AT A GLANCE
Rank: #17 (Last year: #16)
$6.06 Billion (38.4B total)
Prior Fiscal: $6.0 billion
Percentage Change: +1%
No. of Employees: 276,750 (total)
Global Headquarters: Bad Homburg, Germany

KEY EXECUTIVES
Stephan Sturm, Chairman of the Management Board
Francesco De Meo, CEO, Fresenius Helios
Rachel Empey, CFO
Jürgen Götz, Chief Legal and Compliance Officer, and Labor Relations Director
Mats Henriksson, CEO, Fresenius Kabi
Rice Powell, CEO, Fresenius Medical Care
Ernst Wastler, CEO, Fresenius Vamed

It started in August 2017 when Fresenius Medical Care—one of the four “groups” that comprise Fresenius—made a bid to purchase NxStage Medical—a manufacturer of end-stage renal disease and acute kidney failure products—for $30 per share in cash. That sparked the beginning of an almost year and a half-long venture to complete a deal that encountered delays virtually throughout the entire timeframe.

Undoubtedly, the transaction was seen as potentially dead more than a couple times, while NxStage’s stock price fluctuated substantially and losses were being reported. The buyout, however, had received the necessary approval of shareholders and passed antitrust clearance in Germany and the U.K. On the other hand, the U.S. Federal Trade Commission (FTC) still hadn’t provided its blessing on the arrangement. An August 2018 deadline to complete the transaction was looming uncomfortably for many stakeholders involved.

Then in July 2018, about a month before the deadline, NxStage sold its bloodlines business to B. Braun for an undisclosed amount. The sale included the Streamline Bloodline for the Dialog+ hemodialysis system, Streamline Bloodline for the Fresenius Medical Care hemodialysis system, and Streamline Bloodline Long for the Fresenius Medical Care hemodialysis system. The divestiture was performed in order to help gain FTC approval of the Fresenius buyout and was made contingent on the closure of that merger.

More positive news soon followed that announcement and kept the prospect of a successful transaction alive. Just before the deal’s deadline was scheduled to arrive, it was pushed back 90 days to Nov. 5, providing NxStage additional time to clear up any lingering questions from the FTC. A second 90-day delay then was agreed upon just prior to the new deadline, which moved any close of the merger to the next calendar year. Fresenius Medical Care’s CEO Rice Powell explained the second delay was also done to provide even more time for the FTC review.

“NxStage will close. We are later in the year than any of us imagined we would be, but we still believe that it will close,” Rice proclaimed to investors.

Finally, on Feb. 22, 2019, Rice was able to make good on his promise. Just a few days after finally obtaining the FTC’s antitrust approval of the merger, Fresenius Medical Care closed its purchase or NxStage Medical that began approximately 18 months earlier, substantially increasing the home dialysis offerings for the company. According to Reuters, Fresenius is targeting 15 percent of its treatments to be performed within the home by 2022; at the end of 2018, that figure was around 12 percent.

The influx of the new revenue stream via the NxStage acquisition will certainly be welcomed by a company that saw a decrease in sales dollars from 2017 to 2018. Fresenius, as a whole, lost approximately $350 million, or about 1 percent, between the two fiscal years, posting 33.89 billion euros in ’17 and 33.53 billion euros in ’18.

Beneficiary of the new capabilities and product offerings tied to NxStage Medical, Fresenius Medical Care already led the conglomerate in terms of highest annual sales. Although it was down just a bit from its 2017 total of 16.74 billion euros, the business contributed a company-leading 16.55 billion euros. The unit, which focuses on products and services for people with chronic kidney failure, is divided into two segments—Health Care Services and Health Care Products. The significantly larger Services portion saw 2018 sales of 13.26 billion euros in 2018, down 2 percent from the prior year. Products, on the other hand, saw a 1 percent gain between the two years, ending up with 3.28 billion euros during the fiscal period.

Looking at the worldwide market, the demand for the Medical Care offerings originate primarily in North America, where 2018 sales came in at 11.57 billion euros (70 percent of the group’s total sales). That figure, however, marked a 10 percent decline over 2017. Growth was observed in Europe/Middle East/Africa (EMEA) and Asia-Pacific, rising 2 percent and 4 percent respectively. EMEA ended 2018 with sales of 2.59 billion euros, while Asia-Pacific finished with 1.69 billion euros. Experiencing a 5 percent decline, Latin America closed the year with 686 million euros in sales.

The Fresenius Kabi group is divided into four segments, two of which contribute to the annual sales total in this report’s figure. Overall, the unit saw gains across every portion with positive organic sales growth. The group, which specializes in the therapy and care of chronically and critically ill people, contributed 6.54 billion euros to Fresenius’ annual figure, reflecting 7 percent organic sales growth. IV drugs, the largest unit in Kabi, grew 5 percent organically to finish at 2.74 billion euros for 2018. Clinical Nutrition followed with 1.80 billion euros, up 13 percent in organic sales growth from 2017’s 1.67 billion euros.

The remaining two groups join Medical Care’s Products portion to round out the total sales figure for this report. The first—Medical Devices/Transfusion Technology—witnessed 4 percent organic growth, although actual sales totals remained flat between 2018 and 2017. It finished the latest fiscal year at 1.08 billion euros. The last group in Kabi, Infusion Therapy, posted 929 million euros in sales, an organic increase of 7 percent.

Sales totals for Kabi in North America and Europe were almost even—2.36 billion euros and 2.25 billion euros respectively. Asia-Pacific contributed 1.3 billion euros to the unit’s sales, while Latin America/Africa brought in 637 million euros.

Serving as a leading private hospital operator in Europe, with 221 medical facilities in Germany and 404 healthcare centers in Spain, Fresenius Helios enjoyed a 4 percent overall rise in sales during fiscal 2018. The group finished the year at 8.99 billion euros. That total was split at an almost 2:1 ratio between the German and Spanish locations. Sales from the centers in Germany came in at 5.97 billion euros (a 2 percent loss over prior year), while Spain posted 3.02 billion euros (a 17 percent gain).

The last group of the four that comprise Fresenius as a single entity is Vamed. According to the firm’s annual report, Fresenius Vamed manages projects, provides services for hospitals and other healthcare facilities worldwide, and is a leading post-acute care provider in Central Europe. Total sales for the group was 1.69 billion euros—a 37 percent increase over the previous year. Europe accounts for the overwhelming majority of that revenue (78 percent), with other regions making up the balance (Africa, 6 percent; Asia-Pacific, 13 percent; and Latin America, 3 percent). Both units within Vamed saw strong growth, but the Service business sales jumped 57 percent to end at 976 million euros. Project business grew 17 percent to end the year at 712 million euros.

Looking to the future to ensure continued success, Fresenius made a number of investments during 2018 toward that effort. At the firm’s global headquarters, work was being conducted on a new research and development center. With the goal of bringing all R&D employees of the Medical Care segment together at one site, the new facility would connect to the company’s existing R&D center at the location.

The company also broke ground for a new technology center in Schweinfurt, Germany, which is also intended to be used by the Medical Care group. The 86,000-square-foot facility would be used across departments in an effort to better blend production and development.