Form 6-K Fresenius Medical Care For: Mar 31
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM
REPORT OF FOREIGN PRIVATE ISSUER PURSUANT TO RULE 13A-16 OR 15D-16 UNDER THE
SECURITIES EXCHANGE ACT OF 1934
For the month of May 2026.
Commission file number: 001-32749
(Translation of registrant’s name into English)
Else-Kröner-Strasse 1
61346 Bad Homburg
Germany
(Address of principal executive offices)
Indicate by check mark whether the registrant files or will file annual reports under cover of Form 20-F or Form 40-F.
Form 20-F ☒ | Form 40-F ☐ |
Interim Report of Financial Condition and Results of Operations for the three months ended March 31, 2026 and 2025
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Notes to the condensed consolidated interim financial statements | 28 |
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FINANCIAL INFORMATION
Management’s discussion and analysis
In this report, “FME AG,” “Fresenius Medical Care,” or the “Company,” “we,” “us,” or “our” refers to Fresenius Medical Care AG or to Fresenius Medical Care AG and its subsidiaries on a consolidated basis, as the context requires. You should read the following discussion and analysis of the results of operations of the Company and its subsidiaries in conjunction with our unaudited interim consolidated financial statements and related notes contained elsewhere in this report and our disclosures and discussions in our consolidated financial statements as of and for the year ended December 31, 2025, prepared in accordance with International Financial Reporting Standards (IFRS) as issued by the International Accounting Standards Board (IASB), the “IFRS® Accounting Standards,” using the euro as our reporting currency, included in our Annual Report on Form 20-F for the year ended December 31, 2025 (our 2025 Form 20-F).
The term “Care Enablement” refers to the Care Enablement operating segment, the term “Care Delivery” refers to the Care Delivery operating segment and the term “Value-Based Care” refers to the Value-Based Care operating segment. The Care Enablement segment is primarily engaged in the manufacture and distribution of healthcare products and equipment, including research and development (R&D), supply chain, and commercial operations, as well as supporting functions such as regulatory and quality management. The Care Delivery segment is primarily engaged in providing healthcare services for the treatment of chronic kidney disease (CKD), end stage renal disease (ESRD), and in providing other extracorporeal therapies. Care Delivery also includes the pharmaceutical products business and the income from equity method investees related to the sale of certain renal pharmaceuticals by Vifor Fresenius Medical Care Renal Pharma Ltd. (VFMCRP), which are used in the Company’s clinics to provide healthcare services to its patients. The Value-Based Care operating segment is primarily focused on value-based kidney care, including contracting and performance management, clinical care models supported by a national network of nephrologists, and tech-enabled platforms that leverage proprietary informatics and patient engagement tools. Value and risk-based care arrangements with private payors or government programs may include shared savings or losses from reductions or increases in the overall medical spend of a population under management which are accounted for in accordance with IFRS 15, Revenue from Contracts with Customers. Premiums and medical costs included in full risk arrangements, however, are accounted for in accordance with IFRS 17, Insurance Contracts. Premium revenue and claim costs are presented separately as insurance revenue and insurance costs of revenue, respectively, on the consolidated statements of income and constitute the majority of revenue and costs of revenue for the segment. Our operating segments are determined based upon how we manage our businesses and allocate resources with responsibilities by products and services and is aligned to the financial information that is presented on a quarterly basis to the chief operating decision maker.
Our Global Medical Office, which seeks to optimize medical treatments and clinical processes within the Company and supports both Care Delivery and Care Enablement, is centrally managed and its profit and loss are allocated to those specific segments. Similarly, costs related primarily to headquarters overhead charges, including accounting and finance as well as certain human resources, legal, and information technology (IT) costs, are allocated as these costs are attributable to the segments, and are used in the allocation of resources to Care Delivery and Care Enablement. These costs are allocated at budgeted amounts, with the difference between budgeted and actual figures recorded at the corporate level. The Value-Based Care segment maintained its own separate finance, accounting, human resources, legal, medical office, and other administrative functions and is therefore excluded from the allocation process for the three months ended March 31, 2026. However, beginning in April 2026, certain of these functions have been incorporated into the Company’s global functional areas and associated costs will be allocated to that segment in future periods. Additionally, certain costs, which relate mainly to shareholder activities, management activities, global internal audit, and the remeasurement of certain investments and virtual power purchase agreements, are not allocated to a segment but are accounted for as corporate expenses. From January 1, 2026, the project costs for implementing the Company’s new enterprise resource planning (ERP) software are reported as corporate expenses. These activities do not fulfill the definition of a segment according to IFRS 8, Operating Segments, and are reported separately as Corporate (Corporate). Interest income, interest expense, and tax expense are neither included within the measure of segment profit or loss reviewed by the chief operating decision maker nor otherwise regularly provided to the chief operating decision maker by segment and are therefore not included in the presented segment information. While interest income, interest expense, and tax expense are not included in segment profit or loss, these items are reviewed and monitored at the consolidated level by management as part of its overall financial performance assessment. See note 12 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report for a further discussion on our operating segments.
The abbreviations “K,” “M,” and “BN” are used to denote the presentation of amounts in thousands, millions, and billions, respectively. The term “Constant Currency” or at “Constant Exchange Rates” means that we have translated local currency revenue, operating income, net income attributable to shareholders of FME AG, and other items for the current reporting period into euro using the prior year exchange rates to provide a comparable analysis without effect from exchange rate fluctuations on translation, as described below under “Financial condition and results of operations – II. Discussion of measures – Non-IFRS® measures.”
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Forward-looking statements
This report contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended (the Exchange Act). When used in this report, the words “outlook,” “expects,” “anticipates,” “intends,” “plans,” “believes,” “seeks,” “estimates,” “guidance,” “target,” and similar expressions are generally intended to identify forward looking statements. Although we believe that the assumptions and expectations reflected in such forward-looking statements are reasonable, forward-looking statements are inherently subject to risks and uncertainties, many of which cannot be predicted with accuracy and some of which might not be anticipated. Additionally, subsequent events and actual results, financial and otherwise, have differed in the past and, going forward, could differ materially from those set forth in or contemplated by the forward-looking statements contained elsewhere in this report. We have based these forward-looking statements on current estimates and assumptions made to the best of our knowledge. By their nature, such forward-looking statements involve risks, uncertainties, assumptions, and other factors which could cause actual results, including our financial condition and profitability, to differ materially, positively or negatively, relative to the results expressly or implicitly described in or suggested by these statements. Moreover, forward-looking estimates or predictions derived from third parties’ studies or information may prove to be inaccurate. Consequently, we cannot give any assurance regarding the future accuracy of the opinions set forth in this report or the actual occurrence of the projected developments described herein. In addition, even if our future results meet the expectations expressed here, those results may not be indicative of our performance in future periods.
These risks, uncertainties, assumptions, and other factors, including associated costs, could cause actual results to differ from our projected results and include, among others, the following:
| ● | changes in governmental and private payor reimbursement for our complete products and services portfolio, including the United States (U.S. or USA) Medicare and Medicaid reimbursement systems for dialysis and other healthcare services, including potentially significant changes to the Patient Protection and Affordable Care Act of 2010 (Pub.L. 111-148), as amended by the Health Care and Education Reconciliation Act (Pub.L. 111-152) (collectively, ACA) that could result from the expiration of insurance premium subsidies previously available (until their expiration on December 31, 2025) for certain ACA coverage purchased through health care exchanges, which we assume will cause some of our patients to shift from private ACA exchange insurance to other types of reimbursement systems such as Medicare, Medicaid, other commercial insurance, or self-insurance which could lead to an overall decline in reimbursement, or future efforts to revise, repeal or replace the ACA, further legislative efforts to restrict eligibility for Medicaid and changes by regulators to certain reimbursement models, such as the Comprehensive Kidney Care Contracting (CKCC) model, which could significantly impact performance under these models in unanticipated ways; |
| ● | our ability to accurately interpret and comply with complex current and future government regulations applicable to our business including sanctions and export control laws and regulations, laws and regulations in relation to environmental, social, and governance topics, the impact of healthcare, tax and trade law reforms, in particular the Organisation for Economic Co-operation and Development (OECD) initiatives for the reallocation of taxation rights to market countries (Pillar one) and introduction of a global minimum tax (Pillar two) as well as potential countermeasures to OECD Global Tax deals, antitrust and competition laws in the countries and localities in which we operate, other government regulation including, in the U.S., the federal Medicare and Medicaid Fraud and Abuse Amendments of 1977, as amended (the Anti-Kickback Statute), the False Claims Act, the federal Physician Self-Referral Law (the Stark Law), the Civil Monetary Penalty Law, the Health Insurance Portability and Accountability Act, the Health Information Technology for Economic and Clinical Health Act, the Federal Trade Commission Unfair and Deceptive Trade Practices Rule, the Foreign Corrupt Practices Act (FCPA), state laws and judicial rulings prohibiting or limiting enforcement of non-compete clauses, the U.S. Securities and Exchange Commission’s (SEC) climate disclosure rules (which are subject to litigation contesting their validity in the Eighth Circuit Court of Appeals, which has stayed the litigation and ordered the SEC to decide whether to defend the challenged rules or reconsider the rules by statutory notice-and-comment rulemaking) and other similar state laws, as well as the Food, Drug and Cosmetic Act, the U.S. Department of Justice Data Security Program, and, outside the U.S. (International), inter alia, the European Union (EU) Medical Device Regulation (MDR), the EU General Data Protection Regulation, the EU Taxonomy Regulation, the EU Corporate Sustainability Reporting Directive (CSRD), the EU Artificial Intelligence Act, the NIS 2 Directive (Directive (EU) 2022/2555), the German Act on Human Rights Due Diligence in Supply Chains, the EU Due Diligence Directive, the two invoice policy, “Buy China” policy, volume-based procurement policies and the Tendering and Bidding Law in China and other related local legislation, as well as other comparable regulatory regimes in many of the countries where we supply healthcare services and/or products. |
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In the U.S., the interpretation of these statutes and the validity of existing interpretations by the agencies that administer such statutes may be subject to increased uncertainty as a result of the U.S. Supreme Court’s opinion in Loper Bright Enterprises v. Raimondo and Relentless v. Department of Commerce, 603 U.S. (2024) (Loper Bright) in June 2024. Loper Bright overruled the so-called “Chevron Doctrine” under which administrative agencies were accorded significant deference in their interpretation of the statutes they administer. The Loper Bright opinion held that the U.S. Administrative Procedure Act requires courts to “exercise their independent judgment in deciding whether an agency has acted within its statutory authority.” While the effects of the Loper Bright decision will become apparent over the succeeding months and years, it is possible that the decision could result in additional litigation challenging regulations, guidance, and decisions issued by agencies such as the U.S. Food and Drug Administration (FDA) and the Centers for Medicare and Medicaid (CMS), concern over the enforceability of such regulations until tested in court, challenges to CMS guidance in areas such as coverage billing requirements, coding decisions, add-on payments and procedure categorization, and the Medicaid Drug Rebate Program, as well as the validity of advisory opinions and safe-harbor regulations issued by the Office of Inspector General of the Department of Health and Human Services under the Anti-Kickback Statute. Such additional litigation could also result in additional uncertainty regarding such regulations and interpretations due to conflicting interpretations and rulings issued by courts in different jurisdictions. Given the uncertainty created by the Loper Bright decision, we cannot predict its potential impact on our financial condition and results of operations at this time;
| ● | the influence of private payors (including integrated care organizations, commercial insurance, and Medicare Advantage plans, also known as Medicare Part C, offered by private health insurers approved by CMS to provide their members with Medicare Part A, Part B and usually Part D benefits (Medicare Advantage or MA plans), as well as efforts by these organizations to manage costs by limiting healthcare benefits, narrowing their networks, reducing provider reimbursement, implementing prior authorization requirements, and/or restricting options for patient funding of health insurance premiums, including efforts by employer group health plans (EGHPs) and commercial insurers to make dialysis reimbursement payments at a lower rate as a result of the U.S. Supreme Court’s ruling in Marietta Memorial Hospital Employee Health Benefit Plan, et al. v. DaVita Inc. et al. 142 S. Ct. 1968 (2022) (Marietta), particularly if the U.S. Congress fails to enact legislation that would reverse the effects of that decision; |
| ● | the impact of worldwide pandemics, including, without limitation, increased opposition to vaccinations that could mitigate the severity and spread such diseases, changes in government policies that have reduced the number of recommended vaccines and deferred the recommended timing of their use, any or all of which could affect patient vaccine hesitancy and whether commercial insurers cover, without cost-sharing, vaccine costs for certain insureds and potentially reduce the vaccinated population, a significant increase in mortality of patients with chronic kidney diseases as well as an increase in persons experiencing renal failure, the impacts of global viruses on our patients, caregivers, employees, suppliers, supply chain, business, and operations, and consequences of economic downturns resulting from global pandemics; |
| ● | our ability to attract and retain skilled employees and risks that competition for labor, high turnover rates, and meaningfully higher personnel costs as well as legislative, union, or other labor-related activities or changes have and will continue to result in significant increases in our operating costs, decreases in productivity, and partial suspension of operations, and to impact our ability to address additional treatments and growth recovery; |
| ● | the increase in raw material, energy, labor, and other costs, including certain cost increases as well as material shortages and other supply chain impacts related to the conflict in the Middle East, and the impact that inflation may have on a potential impairment of our goodwill, investments, or other assets as noted above. These cost increases and/or supply chain impacts could also impact our cost savings initiatives; |
| ● | the outcome of litigation as well as government and internal investigations; |
| ● | launch of new technology, introduction of generic or new pharmaceuticals and medical devices that compete with our products or services, advances in medical therapies, including the increased utilization of pharmaceuticals that reduce the progression of CKD and its precursors, xenotransplantation research, and development and new market entrants that compete with our businesses (further information regarding the impact of certain pharmaceuticals that reduce the progression of CKD and our analysis of their impact on our cash flow projections and goodwill sensitivity assessments can be found in note 1 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report); |
| ● | product liability risks and the risk of recalls of our products by regulators; |
| ● | our ability to successfully launch our 5008X CAREsystem dialysis machine and related disposables and introduce high- volume hemodiafiltration (HVHDF) in the U.S. and otherwise to continue to grow our healthcare services and products businesses, organically and through acquisitions, including, with respect to acquisitions, the effects of increased enforcement of antitrust and competition laws, and to implement our strategy; |
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| ● | the impact of currency and interest rate fluctuations, including the heightened risk of fluctuations as a result of geopolitical conflicts in certain regions, the impact of the current macroeconomic inflationary environment on interest rates, and a related effect on our borrowing costs; |
| ● | volatility in the valuation of financial instruments connected to energy prices or energy production volumes (such as virtual power purchase agreements (vPPAs)), including the heightened risk of volatility as a result of geopolitical conflicts in certain regions; |
| ● | potential impairment of our goodwill, investments, or other assets due to decreases in the recoverable amount of those assets relative to their book value, particularly as a result of sovereign rating agency downgrades coupled with an economic downturn in various regions, as a result of geopolitical conflicts in certain regions, or as a result of impacts from changes in government regulations affecting reimbursement; |
| ● | our ability to protect our information technology systems and protected health information and personally identifiable information against cyber-attacks and other unauthorized access and disclosure of personal data to prevent other data privacy or security breaches of our data (including data held by our third-party service providers), current and potential litigation arising from cybersecurity and privacy breaches, and the potential effects on our reputation, customer, or vendor relationships, business operations, or competitiveness of any cybersecurity incidents we or our service providers may incur, as well as our ability to effectively capture efficiency goals and align with contractual and other requirements related to data offshoring activities; |
| ● | changes in our costs of purchasing and utilization patterns for pharmaceuticals and our other healthcare products and supplies, the inability to procure raw materials, or disruptions in our supply chain; |
| ● | economic uncertainty resulting from the imposition of tariffs and proposals to impose tariffs, uncertainty arising from refunds of reciprocal tariffs following the U.S. Supreme Court’s determination in Learning Resources v. Trump 607 U.S. , 146 S. Ct. 628 (2026), and deferrals, modifications, and withdrawals of such tariffs and proposals, increases in tariffs and trade barriers that could result from withdrawal by single or multiple countries from multilateral trade agreements or the imposition of sanctions, and other countermeasures in the wake of trade disputes and geopolitical conflicts in certain regions along with the effects of global events, political and/or governmental volatility, and associated developments on healthcare systems, our patients or our business, as well as additional economic uncertainty resulting from budget impasses or government shutdowns; |
| ● | collectability of our receivables, which depends primarily on the efficacy of our billing practices, the financial stability, and liquidity of our governmental and private payors, services from third-party clearinghouses, customers, and intermediaries, as well as payor strategies to delay, dispute, or thwart the collection process; |
| ● | our ability to secure contracts and achieve cost savings and desired clinical outcomes in our operations, including in our value-based care operations and other healthcare risk management programs in which we participate or intend to participate; |
| ● | the greater size, market power, experience, and product offerings of certain competitors in certain geographic regions and business lines; |
| ● | the use of accounting estimates, judgments, and accounting pronouncement interpretations in our consolidated financial statements; |
| ● | our ability to continue to achieve projected cost savings and to implement our strategy to achieve higher margins. On June 17, 2025, we launched our new strategy, FME Reignite, announcing our increased profitability aspirations for 2030 and a new capital allocation framework to enhance value creation. Included within the announcement was the expansion of the transformation of our operating structure and steps to achieve cost savings (FME25 Program) by two years. The total program with its extension was renamed the FME25+ Program (FME25+ Program). The expanded program now targets a cumulative total of €1.2 BN of sustainable savings by the end of 2027, including an additional €400 M through operational efficiencies; |
| ● | our ability to improve our financial performance through the divestiture of non-core and dilutive assets; and |
| ● | our ability to achieve projected price increases for our products and corresponding services. |
Important factors that could contribute to such differences are noted in “Financial condition and results of operations – I. Overview” and “— III. Results of operations, financial position and net assets – Highlights” below, in note 10 of the notes to the consolidated financial statements (unaudited) included in this report, in note 25 of the notes to the consolidated financial statements included in our 2025 Form 20-F, as well as under “Risk Factors,” “Business overview,” “Operating and financial review and prospects,” and elsewhere in that report.
Our business is also subject to other risks and uncertainties that we describe from time to time in our periodic public filings which can be accessed at the SEC website at www.sec.gov. Developments in any of these areas could cause our results to differ materially from the results that we or others have projected or may project.
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The actual accounting policies, the judgments made in the selection and application of these policies, as well as the sensitivities of reported results to changes in accounting policies, assumptions, and estimates, are additional factors to be considered along with our interim financial statements and the discussion under “Results of operations, financial position and net assets” below. For a discussion of our critical accounting policies, see note 2 of the notes to the consolidated financial statements included in our 2025 Form 20-F.
Rounding adjustments applied to individual numbers and percentages shown in this and other reports may result in these figures differing immaterially from their absolute values. Some figures (including percentages) in this report have been rounded in accordance with commercial rounding conventions. In some instances, such rounded figures and percentages may not add up to 100% or to the totals or subtotals contained in this report. Furthermore, totals and subtotals in tables may differ slightly from unrounded figures contained in this report due to rounding in accordance with commercial rounding conventions. A dash (–) indicates that no data were reported for a specific line item in the relevant financial year or period, while a zero (0) is used when the pertinent figure, after rounding, amounts to zero.
Financial condition and results of operations
I. Overview
We are the world’s leading provider of products and services for individuals with renal diseases, based on publicly reported revenue. We provide dialysis and related services for individuals with renal diseases, including through value and risk-based care programs, as well as other healthcare services. We also develop, manufacture, and distribute a wide variety of healthcare products. Our healthcare products include hemodialysis machines, peritoneal dialysis cyclers, dialyzers, peritoneal dialysis solutions, hemodialysis concentrates, solutions and granulates, bloodlines, renal pharmaceuticals, systems for water treatment, as well as acute cardiopulmonary and apheresis products. We supply dialysis clinics we own, operate, or manage with a broad range of products and also sell dialysis products to other dialysis service providers. Our other healthcare services include pharmacy services, vascular specialty services, ambulatory surgery center services, and physician nephrology practice management. We operate in a competitive, international market environment and are, therefore, subject to certain trends, risks, and uncertainties that could cause actual results to differ from our projected results. The major trends affecting the markets in which we operate are: the aging population and increased life expectancies, shortage of donor organs for kidney transplants, and increasing incidence and better treatment of and survival of patients with diabetes and hypertension, which frequently precede the onset of CKD and ESRD, all of which contribute to patient growth. We are also engaged in different areas of healthcare product therapy research.
As a global company delivering healthcare services and products, we face the challenge of addressing the needs of a wide variety of stakeholders, such as patients, customers, payors, regulators, and legislators in different economic environments and healthcare systems. In general, government-funded programs (in some countries in coordination with private insurers) pay for certain healthcare items and services provided to their citizens. Not all healthcare systems provide payment for dialysis treatment. Therefore, the reimbursement systems and ancillary services utilization environment in various countries significantly influence our business.
Significant U.S. reimbursement and legislative developments
A significant portion of healthcare services we provide is paid for by governmental institutions. For the three months ended March 31, 2026, approximately 17% of our consolidated revenue was attributable to U.S. federally-funded healthcare benefit programs, such as Medicare and Medicaid reimbursement, under which reimbursement rates are set by CMS and the states. Legislative or regulatory changes could affect reimbursement rates for a significant portion of the services we provide. The stability of reimbursement in the U.S. has been affected by the ESRD prospective payment system (ESRD PPS) and the U.S. federal government across the board spending cuts in payments to Medicare providers commonly referred to as “U.S. Sequestration.” The One Big Beautiful Bill Act (OBBBA) (P.L. 119-21)), signed into law on July 4, 2025, will also significantly affect Medicaid reimbursement, availability, and eligibility. See detailed discussions on these and further legislative developments below:
| ● | Under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), for patients with Medicare coverage, all ESRD payments for dialysis treatments are made under the ESRD PPS, a single bundled payment rate which provides a fixed payment rate, encompassing substantially all goods and services provided during the dialysis treatment. MIPPA further created the ESRD Quality Incentive Program (QIP) under which dialysis facilities in the U.S. that fail to achieve annual quality standards established by CMS could have base payments reduced in a subsequent year by up to 2%. These programs blend the CMS quality standard measures with industry baselines in an effort to improve quality of care through a pay-for-performance program that operates as a part of the ESRD PPS. |
| ● | Additionally, the Budget Control Act of 2011 (BCA) required a $1.2 trillion reduction in deficits through 2021. As a backup, if Congress could not agree on proposals to reach this target, sequestration or across-the-board spending cuts would go into effect. On April 1, 2013, a 2% reduction to Medicare payments took effect and continues in force. Additionally, the Statutory Pay-As-You-Go Act of 2010 (Statutory PAYGO) requires that if the Congressional Budget Office determines that Congress has passed legislation increasing the federal budget deficit, a 4% sequester cut for Medicare program payments would become effective. To date, Congress has passed legislation increasing the federal deficit on a number of occasions subsequent to the passage of Statutory PAYGO, but has always acted to prevent such sequestration from becoming effective. Spending cuts pursuant to the U.S. Sequestration have adversely affected our operating results in the past and will continue to do so. In |
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| addition, options to restructure the Medicare program in the direction of a defined contribution, “premium support” model, to shift Medicaid funding to a block grant or per capita arrangement, with greater flexibility for the states, have been proposed or considered from time to time. Changes in payment methodologies and funding or payment requirements of (without limitation) the ESRD PPS, the Physician Fee Schedule, the Clinical Laboratory Fee Schedule, and the Ambulatory Surgical Center Payment System may have material effects on our operating results. We may also experience changes in the interpretation of government regulations by the courts. We have very little opportunity to influence or predict the magnitude of many of those changes. |
| ● | On November 20, 2025, CMS issued a final rule for the 2026 ESRD PPS, which CMS projects will increase the total aggregate payments to all ESRD facilities by 2.2%. For CY 2026, the ESRD PPS base rate is $281.71, an increase of $7.89 from the CY 2025 base rate of $273.82. This amount reflects application of the final CY 2026 ESRD Bundled market basket update of 2.1%, which is the result of a 2.9% market basket increase offset by a 0.8% productivity adjustment, as well as applicable budget-neutrality adjustment factors. CMS noted in the final rule that the 1.0 percent target for outlier payments was not achieved in CY 2024 as outlier payments represented approximately 0.8 percent of total Medicare payments. The final Acute Kidney Injury payment rate for CY 2026 is equal to the CY 2026 ESRD PPS base rate. CMS also finalized a budget-neutral payment increase for ESRD facilities in Alaska, Hawaii, and the U.S. Pacific Territories. CMS also finalized the termination of the ESRD Treatment Choices (ETC) Model effective December 31, 2025. |
| ● | Under the ESRD QIP, CMS assesses the total performance of each facility on a set of quality measures specified per payment year and applies up to a 2% payment reduction to facilities that do not meet a minimum total performance score. Beginning with QIP Payment Year (PY) 2027, CMS has removed the Facility Commitment to Health Equity reporting measure, Screening for Social Drivers of Health reporting measure and Screen Positive Rate for Social Drivers of Health reporting measure. CMS also finalized changes to In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems intended to reduce patient and facility burden. CMS has retained the severe acute respiratory syndrome coronavirus 2 and the related Coronavirus disease (COVID-19) Vaccination Coverage Among Healthcare Personnel measure and summarized responses to its requests for information on Health IT and potential quality measures related to nutrition and wellness. |
| ● | On October 31, 2025, CMS released the final Physician Fee Schedule for CY 2026. As required by statute, beginning in CY 2026, there will be two separate conversion factors: one for alternative payment model (APM) qualifying participants (QPs) and one for physicians and practitioners who are not QPs. The final CY 2026 qualifying APM conversion factor of $33.57 represents a projected increase of $1.22 (+3.8%) from the CY 2025 conversion factor of $32.35. Similarly, the final CY 2026 non-qualifying APM conversion factor of $33.40 represents a projected increase of $1.05 (+3.3%) from the CY 2025 conversion factor of $32.35. The final updates are inclusive of the OBBBA one-time adjustment for 2026. The impacts of the final updates are expected to vary by specialty and site of service. |
| ● | On November 21, 2025, CMS released the CY 2026 final rule for hospital outpatient and ambulatory surgery center (ASC) payment systems. For CY 2026, CMS finalized an update factor to the ASC rates of 2.6%. |
| ● | The American Taxpayer Relief Act of 2012 as subsequently modified under the Protecting Access to Medicare Act of 2014 (PAMA) included a provision addressing ESRD-related drugs with only an oral form, which are referred to as “oral-only” drugs and which have previously been paid separately. Subsequently, the Stephen Beck, Jr., Achieving a Better Life Experience Act of 2014 delayed inclusion of oral-only drugs in the ESRD PPS until January 1, 2025. Under the CY 2025 ESRD PPS Final Rule, oral-only drugs were approved for the Transitional Drug Add-on Payment Adjustment (TDAPA) under the ESRD PPS. CMS will utilize the TDAPA for at least two years to collect utilization data before adding these drugs to the ESRD PPS base rate. The TDAPA is generally based on 100% of average sales price. If ASP is not available, then the TDAPA is based on 100% of wholesale acquisition cost (WAC). If WAC is unavailable, then the payment is based on the drug manufacturer’s invoice. As finalized in the CY 2025 ESRD PPS Final Rule, CMS will apply a fixed increase to the calculation of the monthly TDAPA amount during this transition period for claims that include the applicable new oral-only drugs, to cover the incremental operational costs of making these medications available to patients. At the end of this transition period, CMS will initiate rulemaking to modify the base rate, if appropriate, to account for these drugs in the ESRD PPS bundled payment, as CMS did in the CY 2021 final rule for calcimimetics. In addition to the TDAPA payments for these oral-only drugs, CMS will continue the TDAPA payments for two additional drugs. Effective July 1, 2024, taurolidine and heparin sodium, a catheter lock solution instilled into the central venous catheter at the conclusion of each hemodialysis session, qualified for the TDAPA as a drug or biological product used to treat or manage a condition for which there is an existing ESRD PPS functional category. The TDAPA payment period began on July 1, 2024 and will continue through June 30, 2026, at which point the product will both become outlier eligible and also be included in the post-TDAPA add-on payment adjustment calculation. See “III. Results of operations, financial position, and net assets — Highlights,” below for further information. Additionally, effective January 1, 2025, vadadustat, an oral hypoxia-inducible factor prolyl hydroxylase inhibitor indicated for treating anemia due to chronic kidney disease in adults who have been receiving dialysis for at least three months, qualified for the TDAPA as a drug or biological used for anemia management, an existing ESRD PPS functional category. Vadadustat is eligible for the TDAPA throughout CY 2026 but does not qualify for outlier payments. |
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| ● | The OBBBA was signed into law on July 4, 2025. Focused on extending President Trump’s 2017 tax cuts and other domestic policy priorities, the OBBBA includes provisions that limit coverage in Medicaid, Medicare, and the ACA exchanges. Medicaid provisions include approximately $1 trillion in funding cuts to Medicaid through 2034; limits on state-levied taxes on healthcare providers (so-called “provider taxes”) (decreasing from 6% of provider revenues to 3.5% of net patient revenues by 2031) and limits on state-directed payment programs (from average commercial rates to either 100% (ACA expansion) or 110% (ACA non-expansion) of the Medicare payment rates, with certain exceptions), both often used to finance the states’ share of Medicaid spending; increased eligibility verification; limitations on retroactive eligibility; prevention of certain non-citizens from enrolling or receiving benefits under Medicaid; requirement for states to implement cost-sharing for certain populations, and work requirements for certain “able-bodied” beneficiaries (excluding beneficiaries with Medicare Part A/B and with a serious, complex medical condition), among other provisions. Medicare provisions prohibit certain non-citizens from being eligible for Medicare; provide a 2.5% increase in the Medicare Physician Fee Schedule for 2026 as a one-time adjustment; and expand the exemption of certain orphan drugs from the Medicare Drug Price Negotiation Program. The OBBBA also established a $50 BN Rural Health Transformation Program to help fund rural hospitals and other providers over 5 years in an effort to offset decreases in Medicaid funding. ACA-related provisions of the OBBBA limit the availability of premium tax credits for plans through the ACA marketplace to certain non-citizens, shorten the open enrollment period, and eliminate automatic re-enrollment. Overall, the OBBBA includes significant changes involving funding, enrollments, and eligibility. While it is too early to predict the magnitude of the changes or the cumulative effect on the Company, it is important to note that revenues from Medicaid and other government sources (excluding Medicare and Medicare Advantage funds) represented 4.7% of U.S. patient service revenues for the year ended December 31, 2025 (2024: 4.5%). We do not expect the changes resulting from the tax provisions in OBBBA to have a material impact on our effective tax rate or on our cash tax position. |
Presently, there is considerable uncertainty regarding possible future additional changes in healthcare regulation, including the regulation of reimbursement for dialysis services. As a consequence of the pressure to decrease healthcare costs, government reimbursement rate increases in the U.S. have historically been limited and are expected to continue in this fashion. However, any significant decreases in reimbursement under Medicare, Medicaid, Medicare Advantage plans, or from commercial insurance (which could result from changes in legislation, regulation, or other federal pressure on insurers to decrease rates), or in patient access to commercial insurance (as the result, e.g., of the termination of enhanced premium tax credits that expired at the end of 2025), or Medicare Advantage plans could have material adverse effects on our healthcare services business and, because the demand for dialysis products is similarly affected by reimbursement and coverage rates, on our products business. To the extent that increases in operating costs that are affected by inflation or supply chain factors, such as labor and supply costs, are not fully reflected in a compensating increase in reimbursement rates, our business and results of operations would be adversely affected. In addition, the Marietta ruling makes it easier for health plans to design plan benefits for Medicare eligible ESRD patients in a way that makes private health insurance relatively less attractive to ESRD patients and Medicare relatively more attractive. The Restore Protections for Dialysis Patients Act would restore the interpretation of the Medicare Secondary Payer Act prior to the Marietta decision and ensure that patients cannot be discriminated against because of their need for dialysis. That Act was most recently introduced in the U.S. Congress in March 2025 and most recently discussed in hearings in the Ways & Means Subcommittee on Health of the U.S. House of Representatives in March 2026, but as yet has not been enacted. We cannot predict whether the U.S. Congress will enact this or any other proposed legislation that would reverse the potential effects of the Marietta decision. As Medicare and Medicaid reimbursement rates are generally lower than the reimbursement rates paid by commercial insurers, a shift of commercially insured patients to Medicare and Medicaid could have a material adverse impact on our business, financial condition, and results of operations. The Marietta ruling could also result in certain EGHPs reducing the benefits offered for dialysis, which could, depending on the number of patients impacted, have a material and adverse impact on our business, financial condition, and results of operations. For additional information regarding these regulatory matters, see “Information on the Company—Regulatory and Legal Matters—Health Care Reform” in our 2025 Form 20-F.
For additional information, see “Risk Factors” included in our 2025 Form 20-F.
Premium assistance programs
The operation of charitable insurance premium assistance programs such as that offered by the American Kidney Fund (AKF) has received increased attention over the last few years by CMS and state insurance regulators and legislators. The result may be a regulatory framework that differs from the current framework or that varies from state to state. Even in the absence of actions by CMS or state regulators and legislatures to restrict the access that patients currently have to premium assistance programs, insurers are likely to continue efforts to thwart charitable premium assistance by premium assistance programs to our patients. If successful in a material area or scope of our U.S. operations, these efforts would have a material adverse impact on our business and operating results.
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One such law that was enacted is AB290 in California (U.S.). Upon enactment, we, along with other providers and the AKF, filed suit challenging the validity of the law. Jane Doe, et al. v. Xavier Becerra, et al., 8:19-cv-02105, U.S. District Court for the Central District of California, Southern Division. In December 2019, the court issued a preliminary injunction staying implementation of the law. On January 9, 2024, the court issued a summary judgment decision which, among other things, upheld the provisions limiting reimbursement paid to providers who donate to the AKF when such reimbursement relates to services provided to patients who receive AKF support. On May 9, 2024, the court issued a final judgment, but stayed entry of such judgment while the parties appeal. The parties filed cross-appeals and, on April 7, 2026, the U.S. Court of Appeals for the Ninth Circuit (9th Circuit) issued its opinion, affirming in part and reversing in part, the district court’s decision. The 9th Circuit found that three provisions, including the reimbursement limitations, are unconstitutional and cannot be severed from the remainder of the law thereby rendering the entire law unenforceable.
Executive order-based models
On July 10, 2019, an Executive Order on advancing kidney health was signed in the United States. Among other things, the order instructed the Secretary of the U.S. Department of Health and Human Services (HHS) to develop new Medicare payment models to encourage identification and earlier treatment of kidney disease as well as increased home dialysis and transplants. One of these models, the ETC model, a mandatory model that was intended to create financial incentives for home treatment and kidney transplants, was terminated effective December 31, 2025. Pursuant to the Executive Order, the Secretary of HHS also announced voluntary payment models, Kidney Care First (KCF) and CKCC models (graduated, professional and global), aim to build on the existing Comprehensive ESRD Care model. These voluntary models create financial incentives for healthcare providers to manage care for Medicare beneficiaries with CKD stages 4 and 5 and with ESRD, to delay the start of dialysis, and to incentivize kidney transplants. The voluntary models allow healthcare providers to take on various amounts of financial risk by forming an entity known as a Kidney Contracting Entity (KCE). Two options, the CKCC global and professional models, allow renal healthcare providers to assume upside and downside financial risk. A third option, the CKCC graduated model, is limited to assumption of upside risk, but is unavailable to KCEs that include large dialysis organizations such as the Company. Under the global model, the KCE is responsible for 100% of the total cost of care for all Medicare Part A and B services for aligned beneficiaries, and under the professional model, the KCE is responsible for 50% of such costs. As of March 31, 2026, we participated in 21 KCEs. Twenty KCEs began assuming financial risk within the first performance year that commenced January 1, 2022, and four began assuming financial risk within the second performance year that commenced January 1, 2023. Subsequently, three KCEs ended performance. The CKCC model is expected to run through 2027. In September 2025, CMS released the performance scores for the 2024 performance year in which the majority of the KCEs organized in Value-Based Care qualified as high performers in various quality metrics. As of March 2026, approximately 56,000 patients were aligned to KCEs in which we participated.
Company structure
For a description of our structure, especially as relates to our operating segments, see notes 1 and 12 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report.
II. Discussion of measures
Non-IFRS measures®
Certain of the following financial measures and other financial information as well as discussions and analyses set out in this report include measures that are not defined by IFRS Accounting Standards (Non-IFRS Measures). We believe this information, along with comparable IFRS Accounting Standards financial measurements, is useful to our investors as it provides a basis for assessing our performance, payment obligations related to performance-based compensation, our compliance with covenants, and enhanced transparency and comparability of our results. Non-IFRS financial measures should not be viewed or interpreted as a substitute for financial information presented in accordance with IFRS Accounting Standards.
Constant Exchange Rates or Constant Currency (Non-IFRS Measure)
Our presentation of some financial measures used in this report such as changes in revenue, operating income and net income attributable to shareholders of FME AG (or net income) includes the impact of translating local currencies to our reporting currency for financial reporting purposes. We calculate and present these financial measures using both IFRS Accounting Standards and at constant exchange rates to show changes in these metrics and other items without giving effect to period-to-period currency fluctuations. Under IFRS Accounting Standards, amounts received in local (non-euro) currency are translated into euro at the average exchange rate for the period presented. Once we translate the local currency for the constant currency, we then calculate the change, as a percentage, of the current period calculated using the prior period exchange rates versus the prior period. This resulting percentage is a Non-IFRS Measure referring to a change as a percentage at constant currency. These currency-adjusted financial measures are identifiable by the designated terms “Constant Exchange Rates” or “Constant Currency.”
The primary key performance indicators are presented both in accordance with IFRS Accounting Standards and at Constant Currency. Each of these indicators presented at Constant Currency is considered a non-IFRS measure. For the purposes of management compensation, these metrics are also benchmarked at the underlying exchange rates used in the calculation of our incentive compensation targets.
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We believe that the measures at Constant Currency are useful to investors, lenders and other creditors because such information enables them to gauge the impact of currency fluctuations on our revenue, operating income, net income attributable to shareholders of FME AG and other items from period to period. In addition, under our long-term incentive plans, we measure the attainment of certain predetermined financial targets for revenue growth and net income growth in Constant Currency. However, we limit our use of Constant Currency period-over-period changes to a measure for the impact of currency fluctuations on the translation of local currency into euro. We do not evaluate our results and performance without considering both:
| (1) | period-over-period changes in revenue, operating income, net income attributable to shareholders of FME AG, and other items prepared in accordance with IFRS Accounting Standards, and |
| (2) | Constant Currency changes in revenue, operating income, net income attributable to shareholders of FME AG, and other items. |
We caution the readers of this report not to consider these measures in isolation, but to review them in conjunction with changes in revenue, operating income, net income attributable to shareholders of FME AG, and other items prepared in accordance with IFRS Accounting Standards. We present the growth rate derived from non-IFRS measures next to the growth rate derived from IFRS Accounting Standards measures such as revenue, operating income, net income attributable to shareholders of FME AG, and other items. As the reconciliation is inherent in the disclosure included within “Results of operations, financial position and net assets,” below, we believe that a separate reconciliation would not provide any additional benefit.
Return on invested capital (ROIC) (Non-IFRS Measure)
ROIC is the ratio of operating income, for the last twelve months, after tax (net operating profit after tax or NOPAT) to the average invested capital of the last five quarter closing dates, including adjustments for acquisitions and divestitures made during the last twelve months with a purchase price above a €50 M threshold, consistent with the respective adjustments made in the determination of adjusted EBITDA (earnings before interest, taxes, depreciation, and amortization) below (see “Net leverage ratio (Non-IFRS Measure)”). ROIC expresses how efficiently we allocate the capital under our control or how well we employ our capital with regard to investment projects. The following tables show the reconciliation of average invested capital to total assets, which we believe to be the most directly comparable IFRS Accounting Standards financial measure, and how ROIC is calculated:
Reconciliation of average invested capital and ROIC (Non-IFRS Measure, unadjusted)
in € M, except where otherwise specified
March 31, | December 31, | September 30, | June 30, | March 31, | ||||||
2026 | | 2026 | 2025 | | 2025 | | 2025 | | 2025 | |
Total assets | 31,468 | 31,002 | 30,887 | 31,291 | 32,735 | |||||
Plus: Cumulative goodwill amortization and impairment loss | 386 | 379 | 380 | 465 | 494 | |||||
Minus: Cash and cash equivalents(1) | (1,239) | (1,599) | (1,256) | (1,720) | (1,079) | |||||
Minus: Deferred tax assets(1) | (249) | (237) | (231) | (232) | (225) | |||||
Minus: Accounts payable to unrelated parties(1) | (771) | (738) | (726) | (687) | (771) | |||||
Minus: Accounts payable to related parties | (105) | (85) | (92) | (48) | (106) | |||||
Minus: Provisions and other current liabilities(2) | (2,878) | (2,699) | (3,235) | (2,496) | (2,637) | |||||
Minus: Income tax liabilities(1) | (264) | (248) | (256) | (247) | (238) | |||||
Invested capital | 26,348 | 25,775 | 25,471 | 26,326 | 28,173 | |||||
Average invested capital as of March 31, 2026 | 26,419 | |||||||||
Operating income | 1,782 | |||||||||
Income tax expense(3) | (472) | |||||||||
NOPAT | 1,310 |
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Adjustments to average invested capital and ROIC
in € M, except where otherwise specified
| March 31, | | December 31, | | September 30, | | June 30, | | March 31, | |
2026 | | 2026 | 2025(4) | | 2025(4) | | 2025(4) | | 2025(4) | |
Total assets |
| — | — |
| — |
| (56) |
| (58) | |
Plus: Cumulative goodwill amortization and impairment loss | — | — | — | (76) | (78) | |||||
Minus: Cash and cash equivalents |
| — | — |
| — |
| 4 |
| 5 | |
Minus: Deferred tax assets | — | — | — | — | — | |||||
Minus: Accounts payable to unrelated parties | — | — | — | 1 | 1 | |||||
Minus: Accounts payable to related parties | — | — | — | — | — | |||||
Minus: Provisions and other current liabilities(2) |
| — | — |
| — |
| 12 |
| 13 | |
Minus: Income tax liabilities |
| — | — |
| — |
| 2 |
| 2 | |
Invested capital |
| — | — |
| — |
| (113) |
| (115) | |
Adjustment to average invested capital as of March 31, 2026 | (46) | |
|
| | |||||
Adjustment to operating income(4) | (41) | |
| |
| | ||||
Adjustment to income tax expense(4) | 11 | |
| |
| | ||||
Adjustment to NOPAT | (30) | |
| |
| |
Reconciliation of average invested capital and ROIC (Non-IFRS Measure)
in € M, except where otherwise specified
March 31, | | December 31, | | September 30, | | June 30, | | March 31, | ||
2026 | | 2026 | 2025(4) | | 2025(4) | | 2025(4) | | 2025(4) | |
Total assets | 31,468 | 31,002 |
| 30,887 |
| 31,235 |
| 32,677 | ||
Plus: Cumulative goodwill amortization and impairment loss | 386 | 379 |
| 380 |
| 389 |
| 416 | ||
Minus: Cash and cash equivalents(1) | (1,239) | (1,599) |
| (1,256) |
| (1,716) |
| (1,074) | ||
Minus: Deferred tax assets(1) | (249) | (237) | (231) | (232) | (225) | |||||
Minus: Accounts payable to unrelated parties(1) | (771) | (738) | (726) | (686) | (770) | |||||
Minus: Accounts payable to related parties | (105) | (85) | (92) | (48) | (106) | |||||
Minus: Provisions and other current liabilities(2) | (2,878) | (2,699) | (3,235) | (2,484) | (2,624) | |||||
Minus: Income tax liabilities(1) | (264) | (248) | (256) | (245) | (236) | |||||
Invested capital | 26,348 | 25,775 | 25,471 | 26,213 | 28,058 | |||||
Average invested capital as of March 31, 2026 | 26,373 |
| |
| |
| | |||
Operating income(4) | 1,741 |
| |
| |
| | |||
Income tax expense(3), (4) | (461) |
| |
| |
| | |||
NOPAT | 1,280 |
| |
| |
| | |||
ROIC in % | 4.9 | |
| |
| |
Reconciliation of average invested capital and ROIC (Non-IFRS Measure, unadjusted)
in € M, except where otherwise specified
| December 31, | | September 30, | | June 30, | | March 31, | | December 31, | |
2025 | 2025 | 2025 | 2025 | 2025 | 2024 | |||||
Total assets |
| 31,002 |
| 30,887 |
| 31,291 |
| 32,735 |
| 33,567 |
Plus: Cumulative goodwill amortization and impairment loss |
| 379 |
| 380 |
| 465 |
| 494 |
| 504 |
Minus: Cash and cash equivalents(1) |
| (1,599) |
| (1,256) |
| (1,720) |
| (1,079) |
| (1,185) |
Minus: Deferred tax assets(1) |
| (237) |
| (231) |
| (232) |
| (225) |
| (230) |
Minus: Accounts payable to unrelated parties(1) |
| (738) |
| (726) |
| (687) |
| (771) |
| (906) |
Minus: Accounts payable to related parties |
| (85) |
| (92) |
| (48) |
| (106) |
| (55) |
Minus: Provisions and other current liabilities(2) |
| (2,699) |
| (3,235) |
| (2,496) |
| (2,637) |
| (2,803) |
Minus: Income tax liabilities(1) |
| (248) |
| (256) |
| (247) |
| (238) |
| (222) |
Invested capital |
| 25,775 |
| 25,471 |
| 26,326 |
| 28,173 |
| 28,670 |
Average invested capital as of December 31, 2025 |
| 26,883 |
| |
| |
| |
| |
Operating income |
| 1,827 |
| |
| |
| |
| |
Income tax expense(3) |
| (451) |
| |
| |
| |
| |
NOPAT |
| 1,376 |
| |
| |
| |
| |
10
Adjustments to average invested capital and ROIC
in € M, except where otherwise specified
| December 31, | | September 30, | | June 30, | | March 31, | | December 31, | |
2025 | 2025 | 2025(4) | 2025(4) | 2025(4) | 2024(4) | |||||
Total assets |
| — |
| — |
| (56) |
| (58) |
| (57) |
Plus: Cumulative goodwill amortization and impairment loss | — | — | (76) | (78) | (76) | |||||
Minus: Cash and cash equivalents |
| — |
| — |
| 4 |
| 5 |
| 4 |
Minus: Deferred tax assets | — | — | — | — | — | |||||
Minus: Accounts payable to unrelated parties |
| — |
| — |
| 1 |
| 1 |
| 2 |
Minus: Accounts payable to related parties | — | — | — | — | — | |||||
Minus: Provisions and other current liabilities(2) |
| — |
| — |
| 12 |
| 13 |
| 12 |
Minus: Income tax liabilities | — | — | 2 | 2 | 2 | |||||
Invested capital |
| — |
| — |
| (113) |
| (115) |
| (113) |
Adjustment to average invested capital as of December 31, 2025 |
| (68) |
| |
| |
| |
| |
Adjustment to operating income(4) |
| (35) |
| |
| |
| |
| |
Adjustment to income tax expense(4) |
| 9 |
| |
| |
| |
| |
Adjustment to NOPAT |
| (26) |
| |
| |
| |
| |
Reconciliation of average invested capital and ROIC (Non-IFRS Measure)
in € M, except where otherwise specified
| December 31, | | September 30, | | June 30, | | March 31, | | December 31, | |
2025 | | 2025 | | 2024(4) | | 2024(4) | | 2024(4) | | 2023(4) |
Total assets |
| 31,002 |
| 30,887 |
| 31,235 |
| 32,677 |
| 33,510 |
Plus: Cumulative goodwill amortization and impairment loss |
| 379 |
| 380 |
| 389 |
| 416 |
| 428 |
Minus: Cash and cash equivalents(1) |
| (1,599) |
| (1,256) |
| (1,716) |
| (1,074) |
| (1,181) |
Minus: Deferred tax assets(1) |
| (237) |
| (231) |
| (232) |
| (225) |
| (230) |
Minus: Accounts payable to unrelated parties(1) |
| (738) |
| (726) |
| (686) |
| (770) |
| (904) |
Minus: Accounts payable to related parties |
| (85) |
| (92) |
| (48) |
| (106) |
| (55) |
Minus: Provisions and other current liabilities(2) |
| (2,699) |
| (3,235) |
| (2,484) |
| (2,624) |
| (2,791) |
Minus: Income tax liabilities(1) |
| (248) |
| (256) |
| (245) |
| (236) |
| (220) |
Invested capital |
| 25,775 |
| 25,471 |
| 26,213 |
| 28,058 |
| 28,557 |
Average invested capital as of December 31, 2025 |
| 26,815 |
| |
| |
| |
| |
Operating income(4) |
| 1,792 |
| |
| |
| |
| |
Income tax expense(3), (4) |
| (442) |
| |
| |
| |
| |
NOPAT |
| 1,350 |
| |
| |
| |
| |
ROIC in % | | 5.0 |
| |
| |
| |
| |
| (1) | Includes amounts related to assets, and associated liabilities, classified as held for sale. |
| (2) | Including non-current provisions, non-current labor expenses, and variable payments outstanding for acquisitions and excluding pension liabilities and noncontrolling interests subject to put provisions. |
| (3) | Adjusted for noncontrolling partnership interests. |
| (4) | Including adjustments for acquisitions and divestitures made during the last twelve months with a purchase price above a €50 M threshold. |
Net cash provided by (used in) operating activities in % of revenue
Our consolidated statement of cash flows indicates how we generated and used cash and cash equivalents. In conjunction with our other primary interim financial statements, it provides information that helps us evaluate changes to our net assets and our financial structure (including liquidity and solvency). Net cash provided by (used in) operating activities is applied to assess whether a business can internally generate the cash required to make the necessary replacement and expansion of investments. This indicator is impacted by the profitability of our business and the development of working capital, mainly receivables. Net cash provided by (used in) operating activities in percent of revenue shows the percentage of our revenue that is available in terms of financial resources. This measure is an indicator of our operating financial strength.
Free cash flow in % of revenue (Non-IFRS Measure)
Free cash flow (which we define as net cash provided by (used in) operating activities after capital expenditures, before acquisitions and investments) refers to the cash flow we have at our disposal, including cash flows that may be restricted for other uses. This indicator shows the percentage of revenue available for acquisitions and investments, dividends to shareholders, debt servicing, reductions in debt financing, and for repurchasing shares.
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For a reconciliation of cash flow performance indicators for the three months ended March 31, 2026 and 2025 which reconciles free cash flow and free cash flow in percent of revenue to Net cash provided by (used in) operating activities and Net cash provided by (used in) operating activities in percent of revenue, see “III. Results of operations, financial position and net assets - Financial position - Sources of Liquidity.”
Net leverage ratio (Non-IFRS Measure)
The net leverage ratio is a performance indicator used for capital management. To determine the net leverage ratio, debt and lease liabilities less cash and cash equivalents (net debt) is compared to adjusted EBITDA, which we define as EBITDA adjusted for:
| ● | the effects of acquisitions and divestitures made during the last twelve months with a purchase price above a €50 M threshold as defined in our €2 billion sustainability-linked syndicated revolving credit facility (Syndicated Credit Facility) (see note 7 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report), |
| ● | non-cash charges, |
| ● | impairment loss (including any impairment losses associated with the FME25+ Program and Legacy Portfolio Optimization, as defined below), and |
| ● | special items, including: |
| i. | costs related to our FME25+ Program, |
| ii. | the impact from the remeasurement of our investment in Humacyte, Inc. and receivables related to a royalty stream that we are entitled to base on sales made by Humacyte, Inc. in the U.S. (Humacyte Remeasurements), |
| iii. | certain costs associated with the change in the legal form of the Company from a partnership limited by shares (Kommanditgesellschaft auf Aktien - KGaA) into a stock corporation (Aktiengesellschaft - AG) in 2023, (the Conversion), primarily related to the requisite relabeling of our products, transaction costs (such as costs for external advisors and conducting an extraordinary general meeting) and costs related to the establishment of dedicated administrative functions required to manage certain services which have historically been administered at the Fresenius SE & Co. KGaA (Fresenius SE) group level and paid by the Company through corporate charges (Legal Form Conversion Costs), and |
| iv. | costs incurred in relation to strategic divestitures identified during the review of our business portfolio, mainly due to exiting unsustainable markets and divesting non-core businesses, as well as the cessation of certain R&D programs to enable more focused capital allocation towards areas in our core business that are expected to have higher profitable growth (Legacy Portfolio Optimization). For further information regarding these costs during the three months ended March 31, 2026 and 2025, see note 2 c) of the notes to the condensed consolidated interim financial statements (unaudited) included in this report. |
The ratio is an indicator of the length of time the Company needs to service the net debt out of its own resources. We believe that the net leverage ratio provides alternative information that management believes to be useful in assessing our ability to meet our payment obligations in addition to considering the absolute amount of our debt. We have a strong market position in a growing, global, and mainly non-cyclical market. Furthermore, most of our customers have a high credit rating as the dialysis industry is characterized by stable and sustained cash flows. We believe this enables us to work with a reasonable proportion of debt.
Adjusted EBITDA, a non-IFRS Measure, is used in our capital management and is also relevant in major financing instruments, including the Syndicated Credit Facility. You should not consider adjusted EBITDA to be an alternative to net earnings determined in accordance with IFRS Accounting Standards or to cash flow from operating, investing, or financing activities. In addition, not all funds depicted by adjusted EBITDA are available for management’s discretionary use. For example, a substantial portion of such funds are subject to contractual restrictions and functional requirements to fund debt service, capital expenditures, and other commitments as described in more detail elsewhere in this report.
For our self-set target range for the net leverage ratio and a reconciliation of adjusted EBITDA and net leverage ratio as of March 31, 2026 and December 31, 2025, see “III. Results of operations, financial position and net assets - Financial position - Sources of Liquidity.”
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Business metrics for Value-Based Care
The metrics outlined below represent performance indicators utilized by management to evaluate the Value-Based Care operating segment. Value and risk-based care programs include shared risk arrangements in which private payors or government programs share the savings or losses from reductions or increases in the overall medical spend of a population under management assuming that certain quality thresholds are also met. Full risk arrangements include capitated arrangements and shared saving arrangements in which private payors credit us periodic, fixed payments based on expected medical expenses of such members. Since capitation arrangements often can be recognized as premium revenue and the full medical premium for ESRD beneficiaries generally is very large, capitation programs can drive significant revenue and, when costs are effectively managed, profit opportunities; however, these programs also carry significant costs and potential risk of loss due to the full-risk nature of these arrangements. See “I. Overview — Executive order-based models” for further information.
Our financial performance in this segment is directly linked to our ability to manage a defined scope of medical costs within specific parameters for clinical outcomes. Due to the time required for CMS and private payors to review data for programs, we utilize estimates in order to report certain metrics on a timely basis. The key metrics currently used to evaluate performance in the Value-Based Care operating segment include member months under medical cost management (Member Months) and membership.
These metrics are intended for discussion and internal evaluation purposes and may be further refined or expanded in future reporting periods. Because these measures are not derived from financial measures, they do not constitute measures determined in accordance with IFRS Accounting Standards or non-IFRS financial measures, and accordingly, are not reconciled to IFRS Accounting Standards metrics.
Member Months
Member Months is calculated by multiplying the number of members included in value-based reimbursement programs by the corresponding number of months these members participate in those programs. Under certain value-based care programs, we assume both the risk associated with generating savings and the risk related to the total cost of care for attributed patients. The financial results are recorded in earnings as our performance is determined. A change in patient membership may indicate future earnings or losses as our performance is determined through these managed care programs.
Membership
Membership refers to the total number of individuals who are enrolled in a plan or program for which they receive care under a value-based care model. The metric represents the population of patients whose health outcomes, utilization of services and cost of care are measured under value-based care programs.
The correlation between membership and revenue generation depends on the accounting treatment of the underlying contracts:
| ● | For full risk contracts recorded in accordance with IFRS 17, Insurance Contracts, membership typically has a direct correlation to revenue generation. |
| ● | For shared risk contracts and other fee-for-service arrangements recorded in accordance with IFRS 15, Revenue from Contracts with Customers, membership is an indicator of the scale of our programs. However, revenue is subject to performance adjustments and risk-sharing provisions which may result in fluctuations or, in certain instances, the recording of negative revenue. |
III. Results of operations, financial position, and net assets
Highlights
The following items represent notable impacts or trends in our business and/or industry for the three months ended March 31, 2026:
FME25+ Program
The expanded FME25+ program now targets a cumulative total of €1.2 BN of sustainable savings by the end of 2027, including an additional €400 M through operational efficiencies. The cumulative sustainable savings since the inception of the original program was €854 M as of March 31, 2026 (March 31, 2025: €747 M). The following table shows the costs and additional recurring savings for the three months ended March 31, 2026 and 2025.
FME25+ Program impacts on operating income
in € M
| For the three months ended March 31, | |||
| 2026 | | 2025 | |
Costs | 166 |
| 28 | |
Additional recurring operational savings | 50(1) |
| 68 | |
| (1) | Represents savings achieved under our expanded program targeting an additional €400 M sustainable savings through operational efficiencies implemented during 2026 and 2027. |
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In the discussion of our results for the three months ended March 31, 2026 compared to the three months ended March 31, 2025 below, the effects of the costs and savings related to the FME25+ Program are presented on a net basis.
Share buyback
We launched our €1 BN share buyback program (excluding ancillary transaction costs) in two tranches to be completed within two years by August 10, 2027. The first tranche was initiated on August 11, 2025 and completed ahead of schedule on December 29, 2025, under which 14,124,564 shares were repurchased for €586 M (including true-ups). On January 9, 2026, we announced that we would accelerate our share buyback program and start the repurchase of the second tranche, under which we planned to repurchase a total amount of around €414 M from January 12 to May 8, 2026. As of March 31, 2026, 23,324,964 shares were repurchased under both tranches of the program, with cash outflows of €347 M for the three months ended March 31, 2026. As of April 30, 2026, the Company repurchased 24,848,819 shares, or 8.5% of share capital, completing the program significantly earlier than originally planned, after less than a year. For further information, see note 2 d) of the notes to the condensed consolidated interim financial statements (unaudited) included in this report.
Other trends
Recent changes in global trade policy, including new tariffs on most products imported into the U.S. and the possibility of additional trade restrictions, have created increased uncertainty and potential risk within the healthcare industry and to our business operations and financial performance. While we have implemented measures to mitigate these risks, we may see further increased costs for supplies depending on the nature and scope of these shifts on the affected goods and materials we use.
In addition to tariffs, additional macroeconomic factors continue to present challenges as inflation remains elevated, which contributes to higher labor and production costs, as well as ongoing disruptions of global supply chains and new or potential export/import restrictions across key markets. The ongoing conflict in the Middle East has introduced additional volatility within the global energy markets and has significantly impacted trade routes in the region. Such continued, or escalating, conflicts in the region have and could continue to have an impact on fuel and energy prices, increasing the challenges of elevated inflationary pressure and increasing transportation, raw material, and manufacturing costs and could lead to other supply chain impacts such as reductions in raw material availability.
Resulting cost increases have and could continue to adversely impact our financial condition and results of operations, especially if we are unable to absorb these costs through increased reimbursement (which is largely dependent on government action and contractual terms) and increased prices for our products or offset them through supply chain adjustments, product redesign (which could require regulatory approvals), or other operational efficiencies. We are closely monitoring these developments and identifying additional strategies to mitigate potential financial and operational impacts and have experienced a limited impact in the first three months of 2026. However, given the continuously changing nature of these challenges and their broader economic implications, we cannot accurately predict the full extent of their impact on our business. Additionally, influences on currency markets via geopolitical developments and corrective actions taken by central banks may cause such exchange rate developments to differ significantly in the future.
As described in Item 4.B, “Information on the Company — B. Business Overview — Regulatory and Legal Matters — Health care Reform” and “— Reimbursement,” in our 2025 Form 20-F, we are facing regulatory challenges that we assume will impact earnings development in future quarters. In the U.S., the elimination of the ACA premium tax credits (absent any future reenactment) and certain Medicaid-related provisions of the OBBBA are anticipated to adversely affect reimbursement levels and patient volumes. Additionally, certain pharmaceutical products are reimbursed under TDAPA, which provides for separate payment under the ESRD PPS for a limited transitional period. Upon expiration of the applicable TDAPA period, reimbursement for these pharmaceutical products transitions to either a post-TDAPA add-on under the ESRD PPS for dialysis drugs or biologicals for which there is an existing functional category or via a modification to the ESRD PPS rate, if applicable, after CMS undertakes additional rulemaking for dialysis drugs or biologicals for which there is not an existing functional category. The impacts from such changes in reimbursement on our results of operations, financial position, and net assets are described in the following discussions as “Impacts from TDAPA Reimbursement Regulation.” The Impacts from TDAPA Reimbursement Regulation significantly supported our consolidated and Care Delivery operating income results for the three months ended March 31, 2026 and 2025, and resulted in a positive impact on a comparative basis, though management expects this favorable impact to reduce, beginning in the second half of 2026. These U.S. regulatory impacts, together with other evolving global regulatory and reimbursement developments such as volume-based procurement and stricter tender requirements in China, could continue to place pressure on our business in future periods and result in a negative impact on our revenues and operating income.
The following sections summarize our consolidated results of operations, financial position and net assets as well as key performance indicators by reporting segment, as well as Corporate, for the periods indicated. We prepared the information consistent with the manner in which management internally disaggregates financial information to assist in making operating decisions and evaluating management performance.
14
Results of operations
Revenue and operating income generated in countries outside the eurozone are subject to currency fluctuations. As a significant portion of our operations are derived from our businesses in the U.S., the development of the euro against the U.S. dollar can have a material impact on our results of operations, financial position and net assets and the impacts of foreign currency transaction and translation effects are included in the discussion of our key and secondary performance indicators below.
Three months ended March 31, 2026 compared to three months ended March 31, 2025
Results of operations
in € M
| | Change in % | ||||||||
For the three months ended | | Currency | | |||||||
March 31, | translation | Constant | ||||||||
| 2026 | | 2025 | | As reported | | effects | | Currency(1) | |
Revenue |
| 4,612 | 4,881 | (6) | (9) | 3 | ||||
Costs of revenue | (3,433) | (3,697) | (7) | 9 | 2 | |||||
Selling, general and administrative expense |
| (749) | (751) | 0 | 8 | 8 | ||||
Research and development |
| (38) | (43) | (12) | 4 | (8) | ||||
Income from equity method investees |
| 41 | 48 | (14) | 0 | (14) | ||||
Other operating income | 158 | 141 | 12 | (3) | 15 | |||||
Other operating expense | (305) | (248) | 24 | 8 | 32 | |||||
Operating income | 286 | 331 | (14) | (5) | (9) | |||||
Operating income margin | 6.2 | 6.8 | ||||||||
Interest income | 15 | 15 | (2) | (4) | 2 | |||||
Interest expense | (94) | (96) | (3) | 8 | 5 | |||||
Income tax expense | (43) | (61) | (30) | 1 | (29) | |||||
Net income | 164 | 189 | (13) | (4) | (9) | |||||
Net income attributable to noncontrolling interests | (46) | (38) | 23 | 14 | 37 | |||||
Net income attributable to shareholders of FME AG | 118 | 151 | (22) | (1) | (21) | |||||
Basic and diluted earnings per share in € | 0.43 | 0.52 | (17) | (1) | (16) | |||||
| (1) | For further information on Constant Exchange Rates, see “II. Discussion of measures – Non–IFRS measures” above. |
Key Performance Indicators
The following discussions include our operating and reportable segments and the measures we use to manage these segments. For further information, see note 12 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report.
Revenue
in € M
Change in % | ||||||||||||||
For the three months ended |
|
| Currency |
|
|
| Same Market | |||||||
March 31, | translation | Constant | Organic | Treatment | ||||||||||
| 2026 |
| 2025 |
| As reported |
| effects |
| Currency(1) |
| growth |
| Growth(2) | |
| | | | | | | ||||||||
Revenue | 4,612 | 4,881 | (6) | (9) | 3 | 4 | ||||||||
Care Delivery segment | 3,294 | 3,447 | (4) | (9) | 5 | 6 | 0.1 | |||||||
Thereof: U.S. | 2,765 | 2,892 | (4) | (10) | 6 | 7 | (0.4) | |||||||
Thereof: International | 529 | 555 | (5) | (3) | (2) | 3 | 1.3 | |||||||
Value-Based Care segment | 490 | 529 | (7) | (10) | 3 | 3 | ||||||||
Care Enablement segment | 1,299 | 1,367 | (5) | (6) | 1 | 1 | ||||||||
Inter-segment eliminations | (471) | (462) | 2 | (10) | 12 | |||||||||
Thereof: Care Delivery (3) | (121) | (119) | 2 | (11) | 13 | |||||||||
Thereof: Care Enablement (3) | (350) | (343) | 2 | (9) | 11 | |||||||||
| (1) | For further information on Constant Exchange Rates, see “II. Discussion of measures – Non–IFRS measures” above. |
| (2) | Same market treatment growth represents growth in treatments, adjusted for certain reconciling items including (but not limited to) treatments from acquisitions, closed or sold clinics and differences in dialysis days (Same Market Treatment Growth). |
| (3) | Services provided by the Care Delivery segment in the U.S. for patients managed under the Value-Based Care segment are provided at fair market value. We also transfer products from the Care Enablement segment to the Care Delivery segment at fair market value. |
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Patients, dialysis treatments, and clinics
Three months ended March 31, | ||||||||||||||||||
| | | Change | | | | Change | | | | Change | |||||||
2026 | 2025 | in % | 2026 | 2025 | in % | 2026 | 2025 | in % | ||||||||||
Patients | Dialysis treatments | Clinics | ||||||||||||||||
Care Delivery segment | | 289,923 | | 299,358 | | (3) | | 10,672,063 | | 11,007,408 | | (3) | | 3,539 | | 3,674 | | (4) |
Thereof: U.S. |
| 203,930 |
| 205,662 |
| (1) |
| 7,505,920 |
| 7,548,182 |
| (1) |
| 2,562 |
| 2,623 |
| (2) |
Thereof: International |
| 85,993 |
| 93,696 |
| (8) |
| 3,166,143 |
| 3,459,226 |
| (8) |
| 977 |
| 1,051 |
| (7) |
Business metrics for Value-Based Care
Three months ended March 31, | ||||||||||||
Change | Change | |||||||||||
| 2026 | 2025 | in % | 2026 | 2025 | in % | ||||||
Member Months | Membership | |||||||||||
Value-Based Care segment | 460,809 | | 438,187 | | 5 | | 156,541 | | 148,415 | | 5 | |
Consolidated
Revenue decreased as compared to the three months ended March 31, 2025, primarily driven by a negative impact from foreign currency translation and the effect of closed or sold operations, partially offset by organic growth in all segments.
Care Delivery
The decrease in Care Delivery revenue as compared to the three months ended March 31, 2025 was driven by a negative impact from foreign currency translation and the effect of closed or sold operations, partially offset by organic growth. Organic growth was supported by favorable Impacts from TDAPA Reimbursement Regulation, reimbursement rate increases, and favorable payor mix effects. As of March 31, 2026, the number of patients treated in dialysis clinics that we own or operate in Care Delivery decreased as compared to March 31, 2025, primarily driven by divestitures in connection with Legacy Portfolio Optimization and clinic closures in the United States. Treatments in our Care Delivery segment decreased as compared to the three months ended March 31, 2025, mainly due to the effect of closed or sold clinics (primarily related to Legacy Portfolio Optimization). During the three months ended March 31, 2026, we acquired 1, opened 10, and combined, closed, or sold 73 dialysis clinics.
U.S.
In the U.S., the decrease in revenue was driven by a negative impact from foreign currency translation and the effect of closed or sold operations, partially offset by organic growth. Organic growth in the U.S. was supported by favorable Impacts from TDAPA Reimbursement Regulation, reimbursement rate increases, and favorable payor mix effects. Treatments decreased as compared to the three months ended March 31, 2025, primarily driven by the effect of closed or sold clinics. During the three months ended March 31, 2026, we acquired 1, opened 3, and combined, closed, or sold 64 dialysis clinics.
International
In our operations outside the U.S. (International), the decrease in revenue was driven by the effect of closed or sold operations (primarily related to Legacy Portfolio Optimization) and a negative impact from foreign currency translation, partially offset by organic growth. Patients treated in dialysis clinics that we own or operate in International decreased mainly as a result of divestitures in connection with Legacy Portfolio Optimization. The decrease in treatments within International was driven by the effect of closed or sold operations (primarily related to Legacy Portfolio Optimization), partially offset by Same Market Treatment Growth. During the three months ended March 31, 2026, we opened 7, and combined, closed, or sold 9 dialysis clinics.
Value-Based Care
Value-Based Care revenue decreased as compared to the three months ended March 31, 2025 mainly as a result of a negative impact from foreign currency translation, partially mitigated by a favorable impact from business growth. Business growth was primarily driven by organic growth, due to an increase in Member Months mainly from contract expansion and a positive effect from premium rates, partially offset by the amendment of one of our agreements previously classified as a full risk insurance contract to a shared risk contract resulting in a decrease in revenue recognized in 2026 (see note 4 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report).
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Care Enablement
Care Enablement revenue decreased as compared to the three months ended March 31, 2025 primarily driven by a negative impact from foreign currency translation and an unfavorable impact from volume-based procurement and stricter tender requirements in China which weighed on both volumes and prices, partially offset by increased sales of 5008X CAREsystems due to the large-scale rollout of those machines in Care Delivery clinics in the United States. Sales volumes and pricing momentum outside of China were positive as compared to the three months ended March 31, 2025.
Operating income (loss)
in € M
Change in % | ||||||||||
For the three months ended | Currency | |||||||||
March 31, | translation | Constant | ||||||||
2026 | 2025 | As reported | effects | Currency(1) | ||||||
| | |
| | | |||||
Operating income (loss) | 286 | 331 | (14) | (5) | (9) | |||||
Care Delivery segment | 271 | 320 | (15) | (12) | (3) | |||||
Value-Based Care segment | (11) | 3 | n.a. | — | n.a. | |||||
Care Enablement segment | 87 | 94 | (7) | 2 | (9) | |||||
Inter-segment eliminations | (21) | (5) | 303 | (46) | 349 | |||||
Corporate | (40) | (81) | (51) | (25) | (26) | |||||
Operating income (loss) margin | 6.2 | 6.8 | ||||||||
Care Delivery segment | 8.2 | 9.3 | ||||||||
Value-Based Care segment | (2.3) | 0.6 | ||||||||
Care Enablement segment | 6.7 | 6.9 | ||||||||
| (1) | For further information on Constant Exchange Rates, see “II. Discussion of measures – Non–IFRS measures” above. |
Consolidated
The decrease in our operating income was largely driven by net losses associated with the FME25+ Program (mainly driven by impairment losses from the closure of clinics in the U.S.), higher personnel expense, a negative impact from foreign currency translation, higher IT expense (including the implementation of our new ERP software), inflationary cost increases, and an unfavorable impact from foreign currency transaction effects, partially offset by a positive impact from business growth (mainly within Care Delivery) and a decline in the negative impact from Humacyte Remeasurements.
Care Delivery
Care Delivery operating income decreased primarily as a result of net losses associated with the FME25+ Program (mainly driven by impairment losses from the closure of clinics in the U.S.), a negative impact from foreign currency translation, and higher personnel expense, partially offset by a favorable impact from business growth (driven by favorable Impacts from TDAPA Reimbursement Regulation, reimbursement rate increases, and favorable payor mix effects).
Value-Based Care
Value-Based Care recorded an operating loss as compared to operating income for the three months ended March 31, 2025, primarily due to net losses associated with the FME25+ Program mainly driven by a loss from the derecognition of intangible assets recognized for software platform technologies and an unfavorable impact from the reconciliation of prior year contract performance, partially offset by savings rate improvement for certain contracts.
Care Enablement
Care Enablement operating income decreased primarily due to an unfavorable impact from foreign currency transaction effects and inflationary cost increases, partially offset by a favorable impact from business growth (mainly from increased sales of 5008X CAREsystems due to the large-scale rollout of those machines in Care Delivery clinics in the United States, partially offset by an unfavorable impact from volume-based procurement and stricter tender requirements in China which weighed on both volumes and prices) and a favorable impact from the remeasurement of receivables related to a royalty stream that we are entitled to base on sales made by Humacyte, Inc. in the U.S. Sales volumes and pricing momentum outside of China were positive as compared to the three months ended March 31, 2025.
17
Secondary performance indicators and other contributors to profit and loss
Costs of revenue decreased as compared to the three months ended March 31, 2025, primarily due to a positive impact from foreign currency translation, partially offset by higher personnel expense in Care Delivery and higher costs associated with business growth. Costs of revenue by segment for the three months ended March 31, 2026 and 2025 are provided in the following table:
Costs of revenue | ||||||||||
in € M | ||||||||||
Change in % | ||||||||||
For the three months | Currency | |||||||||
ended March 31, | translation | | Constant | |||||||
| 2026 | | 2025 | | As reported | | effects | Currency(1) | ||
Care Delivery segment |
| (2,547) | (2,740) | (7) | 9 | 2 | ||||
Value-Based Care segment |
| (451) | (493) | (8) | 10 | 2 | ||||
Care Enablement segment | (886) | (922) | (4) | 7 | 3 | |||||
Inter-segment eliminations | 449 | 457 | (2) | 10 | 8 | |||||
Corporate |
| 2 | 1 | 271 | (11) | 260 | ||||
| (1) | For further information on Constant Exchange Rates, see “II. Discussion of measures – Non–IFRS measures” above. |
Selling, general and administrative (SG&A) expense remained stable for the three months ended March 31, 2026 as compared to the three months ended March 31, 2025, as a positive impact from foreign currency translation was offset by higher IT expense (including the implementation of our new ERP software).
The decrease in research and development expense was largely driven by a positive impact from foreign currency translation and higher capitalization of development costs.
The decrease in income from equity method investees was primarily driven by lower earnings attributable to VFMCRP.
The increase in other operating income was primarily driven by a gain from the deconsolidation of certain clinics and higher foreign exchange gains.
The increase in other operating expense was primarily driven by net losses associated with the FME25+ Program (mainly driven by impairment losses from the closure of clinics in the U.S.), partially offset by a decline in the negative impact from the remeasurement of our investment in Humacyte, Inc.
For additional information regarding other operating income and expense, see note 2 c) of the notes to the condensed consolidated interim financial statements (unaudited) included in this report.
Net interest expense decreased by 3% from €81 M to €79 M, primarily due to a positive impact from foreign currency translation, higher interest income from bank deposits, and favorable effects from foreign currency swaps, partially offset by an unfavorable impact from refinancing activities (mainly driven by higher debt).
The effective tax rate decreased from 24.4% for the three months ended March 31, 2025 to 20.6%, primarily driven by a higher portion of tax-free income attributable to noncontrolling interests compared to income before income taxes and a lower share of non-deductible expenses.
The increase in net income attributable to noncontrolling interests was primarily due to higher earnings from entities in which we have less than 100% ownership and are fully consolidated.
The decrease in net income attributable to shareholders of FME AG resulted from the combined effects of the items discussed above.
Basic earnings per share decreased primarily due to the decrease in net income attributable to shareholders of FME AG described above. The average weighted number of shares outstanding for the period decreased to 275.2 M during the three months ended March 31, 2026 as compared to 293.4 M in the prior year period primarily driven by purchases of treasury stock under our share buyback program.
We employed 108,165 people (total headcount) as of March 31, 2026 (March 31, 2025: 112,035). This 3% decrease was largely due to the divestiture of certain businesses in connection with Legacy Portfolio Optimization.
18
Financial position
Sources of liquidity
Our primary sources of liquidity are typically cash provided by operating activities, cash provided by short-term debt, proceeds from the issuance of long-term debt, and divestitures. We require this capital primarily to finance working capital needs, fund the FME25+ Program and acquisitions, operate clinics, develop free-standing renal dialysis clinics and other healthcare facilities, purchase equipment for existing or new renal dialysis clinics and production sites, repay debt, pay dividends, repurchase shares (see “Net cash provided by (used in) investing activities” and “Net cash provided by (used in) financing activities” below), and to satisfy put option obligations to holders of minority interests in our majority-owned subsidiaries (see note 11 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report).
As of March 31, 2026, our available borrowing capacity under unutilized credit facilities amounted to approximately €3.3 billion, including €2.0 billion under the Syndicated Credit Facility, which we maintain as a backup for general corporate purposes (see note 7 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report).
In our long-term capital management, we focus primarily on the net leverage ratio, a Non-IFRS measure, and manage against our self-imposed target of 2.5x - 3.0x (see “II. Discussion of measures – Non–IFRS measures – Net leverage ratio (Non-IFRS Measure),” above). The following table shows the reconciliation of net debt and adjusted EBITDA and the calculation of the net leverage ratio as of March 31, 2026 and December 31, 2025.
Reconciliation of adjusted EBITDA and net leverage ratio to the most directly comparable IFRS financial measure
in € M, except for net leverage ratio
| March 31, | | December 31, | |
2026 | 2025 | |||
Debt and lease liabilities(1) | 11,029 | 10,795 | ||
Minus: Cash and cash equivalents | (1,239) | (1,599) | ||
Net debt | 9,790 | 9,196 | ||
Net income(2) | 1,166 | 1,191 | ||
Income tax expense(2) | 303 | 321 | ||
Interest income(2) | (69) | (70) | ||
Interest expense(2) | 382 | 385 | ||
Depreciation and amortization(2) | 1,435 | 1,463 | ||
Adjustments(2), (3) | 495 | 447 | ||
Adjusted EBITDA | 3,712 | 3,737 | ||
Net leverage ratio | 2.6 | 2.5 |
| (1) | Debt includes the following balance sheet line items: short-term debt, current portion of long-term debt, and long-term debt, less current portion. |
| (2) | Last twelve months. |
| (3) | Acquisitions and divestitures made for the last twelve months with a purchase price above a €50 M threshold as defined in the Syndicated Credit Facility (2026: -€2 M; 2025: €1 M), non-cash charges, primarily related to pension expense (2026: €45 M; 2025: €47 M), impairment loss (2026: €134M; 2025: €37 M), and special items, including costs related to the FME25+ Program (2026: €218 M; 2025: €185 M), Legacy Portfolio Optimization (2026: €78 M; 2025: €83 M), Legal Form Conversion Costs (2026: €3 M; 2025: €4 M), and Humacyte Remeasurements (2026: €19 M; 2025: €90 M). See “II. Discussion of measures — Non-IFRS measures — Net leverage ratio (Non-IFRS Measure),” above. |
At March 31, 2026, we had cash and cash equivalents of €1,239 M (December 31, 2025: €1,599 M).
Free cash flow (Net cash provided by (used in) operating activities, after capital expenditures, before acquisitions and investments) is a Non-IFRS Measure, see “II. Discussion of measures – Non–IFRS measures – Net cash provided by (used in) operating activities in % of revenue” and “– Free cash flow in % of revenue (Non-IFRS Measure)” above.
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The following table shows the cash flow performance indicators for the three months ended March 31, 2026 and 2025 and reconciles free cash flow to net cash provided by (used in) operating activities, the most directly comparable IFRS Accounting Standards measures, and free cash flow in percent of revenue to net cash provided by (used in) operating activities in percent of revenue:
Cash flow measures
in € M, except where otherwise specified
For the three months ended | ||||
March 31, | ||||
| 2026 | | 2025 | |
Revenue | 4,612 | 4,881 | ||
Net cash provided by (used in) operating activities | 227 | 163 | ||
Capital expenditures | (190) | (146) | ||
Proceeds from sale of property, plant and equipment | 3 | 4 | ||
Capital expenditures, net | (187) | (142) | ||
Free cash flow | 40 | 21 | ||
Net cash provided by (used in) operating activities in % of revenue | 4.9 | 3.3 | ||
Free cash flow in % of revenue | 0.9 | 0.4 | ||
Net cash provided by (used in) operating activities
Net cash provided by (used in) operating activities is impacted by the profitability of our business, the development of our working capital, principally inventories and receivables, and cash outflows that occur due to a number of specific items as discussed below. The increase in net cash provided by operating activities in percent of revenue for the three months ended March 31, 2026 as compared to the first three months of 2025 was driven by a favorable development of working capital. The development of working capital was mainly due to a positive impact from the development of accounts payable to unrelated parties, partially offset by unfavorable effects from accounts receivable from unrelated parties, primarily as a result of seasonality in invoicing, and a higher inventory level.
The profitability of our business depends significantly on reimbursement rates for our services. For the three months ended March 31, 2026, approximately 78% of our revenue was generated by providing healthcare services (including insurance services), a major portion of which is reimbursed by either public healthcare organizations or private insurers. For the three months ended March 31, 2026, approximately 17% of our consolidated revenue was attributable to reimbursements from U.S. federal healthcare benefit programs such as Medicare and Medicaid. Legislative changes could affect Medicare reimbursement rates for a significant portion of the services we provide as well as the scope of Medicare coverage. A decrease in reimbursement rates or the scope of coverage could have a material adverse effect on our business, financial position and results of operations and thus on our capacity to generate cash flow. See “— Forward-looking statements” and “I. Overview,” above.
We intend to continue to address our current cash and financing requirements using net cash provided by operating activities, issuances under our commercial paper program (see note 6 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report), as well as from the use of our bilateral credit lines. We expect that we will have adequate sources of financing available to us. Our Syndicated Credit Facility is also available for backup financing needs. In addition, to finance acquisitions or meet other needs, we expect to utilize long-term financing arrangements, such as the issuance of bonds (see “Net cash provided by (used in) financing activities” and note 13 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report below).
Net cash provided by (used in) operating activities depends on the collection of accounts receivable. Commercial customers and government institutions generally have different payment cycles. Lengthening their payment cycles could have a material adverse effect on our capacity to generate cash flow. In addition, we could face difficulties enforcing and collecting accounts receivable under the legal systems of, and due to the economic conditions in, some countries. Accounts receivable balances, net of expected credit losses, represented Days Sales Outstanding (DSO) (Non-IFRS Measure) of 65 days at March 31, 2026 (December 31, 2025: 59 days).
DSO by segment is calculated by dividing the respective segment’s trade accounts and other receivables from unrelated parties (including receivables related to assets held for sale) less contract liabilities, converted to euro using the average exchange rate for the period presented by the average daily sales for the last twelve months of that segment, including sales or value-added tax, converted to euro using the average exchange rate for the period. In order to ensure comparability of line items included in the consolidated balance sheets and consolidated statements of income, trade accounts and other receivables from unrelated parties and contract liabilities as of March 31, 2026 are adjusted for a decrease in the amount of €39.3 M and €1.4 M, respectively (December 31, 2025: an increase of €101.3 M and €3.7 M, respectively) which represents the impact on these line items from foreign currency translation. Additionally, daily revenues in the amount of €(0.1) M and €(0.1) M for the twelve months ended March 31, 2026 and December 31, 2025, respectively, are adjusted in relation to amounts related to acquisitions and divestitures made within the reporting period with a purchase price above a €50 M threshold, to increase consistency with the respective adjustments in the determination of adjusted EBITDA (see “II. Discussion of measures — Non-IFRS measures — Net leverage ratio (Non-IFRS Measure)” above) and in the amount of €0.7 M and €1.1 M for the twelve months ended March 31, 2026 and December 31, 2025, respectively to include sales or value-added tax and other smaller effects.
20
The development of DSO by reporting segment is shown in the table below:
Development of days sales outstanding (Non-IFRS Measure)
in days | | March 31, | | December 31, | | |
| 2026 | | 2025 | | Explanation of movement | |
Care Delivery | 65 | 54 | Seasonality in invoicing | |||
Value-Based Care | 32 | 33 | Timing of settlement payments related to certain payor contracts | |||
Care Enablement | 83 | 86 | Improvement through sharpened focus on credit management and cash collection | |||
FME AG | 65 | 59 |
| |
Due to the fact that a large portion of our reimbursement is provided by public healthcare organizations and private payors, we expect that most of our accounts receivable will be collectible.
For information regarding litigation exposure as well as ongoing and future tax audits, see note 10 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report.
Net cash provided by (used in) investing activities
Net cash used in investing activities in the first three months of 2026 was €169 M as compared to net cash used in investing activities of €108 M in the comparable period of 2025. The following table shows a breakdown of our investing activities for the first three months of 2026 and 2025:
Cash flows relating to investing activities
in € M
Acquisitions, investments, | ||||||||||||
Capital expenditures, net, | purchases of intangible | Proceeds from divestitures | ||||||||||
including capitalized | assets and investments in | and the sale of debt | ||||||||||
| development costs | | debt securities | | securities | |||||||
For the three months ended March 31, | ||||||||||||
| 2026 | | 2025 | | 2026 | | 2025 | | 2026 | | 2025 | |
Care Delivery | 102 | 82 | 3 | 6 | 9 | 30 | ||||||
Value-Based Care | 0 | 0 | — | 4 | 0 | — | ||||||
Care Enablement | 85 | 60 | 2 | 8 | 14 | 22 | ||||||
Total | 187 | 142 | 5 | 18 | 23 | 52 | ||||||
The majority of our capital expenditures in the first three months of 2026 was used for the capitalization of machines provided to our customers (including our 5008X CAREsystem), capitalization of certain development costs, capitalized IT implementation costs, expansion of production capacity, maintaining existing clinics and centers, and equipping new clinics and centers. Capital expenditures accounted for approximately 4% and 3% of total revenue in the first three months of 2026 and 2025, respectively.
Acquisitions in the first three months of 2026 relate primarily to the purchase of clinics and centers. Investments in the first three months of 2026 were primarily comprised of purchases of equity investments and debt securities. Divestitures in the first three months of 2026 mainly related to the divestment of debt securities and equity investments.
Acquisitions in the first three months of 2025 relate primarily to the purchase of clinics and centers. Investments in the first three months of 2025 were primarily comprised of purchases of debt securities. Divestitures in the first three months of 2025 mainly related to the divestment of debt securities and equity investments (including divestitures under our Legacy Portfolio Optimization program).
In 2026, we anticipate capital expenditures around €0.8 BN to €1.0 BN and will remain disciplined with regard to acquisition and investment spending, while focusing on the organic growth of our business. Our anticipated capital expenditures are driven by the need to position us well to capture growth opportunities, including the large-scale rollout of our 5008X CAREsystem (for which we are targeting to replace around 20% of our U.S. in-center hemodialysis machines (2008T model) in 2026 with the ultimate goal of replacing 100% by 2030), as well as to maintain quality levels and patient experience. Additionally, we plan accelerated capital expenditures in new production facilities as well as into R&D activities for a more globalized product portfolio.
Net cash provided by (used in) financing activities
In the first three months of 2026, net cash used in financing activities was €436 M as compared to net cash used in financing activities of €139 M in the first three months of 2025.
In the first three months of 2026, cash was mainly used in the purchase of our shares through the share buyback program, the repayment of debt and lease liabilities, and distributions to noncontrolling interests, partially offset by proceeds from debt.
21
In the first three months of 2025, cash was mainly used in the repayment of lease liabilities and distributions to noncontrolling interests, partially offset by proceeds from short-term debt.
For further information, see note 7 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report.
Balance sheet structure
Total assets as of March 31, 2026 increased by 2% to €31.5 BN as compared to €31.0 BN at December 31, 2025. Apart from a 1% positive impact resulting from foreign currency translation, total assets increased by 1% to €31.2 BN primarily due to increases in certain working capital items such as trade accounts and other receivables from unrelated parties (primarily as a result of seasonality in invoicing) as well as inventories, partially offset by decreases in cash and cash equivalents as well as right-of-use assets and property, plant and equipment.
Current assets as a percent of total assets increased to 26% at March 31, 2026 as compared to 25% at December 31, 2025 primarily due to increases in trade accounts and other receivables from unrelated parties (primarily as a result of seasonality in invoicing) and inventories, partially offset by decreases in cash and cash equivalents. The equity ratio, the ratio of our equity divided by total liabilities and shareholders’ equity, decreased to 45% at March 31, 2026 as compared to 46% at December 31, 2025, primarily due to an increase in liabilities driven by an unfavorable impact from foreign currency translation, increased short-term borrowings from unrelated parties and other current financial liabilities. The decrease in the ratio was also driven by an overall decrease in shareholder’s equity mainly due to purchases of treasury stock under our share buyback program, partially offset by a favorable impact from foreign currency translation adjustments and the impact of net income on shareholders’ equity. ROIC decreased slightly to 4.9% at March 31, 2026 as compared to 5.0% at December 31, 2025, primarily driven by the development of operating income. Goodwill, included in the item “Invested capital,” has a significant impact on the calculation of ROIC. The weighted average cost of capital (WACC), including weighted risk premiums for country risks, was 6.6%. For further information on ROIC, see “II. Discussion of measures – Non–IFRS measures – Return on invested capital (ROIC) (Non-IFRS Measure)” above.
Report on post-balance sheet date events
Refer to note 13 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report.
Recently issued accounting standards
Refer to note 1 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report for information regarding recently issued accounting standards.
22
FRESENIUS MEDICAL CARE AG
Interim Financial Statements
Consolidated statements of income
(unaudited)
Consolidated statements of income
in € thousands (K), except per share data
For the three months | ||||||
ended March 31, | ||||||
| Note | | 2026 | | 2025 | |
Revenue: | ||||||
Healthcare services |
| 2 a), 12 | | | ||
Healthcare products |
| 2 a), 12 | | | ||
Insurance contracts | 2 a), 12 | | | |||
| 2 a), 12 | | | |||
Costs of revenue: |
| |||||
Healthcare services |
| | | |||
Healthcare products |
| | | |||
Insurance contracts | | | ||||
12 | | | ||||
Operating (income) expenses: |
| |||||
Selling, general and administrative |
| 2 b) | | | ||
Research and development |
| 12 | | | ||
Income from equity method investees |
| 12 | ( | ( | ||
Other operating income | 2 c) | ( | ( | |||
Other operating expense | 2 c) | | | |||
Operating income |
| | | |||
Other (income) expense: |
| |||||
Interest income |
| ( | ( | |||
Interest expense |
| | | |||
Income before income taxes |
| | | |||
Income tax expense |
| | | |||
Net income |
| | | |||
Net income attributable to noncontrolling interests |
| | | |||
Net income attributable to shareholders of FME AG |
| | | |||
Basic earnings per share |
| 2 d) | | | ||
Diluted earnings per share |
| 2 d) | | | ||
See accompanying notes to the condensed consolidated interim financial statements (unaudited).
23
FRESENIUS MEDICAL CARE AG
Consolidated statements of comprehensive income
(unaudited)
Consolidated statements of comprehensive income
in € K
For the three months | ||||
ended March 31, | ||||
| 2026 | | 2025 | |
Net income | | |||
Other comprehensive income (loss): | ||||
Components that will not be reclassified to profit or loss: | ||||
Actuarial gain (loss) on defined benefit pension plans | | | ||
Income tax (expense) benefit related to components of other comprehensive income not reclassified | ( | ( | ||
| | |||
Components that may be reclassified subsequently to profit or loss: | ||||
Gain (loss) related to foreign currency translation, net of reclassification adjustments resulting from deconsolidation | | ( | ||
FVOCI debt securities | ( | | ||
Gain (loss) related to cash flow hedges | ( | | ||
Cost of hedging | ( | ( | ||
Income tax (expense) benefit related to components of other comprehensive income that may be reclassified | | ( | ||
| ( | |||
Other comprehensive income (loss), net of tax | | ( | ||
Total comprehensive income (loss) | | ( | ||
Comprehensive income attributable to noncontrolling interests | | ( | ||
Comprehensive income (loss) attributable to shareholders of FME AG | | ( | ||
See accompanying notes to the condensed consolidated interim financial statements (unaudited).
24
FRESENIUS MEDICAL CARE AG
Consolidated balance sheets
(unaudited)
Consolidated balance sheets
in € K, except share data
| Note | | March 31, 2026 | | December 31, 2025 | |
Assets | ||||||
Cash and cash equivalents |
| | | |||
Trade accounts and other receivables from unrelated parties |
| | | |||
Accounts receivable from related parties |
| 3 | | | ||
Inventories |
| 5 | | | ||
Current income tax refundable | 1 | | | |||
Other current assets | 1 | | | |||
Other current financial assets | | | ||||
Total current assets | | | ||||
Property, plant and equipment | | | ||||
Right-of-use assets |
| | | |||
Intangible assets | | | ||||
Goodwill | | | ||||
Non-current income tax refundable | 1 | | | |||
Deferred taxes | | | ||||
Investment in equity method investees |
| 12 | | | ||
Other non-current assets | 1 | | | |||
Other non-current financial assets | | | ||||
Total non-current assets | | | ||||
Total assets | | | ||||
Liabilities | ||||||
Accounts payable to unrelated parties | | | ||||
Accounts payable to related parties |
| 3 | | | ||
Current provisions | 1 | | | |||
Other current liabilities | 1 | | | |||
Other current financial liabilities |
| | | |||
Short-term debt from unrelated parties |
| 6 | | | ||
Current portion of long-term debt |
| 7 | | | ||
Current portion of lease liabilities from unrelated parties |
| | | |||
Current portion of lease liabilities from related parties |
| 3 | | | ||
Income tax liabilities | | | ||||
Total current liabilities | | | ||||
Long-term debt, less current portion |
| 7 | | | ||
Lease liabilities from unrelated parties, less current portion |
| | | |||
Lease liabilities from related parties, less current portion |
| 3 | | | ||
Non-current provisions | 1 | | | |||
Other non-current liabilities | 1 | | | |||
Other non-current financial liabilities | | | ||||
Pension liabilities | | | ||||
Income tax liabilities | | | ||||
Deferred taxes | | | ||||
Total non-current liabilities | | | ||||
Total liabilities | | | ||||
Shareholders’ equity: | ||||||
Ordinary shares, no par value, € | | | ||||
Treasury stock, at cost | 2 d) | ( |
| ( | ||
Additional paid-in capital | | | ||||
Retained earnings | | | ||||
Accumulated other comprehensive income (loss) | ( | ( | ||||
Total FME AG shareholders’ equity | | | ||||
Noncontrolling interests | | | ||||
Total equity | | | ||||
Total liabilities and equity | | |
See accompanying notes to the condensed consolidated interim financial statements (unaudited).
25
FRESENIUS MEDICAL CARE AG
Consolidated statements of cash flows
(unaudited)
Consolidated statements of cash flows
in € K
For the three months ended | ||||||
March 31, | ||||||
| Note | | 2026 | | 2025 | |
Operating activities | ||||||
Net income | | | ||||
Adjustments to reconcile net income to net cash provided by operating activities: |
| |||||
Depreciation, amortization and impairment loss |
| 12 | | | ||
Change in deferred taxes, net |
| ( | ( | |||
(Gain) loss from the sale of fixed assets, right-of-use assets, investments and divestitures |
| | | |||
Income from equity method investees |
| 12 | ( | ( | ||
Interest expense, net |
| | | |||
Changes in assets and liabilities, net of amounts from businesses acquired: |
| |||||
Trade accounts and other receivables from unrelated parties |
| ( | ( | |||
Inventories |
| ( | ( | |||
Other current and non-current assets |
| | | |||
Accounts receivable from related parties |
| | | |||
Accounts payable to related parties |
| | | |||
Accounts payable to unrelated parties, provisions and other current and non-current liabilities |
| | ( | |||
Income tax liabilities |
| | | |||
Received dividends from investments in equity method investees | | | ||||
Paid interest |
| ( | ( | |||
Received interest |
| | | |||
Paid income taxes |
| ( | ( | |||
Net cash provided by (used in) operating activities |
| | | |||
Investing activities |
| |||||
Purchases of property, plant and equipment and capitalized development costs |
| ( | ( | |||
Acquisitions, net of cash acquired, investments and purchases of intangible assets |
| ( | ( | |||
Investments in debt securities | ( | ( | ||||
Proceeds from sale of property, plant and equipment |
| | | |||
Proceeds from divestitures, net of cash disposed |
| | | |||
Proceeds from sale of debt securities | | | ||||
Net cash provided by (used in) investing activities |
| ( | ( | |||
Financing activities |
| |||||
Proceeds from short-term debt from unrelated parties |
| | | |||
Repayments of short-term debt from unrelated parties |
| ( | ( | |||
Proceeds from long-term debt |
| | | |||
Repayments of long-term debt |
| ( | ( | |||
Repayments of lease liabilities from unrelated parties |
| ( | ( | |||
Repayments of lease liabilities from related parties |
| ( | ( | |||
Purchase of treasury stock | 2 d) | ( | — | |||
Distributions to noncontrolling interests |
| ( | ( | |||
Contributions from noncontrolling interests |
| | | |||
Net cash provided by (used in) financing activities |
| ( | ( | |||
Effect of exchange rate changes on cash and cash equivalents |
| | ( | |||
Cash and cash equivalents: |
| |||||
Net increase (decrease) in cash and cash equivalents |
| ( | ( | |||
Cash and cash equivalents at beginning of period |
| | | |||
Cash and cash equivalents at end of period |
| | | |||
Thereof: cash and cash equivalents within the disposal groups |
| — | | |||
See accompanying notes to the condensed consolidated interim financial statements (unaudited).
26
FRESENIUS MEDICAL CARE AG
Consolidated statements of shareholders’ equity
For the three months ended March 31, 2026 and 2025 (unaudited)
Consolidated statements of shareholders’ equity
in € K, except share data
Ordinary shares | Treasury stock | Accumulated other comprehensive income (loss) | ||||||||||||||||||||||||||
Additional | Foreign | Total FME AG | Non- | |||||||||||||||||||||||||
Number of | No par | Number of | paid in | Retained | currency | Cash flow | Fair value | shareholders’ | controlling | |||||||||||||||||||
| Note | | shares | | value | | shares | | Amount | | capital | | earnings | | translation | | hedges | | Pensions | | changes | | equity | | interests | | Total equity | |
Balance at December 31, 2024 | | | | — | — | | | ( | ( | ( | ( | | | | ||||||||||||||
Equity-settled share-based payment transactions | 9 | — | — | — | — | | — | — | — | — | — | | — | | ||||||||||||||
Transactions with noncontrolling interests without loss of control | — | — | — | — | | — | — | — | — | — | | ( | ( | |||||||||||||||
Noncontrolling interests due to changes in consolidation group | — | — | — | — | — | — | — | — | — | — | — | | | |||||||||||||||
Contributions from/ to noncontrolling interests | — | — | — | — | — | — | — | — | — | — | — | ( | ( | |||||||||||||||
Put option liabilities |
| 11 | — | — | — | — | — | | — | — | — | — | | — | | |||||||||||||
Net Income |
| — | — | — | — | — | | — | — | — | — | | | | ||||||||||||||
Other comprehensive income (loss) related to: |
| |||||||||||||||||||||||||||
Foreign currency translation, net of reclassification adjustments resulting from deconsolidation |
| 2 c) | — | — | — | — | — | — | ( | | | | ( | ( | ( | |||||||||||||
Cash flow hedges, net of related tax effects |
| — | — | — | — | — | — | — | | — | — | | — | | ||||||||||||||
Pensions, net of related tax effects | — | — | — | — | — | — | — | — | | — | | — | | |||||||||||||||
Fair value changes, net of related tax effects | — | — | — | — | — | — | — | — | — | | | — | | |||||||||||||||
Comprehensive income |
| — | — | — | — | — | — | — | — | — | — | ( | ( | ( | ||||||||||||||
Balance at March 31, 2025 |
| | | — | — | | | ( | ( | ( | ( | | | | ||||||||||||||
Balance at December 31, 2025 |
| | | ( | ( | | | ( | | ( | ( | | | | ||||||||||||||
Equity-settled share-based payment transactions | 9 | — | — | — | — | | — | — | — | — | — | | — | | ||||||||||||||
Purchase of treasury stock | 2 d) | — | — | ( | ( | ( | — | — | — | — | — | ( | — | ( | ||||||||||||||
Transactions with noncontrolling interests without loss of control | — | — | — | — | | — | — | — | — | — | | ( | ( | |||||||||||||||
Noncontrolling interests due to changes in consolidation group | — | — | — | — | — | — | — | — | — | — | — | ( | ( | |||||||||||||||
Contributions from/ to noncontrolling interests | — | — | — | — | — | — | — | — | — | — | — | ( | ( | |||||||||||||||
Put option liabilities |
| 11 | — | — | — | — | — | ( | — | — | — | — | ( | — | ( | |||||||||||||
Net Income |
| — | — | — | — | — | | — | — | — | — | | | | ||||||||||||||
Other comprehensive income (loss) related to: |
| |||||||||||||||||||||||||||
Foreign currency translation, net of reclassification adjustments resulting from deconsolidation |
| 2 c) | — | — | — | — | — | — | | ( | ( | ( | | | | |||||||||||||
Cash flow hedges, net of related tax effects |
| — | — | — | — | — | — | — | ( | — | — | ( | — | ( | ||||||||||||||
Pensions, net of related tax effects | — | — | — | — | — | — | — | — | | — | | — | | |||||||||||||||
Fair value changes, net of related tax effects | — | — | — | — | — | — | — | — | — | ( | ( | — | ( | |||||||||||||||
Comprehensive income |
| — | — | — | — | — | — | — | — | — | — | | | | ||||||||||||||
Balance at March 31, 2026 |
| | | ( | ( | | | ( | ( | ( | ( | | | | ||||||||||||||
See accompanying notes to the condensed consolidated interim financial statements (unaudited).
27
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
1. The Company and basis of presentation
The Company
Fresenius Medical Care AG (FME AG or the Company) is a German stock corporation (Aktiengesellschaft — AG) registered with the commercial register of Hof (Saale) under HRB 6841, with its business address at Else-Kröner-Str. 1, 61352 Bad Homburg v. d. Höhe, Germany. The Company is the world’s leading provider of products and services for individuals with renal diseases, based on publicly reported revenue. The Company provides dialysis and related services for individuals with renal diseases, including through value and risk-based care programs, as well as other healthcare services. The Company also develops, manufactures, and distributes a wide variety of healthcare products. The Company’s healthcare products include hemodialysis machines, peritoneal dialysis cyclers, dialyzers, peritoneal dialysis solutions, hemodialysis concentrates, solutions and granulates, bloodlines, renal pharmaceuticals, systems for water treatment, as well as acute cardiopulmonary and apheresis products. The Company supplies dialysis clinics it owns, operates or manages with a broad range of products and also sells dialysis products to other dialysis service providers. The Company’s other healthcare services include pharmacy services, vascular specialty services, ambulatory surgery center services, and physician nephrology practice management.
In these unaudited notes, “FME AG,” the “Company” or the “Group” refers to Fresenius Medical Care AG or Fresenius Medical Care AG and its subsidiaries on a consolidated basis, as the context requires. “Fresenius SE” and “Fresenius SE & Co. KGaA” refer to Fresenius SE & Co. KGaA. “Management Board” refers to the members of the management board of the Company and “Supervisory Board” refers to the supervisory board of the Company. The term “Care Enablement” refers to the Care Enablement operating segment, the term “Care Delivery” refers to the Care Delivery operating segment and the term “Value-Based Care” refers to the Value-Based Care operating segment. For further discussion of the Company’s operating and reportable segments, see note 12. The abbreviations “K,” “M,” and “BN” are used to denote the presentation of amounts in thousands, millions, and billions, respectively.
Basis of presentation
The consolidated financial statements and other financial information included in the Company’s quarterly reports furnished under cover of Form 6-K and its Annual Report on Form 20-F are prepared solely in accordance with International Financial Reporting Standards (IFRS) as issued by the International Accounting Standards Board (IASB), the “IFRS® Accounting Standards,” using the euro as the Company’s reporting and functional currency.
The interim financial report is prepared in accordance with International Accounting Standard (IAS) 34, Interim Financial Reporting, and contains condensed financial statements, in that it includes selected explanatory notes rather than all of the notes that would be required in a complete set of financial statements. However, the primary financial statements are presented in the format consistent with the consolidated financial statements as presented in the Company’s Annual Report on Form 20-F for the year ended December 31, 2025 (the 2025 Form 20-F) in accordance with IAS 1, Presentation of Financial Statements.
The condensed consolidated interim financial statements at March 31, 2026 and for the three months ended March 31, 2026 and 2025 contained in this report are unaudited and should be read in conjunction with the consolidated financial statements contained in the Company’s 2025 Form 20-F. The preparation of condensed consolidated interim financial statements in conformity with IFRS Accounting Standards requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the condensed consolidated interim financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Such interim financial statements reflect all adjustments that, in the opinion of management, are necessary to provide a fair statement of the results of the periods presented. All such adjustments are of a normal recurring nature.
The effective tax rate of
The results of operations for the three months ended March 31, 2026 are not necessarily indicative of the results of operations for the year ending December 31, 2026.
28
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
The following table shows the amount of goodwill recognized for each CGU as well as the Company’s market capitalization as compared to its shareholder’s equity as of March 31, 2026 and December 31, 2025.
Goodwill analysis
in € K
| March 31, 2026 | | December 31, 2025 | |
Goodwill |
| |
| |
thereof Care Delivery |
| |
| |
thereof Value-Based Care |
| |
| |
thereof Care Enablement |
| |
| |
FME AG shareholders’ equity |
| |
| |
Market capitalization |
| |
| |
Due to the carrying amount of net assets exceeding the Company’s market capitalization, the Company reviewed the impacts on the impairment test, which was performed as of December 31, 2025.
During the first quarter of 2026, the Company compared the carrying amounts of its group of CGUs, Care Delivery, Value-Based Care and Care Enablement, to the respective group of CGU’s value in use, using the free cash flows of the group of CGUs considered in the impairment test as of December 31, 2025, and updated its free cash flow projections using the results of the latest available assessments, including the consideration of the conflict in the Middle East. Cash flow projections were updated to reflect the status of current initiatives, without considering any growth and improvement from the FME25+ Program, as defined below, initiatives which have not yet commenced as of March 31, 2026. WACC parameters were updated as of March 31, 2026.
During the fourth quarter of 2025, the Company performed an analysis in connection with the annual goodwill impairment test as of October 1, 2025 and as described in note 2 a) of the consolidated financial statements contained in the 2025 Form 20-F. The Company’s analysis included qualitative and quantitative simulations to assess the potential impact of GLP-1 receptor agonists and the potential impact of SGLT2 inhibitors on the CKD and ESRD populations, specifically in relation to cash flow projections and goodwill sensitivity assessments based on the analysis of the population impact model (a computational tool to predict the size and age distribution of future patient populations with kidney disease for the coming decade, based on various public-health scenarios). In the Company’s population impact model the sensitivity bands of the various scenarios of GLP-1 receptor agonist and SGLT2 inhibitor utilization in the CKD population suggest an increase in the total CKD population and a reduction in the ESRD population growth rate that remain materially consistent with the patient population forecasts which do not include the utilization of these drugs. Considering the positive cardiovascular effects of the drugs, reducing mortality, as well as the progression-delaying effect on the CKD population, the Company sees a balanced effect of the drugs on the patient population. The Company’s assessment concluded that underlying patient growth assumptions used in its cash flow projections reflect the current understanding of treatment developments. Recent third-party data published during the first three months of 2026 remain consistent with the previously performed simulations.
For a detailed description of the impairment test procedure, see notes 1 g) and 2 a) of the consolidated financial statements contained in the 2025 Form 20-F. As of March 31, 2026, the impairment test procedure was performed for each of the operating segments (Care Delivery, Value-Based Care and Care Enablement). The assessment did not result in any indication of impairment as of March 31, 2026. Management continues to monitor the situation.
During the first quarter of 2026, management reassessed the presentation of certain line items in the consolidated balance sheets in light of their relevance to users. The following changes have been made to enhance transparency and provide more meaningful information regarding the nature and financial impact of these balances:
| ● | Current income tax receivables in the amount of € |
| ● | Non-current income tax receivables in the amount of € |
| ● | Current provisions in the amount of € |
| ● | Non-current provisions in the amount of € |
29
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
In addition, management has determined that assets and liabilities classified as held for sale are no longer material to the financial statements. As a result, these balances have been aggregated within the following line items in the presentation of the Company’s consolidated balance sheets:
| ● | Assets held for sale previously reported separately in amount of € |
| ● | Liabilities directly associated with held for sale previously reported separately, when applicable, will now be aggregated within other current liabilities. As of December 31, 2025, the Company did not record any liabilities directly associated with assets held for sale. |
These changes relate solely to presentation and classification and do not have any impact on the reported results of operations, cash flows, or financial position of the Company. The following table presents the comparative figures as of January 1, 2025 and December 31, 2025, adjusted to conform to the current year’s presentation:
Consolidated balance sheet presentation in 2026
in € K
| January 1, 2025 | | December 31, 2025 | |
Current income tax refundable |
| |
| |
Other current assets |
| |
| |
Non-current income tax refundable |
| |
| |
Other non-current assets |
| |
| |
Current provisions |
| |
| |
Other current liabilities |
| |
| |
Non-current provisions |
| |
| |
Other non-current liabilities |
| |
| |
On May 4, 2026, the Management Board authorized the issuance of the Company’s condensed consolidated interim financial statements (unaudited).
New accounting pronouncements
Recently implemented accounting pronouncements
The Company has prepared its condensed consolidated interim financial statements at and for the three months ended March 31, 2026 in conformity with IFRS Accounting Standards that must be applied for the interim periods starting on or after January 1, 2026. In the three months ended March 31, 2026, there were no recently implemented accounting pronouncements that materially affect the business.
Recent accounting pronouncements not yet adopted
The following new accounting standards and amendments to accounting standards have been published that are not mandatory as of and for the three months ended March 31, 2026 and will not be early adopted by the Company.
30
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
IFRS 18, Presentation and Disclosure in Financial Statements
On April 9, 2024, the IASB issued IFRS 18, Presentation and Disclosure in Financial Statements (IFRS 18). IFRS 18 aims to improve how information is communicated in financial statements to give investors a more comparable basis to analyze companies’ performance. The standard introduces three sets of new requirements: new categories and subtotals in the consolidated statements of income, disclosure regarding management-defined performance measures, and guidance related to the aggregation and disaggregation of certain information. The consolidated statements of income will be split into three newly defined categories (operating, investing, and financing) and will include two newly defined subtotals (operating profit and profit before financing and income taxes). Management-defined performance measures are subtotals of income and expense used in public communication outside the financial statements and communicate management’s view of certain aspects of a company’s performance. Such measures will be required to be described in a clear and understandable manner in a single note explaining how the measure is calculated, why it is useful, providing a reconciliation to the most directly comparable subtotal noted above, the income tax and the effect on noncontrolling interest for each item will be presented in the reconciliation and how the income tax effect is determined. Lastly, companies will be required to disaggregate items if such information is material and to avoid using the label “other” in financial statements. Certain additional details for depreciation and amortization, impairment and other expense classifications may be required. Additionally, IFRS 18 will introduce limited changes to IAS 7, Statement of Cash Flows. Operating profit will be the starting point for reporting cash flows from operating activities using the indirect method and the option for classifying interest and dividend cash flows as operating activities will be eliminated. Dividends and interest paid will be classified in cash flows from financing activities whereas dividends and interest received will be classified in cash flows from investing activities. An entity shall apply those amendments when it applies IFRS 18. IFRS 18 is effective for fiscal periods commencing on or after January 1, 2027, while earlier adoption is permitted. The standard must be applied retrospectively. The standard is expected to impact the Company’s presentation of items within the consolidated financial statements and its notes disclosures once implemented, though the standard is not expected to change how the Company recognizes or measures items in its consolidated financial statements. In order to comply with the extended disclosure requirements under IFRS 18, the Company will expand the disclosures in the notes to the consolidated financial statements, including the disclosure of expenses by function according to their cost type. The Company continues to investigate the appropriate level of disaggregation in accordance with IFRS 18 and the associated effects of IFRS 18 on the consolidated financial statements.
Notably, foreign exchange gains and losses are currently presented in other operating income and other operating expense, but will be presented within the newly defined operating, investing, and financing categories under IFRS 18 which would have an impact on certain related subtotals and key performance indicators for the Company. Similarly, items such as income from equity method investees and the revaluation of certain investments held by the Company, currently presented within operating income, will be shown within the consolidated statement of income in the investing category. Quantitative impacts cannot yet be adequately estimated at this time.
In the Company’s view, no other pronouncements issued by the IASB are expected to have a material impact on the consolidated financial statements.
2. Notes to the consolidated statements of income
a) Revenue
As of January 1, 2026, one of the Company’s agreements previously classified as an insurance contract was amended, effectively removing the transfer of significant insurance risk. As such, revenue from this contract is now recorded in accordance with IFRS 15, Revenues from Contracts with Customers, and is no longer included within revenue from insurance contracts. The Company has recognized the following revenue in the consolidated statements of income for the three months ended March 31, 2026 and 2025:
Revenue
in € K
| Revenue from | Revenue from | ||||||
| contracts with | | insurance | | Revenue from | | ||
| customers | | contracts | | lease contracts | | Total | |
For the three months ended March 31, 2026 | ||||||||
Healthcare services | | — | | — | | | ||
Healthcare products |
| | — | | | |||
Insurance contracts | — | | — | | ||||
Total |
| | | | | |||
31
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
| For the three months ended March 31, 2025 | |||||||
Revenue from | Revenue from | |||||||
| contracts with | | insurance | | Revenue from | | ||
| customers | | contracts | | lease contracts | | Total | |
Healthcare services | | | — | | — | | | |
Healthcare products |
| | — | | | |||
Insurance contracts | — | | — | | ||||
Total |
| | | | | |||
The following table contains a disaggregation of revenue by categories for the three months ended March 31, 2026 and 2025:
Disaggregation of revenue by categories
in € K
| For the three months ended | |||
March 31, | ||||
| 2026 | | 2025 | |
Care Delivery | | | | |
Thereof: U.S. | | | ||
Thereof: International | | | ||
Value-Based Care | | | ||
Care Enablement | | | ||
Inter-segment eliminations | ( | ( | ||
Total | | | ||
For further information on segment revenues, including a split between revenue from internal and external customers, see note 12.
b) Selling, general, and administrative expense
Selling, general and administrative expense recorded in the consolidated statements of income comprises both distribution costs as well as general and administrative expense. Distribution costs are generated in the selling, marketing, and warehousing functions of the Company which are not attributable to production or research and development (R&D). General and administrative expense is generated in the administrative function of the Company’s business and is not attributable to selling, production, or R&D.
The following table discloses the distribution costs as well as general and administrative expense recorded by the Company for the three months ended March 31, 2026 and 2025:
Selling, general and administrative expense
in € K
| For the three months ended | |||
March 31, | ||||
2026 | | 2025 | ||
Distribution costs(1) | | | ||
General and administrative expense(1) | | | ||
Selling, general and administrative expense | | | ||
(1) | The Company reclassified € |
32
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
c) Other operating income and expense
The following table contains reconciliations of the amounts included in other operating income and expense for the three months ended March 31, 2026 and 2025:
Other operating income
in € K
| For the three months ended | |||
March 31, | ||||
| 2026 | | 2025 | |
Foreign exchange gains | | | ||
Gains on right-of-use assets, from the sale of fixed assets, clinics and investments | | | ||
Income from strategic transactions and programs | — | | ||
Other | | | ||
Other operating income | | | ||
Other operating expense
in € K
| For the three months ended | |||
| March 31, | |||
| 2026 | | 2025 | |
Foreign exchange losses | | | ||
Losses on right-of-use assets, from the sale of fixed assets, clinics and investments | | | ||
Revaluation of certain investments (1) |
| | | |
Expenses from strategic transactions and programs | | | ||
Other | | | ||
Other operating expense | | | ||
(1) | Primarily driven by the remeasurement of the Company’s investment in Humacyte, Inc. for the three months ended March 31, 2026 and 2025. |
Included within the “income from strategic transactions and programs” line item in other operating income are the gains from divestitures of certain businesses in connection with strategic programs such as Legacy Portfolio Optimization, defined below.
Included within the “expenses from strategic transactions and programs” line item in other operating expense are the proposed and completed divestitures as well as associated impairment losses of certain businesses in connection with strategic programs such as Legacy Portfolio Optimization, defined below, and the transformation of the Company’s operating structure and steps to achieve cost savings (FME25+ Program). Consistent with the Company’s policy to present impairment losses within other operating expense, such costs related to cost of revenues, selling, general and administrative expense, or R&D expenses are included within other operating expense. “Expenses from strategic transactions and programs” primarily consist of:
| ● | strategic divestiture program expenses identified during the review of the Company’s business portfolio, mainly due to exiting unsustainable markets and divesting non-core businesses, as well as the cessation of certain R&D programs to enable more focused capital allocation towards areas in the Company’s core business that are expected to have higher profitable growth (Legacy Portfolio Optimization). For the three months ended March 31, 2026, the amounts primarily relate to costs associated with the 2025 divestiture of select assets of the Company’s wholly owned Spectra Laboratories. For the three months ended March 31, 2025, the amounts primarily include the proposed divestitures of renal dialysis clinics in Brazil and Malaysia, renal dialysis clinics and products business in Kazakhstan, and select assets of the Company’s wholly owned Spectra Laboratories, as well as related severance payments, and impairment losses resulting from the measurement of assets held for sale (related to the Company’s businesses in Brazil, Kazakhstan, and Malaysia). For the three months ended March 31, 2026, the Company recorded a gain related to reclassification adjustments of foreign currency translation in the amount of € |
| ● | certain impairment losses and expenses in connection with the FME25+ Program; and |
33
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
| ● | certain costs associated with the change of the legal form of the Company from a partnership limited by shares (Kommanditgesellschaft auf Aktien – KGaA) into an AG (the Conversion) in 2023, primarily related to the requisite relabeling of its products, transaction costs (such as costs for external advisors and conducting an extraordinary general meeting) and costs related to the establishment of dedicated administrative functions required to manage certain services which historically had been administered at the Fresenius SE group level and paid by the Company through corporate charges (Legal Form Conversion Costs). |
Expenses from strategic transactions and programs comprised the following for the three months ended March 31, 2026 and 2025:
Expenses from strategic transactions and programs
in € K
| For the three months ended | |||
March 31, | ||||
2026 | | 2025 | ||
Impairment of intangible and tangible assets(1) |
| | | |
Legacy Portfolio Optimization | — | | ||
FME25+ Program |
| | — | |
Impairment resulting from the measurement of assets held for sale |
| — | | |
Legacy Portfolio Optimization | — | | ||
Loss from the sale of business | | — | ||
Legacy Portfolio Optimization | | — | ||
Other(1) | | | ||
FME25+ Program | | — | ||
Legacy Portfolio Optimization | | | ||
Legal Form Conversion Costs | — | | ||
Expenses from strategic transactions and programs |
| | | |
| (1) | For the three months ended March 31, 2026 and 2025, the amounts primarily relate to selling, general and administrative expense. |
d) Earnings per share
The following table contains reconciliations of the numerators and denominators of the basic and diluted earnings per share computations for the three months ended March 31, 2026 and 2025:
Reconciliation of basic and diluted earnings per share
in € K, except share and per share data
| For the three months ended | |||
| March 31, | |||
| 2026 | | 2025 | |
Numerator: |
| |||
Net income attributable to shareholders of FME AG | | | ||
Denominators: | ||||
Weighted average number of shares outstanding | | | ||
Potentially dilutive shares (see note 9) | — | — | ||
Basic earnings per share |
| | | |
Diluted earnings per share |
| | | |
34
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
Share buyback program
On the basis of the authorization granted by the Company’s Annual General Meeting on May 20, 2021, to conduct a share buyback program, the Company launched its €
The following tabular disclosure provides the number of shares acquired in the context of the share buy-back program:
Treasury Stock
| | | Total number of | | ||||
shares purchased | Maximum value of | |||||||
and retired | shares that may yet | |||||||
as part of publicly | be purchased under | |||||||
Total number of | Average price per | announced plans or | the plans or | |||||
Period | shares purchased | share | programs | programs | ||||
| in € |
| in € K | |||||
August 2025 |
| |
| |
| |
| |
September 2025 | | | | | ||||
October 2025 | | | | | ||||
November 2025 | | | | | ||||
December 2025 | | | | — | ||||
January 2026 | | | | | ||||
February 2026 | | | | | ||||
March 2026 | | | | | ||||
Total repurchased treasury stock (1) |
| |
| |
| |
| |
| (1) | The difference between the maximum value of shares that may yet be purchased under the Company’s share buy-back program and the liability for such shares as of March 31, 2026 and December 31, 2025 results from the timing of payments made for share repurchases on a weekly basis. The difference is recorded in the Consolidated statements of equity within Additional paid-in capital. |
3. Related party transactions
Based on its current share ownership as of March 31, 2026, Fresenius SE, under the Company’s Articles of Association, has the right to appoint
35
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
The Company has entered into certain arrangements for services and products with Fresenius SE or its subsidiaries and with certain of the Company’s equity method investees as described in item a) below. The arrangements for leases with Fresenius SE or its subsidiaries are described in item b) below. The Company’s terms related to the receivables or payables for these services, products and leases are generally consistent with the normal terms of the Company’s ordinary course of business transactions with unrelated parties and the Company believes that these arrangements reflect fair market terms. The Company utilizes various methods to verify the commercial reasonableness of its related party arrangements. Financing arrangements with certain equity-method investees as described in item c) below have agreed-upon terms which are determined at the time such financing transactions occur and reflect market rates at the time of the transaction. The relationship between the Company and its key management personnel who are considered to be related parties is described in item d) below.
a) Service agreements and products
The Company is party to service agreements with Fresenius SE and certain of its affiliates (collectively, Fresenius SE Companies) to receive services, including, but not limited to: administrative and facility management services, employee benefit administration services (which ended during 2025), and information technology services. These related party agreements have generally been entered into for periods, or in some cases transitional periods, from several months up to
The Company provides administrative services to one of its equity method investees. The Company also sells products to Fresenius SE Companies and purchases products from Fresenius SE Companies and equity method investees. The Company has also entered into a limited amount of shared procurement contracts with Fresenius SE Companies for the purchase of products from third parties.
In December 2010, the Company and Galenica Ltd. (now known as CSL Vifor) formed the renal pharmaceutical company Vifor Fresenius Medical Care Renal Pharma Ltd., an equity method investee of which the Company owns
Below is a summary, including the Company’s receivables from and payables to the indicated parties, resulting from the above-described transactions with related parties.
Service agreements and products with related parties
in € K
For the three months | For the three months | | | |||||||||||||
| ended March 31, 2026 | | ended March 31, 2025 | | March 31, 2026 | | December 31, 2025 | |||||||||
| Sales of | | Purchases of | | Sales of | | Purchases of | | | | | |||||
| goods and | | goods and | | goods and | | goods and | | Accounts | | Accounts | | Accounts | | Accounts | |
| services | | services | | services | | services | | receivable | | payable | | receivable | | payable | |
Service agreements (1) | | | | | | | |
| | |||||||
Fresenius SE | — | | | | | | | | ||||||||
Fresenius SE affiliates | | | | | | | | | ||||||||
Equity method investees | | — | | — | | — | | — | ||||||||
Total | | | | | | | | | ||||||||
Products | ||||||||||||||||
Fresenius SE affiliates | | | | | | | | | ||||||||
Equity method investees | — | | — | | — | | — | | ||||||||
Total | | | | | | | | | ||||||||
| (1) | In addition to the above shown accounts payable, accrued expenses for service agreements with related parties amounted to € |
36
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
b) Lease agreements
In addition to the above-mentioned product and service agreements, the Company is a party to real estate lease agreements with Fresenius SE Companies, which mainly include leases for the Company’s corporate headquarters in Bad Homburg, Germany. Until December 31, 2025, the Company also leased production sites in Schweinfurt and St. Wendel, Germany which were then purchased by the Company for a total transaction cost of €
Below is a summary resulting from the above described lease agreements with related parties.
Lease agreements with related parties
in € K
| For the three months ended March 31, 2026 | | For the three months ended March 31, 2025 | | March 31, 2026 | | December 31, 2025 | |||||||||||||
| Interest | | Lease | | | Interest | | Lease | | Right-of-use | | Lease | | Right-of-use | | Lease | ||||
| Depreciation | | expense | | expense (1) | | Depreciation | | expense | | expense (1) | | asset | | liability | | asset | | liability | |
Fresenius SE | | | — | | | | | | | | ||||||||||
Fresenius SE affiliates | — | — | — | | | — | — | — | — | — | ||||||||||
Total | | | — | | | | | | | | ||||||||||
| (1) | Short-term leases and expenses relating to variable lease payments as well as low value leases are exempted from balance sheet recognition. |
c) Financing
As of March 31, 2026 and December 31, 2025, the Company had outstanding accounts payable related to a cash pooling program with certain equity-method investees in the amount of €
d) Key management personnel
The members of the Supervisory Board and the Management Board, as key management personnel, as well as their close relatives, are considered related parties of the Company. The Company has entered into service agreements with the members of the Management Board.
4. Insurance contracts
The following tables provide reconciliations of the Company’s portfolios of insurance and reinsurance contracts, showing the change in insurance and reinsurance contract receivables (liabilities) as of March 31, 2026 and December 31, 2025. These receivables and liabilities are recognized in the consolidated balance sheets within trade accounts and other receivables from unrelated parties and accounts payable to unrelated parties, respectively. As of January 1, 2026, one of the Company’s agreements previously classified as an insurance contract was amended, effectively removing the transfer of significant insurance risk. As such, the impacts from this contract are now recorded in accordance with IFRS 15, Revenues from Contracts with Customers, and are no longer included in the following tables as of March 31, 2026.
Reinsurance contract receivables and liabilities
in € K
| March 31, 2026 | | December 31, 2025 | |||||||||
Present | Risk | Present | Risk | |||||||||
value of | adjustment | value of | adjustment | |||||||||
future cash | for non- | future cash | for non- | |||||||||
| flows | | financial risk | | Total | | flows | | financial risk | | Total | |
Reinsurance contract receivables (liabilities) at the beginning of the period | | | ( | | ( | ( | ( | |||||
Incurred claims and other directly attributable expenses | ( | | ( | ( | | ( | ||||||
Changes that relate to past service – changes in the fulfillment cash-flows relating to liabilities for incurred claims (LIC)(1) | ( | — | ( | | — | | ||||||
Claims and other directly attributable expenses paid | — | — | — | ( | — | ( | ||||||
Premium revenue | | — | | | — | | ||||||
Foreign currency translation and other changes | | ( | | | | | ||||||
Reinsurance contract receivables (liabilities) at the end of the period | | ( | | | ( | | ||||||
| (1) | Changes that relate to past service include premium revenue, or a reduction in premium revenue, for past performance years of € |
37
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
Insurance contract receivables and liabilities
in € K
March 31, 2026 | December 31, 2025 | |||||||||||
Present | Risk | Present | Risk | |||||||||
value of | adjustment | value of | adjustment | |||||||||
future cash | for non- | future cash | for non- | |||||||||
| flows | | financial risk | | Total | | flows | | financial risk | | Total | |
Insurance contract receivables (liabilities) at the beginning of the period | | ( | | ( | ( | ( | ||||||
Incurred claims and other directly attributable expenses | ( | ( | ( | ( | ( | ( | ||||||
Changes that relate to past service – changes in the fulfillment cash-flows relating to LIC(1) | ( | ( | ( | | — | | ||||||
Claims and other directly attributable expenses paid | ( | — | ( | ( | — | ( | ||||||
Premium revenue | | — | | | — | | ||||||
Foreign currency translation and other changes | | ( | | | | | ||||||
Insurance contract receivables (liabilities) at the end of the period | | ( | | | ( | | ||||||
| (1) | Changes that relate to past service include premium revenue, or a reduction in premium revenue, for past performance years of € |
5. Inventories
At March 31, 2026 and December 31, 2025, inventories consisted of the following:
Inventories
in € K
March 31, | December 31, | |||
| 2026 | | 2025 | |
Finished goods | | | ||
Healthcare supplies | | | ||
Raw materials and purchased components | | | ||
Work in process | | | ||
Inventories | | |
6. Short-term debt
At March 31, 2026 and December 31, 2025, short-term debt consisted of the following:
Short-term debt
in € K
March 31, | December 31, | |||
| 2026 | | 2025 | |
Borrowings under lines of credit | | | ||
Other | | | ||
Short-term debt | | |
The Company and certain consolidated entities operate a multi-currency notional cash pooling management system. In this cash pooling management system, amounts in euro and other currencies are offset without being transferred to a specific cash pool account. The system is used for an efficient utilization of funds within the Company. The Company met the conditions to offset balances within this cash pool for reporting purposes. At March 31, 2026 and December 31, 2025, cash and borrowings under lines of credit in the amount of €
Commercial paper program
The Company maintains a commercial paper program under which short-term notes of up to €
38
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
7. Long-term debt
As of March 31, 2026 and December 31, 2025, long-term debt consisted of the following:
Long-term debt
in € K
March 31, | December 31, | |||
| 2026 | | 2025 | |
Schuldschein loans | | | ||
Bonds | | | ||
Other | | | ||
Long-term debt | | | ||
Less current portion | ( | ( | ||
Long-term debt, less current portion | | |
Syndicated Credit Facility
The Company entered into a €
8. Capital management
As of March 31, 2026 and December 31, 2025 total equity in percent of total assets was
For details on the Company’s share buy-back program, see note 2 d).
The Company’s financing structure and business model are reflected in its credit ratings. The Company is rated investment grade by S&P Global, Moody’s and Fitch.
The Company’s current corporate credit ratings and outlooks from the credit rating agencies are provided in the table below:
Rating (1)
| S&P Global | | Moody’s | | Fitch | |
Corporate credit rating |
| BBB- |
| Baa3 |
| BBB- |
Outlook |
| stable |
| stable |
| stable |
| (1) | A rating is not a recommendation to buy, sell, or hold securities of the Company and may be subject to suspension, change, or withdrawal at any time by the assigning rating agency. |
9. Share-based plans
Effective March 1, 2026,
39
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
For allocations made during the three months ended March 31, 2026, the Company utilizes a Monte Carlo model to determine the grant date fair values. For the Relative TSR target, the share prices of all shares within the European and U.S. peer groups are simulated, considering historical volatilities and correlations between the different shares as well as risk-free interest rates derived from interest curves for sovereign bonds, depending on the currency for which the respective shares are listed. Additional input factors include the Company’s closing share price as of the grant date, expected dividends, and the
Material input factors to the determination of the weighted average grant date fair value |
| |||
| MB LTIP 2024+ |
| ||
Allocation date | | March 1, 2026 | ||
Share price at grant date | € | | ||
Expected volatility of the Company’s share price |
| | % | |
Vesting period |
| |||
Expected dividends for the Company’s share | Based on proposed dividends, publicly available estimations by financial institutions and projections | |||
Risk-free interest rate for the Company’s share price |
| | % | |
10. Commitments and contingencies
Legal and regulatory matters
The Company is routinely involved in claims, lawsuits, regulatory and tax audits, investigations and other legal matters arising, for the most part, in the ordinary course of its business of providing healthcare services and products. Legal matters that the Company currently deems to be material or noteworthy are described below. The Company records its litigation reserves for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of loss can be reasonably estimated. For the other matters described below, the Company believes that the loss is not probable and/or the loss or range of possible losses cannot be reasonably estimated at this time. The outcome of litigation and other legal matters is always difficult to predict accurately and outcomes that are not consistent with the Company’s view of the merits can occur. The Company believes that it has valid defenses to the legal matters pending against it and is defending itself vigorously. Nevertheless, it is possible that the resolution of one or more of the legal matters currently pending or threatened could have a material adverse effect on its business, results of operations and financial condition.
In 2015, the Company self-reported certain conduct in West Africa with a potential nexus to Germany to the German prosecutor in the state of Hesse and continues to cooperate with government authorities in Germany in their review of allegations previously communicated to the Company regarding certain previously-disclosed conduct in countries outside the U.S. that might violate anti-bribery laws. In September 2023, the Hessian prosecutor opened independent disgorgement proceedings against a German subsidiary of the Company relating to the aforementioned conduct.
In 2014, two New York physicians filed under seal a qui tam complaint in the U.S. District Court for the Eastern District of New York (Brooklyn), alleging violations of the False Claims Act relating to FMCH’s vascular access line of business. On October 6, 2015, the U.S. Attorney for the Eastern District of New York (Brooklyn) issued subpoenas to FMCH indicating that its investigation is likely to be related to the two relators’ complaint. FMCH cooperated in the Brooklyn investigation, which was understood to be separate and distinct from settlements entered in 2015 in Connecticut, Florida and Rhode Island of allegations against American Access Care LLC (AAC) following FMCH’s 2011 acquisition of AAC.
On July 12, 2022, after the court denied the USAO’s motions to renew the sealing of the relators’ complaint, the USAO filed a complaint-in-intervention. United States ex rel. Pepe and Sherman v. Fresenius Vascular Care, Inc. et al, 1:14-cv-3505. On October 3, 2023, the states of New York, New Jersey, and Georgia filed a consolidated complaint-in-intervention. The U.S.’s, the three states’, and relators’ complaints each allege that the defendants billed and received government payment for surgery that was not medically necessary. On March 31, 2026, the court allowed the relators’ motion to file a further amended complaint. FMCH is defending the allegations asserted in the litigation now proceeding with the remaining governmental complainants.
On January 3, 2023, FMCH received a subpoena from the Attorney General for the District of Columbia related to the activities of the American Kidney Foundation (AKF) that is grounded in anti-trust concerns, including market allocation within the District of Columbia. FMCH’s relationship with AKF was the subject of a previously reported and resolved investigation by agencies of the U.S. and litigation against UnitedHealthcare Inc. FMCH is cooperating in the District of Columbia investigation.
40
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
On February 20, 2023, the Company received a statement of claim via the London Court of International Arbitration from its former distributor in Iraq. The Company terminated the distribution agreement in 2018. The former distributor sought, inter alia, compensation for alleged wrongful termination and “quality issues,” as well as damages for lost profits. The Company denied the allegations and filed a counterclaim for malperformance under the distribution agreement. On October 28, 2025, the arbitral tribunal issued its decision by which it dismissed the distributor’s claims in their entirety, granted the Company’s counterclaims fully, and awarded all the Company’s cost claims. On February 18, 2026, the distributor submitted a motion to a German court to set aside the arbitral award, which the Company has requested the court to dismiss.
On April 5, 2024, FMCH received
On March 24, 2025, FMCH received a CID from the U.S. DOJ concerning an investigation as to whether FMCH’s subsidiary, Azura Vascular Care (Azura), billed for certain intravascular ultrasound procedures that were not medically necessary and were upcoded. FMCH is cooperating with the government in the investigation.
On May 9, 2025, a purported class action was filed against the Company alleging violations of the U.S. antitrust laws including allegations of price fixing and territory allocation. United Food and Commercial Workers Local 1776 and Participating Employers Health and Welfare Fund, et al. v. Fresenius Medical Care AG and Fresenius Medical Care Holdings, Inc., U.S.D.C. Colorado, C.A. No. 1:25-cv-01478. The Company is defending itself in this matter.
On December 18, 2025, the Antimonopoly Committee of Ukraine (AMCU) completed an investigation and ruled that one of the Company’s Ukrainian subsidiaries was allegedly engaged in anti-competitive conduct in connection with certain public tenders. The subsidiary in question represented less than
From time to time, the Company is a party to or may be threatened with other litigation or arbitration, claims or assessments arising in the ordinary course of its business. Management regularly analyzes current information including, as applicable, the Company’s defenses and insurance coverage and, as necessary, provides accruals for probable liabilities for the eventual disposition of these matters.
41
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
The Company, like other healthcare providers, insurance plans and suppliers, conducts its operations under intense government regulation and scrutiny. The Company must comply with regulations which relate to or govern the safety and efficacy of medical products and supplies, the marketing and distribution of such products, the operation of manufacturing facilities, laboratories, dialysis clinics and other healthcare facilities, and environmental and occupational health and safety. With respect to its development, manufacture, marketing and distribution of medical products, if such compliance is not maintained, the Company could be subject to significant adverse regulatory actions by the U.S. Food and Drug Administration (FDA) and comparable regulatory authorities outside the U.S. These regulatory actions could include warning letters or other enforcement notices from the FDA, and/or comparable foreign regulatory authority which may require the Company to expend significant time and resources in order to implement appropriate corrective actions. If the Company does not address matters raised in warning letters or other enforcement notices to the satisfaction of the FDA and/or comparable regulatory authorities outside the U.S., these regulatory authorities could take additional actions, including product recalls, injunctions against the distribution of products or operation of manufacturing plants, civil penalties, seizures of the Company’s products and/or criminal prosecution. FMCH completed remediation efforts with respect to a pending FDA warning letter issued in 2011 and is awaiting confirmation whether the letter is now closed. FMCH responded to a second warning letter issued in December 2023 and is engaged with the FDA about continuing remediation efforts under that letter. The Company must also comply with the laws of the U.S., including the federal Anti-Kickback Statute, the federal False Claims Act, the federal Stark Law, the federal Civil Monetary Penalties Law and the federal Foreign Corrupt Practices Act as well as other federal and state fraud and abuse laws. In Germany, where corporations are not subject to criminal law, management boards of companies must ensure business activities comply with the anti-corruption provisions of the criminal code (Strafgesetzbuch), sections 331 et seq.; breaches by individuals exercising commercial activity are subject to prosecution which can result in corporate fines and/or orders for the disgorgement of profit. Applicable laws or regulations may be amended, or enforcement agencies or courts may make new interpretations, such as Executive Order No. 14173 (2025) requiring federal contractors and grantees to certify that they do not operate diversity, equity, and inclusion (DEI) programs violating federal anti-discrimination laws, with knowing submission of false certifications while receiving federal funds subject to possible treble damages under the False Claims Act, and Executive Order No. 14398 (2026) addressing DEI discrimination by federal contractors, that might differ from the Company’s interpretations or the manner in which it conducts its business. In the U.S., enforcement is a high priority for the federal government and some states. In addition, the provisions of the False Claims Act authorizing payment of a portion of any recovery to the party bringing the suit encourage private plaintiffs to commence whistleblower actions. By virtue of this regulatory environment, the Company’s business activities and practices are subject to extensive review by regulatory authorities and private parties, and continuing audits, subpoenas, other inquiries, claims and litigation relating to the Company’s compliance with applicable laws and regulations. The Company may not always be aware that an inquiry or action has begun, particularly in the case of whistleblower actions, which are initially filed under court seal.
The Company operates many facilities and handles the personal data of its patients and beneficiaries throughout the U.S. and other parts of the world and engages with other business associates to help it carry out its healthcare activities. While the Company is committed to training its employees and business associates on applicable laws and procedures, investigating concerns and incidents in a timely manner and taking remedial and corrective action (including disciplinary action) as necessary, in such a widespread, global system it may be difficult to maintain the desired level of oversight and control over the thousands of individuals employed by the Company, its many affiliated companies and its service providers or business associates. The Company recognizes that the laws, regulations and interpretative guidance on data privacy are evolving along with potential litigation and enforcement risks, and it continues to review its processes to adapt to those changes. On occasion, the Company or its business associates may experience a breach under the Health Insurance Portability and Accountability Act Privacy Rule and Security Rules, the EU’s General Data Protection Regulation or other similar laws (Data Protection Laws), which may involve certain impermissible use, access, or disclosure of unsecured personal data pertaining to patients, employees, beneficiaries or others. On those occasions, the Company is committed to compliance with applicable notification and/or reporting requirements and to take appropriate remedial and corrective action, including notification requirements under SEC rules that require public companies to report the occurrence of material cybersecurity incidents. Any such report could trigger litigation arising out of the incident. Cybersecurity incidents involving unauthorized or impermissible access to the Company’s data can also involve encryption or other efforts to deny access to such data and necessitate significant expenditures by the Company to recover or regain access to the data. On September 29, 2023, Cardiovascular Consultants, Ltd. (CCL), a former subsidiary of the Company located in the U.S., became aware that some of its computer systems in the U.S. were affected by a security incident. The Company publicly disclosed information regarding this security breach in a Form 6-K furnished to the SEC, noting that the Company does not expect the incident to have a material impact on its financial condition or results of operations. Subsequently, Fresenius Vascular Care, Inc. d/b/a Azura Vascular Care, a wholly owned subsidiary of the Company located in the U.S., became aware that some of its files had been affected by the same security incident. There are
42
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
The Company relies upon its management structure, regulatory and legal resources, and the effective operation of its compliance program to direct, manage and monitor the activities of its employees. On occasion, the Company may identify instances where employees or other agents deliberately, recklessly or inadvertently contravene the Company’s policies or violate applicable law and, in such instances, the Company will take appropriate corrective and/or disciplinary action. The actions of such persons may subject the Company and its subsidiaries to liability under the Anti-Kickback Statute, the Stark Law, the False Claims Act, Data Protection Laws, the Health Information Technology for Economic and Clinical Health Act and the FCPA, among other laws and comparable state laws or laws of other countries.
Physicians, hospitals and other participants in the healthcare industry are also subject to a large number of lawsuits alleging professional negligence, malpractice, product liability, worker’s compensation or related claims, many of which involve large claims and significant defense costs. The Company has been and is currently subject to these suits due to the nature of its business and expects that those types of lawsuits may continue. Although the Company maintains insurance at a level which it believes to be prudent, it cannot assure that the coverage limits will be adequate or that insurance will cover all asserted claims. A successful claim against the Company or any of its subsidiaries in excess of insurance coverage could have a material adverse effect upon it and the results of its operations. Any claims, regardless of their merit or eventual outcome, could have a material adverse effect on the Company’s reputation and business.
The Company has also had claims asserted against it and has had lawsuits filed against it relating to alleged patent infringements or businesses that it has acquired or divested. These claims and suits relate both to operation of the businesses and to acquisition and divestiture transactions. The Company has, when appropriate, asserted its own claims, and claims for indemnification. A successful claim against the Company or any of its subsidiaries could have a material adverse effect upon its business, financial condition, and the results of its operations. Any claims, regardless of their merit or eventual outcome, could have a material adverse effect on the Company’s reputation and business.
The Company is subject to ongoing and future tax audits in the U.S., Germany and other jurisdictions in the ordinary course of business. Tax authorities routinely pursue adjustments to the Company’s tax returns and disallowances of claimed tax deductions. When appropriate, the Company defends these adjustments and disallowances and asserts its own claims. A successful tax related claim against the Company or any of its subsidiaries could have a material adverse effect upon its business, financial condition, and results of operations.
The German tax authorities re-qualified dividends received in connection with intercompany mandatorily redeemable preferred shares into fully taxable interest payments for the years 2006 until 2013, which could lead to additional tax payments in the mid-double-digit million range. Additionally, German tax authorities objected to the Company’s tax returns and took the position that income of one of the Company’s finance entities for 2017 and future periods should be subject to German Controlled Foreign Corporation taxation resulting in potential additional income tax payments in the low end of triple-digit millions. In both cases, the Company will take any appropriate legal action to defend its position.
The Company is subject to residual value guarantees in certain lease contracts, primarily real estate contracts, for which it is the lessee in the amount of €
Other than those individual contingent liabilities mentioned above, the current estimated amount of the Company’s other known individual contingent liabilities is immaterial.
43
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
11. Financial instruments
The following tables show the carrying amounts and fair values of the Company’s financial instruments at March 31, 2026 and December 31, 2025:
Carrying amount and fair value of financial instruments
in € K
March 31, 2026 |
| Carrying amount |
| Fair value | ||||||||||||
Amortized | Not | |||||||||||||||
| cost | | FVPL | | FVOCI | | classified | | Total | | Level 1 | | Level 2 | | Level 3 | |
Cash and cash equivalents | | | — | — | | | — | — | ||||||||
Trade accounts and other receivables from unrelated parties | | — | — | | | — | — | — | ||||||||
Accounts receivable from related parties | | — | — | — | | — | — | — | ||||||||
Derivatives - cash flow hedging instruments | — | — | — | | | — | | — | ||||||||
Derivatives - not designated as hedging instruments | — | | — | — | | — | | — | ||||||||
Derivatives embedded in Virtual Power Purchase Agreements (vPPAs) | — | | — | — | | — | — | | ||||||||
Equity investments | — | | | — | | | | | ||||||||
Debt securities | — | | | — | | | — | — | ||||||||
Other financial assets(1) | | | — | | | — | — | | ||||||||
Other current and non-current assets | | | | | | — | — | — | ||||||||
Financial assets | | | | | | — | — | — | ||||||||
Accounts payable to unrelated parties | | — | — | — | | — | — | — | ||||||||
Accounts payable to related parties | | — | — | — | | — | — | — | ||||||||
Short-term debt | | — | — | — | | — | — | — | ||||||||
Long-term debt | | — | — | — | | | | — | ||||||||
Lease liabilities | — | — | — | | | — | — | — | ||||||||
Derivatives - cash flow hedging instruments | — | — | — | | | — | | — | ||||||||
Derivatives - not designated as hedging instruments | — | | — | — | | — | | — | ||||||||
Derivatives embedded in vPPAs | — | | — | — | | — | — | | ||||||||
Variable payments outstanding for acquisitions | — | | — | — | | — | — | | ||||||||
Put option liabilities | — | — | — | | | — | — | | ||||||||
Other financial liabilities(2) | | — | — | — | | — | — | — | ||||||||
Other current and non-current liabilities | | | — | | | — | — | — | ||||||||
Financial liabilities | | | — | | | — | — | — | ||||||||
44
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
Carrying amount and fair value of financial instruments
in € K
December 31, 2025 |
| Carrying amount |
| Fair value | ||||||||||||
Amortized | Not | |||||||||||||||
| cost | | FVPL | | FVOCI | | classified | | Total | | Level 1 | | Level 2 | | Level 3 | |
Cash and cash equivalents |
| | | — | — | | | — | — | |||||||
Trade accounts and other receivables from unrelated parties |
| | — | — | | | — | — | — | |||||||
Accounts receivable from related parties |
| | — | — | — | | — | — | — | |||||||
Derivatives - cash flow hedging instruments |
| — | — | — | | | — | | — | |||||||
Derivatives - not designated as hedging instruments |
| — | | — | — | | — | | — | |||||||
Derivatives embedded in vPPAs | — | | — | — | | — | — | | ||||||||
Equity investments |
| — | | | — | | | | | |||||||
Debt securities |
| — | | | — | | | — | — | |||||||
Other financial assets(1) |
| | | — | | | — | — | | |||||||
Other current and non-current assets |
| | | | | | — | — | — | |||||||
Financial assets |
| | | | | | — | — | — | |||||||
Accounts payable to unrelated parties |
| | — | — | — | | — | — | — | |||||||
Accounts payable to related parties |
| | — | — | — | | — | — | — | |||||||
Short-term debt |
| | — | — | — | | — | — | — | |||||||
Long-term debt |
| | — | — | — | | | | — | |||||||
Lease liabilities | — | — | — | | | — | — | — | ||||||||
Derivatives - cash flow hedging instruments |
| — | — | — | | | — | | — | |||||||
Derivatives - not designated as hedging instruments |
| — | | — | — | | — | | — | |||||||
Derivatives embedded in vPPAs |
| — | | — | — | | — | — | | |||||||
Variable payments outstanding for acquisitions |
| — | | — | — | | — | — | | |||||||
Put option liabilities |
| — | — | — | | | — | — | | |||||||
Other financial liabilities(2) |
| | — | — | — | | — | — | — | |||||||
Other current and non-current liabilities | | | — | | | — | — | — | ||||||||
Financial liabilities |
| | | — | | | — | — | — | |||||||
(1) | As of March 31, 2026 other financial assets primarily include receivables related to a royalty stream that the Company is entitled to base on sales made by Humacyte, Inc. in the U.S., lease receivables, notes receivables, deposits, guarantees, and securities, vendor and supplier rebates as well as receivables related to consent agreement on certain pharmaceuticals. As of December 31, 2025 other financial assets primarily include receivables related to a royalty stream that the Company is entitled to base on sales made by Humacyte, Inc. in the U.S., vendor and supplier rebates, lease receivables, notes receivable, receivables related to consent agreement on certain pharmaceuticals as well as deposits, guarantees, and securities. |
(2) | As of March 31, 2026 and December 31, 2025, other financial liabilities primarily include receivable credit balances and goods and services received. |
Derivative and non-derivative financial instruments are categorized in the following three-tier fair value hierarchy that reflects the significance of the inputs in making the measurements. Level 1 inputs are quoted prices for similar instruments in active markets. Level 2 is defined as using valuation models (i.e. mark-to-model) with input factors that are inputs other than quoted prices in active markets that are directly or indirectly observable. Level 3 is defined as using valuation models (i.e. mark-to-model) with input factors that are unobservable inputs for which little or no market data exists, therefore requiring the Company to develop its own assumptions. Fair value information is not provided for financial instruments if the carrying amount is a reasonable estimate of fair value due to the relatively short period of maturity of these instruments. This includes cash and cash equivalents measured at amortized costs, trade accounts and other receivables from unrelated parties, accounts receivable from related parties, other financial assets, accounts payable to unrelated parties, accounts payable to related parties, short-term debt, and other financial liabilities. Transfers between levels of the fair value hierarchy have not occurred as of March 31, 2026 or December 31, 2025. The Company accounts for transfers at the end of the reporting period.
Derivative financial instruments
In order to manage the risk of currency exchange rate and interest rate fluctuations, the Company enters into various hedging transactions by means of derivative instruments with highly rated financial institutions (generally investment grade) as authorized by the Company’s Management. The Company primarily enters into foreign exchange forward contracts and interest rate swaps. In certain instances, the Company enters into derivative contracts that do not qualify for hedge accounting but are utilized for economic purposes (economic hedges). The Company does not use financial instruments for trading purposes.
45
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
In April 2024, the Company signed several vPPAs with wind and solar energy project developers in Germany and in the U.S. with terms of up to
Sensitivities of derivatives embedded in vPPAs to changes in unobservable inputs
in € K
Change in expected electricity prices | | Change in expected production volumes | | Change in expected interest rates | ||||||||
| | | | |||||||||
2026 | ( | ( | | ( | ||||||||
2025 | | ( | | ( | ( | | ||||||
Changes in the fair value of the derivatives embedded in the vPPAs are recognized in other operating income or other operating expense, as applicable, in the consolidated statements of income. Due to the volatile nature of such instruments which may be considered to be speculative, it is difficult to accurately predict what impact the volatility of unobservable inputs, such as changes in expected energy prices or production volumes, may have on the valuation of such instruments in the future. The estimated fair values of these derivative instruments may fluctuate significantly from quarter to quarter and the price at which these derivatives may ultimately be settled could vary significantly from the Company’s current estimates, depending upon market conditions.
The following table provides a reconciliation of derivatives embedded in the vPPAs at March 31, 2026 and December 31, 2025:
Reconciliation of derivatives embedded in vPPAs
in € K
| 2026 | | 2025 | |
Derivatives embedded in the vPPAs - (Liabilities)/Assets | ||||
Beginning balance at January 1, | ( |
| ( | |
Settlements | |
| | |
Gain (loss) recognized in profit or loss (1) | ( |
| | |
Foreign currency translation and other changes | |
| | |
Ending balance at March 31, and December 31, | ( |
| ( | |
(1)Includes realized and unrealized gains / losses.
Non-derivative financial instruments
The significant methods and assumptions used for the classification and measurement of non-derivative financial instruments are as follows:
The Company assessed its business models and the cash flow characteristics of its financial assets. The vast majority of the non-derivative financial assets are held in order to collect contractual cash flows. The contractual terms of the financial assets allow the conclusion that the cash flows represent payment of principal and interest only. Trade accounts and other receivables from unrelated parties, accounts receivable from related parties and other financial assets are consequently measured at amortized cost.
Cash and cash equivalents are comprised of cash funds and other short-term investments. Cash funds are measured at amortized cost. Short-term investments are highly liquid and readily convertible to known amounts of cash. Short-term investments are measured at fair value through profit or loss (FVPL). The risk of changes in fair value is insignificant.
46
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
Equity investments are not held for trading. At initial recognition the Company elected, on an instrument-by-instrument basis, to represent subsequent changes in the fair value of individual strategic investments in other comprehensive income. If equity instruments are quoted in an active market, the fair value is based on price quotations at the period-end-date. As necessary, the Company engages external valuation firms to assist in determining the fair value of Level 3 equity investments. The external valuation uses a discounted cash flow model, which includes significant unobservable inputs such as investment specific forecasted financial statements and weighted average cost of capital, that reflects current market assessments as well as a terminal growth rate.
The majority of the debt securities are held within a business model whose objective is achieving both contractual cash flows and selling the securities. The standard coupon bonds give rise on specified dates to cash flows that are solely payments of principal and interest on the outstanding principal amount. Subsequently, these financial assets have been classified as fair value through other comprehensive income (FVOCI). The smaller part of debt securities does not give rise to cash flows that are solely payments of principal and interest. Consequently, these securities are measured at FVPL. In general, most of the debt securities are quoted in an active market.
Long-term debt is initially recognized at its fair value and subsequently measured at amortized cost. The fair values of major long-term debt are calculated on the basis of market information. Liabilities for which market quotes are available are measured using these quotes. The fair values of the other long-term debt are calculated at the present value of the respective future cash flows. To determine these present values, the prevailing interest rates and credit spreads for the Company as of the balance sheet date are used.
Variable payments outstanding for acquisitions are recognized at their fair value. The estimation of the individual fair values is based on the key inputs of the arrangement that determine the future contingent payment as well as the Company’s expectation of these factors. The Company assesses the likelihood and timing of achieving the relevant objectives. The underlying assumptions are reviewed regularly.
Put option liabilities are recognized at the present value of the exercise price of the option. The exercise price of the option is generally based on fair value and, in certain limited instances, might contain a fixed floor price. The methodology the Company uses to estimate the fair values assumes the greater of net book value or a multiple of earnings, based on historical earnings, development stage of the underlying business and other factors. From time to time the Company engages an external valuation firm to assist in the valuation of certain put options. The external valuation assists the Company in estimating the fair values using a combination of discounted cash flows and a multiple of earnings and/or revenue. Under those limited circumstances in which the put option might contain a fixed floor price, the external valuation firm may assist the Company with the valuation by performing a Monte Carlo Simulation analysis to simulate the exercise price. The put option liabilities are discounted at a pre-tax discount rate that reflects current market assessments of the time value of money and the risks specific to the liability. The estimated fair values of these put options can also fluctuate, and the discounted cash flows as well as the implicit multiple of earnings and/or revenue at which these obligations may ultimately be settled could vary significantly from the Company’s current estimates depending upon market conditions. For the purpose of analyzing the impact of changes in unobservable inputs on the fair value measurement of put option liabilities, the Company assumes an increase on earnings (or enterprise value, where applicable) of
During the second quarter of 2025, the Company entered into an agreement with shareholders of Interwell Health (the Company’s value and risk-based care subsidiary) to accelerate the settlement of put options held by non-physician investors originally granted as part of the 2022 merger of Cricket Health, Interwell Health LLC and Fresenius Health Partners, Inc. The settlement in the amount of $
47
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
The following table provides a reconciliation of Level 3 financial instruments, excluding vPPAs as disclosed above, at March 31, 2026 and December 31, 2025:
Reconciliation from beginning to ending balance of level 3 financial instruments
in € K
| 2026 | | 2025 | ||||||||||||||
Variable | Other | Variable | Other | ||||||||||||||
payments | financial | payments | financial | ||||||||||||||
outstanding | assets | outstanding | assets | ||||||||||||||
Equity | for | Put option | measured at | Equity | for | Put option | measured at | ||||||||||
| investments | | acquisitions | | liabilities | | FVPL (1) | | investments | | acquisitions | | liabilities | | FVPL (1) | ||
Beginning balance at January 1, |
| | | | | | | | | ||||||||
Increase | | | | — | | | | | |||||||||
Decrease | — | ( | ( | — | — | ( | ( | ( | |||||||||
Gain / loss recognized in profit or loss(2) | ( | — | — | | ( | ( | — | ( | |||||||||
Gain / loss recognized in equity |
| — | — | | — | — | — | ( | — | ||||||||
Foreign currency translation and other changes | | | | | ( | ( | ( | ( | |||||||||
Ending balance at March 31, and December 31, | | | | | | | | | |||||||||
| (1) | As of March 31, 2026 and December 31, 2025, other financial assets measured at FVPL consist mainly of receivables related to a royalty stream that the Company is entitled to base on sales made by Humacyte, Inc. in the U.S. |
| (2) | Includes realized and unrealized gains / losses. |
48
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
12. Segment and corporate information
The operating segments are determined based upon how the Company manages its businesses and allocates resources with responsibilities by products and services and is aligned to the financial information that is presented on a quarterly basis to the chief operating decision maker. The Care Enablement segment is primarily engaged in the manufacture and distribution of healthcare products and equipment, including R&D, supply chain, and commercial operations, as well as supporting functions such as regulatory and quality management. The Care Delivery segment is primarily engaged in providing healthcare services for the treatment of CKD, ESRD, and in providing other extracorporeal therapies. Care Delivery also includes the pharmaceutical products business and the income from equity method investees related to the sale of certain renal pharmaceuticals by Vifor Fresenius Medical Care Renal Pharma Ltd., which are used in the Company’s clinics to provide healthcare services to its patients. The Value-Based Care operating segment is primarily focused on value-based kidney care, including contracting and performance management, clinical care models supported by a national network of nephrologists, and tech-enabled platforms that leverage proprietary informatics and patient engagement tools. Value and risk-based care arrangements with private payors or government programs may include shared savings or losses from reductions or increases in the overall medical spend of a population under management which are accounted for in accordance with IFRS 15, Revenue from Contracts with Customers. Premiums and medical costs included in full risk arrangements, however, are accounted for in accordance with IFRS 17, Insurance Contracts. Premium revenue and claim costs are presented separately as insurance revenue and insurance costs of revenue, respectively, on the consolidated statements of income and constitute the majority of revenue and costs of revenue for the segment.
The Company’s Global Medical Office, which seeks to optimize medical treatments and clinical processes within the Company and supports both Care Delivery and Care Enablement, is centrally managed and its profit and loss are allocated to those specific segments. Similarly, costs related primarily to headquarters overhead charges, including accounting and finance as well as certain human resources, legal, and IT costs, are allocated as these costs are attributable to the segments, and are used in the allocation of resources to Care Delivery and Care Enablement. These costs are allocated at budgeted amounts, with the difference between budgeted and actual figures recorded at the corporate level. The Value-Based Care segment maintains its own separate finance, accounting, human resources, legal, medical office, and other administrative functions and is therefore excluded from the allocation process. Additionally, certain costs, which relate mainly to shareholder activities, management activities, global internal audit, and the remeasurement of certain investments and vPPAs are not allocated to a segment but are accounted for as corporate expenses. From January 1, 2026, the project costs for implementing the Company’s new enterprise resource planning software are reported as corporate expenses. These activities do not fulfill the definition of a segment according to IFRS 8, Operating Segments, and are reported separately as Corporate (Corporate). Interest income, interest expense, and tax expense are neither included within the measure of segment profit or loss reviewed by the chief operating decision maker nor otherwise regularly provided to the chief operating decision maker by segment and are therefore not included in the presented segment information.
Management evaluates each segment using measures that reflect all of the segment’s controllable revenues and expenses. With respect to the performance of business operations, management believes that the most appropriate measures are revenue and operating income. Services provided by the Care Delivery segment in the U.S. for patients managed under the Value-Based Care segment are provided at fair market value. The Company also transfers products from the Care Enablement segment to the Care Delivery segment at fair market value. The associated internal revenues and expenses and any remaining internally generated profit or loss for the products transferred and services provided are recorded within the operating segments initially, are eliminated upon consolidation and are included within “Inter-segment eliminations.” Capital expenditures for production are based on the expected demand of the segments and consolidated profitability considerations.
49
FRESENIUS MEDICAL CARE AG
Notes to the interim consolidated financial statements
(unaudited)
(in K, except share and per share data)
Information pertaining to the Company’s segment and Corporate activities for the three months ended March 31, 2026 and 2025 is set forth below. The prior year figures have been restated to align to the new operating and reportable segment structure:
Segment and corporate information
in € K
| Care |
| Value- |
| Care |
| Total |
| Inter-segment | |||||
| Delivery | | Based Care | | Enablement | | Segment | | eliminations | | Corporate | | Total | |
Three months ended March 31, 2026 |
| | |
| |
| |
| |
| |
| | |
Revenue from healthcare services(1) | | | — | | — | — | | |||||||
Revenue from healthcare products(1) | | — | | | — | — | | |||||||
Revenue from contracts with customers(1) | | | | | — | — | | |||||||
Revenue from insurance contracts(1) | — | | — | | — | — | | |||||||
Revenue from lease contracts(1) | — | — | | | — | — | | |||||||
Revenue from external customers | | | | | — | — | | |||||||
Inter-segment revenue | | — | | | ( | — | — | |||||||
Revenue | | | | | ( | — | | |||||||
Costs of revenue | ( | ( | ( | ( | | | ( | |||||||
Research and development | — | — | ( | ( | — | ( | ( | |||||||
Operating income (loss) | | ( | | | ( | ( | | |||||||
Interest | ( | |||||||||||||
Income before income taxes | | |||||||||||||
Depreciation and amortization | ( | ( | ( | ( | | ( | ( | |||||||
Impairment loss | ( | — | ( | ( | — | ( | ( | |||||||
Income (loss) from equity method investees | | — | — | | — | — | | |||||||
Total assets(1) | | | | | ( | | | |||||||
thereof investment in equity method investees(1) | | — | — | | — | — | | |||||||
Additions of property, plant and equipment, intangible assets and right-of-use assets(1) | | | | | ( | | | |||||||
Three months ended March 31, 2025 |
| |||||||||||||
Revenue from healthcare services(1) | | | — | | — | — | | |||||||
Revenue from healthcare products(1) | | — | | | — | — | | |||||||
Revenue from contracts with customers(1) | | | | | — | — | | |||||||
Revenue from insurance contracts(1) | — | | — | | — | — | | |||||||
Revenue from lease contracts(1) | — | — | | | — | — | | |||||||
Revenue from external customers | | | | | — | — | | |||||||
Inter-segment revenue | | — | | | ( | — | — | |||||||
Revenue | | | | | ( | — | | |||||||
Costs of revenue | ( | ( | ( | ( | | | ( | |||||||
Research and development | — | — | ( | ( | — | — | ( | |||||||
Operating income (loss) | | | | | ( | ( | | |||||||
Interest | ( | |||||||||||||
Income before income taxes | | |||||||||||||
Depreciation and amortization | ( | ( | ( | ( | | ( | ( | |||||||
Impairment loss | ( | ( | ( | ( | — | — | ( | |||||||
Income (loss) from equity method investees | | — | — | | — | — | | |||||||
Total assets(1) | | | | | ( | | | |||||||
thereof investment in equity method investees(1) | | — | — | | — | — | | |||||||
Additions of property, plant and equipment, intangible assets and right-of-use assets(1) | | | | | ( | | |
(1) | These line items are included to comply with requirements under IFRS 8 and IFRS 15 or are provided on a voluntary basis, but not included in the information regularly reviewed by the chief operating decision maker. |
13. Events occurring after the balance sheet date
No other significant events have taken place subsequent to the balance sheet date March 31, 2026 that have a material impact on the key figures and earnings presented. Currently, there are no other significant changes in the Company’s structure, management, legal form or personnel.
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Quantitative and qualitative disclosures about market risk
The information in note 26 of the notes to the consolidated financial statements included in the Company’s Annual Report on Form 20-F for the year ended December 31, 2025 and in note 11 of the notes to the condensed consolidated interim financial statements (unaudited) included in this report, is incorporated by this reference.
Controls and procedures
The Company is a “foreign private issuer” within the meaning of Rule 3b-4(c) under the Securities Exchange Act of 1934, as amended (the Exchange Act). As such, the Company is not required to file quarterly reports with the Securities and Exchange Commission (the Commission) and is required to provide an evaluation of the effectiveness of its disclosure controls and procedures, to disclose significant changes in its internal control over financial reporting and to provide certifications of its Chief Executive Officer (CEO) and Chief Financial Officer (CFO) under Sections 302 and 906 of the Sarbanes-Oxley Act of 2002 only in its Annual Report on Form 20-F. The Company furnishes quarterly financial information to the Commission and such certifications under cover of Form 6-K on a voluntary basis. While the Company currently expects to adhere to such reporting processes, there can be no assurance that the Company will continue to do so.
In connection with such voluntary reporting, the Company’s management, including the CEO and CFO, conducted an evaluation of the effectiveness of the Company’s disclosure controls and procedures, as defined in the Securities Exchange Act Rule 13a-15, as of the end of the period covered by this report. Based on that evaluation, the CEO and CFO concluded that the Company’s disclosure controls and procedures were effective as of March 31, 2026 to ensure that the information required to be disclosed by the Company in reports filed or furnished under the Act is (i) recorded, processed, summarized and reported within the time periods specified in the Commission’s rules and forms and (ii) accumulated and communicated to the Management Board, including the CEO and CFO, as appropriate to allow timely decisions regarding required disclosure.
During the past fiscal quarter, there were no changes in internal control over financial reporting that have materially affected, or are reasonably likely to materially affect, the Company’s internal control over financial reporting.
OTHER INFORMATION
Legal proceedings
The information in note 10 of the notes to the condensed consolidated interim financial statements (unaudited), presented elsewhere in this report, is incorporated by this reference.
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Exhibits
The following exhibits are filed within this Report:
Exhibit No. | | |
31.1 | ||
31.2 | ||
32.1 | ||
32.2 | ||
101 | The following financial statements as of and for the three-month period ended March 31, 2026 from the Company’s Report on Form 6-K for the month of May 2026, formatted in iXBRL (Inline eXtensible Business Reporting Language) and included in the body of this report: (i) Consolidated Statements of Income, (ii) Consolidated Statements of Comprehensive Income, (iii) Consolidated Balance Sheets, (iv) Consolidated Statements of Cash Flows, (v) Consolidated Statements of Shareholders’ Equity and (vi) Notes to the Condensed Consolidated Interim Financial Statements. |
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SIGNATURES
Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on its behalf by the undersigned, thereunto duly authorized.
DATE: May 5, 2026
FRESENIUS MEDICAL CARE AG | ||
By: | /s/ HELEN GIZA | |
Name: | Helen Giza | |
Title: | Chief Executive Officer and Chair of the Management Board | |
By: | /s/ MARTIN FISCHER | |
Name: | Martin Fischer | |
Title: | Chief Financial Officer and member of the Management Board | |
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ATTACHMENTS / EXHIBITS