Fresenius Helios (EXTRA: FRE.DE) was already the largest private hospital company in Europe, and now it’s grown even larger. On September 5, 2016, the company announced the acquisition of Quirónsalud, Spain’s largest private hospital operator, with 43 hospitals, 39 outpatient centers, and 300 occupational risk prevention centers.  Quirónsalud was created by the 2014 merger of IDC Salud and Grupo Hospitalario Quirón.

Fresenius Helios, a division of Fresenius SE & Co. KGaA, vaulted to the top of the private European hospital market in September 2013, following the  its acquisition of 43 hospitals and 15 outpatient facilities in Germany, sold by Rhön Klinikum AG, for approximately $4.2 billion. That deal was the result of an earlier, terminated transaction between the parties that was announced in April 2012, which included 53 hospitals and 39 healthcare centers, for $3.9 billion.

Fresenius is paying approximately $6.5 billion (€5.76 billion) for Quirónsalud. Fresenius will issue 6,108,176 shares valued at €400 million to CVC Capital Partners, Víctor Madera and other members of Quirónsalud’s managment board. The balance of the purchase price will be debt-financed.

The acquisition adds 43 hospitals across Spain and sales of approximately €2.5 billion to Helios’ German network. For 2016, Quirónsalud expects sales of approximately €2.5 billion and EBITDA of €460 to €480 million. In 2017, EBITDA is expected to be in the range of €520 to €550 million. The purchase price corresponds to approximately 10.8x at the mid-point of the 2017 EBITDA range. The transaction is highly accretive to Group earnings per share from 2017 and is expected to close in Q4 2016 or Q1 2017.