Investing

We used net cash of $1,125 M and $698 M in investing activities in 2010 and 2009, respectively.

Capital expenditures for property, plant and equipment, net of disposals were $507 M in 2010 and $562 M in 2009. In 2010, capital expenditures were $286 M in the North America segment and $221 M for the International segment. Capital expenditures in 2009 were $295 M in the North America segment and $267 M for the International segment. The majority of our capital expenditures was used for maintaining existing clinics, equipping new clinics, maintenance and expansion of production facilities primarily in North America and Germany and capitalization of machines provided to our customers, primarily in the International segment. Capital expenditures were approximately 4% and 5% of total revenue for 2010 and 2009, respectively.

We invested approximately $632 M cash in 2010, primarily for acquisitions of dialysisDialysisForm of renal replacement therapy where a semipermeable membrane – in peritoneal dialysis the peritoneum of the patient, in hemodialysis the membrane of the dialyzer – is used to clean a patient’s blood. clinics, the formation of a new renal pharmaceutical company with Galenica Ltd. (subject to final anti-trust approval in certain regions), the acquisition of licenses, and the acquisition of Gambro’s peritoneal dialysisPeritoneal Dialysis (PD)Dialysis treatment method using the patient’s peritoneum, i.e. the tissue that covers the inner surface of the abdominal cavity and the abdominal organs, as the dialyzing membrane for blood purification. A sterile dialysis solution is introduced and removed through a catheter that has been surgically implanted into the patient’s abdominal cavity. The solution absorbs toxins and excess water. Most treatments are supported by a machine, the cycler, and are administered by the patients in their home or workplace several times a day or during the night.
business outside the United States ($237 M in the North America segment, $373 M in the International segment and $22 M at Corporate), as compared to $188 M cash in 2009 ($124 M in the North America segment and $64 M in the International segment ). In addition, we invested €100 M ($133 M at September 30, 2010) in short-term investments with banks during 2010, which were divested during the fourth quarter of 2010. We also received $14 M and $2 M in conjunction with divestitures in 2010 and 2009, respectively. In 2008, we granted a loan of $50 M to Fresenius SE & Co. KGaA (until January 27, 2011 Fresenius SE), Bad Homburg v.d.H., Germany (Fresenius SE), our parent, which they repaid on April 30, 2009.

We anticipate capital expenditures of approximately 5% of revenues and expect to make acquisitions of approximately $1,200 M in 2011, including the €485 M acquisition of International Dialysis Centers, the dialysis service business of Euromedic International, which we announced on January 4, 2011.