Fresenius Medical Care AG & Co. KGaA

Investor Presentation • Sep 2, 2010

"In Touch – Leading & Succeeding In Renal Therapy"

Raymond M. Hakim, M.D., PhD., Chief Medical Officer Sr. Executive Vice President Clinical & Scientific Affairs FMCNA

Capital Markets Day Luton, September 1–2, 2010

Doing Well by Doing Good

Improving Anemia Management & Outcomes

Optimization of Anemia Management

• 1. RightStart® at the initiation of dialysis
• 2. RightReturn® after Hospitalization
• 3. Catheter Reduction
• 4. Clinical research to reduce inflammation:
• a. Investigate the use of anti-inflammatory agents and ultrapure dialysate to improve Epogen responsiveness
• 5. Aim for an iron saturation (Tsat) of 30-50%
• 6. Computerized anemia management algorithm
• 7. Hemoglobin goal of 10.5 12.0 gm/dl (to avoid Hemoglobin <10 g/dl)

Optimization of Anemia Management

200% 250% 300% on Dose, % 80% 100% 120% B Group Average Epo Dose, % Patients, % Epo Dose vs. Hemoglobin (Q2 2010) 0% 50% 100% 150% <9.0 9-10 10-11 11-12 12-13 13-14 Average 3-Month Average Hemoglobin (g/dL) Average Epo Administration 0% 20% 40% 60% Percent of patients in HGB

Initiation Of Dialysis In The U.S.

• 57% had albumin concentration below lower limit of normal
• 50% had no visit with dietitian (21% had one visit)
• 80% of patients with Hgb<9 gm/dl were not receiving EPO
• 82% initiated dialysis with a catheter
• 18% had a permanent access 30 days before starting dialysis
• 53% used temporary access 60 days after initiation

Co-Morbidities and Risk Factors Associated with Early Mortality

Co-Morbidity

• Age
• Nutritional Status
• Diabetes
• Cardiovascular Disease
• LVH

Risk Factors

• Unplanned start (w/o permanent access)
• Short (<4 months) prior nephrological care
• Low residual renal output

Reversible Risk Factors

• High catheter rate
• Low albumin
• Anemia
• High Phosphorus
• Volume Overload

Mortality in Year One of Dialysis

Time from dialysis initiation (weeks)

Hospitalization in Year One of Dialysis

Time from dialysis initiation (weeks)

RightStart® Program

Hospital Days Per Patient Year at Risk

Survival of RightStart® Patients

One Year Survival of RightStart® Pts vs. Case-Control matching, All Pts n=approx 8,000

Advantages of the RightStart® Program

Number of new (incident) patients in US	100,000
Number of new (incident) patients in FMS	33,000
Current 1st Year Mortality (USRDS)	25.4%
Number incident pts at end of 1st year without RightStart®	24,618
Expected 1st Year Mortality with RightStart® (HR = 0.75)	19.0%
Number incident pts at end of 1st year with RightStart®	26,730
Lives Saved/Lives Extended from RightStart®	~ 2100 pts/Yr

RightStart® Program Summary

Patients initiating dialysis present with several co-morbidities and risk factors, and knowledge deficits that are associated with a high initial 90-day mortality rate, (generally not reflected in published data).

Several of these risk factors can be attenuated or reversed more rapidly with an intensive team effort during the initial 90 days of therapy.

The RightStart® program, consisting of focused attention on reversible risk factors and patient education, resulted in a significant reduction in mortality and hospitalization during those initial 90 days, which extended up to 1 year following initiation of dialysis.

RightReturn® Program

Re-Hospitalization After Discharge from Hospital

Medicare Fee-For-Service
(N=3 million)

Medical Discharges	% Cumulative Re-Hospitalizations
0-30 days	21.1%
30-60 days	30.3%
61-90 days	36.6%
91-180 days	47.9%
181-365 days	59.4%

Predictors of Re-Hospitalization

		Relative Risk
Age	<55 yr 55-69 yr 70-79	1.0 (ref) 0.99 1.07
ESRD		1.42
No. of Re-Hospitalizations	0 1 2 3	1.0 1.37 1.75 2.5

Pre- To Post-Hospitalization Outcomes

Medical Goals that are Synergistic with the "Bundle"

• 1. Reduce hospitalization and mortality in first 120 days
• 2. Optimize iron, Epogen management
• 3. Increase prevalence of home therapies
• 4. Reduce catheter rates, the main cause of BSI and Epogen "resistance"

Treatment Options Program (TOPs) Overview

• Initiated to educate patients with Stage 3 or 4 CKD prior to ESRD
• Consists of a two-hour education program provided at least every month in each FME "area"
• Patients are referred by their nephrologists or PCPs
• Non-biased presentation of available treatment modalities
• In center
• Home Therapy
• Transplant
• No therapy
• Patients are encouraged to attend with family members
• Advantages of Permanent Access are emphasized

Treatment Options September 2006 thru May 2010

• 35,521 pre-ESRD TOPS educations performed so far
• 132,930 patients admitted to FMS
• 11,579 of this group had TOPS education
• 121,351 starts did not have TOPS education
• Only 8.7% of total starts were TOPS educated

Follow up

• Goals

• Improve home therapy awareness
• Increased use of fistulas
• Decrease catheter utilization
• Early removal of catheters if necessary
• Follow up at 30, 90 and 180 days after TOPs education
• Remind patient to go back to referring physician
• Invite them and their families to return for another round of TOPs (prn)

Fistula/Grafts Start (Feb-May 2010)

23

HD Catheter Starts (Feb-May 2010)

Home Therapy Starts (Feb-May 2010)

Treatment Options Program (TOPs) Outcomes

Participation in TOPS leads to:

• Increased knowledge about Home Therapies and rate of home therapy selection
• Decrease use of hemodialysis catheters
• Greater use of AVF at start of dialysis
• Improved survival rate at 90 days after initiation of dialysis

Catheter Reduction Initiative

Catheter Maintenance Costs Per Patient

"Out of pocket" catheter related costs in the Bundle environment ~ \$ 10,000 per patient per year

Hydration Management

• Hydration management is essential to:
• Reduce hospitalization, ER visits, and "missed treatments.
• Increasing evidence that cardiovascular mortality (~50% of all deaths) is not "atherosclerotic" heart disease, but left ventricle failure.

Background and Medical Need

• The state of hydration depends on:
• Salt and water intake by patient (dietary counseling)
• Sodium "loading" during dialysis
• Sodium loading during dialysis is a major contributor to fluid overload
• increased thirst
• increased fluid intake
• Sources of sodium loading during HD:
• influx from dialysate (dialysate sodium higher than serum sodium)
• priming and rinsing of blood lines with saline
• treatment of hypotensive episodes and cramps with saline infusions

Na+ Distribution – 2008 Data

Na+ Gradient

70% of patients dialyze with dialysate sodium levels in excess of their serum Na+ levels

Projected Sodium Transfer from Dialysate to Serum

A constant Dialysate Na+ 5 mEq/L greater than Serum Na+ will result in very marked positive Na balance during dialysis

Hospital Admissions

Dialysate Sodium - Serum Sodium (mmol/L)

Economic Impact of Fluid Overload

Recent publication (CJASN, 2010) corroborated these estimates

Hospitalizations (-5 days) due to fluid overload in prevalent HD patients did cost Medicare / Medicaid a total of \$266 million (\$6,372 per episode) over a 2-year follow-up period in recent study

Blood Volume Monitor

• BVM tracks change of relative blood volume (RBV)
• If fluid removal exceeds plasma refilling RBV will drop 1
• A rapid drop of RBV may lead to systematic hypotension
• A biofeedback control prevents RBV to drop below individual threshold 2

Thank You!

Solving Today's Medical Needs In Renal Replacement Therapy: Bone Mineral Metabolism

Jose A Diaz-Buxo, MD, FACP Chief Medical and Regulatory Officer SVP Renal Products Group

Overview

• Bone and mineral metabolism (BMM) complications remain a major source of complications among patients with chronic kidney failure
• Despite significant advances in understanding the pathophysiology and treatment of these conditions achieved during the past 40 years, many problems remain to be solved
• The challenge we face in preventing and treating disorders of BMM is best appreciated by taking into account the many factors involved in its development

Chronic Kidney Disease - Factors Influencing Mineral and Bone Disorders

KDOQI Targets for BMM are not Achieved in Most HD Patients1,2

• 51-52 % of patients achieve the calcium target
• 47-49 % the phosphate
• 68-78 % the calcium-phosphate product
• 24-31% the PTH
• Only 2.4-6.9% of patients meet all 4 targets
• Clinical trials show that adjustment of dialysis prescription has great potential to achieve better control of the bone mineral metabolism. For example, dialysate calcium concentration, duration of the dialysis session and hemodiafiltration all have an impact on calcium, phosphate and PTH.

FMC Approach to Bone and Mineral Metabolism

• Use our extensive database to identify signals, trends, drugs and clinical practice effects on BMM
• Integrate clinical practices, dialysis prescription, nutrition and drugs into our therapeutic approach
• Construct theoretical models, test concept in pilot studies and validate them (Phosphorus Kinetic Modeling - PKM)
• Support development of drugs and devices to correct BMM abnormalities

Relative Risk of Mortality versus Phosphorus

o of death Data adjusted for case mix: age, gender, race, diabetes, body surface area, vintage and laboratory: albumin, hemoglobin, equilibrated urea Kt/V, phosphorus, WBC 1.5 2.0 Ref * * * * * * * * * Three-Month average phosphorus Hazard ratio o 0.0 0.5 1.0 *

Data source: Fresenius Data Warehouse Baseline period: Q4 2005; Follow-up period: 2006

Need for Improved Treatment Algorithm to Achieve Phosphate and Calcium Targets

Distribution of phosphate and calcium among patients receiving PhosLo® (n=31,712)

Data source: Fresenius Data Warehouse

Latest lab results between 3/1/2007 and 5/31/2007 among patients with open order for PhosLo® at that time 43

Introduction to Phosphorus Kinetic Modeling (PKM)

• Hyperphosphatemia in dialysis patients is a major cause of:
• Morbidity (Calcification, cardiovascular disease, bone disease)
• Mortality
• Calcium acetate effectively binds phosphorus in the gut to prevent absorption, but may increase calcium load
• Most dialysis patients are in positive calcium balance, regardless of phosphate binder
• Patient compliance with therapy is a strong determinant of phosphate and calcium balance

The Phosphorus Kinetic Model (PKM)

• Definition:
• A kinetic model identifying the interacting effects of vitamin D analogues, phosphate binders and dialysate Ca on P and Ca mass balance in hemodialysis
• Goal of PKM model:
• To help control a hemodialysis patient's serum P level through the use of Calcium Acetate and achieve K/DOQI guidelines for P and Ca without the need for additional blood draws and lab tests
• Optimize phosphate binder therapy and patient compliance
• Match Ca removal during dialysis to Ca accumulation between dialyses to prevent Ca overload or depletion
• Seamless integration between central lab (Spectra), clinic and PKM report
• FMC has completed a pilot study and is conducting a second clinical trial to validate the model

Serum Phosphorus and Calcium

Error bars represent 95% confidence interval, * p < 0.05, compared to month 0 # p < 0.01, compared to month 0

Calcium Phosphorus Product

# p < 0.01, compared to month 0

Physician Report

48

Patient Report

PKM 2 Study Rationale

• Validation of positive results from the pilot study
• The primary endpoint is the change in serum phosphorus between a baseline period and the latest value of the intervention period.
• Addressing the changing clinical/ business paradigm
• PKM algorithm is patient-centric
• Revised PKM algorithm helps manage multi-faceted BMM therapy
  • -Efficient and effective calcium acetate binder therapy
  • -Dialysate calcium concentration
  • -Efficient Vitamin D use
  • -Optimal use of Cinacalcet
• -PKM 2 support quality of care metrics/ initiatives (Bundle)

PKM Clinical Application

• Prescribe patient-specific parameters:
• Recommended dietary phosphorus intake
• Vitamin D dose
• Dialysate
• Phosphate binder dose
• Cinecalcet dose
• Assess patient compliance
• PKM will assist nephrologists in adjusting both phosphate binder dose, dialysis prescription and patient compliance to achieve desired phosphate and calcium values in support of BMM

PKM Conclusions

• Useful tool for helping chronically hyperphosphatemic patients meet phosphorus target without increasing serum calcium.
• PKM report provides valuable bone and mineral metabolism information to physicians and patients that can be used as formal prescription
• PKM provides cost effective optimization of BMM therapy

Thank You!

Dry Weight and Bone Mineral Metabolism Management in EMEALA

Wolfgang Wehmeyer Senior Vice President International Marketing & Medicine

Fresenius Medical Care Experience

OnlineHDF and Body Composition Monitor (BCM) and Bone Mineral Metabolism Management (BMM) are as important as eating and drinking.

An Affordable and User Friendly Product with Impressive Impact

Fluid Overload is as Serious as Diabetes

Fluid Overload is as Serious as Diabetes

The mortality risk of overhydration in haemodialysis patients. Wizemann V, Wabel P, Chamney P, Zaluska W, Moissl U, Rode C, Malecka-Masalska T, Marcelli D. Nephrol Dial Transplant. 2009 May;24(5):1574-9.

BCM

An Affordable and User Friendly Product with Impressive Impact

Fluid Overload is as Serious as Diabetes

50 - 60% of All PD Patients are "Out of Range" (30-40% in HD)

50-60% of All PD Patients are "Out of Range"

Overhydration [L]

Assessment of Fluid Status and Nutritional Status in European Peritoneal Dialysis Patients. Objective Measurement through Body Composition Monitoring

1 Van Biesen W, 2Covic A, 3Fan S, 4Claes K, 5Lichodziejewska-Niemierko M, 6Verger C,

7Steiger J, 8Wabel P, 8Gauly A, 8Schoder V, 8Himmele R

BCM

An Affordable and User Friendly Product with Impressive Impact

Fluid Overload is as Serious as Diabetes

50 - 60% of All PD Patients are "Out of Range" (30-40% in HD)

We Can Do Something About It

We Can Do Something About It

Guided optimization of fluid status in haemodialysis patients. Machek P, Jirka T, Moissl U, Chamney P, Wabel P. Nephrol Dial Transplant. 2010 Feb;25(2):538-44.

BCM Outstanding Clinical Documentation

More than 50 publications in the past 3 years

Achieving Benefits for Patients Requires a Change in Clinical Procedures

• Guiding Rules for NephroCare Centers
• Prescription Strategy of PD Solutions
• Scientific Marketing

Bone Mineral Metabolism FME Online HDF and Osvaren®

A Superior Treatment Proposition

Fresenius Medical Care HDF / Online HDF

Improved Phosphate Control over HF Dialysis

Penne et al. 2010 (CONTRAST study)

• Decreased pre-dialysis phosphate levels after 6 months of treatment with online HDF
• Phosphate treatment targets were satisfied more often, whereas the use of phosphatebinding agents was reduced.
• Increased phosphate removal using HDF potentially may improve clinical outcomes

Vaslaki et al. 2006

• Convective solute transport in oHDF improved the elimination of phosphate
• A constant lowering of serum phosphate levels was possible, which has been not described before to our knowledge

OsvaRen®

• A new combination drug for Hyper-phosphatemia

• Strong data from prospective, randomized trial (CALMAG)
• Effective Phosphate control, faster to target than Sevelamer
• Full Calcium Control through reduction of Ca++ component
• Addition of anti-calcification potential through benefit of Mg++
• Premium Priced over Calcium based binders
• Economically attractive through excellent value compared to Ca-free binders

Convincing Data

Serum Phosphorous Pills per patient per day Ionized Serum Calcium

Time course of serum phosphorus: Fast decline with Osvaren

Area under the curve (AUC, [=total exposure]) for serum phosphorus significantly lower with Osvaren

Study medication intake/day significantly lower at week 25 with Osvaren

No significant difference in ionised serum calcium between groups

Sufficient Serum Magnesium: Benefits

Serum Magnesium Is A Significant Predictor For Survival In Dialysis Patients

Lower serum magnesium levels are an independent factor of vascular calcification in patients with CKD

Study of 515 dialysis patients: Elevated magnesium levels are associated with improved survival

Ishimura 2007 Ishimura 2007 Lacsson 2009

27,544 dialysis patients (FMCNA): Elevated magnesium levels are associated with lower risk of mortality

Summary

Low

Thank You!

Hydration Management North American Strategies for Commercialization

Mark Costanzo, President Renal Therapies Group of FMCNA

Fluid Management Components Under Study At Fresenius Medical Care

Sodium (salt) management Alignment of serum and dialysate sodium

Determination of the target weight/dry weight Application of bioimpedance and plasma-refilling rate

Method to Correct Simplified Na+ Alignment Algorithm

• Calculate mean of patient-specific serum Na+ for the past four months (sNat:t-4)
• Calculate Na+ gradient (gNa) =

dialysate Na (dNa) - sNat:t-4

Hydration Management Flow Diagram

Dry Weight: A Problematic Measure, in Practice

• Dry Weight the weight below which patients develop intradialytic hypotension (IDH) on HD
• Hypotension may occur in overhydrated patients when ultra filtration exceeds plasma refilling rate
• Physicians prescribe a target weight (TW) based on clinical assessment of the patient
• Currently, there are no routine methods available to objectively assess DW

Current Dry Weight Methodologies Technology for Volume Management

Blood Volume Monitoring

Volume management with biofeedback biofeedback technology

Blood Temperature Monitoring Bioimpedance

Achieving target dry weight while maintaining maintaining cardiovascular stability

Determining target dry weight

* not 510k cleared

Global Strategy – Renal Pharma/Therapy – Hydration Management

2008T with CDX Access to Data is Essential for Hydration Management

• Fresenius Clinical Data Exchange™ (CDX) - provides access to clinic MIS system and dialysis treatment data on the 2008T platform
• Lab data and other key MIS content displayed on 2008T for comprehensive prescription decision making
• Online data from blood volume monitor/ bioimpedence measurements used for feedback control
• 2008T allows chair side documentation for adjustment of prescription

Anemia Management

Anemia Management

• Improving Anemia Management and Outcomes
• Impact of Bundle
• Narrowing the Distribution to 10 -12 g/dl
• Improving IV Iron Management
• Reduced Inflammation

Narrowing the Distribution to 10–12 g/dL with Recommended Epogen Dose (RED) Algorithms

• Spectra Lab Results:
• Weekly HGB values (up to 4 mo data)
• Monthly TSAT values (up to 4 mo data)
• Possibly latest ferritin value in past 4 mo (max value for IV iron)
• Optional other lab values relevant to hyporesponse, such as albumin, CRP, aluminum, etc.
• Clinical Data:
• Current Epogen prescription (dose and frequency)
• Current IV iron prescription (dose, frequency)
• Total IV iron administered in past 3 months prior to first run of algorithm. (Later, the HD machine or computer running the algorithm can accumulate this information.) ⁸¹

Diagram of HGB Extrapolation

Time (Weeks)

Fresenius Medical Care Implementation of Anemia Management Algorithm

83

Venofer - Iron Sucrose For Effective Iron Management

PharmaTech Venofer Pump Features/Benefits

• Ease of use Set dose and rate
• Accurate delivery Precise dose and rate delivery
• Reduces set-up time – eliminates syringe fill and labeling
• Cost effective delivery

PharmaTech Anemia Management Module Concept

Features/Benefits:

• Ability to tailor ESA and iron dosing to actual doses administered and optimized with the FMC algorithm.
• Doses entire deliverable volume of ESA from vial
• Documentation displayed for the dose administered
• Simplifies RN's task of measuring out exact ESA doses into the syringes

Water Purity: Does it Make a Difference in Reducing Inflammation?

• Bacteria, endotoxin and DNA fragments in the dialysate may pass into the blood with highly permeable dialysis membranes.
• Monocytes activated by bacteria-derived substances secrete a variety of pro-inflammatory cytokines (IL-1, IL-6 and TNF)
• This inflammatory state is associated with malnutrition, accelerated atherosclerosis and a reduced erythropoietin responsiveness
• Ultrapure dialysis fluid is associated with:
• improved nutritional status
• an increased responsiveness to administration of iron and erythropoietin

Ultrapure Dialysate

Corrective Measures

• Controlled ultrafiltration by placing Diasafe® Plus filters in the fluid path of standard HD machines
• Improve Water Quality
• Reduce bioburden
• Reduce dead space in centralized RO system

Diasafe® Plus Exceeding Proposed AAMI Standards

Dialysate Endotoxin Levels Using Diasafe Filters and Conventional Facility Water Treatment

Sands J. Stano M., Li Z., Bryant R., Ofsthun N., Updyke D., Lazarus J. (2004). Diasafe® decreases endotoxin Levels 16 fold below new AAMI standard. (Abstract submitted for ASN)

AAMI = Association for the Advancement of Medical Instrumentation

Global Strategy – Renal Pharma/Therapy – Anemia Management

2008T with CDX Access to Data is Essential for Anemia Management

• Fresenius Clinical Data Exchange™(CDX) provides access to clinic MIS system and dialysis treatment data on the 2008T platform
• Lab data and other key MIS content displayed on 2008T for comprehensive prescription decision making
• Online data from Venofer® or AMM module used for feedback control
• 2008T allows chair side documentation for adjustment of prescription

Bone Mineral Metabolism

Bone Mineral Metabolism

• Compelling Need
• Phosphate and Bone Mineral Management PharmaTech
• Pharmaceutical Delivery System FMCRx

Compelling Need to Improve Phosphate & Bone Mineral Management

Overall strong quality performance

	North America				EMEA
% of patients	(USA) Q2 2009	Q2 2010		Q2 2009	Q2 2010
Kt/V 1.2	96%	96%		95%	95%
Hemoglobin = 10-12 g/dl	64%	68%		54%	54%
Albumin 3.5 g/dl	82%	81%		88%	86%
Phosphate 3.5-5.5 mg/dl	52%	55%		61%	61%
Hospitalization days	10.1	* 9.9		8.5	9.2

* The hospitalization rates for the US reflects adoption of CMS policy

PharmaTech - Implementation of Phosphorus Kinetic Modeling

Phosphate Binder Portfolio

• PhosLo (calcium acetate gelcap)
• PhosLo authorized generic
• Phoslyra (liquid calcium acetate formulation)
• Clinical trials have proven safety and efficacy. Waiting for FDA to complete upstream reviews
• Aim is to enhance patient adherence and thus serum P management by reducing pill burden, reduce fluid ingestion and providing an alternative for patients with swallowing difficulties
• Interest in licensing of branded or non-calcium based P binder: PA-21

FMCRx

FMCRx is a renal - focused specialty pharmacy with pharmacists who are trained on the special needs and medications of CKD and ESRD patients

Benefits to FMCNA include:

• Medication management improves compliance to drug regimen
• Improved adherence leads to improved quality of life for patients
• Convenience, shipped to the patient's home
• Medication summary report of all drugs prescribed and filled sent to clinics each month
• Control costs under the bundle

Global Strategy – Renal Pharma/Therapy – Bone Mineral Management

Thank you!

"In Touch – Leading & Succeeding In Renal Therapy Worldwide"

Michael Brosnan, Chief Financial Officer

Capital Markets Day Luton, September 1–2, 2010

Agenda

} 1 HISTORICAL HIGHLIGHTS 1. Historical Highlights

} 2 FINANCIAL TARGETS 2. 2010 Financial Guidance

KEY NON-OPERATING INITIATIVES 3. Goal 13 – Strategic Financial Objectives

SUMMARY 4. Goal 13 – Strategic Financial Objectives - Capital Structure

5. Summary

Historical Highlights Topline Growth Drivers

Topline Growth Drivers Revenue

• Geographic Expansion
• Market Share Gains
• Revenue Per Treatment Increases
• Geographical Mix Management
• Successful Execution of Acquisitions and Integration Strategy

Historical Highlights Earnings Growth Drivers

Earnings Growth Drivers Net Income \$891 • Scale Effects • Revenue Per Treatment Increases attributable to FMC AG & Co. KGaA \$455 2005 2009 CAGR 18.3% • Manufacturing Performance • Product Mix • Clinic Cost Control • Favorable Financing Conditions • Slightly Lower Tax Rate

Historical Highlights - Balance Sheet And Cash Flow Growth Drivers

2005 2009

Historical Highlights - Our Credibility With The Capital Markets

	Meeting Guidance and Investor Expectations
	2005	2006	2007	2008	2009
Revenue
Net Income attributable to FMC AG & Co. KGaA
Leverage
Investments
Operating Cash Flow

Agenda

} 1 HISTORICAL HIGHLIGHTS 1. Historical Highlights

} 2 FINANCIAL TARGETS 2. 2010 Financial Guidance

KEY NON-OPERATING INITIATIVES 3. Goal 13 – Strategic Financial Objectives

SUMMARY 4. Goal 13 – Strategic Financial Objectives - Capital Structure

5. Summary

Financial Guidance Outlook 2010

Fully on Track for 2010 Targets

US\$ millions	Guidance
Net revenue	> \$12,000
Net income attributable to FMC AG & Co. KGaA	\$950 - 980
Leverage ratio (Debt/EBITDA)	< 2.5
Capital expenditures Acquisitions Updated	~ \$550 - 650 up to \$500

Financial Guidance Goal 10 - Achievements

	Goal 10	2010 - Guidance
Revenues	> \$ 11.5 bn	> \$12.0 bn
thereof: Pharma Sales incl. internal sales	\$ 400 million	~ \$ 400 million
EBIT Margin	~ 20 bps (incremental increases p.a.)	~ 15.6 %
Interest Expense	< 6.5%	< 5.5%
Tax Rate	< 38 %	34.5% - 35.5 %
Net Income / EPS attributable to FMC AG & Co. KGaA	Low to mid-teen (growth p.a.)	\$ 950 - \$ 980 million
Operating Cash Flow	Maintain to slightly improve current level of 10% of Revenue	> 10 % of Revenue
CapEx & Acquisitions	~7 % of Revenue	~9 % of Revenue

Agenda

1. Historical Highlights

2. 2010 Financial Guidance

3. Goal 13 – Strategic Financial Objectives

4. Goal 13 – Strategic Financial Objectives - Capital Structure

5. Summary

Goal 2013 Strategic Financial Objectives Revenue Growth

(Average Annual, Constant Currency)

	Global Growth	Price/Mix Increase	Market Share & Acquisitions	Total
Services	5 – 6%	up to 2%	1 – 2%	6 – 9%
Products	4 – 5%	up to 1%	1 – 2%	5 – 7%
Total Objective				6 – 8%

Goal 2013 Strategic Financial Objectives EBIT Margin

• Scale effects
• Cost control
• Strategic investment / placement
• US: Bundle / De novos / Payor mix
• International: Leveraging the existing organizational structure through expansions
• Manufacturing capacity / demand management and efficiencies

Goal 2013 Strategic Financial Objectives Net Interest Expense

• Amend & extend the existing Senior Credit Agreement by two years (Term Loan A and Revolving Facility)
• Issuance of Senior Bond early 2011 to refinance subordinated Trust Preferred Securities
• Issuance of Senior Bond to refinance Term Loan B of the Credit Agreement in mid 2012

Goal 2013 Strategic Financial Objectives Effective Tax rate

• Continue on a sustainable basis

Goal 2013 Strategic Financial Objectives Net Income / EPS

Objective	Current	2013 Annual Growth
Net Income attributable to FMC AG & Co. KGaA	\$950 – 980 million	High single to low double digits
EPS		High single to low double digits

Goal 2013 Strategic Financial Objectives Cash from Operations

• Improve profitability
• Continue with effective working capital management
• Strong collection process
• Maintain effective inventory management

Goal 2013 Financial Objectives – Capital Expenditures and Acquisitions

Current	2010
Capex & Acquisitions	Capex & Acquisitions
~9% of Revenue	~7% of Revenue

• Take advantage of existing growth opportunities
• Prudent investment to avoid dilution of return on invested capital

Goal 2013 Strategic Financial Objectives

	2010 - Guidance	Goal 13
Revenues	> \$12bn	6-8% Growth*
EBIT Margins	~ 15.6%	10 - 20 bps (incremental increases p.a.)
Interest Expense	< 5.5%	6.0 to 6.5%
Tax Rate	34.5 – 35.5%	35 – 36%
Net Income attributable to FMC AG & Co. KGaA	\$950 - 980	High single to low double digits
Operating Cash Flow	> 10% of Revenue	> 10% of Revenue
CapEx + Acquisitions	~9% of Revenue	~7% of Revenue

Agenda

} 1 HISTORICAL HIGHLIGHTS 1. Historical Highlights

} 2 2. 2010 Financial Guidance

} 3

} 4 1183. Goal 13 – Strategic Financial Objectives 4. Goal 13 – Strategic Financial Objectives - Capital Structure

5. Summary

Goal 13 – Strategic Financial Objectives Capital Structure

• FME has current guidance Debt/EBITDA ratio of < 2.5x
• Strategically our franchise can operate effectively with ~ 2.5x leverage
• Equivalent to a credit rating of BB to BBB-
• Industry well suited to "reasonable" leverage
  • Non-cyclical
  • Predictable cash flow
  • Attractive profitability
  • Foreseeable investment needs
• This provides the flexibility to seek further investment opportunities and finance them with debt

Goal 13 – Strategic Financial Objectives Capital Structure

Debt Portfolio

• Amend & extend Senior Credit Agreement
• Transition to single tier
• Lengthen average maturity
• Target committed and unutilized facilities at \$300 500 million

Agenda

1. Historical Highlights

2. 2010 Financial Guidance

3. Goal 13 – Strategic Financial Objectives

4. Goal 13 – Strategic Financial Objectives - Capital Structure

5. Summary

Summary

Leadership	• Maintain our global leadership position • Continue to shape the future of the dialysis industry
Quality	• Maintain superior quality in products and services
Growth	• Benefit from product innovations • Take opportunity of international growth potential • Introduce new therapy offerings • Continue horizontal expansion of service and product range
Financial	Control cost and spending • • Seek attractive investment opportunities • Continue profitable growth momentum • Revenue to grow 6-8% per annum, constant currency • Earnings After Tax – high single to low double digits

Thank You for Your Interest in Fresenius Medical Care!