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Business Environment

Business Environment


Overall economic environment

Declining growth rates of many leading economies and an economic slowdown in emerging countries resulted in lower year-on-year growth of the global gross domestic product (GDP); it amounted to just 3.2% in 2012, compared with 3.8% in 2011.

Regional development affected by European debt crisis

The U.S. economy posted slightly higher economic growth in 2012 compared to the previous year, boosted by the stabilization of the real estate market and an increase in investing activities. GDP rose by 2.2% in 2012, compared with 1.8% in 2011.

In 2012, the euro zone as a whole was affected by the sovereign debt crisis in the southern peripheral nations. The uncertain economic situation and persistently high unemployment ensured that consumer spending and investment remained at a low level, which increasingly impaired growth in other industrialized nations.

Asia again showed the strongest growth in 2012. However, in some key markets economic development tailed off compared to the previous year.

The economic situation in Latin America presented itself differently in 2012: Some countries expanded strongly, while in others the economy performed worse than in the previous year. In the region as a whole, economic growth slowed down, largely due to a drop in export demand. A GDP of 2.9% was generated in 2012 (2011: 6.3%).

T. 2.2.1

Real gross domestic product and consumer prices

Change compared to the previous year in %
  Gross domestic product Consumer prices
  2012 2011 2012 2011
Source: Institute for the Global Economy at the University of Kiel, “Weltkonjunktur im Winter 2012”, December 18, 2012; monthly reports of the Deutsche Bundesbank and the European Central Bank
U.S. 2.2 1.8 2.1 3.2
Germany 0.7 3.0 2.0 2.3
Euro zone -0.5 1.4 2.5 2.7
European Union -0.3 1.5 2.5 3.1
New EU member states 0.9 2.2 3.8 2.9
Russia 4.5 4.3 5.5 8.4
Japan 2.0 0.5 -0.2 -0.3
China 7.8 9.2 2.6 5.4
India 3.8 7.9 9.1 8.9
Asia 6.6 8.2 4.3 6.1
Latin America 2.9 6.3 6.2 6.3


3.2 3.8 4.6 5.7

Energy and commodity prices remain high in 2012

Costs for energy and commodities, especially oil, remained at a similarly high level on average in 2012 as in the previous year, with considerable fluctuations over the course of the year. For Fresenius Medical Care, an increase in transport and energy costs of 1% generally means a reduction in the Company’s result after tax of approximately 0.3%. Fresenius Medical Care counters these price fluctuations by concluding long-term supply contracts. In this way, we can limit the possible negative effects of short-term price rises on the Company’s results.

Minimum dependency on economic cycles

Compared with other industries, the dialysis market is barely affected by macroeconomic impacts: Demand for medical care as a whole, including life-preserving products and services for kidney patients, is rising because of the aging population. Consequently, the dialysis market is a growth market. Fresenius Medical Care is therefore only dependent on economic cycles to a limited extent.

Exchange rate developments characterized by weak euro

For Fresenius Medical Care, movements in the U.S. dollar and the euro in relation to one another are especially crucial as we generate a major part of our sales in the U.S. and the euro zone. In reporting terms, an appreciation of the euro is advantageous for us, as our base currency is the U.S. dollar, so that the balance sheet values achieved in euros are higher (translation effect). Consequently, the decline of the euro against the U.S. dollar impacted our business in 2012.

Exchange rate development U.S. dollar/euro
T. 2.2.3

Sensitivity analysis

10% appreciation in currency against the $
  Impact on sales of Fresenius Medical Care
Source: Company data and estimates
Euro ~1.3%
Other European currencies ~0.7%
Renminbi and Hong Kong dollar ~0.2%
Japanese Yen ~0.1%
Other Asian currencies ~0.4%
South American currencies ~0.5%

Our global network of production sites enables us to meet the demand in our dialysis products business. Our production sites are to a large extent based in the markets they serve, so that costs occur in the same currency in which we generate our sales. As a result, we are less affected by long-term currency fluctuations, enabling us to minimize our transaction risks, i. e. risks due to foreign currency items or exchange rate fluctuations. In our service business, the risk is even less because we provide our services locally and therefore in the respective currency. As the service business constitutes Fresenius Medical Care’s major area of operations, the currency risk can be classified as small overall.

Fresenius Medical Care’s business is mainly subject to short-term effects due to volatility in exchange rates, especially fluctuations in the euro against the U.S. dollar, but also in the currencies of our other international locations against the euro.

Further information on the economic environment can be found in the “Comparison of the actual business results with forecasts” section and in the “Outlook” chapter.

Dialysis market

The dialysis market is growing worldwide. With our decades of experience, we can provide patients with high-quality dialysis products and services from a single source. We are therefore ideally placed to expand our business further and consolidate our position as market leader.

Collection and analysis of market data

Reliable information on the development of the dialysis market and its general conditions is an important prerequisite for the success of our business. To obtain and manage representative market information, Fresenius Medical Care has developed its own tool, the Market & Competitor Survey (MCS). We use it to collect and analyze relevant dialysis market and competitor data and then leverage it within the Company. We use this information as a basis for strategic decisions made by management, research and development, and marketing on the one hand, and for our external reporting, such as the annual report, on the other. Unless otherwise stated, the data in this chapter is based on the survey. By regularly adapting the survey, we account for new trends such as changes in the use of certain treatments as well as in the structure of our competitive environment caused for example by the entry of new providers.

Sector-specific conditions

Patient numbers rising worldwide

Chronic kidney failure is a global problem: At the end of 2012, approximately 2.957 M patients were being treated.

T. 2.2.4

Dialysis patients: Regional development

  2012 Change
Source: Company data and estimates
North America 543,000 ~+5%
U.S. 436,000 ~+4%
Europe/Middle East/Africa 617,000 ~+4%
EU 332,000 ~+2%
Asia-Pacific 906,000 ~+9%
Japan 309,000 ~+2%
Latin America 240,000 ~+6%


2,306,000 ~+7%
T. 2.2.5

Patients with end-stage renal disease (ESRD)

in M  
Source: Company data and estimates
Patients with end-stage renal disease (ESRD) 2,957 100%
of which dialysis 2,306 78%
Hemodialysis (HD) 2,056 70%
Peritoneal dialysis (PD) 0,250 8%
of which patients with transplants 0,651 22%

At regional level, the frequency of chronic kidney failure varies. Prevalence, i. e. the relative number of people being treated for end-stage renal disease in a particular country, also differs significantly from one country to another. The prevalence rate, measured in patients per million population (pmp), can be well below 100 in developing countries. On average, the figure in countries in the European Union is just over 1,000 pmp. Countries such as Taiwan, Japan and the U.S. have very high figures. In some cases, they are well over 2,000 pmp. There are various reasons for the significant divergence in prevalence rates:

  • The countries differ demographically, as age structures in the population vary worldwide.
  • The incidence of risk factors for kidney disease such as diabetes and high blood pressure diverges.
  • The genetic predisposition for kidney disease differs around the world.
  • Access to dialysis is still limited in many countries, meaning that many kidney failure sufferers are not treated and thus do not appear in prevalence statistics.
  • Cultural factors such as nutrition play a role.

The number of dialysis patients in 2012 rose by around 7%. In the U.S., Japan, and Western and Central Europe, we again recorded below-average growth in the number of patients in 2012. In these regions, prevalence is already relatively high and patients generally have reliable access to treatment, normally dialysis. In economically weaker regions, growth was above average – an indication that access to dialysis treatment in these countries is still limited but is gradually improving. In addition to easier access to dialysis resulting in better recording of patient numbers, however, other factors also contribute to a rise in global prevalence, for example the spreading incidence of illnesses that cause renal damage such as diabetes and high blood pressure, as well as the general aging of the global population due to medical advances.

Comparison of treatment methods

Of the 2.306 M patients who were undergoing dialysis treatment at the end of 2012, 2.056 M – about 89% – were being treated with hemodialysis and around 250,000 with peritoneal dialysis; see glossary. In a global comparison of treatment methods, hemodialysis is clearly the most commonly used.

The third option for treating patients with end-stage renal disease is kidney transplantation. Approximately 651,000 patients were living with a transplanted kidney at the end of 2012. However, for many years now, the number of donated organs worldwide has been significantly lower than the number of patients on transplant waiting lists. Despite extensive efforts by regional initiatives to increase awareness of kidney donation and the willingness to donate, the share of patients receiving kidney transplantation compared to other treatment methods has remained relatively unchanged over the past ten years.

Dialysis patients can be treated either in a dialysis center or in their own home. Treatment options available for home therapy are home hemodialysis (relatively uncommon so far) and peritoneal dialysis. The ratio of patients treated in dialysis centers to patients on home dialysis varies from region to region.

T. 2.2.6

Regional breakdown of center dialysis and home dialysis

  Center dialysis Home dialysis
Source: Company data and estimates
Europe/Middle East/Africa 93% 7%
Latin America 88% 12%
Asia-Pacific 90% 10%
North America 82% 18%


89% 11%

Our customers are mostly health insurers and companies

Fresenius Medical Care’s most important customers are state-owned or public health insurers, private health insurers, and companies. The Company’s largest private customer, which is also the world’s second-largest provider in the dialysis services sector after Fresenius Medical Care, is the U.S. company DaVita. We generated around 1% of our revenue with DaVita in the last fiscal year.

Healthcare and reimbursement systems vary from country to country

As renal replacement therapy is a life-saving medical service, patients do not usually have to pay for dialysis themselves. Instead, the costs are borne by the responsible healthcare system. The reimbursement systems for dialysis treatment – in other words, the schemes used by healthcare systems to govern the reimbursement costs for dialysis services – differ from country to country and often vary even within countries. The factors determining reimbursement include regional conditions, the kind of treatment provided, regulatory issues, and the type of dialysis service provider (public or private).

The healthcare debate in some countries is currently focused on establishing reimbursement structures based on treatment quality (pay for performance). In this case more responsibility is transferred to the medical service provider, subject to transparency and quality criteria. Such reimbursement models are aimed at achieving high treatment quality combined with lower overall costs for the healthcare system.

One example of a reimbursement model based on qualitative criteria is the bundled reimbursement system for dialysis introduced in the U.S., our biggest sales market, in 2011. It relates to dialysis treatment for patients in the U.S. who are predominantly covered by national health insurance (Medicare or Medicaid patients). All products and services that used to be reimbursed according to the composite rate as well as services that were reimbursed separately in the old system, such as the administration of certain intravenous drugs and diagnostic laboratory tests, are now reimbursed in a lump sum. This bundled reimbursement rate is adapted to patients’ characteristics such as age and weight; it also provides adjustments for patients who require exceptional medical care, which is more costly. The U.S. reimbursement system also takes into account quality parameters such as the regulation of the hemoglobin content of the blood (anemia management) and the effectiveness of dialysis treatment. Additional quality parameters will be introduced in the next few years, such as good results in patient satisfaction surveys and the monitoring of mineral metabolism in the bones.

The automatic budget cuts to reduce government debt in the U.S. also have an impact on government reimbursement levels in the healthcare system. This also affects the dialysis sector. Based on a bill, a reduction of the reimbursement rates for dialysis services by 2% in March 2013 is taken into consideration. However, reimbursement levels are subject to an annual inflation adjustment; this will amount to a 2.3% increase in 2013. Thanks to our vertical business model, we are well positioned to work with reimbursement systems that use qualitative criteria, such as the system in the U.S., and are also well-equipped for any future adjustments.

Fresenius Medical Care in a global comparison

We estimate the volume of the global dialysis market at around $75 BN for 2012, corresponding to an increase of around 2% compared to the previous year (4% in constant currency terms). We assume that market volume can be broken down as follows: dialysis products with around $13 BN and dialysis services (including dialysis drugs) with approximately $62 BN.

Dialysis product market with three major providers

The main dialysis products include dialyzers, hemodialysis machines, concentrates and dialysis solutions, along with products for peritoneal dialysis, see also glossary. In terms of revenue, the three largest manufacturers of dialysis products together accounted for approximately 64% of the worldwide market in 2012. With a market share of approximately 33%, Fresenius Medical Care was the market leader in this segment, followed by Baxter and Gambro. The remaining, mainly Japanese, dialysis product providers all held market shares in the single-digit percentage range.

T. 2.2.7

Market position in major product groups in 2012

  1st 2nd 3rd
Source: Company data and estimates
Dialyzers Fresenius Medical Care Gambro Nipro
Dialysis machines Fresenius Medical Care Nikkiso Gambro
Concentrates for hemodialysis Fresenius Medical Care Fuso Gambro
Bloodline systems Fresenius Medical Care Gambro Kawasumi
Products for peritoneal dialysis Baxter Fresenius Medical Care Terumo
Dialysis products 2012

Dialyzers for hemodialysis are the largest product group in the dialysis market with a worldwide sales volume of around 222 M units in 2012. Around 100 M, or almost half, were made by Fresenius Medical Care, meaning that we comfortably held the largest market share in this segment. We set a new unit sales record in the U.S., our largest single market, with more than 38 M dialyzers sold in 2012.

Hemodialysis machines constitute another key segment of our product business. Here, too, we are the clear market leader: More than 77,000 dialysis machines were sold worldwide in 2012, and some 55% of them were produced by Fresenius Medical Care. Our biggest sales market for dialysis machines is the U.S. In the reporting year, more than 94% of the dialysis machines sold there were made by Fresenius Medical Care. Our 2008 series machine is the leading dialysis system in the U.S. with more than 114,000 units in use. China was our second-largest market after the U.S. for sales of new hemodialysis machines in the reporting year: We delivered more than 7,000 machines there in 2012. Almost half (47%) of all hemodialysis machines currently in use in China were produced by Fresenius Medical Care.

In the area of peritoneal dialysis, we account for 20% of the global market in terms of revenue; see also chart 2.2.10. In the U.S., we hold a market share of 42%. Further information on our position in the home dialysis market, which comprises home hemodialysis and peritoneal dialysis, can be found in the “Home dialysis is still a niche market” section.

Hemodialysis products 2012 Peritoneal dialysis products 2012

Dialysis services – patients mostly looked after in dialysis centers

Renal patients generally receive dialysis treatment in clinics or dialysis centers, which they visit for several hours three times a week. They are treated either during the day or overnight while they sleep. Further treatment options include home dialysis, which patients mostly carry out themselves at home under expert guidance and with the necessary accessories, or dialysis on vacation, for example on a cruise ship or at a resort; Fresenius Medical Care also offers services for these cases. The vast majority of dialysis services, however, involve conventional treatment in clinics or centers.

In 2012, most dialysis patients were cared for in one of around 33,400 dialysis centers worldwide, resulting in an average of some 70 patients per center. The organization of the centers also differs significantly depending on whether the healthcare systems in the individual countries are mainly state-run or privately operated: There are approximately 5,900 dialysis clinics in the U.S. and about 5,400 in the European Union (EU). Whereas only approximately 1% of patients in the U.S. are treated by publicly operated clinics; in the EU, the figure is around 57%. In Japan, on the other hand, private nephrologists (doctors specializing in renal care) play a key role; around 80% of dialysis patients are treated in their dialysis facilities.

Fresenius Medical Care can operate its own therapy centers in countries where the healthcare system allows private-sector companies to provide medical services and an appropriate reimbursement system is in place. For some years now, healthcare systems in a large number of countries have been under pressure to improve the quality of treatment while at the same time keeping healthcare costs as low as possible. Some countries have therefore started to contemplate whether and how specialized private companies can help them in this. Other countries are only just setting up their healthcare systems and are looking to interact with healthcare companies with a good reputation for high quality in their business activities with the aim of developing modern treatment standards. In both cases, Fresenius Medical Care, as an experienced vertically integrated provider, is the right partner: With our high-quality and innovative products and services, we have the ideal prerequisites to continue expanding our position on the dialysis market.

In this respect, the Chinese market is also increasingly important to us: The country’s government is making efforts to develop a modern healthcare system with corresponding reimbursement structures – an important prerequisite for opening the market for dialysis services to international providers. In 2012, we opened our first dialysis clinic in this region in the Eastern Chinese province of Jiangsu, where we care for around 40 patients. This makes Fresenius Medical Care one of the first foreign companies to open a dialysis clinic in this highly restrictive market. However, we will continue to drive our future growth in the Chinese dialysis services market primarily through cooperation with local clinics and management contracts. So far, this applies to 72 clinics (previous year: 52 clinics), which we provide with dialysis machines and disposable products.

Dialysis clinic operators in 2012

In the U.S., Fresenius Medical Care and the second-largest provider, DaVita, together serve over 70% of all dialysis patients; this means that the concentration at dialysis clinics is already relatively high. In the reporting year, Fresenius Medical Care extended its position as market leader and treated more than 160,000 patients, approximately 37% of all dialysis patients in the U.S. (2011: 138,400 patients, approx. 33%). The number of patients we treated also increased significantly in 2012 as a result of the acquisition of dialysis clinic operator Liberty Dialysis Holdings, Inc. Further information on this can be found in the “Company strategy” section and in the “Subsequent events” chapter.

Outside the U.S., the dialysis services segment is still considerably more fragmented: With 1,078 dialysis clinics and more than 93,000 patients in 40 countries, Fresenius Medical Care operates the largest and most international network of clinics by far.

Overall, Fresenius Medical Care further consolidated its clear position as market leader in the dialysis services business in the reporting period: Last year, it treated 257,916 dialysis patients (2011: 233,156) in 3,160 clinics (2011: 2,898).

Dialysis services worldwide in 2012

Dialysis drugs supplement our range

Usually, patients undergoing dialysis require medication to counteract anemia and to control their mineral metabolism – both of which are consequences of chronic kidney failure. In 2012, the market volume of dialysis drugs amounted to about $8.6 BN, based on data from the market research institution IMS MIDAS® and our own internal estimates. The majority of this is allotted to a few drug classes. Approximately $5.5 BN, representing almost two thirds of the total market for dialysis drugs, is generated with erythropoesis-stimulating agents for treating anemia. We source them from the American company Amgen and its partners, for example.

Phosphate binders used to control bone metabolism, on the other hand, are produced in-house, both for use in our own dialysis centers as well as for distribution to third parties. The market volume of phosphate binders was about $1.4 BN in the previous year. We produce iron compounds for the treatment of anemia as part of a joint venture with Galenica – Vifor Fresenius Medical Care Renal Pharma Ltd. We also use them in our own clinics and distribute them to third parties. The market volume of intravenous iron compounds such as these amounted to around $800 M in 2012, of which around half is for the treatment of kidney disease.

Top 5 dialysis providers worldwide in 2012 Fresenius Medical Care: Patients treated in 2012

Events significant for business development

Management Board Changes

Rice Powell succeeded Dr. Ben J. Lipps as Chief Executive Officer (CEO) of Fresenius Medical Care and Chairman of the Management Board, effective January 1, 2013. Previously, he served as Vice Chairman and Member of the Management Board responsible for the region North America. Furthermore, Ron Kuerbitz succeeded Rice Powell as Member of the Management Board responsible for the region North America, also effective January 1, 2013. Ron Kuerbitz joined Fresenius Medical Care North America in 1997, having held various positions within the company and most recently serving as General Counsel and Chief Administration Officer responsible for Market Development and Administration for Fresenius Medical Care North America. Fresenius Medical Care extended its Management Board effective March 1, 2013 and appointed Dr. Olaf Schermeier as Chief Officer of Global Research and Development (R & D) and Member of the Management Board. Before joining Fresenius Medical Care, he has served in a senior position in the field of research and development at the German based company Dräger Medical.

Acquisitions and divestitures

Our investment strategy remained unchanged in 2012. We stepped up investments in our future growth by continually expanding our network of clinics and product business and by increasing our production capacities. In the year under review, our budget for acquisitions was on a similar level compared to 2011. In total, we spent $ 1.615 BN on acquisitions net of divestitures thereof $1.5 BN for the acquisition of Liberty Dialysis Holdings, Inc. In spring 2012 we closed the acquisition following the approval by the United States’ Federal Trade Commission FTC. Further information about our investitures and acquisitions can be found in the section “Financial situation” and in the “Financial report”.


In January 2012, Fresenius Medical Care successfully completed the largest placement of senior notes in the history of the Company. Proceeds from the offering of three senior unsecured notes in euro and U.S. dollar amounting to approximately $1.81 BN was used for acquisitions including the acquisition of Liberty Dialysis Holdings, Inc., to refinance indebtedness and for general corporate purposes.

Further information on senior unsecured notes can be found in the “Financial situation” and in the “Financial report”.

Business environment

The Company’s business environment remained largely unchanged in 2012, as did the relevant legal frameworks for our business. At the beginning of 2011, a new reimbursement system for the treatment of dialysis patients with national health insurance (Medicare) was introduced in the United States, our largest sales market. Specific products and services are now reimbursed with one flat fee instead of being paid individually as was previously the case. In addition to an annual inflationary adjustment starting in 2012 a particular feature of this new reimbursement system is the focus on certain quality parameters such as regulation of the hemoglobin content of the blood (anemia management) and the mineral metabolism in the bones. For further information see the “Healthcare and reimbursement systems” section.


No other significant events took place in 2012 that had a material impact on the operating business or legal structure of Fresenius Medical Care. Fresenius Medical Care continued its outstanding development in the previous fiscal year, achieving record revenue and earnings figures in the year under review. All regions and segments contributed to this success.

Comparison of the actual business results with forecasts

Fresenius Medical Care looks back on another successful business year: We once again achieved new records both in terms of revenue and earnings and were able to sustain our growth path. We largely met our ambitious targets for 2012.

Fresenius Medical Care set new records last year. Revenue rose by 10% to $13.80 BN, our operating result (EBIT) by 7% to $2.22 BN, and net income by 11% to $1.19 BN. We achieved these results despite the difficult general conditions compared to previous years, in particular the negative impact of the devaluation of the euro and other currencies against the U.S. dollar.

At the beginning of the reporting year, we expected revenue of around $14 BN and net income of around $1.14 BN. As the year progressed, we adapted our targets for 2012 to current developments and modified them slightly. The actual figures were in line with our targets.

Consolidated revenue increased by 10% to $13.80 BN in the 2012 fiscal year. The unfavorable development of several currencies against the U.S. dollar prevented us from reaching a higher figure; in constant currency terms, revenue was up by 12% in 2012. All regions – North America, Europe / Middle East / Africa, Asia-Pacific and Latin America – contributed to revenue growth. Further details on the development of revenue can be found in the “Results of operations” section.

Net income attributable to shareholders of Fresenius Medical Care AG & Co. KGaA increased by 11% to $1.19 BN in the fiscal year 2012. This includes a non-taxable investment gain related to the acquisition of Liberty Dialysis Holdings, Inc. It also includes charges related to the amendment of the agreement for the iron product Venofer and a donation to the American Society of Nephrology. Excluding the investment gain and the before mentioned charges net income attributable to shareholders of Fresenius Medical Care AG & Co. KGaA was $1.12 BN, an increase of 4% compared to 2011. Further information can be found in the “Results of operations” section.

The expected steady growth of the dividend is reflected in our dividend proposal: Subject to approval by the Annual General Meeting, the dividend per ordinary share will increase by 9% to €0.75 (2011: €0.69). More information on this can be found in the “Dividend continuity” section.

We earmarked around $700 M for capital expenditures and around $1.80 BN for acquisitions in 2012. We remained almost completely within our target and used $666 M for capital expenditures (net) – corresponding to 4.8% of revenue – and $1.615 BN for acquisitions less divestitures. For further information, see the “Financial situation” section.

The operating cash flow, driven by earnings development and ongoing excellent management of accounts receivables, increased by 41% to $2.04 BN in 2012. At 14.8% of revenue, the operating cash flow was therefore well above the target of 10% of revenue.

According to our forecast, the leverage ratio (defined as the ratio of total financial debt to earnings before interest, taxes, depreciation and amortization = debt / EBITDA) should have been below 3.0 by the end of 2012. The actual leverage ratio was 2.83 as at the reporting date, and therefore also developed as predicted.

The number of employees at Fresenius Medical Care (full-time equivalents) grew from 79,159 at the end of 2011 to 86,153 at the end of 2012, reaching our forecast figure of more than 86,000. The Company’s continued strong organic growth and acquisitions, especially in North America, were key contributing factors.

Research and development expenditures aimed at boosting and enhancing Fresenius Medical Care’s ability to adapt to future requirements amounted to $112 M, not quite meeting our target of around $130 M. This discrepancy was mainly due to exchange rate movements and delays in projects. Our research and development activities are focused on further developing existing product groups. Details can be found in the “Research and development” chapter.

The dialysis market developed as we had predicted: the number of patients worldwide grew by around 7%. As expected, there were no significant changes compared to the previous year concerning the allocation of dialysis patients to different treatment methods. Hemodialysis continued to be by far the most important method used to treat chronic kidney failure in 2012. For further information, see the “Dialysis market” section.

T. 2.2.15

Targets and results for 2012

adjusted for special charges
  Results 2012 Targets 2012 Target achieved
1Proposal subject to the approval of the Annual General Meeting on May 16, 2013.
Revenue +10% to $13.80 BN ~$14 BN check
Net income +4% to $1.12 BN ~$1.14 BN check
Dividend1 +9% per ordinary share to €0.75 Continuous rise check
Capital expenditures, net $666 M ~$700 M check
Acquisitions, net $1.615 BN ~$1.8 BN check
Tax rate 33.9% 33 to 35% check
Debt/EBITDA 2.83 < 3.0 check
Number of employees 86,153 > 86,000 check
Research and development expenses $112 M ~$130 M  
Product innovations 5008 CorDiax Further expansion of product and service range check

The management’s general assessment of business performance

2012 was a very successful year: Revenue and earnings climbed to record levels. We largely achieved all the ambitious targets we set ourselves.

Fresenius Medical Care experienced stronger growth in each of the regions than the dialysis industry as a whole. As a result, we managed to strengthen our market position. We maintained our position as market leader in North America, by far our biggest market, and recorded significant revenue growth in the markets outside of North America (Europe, Latin America and Asia), reinforcing our market position in these regions.

In addition, Fresenius Medical Care continued to boost its profitability in the year under review. Once again, there were improvements in all relevant key figures. This is partly due to our ongoing high level of investments in maintaining existing clinics, equipping new facilities, and expanding production capacities.