# Fresenius Medical Care (FMS.US)

Canonical: https://gigainvestors.com/s/FMS

Analysis as of: 2026-10-16T07:28:35.381Z. Financial observations: FY1997–FY2025.

Listing currency: USD. Reporting currency: EUR.

## Verdict

Not a wonderful business

Quality tests for Buy: not passed (profit record: pass; earnings resilience is evidence only). Published buy qualification: no.

Share price: $22.13 per share; close as of 2026-10-15.

Estimated value: low $38.26 per share, central $43.22 per share, high $49.83 per share. Buy at or below the central value $43.22 per share. Valuation as of 2026-10-16T07:28:35.381Z; scenarios are not confidence intervals.

Expected annual return: 17.8% at the stated quote. About 17.8% a year at today's price (required return 10.0%). required return 10.0% a year (10% floor; US 10-year bond 5.1% + 4 points).

## Checklist

### understandable: pass

- 3 revenue declines in the last 10 years (informational)

- Financial history: 10 years

- Years with declining revenue: 3

- Years with a net loss: 0

- Operating margin variation: 0.30×

Chart: Operating margin; fiscal year observations.

- FY2016: 0.15×

- FY2017: 0.13×

- FY2018: 0.18×

- FY2019: 0.13×

- FY2020: 0.13×

- FY2021: 0.11×

- FY2022: 0.08×

- FY2023: 0.07×

- FY2024: 0.08×

- FY2025: 0.09×

### moat: pass

- ROIC, median of available years: 15.4%

- ROIC, second-lowest year: 11.1%

- Typical minus recent gross margin: 3.7 pp

- Typical gross margin (annual median): 29.0%

- Recent gross margin (lower of latest and 3-year median): 25.3%

- Years with nonpositive capital: 0

- Capital spending / revenue: 9.8%

- ROIC including acquisitions, ten-year median: 3.9%

Chart: ROIC excluding acquisitions; fiscal year observations.

- FY2016: 42.0%

- FY2017: 43.0%

- FY2018: 50.8%

- FY2019: 16.7%

- FY2020: 16.3%

- FY2021: 14.3%

- FY2022: 11.1%

- FY2023: 10.2%

- FY2024: 11.3%

- FY2025: 14.5%

### economics: fail

- incremental invested capital return below threshold

- Owner earnings / net income, 5-yr: 1.85×

- Cash conversion uses consolidated totals: No

- Owner earnings, five-year total: EUR 6.8B

- Net income, five-year total: EUR 3.7B

- Return on incremental invested capital: -0.3%

- Working capital / revenue, annual change: -0.0 pp

- Working capital / revenue, change between three-year averages: -0.2 pp

- Working capital / revenue, final three-year average: 23.9%

Chart: Annual owner cash / profit; fiscal year observations.

- FY2021: 0.94×

- FY2022: 1.63×

- FY2023: 3.14×

- FY2024: 2.94×

- FY2025: 1.63×

### management: fail

- Historical market-dollar context (not the management verdict): 2016 to 2025 (9 years)

- buybacks unrelated to price (informational)

- ROIC first 3 years vs last 3 years: 43.0% vs 11.3%

- Per-share earnings: 1.93 to 0.92 (three-year endpoint medians)

- per-share value declined or ends nonpositive

- acquired goodwill and intangibles (proxy) exceeds half of ten-year net income with low and deteriorating ROIC

- Management verdict uses per-share economic progress: Yes

- Ordinary dilution, 10-year annual growth: -0.6%

- Ordinary dilution, 5-year annual growth: -0.5%

- Market cap gain: EUR -11B

- Cumulative retained earnings: EUR 3.8B

- Diluted shares, 10-year annual growth: -0.6%

- Diluted shares, 5-year annual growth: -0.5%

- $1 test, starting fiscal year: FY2016

- $1 test, ending fiscal year: FY2025

- Per-share value growth: -8.9%

- Per-share value change: EUR -1.01

- Per-share value, starting three-year median: EUR 1.93

- Per-share value, ending three-year median: EUR 0.92

- Buybacks concentrated in cheaper years (correlation): 0.00

- Average buyback yield: 1.8%

- Buyback history: 5 years

- Debt-funded buybacks: No

- Acquisition spending: EUR 19B

- Cumulative net income, 10 years: EUR 10B

- ROIC, first three-year median: 43.0%

- ROIC, last three-year median: 11.3%

Chart: Earnings per share; fiscal year observations.

- FY2016: EUR 1.93

- FY2017: EUR 2.09

- FY2018: EUR 3.23

- FY2019: EUR 1.35

- FY2020: EUR 1.99

- FY2021: EUR 1.09

- FY2022: EUR 0.76

- FY2023: EUR 0.57

- FY2024: EUR 0.92

- FY2025: EUR 1.71

### accounting: pass

- Sloan accruals: -5.2%

- Receivables to sales index (DSRI): 0.91×

- Restructuring years, last five: 0

- Stock compensation / operating cash flow: 0.0%

- Earnings backed by cash: Yes

- Operating cash / earnings: 2.63×

- Accounting red flags: 0

- Goodwill and intangibles / equity: 1.99×

Chart: Sloan accruals; fiscal year observations.

- FY2016: -3.3%

- FY2017: -3.8%

- FY2018: -0.3%

- FY2019: -4.2%

- FY2020: -9.7%

- FY2021: -4.4%

- FY2022: -4.2%

- FY2023: -6.3%

- FY2024: -5.5%

- FY2025: -5.2%

## Holders

- [David Hoeft](https://gigainvestors.com/DAC): tracked 13F investor; follow the investor page for holding quarter and amounts.

- [Richard Pzena](https://gigainvestors.com/PIM): tracked 13F investor; follow the investor page for holding quarter and amounts.

## Price story

Down 35% since Jan 2022 · "However, regulatory headwinds, flat treatment volumes and weakness in China remain key concerns." (finance.yahoo.com, Mar 2026) · sales +1.5%

Story as of 2026-10-16T09:58:46.399Z; price observation 2026-10-15.

Price needs cash profits to shrink 8.2% a year for ten years

- 2025-08-05: Fresenius Medical Care Confirms Guidance After Sales, Profit Rise ([finance.yahoo.com](https://finance.yahoo.com/m/10550bbe-eb20-3db7-a30f-51de006d4196/fresenius-medical-care.html))

- 2026-02-24: Fresenius Medical Care Shares Drop After Outlook Underwhelms ([finance.yahoo.com](https://finance.yahoo.com/m/04a8c5ad-15b8-3625-b4ef-a8742ac2377c/fresenius-medical-care-shares.html))

- 2026-06-25: Fresenius Medical Care dips after US proposes lower dialysis reimbursement rate ([finance.yahoo.com](https://finance.yahoo.com/healthcare/articles/fresenius-medical-care-dips-us-092057534.html))

### Sales · FY2024–2025

sales +1.5%; source https://www.sec.gov/Archives/edgar/data/1333141/000110465926019005/fms-20251231x20f.htm; observed 2026-02-24.

- FY2016: EUR 17B 

- FY2017: EUR 18B 

- FY2018: EUR 17B 

- FY2019: EUR 17B 

- FY2020: EUR 18B 

- FY2021: EUR 18B 

- FY2022: EUR 19B 

- FY2023: EUR 19B 

- FY2024: EUR 19B 

- FY2025: EUR 20B 

### Gross margin · FY2025

gross margin 25.6%; source https://www.sec.gov/Archives/edgar/data/1333141/000110465926019005/fms-20251231x20f.htm; observed 2026-02-24.

- FY2016: 32.3% 

- FY2017: 33.8% 

- FY2018: 31.2% 

- FY2019: 30.9% 

- FY2020: 31.0% 

- FY2021: 27.1% 

- FY2022: 25.2% 

- FY2023: 25.3% 

- FY2024: 24.6% 

- FY2025: 25.6% 

## Owner memo

Memo as of 2026-10-16T08:06:05.509Z.

### How it makes money

Operates in medical care facilities; annual sales are EUR 19.6 billion.

- Source: https://www.sec.gov/Archives/edgar/data/1333141/000110465926019005/fms-20251231x20f.htm (filed 2026-02-24); FY2025: revenue 19627602000; grossProfit 5028929000; margin = grossProfit / revenue.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-10-16); FMS.US: Fresenius Medical Care AG provides dialysis and related services for individuals with renal diseases in Germany, the United States, and internationally. The company offers dialysis treatment and related laboratory and diagnostic services through a network of outpatient dialysis clinics; materials, training, and patient support services comprising clinical monitoring, follow-up assistance, and arranging for delivery of the supplies to the patient's residence; and dialysis services under contract to hospitals in the United States for the hospitalized end-stage renal disease (ESRD) patients and for patients suffering from acute kidney failure. The company operates through Care Delivery and Care Enablement segments. It also develops, manufactures, and distributes various health care products, including hemodialysis machines, peritoneal dialysis cyclers, peritoneal dialysis solutions, hemodialysis concentrates, solutions and granulates, bloodlines, renal pharmaceuticals, systems for water treatment, and acute cardiopulmonary and apheresis products. In addition, the company develops, acquires, and in-licenses renal pharmaceuticals; offers renal medications and supplies to patients at homes or to dialysis clinics; and provides vascular specialty, ambulatory surgery center, physician nephrology practice management, pharmacy and other services. The company sells its products to dialysis clinics, hospitals, and specialized treatment clinics, as well as through local sales forces, independent distributors, dealers, and sales agents. The company was incorporated in 1996 and is headquartered in Bad Homburg, Germany.

### Why customers stay

Margins ranged from 24.6% to 25.6% during 2023–25; it earns 15.4% on its capital.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2023: grossProfit / revenue = 25.3%.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2024: grossProfit / revenue = 24.6%.

- Source: https://www.sec.gov/Archives/edgar/data/1333141/000110465926019005/fms-20251231x20f.htm (filed 2026-02-24); FY2025: grossProfit / revenue = 25.6%.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); 10-year return on capital observations [[2016,0.4202853052523047],[2017,0.4303651378643517],[2018,0.5081501918525183],[2019,0.1674122448677295],[2020,0.16259138124209732],[2021,0.14341409459375218],[2022,0.11145105313557523],[2023,0.10232151260527851],[2024,0.11344447583254076],[2025,0.1452502690119675]]; median 0.15392082512703242. ROIC follows the displayed moat series; financial companies use return on tangible equity.

### Can it raise prices

Kept about a 25% gross margin through 2022 cost inflation.

- Source: https://www.sec.gov/Archives/edgar/data/1333141/000110465926019005/fms-20251231x20f.htm (filed 2026-02-24); Gross margin observations: [[2021,0.2709072215094373],[2022,0.2522777972614417],[2023,0.25316654481272044]]; range within 2 percentage points.

### Where the cash goes

Paid dividends in 10 of 10 years; bought back EUR 562.2 million of shares.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2016: growth capex 361020336.51529646; upkeep 1580594943.4847035; owner earnings 302835176.51529646. Growth capex / owner earnings = 1.1921347469258117.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2017: growth capex 155550447.37157226; upkeep 1629449552.6284277; owner earnings 386029447.37157226. Growth capex / owner earnings = 0.40294969316640583.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2018: growth capex 0; upkeep 2060000000; owner earnings 658449179. Growth capex / owner earnings = 0.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2019: growth capex 247310273.57426763; upkeep 1990689726.4257324; owner earnings 802089273.5742676. Growth capex / owner earnings = 0.30833260301837023.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2020: growth capex 103801829.53329349; upkeep 1984198170.4667065; owner earnings 966077829.5332935. Growth capex / owner earnings = 0.1074466532198959.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2021: growth capex 0; upkeep 1683000000; owner earnings 909984000. Growth capex / owner earnings = 0.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2022: growth capex 0; upkeep 1411000000; owner earnings 1100768000. Growth capex / owner earnings = 0.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2023: growth capex 0; upkeep 684596000; owner earnings 1566372000. Growth capex / owner earnings = 0.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); FY2024: growth capex 0; upkeep 699358000; owner earnings 1580812000. Growth capex / owner earnings = 0.

- Source: https://www.sec.gov/Archives/edgar/data/1333141/000110465926019005/fms-20251231x20f.htm (filed 2026-02-24); FY2025: growth capex 0; upkeep 879241847; owner earnings 1599534153. Growth capex / owner earnings = 0.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); Dividend observations: [[2016,263550027.84],[2017,293973000],[2018,324838000],[2019,354636000],[2020,351170000],[2021,392455000],[2022,395556000],[2023,328623000],[2024,349162000],[2025,405839470]]. Zero only counted when supported by a complete cash-flow statement.

- Source: https://www.sec.gov/Archives/edgar/data/1333141/000110465926019005/fms-20251231x20f.htm (filed 2026-02-24); FY2025: cash repurchases 562185376 EUR.

### Are managers owners

Insiders own 0% of the company.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-10-16); FMS.US SharesStats.PercentInsiders = 0 percentage points; cache date 2026-10-16.

### What the price says

The price assumes cash profits shrink 8.2% yearly over ten years; actual growth was 17.2%.

- Source: https://eodhd.com/financial-apis/stock-etfs-fundamental-data-feeds/ (filed 2026-02-24); Ten-year compound average after fade. Initial solved rate -0.12796973658073557. Price 22.13; FX 1.12128; discount 0.1; same standard ten-year fade to terminal 0.03. FY2015 owner earnings/share 0.5708406291329052 → FY2025 2.797304839032928. Closing-price date 2026-10-15.

## Monthly share-price history (USD per share)

- 2016-10: $40.58 per share

- 2016-11: $38.96 per share

- 2016-12: $42.21 per share

- 2017-01: $40.80 per share

- 2017-02: $41.64 per share

- 2017-03: $42.13 per share

- 2017-04: $44.44 per share

- 2017-05: $47.72 per share

- 2017-06: $48.33 per share

- 2017-07: $47.08 per share

- 2017-08: $47.01 per share

- 2017-09: $48.89 per share

- 2017-10: $48.38 per share

- 2017-11: $49.88 per share

- 2017-12: $52.55 per share

- 2018-01: $57.51 per share

- 2018-02: $52.82 per share

- 2018-03: $51.08 per share

- 2018-04: $50.57 per share

- 2018-05: $49.92 per share

- 2018-06: $50.35 per share

- 2018-07: $48.62 per share

- 2018-08: $50.52 per share

- 2018-09: $51.42 per share

- 2018-10: $39.08 per share

- 2018-11: $40.76 per share

- 2018-12: $32.39 per share

- 2019-01: $36.74 per share

- 2019-02: $39.08 per share

- 2019-03: $40.53 per share

- 2019-04: $42.18 per share

- 2019-05: $36.41 per share

- 2019-06: $39.28 per share

- 2019-07: $34.77 per share

- 2019-08: $33.60 per share

- 2019-09: $33.59 per share

- 2019-10: $36.07 per share

- 2019-11: $36.63 per share

- 2019-12: $36.83 per share

- 2020-01: $38.37 per share

- 2020-02: $38.34 per share

- 2020-03: $32.80 per share

- 2020-04: $39.06 per share

- 2020-05: $42.20 per share

- 2020-06: $43.28 per share

- 2020-07: $43.85 per share

- 2020-08: $42.38 per share

- 2020-09: $42.48 per share

- 2020-10: $38.23 per share

- 2020-11: $42.25 per share

- 2020-12: $41.56 per share

- 2021-01: $40.27 per share

- 2021-02: $34.50 per share

- 2021-03: $36.88 per share

- 2021-04: $39.89 per share

- 2021-05: $40.08 per share

- 2021-06: $41.57 per share

- 2021-07: $39.32 per share

- 2021-08: $38.58 per share

- 2021-09: $34.97 per share

- 2021-10: $33.23 per share

- 2021-11: $29.82 per share

- 2021-12: $32.46 per share

- 2022-01: $33.83 per share

- 2022-02: $32.31 per share

- 2022-03: $33.68 per share

- 2022-04: $30.93 per share

- 2022-05: $30.51 per share

- 2022-06: $24.94 per share

- 2022-07: $18.52 per share

- 2022-08: $17.10 per share

- 2022-09: $14.04 per share

- 2022-10: $13.87 per share

- 2022-11: $15.62 per share

- 2022-12: $16.34 per share

- 2023-01: $18.73 per share

- 2023-02: $19.66 per share

- 2023-03: $21.26 per share

- 2023-04: $24.22 per share

- 2023-05: $21.43 per share

- 2023-06: $23.93 per share

- 2023-07: $26.11 per share

- 2023-08: $23.96 per share

- 2023-09: $21.54 per share

- 2023-10: $16.63 per share

- 2023-11: $20.51 per share

- 2023-12: $20.83 per share

- 2024-01: $19.30 per share

- 2024-02: $19.21 per share

- 2024-03: $19.28 per share

- 2024-04: $21.04 per share

- 2024-05: $21.27 per share

- 2024-06: $19.09 per share

- 2024-07: $19.29 per share

- 2024-08: $19.39 per share

- 2024-09: $21.30 per share

- 2024-10: $19.54 per share

- 2024-11: $22.02 per share

- 2024-12: $22.64 per share

- 2025-01: $24.87 per share

- 2025-02: $24.21 per share

- 2025-03: $24.90 per share

- 2025-04: $25.38 per share

- 2025-05: $28.40 per share

- 2025-06: $28.57 per share

- 2025-07: $25.34 per share

- 2025-08: $25.70 per share

- 2025-09: $26.33 per share

- 2025-10: $26.84 per share

- 2025-11: $23.92 per share

- 2025-12: $23.82 per share

- 2026-01: $22.70 per share

- 2026-02: $23.46 per share

- 2026-03: $22.56 per share

- 2026-04: $22.57 per share

- 2026-05: $21.57 per share

- 2026-06: $22.61 per share

- 2026-07: $25.66 per share

- 2026-08: $22.74 per share

- 2026-09: $22.38 per share

- 2026-10: $22.13 per share

## Annual estimated value (USD per share)

- FY2016: low $12.21 per share, central $13.73 per share, high $15.76 per share

- FY2017: low $9.25 per share, central $10.36 per share, high $11.84 per share

- FY2018: low $11.22 per share, central $12.48 per share, high $13.93 per share

- FY2019: low $6.52 per share, central $7.28 per share, high $8.29 per share

- FY2020: low $17.86 per share, central $21.77 per share, high $25.12 per share

- FY2021: low $13.12 per share, central $15.11 per share, high $17.31 per share

- FY2022: low $15.19 per share, central $17.10 per share, high $19.64 per share

- FY2023: low $16.15 per share, central $18.17 per share, high $20.86 per share

- FY2024: low $24.74 per share, central $27.90 per share, high $32.11 per share

- FY2025: low $36.24 per share, central $40.91 per share, high $47.13 per share

Historical values use today's bond yield for every fiscal year

Historical values use today's FX rate into trading currency for every fiscal year

Historical values use current restated fundamentals and current commodity classification; they are not point-in-time estimates

Prior published observations retained from 2026-10-15T06:34:17.249Z where newer inputs omit a numeric field or fiscal period.

## Sources

[Original 20-F filing](https://www.sec.gov/Archives/edgar/data/1333141/000110465926019005/fms-20251231x20f.htm); period 2025-12-31, filed 2026-02-24.

Estimates depend on assumptions and are not guarantees or investment advice. Underlying data remains subject to its source licenses; public reading does not grant bulk redistribution rights.