinikum Pirna GmbH Pirna Care, in the consolidated statement of financial position as
Helios Hanseklinikum Stralsund GmbH Stralsund
Helios Klinikum Schwelm GmbH Schwelm of December 31, 2020, short-term provisions and other
Helios Health GmbH Berlin
Helios Klinikum Siegburg GmbH Siegburg
Helios Klinik Blankenhain GmbH Blankenhain short-term liabilities in the amount of €103 million related
Helios Klinikum Uelzen GmbH Uelzen
Helios Klinik Bleicherode GmbH Bleicherode
Helios Klinikum Wuppertal GmbH Wuppertal to the self-insurance program have been reclassified to
Helios Klinik für Herzchirurgie
Karlsruhe GmbH Karlsruhe Helios Park-Klinikum Leipzig GmbH Leipzig long-term provisions and other long-term liabilities.
Helios Klinik Herzberg / Osterode GmbH Herzberg am Harz Helios Privatkliniken GmbH Bad Homburg v. d. H.
Helios Klinik Jerichower Land GmbH Burg Helios Reinigung GmbH Berlin
Helios Spital Überlingen GmbH Überlingen d) Hyperinflationary accounting
Helios Klinik Leezen GmbH Leezen
Helios Klinik Leisnig GmbH Leisnig Helios St. Elisabeth Klinik Fresenius Group’s subsidiaries operating in Argentina and
Oberhausen GmbH Oberhausen Lebanon apply IAS 29, Financial Reporting in Hyperinfla-
Helios Klinik Lengerich GmbH Lengerich
Helios St. Elisabeth-Krankenhaus
Helios Klinik Köthen GmbH Köthen (Anhalt) tionary Economies, due to inflation in those countries. For
Bad Kissingen Bad Kissingen
Helios Klinik Rottweil GmbH Rottweil
Helios St. Marienberg Klinik the fiscal year 2021, the application of IAS 29 resulted in
Helios Klinik Schkeuditz GmbH Schkeuditz Helmstedt GmbH Helmstedt
Helios Klinik Schleswig GmbH Schleswig an effect on net income attributable to shareholders of
Helios Versorgungszentren GmbH Berlin
Helios Klinik Volkach GmbH Volkach Helios Vogtland-Klinikum Plauen GmbH Plauen Fresenius SE & Co. KGaA of -€18 million (2020:-€14 million).
Helios Klinik Wipperfürth GmbH Wipperfürth Helios Weißeritztal-Kliniken GmbH Freital
Helios Klinik Zerbst / Anhalt GmbH Zerbst Herzzentrum Leipzig GmbH Leipzig
Helios Kliniken GmbH Berlin Kliniken Miltenberg-Erlenbach GmbH Erlenbach
Helios Kliniken Medizinisches Versorgungszentrum am
Breisgau Hochschwarzwald GmbH Müllheim Helios Klinikum Bad Saarow GmbH Bad Saarow
MVZ Campus Gifhorn GmbH Gifhorn
Annual Report 2021
Poliklinik am
Helios Klinikum Buch GmbH Berlin
Fresenius
291
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
e) Revenue recognition policy Revenue from services is recognized on the date the service IFRS 15 does not apply to lease and insurance contracts.
Revenue is recognized in accordance with IFRS 15, Reve- is performed. At this point of time, the payor is obliged to Revenue from leasing components and insurance con-
nue from Contracts with Customers. pay for the services performed. tracts is determined according to IFRS 16 and IFRS 4,
Revenues from services and products are billed accord- Revenue from product sales is recognized when the respectively.
ing to the usual contract arrangements with customers, customer obtains control of the product, either after pos- Revenues are reported net of sales tax.
patients and related third parties. For services performed session is transferred or upon installation and provision of
for patients, the transaction price is estimated based on the necessary technical instructions or at another point in f) Government grants
either Fresenius Group’s standard rates, rates determined time that better defines transfer of control. The Fresenius Group primarily receives governmental fund-
under reimbursement arrangements or by government reg- A portion of revenues is generated from contracts which ing for hospitals in Germany to finance buildings and medi-
ulations. These arrangements are generally with third party on the one hand give the customer the right to use dialysis cal equipment. Public sector grants are not recognized until
payors, such as U.S. Medicare, U.S. Medicaid, German machines and on the other hand provide the customer with there is reasonable assurance that the respective conditions
health insurance funds or commercial insurers. Amounts disposables and services. In this case, the transaction price are met and the grants will be received. Initially, the grant
billed are recorded net of contractually agreed upon dis- is allocated in accordance with IFRS 15, and revenue is related to assets is recorded as a liability and as soon as the
counts or rebates to reflect the estimated amounts to be recognized separately for the lease and the non-lease com- asset is acquired, the grant is offset against the acquisition
received from these payors. Estimates are determined on ponents of the contract in accordance with IFRS 16 and costs. Grants related to income are recognized in other oper-
the basis of historical experience. IFRS 15, respectively. ating income in the period in which the related costs are
If the collection of the billed amount or a portion of the Fresenius Vamed has performance obligations from incurred. For information regarding COVID-19 related gov-
billed amount for services performed for patients is consid- long-term production contracts that are satisfied over time. ernment grants, please see note 13, Impacts of the COVID-19
ered to be uncertain at the time services are performed, the Revenue is recognized according to progress towards com- pandemic.
Fresenius Group concludes that the consideration is varia- pletion. This progress towards completion of the perfor-
ble (implicit price concession) and records the difference mance obligation is measured based on the costs incurred g) Research and development expenses
between the billed amount and the amount estimated to be in relation to expected total costs of fulfilling the contract, Research is the independent and planned investigation
collectible as a reduction to health care services revenue. contractually defined milestones or performance completed undertaken with the prospect of gaining new scientific or
Implicit price concessions include such items as amounts to date whichever better reflects the progress towards com- technical knowledge and understanding. Development is
due from patients without adequate insurance coverage pletion of the performance obligation. the technical and commercial implementation of research
and patient co-payment and deductible amounts due from results and occurs before the start of the commercial pro-
patients with health care coverage. The Fresenius Group duction or use. The research and development phase of
determines implicit price concessions primarily upon past pharmaceutical products normally ends with the regulatory
Annual Report 2021
collection history.
Fresenius
292
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
approval by the relevant authorities on the market of the Impairment losses, except impairment losses recognized Furthermore, deferred taxes are recognized on certain con-
particular country. Generally, a new pharmaceutical prod- on goodwill, are reversed if there are indications that the solidation adjustments which affect net income attributable
uct is primarily approved in an established market, such as reasons for impairment no longer exist and there has been a to shareholders of Fresenius SE & Co. KGaA. Deferred tax
Europe, the United States, China and Japan. change in the estimates used to determine the asset's recov- assets also include claims for tax reductions which arise
Research expenses are expensed as incurred. Develop- erable amount. This reversal shall not exceed the carrying from the probable expected use of existing tax losses car-
ment expenses that meet the criteria for the recognition of amount that would have been determined had no impair- ryforwards. The recognition of deferred tax assets from
an intangible asset are capitalized (see note 1. III. n., Intan- ment loss been recognized before. net operating losses and their utilization is based on the
gible assets with finite useful lives). Assets held for sale are reported at the lower of their budget planning of the Fresenius Group and implemented
carrying amount and fair value less costs to sell and depre- tax strategies.
h) Impairment ciation is ceased. Deferred tax assets and liabilities are measured at the
The Fresenius Group reviews the carrying amounts of its tax rates that are expected to apply to the period when the
property, plant and equipment, intangible assets and right- i) Capitalized interest asset is realized or the liability is settled, based on tax rates
of-use assets as well as other non-current assets for impair- The Fresenius Group includes capitalized interest as part of that have been enacted or substantially enacted by the end
ment whenever events or changes in circumstances indi- the cost of the asset if it is directly attributable to the acqui- of the reporting period.
cate that the carrying amount is higher than the asset’s sition, construction or manufacture of qualifying assets. For A change in tax rate for the calculation of deferred tax
recoverable amount. The recoverable amount is the higher the fiscal years 2021 and 2020, interest of €7 million and assets and liabilities is recognized in the period the new
of the fair value less costs to sell and its value in use. The €12 million, respectively, based on an average interest rate laws are enacted or substantively enacted. The effects of
fair value less cost of disposal of an asset is estimated as its of 2.40% and 2.57%, respectively, was recognized as a the adjustment are generally recognized in the income
net realizable value. The value in use is the present value of component of the cost of assets. statement. The effects of the adjustment are recognized
future cash flows expected to be derived from the relevant in equity, if the temporary differences are related to items
asset. If it is not possible to estimate the future cash flows j) Income taxes directly recognized in equity.
from the individual assets, impairment is tested on the Current taxes are calculated based on the earnings of the The realizability of the carrying amount of a deferred
basis of corresponding cash generating units. fiscal year and in accordance with local tax rules of the tax asset is reviewed at each date of the statement of finan-
respective tax jurisdictions. Expected and executed addi- cial position. In assessing the realizability of deferred tax
tional tax payments and tax refunds for prior years are also assets, the Management considers to which extent it is
taken into account. probable that the deferred tax asset will be realized. The ulti-
Deferred tax assets and liabilities are recognized for the mate realization of deferred tax assets is dependent upon
future consequences attributable to temporary differences the generation of future taxable income during the periods
Annual Report 2021
between the financial statement carrying amounts of exist- in which those temporary differences and tax loss carryfor-
ing assets and liabilities and their respective tax basis. wards become deductible. The Management considers the
Fresenius
293
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
expected reversal of deferred tax liabilities and projected estimates or future changes in these estimates may have an l) Inventories
future taxable income in making this assessment. impact on future tax payments or tax refunds. Estimates Inventories are comprised of all assets which are held for
Deferred tax assets are recognized to the extent it is are revised in the period in which there is sufficient evidence sale in the ordinary course of business (finished goods), in
probable that sufficient taxable income will be available for to revise the assumptions. the process of production for such sale (work in process) or
the utilization of parts or of the entire deferred tax asset. The German Federal Constitutional Court has declared consumed in the production process or in the rendering of
The Fresenius Group recognizes assets and liabilities that the interest rate pursuant to Section 233a of the Ger- services (raw materials and purchased components).
for uncertain tax treatments to the extent it is probable the man Tax Code is unconstitutional in its current form. As a Inventories are measured at the lower of acquisition
tax will be recovered or that the tax will be payable, respec- result, there is uncertainty over the specific interest rate to and manufacturing cost (determined by using the average
tively. In North America and Germany, interest and penal- be applied for interest on income tax receivables and liabil- or first-in, first-out method) or net realizable value. Manu-
ties related to income taxes, including uncertain tax treat- ities in Germany for future periods, starting in 2019. Until facturing costs are comprised of direct costs, production
ments, do not meet the definition of income taxes, and new legal regulations are passed, this interest rate can only and material overhead, including depreciation charges.
therefore are accounted for under IAS 37. All other jurisdic- be determined using best estimates consistent with account-
tions account for interest and penalties related to income ing standards. For best possible harmonization of oppor- m) Property, plant and equipment
taxes in accordance with local tax rules of the respective tunity and risk, Management has used a conservative Property, plant and equipment are stated at acquisition
tax jurisdiction either under IAS 37 or as income tax expense approach at the reporting date as part of its discretionary and manufacturing cost less accumulated depreciation.
under IAS 12. decision, considering all available information and explana- Repairs and maintenance costs are recognized in profit
The Fresenius Group is subject to ongoing and future tions of the judgment. As of December 31, 2021, the cho- and loss as incurred. The costs for the replacement of
tax audits in the United States, Germany and other jurisdic- sen interest rate is 0.375% per month. components or the general overhaul of property, plant and
tions. Different interpretations of tax laws, particularly due equipment are recognized, if it is probable that future eco-
to the Fresenius Group’s international activities, may lead k) Earnings per share nomic benefits will flow to the Fresenius Group and these
to potential additional tax payments or tax refunds for prior Basic earnings per share are computed by dividing net costs can be measured reliably. Depreciation on property,
years. To consider income tax liabilities or income tax income attributable to shareholders of Fresenius SE & Co. plant and equipment is calculated using the straight-line
receivables, Management’s estimates are based on experi- KGaA by the weighted average number of ordinary shares method over the estimated useful lives of the assets rang-
ences with previous tax audits and local tax rules of the outstanding during the year. Diluted earnings per share ing from 3 to 50 years for buildings and improvements
respective tax jurisdiction and the interpretation of such. include the effect of all potentially dilutive instruments on (with a weighted average life of 16 years) and 2 to 15 years
Differences between actual results and Management’s ordinary shares that would have been outstanding during for machinery and equipment (with a weighted average
the fiscal year. The equity-settled awards granted under life of 11 years).
Fresenius’ and Fresenius Medical Care’s stock option plans
Annual Report 2021
can result in a dilutive effect.
Fresenius
294
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
n) Intangible assets with finite useful lives Losses in value of a lasting nature are recorded as an with indefinite useful lives such as tradenames acquired in
Intangible assets with finite useful lives, such as patents, impairment and are reversed if there are indications that the a purchase method business combination are recognized
product and distribution rights, customer relationships, reasons for impairment no longer exist and there has been a and reported apart from goodwill. They are recorded at fair
non-compete agreements, technology as well as licenses change in the estimates used to determine the asset's recov- value at acquisition.
to manufacture, distribute and sell pharmaceutical drugs erable amount. This reversal shall not exceed the carrying Any excess of the net fair value of identifiable assets
are recognized and reported apart from goodwill and are amount that would have been determined had no impair- and liabilities over cost still existing after reassessing the
amortized using the straight-line method over their respec- ment loss been recognized before. purchase price allocation subsequent to its finalization is
tive useful lives to their residual values and reviewed for Development costs are capitalized as manufacturing recognized immediately in the consolidated statement of
impairment (see note 1. III. h, Impairment). Patient rela- costs when the recognition criteria are met. income.
tionships however are not reported as separate intangible For development costs of dialysis machines manufac- Goodwill and intangible assets with indefinite useful
assets due to the missing contractual basis but are part of tured by Fresenius Medical Care, the timing of the recogni- lives are not amortized but tested for impairment annually
goodwill. The useful lives of patents, product and distribu- tion as assets is based on the technical utilizability of the or when an event becomes known that could trigger an
tion rights range from 5 to 20 years, the average useful life machines. The useful lives of capitalized development costs impairment (impairment test).
is 13 years. The useful lives of customer relationships vary vary from 5 to 20 years, the average useful life is 7 years. To perform the annual impairment test of goodwill, the
from 10 to 30 years, the average useful life is 18 years. Fresenius Kabi capitalizes development costs as soon as Fresenius Group identified several cash generating units
Non-compete agreements with finite useful lives have use- the registration of a new product is very likely. This mainly (CGUs) and determined the carrying amount of each CGU
ful lives ranging from 3 to 25 years with an average useful applies if a product is already approved on an established by assigning the assets and liabilities, including the exist-
life of 7 years. Technology is amortized over a finite useful market. Costs are amortized on a straight-line basis over ing goodwill and intangible assets, to those CGUs. A CGU
live of 15 years. Licenses to manufacture, distribute and the expected useful lives. In 2021, reversals of write-downs is usually defined one level below the segment level based
sell pharmaceutical drugs are amortized over the contrac- and impairments were recorded (see note 7, Research and on regions or the nature of the business activity. Four
tual license period. All other intangible assets are amor- development expenses). CGUs were identified in the segments Fresenius Medical
tized over their individual estimated useful lives between Care and Fresenius Kabi, respectively (Europe (Fresenius
3 and 15 years. o) Goodwill and other intangible assets with Medical Care: EMEA), Latin America, Asia-Pacific and
indefinite useful lives North America). According to the regional organizational
The Fresenius Group identified intangible assets with indefi- structure, the segment Fresenius Helios consists of two
nite useful lives because, based on an analysis of all of the CGUs, Germany and Spain. In addition, an impairment test
relevant factors, there is no foreseeable limit to the period was performed for the Eugin Group which was acquired
over which those assets are expected to generate net cash in 2021. The segment Fresenius Vamed consists of two
Annual Report 2021
inflows for the Group. The identified intangible assets
Fresenius
295
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
CGUs (Project business and Service business). At least p) Leases IFRS 16 requires the Fresenius Group to make judgments
once a year, the Fresenius Group compares the value in A lease is defined as a contract that conveys the right to that affect the valuation of lease liabilities as well as right-
use of each CGU to the CGU’s carrying amount. The recov- use an underlying asset for a period of time in exchange of-use assets, including the determination of which contracts
erable amount as its value in use of a CGU is determined for consideration. are within the scope of IFRS 16, identifying the contract
using a discounted cash flow approach based upon the The Fresenius Group decided not to apply the guidance lease term and determining the incremental borrowing rate.
cash flow expected to be generated by the CGU. In case within IFRS 16 to leases with a total maximum term of With the ‘‘reasonably certain’’ assessments, the Fresenius
that the value in use of the CGU is less than its carrying twelve months (short-term leases) and leases for underlying Group determines if and which future costs based on exten-
amount and the fair value less cost of disposal is not esti- assets of low value. These leases are exempt from balance sion and / or termination options have to be included in the
mated to be higher than the value in use, the difference sheet recognition and lease payments will be recognized as lease liabilities. During these assessments, the Fresenius
is at recorded as an impairment of the carrying amount of expenses over the lease term. Group considers all relevant facts and circumstances that
the CGU goodwill. IFRS 16 is not applied to leases of intangible assets. create an economic incentive for the Fresenius Group
To evaluate the recoverability of intangible assets with to exercise, or not to exercise, an option, including any
indefinite useful lives, the Fresenius Group compares the Lease liabilities expected changes in facts and circumstances (e.g., contract-,
recoverable amounts of the smallest identifiable group of Lease liabilities are recognized at the present value of the object-, entity- or market-specific factors) from the com-
assets that generate largely independent cash inflows with following payments: mencement date until the exercise date of the option. Addi-
their carrying values. An intangible asset’s fair value is tionally, the Fresenius Group’s historical practice regarding
determined using a discounted cash flow approach or ► fixed lease payments (including in-substance fixed the period over which it has typically used particular types
other methods, if appropriate. payments), less any lease incentives receivable, of assets, and its economic reasons for doing so, is also rel-
The recoverability of goodwill and other intangible ► variable lease payments, that are linked to an index evant. Unrecognized extension options are shown as poten-
assets with indefinite useful lives recorded in the Group’s or interest rate, tial future cash outflows (see note 31, Leases).
consolidated statement of financial position was verified. ► expected payments under residual value guarantees, Lease payments are discounted using the implicit inter-
Therefore, in 2021, no impairment losses were recorded. ► the exercise price of purchase options, where exercise est rate underlying the lease if this rate can be readily deter-
In 2020, the Fresenius Group recorded an impairment of is reasonably certain, mined. Otherwise, the incremental borrowing rate of the
goodwill and tradenames of the CGU Fresenius Medical ► lease payments in optional renewal periods, where exer- lessee is used as the discount rate.
Care Latin America of €195 million. cise of extension options is reasonably certain, and
► penalty payments for the termination of a lease, if the
lease term reflects the exercise of the respective termi-
nation option.
Annual Report 2021
Fresenius
296
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Lease liabilities are subsequently measured at amortised Right-of-use assets are depreciated over the shorter of the Purchases and sales of financial assets are accounted for
cost using the effective interest method. Furthermore, lease lease term or the useful life of the underlying asset using on the trading day. Furthermore, the Fresenius Group does
liabilities may be remeasured due to lease modifications or the straight-line method. Where a lease agreement includes not make use of the fair value option, which allows financial
reassessments of the lease. a transfer of ownership at the end of the lease term or the liabilities to be classified at fair value through profit or loss
The incremental borrowing rate is determined when exercise of a purchase option is deemed reasonably cer- upon initial recognition. The Fresenius Group elects to rep-
the Fresenius Group initiates a lease contract or changes tain, right-of-use assets are depreciated over the useful life resent changes in the fair value of selected equity invest-
an existing lease. The interest rate is calculated based on of the underlying asset using the straight-line method. In ments that are not held for trading in other comprehensive
the following components: available interest rate sampling addition, right-of-use assets are reduced by impairment income (loss).
points, group risk margins, shadow rating (credit risk) losses, if any, and adjusted for certain remeasurements. Financial instruments are allocated to categories follow-
margins, country risk margins, handling margins and Right-of-use assets from lease contracts are classified ing the analysis of the business model and cash flow char-
other risk margins. in accordance with the Fresenius Group’s classification of acteristics as required by IFRS 9, Financial Instruments.
For lease contracts that include both lease and non-lease property plant and equipment: The following categories are relevant for the Fresenius
components that are not separable from lease components, Group: financial assets and liabilities measured at amor-
no allocation is performed. Each lease component and any ► Right-of-use assets: land tized cost, financial assets and liabilities measured at fair
associated non-lease components are accounted for as a ► Right-of-use assets: buildings and improvements value through profit and loss and financial assets measured
single lease. ► Right-of-use assets: machinery and equipment at fair value through other comprehensive income (loss).
The reconciliation of the categories to the positions in the
Right-of-use assets In addition to the right-of-use asset categories above, ad- consolidated statement of financial position is shown in
Right-of-use asset are stated at cost, which comprises of: vanced payments on right-of-use assets are presented sep- tabular form in note 32, Financial instruments.
arately. Right-of-use assets from lease contracts and lease
► lease liability amount, liabilities are presented separately from property, plant Cash and cash equivalents
► initial direct costs incurred when entering into the and equipment and other financial debt in the consolidated Cash and cash equivalents comprise cash funds and all
lease, statement of financial position. short-term investments with maturities of up to three
► (lease) payments before commencement date of the months. Short-term investments are highly liquid and
respective lease, and q) Financial instruments readily convertible into known amounts of cash. The risk
► an estimate of costs to dismantle and remove the A financial instrument is any contract that gives rise to a of changes in value is insignificant.
underlying asset, financial asset of one entity and a financial liability or equity
► less any lease incentives received. instrument of another entity.
Annual Report 2021
Fresenius
297
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Trade accounts and other receivables Based on external credit ratings of the counterparties, the In case of objective evidence of a detrimental impact on the
Trade accounts and other receivables are stated at their Fresenius Group considers that its cash and cash equiva- estimated future cash flows of a financial asset, the asset is
nominal value less lifetime expected credit losses. lents have a low credit risk. considered to be credit impaired. This is generally the case
The Fresenius Group does not expect any material after more than 360 days overdue, at the latest.
Impairments credit losses from financial instruments that are measured When a counterpart defaults, all financial assets against
According to IFRS 9, impairments are recognized on the according to the general approach. this counterpart are considered impaired. The definition
basis of expected credit losses (expected credit loss The allowances are estimates comprised of customer of default is mainly based on payment practices specific
model). The Fresenius Group recognizes a loss allowance and financial asset specific evaluations regarding payment to individual regions and businesses.
for expected credit losses on financial assets measured history, current financial stability, and applicable future For further information regarding impairments, please
at amortized cost, contract assets and lease receivables economic conditions. see note 1. IV. c, Critical accounting policies.
as well as for investments in debt instruments measured Financial assets whose expected credit loss is not
at fair value through other comprehensive income. assessed individually are allocated to geographical regions. Put option liabilities
The Fresenius Group recognizes loss allowances for The impairment is generally assessed on the basis of The Fresenius Group, as option writer of existing put op-
expected credit losses (allowance for doubtful accounts) regional macroeconomic indicators such as credit default tions, can be obligated to purchase noncontrolling interests
mainly for trade accounts receivable and cash and cash swaps or scoring models. held by third parties. Put option liabilities are recognized at
equivalents. The amount of expected credit losses is Due to the number of transactions and geographical the present value of the exercise price of the option, to the
updated at each reporting date to reflect changes in credit regions that the Fresenius Group operates in, the Fresenius extent the terms triggering exercise are considered genuine.
risk since initial recognition of the respective instrument. Group’s policy of determining when an individual expected If these put options were exercised, the Fresenius Group
For trade accounts receivable, the Fresenius Group uses credit loss is required considers the appropriate individual would be required to purchase all or part of the third-party
the simplified method which requires recognizing lifetime local facts and circumstances that apply to an account. While owners’ noncontrolling interests at the appraised fair value
expected credit losses. payment and collection practices vary significantly between at the time of exercise.
Expected credit losses on cash and cash equivalents are countries and even agencies within one country, government The methodology the Fresenius Group uses to estimate
measured according to the general method based on IFRS 9. payors usually represent low to moderate credit risks. It the fair values of the put option liabilities assumes the
A significant increase in credit risk will be assessed based is the Fresenius Group’s policy to determine when receiv- greater of net book value or a multiple of earnings, based
on available qualitative as well as quantitative information. ables should be classified as bad debt on a local basis taking on historical earnings, the development stage of the under-
into account local payment practices and local collection lying business and other factors. From time to time the
experience. Fresenius Group engages external valuation firms for
Annual Report 2021
Fresenius
298
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
the valuation of the put options. The external valuation esti- Derivatives embedded in host contracts with a financial the degree of probability of an unfavorable outcome and its
mates the fair values using a combination of discounted liability as host contract are accounted for as separate ability to make a reasonable estimate of the amount of loss.
cash flows and a multiple of earnings and / or revenue. derivatives if their economic characteristics and risks are not The filing of a suit or formal assertion of a claim or
When applicable, the obligations are discounted at a pre- closely related to those of the host contracts. These embed- assessment, or the disclosure of any such suit or asser-
tax discount rate which reflects the interest effects and cur- ded derivatives are measured at fair value with changes in tion, does not necessarily indicate that accrual of a loss
rent market assessments of the time value of money and fair value recognized in the income statement. is appropriate.
the specific risk of the liability. The estimated fair values of
the put options can also fluctuate and the discounted cash r) Liabilities t) Provisions
flows as well as the implicit multiple of earnings and / or At the date of the statement of financial position, liabilities Accruals for other obligations are recognized when there
revenue at which these obligations may ultimately be settled are generally stated at amortized cost, with the exception of is a present obligation to a third party arising from past
could vary significantly from Fresenius Group’s current esti- contingent considerations resulting from a business combi- events, it is probable that the obligation will be settled in
mates depending on market conditions. nation, put option liabilities as well as derivative financial the future and the amount can be reliably estimated.
liabilities. Provisions for warranties and complaints are estimated
Derivative financial instruments based on historical experience.
Derivative financial instruments, which primarily include s) Legal contingencies Non-current provisions with a remaining period of more
foreign currency forward contracts and interest rate swaps, In the ordinary course of Fresenius Group’s operations, the than one year are discounted to the present value of the
are recognized at fair value as assets or liabilities in the Fresenius Group is party to litigation and arbitration and is expenditures expected to settle the obligation.
consolidated statement of financial position. The effective subject to investigations relating to various aspects of its
portion of changes in fair value of cash flow hedges is rec- business. The Fresenius Group regularly analyzes current u) Pension liabilities and similar obligations
ognized in accumulated other comprehensive income (loss) information about such claims for probable losses and pro- Pension obligations for post-employment benefits are
in shareholders’ equity until the secured underlying trans- vides accruals for such matters, including the estimated measured in accordance with IAS 19 (revised 2011),
action is realized (see note 32, Financial instruments). Based legal expenses and consulting services in connection with Employee Benefits, using the projected unit credit method,
on the spot rate changes of hedged items and hedging these matters, as appropriate. The Fresenius Group utilizes taking into account future salary and trends for pension
instruments, the ineffective portion of cash flow hedges is its internal legal department as well as external resources increase.
recognized in current earnings. Changes in the fair value of for these assessments. In making the decision regarding The Fresenius Group uses December 31 as the measure-
derivatives that are not designated as hedging instruments the need for a loss accrual, the Fresenius Group considers ment date when measuring the deficit or surplus of all plans.
are recognized in earnings.
Annual Report 2021
Fresenius
299
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Net interest costs are calculated by multiplying the pension that debt liability. Debt issuance costs related to undrawn calculated using a binomial model. The corresponding lia-
liability at the beginning of the year with the discount rate credit facilities are presented in other assets. These costs bility based on the measurement date fair value is accrued
utilized in determining the benefit obligation. The pension are amortized over the term of the related obligation or over the vesting period of the phantom stock plans.
liability results from the benefit obligation less the fair value credit facility.
of plan assets. x) Self-insurance programs
Remeasurements include actuarial gains and losses w) Share-based compensation plans Under the insurance programs for professional, product
resulting from the evaluation of the defined benefit obliga- The Fresenius Group measures its share-based compen- and general liability, auto liability, worker’s compensation
tion as well as from the difference between actual return sation plans in accordance with IFRS 2, Share-based claims and medical malpractice claims, the largest subsidi-
on plan assets and the expected return on plan assets at Payments. ary of Fresenius Medical Care AG & Co. KGaA (FMC-AG &
the beginning of the year used to calculate the net interest The total cost of stock options granted to members of Co. KGaA), located in the United States, is partially self-
costs. In the event of a surplus for a defined benefit pension the Management Board and executive employees of the insured for professional liability claims. For all other cover-
plan, remeasurements can also contain the effect from Asset Fresenius Group at the grant date were measured using age, FMC-AG & Co. KGaA assumes responsibility for incurred
Ceiling, as far as this effect is not included in net interest an option pricing model and are recognized as expense claims up to predetermined amounts, above which third
costs. over the vesting period of the stock option plans. party insurance applies. Reported liabilities for the year
Remeasurements are recognized in accumulated other The measurement date fair value of cash-settled phan- represent estimated future payments of the anticipated
comprehensive income (loss) completely. It is not allowed tom stocks granted to members of the Management Board expense for claims incurred (both reported and incurred
to reclassify the remeasurements in subsequent periods. and executive employees of the Fresenius Group (except but not reported) based on historical experience and exist-
Components of net periodic benefit cost are recognized in for Fresenius Medical Care) and of cash-settled performance ing claim activity. This experience includes both the rate of
profit and loss of the period. shares granted to members of the Management Board and claims incidence (number) and claim severity (cost) and is
executive employees of the Fresenius Group is calculated combined with individual claim expectations to estimate
v) Debt issuance costs using the Monte Carlo simulation. The corresponding lia- the reported amounts.
Debt issuance costs related to a recognized debt liability bility based on the measurement date fair value is accrued
are presented in the consolidated statement of financial over the vesting period of the phantom stock and perfor-
position as a direct deduction from the carrying amount of mance share plans.
The measurement date fair value of cash-settled phan-
tom stocks granted to members of the Management Board
and executive employees of Fresenius Medical Care is
Annual Report 2021
Fresenius
300
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
y) Foreign currency translation year. Adjustments due to foreign currency translation fluctu- Gains and losses arising from the translation of foreign cur-
The reporting and functional currency is the euro. Substan- ations are excluded from net earnings and are reported in rency positions as well as those arising from the elimination
tially all assets and liabilities of the foreign subsidiaries that accumulated other comprehensive income (loss). In addi- of foreign currency intercompany loans are recorded as
use a functional currency other than the euro are translated tion, the translation adjustments of certain intercompany other operating income or expenses, as far as they are not
at year-end exchange rates, while income and expense are borrowings, which are of a long-term nature, are also re- considered foreign equity instruments. In the fiscal year
translated at annual average exchange rates of the fiscal ported in accumulated other comprehensive income (loss). 2021, only immaterial losses resulted out of this translation.
The exchange rates of the main currencies affecting foreign currency translation developed as follows:
Year-end exchange rate Average exchange rate
December 31, 2021 December 31, 2020 2021 2020
U.S. dollar per € 1.133 1.227 1.183 1.142
Chinese renminbi per € 7.195 8.023 7.628 7.875
Argentinean peso per € 116.780 102.900 112.522 81.042
Australian dollar per € 1.562 1.590 1.575 1.655
Brazilian real per € 6.310 6.374 6.378 5.894
Japanese yen per € 130.380 126.490 129.877 121.846
Korean won per € 1,346.380 1,336.000 1,354.057 1,345.577
Pound sterling per € 0.840 0.899 0.860 0.890
Russian ruble per € 85.300 91.467 87.153 82.725
Swedish krona per € 10.250 10.034 10.146 10.485
z) Fair value hierarchy defined as unobservable inputs for which little or no market and liabilities at the date of the consolidated financial state-
The three-tier fair value hierarchy as defined in IFRS 13, data exists, therefore requiring the company to develop its ments and the reported amounts of income and expenses
Fair Value Measurement, classifies financial assets and lia- own assumptions. The three-tier fair value hierarchy is used during the reporting period. Actual results could differ from
bilities recognized at fair value based on the inputs used in in note 32, Financial instruments. those estimates. Estimates and judgmental assumptions are
estimating the fair value. Level 1 is defined as observable required in particular for the positions trade accounts receiv-
inputs, such as quoted prices in active markets. Level 2 is aa) Use of estimates able, deferred tax assets and pension liabilities as well as
in application of recognized financial mathematical models The preparation of consolidated financial statements in put option liabilities, contingent payments outstanding for
defined as inputs other than quoted prices in active mar- conformity with IFRS requires management to make esti- acquisitions, equity investments and when examining the
Annual Report 2021
kets that are directly or indirectly observable. Level 3 is mates and assumptions that affect the reported amounts of recoverability of goodwill.
assets and liabilities, the disclosure of contingent assets
Fresenius
301
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
bb) Receivables management IAS 1 as an interim standard in 2004. IFRS 4 permitted the use
The entities of the Fresenius Group perform ongoing evalu- In January 2020, the IASB issued Amendments to IAS 1, of national accounting standards for the accounting of
ations of the financial situation of their customers and gen- Classification of Liabilities as Current and Non-current. insurance contracts under IFRS. As a result of the varied
erally do not require a collateral from the customers for the The amendments clarify under which circumstances debt application for insurance contracts, there was a lack of
supply of products and provision of services. Approximately and other liabilities with an uncertain settlement date comparability among peer groups. IFRS 17 eliminates this
13% and 16% of Fresenius Group’s sales were earned and should be classified as current or non-current. Among diversity in practice by requiring all insurance contracts to
subject to the regulations under governmental health care others, the amendments state that liabilities shall be classi- be accounted for using current values. The frequent updates
programs, Medicare and Medicaid, administered by the fied depending on rights that exist at the end of the report- to the insurance values are expected to provide more useful
United States government in 2021 and 2020, respectively. ing period and define under which conditions liabilities information to users of financial statements. On June 25,
might be settled by cash, other economic resources or 2020, the IASB issued amendments to IFRS 17, which
cc) Recent pronouncements, applied equity. On July 15, 2020, the IASB deferred the effective among others, defer the effective date to fiscal years begin-
The Fresenius Group has prepared its consolidated financial date by one year to provide companies with more time to ning on or after January 1, 2023. Earlier adoption is permit-
statements at and for the year ended December 31, 2021 in implement any classification changes resulting from the ted for entities that have also adopted IFRS 9, Financial
conformity with IFRS, as adopted by the EU, that must be amendments. The amendments to IAS 1 are now effective Instruments, and IFRS 15, Revenue from Contracts with
applied for fiscal years beginning on January 1, 2021. for fiscal years beginning on or after January 1, 2023. Customers. The Fresenius Group is currently evaluating the
For the year ended December 31, 2021, there were Earlier adoption is permitted. The Fresenius Group is cur- impact of IFRS 17 on the consolidated financial statements.
no recently implemented accounting pronouncements rently evaluating the impact of the amendments to IAS 1 The EU Commission’s endorsement of the amendments
that had a material effect on the Fresenius Group’s con- on the consolidated financial statements. to IAS 1 is still outstanding.
solidated financial statements. In the Fresenius Group’s view, there are no other IFRS
IFRS 17 standards or interpretations not yet effective that would
dd) Recent pronouncements, not yet applied In May 2017, the IASB issued IFRS 17, Insurance Con- be expected to have a material impact on the consolidated
The International Accounting Standards Board (IASB) issued tracts. In June 2020 and December 2021, further amend- financial statements.
the following new standards relevant for the Fresenius Group ments were published. IFRS 17 establishes principles for
and mandatory for fiscal years commencing on or after the recognition, measurement, presentation and disclosure
January 1, 2022: related to the issuance of insurance contracts. IFRS 17
replaces IFRS 4, Insurance Contracts, which was brought in
Annual Report 2021
Fresenius
302
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
ee) Impacts of the climate change on accounting a) Recoverability of goodwill and intangible assets CGU is determined using estimated future cash flows for
In 2021, the Fresenius Group analyzed potential sustaina- with indefinite useful lives the unit discounted by a weighted average cost of capital
bility risks in the areas of climate change and water scar- The amount of goodwill and other non-amortizable intangi- (WACC) specific to that CGU. Estimating the discounted
city. In both areas, the Fresenius Group has not identified ble assets with indefinite useful lives represents a consider- future cash flows involves significant assumptions, espe-
any significant risks for its business model. Therefore, the able part of the total assets of the Fresenius Group. At cially regarding future reimbursement rates and sales prices,
Fresenius Group does not currently expect any material December 31, 2021 and December 31, 2020, the carrying number of treatments, sales volumes and costs. In deter-
impact of sustainability risks on the accounting. amount of these was €29,220 million and €26,825 million, mining discounted cash flows, the Fresenius Group utilizes
respectively. This represented 41% and 40%, respectively, for every CGU its approved three-year budget, projections
IV. CRITICAL ACCOUNTING POLICIES of total assets. for years 4 to 10 and a corresponding growth rate for all
In the opinion of the Management of the Fresenius Group, An impairment test of goodwill and non-amortizable remaining years. Projections for up to 10 years are possible
the following accounting policies and topics are critical intangible assets with indefinite useful lives is performed due to historical experience and the stability of Fresenius
for the consolidated financial statements in the present at least once a year, or if events occur or circumstances Group’s business, which is largely independent from the
economic environment. The influences and judgments as change that would indicate the carrying amount may not economic cycle. Except for the CGUs in Asia-Pacific, the
well as the uncertainties which affect them are also im- be recoverable. CGUs’ average revenue growth for the 10-year planning
portant factors to be considered when looking at present To determine possible impairments of these assets, the period is between 3% and 6%. In Asia-Pacific, the aver-
and future operating earnings of the Fresenius Group. recoverable amount as its value in use of the cash generat- age growth is in the mid single-digit range for Fresenius
ing units (CGUs) is compared to their carrying amount and Medical Care and in the upper single-digit range for
the fair value less cost of disposal. The value in use of each
Annual Report 2021
Fresenius
303
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Fresenius Kabi. A significant part of goodwill is assigned to integrated, within each CGU. In 2021, WACCs (after tax) for (carrying amount of goodwill as of December 31, 2021:
the CGUs of Fresenius Medical Care and Fresenius Kabi in the CGUs of Fresenius Medical Care ranged from 4.58% to €121 million) by 4.13 percentage points would have led
North America (carrying amounts of goodwill as of Decem- 16.25% and WACCs (after tax) for the CGUs of Fresenius to the value in use being equal to the carrying amount.
ber 31, 2021: €12,224 million and €4,212 million, respec- Kabi ranged from 5.99% to 7.47%. In the CGU Fresenius An increase of the WACC (after tax) of the CGU Fresenius
tively; December 31, 2020: €10,909 million and €3,918 mil- Helios (Germany), the WACC (after tax) was 5.43%, country- Medical Care EMEA (carrying amount of goodwill as of
lion, respectively) as well as the CGUs of Fresenius Helios specific adjustments did not occur. In the CGU Fresenius December 31, 2021: €1,377 million) by 2.09 percentage
in Germany and Spain (carrying amounts of goodwill as Helios (Spain), the WACC (after tax) was 6.34%. In the points would have led to the value in use being equal to
of December 31, 2021: €4,804 million and €3,717 million, business segment Fresenius Vamed, the WACC (after tax) the carrying amount.
respectively; December 31, 2020: €4,576 million and €3,702 was 5.60%. The WACCs (after tax) of the main CGUs of A decrease of the EBIT margin per annum of the CGU
million, respectively). A significant part of the operating Fresenius Medical Care and Fresenius Kabi in North Fresenius Kabi Latin America by 4.08 percentage points and
income is also achieved in these CGUs. For the 10-year America were 4.58% and 6.02%, respectively. of the CGU Fresenius Medical Care EMEA by 3.49 percent-
planning period, the average growth of the operating income If the value in use of the CGU is less than its carrying age points would have led to the value in use being equal to
is in the low to mid single-digit range for these CGUs. For amount and the fair value less cost of disposal is not esti- the carrying amount.
the period after 10 years, the growth rates are 1% to 4% mated to be higher than the value in use, the difference A prolonged downturn in the health care industry with
for Fresenius Medical Care, 3% for Fresenius Kabi, 1% for is recorded as an impairment of the CGU goodwill. lower than expected increases in reimbursement rates
Fresenius Helios (Germany), 1.5% for Fresenius Helios In 2021, no impairment was recognized. In 2020, as a and prices and / or higher than expected costs for providing
(Spain) and 1% for Fresenius Vamed. The growth rates of result of the annual impairment test of goodwill, the Latin health care services and for procuring and selling health
the main CGUs of Fresenius Medical Care and Fresenius America CGU of Fresenius Medical Care recognized an care products or a significant increase of mortality of
Kabi in North America were 1% and 3%, respectively. The impairment of goodwill and tradenames of €195 million to patients with chronic kidney diseases which may be attribut-
discount factor is determined by the WACC of the respec- reduce the carrying amount of goodwill and tradenames. able to COVID-19 could adversely affect the estimated
tive CGU. Fresenius Medical Care’s WACC consisted of a The impairment was driven by a macro-economic downturn future cash flows of certain countries or segments. Future
basic rate of 4.57% and the WACC in the business segment and increasing risk adjustment rates for certain countries adverse changes in a reporting unit’s economic environ-
Fresenius Kabi consisted of a basic rate of 5.43% for 2021, in Latin America. An increase of the WACC (after tax) by ment could affect the discount rate. A decrease in the esti-
respectively. This basic rate is then adjusted by a country- 0.5 percentage points would not have resulted in the recog- mated future cash flows and / or a decline in the reporting
specific risk premium and, if appropriate, by a factor to nition of an impairment loss in 2021. An increase of the unit’s economic environment could result in impairment
reflect higher risks associated with the cash flows from WACC (after tax) of the CGU Fresenius Kabi Latin America charges to goodwill and other intangible assets with indefi-
recent material acquisitions, until they are appropriately nite useful lives which could materially and adversely affect
Fresenius Group’s future operating results.
Annual Report 2021
Fresenius
304
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
b) Legal contingencies c) Allowances for expected credit losses including the use of outside sources where required and
The Fresenius Group is involved in several legal matters Trade accounts receivable are a significant asset and the allowed, have been exhausted, and after appropriate review
arising from the ordinary course of its business. The out- allowances for expected credit losses are a significant esti- by the local management, a receivable deemed to be uncol-
come of these matters may have a material adverse effect mate made by the local Management. Trade accounts receiv- lectible is considered a bad debt and written off.
on the financial position, results of operations or cash flows able were €7,045 million and €6,937 million in 2021 and Deterioration in the aging of receivables and collection
of the Fresenius Group. For details, please see note 30, 2020, respectively, net of allowance. Approximately 48% difficulties could require that the Fresenius Group increases
Commitments and contingencies. and 45%, respectively, of receivables derive from the busi- the estimates of allowances for expected credit losses. Addi-
The Fresenius Group regularly analyzes current infor- ness segment Fresenius Medical Care and mainly relate to tional expenses for uncollectible receivables could have a
mation about such claims for probable losses and provides the dialysis care business in North America. significant negative impact on future operating results.
accruals for such matters, including the estimated legal The major debtors or debtor groups of trade accounts
expenses and consulting services in connection with these receivable were U.S. Medicare and Medicaid health care d) Self-insurance programs
matters, as appropriate. The Fresenius Group utilizes its programs with 15%, private insurers in the United States Under the insurance programs for professional, product
internal legal department as well as external resources for with 7% as well as the public health authority of the region and general liability, auto liability, worker’s compensation
these assessments. In making the decision regarding the of Madrid with 15%, at December 31, 2021. Other than claims and medical malpractice claims, the largest subsid-
need for a provision for legal matters, the Fresenius Group that, the Fresenius Group has no significant risk concentra- iary of Fresenius Medical Care AG & Co. KGaA, located in
considers the degree of probability of an unfavorable out- tion, due to its international and heterogeneous customer the United States, is partially self-insured for professional
come and its ability to make a reasonable estimate of the structure. liability claims. For further details regarding the accounting
amount of loss. The allowances for expected credit losses were €449 policies for self-insurance programs, please see note 1. III. x,
The filing of a suit or formal assertion of a claim or million and €401 million as of December 31, 2021 and Self-insurance programs.
assessment, or the disclosure of any such suit or assertion, December 31, 2020, respectively. A valuation allowance is
does not necessarily indicate that a provision for a loss is calculated if specific circumstances indicate that amounts
appropriate. will not be collectible. When all efforts to collect a receivable,
Annual Report 2021
Fresenius
305
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
2. ACQUISITIONS, DIVESTITURES In 2020, Fresenius Kabi spent €31 million on acquisitions, Eugin Group’s network comprised at the time of the acqui-
AND INVESTMENTS mainly for already planned acquisition related milestone sition 31 clinics and additional 34 sites across 9 countries
payments relating to the acquisition of the biosimilars on 3 continents. With about 1,300 employees, the company
ACQUISITIONS, DIVESTITURES AND INVESTMENTS business. offers a wide spectrum of state-of-the-art services in the
The Fresenius Group made acquisitions, investments and field of fertility treatments. With the acquisition of the Eugin
purchases of intangible assets of €1,085 million and €902 Fresenius Helios Group, Fresenius Helios becomes a leading player in the
million in 2021 and 2020, respectively. In 2021, of this In 2021, Fresenius Helios spent €453 million on acquisitions, dynamically growing market for fertility services and estab-
amount, €999 million was paid in cash and €86 million mainly for the purchase of the Eugin Group. Furthermore, lishes a strong basis for further expansion.
was assumed obligations. subsequent purchase price payments for the Malteser hospi- The acquisition was financed through available cash
tal in Duisburg, Germany, were made and the DRK Kliniken and credit facilities. The purchase price was paid in cash.
Fresenius Medical Care Nordhessen in Kassel, Germany, were acquired. Moreover, The transaction was accounted for as a business com-
In 2021, Fresenius Medical Care spent €628 million on Centro Oncológico de Antioquia S.A. and Clínica Clofán S.A. bination whereby assets and liabilities and noncontrolling
acquisitions, mainly on the purchase of dialysis clinics. were acquired in Colombia. interests are recognized at their fair values. The allocation
of the purchase price is based upon the best information
In 2020, Fresenius Medical Care spent €407 million on Acquisition of the Eugin Group available to management at present.
acquisitions, mainly on the purchase of dialysis clinics. On April 14, 2021, Fresenius Helios has finalized the com- Based on a preliminary purchase price allocation, intan-
plete acquisition of Luarmia S.L., Spain, holding company gible assets in the amount of €41 million and a goodwill of
Fresenius Kabi of all worldwide activities of the Eugin group, and of NMC €348 million which is not deductible for tax purposes were
In 2021, Fresenius Kabi spent €1 million on acquisitions, Eugin US Corporation from NMC Health (together the Eugin recorded for the initial statement of financial position of the
mainly for already planned acquisition related milestone Group), one of the leading international fertility groups. Eugin Group. Any adjustments to acquisition accounting,
payments relating to the acquisition of the biosimilars The purchase price is based on a valuation of €430 mil- net of related income tax effects, will be recorded with a
business. lion. It includes acquired noncontrolling interests and corresponding adjustment to goodwill. Goodwill mainly
debt of approximately €80 million. The noncontrolling represents the market position of the acquired fertility hos-
interests are held by the respective senior doctors. The pitals and employee know-how.
Eugin Group has been consolidated as of April 1, 2021. Since January 1, 2022, the Eugin Group forms a new
and separate Fresenius Helios business and reporting unit,
Helios Fertility, alongside Helios Germany and Helios Spain.
Annual Report 2021
Fresenius
306
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
In the year 2021, the Eugin Group has contributed €133 IMPACTS ON FRESENIUS GROUP’S Goodwill is an asset representing the future economic ben-
million to sales and €19 million to the operating income CONSOLIDATED FINANCIAL STATEMENTS efits arising from other assets acquired in a business com-
(EBIT) of the Fresenius Group since April 1, 2021. RESULTING FROM ACQUISITIONS bination that are not individually identified and separately
In the fiscal year 2021, all acquisitions have been accounted recognized. Goodwill arises principally due to the fair value
In 2020, Fresenius Helios spent €459 million on acquisitions, for applying the purchase method and accordingly have placed on an established stream of future cash flows.
mainly for the purchase of Centro Médico Imbanaco S.A. in been consolidated starting at the date of acquisition. The The acquisitions completed in 2021 or included in the
Colombia. Furthermore, Clínica del Prado S.A. and Clínica excess of the total fair value of consideration paid over the consolidated financial statements for the first time for a full
de la Mujer S.A.S. were acquired in Colombia. In Germany, fair value of the net assets acquired was €1,402 million and year contributed the following amounts to the development
hospitals and outpatient clinics of the Malteser humanitarian €844 million in 2021 and 2020, respectively. The measure- of sales and earnings:
aid group as well as Digitale Gesundheits Gruppe GmbH ment period adjustments from the previous year’s acquisi-
were acquired. tions did not have a significant impact on the consolidated € in millions 2021
Sales 509
financial statements in 2021.
EBITDA 65
Fresenius Vamed The purchase price allocations are not yet finalized for EBIT 45
In 2021, Fresenius Vamed spent €1 million on acquisitions. all acquisitions of the current year. Based on preliminary Net interest -10
purchase price allocations, the recognized goodwill was Net income attributable to
shareholders of Fresenius SE & Co. KGaA 18
In 2020, Fresenius Vamed spent €6 million on acquisitions. €1,065 million and the other intangible assets were €337
million. Of this goodwill, €444 million is attributable to the
The acquisitions increased the total assets of the Fresenius
acquisitions of Fresenius Medical Care and €621 million to
Group by €1,121 million.
the acquisitions of Fresenius Helios.
Annual Report 2021
Fresenius
307
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
NOTES ON THE CONSOLIDATED The special items had the following impact on the consoli- The special items had the following impact on the consoli-
dated statement of income of 2021: dated statement of income of 2020:
STATEMENT OF INCOME Net income Net income
attributable to attributable to
shareholders shareholders
3. SPECIAL ITEMS Interest of Fresenius Interest of Fresenius
Net income attributable to shareholders of Fresenius SE & € in millions EBIT expenses SE & Co. KGaA € in millions EBIT expenses SE & Co. KGaA
Earnings 2021, before Earnings 2020, before
Co. KGaA for the year 2021 in the amount of €1,818 million
special items 4,252 -504 1,867 special items 4,612 -654 1,796
includes special items relating to the Fresenius cost and Expenses associated with the Impairment of goodwill at
efficiency program (including the FME25 program) and Fresenius cost and efficiency Fresenius Medical Care
program (including the FME25 Latin America -195 --- -63
the revaluation of biosimilars contingent purchase price program) -143 --- -82 Revaluations of biosimilars
liabilities. Revaluations of biosimilars contingent purchase price
contingent purchase price liabilities -32 -5 -26
liabilities 49 -2 33 Earnings 2020 according to IFRS 4,385 -659 1,707
Earnings 2021 according to IFRS 4,158 -506 1,818
Net income attributable to shareholders of Fresenius SE &
Co. KGaA for the year 2020 in the amount of €1,707 million
included special items relating to an impairment of good-
will at Fresenius Medical Care Latin America and the reval-
uation of biosimilars contingent purchase price liabilities.
4. SALES
Sales by activity were as follows:
2021
Fresenius Fresenius Fresenius Fresenius Fresenius
€ in millions Medical Care Kabi Helios Vamed Corporate Group
Sales from contracts with customers 17,054 7,123 10,850 1,956 2 36,985
thereof sales of services 13,479 59 10,839 1,283 2 25,662
thereof sales of products and related services 3,575 7,052 --- --- --- 10,627
thereof sales from longterm production contracts --- --- --- 673 --- 673
thereof further sales from contracts with customers --- 12 11 --- --- 23
Annual Report 2021
Other sales 516 3 12 4 --- 535
Sales 17,570 7,126 10,862 1,960 2 37,520
Fresenius
308
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
2020
Fresenius Fresenius Fresenius Fresenius Fresenius
€ in millions Medical Care Kabi Helios Vamed Corporate Group
Sales from contracts with customers 17,410 6,913 9,786 1,742 2 35,853
thereof sales of services 13,810 67 9,782 1,160 1 24,820
thereof sales of products and related services 3,600 6,830 --- --- 1 10,431
thereof sales from longterm production contracts --- --- --- 582 --- 582
thereof further sales from contracts with customers --- 16 4 --- --- 20
Other sales 409 3 12 --- --- 424
Sales 17,819 6,916 9,798 1,742 2 36,277
Other sales include sales from insurance and lease At December 31, 2021, sales recognized that were included As of December 31, 2021 and 2020, respectively, the
contracts. in the contract liabilities balance at the beginning of the Fresenius Group had performance obligations that are
period were €603 million (2020: €72 million). unsatisfied or partially unsatisfied and that are expected to
be satisfied and recorded in sales in the following years.
December 31, 2021, € in millions 2022 2023 2024 2025 2026 thereafter Total
Transaction price of the unsatisfied or partially unsatisfied performance obligations 1,549 1,089 884 1,082 373 450 5,427
December 31, 2020, € in millions 2021 2022 2023 2024 2025 thereafter Total
Transaction price of the unsatisfied or partially unsatisfied performance obligations 1,657 1,206 845 779 529 581 5,597
A sales analysis by business segment and region is shown
in the segment information on pages 285 to 286.
Annual Report 2021
Fresenius
309
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
5. COST OF MATERIALS Fresenius Group’s annual average number of employees by 9. OTHER OPERATING INCOME AND EXPENSES
Cost of materials included in cost of sales was comprised of function is shown below: Other operating income and expenses mainly included in
cost of raw materials, supplies and purchased components 2021 and 2020 foreign exchange gains and losses, income
and cost of purchased services: 2021 2020 related to the equity method investee named Vifor Fresenius
Production 42,773 42,657
Medical Care Renal Pharma Ltd. and valuations of equity and
Service 222,809 217,099
€ in millions 2021 2020 debt investments that are measured at fair value through
Administration 30,831 29,454
Cost of raw materials, supplies and
Sales and marketing 13,574 12,982 profit and loss as well as the release of provisions.
purchased components 7,629 7,333
Research and development 3,641 3,514
Cost of purchased services 1,191 1,461
Total employees (per capita) 313,628 305,706
Cost of materials 8,820 8,794 10. NET INTEREST
Net interest of - €506 million (2020: - €659 million) included
The comparative cost of materials figures for 2020 were 7. RESEARCH AND DEVELOPMENT EXPENSES
interest expenses of €630 million (2020: €752 million)
reduced by €317 million to adjust classifications within cost Research and development expenses of €805 million (2020:
and interest income of €124 million (2020: €93 million).
of sales in the consolidated statement of income. Therefore, €751 million) included expenditures for research and non-
The main portion of the interest expenses resulted from
this reclassification had no impact on the consolidated state- capitalizable development costs as well as regular depreci-
Fresenius Group’s financial liabilities, which are recognized
ment of income. ation and amortization expenses relating to capitalized
at amortized cost (see note 32, Financial instruments). More-
development costs of €22 million (2020: €20 million). Fur-
over, €188 million related to lease liabilities. The main por-
6. PERSONNEL EXPENSES thermore, in 2021, research and development expenses
tion of interest income resulted from trade accounts and
Cost of sales, selling expenses, general and administrative included reversals of write-downs on capitalized develop-
other receivables recognized at amortized cost and from
expenses and research and development expenses included ment expenses of €5 million and impairments of €26 million
interest income related to the release of interest accruals
personnel expenses of €15,610 million and €15,128 million (2020: reversals of write-downs on capitalized development
on tax positions.
in 2021 and 2020, respectively. expenses of €7 million). The expenses for the further devel-
Personnel expenses were comprised of the following: opment of the biosimilars business included in the research
and development expenses amounted to €148 million (2020:
€ in millions 2021 2020 €159 million).
Wages and salaries 12,679 12,357
Social security contributions, cost of retirement 8. GENERAL AND ADMINISTRATIVE EXPENSES
pensions and social assistance 2,931 2,771
thereof retirement pensions 414 395 General and administrative expenses amounted to €4,394
Personnel expenses 15,610 15,128 million (2020: €4,373 million) and were related to expendi-
Annual Report 2021
tures for administrative functions not attributable to research
and development, production or selling.
Fresenius
310
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
11. TAXES A reconciliation between the expected and actual income DEFERRED TAXES
tax expense is shown in the following table. The expected The tax effects of the temporary differences and losses car-
INCOME TAXES corporate income tax expense is computed by applying the ried forward from prior years that gave rise to deferred tax
Income before income taxes was attributable to the follow- German corporation tax rate (including the solidarity sur- assets and liabilities at December 31 are presented below:
ing geographic regions: charge) and the effective trade tax rate on income before
income taxes. The respective combined tax rate was 30.8% € in millions 2021 2020
€ in millions 2021 2020 Deferred tax assets
for the fiscal years 2021 and 2020.
Germany 434 420 Accounts receivable 67 59
International 3,218 3,306 Inventories 175 181
€ in millions 2021 2020
Other current assets 108 88
Total 3,652 3,726
Computed ‘‘expected’’ income tax expense 1,123 1,146 Other noncurrent assets 162 144
Increase (reduction) in income taxes Lease liabilities 1,287 1,199
Income tax expenses (benefits) for 2021 and 2020 consisted resulting from: Provisions and other liabilities 487 467
Items not recognized for tax purposes 96 114 Benefit obligations 322 300
of the following:
Tax rate differential -294 -307 Losses carried forward from prior years 205 191
Tax rate changes 3 4 Deferred tax assets 2,813 2,629
Current Deferred Income
€ in millions taxes taxes taxes Taxfree income -50 -60
Taxes for prior years -17 33 Deferred tax liabilities
2021
Noncontrolling interests -65 -70 Accounts receivable 52 45
Germany 78 19 97
Other 37 43 Inventories 16 6
International 671 65 736
Income tax 833 903 Other current assets 228 183
Total 749 84 833
Effective tax rate 22.8% 24.2% Other noncurrent assets 1,883 1,741
2020 Rightofuse assets 1,171 1,112
Germany 137 -12 125 Provisions and other liabilities 120 120
International 723 55 778 Deferred tax liabilities 3,470 3,207
Total 860 43 903 Net deferred tax assets / liabilities -657 -578
In the consolidated statement of financial position, the net
amounts of deferred tax assets and liabilities are included
as follows:
€ in millions 2021 2020
Annual Report 2021
Deferred tax assets 858 812
Deferred tax liabilities 1,515 1,390
Net deferred tax assets / liabilities -657 -578
Fresenius
311
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The change in the balance of deferred tax assets and The expiration of net operating losses as of December 31, 12. NONCONTROLLING INTERESTS
deferred tax liabilities does not equal the deferred tax 2020 was as follows: As of December 31, noncontrolling interests in net income
expense / benefit. This is due to deferred taxes that are in the Fresenius Group were as follows:
booked directly to equity, the effects of exchange rate for the fiscal years € in millions
2021 37 € in millions 2021 2020
changes on tax assets and liabilities denominated in cur-
2022 38 Noncontrolling interests
rencies other than euro and the acquisition and disposal 2023 37 in Fresenius Medical Care 658 791
of entities as part of ordinary activities. 2024 51 Noncontrolling interests
As of December 31, 2021, Fresenius Medical Care has 2025 61 in Fresenius Vamed 15 0
2026 6 Noncontrolling interests
not recognized a deferred tax liability on approximately in the business segments
2027 38
€10 billion (2020: €9 billion) of undistributed earnings of 2028 6 Fresenius Medical Care 250 271
its foreign subsidiaries, because those earnings are consid- 2029 11 Fresenius Kabi 58 44
2030 and thereafter 178 Fresenius Helios 16 7
ered indefinitely reinvested.
Total 463 Fresenius Vamed 4 3
Total noncontrolling interests 1,001 1,116
NET OPERATING LOSSES
The total remaining operating losses of €1,546 million
The expiration of net operating losses as of December 31, In the fiscal year 2021, Fresenius Medical Care AG & Co.
(2020: €1,127 million) can mainly be carried forward for
2021 is as follows: KGaA paid dividends to noncontrolling interests in the
an unlimited period. The total amount of the existing oper-
amount of €266 million (2020: €238 million).
for the fiscal years € in millions
ating losses as of December 31, 2021 includes an amount
2022 26 of €1,189 million (2020: €1,014 million) that will probably
2023 46 not be realizable. For these operating losses, deferred tax
13. IMPACTS OF THE COVID-19 PANDEMIC
2024 60 The financial statements of the Fresenius Group have been
assets were not recognized.
2025 64 impacted by COVID-19, mostly in the form of lost revenue
2026 93
Based upon the level of historical taxable income and
and additional costs incurred to protect its patients and
2027 41 projections for future taxable income, the Management of
2028 74 employees, to safeguard its production activities and clinical
the Fresenius Group believes it is more likely than not that
2029 5 operations and additional freight and logistic costs. Across
the Fresenius Group will realize the benefits of these deduct-
2030 3 the Fresenius global footprint, various governments in
2031 and thereafter 59 ible differences, net of the existing valuation allowances, at
regions have provided economic assistance programs to
Total 471 December 31, 2021.
address the consequences of the pandemic on companies
and support health care providers and patients. The related
Annual Report 2021
reimbursement payments and funding received by Fresenius
Fresenius
312
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
have been accounted for in accordance with terms and COVID-19 pandemic, of which US$58 million (€49 million) effects related to lockdowns. At the same time the Fresenius
regulations set forth by the local laws and regulations. were recognized in cost of sales in the consolidated state- Group was affected by lower cost in certain areas, for exam-
In Germany, the hospitals of the Fresenius Group have ment of income used to offset eligible costs in 2021. The ple for incentive plans and travel.
received reimbursements and grants to compensate for remaining amounts of government grants received recorded The Fresenius Group is well positioned to meet its
COVID-19 related financial charges. Hospitals have been in deferred income were US$62 million (€55 million) from ongoing financial obligations and has sufficient liquidity
compensated for their increase in capacity and related the Provider Relief Fund Phase 4 at December 31, 2021 to support its normal business activities.
patient services through the postponement of elective treat- and US$22 million (€18 million) from the CARES Act at
ments and provision of additional intensive care beds for December 31, 2020. In 2020, the Fresenius Group also rec- 14. EARNINGS PER SHARE
the treatment of COVID-19 patients and for higher treat- orded a contract liability for advance payments received The following table shows the earnings per share including
ment costs. As these additional reimbursements for hospi- under the CMS Accelerated and Advance Payment program and excluding the dilutive effect from stock options issued:
tal services are paid by the partly state funded health care within short-term provisions and other short-term liabilities
fund, such revenues are recognized in accordance with the and long-term provisions and other long-term liabilities. 2021 2020
Numerators, € in millions
Fresenius Group’s existing revenue recognition policies for Contract liabilities related to the CMS Accelerated and
Net income attributable to
hospital services (IFRS 15, Revenue from Contracts with Advance Payment program were US$443 million (€391 mil- shareholders of
Customers). In 2021, the German hospitals of the Fresenius lion) and US$1,046 million (€852 million) as of Decem- Fresenius SE & Co. KGaA 1,818 1,707
less effect from dilution due to
Group received total reimbursements and grants of €509 ber 31, 2021 and December 31, 2020, respectively. Fresenius Medical Care shares 0 0
million (2020: €742 million), of which €442 million (2020: In addition to the programs above, the Fresenius Group Income available to
all ordinary shares 1,818 1,707
€697 million) were recorded in sales and €67 million (2020: also received grants and other reimbursements under vari-
Denominators in number of shares
€45 million) as grants in other operating income. ous other programs from multiple governments around the Weighted average number of
In the United States, Fresenius Medical Care North world in the amount of €50 million (2020: €52 million). ordinary shares outstanding 558,061,878 557,451,759
Potentially dilutive
America received government grants under the Corona- All funds received from grants comply with the respec-
ordinary shares 94,447 292,103
virus Aid, Relief, and Economic Security Act (CARES Act) tive conditions. The Fresenius Group is obliged and com- Weighted average number of ordinary
from the U.S. government in 2020. During the fourth quar- mitted to fulfilling all the requirements as set out in the shares outstanding assuming dilution 558,156,325 557,743,862
ter of 2021, Fresenius Medical Care received an additional grant funding arrangements.
Basic earnings per share in € 3.26 3.06
US$122 million (€103 million) in new U.S. Department of In addition to the aforementioned additional reimburse- Fully diluted earnings per share in € 3.26 3.06
Health and Human Services funding (Provider Relief Fund ments and compensated costs incurred in various countries,
Phase 4) available for health care providers affected by the the Fresenius Group was affected by impacts COVID-19 had
on the global economy and financial markets as well as
Annual Report 2021
Fresenius
313
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
NOTES ON THE CONSOLIDATED were offset. These solely related to Fresenius Medical When utilized, Fresenius Medical Care assigns interests in
Care (December 31, 2020: €998 million). Before this off- certain receivables to institutional investors under its
STATEMENT OF FINANCIAL POSITION
set, cash and cash equivalents as of December 31, 2021, Accounts Receivable Facility. For further information on
15. CASH AND CASH EQUIVALENTS were €2,881 million (December 31,2020: €2,843 million) the utilization of this facility, please see note 23, Debt.
As of December 31, cash and cash equivalents were as and short-term debt was €2,958 million (December 31, 2020: All trade accounts and other receivables are due within
follows: €1,251 million. one year. Trade accounts and other receivables with a term
of more than one year in the amount of €46 million (2020:
€ in millions 2021 2020 16. TRADE ACCOUNTS AND OTHER €38 million) are included in other noncurrent assets.
Cash 1,833 1,192
RECEIVABLES The following table shows the development of the
Time deposits and securities
(with a maturity of up to 90 days) 931 645 As of December 31, trade accounts and other receivables allowances for expected credit losses during the fiscal year:
Total cash and cash equivalents 2,764 1,837 were as follows:
€ in millions 2021 2020
As of December 31, 2021 and December 31, 2020, ear- € in millions 2021 2020 Allowances for expected credit losses
at the beginning of the year 401 351
marked funds of €154 million and €121 million, respec- Trade accounts and other receivables 7,494 7,338
Change in valuation allowances as recorded
less allowances for expected credit losses 449 401
tively, were included in cash and cash equivalents. in the consolidated statement of income 71 94
Trade accounts and other receivables, net 7,045 6,937
Writeoffs and recoveries of amounts
The Fresenius Group operates a multicurrency notional previously writtenoff -24 -23
cash pooling management system. In this cash pooling man- Within trade accounts and other receivables (before allow- Foreign currency translation 1 -21
agement system amounts in euro and other currencies are Allowances for expected credit losses
ances) as of December 31, 2021, €7,378 million (Decem- at the end of the year 449 401
offset without being transferred to a specific cash pool ber 31, 2020: €7,248 million) relate to revenue from con-
account. The system is used for an efficient utilization of tracts with customers as defined by IFRS 15. This amount Further allowances for expected credit losses are included
funds within the Fresenius Group. The Fresenius Group includes €448 million (December 31, 2020: €400 million) in other current and noncurrent assets (see note 18, Other
met the conditions to offset balances within this cash pool of allowances for expected credit losses. Further trade current and noncurrent assets). As of December 31, 2021,
for reporting purposes. At December 31, 2021, €117 mil- accounts and other receivables, net, relate to other sales. the Fresenius Group had total allowances for expected credit
lion (December 31, 2020: €1,006 million) of the cash bal-
losses of €488 million (2020: €423 million).
ances and the equivalent amount of the overdraft balances
Annual Report 2021
Fresenius
314
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The following table shows the credit risk rating grades of trade accounts receivable and their allowances for expected credit losses:
December 31, 2021 December 31, 2020
thereof thereof credit thereof thereof credit
€ in millions Total overdue1 impaired2 Total overdue1 impaired2
Trade accounts and other receivables 7,494 3,225 691 7,338 3,283 674
less allowances for expected credit losses 449 405 340 401 347 314
Trade accounts and other receivables, net 7,045 2,820 351 6,937 2,936 360
1
Receivables are classified as overdue from the first day of exceeding the contractually agreed payment term.
2
In case of objective evidence of a detrimental impact on the estimated future cash flows of a financial asset, the asset is considered to be credit impaired. This is generally the case after more than 360 days overdue, at the latest.
17. INVENTORIES The companies of the Fresenius Group are obliged to pur-
As of December 31, inventories consisted of the following: chase approximately €1,352 million of raw materials and
purchased components under fixed terms, of which €689
€ in millions 2021 2020 million was committed at December 31, 2021 for 2022.
Raw materials and purchased components 971 913
The terms of these agreements run 1 to 10 years.
Work in process 440 363
Finished goods 2,961 2,796
less reserves 154 127
Inventories, net 4,218 3,945
In 2021 and in 2020, immaterial reversals of writedowns of
inventory were made.
Annual Report 2021
Fresenius
315
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
18. OTHER CURRENT AND NON-CURRENT ASSETS
As of December 31, other current and noncurrent assets were comprised of the following according to the categorization of the financial instruments:
2021 2020
€ in millions thereof short-term thereof short-term
At equity investments 804 --- 764 ---
Tax receivables 520 496 553 530
Contract assets 487 487 474 474
Advance payments 256 252 356 352
Prepaid expenses 124 85 87 61
Accounts receivable resulting from German hospital law 118 104 82 81
Prepaid rent and insurance 47 47 46 46
Other assets 657 487 594 436
Other non-financial assets, net 3,013 1,958 2,956 1,980
Compensation receivable resulting from German hospital law 992 987 516 512
Debt instruments 422 136 401 161
Equity investments 320 --- 393 ---
Leasing receivables 131 --- 109 ---
Deposits 120 48 96 39
Longterm loans 118 42 127 51
Receivable for supplier rebates 21 21 91 91
Derivative financial instruments 20 18 18 18
Other assets 416 77 360 91
Other financial assets, net 2,560 1,329 2,111 963
Other assets, net 5,573 3,287 5,067 2,943
Allowances 39 30 22 18
Other assets, gross 5,612 3,317 5,089 2,961
At equity investments mainly related to the equity method The accounts receivable resulting from German hospital The increase in compensation receivable in 2021 is mainly
investee of Fresenius Medical Care named Vifor Fresenius law contain approved but not yet received earmarked sub- due to delayed budget negotiations with providers.
Medical Care Renal Pharma Ltd. In 2021, income of €93 mil- sidies of the Fresenius Helios operations. The approval is Contract assets mainly related to longterm production
lion (2020: €94 million) resulting from this equity investment evidenced in a letter written by the granting authorities that contracts for which revenue is recognized over time. As
was included in other operating income in the consolidated Fresenius Helios has already received. The compensation of December 31, 2021, they included €1 million (2020:
Annual Report 2021
statement of income. receivable resulting from German hospital law mainly €0.1 million) of allowances for expected credit losses.
relates to income equalization claims for hospital services.
Fresenius
316
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
19. PROPERTY, PLANT AND EQUIPMENT
As of December 31, the acquisition and manufacturing costs as well as accumulated depreciation of property, plant and equipment consisted of the following:
ACQUISITION AND MANUFACTURING COSTS
Foreign
As of currency Changes in As of
€ in millions January 1, 2021 translation consolidation Additions Reclassifications Disposals December 31, 2021
Land 879 0 -10 14 25 3 905
Buildings and improvements 8,731 267 19 158 544 104 9,615
Machinery and equipment 10,058 320 25 670 364 418 11,019
Construction in progress 2,125 84 -4 905 -920 18 2,172
Property, plant and equipment 21,793 671 30 1,747 13 543 23,711
DEPRECIATION
Foreign
As of currency Changes in As of
€ in millions January 1, 2021 translation consolidation Additions Reclassifications Disposals December 31, 2021
Land 17 0 --- 4 1 1 21
Buildings and improvements 3,735 165 -2 462 20 69 4,311
Machinery and equipment 6,123 186 -1 891 -13 378 6,808
Construction in progress 6 0 --- 0 -1 3 2
Property, plant and equipment 9,881 351 -3 1,357 7 451 11,142
ACQUISITION AND MANUFACTURING COSTS
Foreign
As of currency Changes in As of
€ in millions January 1, 2020 translation consolidation Additions Reclassifications Disposals December 31, 2020
Land 848 -11 31 16 0 5 879
Buildings and improvements 8,336 -351 163 174 499 90 8,731
Machinery and equipment 9,593 -452 -7 813 384 273 10,058
Construction in progress 1,886 -91 12 1,137 -815 4 2,125
Property, plant and equipment 20,663 -905 199 2,140 68 372 21,793
Annual Report 2021
Fresenius
317
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
DEPRECIATION
Foreign
As of currency Changes in As of
€ in millions January 1, 2020 translation consolidation Additions Reclassifications Disposals December 31, 2020
Land 15 0 --- 1 1 --- 17
Buildings and improvements 3,562 -182 -8 426 -1 62 3,735
Machinery and equipment 5,774 -256 -28 854 15 236 6,123
Construction in progress 5 0 --- 1 0 0 6
Property, plant and equipment 9,356 -438 -36 1,282 15 298 9,881
CARRYING AMOUNTS
€ in millions December 31, 2021 December 31, 2020
Land 884 862
Buildings and improvements 5,304 4,996
Machinery and equipment 4,211 3,935
Construction in progress 2,170 2,119
Property, plant and equipment 12,569 11,912
Depreciation and impairments on property, plant and LEASING
equipment for the years 2021 and 2020 amounted to Machinery and equipment as of December 31, 2021 and
€1,357 million and €1,282 million, respectively. They are 2020 included medical devices which Fresenius Medical
allocated within cost of sales, selling expenses, general Care and Fresenius Kabi lease to hospitals, patients
and administrative expenses and research and develop- and physicians under operating leases in an amount of
ment expenses, depending upon the use of the asset. In €914 million and €884 million, respectively.
2021, depreciation and impairments on property, plant For information on the development of the rightofuse
and equipment included impairment losses of €37 million. assets, see note 31, Leases.
Annual Report 2021
Fresenius
318
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
20. GOODWILL AND OTHER INTANGIBLE ASSETS
As of December 31, the acquisition cost and accumulated amortization of intangible assets consisted of the following:
ACQUISITION COST
Foreign
As of currency Changes in As of
€ in millions January 1, 2021 translation consolidation Additions Reclassifications Disposals December 31, 2021
Goodwill 26,794 1,280 1,052 13 --- 1 29,138
Customer relationships 755 10 --- 0 --- --- 765
Tradenames with finite useful lives 690 2 0 --- 1 --- 693
Capitalized development costs 937 31 0 41 12 1 1,020
Patents, product and distribution rights 637 46 0 10 2 29 666
Software 1,355 38 6 237 -32 54 1,550
Technology 947 68 --- --- 0 --- 1,015
Tradenames with indefinite useful lives 224 18 35 --- --- --- 277
Noncompete agreements 315 25 6 --- --- 2 344
Management contracts 3 0 --- --- --- 0 3
Other 377 14 2 41 -17 21 396
Goodwill and other intangible assets 33,034 1,532 1,101 342 -34 108 35,867
AMORTIZATION
Foreign
As of currency Changes in As of
€ in millions January 1, 2021 translation consolidation Additions Reclassifications Disposals December 31, 2021
Goodwill 195 --- --- --- --- --- 195
Customer relationships 203 5 --- 39 --- --- 247
Tradenames with finite useful lives 168 1 --- 41 --- --- 210
Capitalized development costs 256 14 --- 43 --- 1 312
Patents, product and distribution rights 404 28 --- 27 0 1 458
Software 625 17 0 160 -63 52 687
Technology 357 25 --- 72 1 --- 455
Tradenames with indefinite useful lives --- --- --- 1 --- --- 1
Noncompete agreements 281 23 0 9 --- 2 311
Management contracts 1 0 --- 1 --- --- 2
Annual Report 2021
Other 209 7 0 21 -1 21 215
Goodwill and other intangible assets 2,699 120 0 414 -63 77 3,093
Fresenius
319
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
ACQUISITION COST
Foreign
As of currency Changes in As of
€ in millions January 1, 2020 translation consolidation Additions Reclassifications Disposals December 31, 2020
Goodwill 27,737 -1,491 537 11 --- 0 26,794
Customer relationships 765 -10 --- 2 -2 --- 755
Tradenames with finite useful lives 693 -3 --- --- --- --- 690
Capitalized development costs 923 -29 --- 65 -21 1 937
Patents, product and distribution rights 745 -52 --- 4 3 63 637
Software 1,109 -47 4 238 68 17 1,355
Technology 1,022 -75 0 --- 0 --- 947
Tradenames with indefinite useful lives 243 -19 0 0 --- --- 224
Noncompete agreements 337 -27 7 0 --- 2 315
Management contracts 3 0 --- --- 0 --- 3
Other 491 -21 7 34 -33 101 377
Goodwill and other intangible assets 34,068 -1,774 555 354 15 184 33,034
AMORTIZATION
Foreign
As of currency Changes in As of
€ in millions January 1, 2020 translation consolidation Additions Reclassifications Disposals December 31, 2020
Goodwill --- --- --- 195 --- --- 195
Customer relationships 167 -5 --- 43 -2 --- 203
Tradenames with finite useful lives 129 -2 --- 41 --- --- 168
Capitalized development costs 258 -15 --- 13 0 --- 256
Patents, product and distribution rights 470 -31 0 31 1 67 404
Software 528 -21 0 129 0 11 625
Technology 307 -23 --- 73 0 --- 357
Tradenames with indefinite useful lives --- --- --- --- --- --- ---
Noncompete agreements 296 -24 0 11 0 2 281
Management contracts --- 0 --- 1 --- --- 1
Other 307 -13 -1 17 0 101 209
Goodwill and other intangible assets 2,462 -134 -1 554 -1 181 2,699
Annual Report 2021
Fresenius
320
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
CARRYING AMOUNTS
€ in millions December 31, 2021 December 31, 2020
Goodwill 28,943 26,599
Customer relationships 518 552
Tradenames with finite useful lives 483 522
Capitalized development costs 708 681
Patents, product and distribution rights 208 233
Software 863 730
Technology 560 590
Tradenames with indefinite useful lives 276 224
Noncompete agreements 33 34
Management contracts 1 2
Other 181 168
Goodwill and other intangible assets 32,774 30,335
Amortization and impairments on intangible assets expenses and research and development expenses, depend- the cash generating unit (CGU) Fresenius Medical Care
amounted to €414 million and €554 million for the years ing upon the use of the asset. In 2020, amortization and Latin America. This was allocated within general and
2021 and 2020, respectively. It is allocated within cost impairments on intangible assets included €195 million administrative expenses.
of sales, selling expenses, general and administrative related to an impairment of goodwill and tradenames of
The split of intangible assets into amortizable and non-amortizable intangible assets is shown in the following tables:
AMORTIZABLE INTANGIBLE ASSETS
December 31, 2021 December 31, 2020
Acquisition Accumulated Carrying Acquisition Accumulated Carrying
€ in millions cost amortization amount cost amortization amount
Customer relationships 765 247 518 755 203 552
Tradenames 693 210 483 690 168 522
Capitalized development costs 1,020 312 708 937 256 681
Patents, product and distribution rights 666 458 208 637 404 233
Software 1,550 687 863 1,355 625 730
Technology 1,015 455 560 947 357 590
Annual Report 2021
Noncompete agreements 344 311 33 315 281 34
Other 396 215 181 377 209 168
Total 6,449 2,895 3,554 6,013 2,503 3,510
Fresenius
321
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Fresenius Medical Care capitalized development costs in development costs capitalized amounted to €647 million at writedowns on capitalized development expenses of
an amount of €58 million for the fiscal year 2021 (2020: December 31, 2021 (December 31, 2020: €646 million). The €5 million and impairments of €26 million (2020: rever-
€32 million). Capitalized development costs are amortized amortization is recorded on a straightline basis over a use- sals of writedowns on capitalized development expenses
on a straightline basis over a useful life of 7 years. The ful life of 5 to 20 years and amounted to €15 million for the of €7 million) (see note 7, Research and development
amortization expense for the fiscal year 2021 amounted to fiscal year 2021 (2020: €15 million). Furthermore, in 2021, expenses). These are included in the preceding amortiza-
€6 million (2020: €5 million). In the case of Fresenius Kabi, research and development expenses included reversals of tion tables in the columns additions.
NON-AMORTIZABLE INTANGIBLE ASSETS
December 31, 2021 December 31, 2020
Acquisition Accumulated Carrying Acquisition Accumulated Carrying
€ in millions cost amortization amount cost amortization amount
Goodwill 29,138 195 28,943 26,794 195 26,599
Tradenames 277 1 276 224 --- 224
Management contracts 3 2 1 3 1 2
Total 29,418 198 29,220 27,021 196 26,825
The carrying amount of goodwill has developed as follows:
Fresenius Fresenius Fresenius Fresenius Fresenius
€ in millions Medical Care Kabi Helios Vamed Corporate Group
Carrying amount as of January 1, 2020 14,017 5,431 7,988 295 6 27,737
Additions 254 --- 290 4 --- 548
Disposals --- 0 --- 0 --- 0
Impairment loss -195 --- --- --- --- -195
Foreign currency translation -1,117 -373 --- -1 --- -1,491
Carrying amount as of December 31, 2020 12,959 5,058 8,278 298 6 26,599
Additions 444 --- 621 0 --- 1,065
Disposals --- -1 0 --- --- -1
Foreign currency translation 958 316 4 2 --- 1,280
Carrying amount as of December 31, 2021 14,361 5,373 8,903 300 6 28,943
The increase of goodwill mainly relates to foreign currency As of December 31, 2021, the carrying amounts of the
translation and acquisitions (see note 2, Acquisitions, divesti- other nonamortizable intangible assets were €226 million
Annual Report 2021
tures and investments). (2020: €210 million) for Fresenius Medical Care, €15 mil-
lion (2020: €16 million) for Fresenius Kabi and €36 million
(2020: €0 million) for Fresenius Helios.
Fresenius
322
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
21. PROVISIONS
As of December 31, provisions consisted of the following:
2021 2020
thereof thereof
€ in millions short-term short-term
Selfinsurance programs 427 306 371 264
Personnel expenses 384 288 283 165
Warranties and complaints 240 236 246 244
Litigation and other legal risks 72 50 141 123
Interest payable related to income taxes 53 --- 73 ---
Other provisions 482 269 455 276
Provisions 1,658 1,149 1,569 1,072
The following table shows the development of provisions in the fiscal year:
Foreign
As of currency Changes in As of
€ in millions January 1, 2021 translation consolidation Additions Reclassifications Utilized Reversed December 31, 2021
Selfinsurance programs 371 18 --- 71 --- -7 -26 427
Personnel expenses 283 8 11 206 0 -102 -22 384
Warranties and complaints 246 1 6 122 --- -120 -15 240
Litigation and other legal risks 141 -1 0 23 0 -55 -36 72
Interest payable related to income taxes 73 0 --- 2 --- -1 -21 53
Other provisions 455 2 11 186 0 -124 -48 482
Total 1,569 28 28 610 0 -409 -168 1,658
Provisions for personnel expenses mainly refer to share- For details regarding provisions for selfinsurance programs, For details regarding litigation and other legal risks, please
based and other compensation plans, severance payments please see note 1. III. x, Selfinsurance programs. see note 30, Commitments and contingencies.
and jubilee payments.
Annual Report 2021
Fresenius
323
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
22. OTHER LIABILITIES
As of December 31, other liabilities consisted of the following according to the categorization of the financial instruments:
2021 2020
thereof thereof
€ in millions short-term short-term
Personnel liabilities1 1,608 1,478 1,571 1,379
Contract liabilities 534 504 962 648
Tax liabilities 335 314 295 276
Accounts payable resulting from German hospital law 179 178 152 152
Deferred income 170 142 116 85
All other liabilities 1,193 975 984 799
Other non-financial liabilities1 4,019 3,591 4,080 3,339
Invoices outstanding 1,066 1,066 1,011 1,011
Put option liabilities 1,044 685 901 646
Debtors with credit balances 676 676 526 526
Accrued contingent payments outstanding for acquisitions 528 41 581 56
Bonuses and discounts 296 296 277 277
Interest liabilities 145 145 168 168
Compensation payable resulting from German hospital law 133 132 68 68
Legal matters, advisory and audit fees 56 56 46 46
Derivative financial instruments 47 47 88 88
Commissions 31 31 33 33
All other liabilities 4 0 3 0
Other financial liabilities1 4,026 3,175 3,702 2,919
Other liabilities 8,045 6,766 7,782 6,258
1
€1,377 million were reclassified from other financial liabilities to other non-financial liabilities as of December 31, 2020.
Personnel liabilities mainly include liabilities for wages and technical instructions whereas a receivable is recognized Fresenius Group would be required to purchase all or
salaries and social security liabilities. once the machine is delivered or billed to the customer. part of thirdparty owners’ noncontrolling interests at the
Contract liabilities primarily relate to advance payments The accounts payable resulting from German hospital appraised fair value at the time of exercise.
for Fresenius Medical Care under the CMS Accelerated and law contain earmarked subsidies received but not yet spent The accrued contingent payments outstanding for acqui-
Advance Payment program which are recorded as contract appropriately by Fresenius Helios. The amount not yet spent sitions include €441 million at December 31, 2021 (2020:
liability upon receipt and recognized as revenue when the appropriately is classified as liability. €486 million) for the acquisition of the biosimilars business.
Annual Report 2021
respective services are provided. Furthermore, contract The Fresenius Group, as option writer of existing put
liabilities relate to advance payments from customers and options, has potential obligations to purchase noncontrol-
to sales of dialysis machines. In these cases, revenue is rec- ling interests held by third parties in certain of its consoli-
ognized upon installation and provision of the necessary dated subsidiaries. If these put options were exercised, the
Fresenius
324
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
23. DEBT
SHORT-TERM DEBT
As of December 31, short-term debt consisted of the following:
Book value
€ in millions 2021 2020
Fresenius SE & Co. KGaA Commercial Paper 1,056 30
Fresenius Medical Care AG & Co. KGaA Commercial Paper 715 20
Other short-term debt 1,070 195
Short-term debt 2,841 245
Other short-term debt mainly consists of borrowings by borrowings at December 31, 2021 and 2020 were 1.29%
certain entities of the Fresenius Group under lines of credit and 2.25%, respectively.
with commercial banks. The average interest rates on the
LONG-TERM DEBT
As of December 31, long-term debt net of debt issuance costs consisted of the following:
Book value
€ in millions 2021 2020
Fresenius Medical Care Credit Agreement --- 1,162
Fresenius Credit Agreement --- 1,793
Schuldschein Loans 1,757 1,793
Other 843 406
Subtotal 2,600 5,154
less current portion 473 1,132
Long-term debt, less current portion 2,127 4,022
Annual Report 2021
Fresenius
325
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Fresenius Medical Care Syndicated Credit Facility facility. Based on this structure, the credit facility’s margin
On July 1, 2021, Fresenius Medical Care AG & Co. KGaA may rise or fall depending on the company's sustainability
(FMC-AG & Co. KGaA) entered into a new syndicated revolv- performance. The new credit facility replaces the US$900
ing credit facility of €2,000 million with a group of 34 core million and €600 million revolving credit facilities (Fresenius
relationship banks (FMC Syndicated Credit Facility). It has a Medical Care Credit Agreement), initially signed in 2012
term of five years plus two one-year extension options and and amended from time to time. As of December 31, 2021
can be drawn in different currencies. In addition, a sustain- the FMC Syndicated Credit Facility was undrawn and serves
ability component has been embedded in the new credit as backup line for the company.
The following table shows the available and outstanding amounts under the Fresenius Medical Care Credit Agreement at
December 31, 2020:
2020
Maximum amount available Balance outstanding
€ in millions € in millions
Revolving Credit Facility (in US$) 2017 / 2022 US$900 million 734 US$0 million ---
Revolving Credit Facility (in €) 2017 / 2022 €600 million 600 €0 million ---
Term Loan (in US$) 2017 / 2022 US$1,110 million 904 US$1,110 million 904
Term Loan (in €) 2017 / 2022 €259 million 259 €259 million 259
Total 2,497 1,163
less financing cost 1
Total 1,162
The U.S. dollar denominated loan and the euro denomi-
nated loan of the Fresenius Medical Care Credit Agree-
ment were prematurely redeemed at May 20, 2021.
Annual Report 2021
Fresenius
326
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Fresenius Syndicated Credit Facility component has been included in the credit facility. Corre-
On July 1, 2021, Fresenius SE & Co. KGaA entered into a spondingly, the credit facility’s margin can be adjusted
new syndicated revolving credit facility of €2,000 million up or down according to changes in Fresenius’ sustaina-
with a group of 29 core relationship banks (FSE Syndicated bility performance. The new credit facility replaces the
Credit Facility). It has a maturity of five years with two one- €1,100 million and US$500 million revolving credit facili-
year extension options and can be drawn in various curren- ties (Fresenius Credit Agreement), originally entered into in
cies. Emphasizing Fresenius’ commitment to embed sus- 2012 and amended from time to time. As of December 31,
tainability in all aspects of its business, a sustainability 2021, the FSE Syndicated Credit Facility was undrawn and
serves as backup line for the company.
The following table shows the available and outstanding amounts under the Fresenius Credit Agreement at
December 31, 2020:
2020
Maximum amount available Balance outstanding
€ in millions € in millions
Revolving Credit Facility (in €) 2017 / 2022 €1,100 million 1,100 €0 million ---
Revolving Credit Facility (in US$) 2017 / 2022 US$500 million 407 US$0 million ---
Term Loan (in €) 2017 / 2021 €750 million 750 €750 million 750
Term Loan (in €) 2017 / 2022 €675 million 675 €675 million 675
Term Loan (in US$) 2017 / 2022 US$455 million 371 US$455 million 371
Total 3,303 1,796
less financing cost 3
Total 1,793
The U.S. dollar denominated loan was prematurely The euro denominated loans were prematurely redeemed
redeemed at March 29, 2021 and refinanced through at April 1, 2021 through the issuance proceeds of bonds
bilateral loans with a maturity of up to three years. (see note 24, Bonds).
Annual Report 2021
Fresenius
327
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Schuldschein Loans
As of December 31, Schuldschein Loans of the Fresenius Group net of debt issuance costs consisted of the following:
Book value
€ in millions
Interest rate
Notional amount Maturity fixed / variable 2021 2020
Fresenius SE & Co. KGaA 2017 / 2022 €372 million Jan. 31, 2022 0.93% / variable 372 372
Fresenius SE & Co. KGaA 2015 / 2022 €21 million April 7, 2022 1.61% 21 21
Fresenius SE & Co. KGaA 2019 / 2023 €378 million Sept. 25, 2023 0.55% / variable 378 377
Fresenius SE & Co. KGaA 2017 / 2024 €421 million Jan. 31, 2024 1.40% / variable 421 420
Fresenius SE & Co. KGaA 2019 / 2026 €238 million Sept. 23, 2026 0.85% / variable 238 238
Fresenius SE & Co. KGaA 2017 / 2027 €207 million Jan. 29, 2027 1.96% / variable 206 207
Fresenius SE & Co. KGaA 2019 / 2029 €84 million Sept. 24, 2029 1.10% 84 84
Fresenius US Finance II, Inc. 2016 / 2021 US$33 million March 10, 2021 2.66% --- 27
Fresenius US Finance II, Inc. 2016 / 2023 US$43 million March 10, 2023 3.12% 37 47
Schuldschein Loans 1,757 1,793
The variable tranche of US$15.5 million of the Schuldschein Accounts Receivable Facility of above as part of the balance outstanding at December 31,
Loans of Fresenius US Finance II, Inc. in the amount of Fresenius Medical Care 2021, however, they reduce available borrowings under the
US$58 million which were originally due on March 10, On August 11, 2021, the asset securitization facility Accounts Receivable Facility.
2023, was prematurely redeemed at December 10, 2021. (Accounts Receivable Facility) of Fresenius Medical Care Under the Accounts Receivable Facility, certain receiv-
As of December 31, 2021, the Schuldschein Loans of was amended and restated, extending it until August 11, ables are contributed to NMC Funding Corp. (NMC Funding),
Fresenius SE & Co. KGaA in the amount of €372 million due 2024. The maximum capacity of US$900 million (€768 mil- a wholly owned subsidiary of Fresenius Medical Care. NMC
on January 31, 2022 and in the amount of €21 million due lion at August 11, 2021) remains unchanged under the Funding then assigns percentage ownership interests in
on April 7, 2022, are shown as current portion of long-term restated Accounts Receivable Facility. the accounts receivable to certain bank investors (and
debt in the consolidated statement of financial position. At December 31, 2021 and December 31, 2020, there their conduit affiliates). Under the terms of the Accounts
The Schuldschein Loans of Fresenius SE & Co. KGaA were no outstanding borrowings under the Accounts Receivable Facility, NMC Funding retains the rights in
issued before 2017 are guaranteed by Fresenius Kabi AG Receivable Facility. Fresenius Medical Care had letters of the underlying cash flows of the transferred receivables.
and Fresenius ProServe GmbH. The Schuldschein Loans of credit outstanding under the Accounts Receivable Facility Interest is remitted to the bank investors at the end of each
Fresenius US Finance II, Inc. are guaranteed by Fresenius in the amount of US$13 million (€11 million) at Decem- tranche period. If NMC Funding requires additional credit,
Annual Report 2021
SE & Co. KGaA, Fresenius Kabi AG and Fresenius ProServe ber 31, 2021 and US$13 million (€10 million) at Decem-
GmbH. ber 31, 2020. These letters of credit are not included
Fresenius
328
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
the principal cash flows are reinvested to purchase addi- CREDIT LINES AND OTHER SOURCES OF LIQUIDITY program was amended and the available borrowing capac-
tional interests in the receivables. Borrowings under the In addition to the financial liabilities described before, the ity increased from €1,000 million to €1,500 million. As of
Accounts Receivable Facility are expected to remain long- Fresenius Group maintains credit facilities which have not December 31, 2021, the commercial paper program of
term. NMC Funding retains significant risks and rewards in been utilized, or have only been utilized in part, as of the Fresenius SE & Co. KGaA was utilized in the amount of
the receivables, among other things, the percentage owner- reporting date. At December 31, 2021, the additional finan- €1,056 million.
ship interest assigned requires Fresenius Medical Care to cial headroom resulting from unutilized credit facilities Fresenius Medical Care can also issue shortterm notes
retain first loss risk in those receivables, and Fresenius was approximately €5.0 billion. Syndicated credit facilities under a commercial paper program. On October 15, 2021,
Medical Care can, at any time, recall all the then outstand- accounted for €4.0 billion of Fresenius Medical Care AG & the commercial paper program was amended and the avail-
ing transferred interests in the accounts receivable. Con- Co. KGaA (€2.0 billion) and Fresenius SE & Co. KGaA able borrowing capacity increased from €1,000 million to
sequently, the receivables remain on the consolidated (€2.0 billion). Furthermore, bilateral facilities with com- €1,500 million. As of December 31, 2021, the commercial
statement of financial position and the proceeds from the mercial banks of approximately €1.0 billion were available. paper program of Fresenius Medical Care AG & Co. KGaA
transfer of percentage ownership interests are recorded Moreover, a bilateral loan agreement with the European was utilized in the amount of €715 million.
as long-term debt. Investment Bank was concluded in December 2021 in the Additional financing of up to US$900 million (€795 mil-
NMC Funding pays interest to the bank investors, calcu- amount of €400 million, which was disbursed on January 31, lion) can be provided using the Fresenius Medical Care
lated based on the commercial paper rates for the particu- 2022 and will be available to Fresenius SE & Co. KGaA until Accounts Receivable Facility which had been utilized with
lar tranches selected. Refinancing fees, which include legal December 2025. US$13 million (€11 million) as of December 31, 2021.
costs and bank fees, are amortized over the term of the In addition, Fresenius SE & Co. KGaA has a commercial
facility. paper program under which shortterm notes can be
issued. On September 15, 2021, the commercial paper
Annual Report 2021
Fresenius
329
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
24. BONDS which enable the companies to issue bonds up to a total of the financing activities were mainly used for general cor-
Fresenius SE & Co. KGaA and Fresenius Medical Care volume of €12.5 billion and €10 billion, respectively, each porate purposes, including refinancing of existing financial
AG & Co. KGaA each maintain debt issuance programs in various currencies and maturities. In 2021, the proceeds liabilities.
As of December 31, bonds of the Fresenius Group net of debt issuance costs consisted of the following:
Book value € in millions
Notional amount Maturity Interest rate 2021 2020
Fresenius Finance Ireland PLC 2017 / 2022 €700 million Jan. 31, 2022 0.875% --- 699
Fresenius Finance Ireland PLC 2017 / 2024 €700 million Jan. 30, 2024 1.50% 699 698
Fresenius Finance Ireland PLC 2021 / 2025 €500 million Oct. 1, 2025 0.00% 497 ---
Fresenius Finance Ireland PLC 2017 / 2027 €700 million Feb. 1, 2027 2.125% 695 694
Fresenius Finance Ireland PLC 2021 / 2028 €500 million Oct. 1, 2028 0.50% 497 ---
Fresenius Finance Ireland PLC 2021 / 2031 €500 million Oct. 1, 2031 0.875% 494 ---
Fresenius Finance Ireland PLC 2017 / 2032 €500 million Jan. 30, 2032 3.00% 496 495
Fresenius SE & Co. KGaA 2014 / 2021 €450 million Feb. 1, 2021 3.00% --- 450
Fresenius SE & Co. KGaA 2014 / 2024 €450 million Feb. 1, 2024 4.00% 449 450
Fresenius SE & Co. KGaA 2019 / 2025 €500 million Feb. 15, 2025 1.875% 497 496
Fresenius SE & Co. KGaA 2020 / 2026 €500 million Sep. 28, 2026 0.375% 495 495
Fresenius SE & Co. KGaA 2020 / 2027 €750 million Oct. 8, 2027 1.625% 742 740
Fresenius SE & Co. KGaA 2020 / 2028 €750 million Jan. 15, 2028 0.75% 745 744
Fresenius SE & Co. KGaA 2019 / 2029 €500 million Feb. 15, 2029 2.875% 495 495
Fresenius SE & Co. KGaA 2020 / 2033 €500 million Jan. 28, 2033 1.125% 497 497
Fresenius US Finance II, Inc. 2014 / 2021 US$300 million Feb. 1, 2021 4.25% --- 244
Fresenius US Finance II, Inc. 2015 / 2023 US$300 million Jan. 15, 2023 4.50% 265 243
FMC Finance VII S.A. 2011 / 2021 €300 million Feb. 15, 2021 5.25% --- 299
Fresenius Medical Care AG & Co. KGaA 2019 / 2023 €650 million Nov. 29, 2023 0.25% 649 648
Fresenius Medical Care AG & Co. KGaA 2018 / 2025 €500 million July 11, 2025 1.50% 498 497
Fresenius Medical Care AG & Co. KGaA 2020 / 2026 €500 million May 29, 2026 1.00% 496 496
Fresenius Medical Care AG & Co. KGaA 2019 / 2026 €600 million Nov. 30, 2026 0.625% 595 594
Fresenius Medical Care AG & Co. KGaA 2019 / 2029 €500 million Nov. 29, 2029 1.25% 497 497
Fresenius Medical Care AG & Co. KGaA 2020 / 2030 €750 million May 29, 2030 1.50% 746 745
Fresenius Medical Care US Finance, Inc. 2011 / 2021 US$650 million Feb. 15, 2021 5.75% --- 529
Fresenius Medical Care US Finance II, Inc. 2012 / 2022 US$700 million Jan. 31, 2022 5.875% 618 570
Annual Report 2021
Fresenius Medical Care US Finance II, Inc. 2014 / 2024 US$400 million Oct. 15, 2024 4.75% 352 325
Fresenius Medical Care US Finance III, Inc. 2019 / 2029 US$500 million June 15, 2029 3.75% 434 400
Fresenius Medical Care US Finance III, Inc. 2020 / 2031 US$1,000 million Feb. 16, 2031 2.375% 875 807
Fresenius Medical Care US Finance III, Inc. 2021 / 2026 US$ 850 million Dec. 1, 2026 1.875% 744 ---
Fresenius Medical Care US Finance III, Inc. 2021 / 2031 US$ 650 million Dec. 1, 2031 3.00% 567 ---
Bonds 14,634 13,847
Fresenius
330
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
FRESENIUS SE & CO. KGAA The holders of Fresenius bonds have the right to request On September 16, 2020, Fresenius Medical Care US
On April 1, 2021, Fresenius Finance Ireland PLC issued that the issuers repurchase the bonds at 101% of principal Finance III, Inc. issued bonds with a volume of US$1,000
bonds with an aggregate volume of €1,500 million. The plus accrued interest upon the occurrence of a change of million. The bonds have a maturity of 10 years and 5 months.
bonds consist of three tranches with maturities of four and control followed by a decline in the rating of the respective On May 29, 2020, Fresenius Medical Care AG & Co. KGaA
a half, seven and a half and ten and a half years. bonds. issued bonds with an aggregate volume of €1,250 million.
On September 28, 2020, Fresenius SE & Co. KGaA issued Fresenius SE & Co. KGaA has agreed to a number of cov- The bonds consist of 2 tranches with maturities of 6 and
bonds with an aggregate volume of €1,000 million. The enants to provide protection to the holders of bonds issued 10 years.
bonds consist of 2 tranches with maturities of 6 years and before 2017, which partly restrict the scope of action of As of December 31, 2021, the bonds issued by Fresenius
12 years and 4 months. Fresenius SE & Co. KGaA and its subsidiaries (excluding Medical Care US Finance II, Inc. in the amount of US$700
On April 8, 2020, Fresenius SE & Co. KGaA issued bonds Fresenius Medical Care AG & Co. KGaA (FMC-AG & Co. million, which were due on January 31, 2022, are shown as
with a volume of €750 million. The bonds have a maturity KGaA) and its subsidiaries). These covenants include current portion of bonds in the consolidated statement of
of seven and a half years. restrictions on further debt that can be raised, the mortgag- financial position.
On January 15, 2020, Fresenius SE & Co. KGaA issued ing or sale of assets, the entering into sale and leaseback The bonds of Fresenius Medical Care US Finance II, Inc.
bonds in the amount of €750 million. The bonds have a transactions as well as mergers and consolidations with and Fresenius Medical Care US Finance III, Inc. (wholly
maturity of eight years. other companies. Some of these restrictions were suspended owned subsidiaries of FMCAG & Co. KGaA) are guaranteed
The bonds issued by Fresenius Finance Ireland PLC automatically as the rating of the respective bonds reached jointly and severally by FMCAG & Co. KGaA and Fresenius
in the amount of €700 million, which were originally due investment grade status. As of December 31, 2021, the Medical Care Holdings, Inc. As for all outstanding U.S. dol-
on January 31, 2022, were redeemed prior to maturity on Fresenius Group was in compliance with all of its covenants. lar bonds, the issuers may redeem the respective bonds at
November 15, 2021. any time at 100% of principal plus accrued interest and a
All bonds of Fresenius US Finance II, Inc. and of FRESENIUS MEDICAL CARE AG & CO. KGAA premium calculated pursuant to the terms of the indentures.
Fresenius Finance Ireland PLC are guaranteed by On May 18, 2021, Fresenius Medical Care US Finance III, The holders of Fresenius Medical Care bonds have the
Fresenius SE & Co. KGaA. All bonds issued before 2019, Inc. issued bonds with an aggregate volume of US$1,500 right to request that the respective issuers repurchase the
may be redeemed prior to their maturity at the option of million. The bonds consist of two tranches with maturities respective bonds at 101% of principal plus accrued interest
the issuers at a price of 100% plus accrued interest and a of five years and seven months and ten years and seven upon the occurrence of a change of control of FMCAG & Co.
premium calculated pursuant to the terms of the indentures months. KGaA followed by a decline in the rating of the respective
under observance of certain notice periods. bonds.
Annual Report 2021
Fresenius
331
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
FMCAG & Co. KGaA has agreed to a number of covenants covenants include restrictions on further debt that can be were suspended automatically as the rating of the respec-
to provide protection to the holders of bonds issued before raised, the mortgaging or sale of assets, the entering into tive bonds reached investment grade status. As of Decem-
2018 which, under certain circumstances, restrict the scope sale and leaseback transactions as well as mergers and con- ber 31, 2021, FMCAG & Co. KGaA and its subsidiaries were
of action of FMCAG & Co. KGaA and its subsidiaries. These solidations with other companies. Some of these restrictions in compliance with all of their covenants under the bonds.
25. CONVERTIBLE BONDS
As of December 31, the convertible bonds of the Fresenius Group net of debt issuance costs consisted of the following:
Book value
€ in millions
Current
Notional amount Maturity Coupon conversion price 2021 2020
Fresenius SE & Co. KGaA 2017 / 2024 €500 million Jan. 31, 2024 0.000% €105.2603 482 474
Convertible bonds 482 474
The fair value of the derivative embedded in the convertible 26. PENSIONS AND SIMILAR OBLIGATIONS plans. In general, plan benefits in defined benefit plans are
bonds of Fresenius SE & Co. KGaA was €70 thousand and based on all or a portion of the employees’ years of services
€117 thousand at December 31, 2021 and December 31, GENERAL and final salary. Plan benefits in defined contribution plans
2020, respectively. Fresenius SE & Co. KGaA purchased The Fresenius Group recognizes pension costs and related are determined by the amount of contribution by the em-
stock options (call options) with a corresponding fair value pension liabilities for current and future benefits to quali- ployee and the employer, both of which may be limited by
to hedge future fair value fluctuations of this derivative. fied current and former employees of the Fresenius Group. legislation, and the returns earned on the investment of
Potential conversions are always cashsettled. Any Fresenius Group’s pension plans are structured in accord- those contributions. For the members of the Management
increase of Fresenius’ share price above the conversion ance with the differing legal, economic and fiscal circum- Board of Fresenius Management SE, both defined benefit
price would be offset by a corresponding value increase stances in each country. The Fresenius Group currently has plans as well as defined contribution plans exist. In their
of the call options. two types of plans, defined benefit and defined contribution basic features, these are similar to the obligations for the
employees.
Annual Report 2021
Fresenius
332
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Upon retirement under defined benefit plans, the Fresenius variations in the actuarial assumptions and by differences Under defined contribution plans, the Fresenius Group
Group is required to pay defined benefits to former employ- between the actual and the estimated projected benefit ob- pays defined contributions to an independent third party as
ees when the defined benefits become due. Defined benefit ligations and the return on plan assets for that year. A com- directed by the employee during the employee’s service life
plans may be funded or unfunded. The Fresenius Group pany’s pension liability is impacted by these actuarial gains which satisfies all obligations of the Fresenius Group to the
has funded defined benefit plans in particular in the United or losses. employee. The employee retains all rights to the contribu-
States, Norway, the United Kingdom, the Netherlands, Related to defined benefit plans, the Fresenius Group tions made by the employee and to the vested portion of
Switzerland and Austria. Unfunded defined benefit plans is exposed to certain risks. Besides general actuarial risks, the Fresenius Group paid contributions upon leaving the
are located in Germany and France. e.g. the longevity risk and the interest rate risk, the Fresenius Fresenius Group. The Fresenius Group has a main defined
Actuarial assumptions generally determine benefit obli- Group is exposed to market risk as well as to investment risk. contribution plan in the United States.
gations under defined benefit plans. The actuarial calcula- In the case of Fresenius Group’s funded plans, the
tions require the use of estimates. The main factors used in defined benefit obligation is offset against the fair value of DEFINED BENEFIT PENSION PLANS
the actuarial calculations affecting the level of the benefit plan assets (deficit or surplus). A pension liability is recog- At December 31, 2021, the defined benefit obligation
obligations are: assumptions on life expectancy, the discount nized in the consolidated statement of financial position if (DBO) of the Fresenius Group of €2,240 million (2020:
rate and future salary and benefit levels. Under Fresenius the defined benefit obligation exceeds the fair value of plan €2,086 million) included €583 million (2020: €522 million)
Group’s funded plans, assets are set aside to meet future assets. An asset is recognized and reported under other funded by plan assets and €1,657 million (2020: €1,564 mil-
payment obligations. An estimated return on the plan assets in the consolidated statement of financial position if lion) covered by pension liabilities. Furthermore, the pen-
assets is recognized as income in the respective period. the fair value of plan assets exceeds the defined benefit sion liability contains benefit obligations offered by other
Actuarial gains and losses are generated when there are obligation and if the Fresenius Group has a right of reim- subsidiaries of Fresenius Medical Care in an amount of
bursement against the fund or a right to reduce future pay- €46 million (2020: €44 million). The current portion of the
ments to the fund. pension liability in an amount of €28 million (2020: €26 mil-
lion) is recognized in the consolidated statement of
Annual Report 2021
Fresenius
333
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
financial position within shortterm provisions and other Fresenius Medical Care Holdings, Inc. (FMCH), a subsidi- the authority and discretion to manage the assets of the
shortterm liabilities. The noncurrent portion of €1,675 mil- ary of Fresenius Medical Care AG & Co. KGaA, has a defined fund and to approve and adopt certain plan amendments.
lion (2020: €1,582 million) is recorded as pension liability. benefit pension plan for its employees in the United States The board of directors of National Medical Care, Inc., a
The major part of pension liabilities relates to Germany. and supplemental executive retirement plans. During the subsidiary of Fresenius Medical Care, reserves the right to
At December 31, 2021, 85% of the pension liabilities were first quarter of 2002, FMCH curtailed these pension plans. approve or adopt all major plan amendments, such as ter-
recognized in Germany and 12% predominantly in the rest Under the curtailment amendment for substantially all mination, modification or termination of the future benefit
of Europe and North America. 48% of the beneficiaries were employees eligible to participate in the plan, benefits have accruals and plan mergers with other pension plans.
located in North America, 36% in Germany and the remain- been frozen as of the curtailment date and no additional Benefit plans offered by other subsidiaries of Fresenius
der throughout the rest of Europe and other continents. defined benefits for future services will be earned. FMCH Medical Care outside of the United States, Germany and
79% of the pension liabilities in an amount of has retained all employee benefit obligations as of the cur- France contain separate benefit obligations. The total pen-
€1,703 million relate to the ‘‘Versorgungsordnung der tailment date. Each year, FMCH contributes to the plan sion liability for these other plans was €46 million and
FreseniusUnternehmen’’ established in 2016 (Pension Plan covering United States employees at least the minimum €44 million at December 31, 2021 and 2020, respectively.
2016), which applied for most of the German entities of the amount required by the Employee Retirement Income The current pension liability of €4 million (2020: €4 mil-
Fresenius Group for entries up until December 31, 2019 Security Act of 1974, as amended. In 2021, there was no lion) is recognized as a current liability in the line item
except Fresenius Helios and Fresenius Vamed. For new minimum funding requirement for the defined benefit plan. shortterm provisions and other shortterm liabilities. The
entrants from January 1, 2020 onwards, a new defined con- FMCH voluntarily provided €1 million. Expected funding noncurrent pension liability of €42 million (2020: €40 mil-
tribution plan applies for these entities. The remaining pen- for 2022 is €1 million. lion) for these plans is recorded as pension liability in the
sion liabilities relate to individual plans from Fresenius Controlling and managing the administration of the plan consolidated statement of financial position.
Helios entities in Germany and nonGerman Group entities. in the United States was delegated by Fresenius Medical Fresenius Group’s benefit obligations relating to fully
Plan benefits are generally based on an employee’s Care to an administrative committee. This committee has or partly funded pension plans were €716 million. Bene-
years of service and final salary. Consistent with predomi- fit obligations relating to unfunded pension plans were
nant practice in Germany, the benefit obligations of the €1,524 million.
German entities of the Fresenius Group are unfunded.
The German Pension Plan 2016 does not have a separate
pension asset.
Annual Report 2021
Fresenius
334
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The following table shows the changes in benefit obliga- € in millions 2021 2020 the benefit obligations in any pension plan. Furthermore,
Fair value of plan assets at the beginning
tions, the changes in plan assets, the deficit or surplus of for the years 2021 and 2020, there were no effects from as-
of the year 522 626
the pension plans and the pension liability. Benefits paid Foreign currency translation 36 -31 set ceiling.
as shown in the changes in benefit obligations represent Actual return (cost) on plan assets 31 44 The discount rates for all plans are based upon yields of
Interest income from plan assets 11 12
payments made from both the funded and unfunded plans portfolios of highly rated debt instruments with maturities
Actuarial gains (losses) arising from
while the benefits paid as shown in the changes in plan as- experience adjustments 20 32 that mirror the plan’s benefit obligation. Fresenius Group’s
sets include only benefit payments from Fresenius Group’s Contributions by the employer 14 21 discount rate is the weighted average of these plans based
Contributions by plan participants 5 4
funded benefit plans. upon their benefit obligations.
Transfer of plan participants 10 -102
The net pension liability has developed as follows: Benefits paid -35 -40 The following weighted average assumptions were uti-
Fair value of plan assets at the end lized in determining benefit obligations as of December 31:
€ in millions 2021 2020 of the year 583 522
Benefit obligations at the beginning Net funded position as of December 31 1,657 1,564
in % 2021 2020
of the year 2,086 2,132 Benefit plans offered by other subsidiaries 45 44
Discount rate 1.66 1.61
Changes in entities consolidated -2 5 Net pension liability as of December 31 1,702 1,608
Rate of compensation increase 2.80 2.79
Foreign currency translation 45 -40
Rate of pension increase 1.60 1.36
Service cost 85 89
As of December 31, 2021, pension liabilities in the amount
Past service cost 0 3
Settlements 0 0 of €41 million (December 31, 2020: €46 million) related Mainly changes in the discount factor, as well as inflation
Net interest cost 34 34 to the members of the Management Board of Fresenius and mortality assumptions used for the actuarial computa-
Contributions by plan participants 5 4 Management SE.
Transfer of plan participants 9 -101
tion resulted in actuarial losses in 2021 which increased the
Remeasurements 36 19
The plan assets are neither invested in the Fresenius fair value of the defined benefit obligation. Unrecognized
Actuarial losses (gains) arising from Group nor in related parties of the Fresenius Group. actuarial losses were €853 million (2020: €887 million).
changes in financial assumptions 46 15 As of December 31, 2021, the fair value of plan assets
Actuarial losses (gains) arising from
changes in demographic assumptions -4 1 relating to individual pension plans exceeded the corre-
Actuarial losses (gains) arising from sponding benefit obligations by €1 million. As of Decem-
experience adjustments -6 3
ber 31, 2020, the fair value of plan assets did not exceed
Benefits paid -58 -59
Benefit obligations at the end of the year 2,240 2,086
thereof vested 1,828 1,686
Annual Report 2021
Fresenius
335
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Sensitivity analysis and for pension increases excludes the U.S. pension plan, The following weighted average assumptions were used
Increases and decreases in principal actuarial assumptions because it is frozen and therefore is not affected by changes in determining net periodic benefit cost for the year ended
by 0.5 percentage points would affect the pension liability from these two actuarial assumptions. December 31:
as of December 31, 2021 as follows:
Further explanatory notes in % 2021 2020
0.5 pp 0.5 pp Discount rate 2.02 2.03
Development of pension liability € in millions increase decrease Defined benefit pension plans’ net periodic benefit costs
Rate of compensation increase 2.93 2.89
Discount rate -206 236 of €107 million (2020: €114 million) were comprised of the Rate of pension increase 1.54 1.71
Rate of compensation increase 36 -35 following components:
Rate of pension increase 126 -112
The following table shows the expected benefit payments
€ in millions 2021 2020
for the next 10 years:
The sensitivity analysis was calculated based on the aver- Service cost 84 92
age duration of the pension obligations determined at Net interest cost 23 22
Net periodic benefit cost 107 114 for the fiscal years € in millions
December 31, 2021. The calculations were performed iso- 2022 57
lated for each significant actuarial parameter, in order to 2023 59
Net periodic benefit cost is allocated as personnel expense 2024 63
show the effect on the fair value of the pension liability sep-
within cost of sales, selling expenses, general and adminis- 2025 66
arately. The sensitivity analysis for compensation increases
trative expenses as well as research and development 2026 70
2027 to 2031 399
expenses. The allocation depends upon the area in which
Total expected benefit payments 714
the beneficiary is employed.
At December 31, 2021 and at December 31, 2020, the
weighted average duration of the defined benefit obliga-
tion was 19 years.
Annual Report 2021
Fresenius
336
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The fair values of plan assets by categories were as follows:
December 31, 2021 December 31, 2020
Quoted prices in Quoted prices in
active markets Significant Significant active markets Significant Significant
for identical assets observable inputs unobservable inputs for identical assets observable inputs unobservable inputs
€ in millions Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 Total
Categories of plan assets
Equity investments 81 85 --- 166 64 79 --- 143
Index funds1 44 85 --- 129 35 79 --- 114
Other equity invest-
ments 37 --- --- 37 29 --- --- 29
Fixed income investments 103 220 8 331 109 192 7 308
Government securities2 21 0 --- 21 25 0 --- 25
Corporate bonds3 29 212 --- 241 28 183 --- 211
Other fixed income
investments4 53 8 8 69 56 9 7 72
Other5 74 12 --- 86 57 14 --- 71
Total 258 317 8 583 230 285 7 522
1
This category is mainly comprised of lowcost equity index funds not actively managed that track the S & P 500, S & P 400,
Russell 2000, the MSCI Emerging Markets Index and the Morgan Stanley International EAFE Index.
2
This category is primarily comprised of fixed income investments by the U.S. government and government sponsored entities.
3
This category primarily represents investment grade bonds of U.S. issuers from diverse industries.
4
This category is mainly comprised of private placement bonds as well as collateralized mortgage obligations as well as cash and
funds that invest in U.S. treasury obligations directly or in U.S. treasury backed obligations.
5
This category mainly represents cash, money market funds as well as mutual funds comprised of high grade corporate bonds.
The methods and inputs used to measure the fair value of Cash is stated at nominal value which equals the fair value. returns for each asset class weighted by the allocation of
plan assets are as follows: U.S. Treasury money market funds as well as other the assets. The range of returns developed relies both on
Index funds are valued based on market quotes. money market and mutual funds are valued at their market forecasts, which include the actuarial firm’s expected long-
Other equity investments are valued at their market prices. term rates of return for each significant asset class or eco-
prices as of the date of the statement of financial position. nomic indicator, and on broad-market historical benchmarks
Government bonds are valued based on both market Plan investment policy and strategy for expected return, correlation, and volatility for each asset
prices (Level 1) and market quotes (Level 2). in the United States class.
Corporate bonds and other bonds are valued based on The Fresenius Group periodically reviews the assumptions The overall investment strategy for the U.S. pension
market quotes as of the date of the statement of financial for long-term expected return on pension plan assets. As plan is to achieve a mix of approximately 99% of invest-
Annual Report 2021
position. part of the assumptions review, a range of reasonable ments for long-term growth and income and 1% in cash
expected investment returns for the pension plan as a whole or cash equivalents. Investment income and cash or cash
was determined based on an analysis of expected future equivalents are used for near-term benefit payments.
Fresenius
337
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Investments are governed by the plan investment policy DEFINED CONTRIBUTION PLANS future payment obligations, the calculation of a pension lia-
and include well diversified index funds or funds targeting Fresenius Group’s total expense under defined contribution bility in accordance with IAS 19 is not possible. Therefore,
index performance. plans for 2021 was €201 million (2020: €187 million). Of the obligation is accounted for as defined contribution plan
The plan investment policy, utilizing a revised target this amount, €111 million related to contributions by the in accordance with IAS 19.34a. The contributions are col-
investment allocation in a range around 26% equity and Fresenius Group to several public supplementary pension lected as part of a pay-as-you-go system and are based upon
74% fixed income investments, considers that there will be funds for employees of Fresenius Helios. This includes applying a fixed rate to given parts of the employees’ gross
a time horizon for invested funds of more than five years. €28 million for contributions related to financing the deficit remuneration.
The total portfolio will be measured against a custom index of past service costs. Further €68 million related to contribu- Paid contributions are accounted for as personnel
that reflects the asset class benchmarks and the target tions to the U.S. savings plan, which employees of Fresenius expenses within cost of sales, selling expenses as well as
asset allocation. The plan investment policy does not allow Medical Care Holdings, Inc. can join. general and administrative expenses and amounted to
investments in securities of Fresenius Medical Care AG & Co. In accordance with applicable collective bargaining €111 million in 2021 (2020: €100 million). Thereof, €64 mil-
KGaA or other related party securities. The performance agreements, the Fresenius Group pays contributions for lion (2020: €57 million) were payments to Rheinische
benchmarks for the separate asset classes include: S & P a given number of employees of Fresenius Helios to the Zusatzversorgungskasse, to Versorgungsanstalt des
500 Index, S & P 400 MidCap Index, Russell 2000 Index, Rheinische Zusatzversorgungskasse (a supplementary pen- Bundes und der Länder and to Zusatzversorgungskasse
MSCI EAFE Index, MSCI Emerging Markets Index, Barclays sion fund) and to other public supplementary pension funds Baden-Württemberg (2020: Zusatzversorgungskasse
Capital LongCorporate Bond Index, Bloomberg Barclays (together referred to as ZVK ÖD) to complement statutory Wiesbaden) (supplementary pension funds). The Group
U.S. Corporate High Yield Index, and Bloomberg Barclays retirement pensions. Given that employees from multiple expects to contribute in 2022 €118 million (including pay-
U.S. High Yield Fallen Angel 3% Capped Index. participating entities are insured by these ZVK ÖDs, these ments relating to past service costs).
The following schedule describes Fresenius Group’s plans are considered Multi-Employer plans. Under the U.S. savings plan, employees can deposit up
allocation for all of its funded plans. ZVK ÖDs are defined benefit plans according to IAS 19 to 75% of their pay up to an annual maximum of US$20,500
since employees are entitled to the statutory benefits regard- if under 50 years old (US$27,000 if 50 or over). Fresenius
Allocation Allocation Target
in % 2021 2020 allocation less of the amounts contributed. The plan assets of the fund Medical Care will match 50% of the employee deposit
Equity investments 28.37 27.45 26.91 necessary to evaluate and calculate the funded status of the up to a maximum company contribution of 3% of the
Fixed income investments 57.03 59.08 59.46 Group cannot be obtained from the supplementary pension employee’s pay. Fresenius Medical Care’s total expense
Other incl. real estate / fonds 14.60 13.47 13.63
funds and therefore due to the missing information about under this defined contribution plan for the years ended
Total 100.00 100.00 100.00
December 31, 2021 and 2020 was €68 million and €65 mil-
lion, respectively.
Contributions to plan assets for the fiscal year 2022 are
Annual Report 2021
expected to amount to €16 million.
Fresenius
338
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
27. NONCONTROLLING INTERESTS 28. FRESENIUS SE & CO. KGAA shareholders’ subscription right (e. g. to eliminate fractional
As of December 31, noncontrolling interests in the SHAREHOLDERS’ EQUITY amounts). For cash contributions, the authorization can only
Fresenius Group were as follows: be exercised if the issue price is not significantly below the
SUBSCRIBED CAPITAL stock exchange price of the already listed shares at the time
€ in millions 2021 2020 the issue price is fixed with final effect by the general part-
Noncontrolling interests
in Fresenius Medical Care AG & Co. KGaA 8,609 7,600
Development of subscribed capital ner. Furthermore, in case of a capital increase against cash
Noncontrolling interests As of January 1, 2021, the subscribed capital of Fresenius contributions, the proportionate amount of the shares issued
in VAMED Aktiengesellschaft 88 91 SE & Co. KGaA consisted of 557,540,909 bearer ordinary with exclusion of subscription rights may not exceed 10%
Noncontrolling interests
in the business segments shares. of the subscribed capital. An exclusion of subscription rights
Fresenius Medical Care 1,280 1,116 During the fiscal year 2021, 961,234 stock options were in the context of the use of other authorizations concerning
Fresenius Kabi 161 129 exercised. Consequently, as of December 31, 2021, the the issuance or the sale of the shares of Fresenius SE & Co.
Fresenius Helios 134 122
subscribed capital of Fresenius SE & Co. KGaA consisted of KGaA or the issuance of rights which authorize or bind to
Fresenius Vamed 18 16
Total noncontrolling interests 10,290 9,074 558,502,143 bearer ordinary shares. The shares are issued the subscription of shares of Fresenius SE & Co. KGaA has
as nonpar value shares. The proportionate amount of the to be taken into consideration during the duration of the
For further financial information relating to Fresenius subscribed capital is €1.00 per share. Authorized Capital until its utilization. In the case of a sub-
Medical Care see the consolidated segment reporting on scription in kind, the subscription right can be excluded
pages 285 to 286. AUTHORIZED CAPITAL only in order to acquire a company, parts of a company or
Noncontrolling interests changed as follows: Currently, Fresenius SE & Co. KGaA has a statutory Author- a participation in a company.
ized Capital in the nominal amount of €125,000,000. The authorizations granted concerning the exclusion of
€ in millions 2021 The general partner, Fresenius Management SE, is subscription rights can be used by Fresenius Management
Noncontrolling interests as of December 31, 2020 9,074 authorized, with the approval of the Supervisory Board, SE only to such extent that the proportional amount of the
Noncontrolling interests in profit 1,001
until May 17, 2023, to increase Fresenius SE & Co. KGaA’s total number of shares issued with exclusion of the subscrip-
Purchase of noncontrolling interests 98
Stock options 4 share capital (subscribed capital) by a total amount of up tion rights does not exceed 10% of the subscribed capital.
Dividend payments -577 to €125,000,000 through a single or multiple issues of new An exclusion of subscription rights in the context of the use
Currency effects and other changes 690 bearer ordinary shares against cash contributions and / or of other authorizations concerning the issuance or the sale
Noncontrolling interests as of December 31, 2021 10,290
contributions in kind (Authorized Capital I). of the shares of Fresenius SE & Co. KGaA or the issuance of
The number of shares must increase in the same pro- rights which authorize or bind to the subscription of shares
portion as the subscribed capital. A subscription right of Fresenius SE & Co. KGaA has to be taken into considera-
Annual Report 2021
must be granted to the shareholders in principle. In defined tion during the duration of the Authorized Capital until its
cases, the general partner is authorized, with the consent utilization.
of the Supervisory Board, to decide on the exclusion of the
Fresenius
339
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
CONDITIONAL CAPITAL compensation plans). Another Conditional Capital III exists
In order to fulfill the subscription right under the current for the authorization to issue option bearer bonds and / or
stock option plan 2013 of Fresenius SE & Co. KGaA, convertible bonds.
Conditional Capital IV exists (see note 36, Share-based The following table shows the development of the
Conditional Capital:
in € Ordinary shares
Conditional Capital I Fresenius AG Stock Option Plan 2003 (expired) 4,735,083
Conditional Capital II Fresenius SE Stock Option Plan 2008 (expired) 3,452,937
Conditional Capital III option bearer bonds and / or convertible bonds 48,971,202
Conditional Capital IV Fresenius SE & Co. KGaA Stock Option Plan 2013 23,786,091
Total Conditional Capital as of January 1, 2021 80,945,313
Fresenius SE & Co. KGaA Stock Option Plan 2013 --- options exercised -961,234
Total Conditional Capital as of December 31, 2021 79,984,079
As of December 31, 2021, the Conditional Capital was composed as follows:
in € Ordinary shares
Conditional Capital I Fresenius AG Stock Option Plan 2003 (expired) 4,735,083
Conditional Capital II Fresenius SE Stock Option Plan 2008 (expired) 3,452,937
Conditional Capital III option bearer bonds and / or convertible bonds 48,971,202
Conditional Capital IV Fresenius SE & Co. KGaA Stock Option Plan 2013 22,824,857
Total Conditional Capital as of December 31, 2021 79,984,079
CAPITAL RESERVES DIVIDENDS Thereby, the Else Kröner-Fresenius-Stiftung was paid the
Capital reserves are comprised of the premium paid on the Under the German Stock Corporation Act (AktG), the dividend which it is entitled as a shareholder in the ordi-
issue of shares and the exercise of stock options (additional amount of dividends available for distribution to share- nary share capital of Fresenius SE & Co. KGaA.
paid-in capital). holders is based upon the unconsolidated retained earn-
ings of Fresenius SE & Co. KGaA as reported in its state- TREASURY STOCK OF FRESENIUS MEDICAL CARE
OTHER RESERVES ment of financial position determined in accordance In 2020, Fresenius Medical Care repurchased 5,687,473 ordi-
Annual Report 2021
Other reserves are comprised of earnings generated by with the German Commercial Code (HGB). nary shares for an amount of €366 million.
Group entities in prior years to the extent that they have In May 2021, a dividend of €0.88 per bearer ordinary On April 1, 2020, Fresenius Medical Care concluded the
not been distributed. share was approved by Fresenius SE & Co. KGaA’s share- current share buy-back program.
holders at the Annual General Meeting and paid after-
wards. The total dividend payment was €491 million.
Fresenius
340
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
29. OTHER COMPREHENSIVE INCOME (LOSS) financial statements and the effects of measuring financial
Other comprehensive income (loss) is comprised of all instruments at their fair value as well as the change in
amounts recognized directly in equity (net of tax) resulting benefit obligation.
from the currency translation of foreign subsidiaries’
Changes in the components of other comprehensive income (loss) in 2021 and 2020 were as follows:
Amount Amount
€ in millions before taxes Tax effect after taxes
Positions which will be reclassified into net income in subsequent years
Cash flow hedges 5 -1 4
Change in unrealized gains / losses 8 -1 7
Realized gains / losses due to reclassifications -3 0 -3
FVOCI debt instruments 30 -5 25
Foreign currency translation -2,075 -5 -2,080
Positions which will not be reclassified into net income in subsequent years
FVOCI equity investments 4 -1 3
Equity method investees - share of OCI 58 0 58
Actuarial gains / losses on defined benefit pension plans 28 -7 21
Total changes 2020 -1,950 -19 -1,969
Positions which will be reclassified into net income in subsequent years
Cash flow hedges -6 2 -4
Change in unrealized gains / losses -22 5 -17
Realized gains / losses due to reclassifications 16 -3 13
FVOCI debt instruments -10 2 -8
Foreign currency translation 1,475 4 1,479
Positions which will not be reclassified into net income in subsequent years
FVOCI equity investments -28 8 -20
Equity method investees - share of OCI -23 0 -23
Actuarial gains / losses on defined benefit pension plans -15 8 -7
Total changes 2021 1,393 24 1,417
Annual Report 2021
Fresenius
341
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
OTHER NOTES that the Fresenius Group determines an unfavorable out- Justice (DOJ) about these investigations. The DOJ and
come is probable and the amount of loss can be reasonably the SEC also conducted their own investigations, in which
30. COMMITMENTS AND CONTINGENCIES estimated. For the other matters described below, the FMC-AG & Co. KGaA cooperated.
As of December 31, 2021, future investment commitments Fresenius Group believes that the loss is not probable In the course of this dialogue, FMC-AG & Co. KGaA
existed in respect to acquired hospitals, which are projected and / or the loss or range of possible losses cannot be identified and reported to the DOJ and the SEC, and took
to amount up to €70 million until 2024. No investment com- reasonably estimated at this time. remedial actions with respect to, conduct that resulted in
mitments relate to the year 2022. The outcome of litigation and other legal matters is the DOJ and the SEC seeking monetary penalties including
As of December 31, 2020, future investment commit- always difficult to predict accurately and outcomes that are disgorgement of profits and other remedies. This conduct
ments existed in respect to acquired hospitals, which are not consistent with Fresenius Group’s view of the merits revolved principally around FMC-AG & Co. KGaA's products
projected to amount up to €124 million until 2024. Thereof can occur. The Fresenius Group believes that it has valid business in countries outside the United States.
€66 million related to the year 2021. defenses to the legal matters pending against it and is On March 29, 2019, FMC-AG & Co. KGaA entered into
Besides the above-mentioned contingent liabilities, defending itself vigorously. Nevertheless, it is possible that a non-prosecution agreement (NPA) with the DOJ and a
the current estimated amount of Fresenius Group’s other the resolution of one or more of the legal matters currently separate agreement with the SEC (SEC Order) intended to
known individual contingent liabilities is immaterial. pending or threatened could have a material adverse effect resolve fully and finally the U.S. government allegations
on its business, results of operations and financial condition. against FMC-AG & Co. KGaA arising from the investigations.
LEGAL AND REGULATORY MATTERS Both agreements included terms starting August 2, 2019.
The Fresenius Group is routinely involved in claims, law- Internal review / FCPA Compliance The DOJ NPA and SEC Order are both scheduled to termi-
suits, regulatory and tax audits, investigations and other Beginning in 2012, Fresenius Medical Care AG & Co. KGaA nate on December 31, 2022. In 2019, FMC-AG & Co. KGaA
legal matters arising, for the most part, in the ordinary (FMC-AG & Co. KGaA) received certain communications paid a combined total in penalties and disgorgement of
course of its business of providing health care services and alleging conduct in countries outside the United States that approximately US$232 million (€206 million) to the DOJ
products. Legal matters that the Fresenius Group currently might violate the Foreign Corrupt Practices Act or other and the SEC in connection with these agreements. The
deems to be material or noteworthy are described below. anti-bribery laws. FMC-AG & Co. KGaA conducted investi- entire amount paid to the DOJ and the SEC was reserved
The Fresenius Group records its litigation reserves for cer- gations with the assistance of outside counsel and, in a for in charges that FMC-AG & Co. KGaA recorded in 2017
tain legal proceedings and regulatory matters to the extent continuing dialogue, advised the Securities and Exchange and 2018 and announced in 2018. As part of the resolution,
Commission (SEC) and the United States Department of FMC-AG & Co. KGaA agreed to certain self-reporting obliga-
tions and to retain an independent compliance monitor.
Annual Report 2021
Fresenius
342
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Due in part to COVID-19 pandemic restrictions, the moni- personal injury litigation and funded US$220 million (€179 physicians involving contracts relating to the management
torship program faced certain delays, but FMC-AG & Co. million) of the settlement fund under a reciprocal reserva- of in-patient acute dialysis services. On August 27, 2020,
KGaA is working to complete all its obligations under the tion of rights. FMCH accrued a net expense of US$60 mil- after the USAO declined to pursue the matter by interven-
resolution with the DOJ and SEC in 2022. lion (€49 million) in connection with the settlement, includ- ing, the United States District Court for Maryland unsealed
In 2015, FMC-AG & Co. KGaA self-reported to the Ger- ing legal fees and other anticipated costs. Following the a 2014 relator’s qui tam complaint that gave rise to the inves-
man prosecutor conduct with a potential nexus to Germany settlement, FMCH's insurers in the AIG group initiated liti- tigation. The relator thereafter served the complaint and
and continues to cooperate with government authorities gation against FMCH seeking to be indemnified by FMCH proceeded on his own in part by filing an amended com-
in Germany in their review of the conduct that prompted for their US$220 million (€179 million) outlay and FMCH plaint making broad allegations about financial relation-
FMC-AG & Co. KGaA's and United States government initiated litigation against the AIG group to recover defense ships between FMCH and nephrologists. FMCH’s motion
investigations. and indemnification costs FMCH had borne. National Union to dismiss the amended complaint remains pending. On
Since 2012, FMC-AG & Co. KGaA has made and contin- Fire Insurance v. Fresenius Medical Care, 2016 Index October 5, 2021, the District Court for Maryland granted
ues to make further significant investments in its compli- No. 653108 (Supreme Court of New York for New York FMCH’s motion to transfer the case to the United States
ance and financial controls and in its compliance, legal County). District Court for Massachusetts, where the litigation
and financial organizations. FMC-AG & Co. KGaA's remedial Discovery in the litigation is complete. The AIG group continues. Flanagan v. Fresenius Medical Care Holdings,
actions included separation from those employees respon- abandoned certain of its coverage claims and submitted Inc., 1:21-cv-11627.
sible for the above-mentioned conduct. FMC-AG & Co. KGaA expert reports on damages asserting that, if AIG prevails
is dealing with post-U.S. Foreign Corrupt Practices Act on all its remaining claims, it should recover US$60 mil- Civil complaint ‘‘Hawaii’’
(FCPA) review matters on various levels. FMC-AG & Co. lion (€49 million). FMCH contests all of AIG’s claims and In July 2015, the Attorney General for Hawaii issued a
KGaA continues to be fully committed to compliance with submitted expert reports supporting rights to recover civil complaint under the Hawaii False Claims Act alleging
the FCPA and other applicable anti-bribery laws. US$108 million (€88 million) from AIG, in addition to the a conspiracy pursuant to which certain Liberty Dialysis
US$220 million (€179 million) already funded. A trial date subsidiaries of Fresenius Medical Care Holdings, Inc.
Product liability litigation has not been set in the matter. (FMCH) overbilled Hawaii Medicaid for Liberty's Epogen®
Personal injury and related litigation involving Fresenius administrations to Hawaii Medicaid patients during the
Medical Care Holding Inc.’s (FMCH) acid concentrate prod- Subpoena ‘‘Maryland’’ period from 2006 through 2010, prior to the time of FMCH's
uct, labeled as Granuflo® or Naturalyte®, first arose in In August 2014, Fresenius Medical Care Holdings, Inc. acquisition of Liberty. Hawaii v. Liberty Dialysis - Hawaii,
2012. FMCH’s insurers agreed to the settlement in 2017 of (FMCH) received a subpoena from the United States Attor- LLC et al., Case No. 15-1-1357-07 (Hawaii 1st Circuit). The
ney’s Office (USAO) for the District of Maryland inquiring State alleges that Liberty acted unlawfully by relying on
into FMCH's contractual arrangements with hospitals and incorrect and unauthorized billing guidance provided to
Annual Report 2021
Liberty by Xerox State Healthcare LLC, which acted as
Fresenius
343
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Hawaii's contracted administrator for its Medicaid program USAO investigation, which has come to focus on purchases Care for a period beginning after FMCH's acquisition of
reimbursement operations during the relevant period. and sales of minority interests in ongoing outpatient facili- American Access Care LLC (AAC) in October 2011. FMCH
With discovery concluded, the State has specified that its ties between FMCH and physician groups. is cooperating in the Brooklyn USAO investigation. The
demands for relief relate to US$7.7 million (€6.3 million) in On November 25, 2015, FMCH received a subpoena Brooklyn USAO has indicated that its investigation is
overpayments on approximately twenty thousand ‘‘claims’’ under the False Claims Act from the United States Attorney nationwide in scope and is focused on whether certain
submitted by Liberty. After prevailing on motions by Xerox for the Eastern District of New York (Brooklyn) also inquir- access procedures performed at Azura facilities were
to preclude it from doing so, FMCH is pursuing third-party ing into FMCH's involvement in certain dialysis facility joint medically unnecessary and whether certain physician assis-
claims for contribution and indemnification against Xerox. ventures in New York. On September 26, 2018, the Brook- tants employed by Azura exceeded their permissible scope
The State's False Claims Act complaint was filed after lyn USAO declined to intervene on the qui tam complaint of practice. Allegations against AAC arising in districts in
Liberty initiated an administrative action challenging the filed under seal in 2014 that gave rise to this investigation. Connecticut, Florida and Rhode Island relating to utilization
State's recoupment of alleged overpayments from sums CKD Project LLC v. Fresenius Medical Care, 2014 Civ. 06646 and invoicing were settled in 2015.
currently owed to Liberty. The civil litigation and adminis- (E.D.N.Y. November 12, 2014). The District Court unsealed
trative action are proceeding in parallel. Trial in the civil the complaint, allowing the relator to proceed on its own. Subpoena ‘‘New York’’ (Shiel)
litigation has been postponed because of COVID-19-related On August 3, 2021, the District Court granted FMCH’s mo- On November 18, 2016, Fresenius Medical Care Holdings,
administrative issues and has been rescheduled for August tion to dismiss the relator’s amended complaint, dismissed Inc. (FMCH) received a subpoena under the False Claims
2022. the case with prejudice and declined to allow further amend- Act from the United States Attorney for the Eastern District
ment. On August 27, 2021, the relator appealed to the of New York (Brooklyn) seeking documents and information
Subpoenas ‘‘Colorado and New York’’ United States Court of Appeals for the Second Circuit. relating to the operations of Shiel Medical Laboratory, Inc.
On August 31, 2015, Fresenius Medical Care Holdings, Inc. (Shiel), which FMCH acquired in October 2013. In the
(FMCH) received a subpoena under the False Claims Act Subpoena ‘‘Fresenius Vascular Care’’ (AAC) course of cooperating in the investigation and preparing to
from the United States Attorney for the District of Colorado Beginning October 6, 2015, the United States Attorney respond to the subpoena, FMCH identified falsifications
(Denver) inquiring into FMCH's participation in and man- for the Eastern District of New York (Brooklyn) has led an and misrepresentations in documents submitted by a Shiel
agement of dialysis facility joint ventures in which physi- investigation, through subpoenas issued under the False salesperson that relate to the integrity of certain invoices
cians are partners. FMCH has cooperated in the Denver Claims Act, of utilization and invoicing by Fresenius Medical submitted by Shiel for laboratory testing for patients in long-
Care Holdings, Inc.'s (FMCH) subsidiary Azura Vascular term care facilities. On February 21, 2017, FMCH termi-
nated the employee and notified the United States Attorney
of the termination and its circumstances. The terminated
employee's conduct is expected to result in demands for
Annual Report 2021
Fresenius
344
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
FMCH to refund overpayments and to pay related penalties subsidiaries under the False Claims Act concerning FMCH's legislation, and triggered a stay of FDA approval of the
under applicable laws, but the monetary value of such pay- retail pharmaceutical business. The subpoenas, and the ANDAs for 30 months (specifically, up to July 29, 2020 for
ment demands cannot yet be reasonably estimated. FMCH subsequent investigation in which FMCH cooperated, were Lupin’s ANDA; and August 6, 2020 for Teva’s ANDA. In re-
contends that, under the asset sale provisions of its 2013 apparently predicated on but were not limited to a com- sponse to another ANDA being filed for a generic Velphoro®,
Shiel acquisition, it is not responsible for misconduct by plaint filed on November 6, 2015 by two former employees. VFMCRP filed a complaint for patent infringement against
the terminated employee or other Shiel employees prior to United States ex rel. Keasler et al. v. Fresenius Medical Annora Pharma Private Ltd., and Hetero Labs Ltd. (collec-
the date of the acquisition. The Brooklyn USAO continues Care Rx, LLC, 03:15-Civ-01183 (M.D. Tenn. 2015). On tively, Annora), in the U.S. District Court for the District of
to investigate a range of issues involving Shiel, including August 17, 2021, the District Court dismissed the case Delaware on December 17, 2018. The case was settled
allegations of improper compensation (kickbacks) to physi- without prejudice after the Nashville USAO declined to among the parties, thus terminating the court action on
cians, and has disclosed that multiple sealed qui tam com- intervene and the relators elected not to proceed. August 4, 2020. On May 26, 2020, VFMCRP filed a further
plaints underlie the investigation. complaint for patent infringement against Lupin in the U.S.
On December 12, 2017, FMCH sold to Quest Diagnostics Vifor patent infringement District Court for the District of Delaware (Case No. 1:20-
certain Shiel operations that are the subject of this Brook- Fresenius Medical Care (Delaware) cv-00697-MN) in response to Lupin’s ANDA for a generic
lyn subpoena, including the misconduct reported to the On March 12, 2018, Vifor Fresenius Medical Care Renal version of Velphoro® and on the basis of a newly listed
United States Attorney. Under the Quest Diagnostics sale Pharma Ltd. and Vifor Fresenius Medical Care Renal Pharma patent in the Orange Book. On July 6, 2020, VFMCRP filed
agreement, FMCH retains responsibility for responding to France S.A.S. (collectively, VFMCRP), filed a complaint for an additional complaint for patent infringement against
the Brooklyn investigation and for liabilities arising from patent infringement against Lupin Atlantis Holdings SA and Lupin and Teva in the U.S. District Court for the District of
conduct occurring after its 2013 acquisition of Shiel and Lupin Pharmaceuticals Inc. (collectively, Lupin), and Teva Delaware (Case No. 1:20-cv-00911-MN, second complaint)
prior to its sale of Shiel to Quest Diagnostics. FMCH is Pharmaceuticals USA, Inc. (Teva) in the U.S. District Court in response to the companies’ ANDA for generic versions
cooperating in the investigation. for the District of Delaware (Case 1:18-cv-00390-MN, first of Velphoro® and on the basis of two newly listed patents
complaint). The patent infringement action is in response in the Orange Book. All cases involving Lupin as defendant
Subpoena ‘‘American Kidney Fund’’ / to Lupin and Teva’s filings of Abbreviated New Drug Appli- were settled among the parties, thus terminating the corre-
CMS Litigation cations (ANDA) with the U.S. Food and Drug Administra- sponding court actions on December 18, 2020. In relation
In May 2017, the United States Attorney for the Middle Dis- tion (FDA) for generic versions of Velphoro®. Velphoro® to the remaining pending cases and the defendant Teva,
trict of Tennessee (Nashville) issued identical subpoenas to is protected by patents listed in the FDA’s Approved Drug trial took place for the first complaint between January 19
Fresenius Medical Care Holdings, Inc. (FMCH) and two Products with Therapeutic Equivalence Evaluations, also and 22, 2021. Another patent newly listed in the Orange
known as the Orange Book. The complaint was filed within Book was added to the second complaint on June 23, 2021.
the 45-day period provided for under the Hatch-Waxman Trial is scheduled for the second complaint for June 2022.
Annual Report 2021
Fresenius
345
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Subpoena ‘‘Colorado (Denver)’’ paid for dialysis treatments provided to Tricare benefi- Subpoena ‘‘Northern District of Texas (Dallas)’’
On December 17, 2018, Fresenius Medical Care Holdings, ciaries based on a recasting or ‘‘crosswalking’’ of codes On March 25, 2021, Fresenius Medical Care Holdings, Inc.
Inc. (FMCH) was served with a subpoena under the False used and followed in invoicing without objection for many (FMCH) received a grand jury subpoena issued from the
Claims Act from the United States Attorney for the District years. Tricare administrators have acknowledged the United States District Court for the Northern District of
of Colorado (Denver) as part of an investigation of allega- unpublished administrative action and declined to change Texas (Dallas). The subpoena sought documents compris-
tions against DaVita, Inc. involving transactions between or abandon it. On July 8, 2020, the U.S. government filed ing communications between employees of FMCH and
FMCH and DaVita. The subject transactions include sales its answer (and confirmed its position) and litigation is con- DaVita and partially overlaps in content the 2018 Denver
and purchases of dialysis facilities, dialysis-related products tinuing. The court has not yet set a date for trial in this mat- subpoena. The Dallas subpoena is part of a separate inves-
and pharmaceuticals, including dialysis machines and dia- ter. FMCH has imposed a constraint on revenue otherwise tigation by the Anti-Trust Division of the Department of
lyzers, and contracts for certain administrative services. recognized from the Tricare program that it believes, in con- Justice into possible employee ‘‘no poaching’’ and similar
FMCH cooperated in the investigation. sideration of facts currently known, sufficient to account for agreements to refrain from competition and is related to
the risk of this litigation. the indictments in United States v. Surgical Care Affiliates,
Litigation Tricare Program 3:2021-Cr-0011 (N.D. Tex.) and United States v. DaVita, Inc.
On June 28, 2019, certain Fresenius Medical Care Holdings, Subpoena ‘‘Massachusetts ChoiceOne et al., 1:21-cr00229 (D. Col.). The unnamed co-conspirators
Inc. (FMCH) subsidiaries filed a complaint against the and Medspring’’ described in the Surgical Care Affiliates and DaVita indict-
United States seeking to recover monies owed to them by On August 21, 2020, Fresenius Medical Care Holdings, Inc. ments do not include FMCH, Fresenius Medical Care AG &
the United States Department of Defense under the Tricare (FMCH) was served with a subpoena from the United Co. KGaA, or any of their employees. FMCH understands
program, and to preclude Tricare from recouping monies States Attorney for the District of Massachusetts request- that it has completed production of material sought under
previously paid. Bio-Medical Applications of Georgia, Inc., ing information and documents related to urgent care cen- the subpoena.
et al. v. United States, CA 19-947, United States Court of ters that FMCH owned, operated, or controlled as part of
Federal Claims. Tricare provides reimbursement for dialy- its ChoiceOne and Medspring urgent care operations prior Subpoena ‘‘Nevada’’
sis treatments and other medical care provided to members to its divestiture of and exit from that line of business in In November 2014, Fresenius Kabi Oncology Limited (FKOL)
of the military services, their dependents and retirees. The 2018. The subpoena appears to be related to an ongoing received a subpoena from the U.S. Department of Justice
litigation challenges unpublished administrative actions by investigation of alleged upcoding in the urgent care indus- (DOJ), U.S. Attorney for the District of Nevada. The sub-
Tricare administrators reducing the rate of compensation try, which has resulted in certain published settlements poena requested documents in connection with the Janu-
under the federal False Claims Act. FMCH is cooperating ary 2013 inspection by the U.S. Food and Drug Admin-
in the investigation. istration (FDA) of FKOL’s plant for active pharmaceutical
Annual Report 2021
Fresenius
346
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
ingredients in Kalyani, India. That inspection resulted in a provisions, Fresenius Kabi undertakes to make a payment and distribution of medical products, if such compliance is
warning letter from the FDA in July 2013. The subpoena of US$68.5 million to Lilly less the amount of €28 million not maintained, the Fresenius Group could be subject to
marked the DOJ’s criminal and / or civil investigation in this already paid during the proceedings in France. In parallel, significant adverse regulatory actions by the U.S. Food
connection and sought information from throughout the all court proceedings pending in Europe in relation to the and Drug Administration (FDA) and comparable regula-
Fresenius Kabi group. Fresenius Kabi fully cooperated with patent in dispute are discontinued by the parties, including tory authorities outside the United States. These regulatory
the governmental investigation. In January 2021, Fresenius the proceedings in France. As of June 30, 2021, Fresenius actions could include warning letters or other enforcement
Kabi has entered into a final agreement (Plea Agreement) Kabi has made all payments required under the settlement notices from the FDA, and / or comparable foreign regulatory
with the DOJ in which Fresenius Kabi undertakes to make a agreement. authority which may require the Fresenius Group to expend
penalty payment of US$50 million. The agreement includes significant time and resources in order to implement appro-
other measures to ensure that a misconduct of the nature General risks priate corrective actions. If the Fresenius Group does not
detected in 2013 will not occur again in the future. The final From time to time, the Fresenius Group is a party to or may address matters raised in warning letters or other enforce-
agreement has received court sentencing and was imple- be threatened with other litigation or arbitration, claims or ment notices to the satisfaction of the FDA and / or compa-
mented accordingly. The payment was made on the basis assessments arising in the ordinary course of its business. rable regulatory authorities outside the United States, these
of an existing accrual. Management regularly analyzes current information includ- regulatory authorities could take additional actions, includ-
ing, as applicable, the Fresenius Group’s defenses and ing product recalls, injunctions against the distribution of
Patent Dispute Fresenius Kabi France insurance coverage and, as necessary, provides accruals products or operation of manufacturing plants, civil penal-
Patent dispute between Fresenius Kabi and Eli Lilly in for probable liabilities for the eventual disposition of these ties, seizures of the Fresenius Group’s products and / or
France and other European countries regarding Eli Lilly’s matters. criminal prosecution. Fresenius Medical Care Holdings,
originator product Alimta® and Fresenius Kabi’s generic The Fresenius Group, like other health care providers, Inc. completed remediation efforts with respect to one
Pemetrexed sold in France and further countries in Europe. insurance plans and suppliers, conducts its operations pending FDA warning letter and is awaiting confirmation as
The Paris Tribunal has now rendered a decision in favor of under intense government regulation and scrutiny. The to whether the letter is now closed. Fresenius Kabi is cur-
Eli Lilly holding Fresenius Kabi France to infringe Eli Lilly’s Fresenius Group must comply with regulations which relate rently engaged in remediation efforts with respect to two
patent and to make a preliminary payment of €28 million to or govern the safety and efficacy of medical products pending FDA warning letters. The Fresenius Group must
for patent infringement and damages due to unfair compe- and supplies, the marketing and distribution of such prod- also comply with the laws of the United States, including
tition, including lost sales and price decrease. This amount ucts, the operation of manufacturing facilities, laboratories, the federal Anti-Kickback Statute, the federal False Claims
is covered by an existing higher accrual. In March 2021, hospitals, dialysis clinics and other health care facilities, Act, the federal Stark Law, the federal Civil Monetary Pen-
Fresenius Kabi and Eli Lilly have entered into a pan- and environmental and occupational health and safety. alties Law and the federal Foreign Corrupt Practices Act
European settlement pursuant to which, among other With respect to its development, manufacture, marketing as well as other federal and state fraud and abuse laws.
Annual Report 2021
Fresenius
347
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Applicable laws or regulations may be amended, or enforce- associates. On occasion, the Fresenius Group or its busi- for Economic and Clinical Health Act and the Foreign Cor-
ment agencies or courts may make interpretations that differ ness associates may experience a breach under the Health rupt Practices Act, among other laws and comparable state
from the Fresenius Group’s interpretations or the manner Insurance Portability and Accountability Act Privacy Rule laws or laws of other countries.
in which it conducts its business. Enforcement has become and Security Rules, the EU’s General Data Protection Regu- Physicians, hospitals and other participants in the health
a high priority for the federal government and some states. lation and / or other similar laws (Data Protection Laws) care industry are also subject to a large number of lawsuits
In addition, the provisions of the False Claims Act authoriz- when there has been impermissible use, access, or disclo- alleging professional negligence, malpractice, product lia-
ing payment of a portion of any recovery to the party bring- sure of unsecured personal data or when the Fresenius bility, worker’s compensation or related claims, many of
ing the suit encourage private plaintiffs to commence whis- Group or its business associates neglect to implement the which involve large claims and significant defense costs.
tleblower actions. By virtue of this regulatory environment, required administrative, technical and physical safeguards The Fresenius Group has been and is currently subject to
the Fresenius Group’s business activities and practices are of its electronic systems and devices, or a data breach that these suits due to the nature of its business and expects
subject to extensive review by regulatory authorities and results in impermissible use, access or disclosure of personal that those types of lawsuits may continue. Although the
private parties, and continuing audits, subpoenas, other identifying information of its employees, patients and bene- Fresenius Group maintains insurance at a level which it
inquiries, claims and litigation relating to the Fresenius ficiaries. On those occasions, the Fresenius Group must believes to be prudent, it cannot assure that the coverage
Group’s compliance with applicable laws and regulations. comply with applicable breach notification requirements. limits will be adequate or that insurance will cover all
The Fresenius Group may not always be aware that an The Fresenius Group relies upon its management struc- asserted claims. A successful claim against the Fresenius
inquiry or action has begun, particularly in the case of whis- ture, regulatory and legal resources, and the effective oper- Group or any of its subsidiaries in excess of insurance
tleblower actions, which are initially filed under court seal. ation of its compliance program to direct, manage and coverage could have a material adverse effect upon it and
The Fresenius Group operates many facilities and han- monitor the activities of its employees. On occasion, the the results of its operations. Any claims, regardless of their
dles the personal data of its patients and beneficiaries Fresenius Group may identify instances where employees merit or eventual outcome, could have a material adverse
throughout the United States and other parts of the world, or other agents deliberately, recklessly or inadvertently effect on the Fresenius Group’s reputation and business.
and engages with other business associates to help it carry contravene the Fresenius Group’s policies or violate appli- The Fresenius Group has also had claims asserted
out its health care activities. In such a widespread, global cable law. The actions of such persons may subject the against it and has had lawsuits filed against it relating to
system, it is often difficult to maintain the desired level of Fresenius Group and its subsidiaries to liability under the alleged patent infringements or businesses that it has
oversight and control over the thousands of individuals Anti-Kickback Statute, the Stark Law, the False Claims Act, acquired or divested. These claims and suits relate both
employed by many affiliated companies and its business Data Protection Laws, the Health Information Technology
Annual Report 2021
Fresenius
348
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
to operation of the businesses and to the acquisition and 31. LEASES LEASES IN THE CONSOLIDATED STATEMENT
divestiture transactions. The Fresenius Group has, when The Fresenius Group leases land, buildings and improve- OF INCOME
appropriate, asserted its own claims, and claims for indem- ments, machinery and equipment, as well as IT- and office The following table shows the effects from lease agreements
nification. A successful claim against the Fresenius Group equipment under various lease agreements. on the consolidated statements of income for 2021 and 2020:
or any of its subsidiaries could have a material adverse
effect upon its business, financial condition, and the results € in millions 2021 2020
Depreciation on right-of-use assets 878 877
of its operations. Any claims, regardless of their merit or
Impairments on right-of-use assets 18 2
eventual outcome, could have a material adverse effect on Expenses relating to short-term leases 64 67
the Fresenius Group’s reputation and business. Expenses relating to leases of low-value assets 46 46
Expenses relating to variable lease payments 22 22
Other expenses / income from lease agreements -6 -17
Interest expenses on lease liabilities 188 205
LEASES IN THE CONSOLIDATED STATEMENT OF FINANCIAL POSITION
At December 31, the acquisition costs and the accumulated depreciation of right-of-use assets consisted of the following:
ACQUISITION COSTS
Foreign
As of currency Changes in As of
€ in millions January 1, 2021 translation consolidation Additions Reclassifications Disposals December 31, 2021
Right-of-use assets: Land 121 1 0 13 0 7 128
Right-of-use assets: Buildings and improvements 6,663 373 117 807 -7 124 7,829
Right-of-use assets: Machinery and equipment 579 28 1 95 -53 47 603
Right-of-use assets: Advanced Payments --- --- --- --- --- --- ---
Right-of-use assets 7,363 402 118 915 -60 178 8,560
In the fiscal year 2021, reclassifications were mainly made to property, plant and equipment as the Fresenius Group purchased previously leased buildings and equipment from the
landlords.
Annual Report 2021
Fresenius
349
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
DEPRECIATION
Foreign
As of currency Changes in As of
€ in millions January 1, 2021 translation consolidation Additions Reclassifications Disposals December 31, 2021
Right-of-use assets: Land 18 0 0 9 0 2 25
Right-of-use assets: Buildings and improvements 1,376 100 -2 762 -6 68 2,162
Right-of-use assets: Machinery and equipment 278 15 0 125 -19 40 359
Right-of-use assets: Advanced Payments --- --- --- --- --- --- ---
Right-of-use assets 1,672 115 -2 896 -25 110 2,546
ACQUISITION COSTS
Foreign
As of currency Changes in As of
€ in millions January 1, 2020 translation consolidation Additions Reclassifications Disposals December 31, 2020
Right-of-use assets: Land 112 -3 0 15 0 3 121
Right-of-use assets: Buildings and improvements 6,204 -403 29 983 -31 119 6,663
Right-of-use assets: Machinery and equipment 587 -37 1 89 -40 21 579
Right-of-use assets: Advanced Payments 0 0 --- 0 0 0 ---
Right-of-use assets 6,903 -443 30 1,087 -71 143 7,363
In the fiscal year 2020, reclassifications were mainly made to property, plant and equipment as the Fresenius Group purchased previously leased buildings and equipment from the
landlords.
DEPRECIATION
Foreign
As of currency Changes in As of
€ in millions January 1, 2020 translation consolidation Additions Reclassifications Disposals December 31, 2020
Right-of-use assets: Land 9 0 0 9 0 0 18
Right-of-use assets: Buildings and improvements 765 -82 -6 726 3 30 1,376
Right-of-use assets: Machinery and equipment 170 -16 0 144 -4 16 278
Right-of-use assets: Advanced Payments --- --- --- --- --- --- ---
Right-of-use assets 944 -98 -6 879 -1 46 1,672
Annual Report 2021
Fresenius
350
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
CARRYING AMOUNTS
€ in millions December 31, 2021 December 31, 2020
Right-of-use assets: Land 103 103
Right-of-use assets: Buildings and improvements 5,667 5,287
Right-of-use assets: Machinery and equipment 244 301
Right-of-use assets: Advanced Payments --- ---
Right-of-use assets 6,014 5,691
Depreciation expense and impairments on right-of-use LEASES IN THE CONSOLIDATED STATEMENT Potential future cash outflows resulting from the exercise
assets amounted to €896 million for the year ended Decem- OF CASH FLOWS of options were not reflected in the measurement of the
ber 31, 2021 (2020: €879 million). These expenses are allo- Total cash outflows from leases were €1,194 million for the lease liabilities if the exercise of the respective option was
cated within costs of sales, selling, general and administra- year ended December 31, 2021 (2020: €1,212 million). not considered reasonably certain.
tive and research and development expenses depending In the consolidated statement of cash flows, the interest The major part of the potential future cash outflows
upon the area in which the asset is used. In 2021, depre- component of recognized leases is shown in net cash pro- resulting from extension options relates to extension
ciation expense and impairments on right-of-use assets vided by / used in operating activities, the amortization com- options in real estate lease agreements, primarily for dialy-
included impairment losses of €18 million. ponent is shown in net cash provided by / used in financing sis clinics of Fresenius Medical Care in North America.
As of December 31, 2021, lease liabilities comprised a activities. Individual lease agreements include multiple extension
current portion of €832 million (2020: €766 million) and a The following potential future cash outflows were not options. The Fresenius Group uses extension options to
non-current portion of €5,758 million (2020: €5,422 million). reflected in the measurement of the lease liabilities: obtain a high degree of flexibility in performing its business.
In 2021, approximately 71% of the lease liabilities related These extension options held are exercisable solely by the
to Fresenius Medical Care, approximately 17% to Fresenius € in millions 2021 2020 Fresenius Group.
Potential cash outflows from:
Helios, approximately 7% to Fresenius Vamed and approx-
extension options 7,646 6,781
imately 5% to Fresenius Kabi. purchase options 260 267
leases that the Fresenius Group
entered into as a lessee
that have not yet begun 202 243
residual value guarantees 101 89
variable lease payments 64 67
penalty payments from the
exercise of termination options 11 11
Annual Report 2021
Fresenius
351
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
32. FINANCIAL INSTRUMENTS
VALUATION OF FINANCIAL INSTRUMENTS
Carrying amounts of financial instruments
As of December 31, the carrying amounts of financial instruments by item of the statement of financial position and structured according to categories were as follows:
December 31, 2021
Relating to no category
Derivatives Valuation
designated according to
Fair value as cash flow Put option IFRS 16 for
Fair value through other hedging liabilities leasing
through profit comprehensive instruments measured receivables and
€ in millions Carrying amount Amortized cost and loss1 income2 at fair value at fair value liabilities
Financial assets
Cash and cash equivalents 2,764 1,936 828
Trade accounts and other receivables, less allowances for expected credit losses 7,045 6,822 108 34 81
Accounts receivable from and loans to related parties 147 147
Other financial assets3 2,560 1,667 342 412 8 131
Financial assets 12,516 10,572 1,278 446 8 --- 212
Financial liabilities
Trade accounts payable 2,039 2,039
Short-term accounts payable to related parties 92 92
Short-term debt 2,841 2,841
Short-term debt from related parties 8 8
Long-term debt 2,600 2,600
Lease liabilities 6,590 6,590
Bonds 14,634 14,634
Convertible bonds 482 482
Other financial liabilities4 4,026 2,407 557 18 1,044
Financial liabilities 33,312 25,103 557 --- 18 1,044 6,590
1
All included financial assets and liabilities are mandatorily measured at fair value through profit and loss according to IFRS 9.
2
The option to measure equity instruments at fair value through other comprehensive income has been exercised. The option has been used for €85 million other investments (included in other financial assets).
3
Other financial assets are included in the item other current and non-current assets in the consolidated statement of financial position.
Annual Report 2021
4
Other financial liabilities are included in the items short-term provisions and other short-term liabilities and long-term provisions and other long-term liabilities in the consolidated statement of financial position.
In the fiscal year 2021, reclassifications between the categories were immaterial.
Fresenius
352
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
December 31, 2020
Relating to no category
Derivatives Valuation
designated according to
Fair value as cash flow Put option IFRS 16 for
Fair value through other hedging liabilities leasing
through profit comprehensive instruments measured receivables and
€ in millions Carrying amount Amortized cost and loss1 income2 at fair value at fair value liabilities
Financial assets
Cash and cash equivalents 1,837 1,271 566
Trade accounts and other receivables, less allowances for expected credit losses 6,937 6,783 45 34 75
Accounts receivable from and loans to related parties 110 110
Other financial assets3 2,111 1,190 357 447 8 109
Financial assets 10,995 9,354 968 481 8 --- 184
Financial liabilities
Trade accounts payable 1,816 1,816
Short-term accounts payable to related parties 67 67
Short-term debt 245 245
Short-term debt from related parties 5 5
Long-term debt 5,154 5,154
Lease liabilities 6,188 6,188
Bonds 13,847 13,847
Convertible bonds 474 474
Other financial liabilities4,5 3,702 2,132 654 15 901
Financial liabilities 31,498 23,740 654 --- 15 901 6,188
1
All included financial assets and liabilities are mandatorily measured at fair value through profit and loss according to IFRS 9.
2
The option to measure equity instruments at fair value through other comprehensive income has been exercised. The option has been used for €149 million (included in other financial assets).
3
Other financial assets are included in the item other current and non-current assets in the consolidated statement of financial position.
4
Other financial liabilities are included in the items short-term provisions and other short-term liabilities and long-term provisions and other long-term liabilities in the consolidated statement of financial position.
5
€1,377 million were reclassified from other financial liabilities to other non-financial liabilities.
During the fiscal year 2020, no material reclassifications of financial instruments were required.
Annual Report 2021
Fresenius
353
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Fair value of financial instruments
The following table shows the carrying amounts and the fair value hierarchy levels as of December 31:
December 31, 2021 December 31, 2020
Fair value Fair value
Carrying Carrying
€ in millions amount Level 1 Level 2 Level 3 amount Level 1 Level 2 Level 3
Financial assets
Cash and cash equivalents1 828 828 566 566
Trade accounts and other receivables,
less allowances for expected credit losses1 142 142 79 79
Other financial assets1
Debt instruments 422 418 4 401 396 5
Equity investments 320 122 105 93 393 12 162 219
Derivatives designated as cash flow hedging instruments 8 8 8 8
Derivatives not designated as hedging instruments 12 12 10 10
Financial liabilities
Long-term debt 2,600 2,626 5,154 5,210
Bonds 14,634 15,201 13,847 14,847
Convertible bonds 482 499 474 490
Other financial liabilities1
Put option liabilities 1,044 1,044 901 901
Accrued contingent payments outstanding for acquisitions 528 528 581 581
Derivatives designated as cash flow hedging instruments 18 18 15 15
Derivatives not designated as hedging instruments 29 29 73 73
1
Fair value information is not provided for financial instruments, if the carrying amount is a reasonable estimate of the fair value due to the
relatively short period of maturity of these instruments.
The significant methods and assumptions used to estimate Cash and cash equivalents include short-term financial Trade accounts receivable from factoring contracts are
the fair values of financial instruments as well as classifica- investments that are measured at fair value through profit measured on the basis of observable market information
tion of fair value measurements according to the three-tier and loss. The fair value of these assets, which are quoted (Level 2).
fair value hierarchy are as follows: in an active market, is based on price quotations at the
date of the consolidated financial statements (Level 1).
Annual Report 2021
Fresenius
354
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The majority of debt instruments included in other financial During 2021, gains of €34 million (December 31, 2020: The fair values of major long-term financial instruments are
assets are bonds that are quoted in an active market and €0 million) were transferred from other comprehensive calculated on the basis of market information. Liabilities for
therefore measured at fair value (Level 1) which is based income (loss) to retained earnings as two investments were which market quotes are available are measured with the
on price quotations at the date of the consolidated finan- disposed of. Of this amount, €11 million was attributable to market quotes at the reporting date (Level 1). The fair values
cial statements. Further debt instruments give rise to cash the shareholders of Fresenius SE & Co. KGaA. In 2021, the of the other long-term financial liabilities are calculated at
flows on specified dates (Level 2). Fresenius Group recognized dividends of €2 million from the present value of respective future cash flows. To deter-
Equity investments are not held for trading. At initial these equity investments. mine these present values, the prevailing interest rates and
recognition, the Fresenius Group elected, on an instrument- The fair values of equity investments are based on ob- credit spreads for the Fresenius Group as of the date of the
by-instrument basis, to represent subsequent changes in servable market information (Level 2). From time to time statement of financial position are used (Level 2).
the fair value of individual strategic investments in other the Fresenius Group engages external valuation firms to The valuation of the put option liabilities is determined
comprehensive income (loss). All equity investments for determine the fair value of Level 3 equity investments. The using significant unobservable inputs (Level 3). From time
which changes in fair value are recorded in other compre- external valuation uses a discounted cash flow model, which to time, the Fresenius Group engages external valuation
hensive income (loss) relate to purchases of publicly traded includes significant unobservable inputs such as investment firms for these valuations. The method for calculating the
shares or percentage ownership of companies in the health specific forecasted financial statements, weighted average fair value is described in note 1.III.q, Financial instruments.
sciences or adjacent fields and are made up of individually cost of capital, that reflects current market assessments For the purpose of analyzing the impact of changes in un-
non-significant investments. At December 31, 2021, the as well as a terminal growth rate. The fair values of other observable inputs on the fair value measurement of put
Fresenius Group held 70 non-listed equity investments equity investments that are traded in an active market, are option liabilities, the Fresenius Group assumes an increase
(December 31, 2020: 85) with a fair value of €85 million based on price quotations at the date of the consolidated on earnings of 10% compared to the actual estimation as of
(December 31, 2020: €137 million) and no listed equity financial statements (Level 1). the balance sheet date. The corresponding increase in fair
investments. At December 31, 2020, the Fresenius Group
held one listed equity investment with a fair value of
€12 million.
Annual Report 2021
Fresenius
355
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
value is then compared to the total liabilities and the Fresenius Group. 95% of the put option liabilities related that determine the future contingent payment as well as the
shareholder’s equity of the Fresenius Group. This analysis to Fresenius Medical Care at December 31, 2021 (Decem- Fresenius Group’s expectation of these factors (Level 3).
shows that an increase of 10% in the relevant earnings ber 31, 2020: 98%). The Fresenius Group assesses the likelihood and timing of
would have an effect of less than 1% on the total liabili- Contingent payments outstanding for acquisitions are achieving the relevant objectives. The underlying assump-
ties and less than 1% on the shareholder’s equity of the recognized at their fair value. The estimation of the individ- tions are reviewed regularly.
ual fair values is based on the key inputs of the arrangement
The following table shows the changes of the fair values of financial instruments classified as Level 3 in the fiscal years 2021 and 2020:
Accrued contingent
payments outstanding Put option
€ in millions Equity investments for acquisitions liabilities
As of January 1, 2020 183 595 952
Transfer from Level 2 7 1 ---
Additions --- 26 51
Disposals --- -73 -99
Gain / loss recognized in profit or loss 46 35 0
Gain / loss recognized in equity --- --- 74
Currency effects and other changes -17 -3 -77
As of December 31, 2020 219 581 901
Transfer to Level 1 -159 --- ---
Additions 21 25 146
Disposals --- -27 -19
Gain / loss recognized in profit or loss -1 -52 0
Gain / loss recognized in equity --- 0 -57
Currency effects and other changes 13 1 73
As of December 31, 2021 93 528 1,044
At September 30, 2021, Fresenius Medical Care transferred Care as a result of this merger and in a contemporaneous interest rates applicable for the remaining term of the con-
its investment in Humacyte, Inc. (Humacyte) with a carry- private placement are quoted in an active market, and tract as of the date of the statement of financial position. To
ing amount of €159 million from Level 3 to Level 1, after Humacyte has registered shares held by Fresenius Medical determine the fair value of foreign exchange forward con-
Humacyte completed its merger with Alpha Healthcare Care for resale under the Securities Act of 1933. tracts, the contracted forward rate is compared to the cur-
Annual Report 2021
Acquisition Corporation, a special purpose acquisition com- Derivatives, mainly consisting of interest rate swaps and rent forward rate for the remaining term of the contract as
pany. The shares in Alpha Healthcare Acquisition Corpora- foreign exchange forward contracts, are valued as follows: of the date of the statement of financial position. The result
tion (now called Humacyte) received by Fresenius Medical The fair value of interest rate swaps is calculated by dis- is then discounted on the basis of the market interest rates
counting the future cash flows on the basis of the market prevailing at the date of the statement of financial position
for the respective currency.
Fresenius
356
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Fresenius Group’s own credit risk is incorporated in the fair calculation of the credit risk considered in the valuation is an adequate straight bond discounted with the market
value estimation of derivatives that are liabilities. Counter- done by multiplying the default probability appropriate for interest rates as of the reporting date. The fair value of
party credit risk adjustments are factored into the valuation the duration with the expected discounted cash flows of the the call options is calculated from price quotations.
of derivatives that are assets. The Fresenius Group moni- derivative financial instrument. For the calculation of the fair value of derivative finan-
tors and analyzes the credit risk from derivative financial Derivatives not designated as hedging instruments cial instruments, the Fresenius Group uses market quoted
instruments on a regular basis. For the valuation of deriva- comprise derivatives embedded in convertible bonds and input parameters. Therefore, these are classified as Level 2
tive financial instruments, the credit risk is considered in call options which have been purchased to hedge the con- in accordance with the defined fair value hierarchy levels.
the fair value of every individual instrument. The basis for vertible bonds. The fair value of the embedded derivatives Derivative financial instruments are marked to market
the default probability are Credit Default Swap Spreads is calculated using the difference between the market value each reporting period, resulting in carrying amounts equal
of each counterparty appropriate for the duration. The of the particular convertible bonds and the market value of to fair values at the reporting date.
FAIR VALUES OF DERIVATIVE FINANCIAL INSTRUMENTS
December 31, 2021 December 31, 2020
€ in millions Assets Liabilities Assets Liabilities
Foreign exchange contracts (current) 8 18 8 15
Foreign exchange contracts (non-current) 0 0 0 0
Derivatives in cash flow hedging relationships 8 18 8 15
Interest rate contracts (current) --- 0 --- ---
Interest rate contracts (non-current) --- --- --- 0
Foreign exchange contracts (current) 10 29 10 73
Foreign exchange contracts (non-current) 2 0 --- ---
Derivatives embedded in the convertible bonds --- 0 --- 0
Call options to secure the convertible bonds 0 --- 0 ---
Derivatives not designated as hedging instruments 12 29 10 73
Derivatives not designated as hedging instruments, which The current portion of derivatives indicated as assets in the are recognized in other non-current assets or in long-term
are derivatives that do not qualify for hedge accounting, are preceding table is recognized within other current assets in provisions and other long-term liabilities, respectively. The
also solely entered into to hedge economic business trans- the consolidated statement of financial position, while the derivatives embedded in the convertible bonds and the call
actions and not for speculative purposes. current portion of those indicated as liabilities is included options to secure the convertible bonds are recognized in
Annual Report 2021
in short-term provisions and other short-term liabilities. other current and non-current liabilities / assets in the con-
The non-current portions indicated as assets or liabilities solidated statement of financial position.
Fresenius
357
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
To reduce the credit risk arising from derivatives, the subject to netting arrangements. Offsetting these derivative accounts and other receivables and loans to related par-
Fresenius Group concluded master netting agreements financial instruments would have resulted in net assets of ties. Interest expense of €630 million (2020: €752 million)
with banks. Through such agreements, positive and nega- €12 million and €7 million as well as net liabilities of €35 resulted mainly from Fresenius Group’s financial liabili-
tive fair values of the derivative contracts could be offset million and €78 million at December 31, 2021 and Decem- ties, which are recognized at amortized cost. Moreover,
against one another if a partner becomes insolvent. This ber 31, 2020, respectively. €188 million (2020: €205 million) related to lease liabilities.
offsetting is valid for transactions where the aggregate During 2021, the Fresenius Group recognized net losses
amount of obligations owed to and receivable from are not Effects of financial instruments recorded in the of €56 million (2020: net gains of €44 million) from changes
equal. If insolvency occurs, the party which owes the larger consolidated statement of income in the fair value of equity investments and debt instruments
amount is obliged to pay the other party the difference In 2021, the net gains and losses from financial instruments that are measured at fair value through profit and loss within
between the amounts owed in the form of one net payment. consisted of allowances for expected credit losses (includ- other operating income and expenses.
These master netting agreements do not provide a ing recoveries) in an amount of €71 million (2020: €94 mil- Income of €52 million (2020: expenses of €35 million)
basis for offsetting the fair values of derivative financial lion) and expenses from foreign currency transactions of resulted from the valuation of contingent payments out-
instruments in the consolidated statement of financial posi- €25 million (2020: €41 million). In 2021, interest income of standing. Income and expense from financial instruments
tion as the offsetting criteria under International Financial €124 million resulted mainly from trade accounts and other recorded in other comprehensive income (loss) related to
Reporting Standards are not satisfied. receivables recognized at amortized cost and from interest derivatives in cash flow hedging relationships and to equity
At December 31, 2021 and December 31, 2020, the income related to the release of interest accruals on tax investments and debt instruments measured at fair value
Fresenius Group had €18 million and €16 million of deriv- positions. In 2020, interest income of €93 million resulted through other comprehensive income.
ative financial assets subject to netting arrangements and mainly from the valuation of the derivatives embedded in
€41 million and €87 million of derivative financial liabilities the convertible bonds of Fresenius SE & Co. KGaA, trade
Annual Report 2021
Fresenius
358
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The changes of cash flow hedges on the consolidated statement of comprehensive income (loss) before tax for the years 2021 and 2020 are as follows:
EFFECT OF DERIVATIVES ON THE CUMULATED OTHER COMPREHENSIVE INCOME (LOSS)
2021
Cash Flow Hedge Reserve Costs of Hedging Reserve
Changes of the Changes of the Affected line item in the
unrealized gains / losses Reclassifications from unrealized gains / losses Reclassifications from consolidated statement of
in other comprehensive other comprehensive in other comprehensive other comprehensive income / consolidated
€ in millions income (loss) income (loss)1 income (loss) income (loss)1 statement of financial position
Interest rate contracts --- 2 n.a. n.a Interest income / expense
Foreign exchange contracts -21 13 -1 1
thereof 1 1 Sales
-1 -1 Cost of sales
General and administrative
0 --- expenses
Other operating income /
12 3 expenses
--- -2 Interest income / expense
1 0 Inventories
Derivatives in cash flow hedging relationships -21 15 -1 1
2020
Cash Flow Hedge Reserve Costs of Hedging Reserve
Changes of the Changes of the Affected line item in the
unrealized gains / losses Reclassifications from unrealized gains / losses Reclassifications from consolidated statement of
in other comprehensive other comprehensive in other comprehensive other comprehensive income / consolidated
€ in millions income (loss) income (loss)1 income (loss) income (loss)1 statement of financial position
Interest rate contracts -1 2 n.a. n.a Interest income / expense
Foreign exchange contracts 10 -8 -1 3
thereof -5 2 Sales
-2 4 Cost of sales
General and administrative
-1 --- expenses
Other operating income /
0 -1 expenses
--- -2 Interest income / expense
Annual Report 2021
0 0 Inventories
Derivatives in cash flow hedging relationships 9 -6 -1 3
1
In the consolidated statement of income, no gains or losses from ineffectiveness and only immaterial gains / losses from a hedged underlying transaction,
that is no longer expected to occur, are recognized. Gains are shown with a negative sign and losses with a positive sign.
Fresenius
359
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The Fresenius Group solely designates the spot element flow hedge reserve within other comprehensive income adjustment in the same period as the hedged forecasted
of the foreign exchange forward contracts as hedging in- (loss). The forward points of the foreign exchange forward cash flows affect profit or loss. For cash flow hedges of for-
strument in cash flow hedges. Changes of the fair value contract is accounted for as cost of hedging reserve within eign currency risk associated with forecasted purchases of
of derivative financial instruments that are designated as other comprehensive income (loss). non-financial assets, the amounts accumulated in the cash
cash flow hedges are recorded within other comprehen- For all cash flow hedges, except for foreign currency flow hedge reserve are instead included directly in the initial
sive income (loss). risk associated with forecasted purchases of non-financial cost of the asset when it is recognized. The same approach
The effective portion of changes in fair value of the spot assets, the amounts accumulated in the cash flow hedge applies to the amounts accumulated in the costs of hedging
element of the hedging instruments is accumulated in a cash reserve are reclassified to profit or loss as a reclassification reserve.
EFFECT OF DERIVATIVES ON THE CONSOLIDATED STATEMENT OF INCOME
Gain or loss recognized in
the consolidated statement of income
Affected line item in the
€ in millions 2021 2020 consolidated statement of income
Interest rate contracts 0 0 Interest income / expense
Other operating income /
Foreign exchange contracts 87 -73 expense
Foreign exchange contracts 5 5 Interest income / expense
Derivatives embedded in the convertible bonds 0 2 Interest income / expense
Call options to secure the convertible bonds 0 -2 Interest income / expense
Derivatives not designated as hedging instruments 92 -68
In 2021, gains (2020: losses) from foreign exchange con- MARKET RISK Fresenius Group issues bonds and commercial papers and
tracts not designated as hedging instruments recognized in The Fresenius Group is exposed to effects related to for- enters into long-term credit agreements and Schuldschein
the consolidated statement of income are faced by losses eign exchange fluctuations in connection with its interna- Loans with banks. Due to these financing activities, the
(2020: gains) from the underlying transactions in the corre- tional business activities that are denominated in various Fresenius Group is exposed to interest risk caused by
sponding amount. currencies. In order to finance its business operations, the changes in variable interest rates and the risk of changes
in the fair value of statement of financial position items
bearing fixed interest rates.
In order to manage the risk of interest rate and foreign
Annual Report 2021
exchange rate fluctuations, the Fresenius Group enters into
Fresenius
360
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
certain hedging transactions with financial institutions The Fresenius Group makes sure there is an economic rela- areas. Therefore, the subsidiaries are affected by changes
within the limits approved by the Management Board, tionship between the hedged item and the hedging instru- of foreign exchange rates between the invoicing currencies
which are set depending on the counterparty’s rating. The ment and ensures reasonable hedge ratios of the desig- and the local currencies in which they conduct their busi-
counterparties generally have an investment grade rating. nated hedged items with interest and currency risks. This nesses. Solely for the purpose of hedging existing and
Derivative financial instruments are not entered into for is achieved by matching to a large extent the critical terms foreseeable foreign exchange transaction exposures, the
trading purposes. of the interest and foreign exchange derivatives with the Fresenius Group applies appropriate financial instruments.
The Fresenius Group makes sure that hedge accounting critical terms of the underlying exposures. Therefore, For loans in foreign currencies, the Fresenius Group enters
relationships are aligned with its Group risk management the earnings of the Fresenius Group were not materially into foreign exchange swap contracts. The Fresenius Group
objectives and strategy and that a qualitative and forward- affected by hedge ineffectiveness in the reporting period. solely designates the spot element of the foreign exchange
looking approach is used for assessing hedge effectiveness. In principle, sources of inefficiency are risk of credit default forward contract as hedging instrument in cash flow hedges
In general, the Fresenius Group conducts its derivative and time lags of underlying exposures. and uses a hedge ratio for designated risks of 1 : 1. The
financial instrument activities under the control of a single fair value of foreign exchange contracts designated as
centralized department. The Fresenius Group has estab- Foreign exchange risk management cash flow hedges used to hedge operating transaction risks
lished guidelines derived from best practice standards in The Fresenius Group has determined the euro as its finan- was -€13 million (December 31, 2020: -€1 million) and
the banking industry for risk assessment procedures and cial reporting currency. Therefore, foreign exchange trans- in relation with loans in foreign currencies €3 million
supervision concerning the use of financial derivatives. lation risks resulting from the fluctuation of exchange rates (December 31, 2020: -€6 million).
These guidelines require amongst other things a clear seg- between the euro and the local currencies, in which the As of December 31, 2021, the notional amounts of for-
regation of duties in the areas of execution, administration, financial statements of the foreign subsidiaries are prepared, eign exchange contracts totaled €2,917 million (Decem-
accounting and controlling. Risk limits are continuously have an impact on results of operations and financial posi- ber 31, 2020: €3,230 million). Thereof €2,671 million
monitored and, where appropriate, the use of hedging tions reported in the consolidated financial statements. (December 31, 2020: €3,228 million) were due in less
instruments is adjusted to that extent. Besides translation risks, foreign exchange transaction than 12 months. As of December 31, 2021, the Fresenius
The Fresenius Group defines benchmarks for individual risks exist. These mainly relate to transactions denomi- Group was party to foreign exchange contracts with a
exposures in order to quantify interest and foreign exchange nated in foreign currencies, such as purchases and sales, maximum remaining term to maturity of 33 months. The
risks. The benchmarks are derived from achievable and sus- projects and services as well as intragroup sales of prod- Fresenius Group uses a Cash-Flow-at-Risk (CFaR) model in
tainable market rates. Depending on the individual bench- ucts to other Fresenius Group entities in different currency
marks, hedging strategies are determined and implemented.
Annual Report 2021
Fresenius
361
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
order to estimate and quantify such transaction risks from The following table shows the average hedging rates and (December 31, 2020: -€43 thousand). The euro interest rate
foreign currencies. The basis for the analysis of the currency nominal amounts of foreign exchange contracts for mate- swap expires in 2022. It bears an interest rate of 3.39%. As
risks are the foreign currency cash flows that are reasonably rial currency pairs at December 31, 2021. of December 10, 2020, U.S. dollar denominated interest rate
expected to arise within the following 12 months, less any swaps in the amount of US$200 million (€165 million on
Nominal amount in Average hedging
hedges. Under the CFaR approach, the potential currency € millions rate December 10, 2020) with an original maturity on March 10,
fluctuations of these net exposures are shown as probability Euro / U.S. dollar 673 1.1569 2021 were closed out. Accordingly, the underlying was
distributions based on historical volatilities and correlations, Euro / Swedish krona 515 10.2869 redeemed prior to maturity.
Euro / Chinese renminbi 399 7.5521
using the values of the last 50 exchange rates with an inter- The pre-hedges are used to hedge interest rate expo-
val of 21 trading days. The calculation is made assuming a sures with regard to interest rates which are relevant for the
confidence level of 95% and a holding period of up to one Interest rate risk management future long-term debt issuance and which could rise until
year. Fresenius Group’s interest rate risks mainly arise from the respective debt is actually issued. These pre-hedges are
The aggregation of currency risks has risk-mitigating money market and capital market transactions of the settled at the issuance date of the corresponding long-term
effects due to correlations between the transactions con- Group for financing its business activities. debt with the settlement amount recorded in accumulated
cerned, i. e. the overall portfolio’s risk exposure is gener- The Fresenius Group applies appropriate financial instru- other comprehensive income (loss) amortized to interest
ally less than the sum total of the underlying individual ments in order to protect against the risk of rising interest expense over the life of the debt. At December 31, 2021
risks. As of December 31, 2021, the Fresenius Group’s cash rates. These interest rate derivatives are exclusively desig- and December 31, 2020, the Fresenius Group had a loss
flow at risk amounted to €44 million based on a net expo- nated as cash flow hedges and have been entered into in of €8 million, respectively, related to such settlements of
sure of €1,990 million. This means, with a probability of order to convert payments based on variable interest rates pre-hedges deferred in accumulated other comprehensive
95%, a potential loss in relation to the forecasted foreign into payments at a fixed interest rate and in anticipation of income (loss), net of tax.
exchange cash flows of the next 12 months will be not future long-term debt issuances (pre-hedges). As of Decem- Interest payables and interest receivables in connection
higher than €44 million. ber 31, 2021, the euro denominated interest rate swap with the swap agreements are accrued and recorded as an
had a notional volume of €482 thousand (December 31, adjustment to the interest expense at each reporting date.
2020: €1 million). The fair value was -€12 thousand
Annual Report 2021
Fresenius
362
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Concerning interest rate contracts, unscheduled repay- Management of the Interest Rate Benchmark Reform CREDIT RISK
ments or the renegotiation of hedged items may in some (IBOR-Reform) The Fresenius Group is exposed to potential losses regard-
cases lead to the de-designation of the hedging instrument, A fundamental reform of major interest rate benchmarks is ing financial instruments in the event of non-performance
which existed up to that point. From that date, the respec- being undertaken globally. This includes the replacement by counterparties. With respect to derivative financial instru-
tive hedging transactions are recognized in the consoli- of certain interbank offered rates (IBORs) with alternative ments, it is not expected that any counterparty will fail to
dated statement of income. nearly risk-free rates (referred to as IBOR reform). The meet its obligations as the counterparties are highly rated
For purposes of analyzing the impact of changes in Fresenius Group has exposures to relevant IBORs through financial institutions (generally investment grade). The
the relevant reference interest rates on Fresenius Group’s its financial instruments, which will be affected as part of maximum credit exposure of derivatives is represented by
results of operations, the Group calculates the portion of this market-wide initiative. the fair value of those contracts with a positive fair value
financial debt which bears variable interest rates and which As of December 31, 2021, the LIBOR referencing loans amounting to €20 million (December 31, 2020: €18 million)
has not been hedged by means of interest rate swaps or amount to less than €500 million. The majority of the expo- for foreign exchange derivatives. At December 31, 2021
options against rising interest rates. For this particular part sure is related to U.S. dollar LIBOR linked loan contracts in and at December 31, 2020, the Fresenius Group’s interest
of its liabilities, the Fresenius Group assumes an increase the amount of €441 million. For these U.S. dollar loans, it rate derivative did not bear a credit risk. The maximum
in the reference rates of 0.5% compared to the actual rates is planned to replace the current LIBOR reference interest credit risk resulting from the use of non-derivative financial
as of the date of the statement of financial position. The rates with SOFR (Secured Overnight Financing Rate) refer- instruments is defined as the total amount of all receivables.
corresponding additional annual interest expense is then ence interest rates as the new interest basis in due course. In order to control this credit risk, the Management of
compared to the net income attributable to shareholders The Syndicated Credit Facilities of Fresenius SE & Co. the Fresenius Group performs an aging analysis of trade
of Fresenius SE & Co. KGaA. This analysis shows that an KGaA and Fresenius Medical Care AG & Co. KGaA, both in accounts receivable. For details on trade accounts receiv-
increase of 0.5% in the relevant reference rates would the amount of €2 billion, have a certain level of London able and on the allowances for expected credit losses,
have an effect of approximately 0.8% on the consolidated Inter-Bank Offered Rate (LIBOR) exposure due to the possi- please see note 16, Trade accounts and other receivables.
net income attributable to shareholders of Fresenius SE & bility of multicurrency drawings in U.S. dollar as well as in
Co. KGaA and an effect of less than 0.1% on Fresenius SE & euro and will be amended before the expected cessation of
Co. KGaA shareholders’ equity. the U.S. dollar LIBOR in 2023.
Beyond the measures described above, the Fresenius
Group continuously analyzes the extent to which contracts
which reference other IBOR cash flows besides LIBOR
currencies will need to be adjusted and how to manage
communication regarding the ongoing IBOR reform with
Annual Report 2021
counterparties.
Fresenius
363
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
LIQUIDITY RISK of the Group by means of effective working capital and cash generated by operating activities and additional short-
The liquidity risk is defined as the risk that a company is cash management as well as an anticipatory evaluation of term and long-term borrowings are sufficient to meet the
potentially unable to meet its financial obligations. The refinancing alternatives. The Management of the Fresenius company’s foreseeable demand for liquidity (see note 23,
Management of the Fresenius Group manages the liquidity Group believes that existing credit facilities as well as the Debt).
The following table shows the future undiscounted contractual cash flows (including interests) resulting from recognized financial liabilities and derivative financial instruments:
2021 2020
€ in millions up to 1 year 1 to 3 years 3 to 5 years more than 5 years up to 1 year 1 to 3 years 3 to 5 years more than 5 years
Non-derivative financial instruments
Long-term debt (including Accounts Receivable Facility)1 86 594 75 111 1,209 2,924 540 653
Short-term debt 2,853 --- --- --- 250 --- --- ---
Lease liabilities 1,008 1,834 1,399 3,580 926 1,686 1,259 3,451
Bonds 886 2,889 4,216 8,501 1,807 2,599 2,814 8,512
Convertible bonds --- 500 --- --- --- --- 500 ---
Trade accounts payable 2,039 --- --- --- 1,816 --- --- ---
Other financial liabilities2 2,502 3 1 1 2,208 3 1 0
Contingent payments outstanding for acquisitions 41 256 83 160 56 267 97 183
Put option liabilities 683 231 171 90 646 103 112 74
Total non-derivative financial instruments 10,098 6,307 5,945 12,443 8,918 7,582 5,323 12,873
Derivative financial instruments
Derivatives designated as cash flow hedging instruments
Inflow -667 -2 --- --- -520 0 --- ---
Outflow 688 3 --- --- 537 0 --- ---
Net derivatives designated as cash flow hedging instruments 21 1 --- --- 17 0 --- ---
Derivatives not designated as hedging instruments
Inflow -1,039 -1 --- --- -1,844 --- --- ---
Outflow 1,074 1 --- --- 1,918 0 0 ---
Net derivatives not designated as hedging instruments 35 0 --- --- 74 0 0 ---
Total derivative financial instruments 56 1 --- --- 91 0 0 ---
Total non-derivative and derivative financial instruments 10,154 6,308 5,945 12,443 9,009 7,582 5,323 12,873
1
Future interest payments for financial liabilities with variable interest rates were calculated using the latest interest rates fixed prior to December 31, 2021.
Annual Report 2021
2
€1,378 million were reclassified from other financial liabilities to other non-financial liabilities.
Fresenius
364
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
33. INFORMATION ON CAPITAL MANAGEMENT Shareholders’ equity and debt have developed as follows: long-term financing. In the choice of financing instruments,
The Fresenius Group has a solid financial profile. Capital market capacity, investor diversification, capital cost, flexi-
management includes both equity and debt. Principal objec- SHAREHOLDERS’ EQUITY bility, credit conditions and the existing maturity profile are
tives of Fresenius Group’s capital management are to ensure € in millions December 31, 2021 December 31, 2020
taken into account.
financial flexibility, to limit refinancing risks and to optimize Shareholders’ equity 29,288 26,023 The leverage ratio on the basis of net debt / EBITDA is a
the weighted average cost of capital. Further, it is sought to Total assets 71,962 66,646 key financial figure for the Fresenius Group. As of Decem-
achieve a balanced mix of equity and debt. Equity ratio 40.7% 39.0% ber 31, 2021, the leverage ratio, calculated on the basis
Due to the company’s diversification within the health of year-end exchange rates, before special items was 3.55
care sector and the strong market positions of the business Fresenius SE & Co. KGaA is not subject to any capital (December 31, 2020: 3.4).
segments in global, growing and non-cyclical markets, pre- requirements provided for in its articles of association. Fresenius Group’s solid financing strategy is reflected in
dictable and sustainable cash flows are generated. They Fresenius SE & Co. KGaA has obligations to issue shares its investment grade credit ratings. The Fresenius Group is
allow a reasonable proportion of debt. Moreover, Fresenius out of the Conditional Capital relating to the exercise of covered by the rating agencies Moody’s, Standard & Poor’s
Group’s customers are generally of high credit quality. stock options on the basis of the existing 2013 Stock Option and Fitch.
Measures to strengthen the equity base may also be Plan (see note 36, Share-based compensation plans). The following table shows the company rating of
considered in exceptional cases to ensure long-term Fresenius SE & Co. KGaA:
growth, for instance to finance a major acquisition. DEBT
€ in millions December 31, 2021 December 31, 2020 RATING OF FRESENIUS SE & CO. KGAA
Debt 27,155 25,913
December 31, 2021 December 31, 2020
Total assets 71,962 66,646
Standard & Poor’s
Debt ratio 37.7% 38.9%
Corporate Credit Rating BBB BBB
Outlook stable stable
Assuring financial flexibility is the top priority in the Group’s Moody’s
financing strategy. This flexibility is achieved through a Corporate Credit Rating Baa3 Baa3
Outlook stable stable
broad spread of maturities, a wide range of financing instru- Fitch
ments and a high degree of diversification of investors and Corporate Credit Rating BBB - BBB -
banks. Fresenius Group’s maturity profile displays a broad Outlook stable stable
spread of maturities with a high proportion of medium- and
In 2021 and 2020, Fresenius Group’s rating remained
Annual Report 2021
unchanged.
Fresenius
365
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
34. SUPPLEMENTARY INFORMATION Cash paid for acquisitions consisted of the following: In 2021, €129 million of cash paid for investments, net of
ON THE CONSOLIDATED STATEMENT cash acquired, related to investments in securities in the
OF CASH FLOWS € in millions 2021 2020 business segment Fresenius Medical Care.
Assets acquired 1,057 1,098
The consolidated statements of cash flows of the Fresenius Proceeds from the sale of subsidiaries were €54 million
Liabilities assumed -35 -273
Group for the fiscal years 2021 and 2020 are shown on Noncontrolling interests -120 -37 in 2021 (2020: €32 million.)
pages 281 and 282. Debt assumed -86 -182
Cash funds reported in the consolidated statement of Cash paid 816 606
Cash acquired -55 -27
cash flows and in the consolidated statement of financial
Cash paid for acquisitions, net 761 579
position are comprised of cash on hand, checks, securities Cash paid for investments,
and cash at bank which are readily convertible within three net of cash acquired 206 108
Cash paid for intangible assets, net 32 33
months and are subject to insignificant risk of changes in
Total cash paid for acquisitions and invest-
value. ments and purchases of intangible assets 999 720
In 2021, Fresenius Helios has used subsidies for invest-
ments in property, plant and equipment in the amount of
€99 million (2020: €97 million), that were offset in purchases
of property, plant and equipment in the consolidated state-
ment of cash flows.
The following table shows a reconciliation of debt to cash flow from financing activities in 2021 and 2020:
Non-cash changes
Assumed as
part of Foreign currency Amortization of debt New lease
€ in millions January 1, 2021 Cash flow acquisitions translation issuance costs contracts Other1 December 31, 2021
Short-term debt 245 2,591 1 1 --- --- 3 2,841
Long-term debt, less Accounts Receivable
Facility of Fresenius Medical Care 5,154 -2,569 24 62 6 --- -77 2,600
Lease liabilities 6,188 -880 121 319 --- 915 -73 6,590
Bonds 13,847 461 --- 300 17 --- 9 14,634
Convertible bonds 474 --- --- --- 8 --- --- 482
Accounts Receivable Facility of Fresenius Medical Care --- --- --- --- --- --- --- ---
Annual Report 2021
1
Under the effective interest method, non-cash changes result from the compounding interest on lease liabilities in the amount of €188 million.
Fresenius
366
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Non-cash changes
Assumed as
part of Foreign currency Amortization of debt New lease
€ in millions January 1, 2020 Cash flow acquisitions translation issuance costs contracts Other1 December 31, 2020
Short-term debt 2,475 -2,247 5 -8 --- --- 20 245
Long-term debt, less Accounts Receivable
Facility of Fresenius Medical Care 6,629 -1,377 145 -128 -1 --- -114 5,154
Lease liabilities 6,439 -937 35 -377 --- 1,087 -59 6,188
Bonds 10,467 3,640 --- -290 9 --- 21 13,847
Convertible bonds 865 -400 --- --- 1 --- 8 474
Accounts Receivable Facility of Fresenius Medical Care 380 -374 --- -6 --- --- --- ---
1
Under the effective interest method, non-cash changes result from the compounding interest on lease liabilities in the amount of €205 million.
Interest payments are included in the consolidated state- The key data disclosed in conjunction with the consolidated The column Corporate is comprised of the holding func-
ment of cash flows under net cash provided by operating segment reporting correspond to the key data of the inter- tions of Fresenius SE & Co. KGaA as well as Fresenius Digital
activities. In fiscal year 2021, cash payments related to nal reporting system of the Fresenius Group. Internal and Technology GmbH, which provides services in the field of
interest amounted to €502 million (2020: €609 million). external reporting and accounting correspond to each other; information technology. Furthermore, Corporate includes
Accrued interest on debt and bonds is reported in the the same key data and definitions are used. intersegment consolidation adjustments as well as special
consolidated statement of financial position under short- Sales and proceeds between the segments are indica- items (see note 3, Special items).
term provisions and other short-term liabilities. tive of the actual sales and proceeds agreed with third Details on the business segments are shown on page
parties. Administrative services are billed in accordance 288 of the notes.
35. NOTES ON THE CONSOLIDATED with service level agreements. Segment reporting by region takes account of geograph-
SEGMENT REPORTING The business segments were identified in accordance ical factors and the similarity of markets in terms of oppor-
with IFRS 8, Operating Segments, which defines the seg- tunities and risks. The allocation to a particular region is
GENERAL ment reporting requirements in the annual financial state- based on the domicile of the customers.
The consolidated segment reporting tables shown on pages ments and interim reports with regard to the operating
285 to 286 of this Annual Report are an integral part of the business, product and service businesses and regions. NOTES ON THE BUSINESS SEGMENTS
notes. The business segments of the Fresenius Group are as The key figures used by the Management Board to assess
The Fresenius Group has identified the business seg- follows: segment performance, have been selected in such a way
ments Fresenius Medical Care, Fresenius Kabi, Fresenius that they include all items of income and expenses which
Helios and Fresenius Vamed, which corresponds to the ► Fresenius Medical Care fall under the area of responsibility of the business seg-
Annual Report 2021
internal organizational and reporting structures (Manage- ► Fresenius Kabi ments. The Management Board is convinced that the most
ment Approach) at December 31, 2021. ► Fresenius Helios suitable performance indicator is the operating income
► Fresenius Vamed (EBIT). The Management Board believes that, in addition to
the operating income, the figure for earnings before interest,
taxes and depreciation / amortization (EBITDA) can also
Fresenius
367
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
help investors to assess the ability of the Fresenius Group Acquisitions refer to the purchase of shares in legally inde- RECONCILIATION OF KEY FIGURES
to generate cash flows and to meet its financial obligations. pendent companies and the acquisition of business divi- TO CONSOLIDATED EARNINGS
Depreciation and amortization is presented for property, sions and intangible assets (e. g. licenses). The key figures € in millions 2021 2020
plant and equipment and intangible assets with definite use- shown with regard to acquisitions present the contractual Total EBIT of reporting segments 4,296 4,648
ful lives of the respective business segment. purchase prices comprising amounts paid in cash (less Special items -94 -227
Net interest is comprised of interest expenses and cash acquired), debts assumed and the issuance of shares, General corporate expenses
Corporate (EBIT) -44 -36
interest income. whereas for the purposes of the statement of cash flows, Group EBIT 4,158 4,385
Net income attributable to shareholders of Fresenius only cash purchase price components less acquired cash Interest expenses -630 -752
SE & Co. KGaA is defined as earnings after income taxes and cash equivalents are reported. Interest income 124 93
Income before income taxes 3,652 3,726
and noncontrolling interests. The EBITDA margin is calculated as a ratio of EBITDA
The operating cash flow is the cash provided by / used to sales.
RECONCILIATION OF NET DEBT WITH THE CONSOLIDATED
in operating activities. The EBIT margin is calculated as a ratio of EBIT to
STATEMENT OF FINANCIAL POSITION
The cash flow before acquisitions and dividends is the sales.
operating cash flow less net capital expenditure. The return on operating assets (ROOA) is defined as the € in millions Dec. 31, 2021 Dec. 31, 2020
Debt is comprised of bank loans, bonds, convertible ratio of EBIT to average operating assets. Operating assets Short-term debt 2,841 245
Short-term debt from related parties 8 5
bonds, lease liabilities, liabilities relating to outstanding are defined as total assets less deferred tax assets, trade Current portion of long-term debt 473 1,132
acquisitions as well as intercompany liabilities. accounts payable and advance payments from customers Current portion of lease liabilities 832 766
Other operating liabilities include the sum of short-term as well as guaranteed subsidies. Current portion of bonds 618 1,522
Long-term debt, less current portion 2,127 4,022
and long-term liabilities, less debt and less liabilities for In addition, the key indicators ‘‘Depreciation and amor-
Lease liabilities, less current portion 5,758 5,422
deferred taxes. tization in % of sales’’ and ‘‘Operating cash flow in % of Bonds, less current portion 14,016 12,325
Capital expenditure mainly contains additions to prop- sales’’ are also disclosed. Convertible bonds 482 474
erty, plant and equipment, including non-cash effective Debt 27,155 25,913
less cash and cash equivalents 2,764 1,837
items. Net debt 24,391 24,076
Net debt excluding lease liabilities amounted to €17,801
million at December 31, 2021 (December 31, 2020:
€17,888 million).
Annual Report 2021
Fresenius
368
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The following table shows the long-lived assets by geograph- 36. SHARE-BASED COMPENSATION PLANS SHARE-BASED COMPENSATION PLANS OF
ical region: FRESENIUS SE & CO. KGAA
COMPENSATION COST IN CONNECTION WITH THE
€ in millions Dec. 31, 2021 Dec. 31, 2020 SHARE-BASED COMPENSATION PLANS OF THE Description of the Fresenius SE & Co. KGaA
Germany 11,270 10,233
FRESENIUS GROUP share-based compensation plans in place
Spain 7,671 7,196
Europe (excluding Germany and Spain) 3,765 4,090
In 2021, the Fresenius Group recognized compensation As of December 31, 2021, Fresenius SE & Co. KGaA had
North America 26,147 23,797 cost in an amount of €1 million for stock options granted two share-based compensation plans in place: the
Asia-Pacific 2,612 2,480 in 2017 for the last time. In 2020, the Fresenius Group rec- Fresenius SE & Co. KGaA Long Term Incentive Program
Latin America 874 1,052
ognized €6 million in income in relation to stock options 2013 (2013 LTIP) which is based on stock options and
Africa 73 66
Total long-lived assets1 52,412 48,914 granted since 2016. The amount recognized in income was phantom stocks and the Long Term Incentive Plan 2018
1
The aggregate amount of long-lived assets is the sum mainly due to the non-achievement of the plan targets (LTIP 2018) which is solely based on performance shares.
of non-current assets less deferred tax assets and less
other non-current financial assets. and the resulting forfeiture of three quarters of the stock Currently, solely LTIP 2018 can be used to grant perfor-
options granted in 2017. For stock incentive plans which mance shares.
In 2021, the Fresenius Group generated sales of €8,461
are performance-based, the Fresenius Group recognizes
million (2020: €8,059 million) in Germany. Sales in the
compensation cost over the vesting periods, based on the LTIP 2018
United States were €14,088 million at actual rates (2020:
market values of the underlying stock at the grant date. On April 12, 2018 and March 15, 2018, respectively, the
€14,540 million) and €14,587 million in constant currency
The expenses related to cash-settled share-based pay- Management Board and Supervisory Board of the general
in 2021.
ment transactions are determined based upon the fair value partner, Fresenius Management SE, resolved the Long
In 2021, the segment Fresenius Medical Care generated
at measurement date and the number of phantom stocks Term Incentive Plan 2018 (LTIP 2018).
other sales in the amount of €516 million (2020: €409 mil-
or performance shares granted which will be recognized The LTIP 2018 is based solely on virtual stocks (perfor-
lion), Fresenius Kabi €3 million (2020: €3 million), Fresenius
over the vesting period. In 2021, the Fresenius Group recog- mance shares). The performance shares issued through
Helios €12 million (2020: €12 million) and Fresenius Vamed
nized expenses of €27 million (2020: €31 million) in con- the plan are non-equity-backed, virtual compensation instru-
€4 million (2020: €0 million). All other sales are sales from
nection with cash-settled share-based payment transactions. ments. When performance targets are reached and other
contracts with customers.
At December 31, 2021, the Fresenius Group has accrued prerequisites are met, they guarantee the entitlement to
€72 million (December 31, 2020: €83 million) for its share- a cash payment by Fresenius SE & Co. KGaA or one of its
based compensation plans. affiliated companies.
The plan is available both for members of the Manage-
ment Board (with the exception of Mr. Rice Powell, who
Annual Report 2021
receives his compensation from Fresenius Medical Care
Management AG) and other executives. Performance shares
may be granted once annually over a period of five years.
The grant to the members of the Management Board is
Fresenius
369
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
made by the Supervisory Board of the general partner, value of 250% of the grant value, the entitlement of all other statements. For the ascertainment of the currency transla-
Fresenius Management SE, the grant to the other execu- plan participants is limited to a maximum value of 400%. tion effects, all line items of the income statements of the
tives is made by the Management Board of Fresenius Man- The LTIP 2018 has two equally weighted performance companies that are included in the consolidated financial
agement SE, in each case on the basis of a grant value targets: firstly, the growth rate of the adjusted consolidated statements and which have a functional currency other
determined at its discretion. The grant value is determined net income (adjusted for currency effects) and, secondly, than the reporting currency (euro) of the Fresenius Group
in consideration of the personal performance and the the relative Total Shareholder Return based on the STOXX are translated with the average exchange rates of the
responsibilities of the concerned plan participant. The num- Europe 600 Health Care Index. Disbursement entitlement Fresenius Group fiscal year of the consolidated financial
ber of performance shares granted is calculated through requires that at least one of the two performance targets statements that are the basis for the comparison.
applying the grant value and the average stock market price must be reached or surpassed over the four-year perfor- For the ‘‘Total Shareholder Return’’ performance target,
of the Fresenius share over the period of 60 stock exchange mance period. a target achievement of 100% is met when the Total Share-
trading days prior to the grant date. For the performance target ‘‘Net Income Growth Rate’’ holder Return of Fresenius SE & Co. KGaA in comparison
The number of performance shares may change over a a level of target achievement of 100% is reached when the with the Total Shareholder Return of the other companies
period of four years, depending on the level of achieve- same is at least 8% over the four-year performance period. of the STOXX Europe 600 Health Care Index achieves an
ment of the performance targets described in more detail If the growth rate falls below or corresponds to only 5%, average ranking within the benchmark companies, i. e.
below. This could entail the entire loss of all performance the level of target achievement is 0%. If the growth rate is exactly in the middle (50th percentile), over the four-year
shares or also --- at maximum --- the doubling of their num- between 5% and 8%, the level of target achievement is performance period. If the ranking corresponds to the 25th
ber. The resulting number of performance shares, which between 0% and 100%, while, where the growth rate is percentile or less, the level of target achievement is 0%.
is determined after a performance period of four years between 8% and 20%, the level of target achievement will Where the ranking is between the 25th percentile and the
and based on the respective level of target achievement, be between 100% and 200%. Intermediate values are cal- 50th percentile, the level of target achievement is between
is deemed finally earned four years after the date of the culated through linear interpolation. The net income is 0% and 100%; and, for a ranking between the 50th per-
respective grant. The number of vested performance the consolidated net income attributable to shareholders centile and the 75th percentile, between 100% and 200%.
shares is then multiplied by the average stock exchange of Fresenius SE & Co. KGaA reported in the consolidated Intermediate values will also be calculated through linear
price of Fresenius SE & Co. KGaA’s share over a period of financial statements of Fresenius SE & Co. KGaA prepared interpolation. Total Shareholder Return denotes the per-
60 stock exchange trading days prior to the lapse of this in accordance with IFRS, adjusted for extraordinary effects. centage change in the stock market price within the perfor-
vesting period plus the total of the dividends per share of The determination of the adjusted net income (adjusted mance period including reinvested dividends and all capital
Fresenius SE & Co. KGaA paid by Fresenius SE & Co. KGaA for currency effects) and the change in comparison with the measures, whereby capital measures are to be calculated
between the grant date and the vesting date. The resulting adjusted net income (not adjusted for currency effects) of through rounding down to the fourth decimal place.
amount will be paid to the respective plan participant in the previous Fresenius Group fiscal year will be verified in The ranking values are determined using the composi-
Annual Report 2021
cash. The potential disbursement entitlement of each mem- a binding manner by the auditors of Fresenius SE & Co. tion of STOXX Europe 600 Health Care on the grant date.
ber of the Management Board is limited to a maximum KGaA on the basis of the audited consolidated financial For equalization purposes, the relevant market price is the
Fresenius
370
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
average market price in the period of 60 stock exchange phantom stock awards which entitle the holder to receive (factor 3). The participants are now entitled to receive
trading days prior to the beginning and end of a perfor- cash payments upon exercising the phantom stock. Each of three bearer ordinary shares of Fresenius SE & Co. KGaA.
mance period; the relevant currency is that of the main the 2013 SOP and 2013 PSP making up the 2013 LTIP have The exercise price was reduced proportionally.
stock exchange of a company, which was listed in STOXX been established under a stand-alone legal documentation. The granting of the options occurred in five annual
Europe 600 Health Care on the grant date. tranches, each to the last Monday in July or the first Mon-
A level of target achievement in excess of 200% is not 2013 SOP day in December. With respect to new options, the Supervi-
possible for both performance targets. Under the 2013 SOP, which was approved by the Annual sory Board of Fresenius Management SE determined the
To calculate the level of overall target achievement, the General Meeting of Fresenius SE & Co. KGaA on May 17, stock options granted to members of Fresenius Manage-
level of target achievement of the two performance targets 2013, Fresenius Management SE was originally author- ment SE’s Management Board, whereas the Management
are given equal weighting. The total number of performance ized to issue up to 8.4 million subscription rights for an Board of Fresenius Management SE determined the other
shares vested on each plan participant is calculated through amount of 8.4 million non-par value ordinary bearer participants in the 2013 SOP and the stock options granted
multiplying the number of performance shares granted by shares of Fresenius SE & Co. KGaA until May 16, 2018. to them.
the overall target achievement. Of the up to 8.4 million options, up to 1.6 million options The exercise price of an option equals the volume-
The performance targets for the 2018 grant were not were designated for members of the Management Board of weighted average stock market price (closing price) of the
achieved. Therefore, the performance shares granted in Fresenius Management SE; up to 4.4 million options were non-par value ordinary bearer share of Fresenius SE & Co.
2018 forfeited. designated for members of the management of directly or KGaA in the electronic Xetra trading of Deutsche Börse AG
In the event of violation of compliance rules, the Super- indirectly affiliated companies (except for Fresenius Medical in Frankfurt am Main, or a comparable successor system,
visory Board of Fresenius Management SE, in due exercise Care) and up to 2.4 million options were designated for on the last 30 calendar days prior to the respective grant
of its discretion, is entitled to reduce the number of per- executive employees of Fresenius SE & Co. KGaA and its af- date.
formance shares vested on a member of the Management filiated companies (except for Fresenius Medical Care). Options granted have an eight-year term but can be
Board to zero. Regarding all other plan participants, such In connection with the stock split in 2014, the total vol- exercised only after a four-year vesting period. The exercise
decision is made by the Management Board of Fresenius ume of not yet granted subscription rights increased in the of options is subject to the condition precedent, in each case,
Management SE. Furthermore, Fresenius SE & Co. KGaA is same proportion as the subscribed capital (factor 3) as far that the annual success target within a four-year waiting
entitled to a complete or partial reimbursement in the event as options had not yet been granted under the 2013 SOP. period is achieved. The success target is achieved in each
of violation of compliance rules in the period of three years The same applies to the subsets of the subscription rights case if, after the granting of the options to the respective
following disbursement. that are attributable to individual groups of participants. entitled person, either (i) the consolidated net income
For stock options that were granted before the stock split attributable to shareholders of Fresenius SE & Co. KGaA
2013 LTIP 2014 came into effect, the entitlement of the participants to according to IFRS, adjusted for extraordinary effects and
Annual Report 2021
The 2013 LTIP is comprised of the Fresenius SE & Co. KGaA receive new shares through the exercise of stock options on a constant currency basis, has increased by at least 8%
Stock Option Plan 2013 (2013 SOP) and the Fresenius SE & increased in the same proportion as the subscribed capital per annum in comparison to the previous year in each case
Co. KGaA Phantom Stock Plan 2013 (2013 PSP). It com- within the waiting period, or (ii) --- if this is not the case ---
bines the granting of stock options with the granting of the compounded annual growth rate of the consolidated
Fresenius
371
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
net income attributable to shareholders of Fresenius SE & 2013 PSP within a four-year waiting period is achieved. The success
Co. KGaA according to IFRS, adjusted for extraordinary Fresenius SE & Co. KGaA’s 2013 PSP was established in target is achieved in each case if, after the granting of the
effects and on a constant currency basis, during the four May 2013, together with the 2013 SOP in line with the subscription rights to the respective entitled person, either
years of the waiting period amounts to at least 8%. In 2013 LTIP. Awards of phantom stocks can be granted on (i) the consolidated net income attributable to shareholders
the event that the success target within the four-year wait- each stock option grant date. Phantom stocks awarded of Fresenius SE & Co. KGaA according to IFRS, adjusted for
ing period is not achieved for the individual years or for under the 2013 PSP may be granted to the members of extraordinary effects and on a constant currency basis, has
the compounded annual growth rate, the options issued in Fresenius Management SE’s Management Board, the mem- increased by at least 8% per annum in comparison to the
each case are forfeited in proportion to the non-achievement bers of the management of directly or indirectly affiliated previous year in each case within the waiting period, or
of the success target within the waiting period, i. e. by one companies (except for Fresenius Medical Care) and to (ii) --- if this is not the case --- the compounded annual growth
quarter, two quarters, three quarters, or completely. In executive employees of Fresenius SE & Co. KGaA and its rate of the consolidated net income attributable to share-
the years 2013 to 2019, the performance targets for stock affiliated companies (except for Fresenius Medical Care). holders of Fresenius SE & Co. KGaA according to IFRS,
options granted in 2013 to 2016 were met. For stock options The holders of phantom stocks, that had been issued adjusted for extraordinary effects and on a constant currency
granted in 2017, only one quarter of the performance target before the stock split 2014 came into effect, were granted basis, during the four years of the waiting period amounts to
was achieved. Therefore, in 2020, three quarters of the stock an economic compensation through retroactively tripling at least 8%. In the event that the success target within the
options granted in 2017 were forfeited. the number of phantom stocks granted before the stock four-year waiting period is not achieved for the individual
The adjusted net income attributable to shareholders split 2014 came into effect. years or for the compounded annual growth rate, the phan-
of Fresenius SE & Co. KGaA according to IFRS (currency As under the 2013 SOP, the Supervisory Board of tom stock awards issued in each case are forfeited in pro-
adjusted) and changes thereto compared to the adjusted net Fresenius Management SE determined the phantom portion to the non-achievement of the success target within
income according to IFRS (without currency adjustment) of stocks granted to members of Fresenius Management SE’s the waiting period, i. e. by one quarter, two quarters, three
the relevant comparison year shall be verified with binding Management Board, whereas the Management Board of quarters, or completely. In the years 2013 to 2019, the per-
effect in each case by the auditors of Fresenius SE & Co. Fresenius Management SE determined the other partici- formance targets for phantom stocks granted in 2013 to
KGaA on the basis of the audited consolidated financial pants in the 2013 PSP and the phantom stocks granted to 2016 were met. For phantom stocks granted in 2017, only
statements. Upon exercise of vested options, Fresenius SE & them. one quarter of the performance target was achieved. There-
Co. KGaA has the right to grant treasury shares in lieu of Phantom stock awards under the 2013 PSP entitle the fore, in 2020, three quarters of the phantom stocks granted
increasing capital by the issuance of new shares. holder to receive a cash payment. Each phantom stock award in 2017 were forfeited.
After the expiration of the waiting period, all options in shall entitle the holder to receive the volume-weighted aver- The adjusted net income attributable to shareholders
respect of which the success target has been achieved may age stock market price (closing price) of the non-par value of Fresenius SE & Co. KGaA according to IFRS (currency ad-
be exercised at any time outside the designated blackout ordinary bearer share of Fresenius SE & Co. KGaA in the justed) and changes thereto compared to the adjusted net
Annual Report 2021
periods. electronic Xetra trading of Deutsche Börse AG in Frankfurt income according to IFRS (without currency adjustment) of
The last options were granted in 2017. am Main, or a comparable successor system, during the the relevant comparison year shall be verified with binding
last three months prior to the date the phantom stock is effect in each case by the auditors of Fresenius SE & Co.
exercised. KGaA on the basis of the audited consolidated financial
The exercise of phantom stock is subject to the condi- statements.
Fresenius
tion precedent, in each case, that the annual success target
372
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
After the expiration of the waiting period, all exercisable including 183,420 performance shares valued at €8 million Of the 6,117,024 outstanding stock options issued under
phantom stocks will be deemed to be exercised and cashed to the members of the Management Board of Fresenius the 2013 LTIP, 5,633,679 were exercisable at December 31,
out on March 1 following the end of the waiting period (or Management SE. The fair value per performance share at 2020. The members of the Fresenius Management SE
the following banking day). At December 31, 2021, the pro- the grant date was €41.98. Management Board held 890,156 stock options. 231,684
vision for phantom stocks issued in 2017 that will be exer- During the fiscal year 2021, Fresenius SE & Co. KGaA phantom stocks issued under the 2013 LTIP were outstand-
cised and paid out on March 1, 2022, amounted to €1 mil- received cash of €32 million from the exercise of 961,234 ing at December 31, 2020. The members of the Fresenius
lion. At December 31, 2020, the provision for phantom stock options. The average stock price of the ordinary share Management SE Management Board held 35,464 phantom
stocks issued in 2016 that were exercised and paid out at the exercise date was €44.32. stocks. At December 31, 2020, the Management Board
on March 1, 2021, amounted to €7 million. During the fiscal year 2020, Fresenius SE & Co. KGaA members of Fresenius Management SE held 467,335 per-
The last phantom stocks were granted in 2017. received cash of €5 million from the exercise of 160,930 formance shares and employees of Fresenius SE & Co. KGaA
stock options. The average stock price of the ordinary share held 1,684,235 performance shares under the LTIP 2018.
Transactions during 2021 and 2020 at the exercise date was €40.63. Stock option transactions are summarized as follows:
On September 13, 2021, Fresenius SE & Co. KGaA awarded At December 31, 2021, 4,967,507 stock options issued
Weighted
915,105 performance shares under the LTIP 2018, the total under the 2013 LTIP were outstanding and exercisable. average
Ordinary shares exercise price Number of options
fair value at the grant date being €41 million, including The members of the Fresenius Management SE Manage- December 31 Number of options in € exercisable
193,800 performance shares valued at €9 million to the ment Board held 603,281 stock options. 38,592 phantom Balance 2019 8,435,555 58.34 4,245,296
members of the Management Board of Fresenius Manage- stocks issued under the 2013 LTIP were outstanding at exercised 160,930 33.78
ment SE. The fair value per performance share at the grant December 31, 2021. The members of the Fresenius Manage- forfeited 2,157,601 71.23
Balance 2020 6,117,024 54.44 5,633,679
date was €44.75. ment SE Management Board held 5,059 phantom stocks. exercised 961,234 32.82
On September 14, 2020, Fresenius SE & Co. KGaA At December 31, 2021, the Management Board members forfeited 168,033 63.77
awarded 924,237 performance shares under the LTIP 2018, of Fresenius Management SE held 582,234 performance expired 20,250 32.12
Balance 2021 4,967,507 58.40 4,967,507
the total fair value at the grant date being €39 million, shares and employees of Fresenius SE & Co. KGaA held
2,367,562 performance shares under the LTIP 2018.
Annual Report 2021
Fresenius
373
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The following tables provide a summary of outstanding and exercisable options for ordinary shares at December 31:
December 31, 2021
Options outstanding and exercisable
Weighted average
Range of
remaining Weighted average
exercise prices contractual life exercise price
in € Number of options in years in €
35,01 --- 40,00 1,144,742 0.58 36.92
60,01 --- 65,00 1,616,095 1.59 60.66
65,01 --- 70,00 1,741,963 2.57 66.05
70,01 --- 75,00 464,707 3.58 74.77
4,967,507 1.89 58.40
December 31, 2020
Options outstanding Options exercisable
Weighted average Weighted average
Range of
remaining Weighted average remaining Weighted average
exercise prices contractual life exercise price contractual life exercise price
in € Number of options in years in € Number of options in years in €
30,01 --- 35,00 868,831 0.63 32.27 868,831 0.63 32.27
35,01 --- 40,00 1,261,520 1.58 36.92 1,261,520 1.58 36.92
60,01 --- 65,00 1,683,220 2.59 60.66 1,675,440 2.58 60.64
65,01 --- 70,00 1,827,888 3.57 66.05 1,827,888 3.57 66.05
70,01 --- 75,00 475,565 4.58 74.77 ---
6,117,024 2.55 54.44 5,633,679 2.38 52.71
At December 31, 2021, the aggregate intrinsic value of
exercisable options for ordinary shares was -€114 million
(December 31, 2020: -€84 million).
At December 31, 2021, there was no unrecognized
compensation cost related to non-vested options granted
under the 2013 LTIP (December 31, 2020: €1 million).
Annual Report 2021
Fresenius
374
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
SHARE-BASED COMPENSATION PLANS OF Plan 2016 (LTIP 2016) terminated. Furthermore, as of Janu- For the members of the management boards of affiliated
FRESENIUS MEDICAL CARE AG & CO. KGAA ary 1, 2020, the issuance of performance shares under the companies and managerial staff members, the Manage-
As of December 31, 2021, Fresenius Medical Care AG & Co. Fresenius Medical Care Management Board Long Term ment Board of FMC Management AG has approved and
KGaA (FMC-AG & Co. KGaA) has various share-based com- Incentive Plan 2019 (MB LTIP 2019) is no longer possible. adopted the FMC-AG & Co. KGaA Long Term Incentive
pensation plans, which may either be equity- or cash-settled. In order to continue to enable the members of the Man- Plan 2019 (LTIP 2019) effective January 1, 2019.
agement Board, the members of the management boards The LTIP 2016, the MB LTIP 2019, the LTIP 2019 and
Fresenius Medical Care AG & Co. KGaA long-term of affiliated companies and managerial staff members to the MB LTIP 2020 are each variable compensation pro-
incentive plans during 2016 --- 2021 (Performance adequately participate in the long-term, sustained success grams with long-term incentive effects which allocate or
Shares) of Fresenius Medical Care, successor programs were intro- allocated so-called performance shares. Performance
As of May 11, 2016, the issuance of stock options and duced. For members of the Management Board, the Super- shares are non-equity, cash-settled virtual compensation
phantom stocks under the FMC-AG & Co. KGaA Long Term visory Board of Fresenius Medical Care Management AG instruments which may entitle plan participants to receive
Incentive Program 2011 (LTIP 2011) terminated. Further- (FMC Management AG) has approved and adopted the a cash payment depending on the achievement of pre-
more, as of January 1, 2019, the issuance of performance Fresenius Medical Care Management Board Long Term In- defined performance targets further defined below as well
shares under the FMC-AG & Co. KGaA Long Term Incentive centive Plan 2020 (MB LTIP 2020) effective January 1, 2020. as FMC-AG & Co. KGaA’s share price development.
The following table provides an overview of these plans.
MB LTIP 2020 LTIP 2019 MB LTIP 2019 LTIP 2016
Members of the
Members of the Members of the Management Board and
Eligible persons Management Board Other plan participants Management Board other plan participants
Years in which an allocation occurred 2020 - 2021 2019 - 2021 2019 2016 - 2018
November (2020),
Months in which an allocation occurred March (2021) July, December July, December July, December
Under the current compensation system, the Supervisory during a fiscal year, the amount to be allocated to such receives his or her base salary at the time of the allocation.
Board of FMC Management AG defines an initial value for member can be pro-rated. For plan participants other than In order to determine the number of performance shares
each Management Board member’s allocation by applying the members of the Management Board, the determination each plan participant receives, the respective allocation
a multiplier to the relevant base salary. Such allocation of the allocation value will be made by the Management value will be divided by the value per performance share
Annual Report 2021
value equals 135% (multiplier of 1.35) of the relevant base Board, taking into account the individual responsibility of at the time of the allocation, which is mainly determined
salary. In case of appointments to the Management Board each plan participant. The initial allocation value is deter- based on the average price of FMC-AG & Co. KGaA’s shares
mined in the currency in which the respective participant over a period of 30 calendar days prior to the respective
allocation date.
Fresenius
375
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The number of allocated performance shares may change In addition to the three performance targets above, and Revenue, net income and ROIC are determined according
over the performance period of three years, depending on for the LTIP 2019 exclusively, the level of achievement for to FMC-AG & Co. KGaA’s consolidated reported and audited
the level of achievement of the following: (i) revenue growth performance shares allocated in year 2019 may be subject figures in euro for the financial statements prepared in
at constant currency (revenue growth), (ii) growth of the to an increase if certain targets in relation to the second accordance with IFRS, applying the respective plan terms.
net income attributable to the shareholders of FMC-AG & phase of FMC-AG & Co. KGaA’s Global Efficiency Program Revenue growth, net income growth and the fulfillment of
Co. KGaA at constant currency (net income growth) and (GEP-II targets) and in relation to the free cash flow (free the GEP-II targets, for the purpose of the relevant plan, are
(iii) return on invested capital (ROIC). cash flow target) are achieved. determined at constant currency.
Performance targets
The performance targets and the target values to be applied for the fiscal year 2021 for performance shares allocated in the
fiscal year under the MB LTIP 2020 and under the LTIP 2019 are presented in the table below.
Target values Target achievement Weight
≤1% 0%
Performance target 1:
6% 100% 1/3
Revenue Growth
≥11% 200%
≤0% 0%
Performance target 2:
5% 100% 1/3
Net Income Growth
≥10% 200%
≤5.5% 0%
Performance target 3:
6% 100% 1/3
ROIC
≥6.5% 200%
If revenue growth, net income growth or ROIC range lead to a target achievement level of 0% and the maximum be reached if net income growth is 5%. In case of net
between these values, the respective degree of target target achievement level of 200% will be reached in case of income growth of 0%, the target achievement level will
achievement will be linearly interpolated between these revenue growth of at least 11%. If revenue growth ranges also be 0%; the maximum target achievement of 200%
values. between these values, the degree of target achievement will will be reached in the case of net income growth of at
For performance shares allocated in 2020, for the fiscal be linearly interpolated between these values. least 10%. If net income growth ranges between these
years 2020 and 2021, an annual target achievement level of For performance shares allocated in 2020, for the fiscal values, the degree of target achievement will be linearly
100% will be reached for the revenue growth performance years 2020 and 2021, an annual target achievement level of interpolated between these values.
Annual Report 2021
target if revenue growth is 6%; revenue growth of 1% will 100% for the net income growth performance target will
Fresenius
376
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
For performance shares allocated in 2020, for the fiscal 2016, 7.5% for 2017, 7.7% for 2018, 7.9% for 2019, 8.1% between 0% and 200%, the increase of the overall target
years 2020 and 2021, an annual target achievement level of for 2020 and 8.1% for 2021. A target achievement level of achievement will be calculated by means of linear interpola-
100% for the ROIC performance target will be reached if 0% will be reached if the ROIC falls below the target ROIC tion. The overall target achievement shall not exceed 200%.
ROIC is 6.0%. In case of a ROIC of 5.5%, the target achieve- for the applicable year by 0.2 percentage points or more, The number of performance shares allocated to the plan
ment level will be 0%; the maximum target achievement whereas the maximum target achievement level of 200% participants at the beginning of the performance period will
of 200% will be reached in the case of a ROIC of at least will be reached if the target ROIC for the respective year is each be multiplied by the level of overall target achievement
6.5%. Between these values, the degree of target achieve- exceeded by 0.2 percentage points or more. The degree of in order to determine the final number of performance
ment will be determined by means of linear interpolation. target achievement will be determined by means of linear shares.
For performance shares allocated throughout 2016 to interpolation if the ROIC ranges between these values. In
2019, for each individual year of the three-year performance case the annual ROIC target achievement level in the third Vesting conditions
period, an annual target achievement level of 100% will be year of a performance period for performance shares allo- For the MB LTIP 2020, the final number of performance
reached for the revenue growth performance target if reve- cated throughout years 2016 to 2019 is equal to or higher shares is generally deemed earned three years after the day
nue growth is 7%; revenue growth of 0% will lead to a than the ROIC target achievement level in each of the of an allocation. The number of such vested performance
target achievement level of 0% and the maximum target two previous years of such performance period, the ROIC shares is then multiplied by the average FMC-AG & Co.
achievement level of 200% will be reached in case of reve- target achievement level of the third year is deemed to be KGaA share price over a period of 30 calendar days prior
nue growth of at least 16%. If revenue growth ranges achieved for all years of the applicable performance period. to the lapse of this vesting period. The respective resulting
between these values, the degree of target achievement For all plans, the achievement level for each of the three amount, which is capped in total at an amount equaling
will be linearly interpolated between these values. performance targets will be weighted annually at one-third 400% of the allocation value received by the participant
For performance shares allocated throughout 2016 to determine the yearly target achievement for each year of and which can be reduced to meet the respective maximum
to 2019, for each individual year of the three-year perfor- the three-year performance period. The level of overall tar- compensation of the participant, less taxes and contribu-
mance period, an annual target achievement level of 100% get achievement over the three-year performance period tions, is transferred to a credit institution which uses it for
for the net income growth performance target will be will then be determined on the basis of the mean of these the purchase of shares of FMC-AG & Co. KGaA on the stock
reached if net income growth is 7%. In case of net income three average yearly target achievements. The overall tar- exchange on behalf of the participant. The shares acquired
growth of 0%, the target achievement level will also be get achievement can be in a range of 0% to 200%. For in this way are subject to a holding period of at least one
0%; the maximum target achievement of 200% will be performance shares allocated in fiscal year 2019 under year. After the lapse of this holding period, the participant
reached in the case of net income growth of at least 14%. the LTIP 2019, the overall target achievement shall be can decide to further hold or sell these shares.
Between these values, the degree of target achievement increased by 20 percentage points if the GEP-II targets For the LTIP 2019, the final number of performance
will be determined by means of linear interpolation. achievement is 100%. Furthermore, the overall target shares is generally deemed earned three years after the
Annual Report 2021
For Performance Shares allocated throughout 2016 to achievement for performance shares allocated in year day of a respective allocation. The number of such vested
2019, an annual target achievement level of 100% for ROIC 2019 under the LTIP 2019 shall be increased by 20 per- performance shares is then multiplied by the average FMC-
will be reached if the target ROIC as defined for the appli- centage points if the free cash flow target achievement AG & Co. KGaA share price over a period of 30 calendar
cable year is reached. For performance shares allocated is 200%. In case of a GEP-II targets achievement between days prior to the lapse of this vesting period. The respective
throughout 2016 to 2019, the target ROIC is 7.3% for 0% and 100% and a free cash flow target achievement
Fresenius
377
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
resulting amount, which is capped in total at an amount was established by resolution of FMC Management AG’s Phantom stock awards under the LTIP 2011 entitled the
equaling 400% of the allocation value received by the par- Management and Supervisory Boards, forms FMC-AG & Co. holders to receive payment in euro from FMC-AG & Co.
ticipant, will then be paid to the plan participants as cash KGaA’s Long Term Incentive Program 2011 (LTIP 2011). KGaA upon exercise of the phantom stock. The payment
compensation. Under the LTIP 2011, participants were granted awards, per phantom stock in lieu of the issuance of such stock was
For the MB LTIP 2019, the final number of performance which consisted of a combination of stock options and based upon the share price on the Frankfurt Stock Exchange
shares is generally deemed earned four years after the day phantom stocks. The final grant under the LTIP 2011 was of one of FMC-AG & Co. KGaA’s shares on the exercise date.
of a respective allocation. The number of such vested per- made in December 2015. Awards under the LTIP 2011 were Phantom stock awards had a five-year term and could be
formance shares is then multiplied by the average FMC- subject to a four-year vesting period. Vesting of the awards exercised for the first time after a four-year vesting period.
AG & Co. KGaA share price over a period of 30 calendar granted was subject to achievement of predefined perfor- For participants who were U.S. taxpayers, the phantom stock
days prior to the lapse of this vesting period. The resulting mance targets. The 2011 SOP was established with a condi- was deemed to be exercised in any event in the month of
amount will then be paid to the plan participants as cash tional capital increase up to €12 million subject to the issue March following the end of the vesting period.
compensation. of up to 12 million non-par value bearer ordinary shares with
For the LTIP 2016, the final number of performance a nominal value of €1.00 per share. Transactions during 2021 and 2020
shares is generally deemed earned four years after the day Stock options granted under the LTIP 2011 have an During 2021, FMC-AG & Co. KGaA allocated 192,446 perfor-
of an allocation. The number of such vested performance eight-year term and can be exercised for the first time after mance shares under the MB LTIP 2020 at a measurement
shares is then multiplied by the average FMC-AG & Co. KGaA a four-year vesting period. The exercise price of stock date weighted average fair value of €54.69 each and a total
share price over a period of 30 calendar days prior to the options granted under the LTIP 2011 shall be the average fair value of €11 million, which will be revalued if the fair
lapse of this vesting period. The resulting amount will then stock exchange price on the Frankfurt Stock Exchange of value changes. The total fair value will be amortized over
be paid to the plan participants as cash compensation. FMC-AG & Co. KGaA’s shares during the 30 calendar days the vesting period.
immediately prior to each grant date. Stock options granted During 2021, FMC-AG & Co. KGaA allocated 935,814 per-
Fresenius Medical Care AG & Co. KGaA under the LTIP 2011 to U.S. participants are non-qualified formance shares under the LTIP 2019 at a measurement
Long Term Incentive Program 2011 (stock options stock options under the United States Internal Revenue date weighted average fair value of €53.27 each and a total
and phantom stocks) Code of 1986, as amended. Stock options under the LTIP fair value of €50 million, which will be revalued if the fair
On May 12, 2011, the Fresenius Medical Care AG & Co. 2011 are not transferable by a participant or a participant’s value changes. The total fair value will be amortized over
KGaA Stock Option Plan 2011 (2011 SOP) was established heirs, and may not be pledged, assigned, or disposed of the vesting period.
by resolution of Fresenius Medical Care AG & Co. KGaA’s otherwise.
(FMC-AG & Co. KGaA) Annual General Meeting. The 2011
SOP, together with the Phantom Stock Plan 2011, which
Annual Report 2021
Fresenius
378
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
During 2020, FMC-AG & Co. KGaA allocated 159,607 perfor- During 2020, FMC-AG & Co. KGaA allocated 800,165 per- During 2021, FMC-AG & Co. KGaA received cash of €6 mil-
mance shares under the MB LTIP 2020 at a measurement formance shares under the LTIP 2019 at a measurement lion from the exercise of stock options. The intrinsic value
date weighted average fair value of €64.20 each and a total date weighted average fair value of €64.06 each and a total of stock options exercised in 2021 was €2 million.
fair value of €10 million, which will be revalued if the fair fair value of €51 million, which will be revalued if the fair During 2020, FMC-AG & Co. KGaA received cash of
value changes. The total fair value will be amortized over value changes. The total fair value will be amortized over €12 million from the exercise of stock options. The intrinsic
the vesting period. the vesting period. value of stock options exercised in 2020 was €4 million.
Information on holdings under share-based plans
At December 31, the members of the Management Board and plan participants other than the members of the Management Board held the following performance shares under the
share-based plans:
2021 2020
Members of the Members of the
Performance Shares Management Board Other plan participants Total Management Board Other plan participants Total
MB LTIP 2020 352,053 --- 352,053 159,607 --- 159,607
LTIP 2019 8,869 2,399,649 2,408,518 8,869 1,522,102 1,530,971
MB LTIP 2019 102,435 12,564 114,999 102,435 12,564 114,999
LTIP 2016 56,624 366,059 422,683 135,473 947,133 1,082,606
Additionally, at December 31, 2021, the members of The table below provides reconciliations for options out-
the Management Board of FMC Management AG held standing at December 31, 2021, 2020 and 2019:
455,970 stock options (December 31, 2021: 465,308) and
Weighted average
plan participants other than the members of the Manage- Number of options exercise price
Stock options for shares in thousands in €
ment Board held 2,557,339 stock options (December 31,
Balance at December 31, 2019 3,489 70.32
2021: 2,735,766) under the 2011 SOP.
exercised1 235 53.00
expired 53 75.65
Balance at December 31, 2020 3,201 71.50
exercised2 128 49.83
expired 60 70.60
Balance at December 31, 2021 3,013 72.44
Annual Report 2021
1
The average share price at the date of exercise of the options was €71.75.
2
The average share price at the date of exercise of the options was €65.92.
Fresenius
379
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
The following tables provide a summary of fully vested options outstanding and exercisable at December 31, 2021 and
December 31, 2020, respectively:
December 31, 2021
Weighted average
Range of
remaining Weighted average
exercise prices contractual life exercise price
in € Number of options in years in €
45,01 --- 50,00 488,745 0.57 49.93
55,01 --- 60,00 31,080 0.92 58.63
75,01 --- 80,00 2,493,484 1.58 77.02
3,013,309 1.41 72.44
December 31, 2020
Weighted average
Range of
remaining Weighted average
exercise prices contractual life exercise price
in € Number of options in years in €
45,01 --- 50,00 630,870 1.44 49.91
55,01 --- 60,00 31,080 1.92 58.63
75,01 --- 80,00 2,539,124 2.58 77.03
3,201,074 2.35 71.50
37. RELATED PARTY TRANSACTIONS Fresenius Medical Care has entered into exclusive supply 38. SUBSEQUENT EVENTS
In 2021, €18 million (2020: €12 million) were paid to agreements to purchase certain pharmaceuticals from, as The months of January and February were characterized
Fresenius Management SE as compensation for the Manage- well as certain exclusive distribution agreements with, its worldwide by a regionally varying development of the
ment Board and the Supervisory Board, general partners’ associate Vifor Fresenius Medical Care Renal Pharma Ltd. COVID-19 pandemic with again significantly rising infec-
fees and other reimbursements of out-of pocket expenses. Under the terms of certain unconditional purchase agree- tion numbers, particularly due to the Omikron variant.
At December 31, 2021, there were outstanding liabilities ments, Fresenius Medical Care is obligated to purchase Large-scale constraints of public and private life are still
payable to Fresenius Management SE in the amount of approximately €1,240 million of pharmaceuticals, of enacted in various countries in order to curtail the spread
€49 million (December 31, 2020: €41 million), consisting which €298 million is committed at December 31, 2021 of COVID-19. The vaccination programs were continued
mainly of pension obligations and Management Board for 2022. The terms of these agreements extend over four worldwide and the development in each country differs. The
compensation (see page 234 ff.). years. In the fiscal year 2021, the Fresenius Group pur- further development of the global situation and its impact on
Annual Report 2021
The aforementioned payments are net amounts. In addi- chased goods and services in a total amount of €446 mil- Fresenius remain uncertain. Cost inflation and supply chain
tion, VAT was paid. lion from Vifor Fresenius Medical Care Renal Pharma Ltd. disruption continue to be a theme on a global level.
In 2021 and 2020, the Else Kröner-Fresenius-Stiftung (2020: €474 million).
was paid the dividends which it is entitled as a shareholder
in the ordinary share capital of Fresenius SE & Co. KGaA.
Fresenius
380
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
Beyond that, there have been no significant changes in the €7,455 thousand (2020: €8,348 thousand is performance- defined contribution plans. The amount of the benefits is
Fresenius Group’s operating environment following the end based. The amount of the short-term performance-based calculated based on the amount of the pensionable income
of the fiscal year 2021 until February 21, 2022. No other compensation depends on the achievement of targets relat- and is generally paid out in installments or as a lump sum
events of material importance on the assets and liabilities, ing to the net income and the sales of the Fresenius Group upon retirement or attainment of retirement age.
financial position, and results of operations of the Group and the business segments as well as on the achievement The total compensation paid to the Supervisory Board
have occurred following the end of the fiscal year. of sustainability criteria. As a long-term incentive compo- of Fresenius SE & Co. KGaA and its committees was €2,502
nent, the members of the Management Board received thousand in 2021 (2020: €1,990 thousand). The total com-
39. COMPENSATION OF THE MANAGEMENT 193,800 performance shares of Fresenius SE & Co. KGaA pensation paid to the Supervisory Board of Fresenius Man-
BOARD AND THE SUPERVISORY BOARD (2020: 183,420) and 40,894 performance shares of Fresenius agement SE and its committees was €1,353 thousand in
Detailed and individualized information regarding the com- Medical Care AG & Co. KGaA (2020: 35.030) in the equiva- 2021 (2020: €940 thousand).
pensation of the members of the Management Board and lent value of €10,979 thousand (2020: €9,870 thousand). The members of the Supervisory Board receive a fixed
of the Supervisory Board is disclosed in the Compensation The total compensation of the Management Board was compensation, fringe benefits (consisting of reimbursement
Report. €27,036 thousand (2020: €25,070 thousand). of expenses and insurance coverage) and, if they perform
The compensation of the Management Board of In the fiscal year 2021, the Fresenius Group recognized any duties on the Audit Committee of the Supervisory Board,
Fresenius Management SE is, as a whole, performance- expense, under IFRS, from share-based compensation remuneration for this committee activity. At the end of the
based and geared towards promoting sustainable corporate plans for the Management Board of €1,131 thousand fiscal year, there were outstanding balances for the remu-
development. It is composed of the following elements: (2020: income of €1,374 thousand), a cost for pension neration of the members of the supervisory boards amount-
plans for the members of the Management Board of €5,774 ing to €3,855 thousand (2020: €2,930 thousand). In addi-
► non-performance-based compensation thousand (2020: income of €424 thousand) and expenses tion, the employee representatives on the Supervisory Board
(fixed compensation and fringe benefits) for early termination of service agreements of €6,336 thou- receive a regular salary from their respective employment
► short-term performance-based compensation sand (2020: €1,210 thousand). In accordance with IFRS, contracts.
(one-year variable compensation (bonus)) the total compensation expense for the Management In 2021, based on pension commitments to former mem-
► components with long-term incentive effects Board recognized in the statement of income amounted bers of the Management Board, €8,102 thousand (2020:
(multi-year variable compensation comprising to €29,298 thousand (2020: €14,429thousand). In addition, €1,461 thousand) was paid. The pension obligation accord-
performance shares and postponed payments of there were outstanding balances of €53,158 thousand ing to IFRS for these persons amounted to €34,714 thousand
the one-year variable compensation / of the bonus) (2020: €61,096 thousand) for members of the Management in 2021 (2020: €23,867 thousand).
Board at the end of the fiscal year, mainly for pension com- In the fiscal years 2021 and 2020, no loans or advance
The cash compensation paid to the Management Board for mitments and performance-related compensation. Terms payments on future compensation components were granted
Annual Report 2021
the performance of its responsibilities was €16,057 thou- and conditions of long-term variable compensation are to any member of the Management Board of Fresenius
sand (2020: €15,017 thousand). Thereof, €8,602 thousand detailed under note 36, Share-based compensation plans. Management SE.
(2020: €6,669 thousand) is not performance-based and Pension commitments arise under defined benefit and
Fresenius
381
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
40. AUDITOR’S FEES
In 2021 and 2020, fees for the auditor PricewaterhouseCoopers GmbH, Frankfurt am Main (PwC), and its affiliates were expensed as follows:
2021 2020
€ in millions Total Germany Total Germany
Audit fees 23 8 20 7
Audit-related fees 3 3 3 2
Tax consulting fees 1 --- 1 0
Other fees 2 2 5 5
Total auditor’s fees 29 13 29 14
The leading auditor has been responsible for the audit of 41. CORPORATE GOVERNANCE
the consolidated financial statements since 2020. For each consolidated stock exchange listed entity, the
In the fiscal year 2021, both worldwide and in Germany, declaration pursuant to Section 161 of the German Stock
audit-related fees and other fees mainly related to the review Corporation Act (Aktiengesetz) has been issued and made
of quarterly financial statements, audit services for the Ger- available to shareholders on the website of Fresenius SE &
man hospitals of the Fresenius Group and in connection Co. KGaA (www.fresenius.com / corporate-governance),
with financing activities and consulting fees with regard and of Fresenius Medical Care AG & Co. KGaA
to corporate governance. In 2021, tax consulting fees (www.freseniusmedicalcare.com).
related to general tax consulting.
Annual Report 2021
Fresenius
382
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
► Notes | Responsibility statement | Auditor‘s report
42. PROPOSAL FOR THE DISTRIBUTION The Management Board of Fresenius Management SE
OF EARNINGS will propose a scrip dividend to the Supervisory Board.
The general partner and the Supervisory Board of Fresenius wants to give its shareholders the opportunity
Fresenius SE & Co. KGaA propose to the Annual General to opt to receive a portion of the dividend (Dividend Option
Meeting that the earnings for 2021 of Fresenius SE & Co. Portion) in Fresenius SE & Co. KGaA shares. The remaining
KGaA are distributed as follows: portion of the dividend (Dividend Base Portion) will always
be paid in cash.
in €
Payment of a dividend of €0.92 per bearer
ordinary share on the 558,502,143 ordinary
shares entitled to dividend 513,821,971.56
Balance to be carried forward 52,789.29
Retained earnings 513,874,760.85
Bad Homburg v. d. H., February 21, 2022
Fresenius SE & Co. KGaA,
represented by:
Fresenius Management SE, its general partner
The Management Board
S. Sturm Dr. S. Biedenkopf Dr. F. De Meo R. Empey
Annual Report 2021
Fresenius
R. Powell M. Sen Dr. E. Wastler
383
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes ► Responsibility statement | Auditor‘s report
RESPONSIBILITY STATEMENT Group management report includes a fair review of the
‘‘To the best of our knowledge, and in accordance with the development and performance of the business and the
applicable reporting principles, the consolidated financial position of the Group, together with a description of the
statements give a true and fair view of the assets, liabilities, principal opportunities and risks associated with the
financial position and profit or loss of the Group, and the expected development of the Group.’’
Bad Homburg v. d. H., February 21, 2022
Fresenius SE & Co. KGaA,
represented by:
Fresenius Management SE, its general partner
The Management Board
S. Sturm Dr. S. Biedenkopf Dr. F. De Meo R. Empey
R. Powell M. Sen Dr. E. Wastler
Annual Report 2021
Fresenius
384
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement ► Auditor‘s report
The following copy of the auditor's report also includes a In our opinion, on the basis of the knowledge obtained in Wirtschaftsprüfer [Institute of Public Auditors in Germany]
"Report on the audit of the electronic renderings of the the audit, (IDW). We performed the audit of the consolidated financial
consolidated financial statements and the group manage- statements in supplementary compliance with the Interna-
ment report prepared for disclosure purposes in accord- ► the accompanying consolidated financial statements tional Standards on Auditing (ISAs). Our responsibilities
ance with § 317 Abs. 3b HGB" ("Separate report on ESEF comply, in all material respects, with the IFRSs as under those requirements, principles and standards are
conformity"). The subject matter (ESEF documents to be adopted by the EU and the additional requirements of further described in the ‘‘Auditor’s Responsibilities for the
audited) to which the separate report on ESEF conformity German commercial law pursuant to § [Article] 315e Audit of the Consolidated Financial Statements and of the
relates is not attached. The audited ESEF documents can Abs. [paragraph] 1 HGB [Handelsgesetzbuch: German Group Management Report‘‘ section of our auditor’s report.
be inspected in or retrieved from the Federal Gazette. Commercial Code] and, in compliance with these We are independent of the group entities in accordance
requirements, give a true and fair view of the assets, with the requirements of European law and German com-
Note: This is a translation of the German original. Solely liabilities, and financial position of the Group as at mercial and professional law, and we have fulfilled our
the original text in German language is authoritative. 31 December 2021, and of its financial performance other German professional responsibilities in accordance
for the financial year from 1 January to 31 December with these requirements. In addition, in accordance with
INDEPENDENT AUDITOR’S REPORT 2021, and Article 10 (2) point (f) of the EU Audit Regulation, we
► the accompanying group management report as a whole declare that we have not provided non-audit services pro-
To Fresenius SE & Co. KGaA, Bad Homburg v. d. Höhe provides an appropriate view of the Group’s position. hibited under Article 5 (1) of the EU Audit Regulation. We
In all material respects, this group management report believe that the audit evidence we have obtained is suffi-
REPORT ON THE AUDIT OF THE CONSOLIDATED is consistent with the consolidated financial statements, cient and appropriate to provide a basis for our audit opin-
FINANCIAL STATEMENTS AND OF THE GROUP complies with German legal requirements and appro- ions on the consolidated financial statements and on the
MANAGEMENT REPORT priately presents the opportunities and risks of future group management report.
development.
Audit Opinions Key Audit Matters in the Audit of the Consolidated
We have audited the consolidated financial statements of Pursuant to § 322 Abs. 3 Satz [sentence] 1 HGB, we declare Financial Statements
Fresenius SE & Co. KGaA, Bad Homburg v. d. Höhe, and its that our audit has not led to any reservations relating to the Key audit matters are those matters that, in our profes-
subsidiaries (the Group), which comprise the consolidated legal compliance of the consolidated financial statements sional judgment, were of most significance in our audit of
statement of financial position as at 31 December 2021, and of the group management report. the consolidated financial statements for the financial year
and the consolidated statement of comprehensive income, from 1 January to 31 December 2021. These matters were
consolidated statement of profit or loss, consolidated state- Basis for the Audit Opinions addressed in the context of our audit of the consolidated
ment of changes in equity and consolidated statement of We conducted our audit of the consolidated financial state- financial statements as a whole, and in forming our audit
cash flows for the financial year from 1 January to 31 Decem- ments and of the group management report in accordance opinion thereon; we do not provide a separate audit opin-
ber 2021, and notes to the consolidated financial statements, with § 317 HGB and the EU Audit Regulation (No. 537 / 2014, ion on these matters.
including a summary of significant accounting policies. In referred to subsequently as ‘‘EU Audit Regulation’’) in com-
addition, we have audited the group management report of pliance with German Generally Accepted Standards for
Fresenius SE & Co. KGaA for the financial year from 1 Janu- Financial Statement Audits promulgated by the Institut der
ary to 31 December 2021.
385
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement ► Auditor‘s report
In our view, the matter of most significance in our audit The recoverable amount is generally determined using 2. As part of our audit, we assessed with the support of
was as follows: the value in use. The present value of the future cash our internal valuation specialists the methodology used
flows from the respective cash-generating units normally for the purposes of performing the impairment test,
I. Recoverability of goodwill serves as the basis of valuation. Present values are cal- among other things. In doing so, we also assessed the
culated using discounted cash flow models. For this pur- acceptability of projecting beyond the budget period.
Our presentation of this key audit matter has been structured pose, the approved three-year budgets as well as projec- Moreover, we reconciled, among other things, the
as follows: tions for years 4 to 10 of the respective cash-generating future cash inflows used for the calculation with the
units form the starting point which are extrapolated approved three-year budgets and projections for years
1. Matter and issue based on assumptions about long-term rates of growth. 4 to 10 of the respective cash-generating units. In doing
2. Audit approach and findings Expectations relating to future market developments so, we also assessed the appropriateness of the calcula-
3. Reference to further information and assumptions about the development of macroeco- tion including the applied growth rates, in particular
nomic factors are also taken into account. In addition, by reconciling it with underlying documentation, the
Hereinafter we present the key audit matter: expectations about the continuation of the Corona pan- expected growth rate in respective markets and general
demic were formed and the corresponding effects on and sector-specific market expectations. In this connec-
I. Recoverability of goodwill the budgets of the respective cash-generating units tion, we also evaluated the assessment of the executive
were taken into account. The discount rate used is the directors regarding the effects of the Corona pandemic
1. In the Company's consolidated financial statements weighted average cost of capital for the respective cash- on the budgets of the respective cash-generating units
goodwill amounting in total to EUR 28.943 Mio (40,2% generating units. The impairment test determined that and examined how they were taken into account in esti-
of total assets or 98,8% of equity) is reported under the no write-downs were necessary. mating the future cash flows. In addition, we assessed
"Goodwill" balance sheet item. Goodwill is tested for The outcome of this valuation is dependent to a large the appropriate consideration of the costs of Group
impairment by the Company once a year or when there extent on the estimates made by the executive directors functions. In the knowledge that even relatively small
are indications of impairment to determine any possible with respect to the future cash inflows from the respec- changes in the discount rate or the growth rates applied
need for write-downs. The impairment test is carried out tive cash-generating units, the discount rate used, the can have a material impact on the value of the entity
at the level of the cash-generating units to which the rele- rate of growth and other assumptions, and is therefore calculated in this way, we focused our testing in partic-
vant goodwill is allocated individually or as a group. The also against the background of the ongoing Corona pan- ular on the parameters used to determine the discount
carrying amount of the relevant cash-generating units, demic, subject to considerable uncertainty. Against this rate as well as growth rates applied, and assessed the
including goodwill, is compared with the corresponding background and due to the complex nature of the valua- calculation models. In order to reflect the uncertainty
recoverable amount in the context of the impairment test. tion, this matter was of particular significance in the
context of our audit.
386
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement ► Auditor‘s report
inherent in the projections, we evaluated the sensitivity Our audit opinions on the consolidated financial statements true and fair view of the assets, liabilities, financial posi-
analyses performed by the Company and carried out and on the group management report do not cover the other tion, and financial performance of the Group. In addition,
our own sensitivity analyses for those groups of cash- information, and consequently we do not express an audit the executive directors are responsible for such internal
generating units with low headroom (recoverable amount opinion or any other form of assurance conclusion thereon. control as they have determined necessary to enable the
compared to carrying amount) and verified that the In connection with our audit, our responsibility is to preparation of consolidated financial statements that are
necessary disclosures were made in the notes to the read the other information mentioned above and, in so free from material misstatement, whether due to fraud or
consolidated financial statements. doing, to consider whether the other information error.
Overall, the valuation parameters and assumptions In preparing the consolidated financial statements, the
used by the executive directors are in line with our ► is materially inconsistent with the consolidated finan- executive directors are responsible for assessing the Group’s
expectations and are also within the ranges considered cial statements, with the group management report ability to continue as a going concern. They also have the
by us to be reasonable. disclosures audited in terms of content or with our responsibility for disclosing, as applicable, matters related
knowledge obtained in the audit, or to going concern. In addition, they are responsible for finan-
3. The Company's disclosures on the balance sheet item ► otherwise appears to be materially misstated. cial reporting based on the going concern basis of account-
"Goodwill" are contained in note 1. III. o), note 1.IV. a) ing unless there is an intention to liquidate the Group or to
and note 20 of the notes to the consolidated financial If, based on the work we have performed, we conclude cease operations, or there is no realistic alternative but to
statements. that there is a material misstatement of this other infor- do so.
mation, we are required to report that fact. We have Furthermore, the executive directors are responsible for
Other Information nothing to report in this regard. the preparation of the group management report that, as a
The executive directors are responsible for the other whole, provides an appropriate view of the Group’s position
information. Responsibilities of the Executive Directors and the and is, in all material respects, consistent with the consol-
The other information comprises Supervisory Board for the Consolidated Financial idated financial statements, complies with German legal
Statements and the Group Management Report requirements, and appropriately presents the opportunities
► the statement on corporate governance pursuant to The executive directors are responsible for the preparation and risks of future development. In addition, the executive
§ 289f HGB and § 315d HGB of the consolidated financial statements that comply, in all directors are responsible for such arrangements and
► the separate non-financial group report pursuant to material respects, with IFRSs as adopted by the EU and the measures (systems) as they have considered necessary to
§ 315b Abs. 3 HGB additional requirements of German commercial law pursu- enable the preparation of a group management report that
► the remuneration report pursuant to § 162 AktG ant to § 315e Abs. 1 HGB and that the consolidated financial is in accordance with the applicable German legal require-
[Aktiengesetz: German Stock Corporation Act], for statements, in compliance with these requirements, give a ments, and to be able to provide sufficient appropriate evi-
which the supervisory board is also responsible dence for the assertions in the group management report.
► all remaining parts of the annual report --- excluding
cross-references to external information --- with the
exception of the audited consolidated financial state-
ments, the audited group management report and
our auditor’s report
387
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement ► Auditor‘s report
The supervisory board is responsible for overseeing the We exercise professional judgment and maintain profes- ► Conclude on the appropriateness of the executive
Group’s financial reporting process for the preparation of sional skepticism throughout the audit. We also: directors’ use of the going concern basis of accounting
the consolidated financial statements and of the group and, based on the audit evidence obtained, whether a
management report. ► Identify and assess the risks of material misstatement material uncertainty exists related to events or condi-
of the consolidated financial statements and of the tions that may cast significant doubt on the Group’s
Auditor’s Responsibilities for the Audit of the group management report, whether due to fraud or ability to continue as a going concern. If we conclude
Consolidated Financial Statements and of the error, design and perform audit procedures responsive that a material uncertainty exists, we are required to
Group Management Report to those risks, and obtain audit evidence that is suffi- draw attention in the auditor’s report to the related dis-
Our objectives are to obtain reasonable assurance about cient and appropriate to provide a basis for our audit closures in the consolidated financial statements and
whether the consolidated financial statements as a whole opinions. The risk of not detecting a material misstate- in the group management report or, if such disclosures
are free from material misstatement, whether due to fraud ment resulting from fraud is higher than for one result- are inadequate, to modify our respective audit opin-
or error, and whether the group management report as a ing from error, as fraud may involve collusion, forgery, ions. Our conclusions are based on the audit evidence
whole provides an appropriate view of the Group’s position intentional omissions, misrepresentations, or the over- obtained up to the date of our auditor’s report. How-
and, in all material respects, is consistent with the consoli- ride of internal controls. ever, future events or conditions may cause the Group
dated financial statements and the knowledge obtained in ► Obtain an understanding of internal control relevant to to cease to be able to continue as a going concern.
the audit, complies with the German legal requirements the audit of the consolidated financial statements and ► Evaluate the overall presentation, structure and con-
and appropriately presents the opportunities and risks of of arrangements and measures (systems) relevant to tent of the consolidated financial statements, including
future development, as well as to issue an auditor’s report the audit of the group management report in order to the disclosures, and whether the consolidated financial
that includes our audit opinions on the consolidated finan- design audit procedures that are appropriate in the cir- statements present the underlying transactions and
cial statements and on the group management report. cumstances, but not for the purpose of expressing an events in a manner that the consolidated financial state-
Reasonable assurance is a high level of assurance, but audit opinion on the effectiveness of these systems. ments give a true and fair view of the assets, liabilities,
is not a guarantee that an audit conducted in accordance ► Evaluate the appropriateness of accounting policies financial position and financial performance of the
with § 317 HGB and the EU Audit Regulation and in com- used by the executive directors and the reasonableness Group in compliance with IFRSs as adopted by the EU
pliance with German Generally Accepted Standards for of estimates made by the executive directors and related and the additional requirements of German commercial
Financial Statement Audits promulgated by the Institut der disclosures. law pursuant to § 315e Abs. 1 HGB.
Wirtschaftsprüfer (IDW) and supplementary compliance
with the ISAs will always detect a material misstatement.
Misstatements can arise from fraud or error and are con-
sidered material if, individually or in the aggregate, they
could reasonably be expected to influence the economic
decisions of users taken on the basis of these consolidated
financial statements and this group management report.
388
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement ► Auditor‘s report
► Obtain sufficient appropriate audit evidence regarding We also provide those charged with governance with a for publication purposes complies in all material respects
the financial information of the entities or business statement that we have complied with the relevant inde- with the requirements of § 328 Abs. 1 HGB for the electronic
activities within the Group to express audit opinions on pendence requirements, and communicate with them all reporting format (‘‘ESEF format’’). In accordance with Ger-
the consolidated financial statements and on the group relationships and other matters that may reasonably be man legal requirements, this assurance work extends only
management report. We are responsible for the direc- thought to bear on our independence, and where applica- to the conversion of the information contained in the con-
tion, supervision and performance of the group audit. ble, the related safeguards. solidated financial statements and the group management
We remain solely responsible for our audit opinions. From the matters communicated with those charged report into the ESEF format and therefore relates neither
► Evaluate the consistency of the group management with governance, we determine those matters that were of to the information contained within these renderings nor to
report with the consolidated financial statements, its most significance in the audit of the consolidated financial any other information contained in the electronic file identi-
conformity with German law, and the view of the statements of the current period and are therefore the key fied above.
Group’s position it provides. audit matters. We describe these matters in our auditor’s In our opinion, the rendering of the consolidated finan-
► Perform audit procedures on the prospective infor- report unless law or regulation precludes public disclosure cial statements and the group management report con-
mation presented by the executive directors in the about the matter. tained in the electronic file identified above and prepared
group management report. On the basis of sufficient for publication purposes complies in all material respects
appropriate audit evidence we evaluate, in particular, OTHER LEGAL AND REGULATORY with the requirements of § 328 Abs. 1 HGB for the electronic
the significant assumptions used by the executive REQUIREMENTS reporting format. Beyond this assurance opinion and our
directors as a basis for the prospective information, audit opinion on the accompanying consolidated financial
and evaluate the proper derivation of the prospective REPORT ON THE ASSURANCE ON THE ELECTRONIC statements and the accompanying group management
information from these assumptions. We do not express RENDERING OF THE CONSOLIDATED FINANCIAL report for the financial year from 1 January to 31 December
a separate audit opinion on the prospective information STATEMENTS AND THE GROUP MANAGEMENT 2021 contained in the "Report on the Audit of the Consoli-
and on the assumptions used as a basis. There is a REPORT PREPARED FOR PUBLICATION PURPOSES dated Financial Statements and on the Group Management
substantial unavoidable risk that future events will IN ACCORDANCE WITH § 317 ABS. 3A HGB Report" above, we do not express any assurance opinion on
differ materially from the prospective information. the information contained within these renderings or on
Assurance Opinion the other information contained in the electronic file identi-
We communicate with those charged with governance We have performed assurance work in accordance with fied above.
regarding, among other matters, the planned scope and § 317 Abs. 3a HGB to obtain reasonable assurance as to
timing of the audit and significant audit findings, including whether the rendering of the consolidated financial state- Basis for the Assurance Opinion
any significant deficiencies in internal control that we iden- ments and the group management report (hereinafter We conducted our assurance work on the rendering of the
tify during our audit. the ‘‘ESEF documents’’) contained in the electronic file consolidated financial statements and the group manage-
FSE_KGaA_KA_KLB_ESEF-2021-12-31.zip and prepared ment report contained in the electronic file identified
above in accordance with § 317 Abs. 3a HGB and the IDW
Assurance Standard: Assurance Work on the Electronic
389
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement ► Auditor‘s report
Rendering, of Financial Statements and Management Group Auditor’s Responsibilities for the Assurance ► Evaluate whether the ESEF documents provide an
Reports, Prepared for Publication Purposes in Accordance Work on the ESEF Documents XHTML rendering with content equivalent to the
with § 317 Abs. 3a HGB (IDW AsS 410 (10.2021)) and the Our objective is to obtain reasonable assurance about audited consolidated financial statements and to the
International Standard on Assurance Engagements 3000 whether the ESEF documents are free from material non- audited group management report.
(Revised). Our responsibility in accordance therewith is compliance with the requirements of § 328 Abs. 1 HGB, ► Evaluate whether the tagging of the ESEF documents
further described in the "Group Auditor’s Responsibilities whether due to fraud or error. We exercise professional with Inline XBRL technology (iXBRL) in accordance
for the Assurance Work on the ESEF Documents" section. judgment and maintain professional skepticism through- with the requirements of Articles 4 and 6 of the Dele-
Our audit firm applies the IDW Standard on Quality Man- out the assurance work. We also: gated Regulation (EU) 2019 / 815, in the version in
agement 1: Requirements for Quality Management in the force at the date of the consolidated financial state-
Audit Firm (IDW QS 1). ► Identify and assess the risks of material non-compliance ments, enables an appropriate and complete machine-
with the requirements of § 328 Abs. 1 HGB, whether due readable XBRL copy of the XHTML rendering.
Responsibilities of the Executive Directors and the to fraud or error, design and perform assurance proce-
Supervisory Board for the ESEF Documents dures responsive to those risks, and obtain assurance FURTHER INFORMATION PURSUANT TO
The executive directors of the Company are responsible for evidence that is sufficient and appropriate to provide ARTICLE 10 OF THE EU AUDIT REGULATION
the preparation of the ESEF documents including the elec- a basis for our assurance opinion. We were elected as group auditor by the annual general
tronic renderings of the consolidated financial statements ► Obtain an understanding of internal control relevant to meeting on 21 May 2021. We were engaged by the super-
and the group management report in accordance with § 328 the assurance work on the ESEF documents in order visory board on 13 October 2021. We have been the group
Abs. 1 Satz 4 Nr. [number] 1 HGB and for the tagging of to design assurance procedures that are appropriate in auditor of the Fresenius SE & Co. KGaA, Bad Homburg v. d.
the consolidated financial statements in accordance with the circumstances, but not for the purpose of express- Höhe, without interruption since the financial year 2020.
§ 328 Abs. 1 Satz 4 Nr. 2 HGB. ing an assurance opinion on the effectiveness of these We declare that the audit opinions expressed in this audi-
In addition, the executive directors of the Company are controls. tor’s report are consistent with the additional report to the
responsible for such internal control as they have considered ► Evaluate the technical validity of the ESEF documents, audit committee pursuant to Article 11 of the EU Audit Regu-
necessary to enable the preparation of ESEF documents that i.e., whether the electronic file containing the ESEF lation (long-form audit report).
are free from material non-compliance with the requirements documents meets the requirements of the Delegated
of § 328 Abs. 1 HGB for the electronic reporting format, Regulation (EU) 2019 / 815 in the version in force at
whether due to fraud or error. the date of the consolidated financial statements on
The supervisory board is responsible for overseeing the technical specification for this electronic file.
the process for preparing the ESEF documents as part of
the financial reporting process.
390
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Consolidated statement of income | Consolidated statement of comprehensive income | Consolidated statement of financial position
Consolidated statement of cash flows | Consolidated statement of changes in equity | Consolidated segment reporting
Notes | Responsibility statement ► Auditor‘s report
REFERENCE TO AN OTHER MATTER --- USE OF GERMAN PUBLIC AUDITOR RESPONSIBLE
THE AUDITOR’S REPORT FOR THE ENGAGEMENT
Our auditor’s report must always be read together with The German Public Auditor responsible for the engagement
the audited consolidated financial statements and the is Dr. Bernd Roese.
audited group management report as well as the assured
ESEF documents. The consolidated financial statements Frankfurt am Main, February 21, 2022
and the group management report converted to the ESEF
format --- including the versions to be published in the PricewaterhouseCoopers GmbH
Federal Gazette --- are merely electronic renderings of the Wirtschaftsprüfungsgesellschaft
audited consolidated financial statements and the audited
group management report and do not take their place. In
particular, the ‘‘Report on the Assurance on the Electronic
Rendering of the Consolidated Financial Statements and (Original German Version signed by:)
the Group Management Report Prepared for Publication
Purposes in Accordance with § 317 Abs. 3a HGB’’ and our Dr. Ulrich Störk Dr. Bernd Roese
assurance opinion contained therein are to be used solely Wirtschaftsprüfer Wirtschaftsprüfer
together with the assured ESEF documents made available (German Public Auditor) (German Public Auditor)
in electronic form.
391
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Boards | Glossary | Sources | Imprint
Financial calendar | Fresenius share / ADR | Contact
FURTHER
INFORMATION
393 Boards
397 Glossary
402 Sources
403 Imprint
404 Financial calendar
404 Fresenius share / ADR
404 Contact
6
Fresenius | Annual Report 2021
392
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
oards | Glossary | Source | Imprint
B
Financial calendar | Fresenius share / ADR | Contact
BOARDS
SUPERVISORY BOARD FRESENIUS SE & CO. KGAA
Membership of statutory supervisory boards
and comparable domestic or foreign supervisory bodies
Name Occupation Year of birth Initial appointment External positions as at Dec. 31, 2021 Fresenius Group company positions as at Dec. 31, 2021
Wolfgang Kirsch Member of various Supervisory Boards 1955 2021 Adolf Würth GmbH & Co. KG Fresenius Management SE
(Chair since May 21, 2021) AGCO Corporation, USA 1 (until April 22, 2021) (Chair since May 21, 2021)
Dr. Gerd Krick 2 Honorary Chairman of the Supervisory Board 1938 2003 Fresenius Management SE
(until May 21, 2021, Chair) of Fresenius SE & Co. KGaA and (until May 21, 2021; Chair)
Fresenius Management SE Fresenius Medical Care Management AG
(until May 20, 2021)
VAMED AG , Austria
(until July 08, 2021; Chair)
Prof. Dr. med. D. Michael Albrecht Medical Director and Spokesman of the 1949 2011 Universitätsklinikum Aachen
Management Board of the University Hospital
Carl Gustav Carus Dresden
Stefanie Balling Full-time Works Council Member 1968 2016
Fresenius Medical Care Deutschland GmbH
Bernd Behlert Full-time Works Council Member 1958 2018 Helios Vogtland-Klinikum Plauen GmbH
Helios Vogtland-Klinikum Plauen GmbH
Michael Diekmann Member of various Supervisory Boards 1954 2015 Allianz SE 1 (Chair) Fresenius Management SE
Deputy Chair Siemens AG 1
Grit Genster Secretary of the Trade Union ver.di, 1973 2020
Deputy Chair Vereinte Dienstleistungsgewerkschaft
Division Manager Health Care /
Health Policy
Konrad Kölbl Full-time Works Council Member 1959 2007 VAMED-KMB Krankenhausmanagement
VAMED-KMB Krankenhausmanagement und und Betriebsführungsges. m. b. H., Austria
Betriebsführungsges. m.b.H. (until February 28, 2021)
Frauke Lehmann Full-time Works Council Member 1963 2016 Helios Kliniken Schwerin GmbH
Fresenius | Annual Report 2021
Helios Kliniken Schwerin GmbH (Deputy Chair)
Prof. Dr. med. Iris Löw-Friedrich Chief Medical Care Officer and 1960 2016 Evotec AG 1
Executive Vice President, (Chair since June 15, 2021)
Head of Development, UCB S.A.
The term of office expires at the end of the Annual General Meeting 2025.
1
Stock-listed company
2
Dr. Krick resigned from the Supervisory Board of Fresenius Management SE on May 21, 2021. He was appointed Honorary Chairman of the Supervisory Board.
393
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
oards | Glossary | Source | Imprint
B
Financial calendar | Fresenius share / ADR | Contact
BOARDS
SUPERVISORY BOARD FRESENIUS SE & CO. KGAA
Membership of statutory supervisory boards
and comparable domestic or foreign supervisory bodies
Name Occupation Year of birth Initial appointment External positions as at Dec. 31, 2021 Fresenius Group company positions as at Dec. 31, 2021
Klaus-Peter Müller Honorary Chairman of the Supervisory Board 1944 2008 Fresenius Management SE (until May 21, 2021)
of Commerzbank AG
Oscar Romero de Paco Production staff member 1974 2016
Fresenius Kabi España S.A.U.
Hauke Stars Member of supervisory bodies 1967 2016 Kühne + Nagel International AG, Switzerland 1
(until January 31, 2022) RWE AG (since April 28, 2021)
Susanne Zeidler Member of various Supervisory Boards 1961 2022 DWS Investment GmbH Fresenius Management SE (since May 21, 2021)
(since February 9, 2022)
The term of office expires at the end of the Annual General Meeting 2025.
1
Stock-listed company
COMMITTEES OF THE SUPERVISORY BOARD
Nomination Committee Audit Committee Joint Committee 1
Wolfgang Kirsch (since May 21, 2021; Chair) Klaus-Peter Müller (Chair) Dr. Dieter Schenk (Chair)
Michael Diekmann Grit Genster Michael Diekmann
Dr. Gerd Krick (until May 21, 2021; Chair) Wolfgang Kirsch (since May 21, 2021) Wolfgang Kirsch (since May 21, 2021)
Klaus-Peter Müller Konrad Kölbl Dr. Gerd Krick (until May 21, 2021)
Dr. Gerd Krick (until May 21, 2021; Chair) Klaus-Peter Müller (until May 21, 2021)
Fresenius | Annual Report 2021
Hauke Stars Hauke Stars (since May 21, 2021)
1
The committee consists equally of two members each of the Supervisory Board of Fresenius SE & Co. KGaA and of Fresenius Management SE
394
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
oards | Glossary | Source | Imprint
B
Financial calendar | Fresenius share / ADR | Contact
BOARDS
MANAGEMENT BOARD FRESENIUS MANAGEMENT SE
(General partner of Fresenius SE & Co. KGaA)
Membership of statutory supervisory boards
and comparable domestic or foreign supervisory bodies
Name Segment Year of birth Initial appointment Term expires External positions as at Dec. 31, 2021 Fresenius Group company positions as at Dec. 31, 2021
Stephan Sturm Chairman 1963 2005 2026 Deutsche Lufthansa AG 1 Fresenius Kabi AG (Chair)
(until May 4, 2021) Fresenius Medical Care Management AG
(Chair)
VAMED AG, Austria (Chair since July 8, 2021;
formerly Deputy Chair)
Dr. Sebastian Biedenkopf Responsible for Human Resources 1964 2020 2023
(Labor Relations Director),
Risk Management and Legal
Dr. Francesco De Meo Business Segment 1963 2008 2026
Fresenius Helios
Rachel Empey Chief Financial Officer 1976 2017 2025 BMW Group 1 Fresenius Kabi AG (Deputy Chair)
(since May 12, 2021) Fresenius Medical Care Management AG
Inchcape, plc, Great Britain 1
(until April 30, 2021; Non-Executive Director)
Mats Henriksson Business Segment 1967 2013 2022
(until March 16, 2021) Fresenius Kabi
Rice Powell Business Segment 1955 2013 2022 Fresenius Medical Care Holdings, Inc., USA
Fresenius Medical Care (Chair)
Vifor Fresenius Medical Care Renal Pharma
Ltd., Switzerland 1 (Deputy Chair)
Michael Sen Business Segment 1968 2021 2024
(since April 12, 2021) Fresenius Kabi
Dr. Ernst Wastler Business Segment 1958 2008 2025 Vamed-KMB Krankenhausmanagement
Fresenius Vamed und Betriebsführungsges. m. b. H., Austria
(Chair)
Fresenius | Annual Report 2021
1
Stock-listed company
395
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
oards | Glossary | Source | Imprint
B
Financial calendar | Fresenius share / ADR | Contact
BOARDS
SUPERVISORY BOARD FRESENIUS MANAGEMENT SE
(General partner of Fresenius SE & Co. KGaA)
Membership of statutory supervisory boards
and comparable domestic or foreign supervisory bodies
Name Occupation Year of birth Initial appointment External positions as at Dec. 31, 2021 Fresenius Group company positions as at Dec. 31, 2021
Wolfgang Kirsch Member of various Supervisory Boards 1955 2020 Adolf Würth GmbH & Co. KG Fresenius SE & Co. KGaA 1
(Chair since May 21, 2021) AGCO Corporation Duluth, USA (Chair since May 21, 2021)
Dr. Gerd Krick 2 Honorary Chairman of the Supervisory Board 1938 2010 Fresenius SE & Co. KGaA 1
(until May 21, 2021; Chair) of Fresenius SE & Co. KGaA and (until May 21, 2021; Chair)
Fresenius Management SE Fresenius Medical Care Management AG
(until May 20, 2021)
VAMED AG , Austria
(until July 08, 2021; Chair)
Dr. Frank Appel Chief Executive Officer 1961 2021
(since May 21, 2021) Deutsche Post DHL Group 1
Michael Diekmann Member of various Supervisory Boards 1954 2015 Allianz SE 1 (Chair) Fresenius SE & Co. KGaA 1 (Deputy Chair)
Siemens AG 1
Dr. Heinrich Hiesinger Member of various Supervisory Boards 1960 2020 ZF Friedrichshafen AG
(Chair since January 01, 2022)
BMW AG 1
Deutsche Post AG 1
Klaus-Peter Müller Honorary Chairman of the Supervisory Board 1944 2010 Fresenius SE & Co. KGaA 1
(until May 21, 2021) of Commerzbank AG
Dr. Dieter Schenk Member of various Supervisory Boards 1952 2010 HWT invest AG Fresenius Medical Care AG & Co. KGaA 1
Deputy Chair Gabor Shoes AG (Chair) (Chair)
TOPTICA Photonics AG (Chair) Fresenius Medical Care Management AG
Else Kröner-Fresenius-Stiftung (Deputy Chair)
(Chair of Foundation Board)
Susanne Zeidler Member of various Supervisory Boards 1961 2021 DWS Investment GmbH
(since May 21, 2021)
Fresenius | Annual Report 2021
Dr. Karl Schneider Honorary Member of the Supervisory Board
of Fresenius Management SE
The term of office expires at the end of the Annual General Meeting 2025.
1
Stock-listed company
2
Dr. Krick resigned from the Supervisory Board of Fresenius Management SE on May 21, 2021. He was appointed Honorary Chairman of the Supervisory Board.
396
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Boards Glossary | Source | Imprint
Financial calendar | Fresenius share / ADR | Contact
GLOSSARY
Health care terms / Products and services
Apheresis CAR T cell therapy Dialyzer Immunosuppression
A medical technology in which the blood of a person In this therapy form, the immune cells of patients are Special filter used in hemodialysis for removing toxic The suppression of the body’s own defense system.
is passed through a device that separates out one collected, genetically modified, and reinfused into the substances, waste products of metabolic processes,
particular blood component and returns the remainder patient with better characteristics than before. In the and excess water from the blood. The dialyzer is some- LOVO
to the circulation. This technology is used for the patient’s body, they activate the immune system and times referred to as the “artificial kidney”. LOVO is a cell processing system to wash differentiated
collection of various blood components by donors, as destroy cancer cells. and undifferentiated white blood cells for laboratory
well as for therapeutic applications for patients. DRG flat rate per case and research use. It is designed to offer a simple, fast,
CUE The Diagnosis Related Group (DRG) is a flat rate per and automated method to remove supernatant, add and
Bioequivalence Cue is an automated cell processing system capable case and forms the basis for the reimbursement of reduce volume in a fully closed system.
The active pharmaceutical ingredient of the generic of washing, concentrating, and preparing white inpatients treated in German hospitals.
product is the same as that of the reference product. blood cell suspensions for cryopreservation (freezing Medicare / Medicaid
Both are therefore interchangeable with each other. in liquid nitrogen) and/or dispensing into final con- Enteral nutrition A program developed by the federal U.S. Social Secu-
tainers. Application of liquid nutrition as a tube or sip feed rity Administration that reimburses health insurance
Biosimilars via the gastrointestinal tract. companies and providers of medical services for
A biosimilar is a drug that is “similar” to another bio- Dialysis medical care to individuals over 65, people with chronic
logic drug already approved. Form of renal replacement therapy where a semiper- FDA (U.S. Food & Drug Administration) kidney failure, or the disabled.
meable membrane – in peritoneal dialysis the perito- Official authority for food observation and drug regis-
Blood volume substitutes neum of the patient, in hemodialysis the membrane of tration in the United States. Outpatient clinic
They are used for the temporary stabilization and / or the dialyzer – is used to clean a patient’s blood. Interdisciplinary facility for outpatient care, managed
maintenance of blood volume, for example, in the Hemocompatibility by physicians. The responsible body of a medical care
event of major blood loss. Dialysis machine Blood compatibility center includes all service providers (such as physi-
The hemodialysis process is controlled by a dialysis cians, pharmacists, health care facilities) that are autho-
machine, which pumps blood, adds anticoagulants, HD (Hemodialysis) rized to treat patients with statutory health insurance.
regulates the cleansing process, and controls the mix- A treatment method for dialysis patients where the
ture of dialysate and its flow rate through the system. blood of the patient is cleansed by a dialyzer. The sol-
ute exchange between blood and dialysate is domi-
Dialysis solution / Dialysate nated by diffusive processes.
Fresenius | Annual Report 2021
Fluid used in the process of dialysis in order to remove
the filtered out substances and excess water from the Immunogenicity
blood. The ability of an antigen to cause an immune
response (immunization, sensitization).
397
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Boards Glossary | Source | Imprint
Financial calendar | Fresenius share / ADR | Contact
GLOSSARY
Health care terms / Products and services
Parenteral nutrition Subcutaneous injection
Application of nutrients directly into the bloodstream An injection of vaccines or drugs into the subcutane-
of the patient (intravenously). This is necessary if the ous fat tissue.
condition of a patient does not allow them to absorb
and metabolize essential nutrients orally or as sip and Telematics infrastructure
tube feed in a sufficient quantity. The telematics infrastructure is intended to network all
those involved in the German health care system and
PD (Peritoneal dialysis) enable a secure exchange of information across sectors
Dialysis treatment method using the patient’s perito- and systems.
neum as a filter to cleanse their blood.
Multi-chamber bag
Pharmacokinetics The multi-chamber bag contains all the macronutrients
The effect of the body on the drug. like amino acids, glucose, and lipids, as well as
electrolytes, in separate chambers. Immediately before
Pharmacodynamics infusion, all nutrients are mixed thoroughly within the
The effect of the drug on the body. bag simply by opening individual chambers. This
reduces the risk of contamination and saves time
Prevalence when preparing the infusions.
Number of all patients who suffer from a specific
disease within a defined period. The prevalence rate UNE
indicates the number of people with this specific The Spanish Association for Standardization, UNE, is
disease (e.g., terminal kidney failure) treated per mil- the body legally responsible for the development of
lion population. standards in Spain. It is the Spanish representative in
ISO.
PPP (public-private partnership model)
Public-private partnership describes a government
service or private business venture that is funded and
Fresenius | Annual Report 2021
operated through a partnership of government and
one or more private-sector companies. In most cases,
PPP accompanies a part-privatization of govern
mental services.
398
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Boards Glossary | Source | Imprint
Financial calendar | Fresenius share / ADR | Contact
GLOSSARY
Financial terms 1
After adjustments Cash flow Cash flow from investing activities Cash flow before acquisitions and dividends
In order to measure the operating performance Financial key figure that shows the net balance Cash flow from investing activities is a financial mea- Fresenius uses the cash flow before acquisitions and
extending over several periods, key performance of incoming and outgoing payments during a report- sure opposing payments for the acquisition or pur- dividends as the financial measure for free cash flow.
measures are “adjusted“ where applicable. Adjusted ing period. chase of property, plant and equipment and invest- Cash flow before acquisitions and dividends is calcu-
measures are labelled with “after adjustments”. A ments versus proceeds from the sale of property, plant lated by operating cash flow less investments (net).
reconciliation table is available within the respective Operating cash flow and equipment and investments. Net investments are calculated by payments for the
quarterly or annual report and presents the com Operating cash flow is a financial measure showing purchase of property, plant and equipment less pro-
position of special items. cash inflows from operating activities during a period. Cash flow from financing activities ceeds from the sale of property, plant and equipment.
Operating cash flow is calculated by subtracting Cash flow from financing activities is a financial mea-
Before special items non-cash income and adding non-cash expenses to sure showing how the investments of the reporting
In order to measure the operating performance extend- net income. period were financed.
ing over several periods, key performance measures
are adjusted by special items, where applicable. Cash flow from financing activities is calculated from
Adjusted measures are labelled with “before special additions to equity plus proceeds from the exercise of
items”. A reconciliation table is available within the stock options, less dividends paid, plus proceeds
respective quarterly or annual report and presents the from debt increase (loans, bonds, etc.), less repayments
composition of special items. of debt, plus the change in noncontrolling interests,
plus proceeds from the hedge of exchange rate effects
due to corporate financing.
Fresenius | Annual Report 2021
1
Integral part of Group Management Report 399
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Boards Glossary | Source | Imprint
Financial calendar | Fresenius share / ADR | Contact
GLOSSARY
Financial terms 1
Constant currencies EBITDA (Earnings before Interest, Taxes, NOPAT ROOA (Return on Operating Assets)
Constant currencies for income and expenses are Depreciation and Amortization) Net Operating Profit After Taxes (NOPAT) is calcu- Calculated as the ratio of EBIT to operating assets
calculated using prior-year average rates; constant EBITDA is calculated from EBIT by adding deprecia- lated from operating income (EBIT), as stated in the (average).
currencies for assets and liabilities are calculated tions recognized in income and deducting write-ups profit and loss statement, less income taxes.
using the mid-closing rate on the date of the respec- recognized in income, both on intangible assets as Operating assets = total assets - deferred tax
tive statement of financial position. well as property, plant and equipment. Organic growth assets - trade accounts payable - cash held in
Growth that is generated by a company’s existing trust - payments received on account - approved
CSR (Corporate Social Responsibility) EBITDA margin businesses and not by acquisitions, divestitures, or subsidies.
CSR refers to the social responsibility of companies. EBITDA margin is calculated as the ratio of EBITDA to foreign exchange impact.
Their operations can affect economic, social, and sales. SOI (Scope of Inventory)
environmental conditions all over the world. ROE (Return on Equity) Indicates the average number of days between
Net debt / EBITDA Measure of a corporation’s profitability revealing how receiving goods as inventory and the sale of
DSO (Days Sales Outstanding) Net debt / EBITDA is a financial measure reflecting the much profit a company generates with the money the finished product.
Indicates the average number of days it takes for a ability of Fresenius to fulfill its payment obligations. shareholders have invested.
receivable to be paid. Net debt and EBITDA are calculated at LTM (last-12- ROE is calculated by fiscal year’s net income / total Calculated by: (Inventories / Costs of goods
month) average exchange rates, respectively. equity × 100. sold) × 365 days.
EBIT (Earnings before Interest and Taxes)
EBIT does include depreciation and write-ups on Calculation of net debt: ROIC (Return on Invested Capital) Working capital
property, plant and equipment. Short-term debt Calculated by: (EBIT - taxes) / Invested capital. Current assets (including prepaid expenses) -
+ Short-term debt from related parties accruals - trade accounts payable - other liabili-
EBIT is calculated by subtracting cost of sales, selling, + Current portion of long-term debt and capital lease Invested capital = total assets + accumulated amorti- ties - deferred income.
general, and administrative expenses, and research obligations zation of goodwill - deferred tax assets - cash and cash
and development expenses from sales. + Current portion of Senior Notes equivalents - trade accounts payable - accruals (without
+ Long-term debt and capital lease obligations, less pension accruals) - other liabilities not bearing interest.
EBIT margin current portion
EBIT margin is calculated as the ratio of EBIT to sales. + Senior Notes, less current portion
+ Convertible bonds
Fresenius | Annual Report 2021
= Debt
- Less cash and cash equivalents
= Net debt
1
Integral part of Group Management Report 400
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Boards Glossary | Source | Imprint
Financial calendar | Fresenius share / ADR | Contact
GLOSSARY
Financial terms 1
RECONCILIATION OF AVERAGE INVESTED CAPITAL AND ROIC RECONCILIATION OF AVERAGE OPERATING ASSETS AND ROOA
December 31, December 31, December 31, December 31,
€ in millions, except for ROIC 2021 2020 € in millions, except for ROOA 2021 2020
Total assets 71,962 66,646 Total assets 71,962 66,646
Plus: Cumulative goodwill amortization 719 690 Minus: Contract liabilities - 5 35 - 962
Minus: Cash and cash equivalents - 2 ,764 - 1,837 Minus: Payments received on account 0 0
Minus: Loans to related parties - 6 3 - 62 Minus: Cash held in trust - 154 - 121
Minus: Deferred tax assets - 8 58 - 812 Minus: Loans to related parties - 6 3 - 62
Minus: Accounts payable - 2 ,039 - 1,816 Minus: Deferred tax assets - 8 58 - 812
Minus: Accounts payable to related parties - 9 2 - 67 Minus: Accounts payable - 2 ,039 - 1,816
Minus: Provisions and other current liabilities 1 - 8 ,925 - 8 ,649 Minus: Accounts payable to related parties - 9 2 - 67
Minus: Income tax payable - 495 - 5 04 Minus: Approved subsidies due to Hospital Funding Act
Invested capital 57,445 53,589 (“Krankenhausfinanzierungsgesetz”, KHG) - 118 - 82
Operating assets 68,103 62,724
Average invested capital as of December 31, 2021 / 2020 2 55,893 54,648
Operating income 3, 4 4,260 4,614 Average operating assets as of December 31, 2021 / 2020 1 65,384 62,976
Income tax expense - 9 64 - 1,065 Operating income 2, 3 4,260 4,614
NOPAT 3, 4
3,296 3,549 ROOA in % 6.5% 7.3%
ROIC in % 5.9% 6.5% 1
Includes adjustments for acquisitions in the respective reporting period with a purchase price above a certain level
(2021: € 868 million; 2020: € 346 million).
1
Includes non-current provisions and payments outstanding for acquisition; does not include pension liabilities and noncontrolling interests 2
Includes adjustments for acquisitions in the respective reporting period with a purchase price above a certain level
subject to put provisions. (2021: € 8 million; 2020: € 2 million).
2
Includes adjustments for acquisitions in the respective reporting period with a purchase price above a certain level 3
Before special items
(2021: € 752 million; 2020: € 220 million).
3
Includes adjustments for acquisitions in the respective reporting period with a purchase price above a certain level
(2021: € 8 million; 2020: € 2 million). For a detailed overview of special items and adjustments please see the reconciliation tables on pages 74 – 76.
Fresenius | Annual Report 2021
4
Before special items
For a detailed overview of special items and adjustments please see the reconciliation tables on pages 74 – 76.
1
Integral part of Group Management Report 401
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Boards | Glossary Source | Imprint
Financial calendar | Fresenius share / ADR | Contact
SOURCE
Market dynamics of business segments
Fresenius Medical Care Fresenius Kabi Fresenius Helios Fresenius Vamed
Page 8 Page 11 Page 14 Page 17
~ 1.6 million patients require renal replacement Continuing growth of generics and biopharma Inpatient treatments could be performed in Telemedicine market in Europe is estimated
therapy by 2030 ceuticals in 2022 expected outpatient settings in 25% of cases. to grow 19.1% p.a. from 2020 to 2026
Source: own research Fresenius Medical Care Source: own research Fresenius Kabi Source: Bertelsmann Stiftung, Spotlight Gesundheit, Source: https://www.graphicalresearch.com/industry-
2019, Ärztliche Vergütung insights/1476/europe-telemedicine-market
Home dialysis Global addressable market 2021 ~ € 114 bn
By 2025, the Company aims to perform 25 % Source: own research Fresenius Kabi Hospital market in Germany ~ € 111 bn Global preventive health care is estimated
of all treatments in the U.S. in a home setting Source: German Federal Statistical Office, 2019 data to grow 9.5% p.a. till 2025
Source: own research Fresenius Medical Care Increase of the population older than 60 years (most recent market data available refers to the year Source: World Health Organization, 2013 – 2015,
Source: https://www.un.org/en/development/desa/ 2019 as no more recent data has been published); www.who.org
Global market for dialysis population/publications/pdf/ageing/ own research Helios Germany
products and services ~ € 79 bn WorldPopulationAgeing2019-Highlights.pdf The share of the EU population aged 80 years or
Source: own research Fresenius Medical Care Downloads of e-health apps older
Rising cost consciousness in health care spending – Source: McKinsey & Company, eHealth Monitor 2020 Source: EC Europe, Eurostat, 2021
Big Data is driving new treatment models significant savings from generics
~ 53 m dialysis treatments in 2021 Source: Association for Accessible Medicines (AAM): Average increase of private health insurance Outsourcing of non-medical services provided
Source: own research Fresenius Medical Care 2019 Generic Drug and Biosimilars Access and policies in Spain of ~ 2.5% p.a. by public institutions to private providers in
Savings in the U.S.; IMS Health 2015, The Role of Source: Asociación ICEA (Investigación Cooperativa Germany.
Quality in dialysis treatments enables saving Generic Medicines in Sustaining Healthcare Systems – entre Entidades Aseguradoras y Fondos de Pensiones), Source: German Federal Statistical Office, 2019 data
in the U.S. market A European Perspective data from 2011 to 2019 (most recent market data available refers to the year
Source: Kidney Care Partners: United States Renal 2019 as no more recent data has been published)
Data System. 2018 USRDS annual data report: Expected market growth of biosimilars Private hospital market in Spain ~ € 16 bn
Epidemiology of kidney disease in the United States. 2021 to 2028 Source: market data based on own research and Emerging markets’ share of global health
National Institutes of Health, National Institute of Dia- Source: https://www.fortunebusinessinsights.com/ refers to the addressable market for Quirónsalud. expenditure will grow to 33% by 2022.
betes and Digestive and Kidney Diseases, Bethesda, industry-reports/u-s-biosimilars-market-100990 Source: https://www.ihealthcareanalyst.com/
Fresenius | Annual Report 2021
MD, 2018. Most common positive benefit for e-health
Growing health care spending in emerging markets applications.
Source: UBS, Longer Term Investments: EM health- Source: McKinsey & Company, eHealth Monitor 2020
care (2018)
402
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Boards | Glossary | Source Imprint
Financial calendar | Fresenius share / ADR | Contact
IMPRINT
Commercial Register: Bad Homburg v. d. H.; HRB 11852
Chairman of the Supervisory Board: Wolfgang Kirsch
General Partner: Fresenius Management SE
Registered Office and Commercial Register: Bad Homburg v. d. H.; HRB 11673
Management Board: Stephan Sturm (President and CEO), Dr. Sebastian Biedenkopf, Dr. Francesco De Meo, Rachel Empey, Rice Powell, Michael Sen, Dr. Ernst Wastler
Chairman of the Supervisory Board: Wolfgang Kirsch
The German version of this Annual Report is legally binding.
The editorial closing date of this Annual Report was on March 17, 2022, and it was published on March 24, 2022. Rounding differences may occur.
The Annual Report and the financial statements of Fresenius SE & Co. KGaA are available on our website at: https://www.fresenius.com/financial-reports-and-presentations .
You will find further information and current news about our company on our website at: www.fresenius.com.
Forward-looking statements:
This Annual Report contains forward-looking statements. These statements represent assessments that we have made on the basis of the information available to us
at the time. Should the assumptions on which the statements are based not occur, or if risks should arise – as mentioned in the risk report and the SEC filings of
Fresenius Medical Care AG & Co. KGaA – the actual results could differ materially from the results currently expected.
Design concept / realization: Hilger Boie Waldschütz Design, Wiesbaden
Fresenius | Annual Report 2021
403
To our shareholders Group Management Report Group Non-Financial Report Corporate Governance Consolidated financial statements Further information Table of contents
Boards | Glossary | Source | Imprint
Financial calendar | Fresenius share / ADR | Contact
FINANCIAL CALENDAR
Report on 1st quarter 2022
Conference call, live webcast May 4, 2022
Virtual Annual General Meeting, Bad Homburg, Germany May 13, 2022
Report on 2nd quarter 2022
Conference call, live webcast August 2, 2022
Report on 3rd quarter 2022
Conference call, live webcast November 1, 2022
Schedule updates, information on live webcasts, and other events at www.fresenius.com/events-and-roadshows
FRESENIUS SHARE / ADR
Ordinary share ADR
Securities identification no. 578 560 CUSIP 35804M105
Ticker symbol FRE Ticker symbol FSNUY
ISIN DE0005785604 ISIN US35804M1053
Bloomberg symbol FRE GR Structure Sponsored Level 1 ADR
Reuters symbol FREG.de Ratio 4 ADR = 1 share
Main trading location Frankfurt / Xetra Trading platform OTC
Fresenius | Annual Report 2021
CONTACT
Corporate Headquarters Postal address Contact for shareholders Contact for journalists
Else-Kröner-Straße 1 Fresenius SE & Co. KGaA Investor Relations & Sustainability Corporate Communications
Bad Homburg v. d. H. 61346 Bad Homburg v. d. H. Telephone: ++ 49 61 72 6 08-24 87 Telephone: ++ 49 61 72 6 08-23 02
Germany Germany Telefax: ++ 49 61 72 6 08-24 88 Telefax: ++ 49 61 72 6 08-22 94
E-mail: [email protected] E-mail: [email protected]
404
You might also like
- Strategic Analysis For Novo Nordisk's International Expansion Into BrazilNo ratings yetStrategic Analysis For Novo Nordisk's International Expansion Into Brazil10 pages
- Advanced Introduction To The Austrian School of EconomicsNo ratings yetAdvanced Introduction To The Austrian School of Economics3 pages
- Fresenius_Company_Presentation_November_2024_0No ratings yetFresenius_Company_Presentation_November_2024_067 pages
- Factsheet 2020: Who We Are Ceo and Chairman Products and ServicesNo ratings yetFactsheet 2020: Who We Are Ceo and Chairman Products and Services1 page
- Fresenius Se & Co.: Fresenius Se & Co. Kgaa Is A German Health Care Company Based in Bad Homburg. The FreseniusNo ratings yetFresenius Se & Co.: Fresenius Se & Co. Kgaa Is A German Health Care Company Based in Bad Homburg. The Fresenius3 pages
- Fresenius Reports Q314 Results and Confirms FY14 OutlookNo ratings yetFresenius Reports Q314 Results and Confirms FY14 Outlook2 pages
- PhilipsFullAnnualReport2024 English UnlockedNo ratings yetPhilipsFullAnnualReport2024 English Unlocked302 pages
- Haleon Annual Report and Form 20F 2024.PDF.downloadassetNo ratings yetHaleon Annual Report and Form 20F 2024.PDF.downloadasset224 pages
- Agfa - Annual 2022 - EN Online - 2023-10-10 - 12-08No ratings yetAgfa - Annual 2022 - EN Online - 2023-10-10 - 12-08324 pages
- Corporate Presentation Grupo Fleury 1Q16No ratings yetCorporate Presentation Grupo Fleury 1Q1644 pages
- philips-third-quarter-results-2024-reportNo ratings yetphilips-third-quarter-results-2024-report14 pages
- Haleon FY 2022 Presentation 02 March 2023.PDF - DownloadassetNo ratings yetHaleon FY 2022 Presentation 02 March 2023.PDF - Downloadasset44 pages
- Building Shared Success: Annual Report and Accounts 2020100% (1)Building Shared Success: Annual Report and Accounts 2020244 pages
- Sanofi AR 2023 - C2C - 02!05!24 - Spread View Interactive (Hires)No ratings yetSanofi AR 2023 - C2C - 02!05!24 - Spread View Interactive (Hires)132 pages
- unilever-directors-remuneration-report-2023No ratings yetunilever-directors-remuneration-report-202339 pages
- novartis 2024 meet-novartis-management-2024-ceo-presentationNo ratings yetnovartis 2024 meet-novartis-management-2024-ceo-presentation32 pages
- 2024-01-31 Pharmaceuticals and Healthcare Europe Moody'sNo ratings yet2024-01-31 Pharmaceuticals and Healthcare Europe Moody's8 pages
- To the Moon Investing: Visually Mapping Your Winning Stock Market PortfolioFrom EverandTo the Moon Investing: Visually Mapping Your Winning Stock Market PortfolioNo ratings yet
- Benefits Realisation: The Change-Driven Approach to Project SuccessFrom EverandBenefits Realisation: The Change-Driven Approach to Project SuccessNo ratings yet
- Schools - HSMS 20111123 Central RegisterNo ratings yetSchools - HSMS 20111123 Central Register79 pages
- ROMARES. Accounting For Special Transactions - Semi FinalsNo ratings yetROMARES. Accounting For Special Transactions - Semi Finals4 pages
- Muhammad Ikram: Highlights of QualificationsNo ratings yetMuhammad Ikram: Highlights of Qualifications2 pages
- Instant ebooks textbook Statistical Quality Control Using MINITAB R JMP and Python 1st Edition Bhisham C. Gupta download all chaptersNo ratings yetInstant ebooks textbook Statistical Quality Control Using MINITAB R JMP and Python 1st Edition Bhisham C. Gupta download all chapters81 pages
- Analyzing and Recording Financial TransactionsNo ratings yetAnalyzing and Recording Financial Transactions2 pages
- IAS 8 - Accounting Policies, Changes in Accounting Estimates and Errors L1100% (1)IAS 8 - Accounting Policies, Changes in Accounting Estimates and Errors L183 pages
- Supervalu Case Study: Professional Development ProgramNo ratings yetSupervalu Case Study: Professional Development Program7 pages
- (Ebook) Fashion Marketing by Mike Easey ISBN 9781405139533, 1405139536 instant download100% (3)(Ebook) Fashion Marketing by Mike Easey ISBN 9781405139533, 1405139536 instant download48 pages
- Marketing Health Services, 3rd Edition PDF DOCX Download100% (8)Marketing Health Services, 3rd Edition PDF DOCX Download17 pages
- Unit Iii Preparation of Bank Balance SheetNo ratings yetUnit Iii Preparation of Bank Balance Sheet6 pages
