Fresenius Medical Care Reports Strong Start for 2009 and Confirms Outlook for Full Year

Summary First Quarter 2009:

• Net revenue: $ 2,560 million, + 2%
• Operating income (EBIT): $ 396 million, + 2%
• Net income attributable to Fresenius Medical Care AG & Co. KGaA: $ 198 million, + 7%
• Earnings per share: $ 0.67, + 6%

Bad Homburg, Germany – Fresenius Medical Care AG & Co. KGaA ("the Company" or "FMC AG & Co. KGaA"), the world's largest provider of dialysis products and services, today announced its results for the first quarter of 2009.

Revenue
Net revenue for the first quarter of 2009 increased by 2% to $2,560 million (8% at constant currency) compared to the first quarter of 2008. Organic revenue growth worldwide was 8%. Dialysis services revenue grew by 4% to $1,923 million (8% at constant currency) in the first quarter of 2009. Dialysis product revenue decreased by 5% to $637 million (an increase of 8% at constant currency) in the same period.

North America revenue increased by 6% to $1,774 million. Dialysis services revenue grew by 5% to $1,577 million. Average revenue per treatment for the U.S. clinics was $338 in the first quarter of 2009 compared to $326 for the first quarter of 2008 and $335 for the fourth quarter of 2008. This development was based on an increase in underlying reimbursement rates and stable EPO utilization. Dialysis product revenue increased by 14% to $197 million and was led by sales of the newly licensed intravenous iron products and strong sales of the 2008K hemodialysis machines.

International revenue was $786 million, a decrease of 7% (an increase of 11% at constant currency) compared to the first quarter of 2008. Dialysis services revenue reached $346 million, a decrease of 1% (an increase of 18% at constant currency). Dialysis product revenue decreased by 11% to $440 million. Sales grew by 6% based on constant currencies, led by strong pharmaceutical sales and sales of products for acute care treatments.

Earnings
Operating income (EBIT) increased by 2% to $396 million compared to $389 million in the first quarter of 2008. Operating margin remained unchanged at 15.5% in the first quarter of 2009 compared to the first quarter of 2008.

In North America, the operating margin decreased by 110 basis points from 16.4% to 15.3% in the first quarter of 2009 primarily due to higher personnel expenses, increased pharmaceutical costs and the impact of one less dialysis day in the first quarter of 2009 compared to the first quarter of 2008. These effects were partially offset by increased dialysis treatment rates and sales of the newly licensed intravenous iron products.

In the International segment, the operating margin increased by 170 basis points to 18.7% due to reduced manufacturing costs and operating expenses.

Net interest expense for the first quarter of 2009 was $74 million compared to $83 million in the same quarter of 2008. This positive development was mainly attributable to lower short term interest rates.

Income tax expense was $116 million for the first quarter of 2009 nearly equal to the first quarter of 2008, reflecting effective tax rates of 35.9% and 37.3%, respectively.

Net income attributable to FMC AG & Co. KGaA for the first quarter of 2009 was $198 million, an increase of 7%.

Earnings per share (EPS) for the first quarter of 2009 rose by 6% to $0.67 per ordinary share compared to $0.63 for the first quarter of 2008. The weighted average number of shares outstanding for the first quarter of 2009 was approximately 297.7 million shares compared to 296.6 million shares for the first quarter of 2008. The increase in shares outstanding resulted from stock option exercises in 2008 and in the first quarter of 2009.

Cash Flow
In the first quarter of 2009, the Company generated $156 million in cash from operations, representing approximately 6% of revenue. The cash flow generation benefited from a decrease in Days Sales Outstanding (DSO) in the first quarter of 2009 compared to the fourth quarter of 2008 of two days but was negatively affected by higher other working capital requirements.

A total of $111 million was spent for capital expenditures, net of disposals. Free Cash Flow before acquisitions was $45 million compared to $39 million in the first quarter of 2008. A total of $36 million in cash was used for acquisitions net of divestitures. Free Cash Flow after acquisitions and divestitures was $9 million compared to $6 million in the first quarter of last year.


Patients – Clinics – Treatments
As of March 31, 2009, Fresenius Medical Care treated 187,476 patients worldwide, which represents a 6% increase in patients compared to the same period last year. North America provided dialysis treatments for 127,121 patients, an increase of 4%. Including 31 clinics managed by Fresenius Medical Care North America, the number of patients in North America was 128,763. The International segment served 60,355 patients, an increase of 11% over last year.

As of March 31, 2009, the Company operated a total of 2,448 clinics worldwide. This is comprised of 1,714 clinics in North America (1,745 including managed clinics), an increase of 5%, and 734 clinics in the International segment, an increase of 12%.

Fresenius Medical Care delivered approximately 7.04 million dialysis treatments worldwide during the first quarter of 2009. This represents an increase of 5% over the same quarter last year. North America accounted for 4.74 million treatments, an increase of 2%, and the International segment delivered 2.30 million treatments, an increase of 11%.

Employees
As of March 31, 2009, Fresenius Medical Care had 65,670 employees (full-time equivalents) worldwide compared to 64,666 employees at the end of 2008. The increase of approximately 1,000 employees is primarily due to overall growth in the Company's business.

Debt/EBITDA Ratio
The ratio of debt to Earnings before Interest, Taxes, Depreciation and Amortization (EBITDA) decreased from 2.82 at the end of the first quarter of 2008 to 2.64 at the end of the first quarter of 2009. At the end of 2008, the debt/EBITDA ratio was 2.69.

Refinancing of Notes
On April 27, 2009, the Company issued euro denominated notes totaling €200 million in anticipation of retiring the existing €200 million Euro Notes issued in 2005 which are due in July 2009. The newly issued Euro Notes consist of 4 tranches having terms of 3.5 and 5.5 years with floating and fixed interest rate tranches. The initial average interest rate is 6.95%.

Rating
There have been no rating changes in the first quarter of 2009, Standard & Poor's Rating Services rates the Company's corporate credit as ‘BB' with a ‘negative' outlook.

Moody's continued to rate the Company's corporate credit as ‘Ba1' with a ‘stable' outlook.

Fitch rates the Company's corporate credit as ‘BB' with a ‘negative' outlook.


Outlook for 2009 fully confirmed
For the full year 2009, the Company expects to achieve revenue of more than $11.1 billion, which is more than 8% growth in constant currency.

Net income attributable to FMC AG & Co. KGaA is expected to be between $850 million and $890 million in 2009.

In addition, the Company expects to spend $550 to $650 million on capital expenditures and $200 to $300 million on acquisitions. The debt/EBITDA ratio is projected to remain below 2.7.


Ben Lipps, Chief Executive Officer of Fresenius Medical Care, commented: "We are pleased to have a strong start into the year, which is fully in line with our guidance for 2009. We have made good progress in 2009 despite the 2008 cost increases, which we are attempting to mitigate, and the volatile currency environment. Our underlying business continues at its excellent 8% organic growth rate. Our global expansion of products and services is on target and we are confident that we will achieve our targets in 2009."

Conference Call
Fresenius Medical Care will hold a conference call to discuss the results of the first quarter of 2009 on Thursday, April 30, 2009, at 3.30 p.m. CEDT / 9.30 a.m. EDT. The Company invites journalists to listen to the live webcast of the call at the Company's website www.fmc-ag.com / Investor Relations / Presentations. A replay will be available shortly after the meeting.