HOSpItAl WItH A sana Kliniken aG

Transcription

Fu
tuRE
HOSpItAl WItH A
AnnuAl REpORt 2011
Sana Kliniken AG
Oskar-Messter-Straße 24 ❘ 85737 Ismaning ❘ Germany
tel. +49 (0)89 678204-0 ❘ Fax +49 (0)89 678204-179
[email protected] ❘ www.sana.de
sana Kliniken aG
5-year overview of ratios
the Sana facilities
2007
2008
2009
2010
2011
result of operations
Sales
EuR million
946.0
1,063.5
1,254.0
1,484.9
1,629.2
EBItdA
EuR million
97.5
103.0
119.9
147.8
151.9
EBIt
EuR million
49.9
60.0
66.7
85.4
91.7
EAt
EuR million
32.1
36.2
40.3
47.7
52.8
EBItdA margin
in %
10.3
9.7
9.6
10.0
9.3
EBIt margin
in %
5.3
5.6
5.3
5.8
5.6
Equity ratio
in %
26.0
28.5
31.4
26.8
33.5
net gearing
in %
Key ratios
Hameln
net debt to EBItdA
83.1
60.4
38.8
72.9
44.7
2.30
1.83
1.26
2.04
1.56
Return on capital employed (RoCE)
in %
8.5
8.7
9.5
10.3
9.9
Return on equity
in %
13.1
12.4
11.5
11.9
11.2
Balance sheet total
EuR million
1,037.6
1,097.2
1,234.6
1,541.0
1,583.7
Balance sheet and cash flow
Hospital with Sana majority holding
Hospital with Sana minority holding
Hospital managed by Sana
Retirement and care homes
with Sana majority holding
with Sana minority holding
managed by Sana
Acute care hospital
Rehabilitation hospital
Acute care and rehabilitation hospital
newly acquired in 2012, not included
in 2011 annual financial statements
Munich Airport
Munich
The complete ownership
overviews can be found from
page 142 onwards.
Hospitals
Retirement and
nursing homes
Medical care
centres
Sana majority holding
37
5
15
Sana minority holding
8
7
6 2)
Managed by Sana
10
5
2
total
55
17
23
1)
2)
1)
Two of these hospitals are not included in the consolidated financial statements. Consequently, there are 43 Group hospitals.
Three of these medical care centres are not included in the consolidated financial statements.
Consequently, there are 18 medical care centres in the Group.
net debt
EuR million
224.0
189.0
150.6
301.4
237.0
Shareholders’ equity
EuR million
269.5
312.8
387.9
413.2
530.4
Capital expenditure
EuR million
99.7
91.1
98.8
119.0
129.0
of which equity-financed
EuR million
37.4
55.0
68.8
73.2
77.7
of which subsidised
EuR million
62.3
36.1
30.0
45.8
51.3
EuR million
65.5
92.9
106.7
113.6
131.9
Cash flow from operations
others
In-patient treatment cases
number
253,506
278,784
317,889
368,668
399,800
Out-patient cases
number
626,256
696,556
829,471
965,763
1,070,448
Fully out-patient beds
number
6,700
6,683
7,403
8,516
8,837
Employees
number
16,338
16,495
19,148
22,483
23,626
Sana Kliniken
Contents
2 Hospital with a future
2Interview with the
Sana Kliniken AG is Germany’s fourth largest private hospital group. Its business model is based on long-term success and stakeholders’ confidence in
the company. this includes double-digit growth rates, innovative services,
company management geared towards value-based success factors and a
commitment to transparency. Our goal is high-end medicine with a wide range
of care services. Sana works closely with independent doctors and pursues
the expansion of integrated care, sharing joint regional responsibility with
doctors and hospitals.
Chairman of the Management Board
6 Best practices
22From the company
22 Highlights from the company
24Foreword by the Chairman
of the Supervisory Board
25 Report of the Supervisory Board
26 Executive bodies
We meet the increasing requirements for patient safety through Group-wide
clinical quality and risk management. patient care and sustainable growth are
top priorities for our owners, the private health insurance companies. Sana
hospitals are open to all policyholders.
88Consolidated annual
financial statements
89 Consolidated income statement
89 Consolidated statement
of comprehensive income
90 Consolidated statement of financial position
28 Shareholders
92 Consolidated statement of changes in equity
30 Highlights from medicine and science
93 Consolidated statement of cash flows
32 Quality and innovation management
94 Notes to the consolidated financial statements 46 Staff report
145Further information
tARGEtS FOR 2011
RESultS FOR 2011
OutlOOK FOR 2012
• Consolidated net revenue
EuR 1.63 billion
• Further double-digit growth
in core business
• Strengthening of Sana’s profile
on the healthcare market
management structure
65 Sector-specific situation
67 The 2011 financial year – financial overview
• Successful integration of the newly
acquired hospitals and creation of
a care cluster in Berlin-Brandenburg
• Targeted strategic enhancement
of the Sana portfolio
• Attainment of target ranges:
RoCE: 9.9 %
(1.7 x the cost of capital employed)
Net debt to EBITDA: < 3.00
Net debt to EBITDA: 1.56
Net gearing: < 100 %
Net gearing: 44.7 %
79 Supplementary report
86 Forecast report
• Stable sustainable growth through
further adherence to the defined
target ranges in 2012
capital
• Adoption of the highest equity measure in the company’s history totalling
EuR 160 million, extending the equity
base to EuR 530 million
70 Earnings, asset and financial situation
80 Opportunity and risk report
• Outstanding patient satisfaction
as a quality feature:
Among this year’s winners of
techniker Krankenkasse’s
“tK Klinikus” awards, eight Sana
hospitals were rewarded for aboveaverage patient satisfaction
RoCE: 1.5 x the cost of
capital employed
• Carrying out a capital increase
to strengthen the growth process
61 Organisational and
64 Macroeconomic factors
ratios
• Adherence to the target ranges of:
59 Overview of the 2011 financial year
60Overview of the organisation
62 Corporate strategy and control
• Double-digit revenue growth attained
despite a challenging general situation
(e.g. EHEC crisis)
portfolio
• Continuation of the successful
expansion of the hospital portfolio
145 Auditor’s report
146 Addresses of the Sana facilities
and operations
Growth
• Further double-digit growth with
expected consolidated net revenue
of approximately EuR 1.7 billion
58 Group management report
59 General and business conditions
• Future-oriented optimisation
of the borrowing structure
148 Imprint
ANNUAL REPORT OF SANA KLINIKEN AG 2011
Hospital with a future
From the company
Group management report
Consolidated financial statements Further information
Interview with the Chairman of the Management Board
Future
Hospital with a
Where is healthcare going? How can care be ensured
in the long term, especially in structurally weak areas?
And what is the role of the private hospital companies
in all this? Dr Michael Philippi, Chairman of the
Management Board of Sana Kliniken AG, provides
an outlook for 2012 and beyond.
“Hospital with a future” is the theme of the annual report for 2011. Is the focus here on
shareholder value?
The confidence of shareholders and the capital markets can only be gained through sustainable
operations. This includes attaining an appropriate return on equity and interest on borrowing.
Hospitals are capital-intensive. Managing the structural change that lies ahead will require substantial investment. Either the state provides the funds – in contravention of its stated aim of
making savings – or the hospitals generate these funds themselves. The question is not whether
we need to earn money, but “how”. And we are working on this every single day. A private hospital
company focuses on finding a stable balance between patient requirements, employee interests
and economic challenges.
The problems of healthcare provision in rural regions are currently the subject of much
discussion. What solutions does Sana have to offer?
The hospitals of the Cham district, which we purchased a few weeks ago, are a good example of
the tasks to be overcome. In the past, the three hospitals in the district have tried to distinguish
themselves from the competition. It is clear that the local interests of the individual locations have
dominated. Our task will be to view hospital care in the district holistically, devise sound medical
focal points and thus improve and expand the overall range of services. This is the only way to
turn the substantial deficit of the district hospitals into surpluses and ensure high-level medical
care in the future.
2
Dr Michael Philippi
(CEO)
“Our experience proves that there are
viable individual solutions in each case.”
Our experience in similar care situations, for instance, in Templin in the Uckermark district,
Pegnitz in Upper Franconia or Wildbad in the Black Forest, proves that there are viable individual
solutions in each case.
Where do you see the future of hospital care in rural regions?
The hospitals will be at the heart of healthcare provision in the country. I firmly believe that the
independent specialist doctors will only work in conjunction with the hospitals in future. First-aid
and emergency care services at practice clinics, which will gradually have to absorb care responsibilities in conjunction with specialist providers, are only feasible on an out-patient-in-patient
basis in the long term. In these regions, we are at the start of a convergence of the care sectors.
This is also an essential requirement for creating attractive incentives to work outside the urban
area, especially for doctors.
Does this mean that the privatisation wave is now reaching rural districts?
If a privatisation wave ever occurs, it must also incorporate the small and medium-sized hospitals.
Even though public debate is naturally focused on the situation of the major players – university
hospitals, medical centres and maximum-care hospitals – hospital care in Germany is mainly
provided by small and medium-sized hospitals. However, in view of experience from recent years,
forecasts on the extent of privatisation should be viewed with caution. But one thing is true: the
economic pressure on the rural districts is growing. Ultimately, healthcare provision is about
preserving an essential part of the infrastructure.
3
From the company
Interview with the Chairman of the Management Board
Management Board
of Sana Kliniken AG*
So don’t you think the local authorities have the right capabilities?
I do, but I see the huge strains and the wide variety of different tasks as well as the financial
bottlenecks, all in the midst of a serious debt crisis. We can take one task away from the rural
districts: ensuring hospital care. There are plenty of other issues that require the capabilities of
our regional administrative bodies.
“We have the challenging
task of making Sana
Kliniken fit for the conditions and requirements
of the future.”
“ Only financially sound
hospitals can meet their
responsibility to people and
their respective regions on
a long-term basis.”
“Our employees are a
key success factor,
which is why personnel
management is a top
priority at Sana.”
Dr Michael Philippi
Thomas Lemke
Jan Stanslowski
The business studies graduate who also holds a
PhD from the University of Cologne looks back
on a long and successful career at Sana Kliniken
AG. The former managing director of a consultancy firm has held several managerial posts
at Sana since 1995, and was appointed to the
senior management team in 2004. Dr Michael
Philippi, born in 1957, became Chairman of the
Management Board in 2008.
After graduating from the Technical University
Berlin with a degree in business administration,
Thomas Lemke (intake year 1969) worked for
several years in a senior role as a tax consultant
and auditor for a prestigious international auditing firm. He joined the Management Board of
Sana Kliniken AG in 2006.
Jan Stanslowski, born 1965, is optimally
acquainted with the hospital management
operations of Sana Kliniken AG, having worked
for the company in several managerial posts.
The business studies graduate, who studied at
the University of Innsbruck, has been a member
of Sana’s Management Board since 2006.
He also took on the role of Labour Relations
Director in 2008.
As a commercial enterprise, you claim to be committed to social responsibility. How
can the two be reconciled?
Hospitals are often a regional economic factor and the biggest employer in a region. This results
in a high level of responsibility, particularly as a commercial enterprise dealing with the conflicting
priorities of healthcare. Value-oriented corporate management must be lived out on a daily basis.
That is why we encourage our hospitals to exercise social commitment in their locality. In this way,
we can vindicate the trust placed in us.
Where do you see your company at the end of 2012?
We will improve our existing skills and continue to grow. We are ready and able to take on
responsibility for new locations. The financial conditions were put in place with the capital increase
last year. 2012 got off to a good start with the acquisition of the hospitals of the Cham district and
Hanseklinikum Wismar. Progress with quality and personnel management is also on the agenda.
This will create new impetus to make choosing Sana Kliniken AG as a partner an easier decision
for municipal and non-profit operators.
“We are well-placed to take on
responsibility
for new locations.”
(CEO)
Member of the Management Board
(CFO)
and Labour Relations Director
* Dr Markus Müschenich left the company on 31 January 2012.
4
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“My grandson is treated here just as
well
as I am.”
Investment in key medicine
for the 21st century
Innovative medicine, profitability and financial
strength are three of the main advantages that set
private hospitals apart. These are important factors
in a healthcare system that is chronically affected
by financial constraints. With a sound economic
situation, they are playing a key role in ensuring
ongoing top-level patient care in the future. The
example of the medical centres in Hof (Franconia)
and Duisburg shows what this means in practice.
Sana Kliniken has breathed new life into both
locations. They are now regarded as innovative,
integrated health centres with highly attractive care
services. The cardiology, neurology, orthopaedics and
geriatric medicine departments play a major role here,
and are the keys to 21st-century medicine in the context
of demographic change.
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From the company
Consolidated financial statements Sana Klinikum Hof: improved medical treatment and service
When Sana Kliniken AG acquired the hospital in 2006, it was dominated by one thing in particular: challenges. As
well as losses and a high investment requirement, the growing loss of confidence among the population was
particularly unsettling. Only 60 per cent of all patients in the catchment area opted for treatment at the former
municipal hospital. Consequently, Sana undertook modernisation measures and significantly extended the range
of services. The care requirement arising from demographic trends was constantly at the heart of this. Major care
gaps were closed in the areas of cardiology and neurology. At the request of the German Ministry of Health, important care services for people in the final phase of their life were put in place with the creation of a department for
palliative care and pain therapy at the Sana Klinikum Hof. Optimised structures and processes such as central
occupancy management ensure more efficient capacity utilisation and extra quality for patients. They benefit from
much-reduced waiting times and less overcrowding. The admissions procedure has also noticeably improved.
Klinikum Duisburg: into the black with high quality
40 per cent revenue growth – this impressive figure was posted at the Klinikum Duisburg four years after Sana
took over the reins. It was incorporated in the Sana Kliniken AG Group with a 49 per cent stake. The impressive
financial figures are accompanied by the expansion of the existing main areas of expertise in order to safeguard
the hospital’s position as a maximum-care provider in the competitive environment. However, the main focal point
is the quality of care for patients. The KTQ and patient safety certification obtained is proof of this. The range of
services has also been extended with a view to the future, for example by establishing a centre for geriatric trauma
and orthopaedics and expanding the top-level perinatal centre, thus reinforcing the family-oriented ethos of the
hospital. With its extensive specialist departments, the neurological centre has a high profile and is the only one
of its kind in the region. Numerous external linkups are also significant factors in the success of the neurological
centre. And as more work also requires more staff, almost 300 new full-time employees have been taken on by
Sana at the Klinikum Duisburg.
Sana Klinikum Hof
Academic Teaching Hospital of
Friedrich Alexander University, Erlangen-Nuremberg
iii
MILESTONES
• Introduction of innovative organisational concepts:
central patient admission and occupancy management
• Implementation of new specialist departments for cardiology,
neurology and gastroenterology
• Establishment of palliative care and pain therapy
• Formation of the national intestinal centre
• Creation of transparent communication
and information structures
!
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www.sana-klinikum-hof.de
Klinikum Duisburg
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M
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fo
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and
Further information
Academic Teaching Hospital
of the University of Duisburg-Essen
MILESTONES
• Creation of 300 new jobs since acquisition as
a minority holding by Sana in 2007
• Development of the neurological centre as the only
one of its kind in the region
• Establishment of the centre for geriatric trauma
and orthopaedics
• Expansion of the top-level perinatal centre for
prenative babies (level 1)
• Family-oriented ethos through creation of an
interdisciplinary early intervention centre
www.klinikum-duisburg.de
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“Although I am not on duty every weekend,
my patients receive the
best
possible care in an emergency.”
Fit e
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for ure
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Innovative structures for local care
Healthcare and nursing are elements of the basic care provision of
any society. Probably the most significant socioeconomic change facing
our society is demographic change: the population is getting older
overall, and population numbers are falling. This trend starts earlier in
rural, structurally weak areas than in conurbations. Sana hospitals like
the one in Pegnitz in Upper Franconia or Bad Wildbad in the Northern
Black Forest ensure local basic and standard care in these rural regions.
To this end, they work closely with independent doctors and pursue the
integrated care, sharing joint regional responsibility with doctors and
hospitals. As a privately operated hospital, the Sana Klinik Pegnitz in the
region of Upper Franconia performs public services because the public
sector has had to scale down its commitment for financial reasons.
10
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From the company
Sana Klinik Pegnitz
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MILESTONES
• Safeguarding of local care
• Out-patient emergency care at night and at weekends
provided by an emergency doctor at the hospital
• Expansion of the range of medical services
in endoprosthetics
• Formation of the general medical training association
with independent general practitioners to ensure general
practitioner care in the region
• Employees have shared in the company’s success
in the past three years
www.sana-pegnitz.de
Sana Klinik Pegnitz: on a constant upward trend
Its acquisition by Sana Kliniken AG in September 2005 ensured the survival of the Pegnitz hospital, the
third-largest employer in the region with over 200 staff. Since then, the performance of the hospital has
been extremely positive: the number of patients is rising steadily, the headcount has been increased by
10 per cent and the hospital has even seen a new influx of new talent in healthcare careers over the past
three years. In contrast to other smaller hospital locations in Germany, the Sana Klinik Pegnitz has not been
converted to a specialist clinic in the context of privatisation. Instead, it continues to cover the full range
of basic care for the local population – including out-patient emergency care at weekends and overnight.
The range of medical care has actually been extended even further as a result of substantial investment.
The hospital’s cooperation with independent doctors is particularly intensive, ensuring optimum all-round
support for every single patient.
Sana-Kliniken Bad Wildbad: state-of-the-art location with top-class services
In the structurally weak rural district of Calw, the Sana-Kliniken Bad Wildbad are fulfilling an important care
mandate. The location specialises in rheumatology, joint surgery and endoprosthetics, and also provides
basic acute medical care. The Sana-Kliniken Bad Wildbad are the only ones in Baden-Württemberg with
an internal and orthopaedic rheumatology department – and have a care chain from out-patient care
through full or partial in-patient treatment to rehabilitation and an out-patient treatment centre. The emergency surgery opened in January 2011 at the premises of the Sana-Kliniken Bad Wildbad enable provision
care for patients outside the working hours of independent doctors. Following extensive conversion work
and as a result of cooperation with a surgery for radiology and nuclear medicine, the hospital’s services
now include state-of-the-art MRI examinations. This means that patients no longer have to travel to Calw,
Pforzheim or Karlsruhe. In addition, the new surgery has created further new jobs in Bad Wildbad.
12
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MILESTONES
• Care mandate – including emergency care –
for the western German district of Calw
• New state-of-the-art hospital – attractive for
the townscape and to employees
• Efficient process organisation: much-improved
performance combined with reduced bed capacity
• Internal emergency medical practice in close
cooperation with independent doctors
• Outstanding radiology and MRT equipment
• Provision of orthopaedic and neurological aftercare
• Employees share in the company’s success
• State-wide care mandate as the Baden-Württemberg
rheumatism centre
www.sana-wildbad.de
13
“Contracts from the hospital are a
key pillar
for local trade and SMEs in the district.”
Stable economic strength
in the region
The employment market in the hospital sector has
proved to be crisis-resistant. At regional level, Sana
hospitals create jobs for many employees, including
in rural areas. They do not have to travel far either:
on average, our hospital employees live within a
radius of five to ten kilometres of their hospital
and are often actively involved in community
life. The Sana Klinikum Hameln-Pyrmont
and the Lausitzer Seenland Klinikum are
among the largest employers in their respective regions – and among the most popular.
We always aim to create attractive conditions so that our employees can enjoy a
pleasant working environment. However,
Sana is not only a job engine, it also drives
the economy as a key customer for local
trade and SMEs. In investment projects, we
give priority to regional firms when awarding
contracts, thus increasing economic strength
in the rural districts.
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From the company
Sana Klinikum Hameln-Pyrmont
Sana Klinikum Hameln-Pyrmont: fully focused on the future
With 1,300 employees and a volume of sales amounting to EUR 85 million, the Sana Klinikum Hameln-Pyrmont
is the second-largest employer in the town of Hameln. When Sana acquired the hospital in 2009, one of its key
pledges was to expand the location and make it fit for the future. Sana invested EUR 70 million in rebuilding the
hospital. Further modernisation work totalling EUR 2 million has been carried out on the hospital campus. Regional
firms in particular have benefited from the substantial volume of contracts. In addition, through innovative services
in secretarial and office organisation, preventive healthcare and training, 35 new jobs have been created in the
region. 120 training posts in eight healthcare careers ensure long-term prospects for young people, and are also
a valuable investment in the workforce of tomorrow. Outside of the conurbations in particular, it is essential to
counter the threat of a shortage of specialist staff, which has already become a reality in some places.
of the Medical University of Hanover
MILESTONES
• Development of the healthcare campus on Wilhelmstraße
• Formation of the centre for out-patient operations
• Establishment of two medical care centres for improved
out-patient care
• Creation of 35 new jobs as a result of innovative services
• Promotion of local cultural projects
Lausitzer Seenland Klinikum: new name – new direction
Sana Kliniken AG, a strategic partner of the Hoyerswerda council in the context of a 49 per cent minority holding,
senses a special responsibility for this hospital location, both to its own employees and to the region. Lausitzer
Seenland meant more than a new name for the hospital in 2010 – it also removed the negative image of the past
and reinforced its role as the largest local employer with over 1,000 staff. Intensive negotiations with service workers’
union ver.di led to the phased introduction of the Sana Group collective agreement. As well as significantly
improved pay terms, promotion of preventive healthcare and reconciliation of career and family for employees are
also core components of the agreement. The hospital’s own medical vocational college provides 75 training posts
and takes part in numerous career-guidance measures for young people. Emergency care in the region was
noticeably improved by the rescue coordination centre opened in 2011 to supplement the helicopter landing pad
on the roof of the hospital. The hospital is therefore well-equipped to provide disaster relief in future.
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www.sana-hm.de
Lausitzer Seenland Klinikum
of the Technical University of Dresden
aa
MILESTONES
• Optimum structure for emergency care in the region
• Investment in high-performance MRI
• Creation of attractive conditions and remuneration for
employees by means of the Sana Group collective agreement
• Focus on training: numerous projects for retraining and
awards for trainees with excellent results
• Extension of cultural commitment as well as promotion
of regional projects such as the Lausitzer workshops
for employment of disabled people
!
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At
www.seenlandklinikum.de
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Krankenhaus
Hospital with
mitaZukunft
future
“With intelligent programmes for preventive healthcare and early detection, a
sustainable in-house health management
scheme can help employees and
benefit
the company.”
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ab
Valu
Active commitment in the social sphere
As the fourth-largest private hospital Group, Sana Kliniken AG also regards
corporate responsibility as its contribution to society. In this respect, the Sana hospitals
have a wide range of commitments: in over 150 social projects at all 50 hospital locations
in the areas of children and young people, culture and sport. International aid projects
are also supported, as shown by the example of the Regio Kliniken. We are also the
only private operator of hospices. As a healthcare service provider, prevention is a top
priority. For this reason, Sana hospitals such as the hospital in Remscheid have set
up programmes for health awareness and early identification of diseases such as breast
cancer and bowel cancer. We are involved in numerous cooperations with universities,
interest groups and self-help organisations.
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From the company
Sana-Klinikum Remscheid
Academic Teaching Hospital of the University of Cologne
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MILESTONES
• Focus on health awareness and preventive
healthcare for people in the region
• Support of the medical advisory centre
for mistreated and abused children
• Involvement in the youth sport programme
for running and handball
• Raising awareness of breast cancer care
for employees at the premises in the region
• Establishment of the preventive healthcare
programme relating to early detection of
bowel cancer
www.sana-klinikum-remscheid.de
Regio Kliniken
Academic Teaching Hospitals of the
University of Hamburg-Eppendorf
Sana-Klinikum Remscheid: early detection, prompt action
As a major healthcare provider, the Sana-Klinikum Remscheid is particularly committed to health awareness and
preventive healthcare in the region. The focus here is on children and young people, employees and the issue of
early detection in general. To this end, numerous cooperations have been concluded with other companies in
Bergisches Land. For example, recipients of financial support include the “Bergisches Land Medical Advisory
Centre”, which helps neglected, mistreated and/or sexually abused children and young people and their families.
Regional youth sport schemes in the field of running and handball are also supported. For employees, the hospital has successfully run a preventive healthcare programme relating to the early detection of bowel cancer.
Another focal point is breast cancer care for female employees of regional companies. With active assistance
from the Mayor of Remscheid, a patron of this campaign, female employees are informed about breast cancer
care on the premises.
Regio Kliniken GmbH: help that matters
Regio Kliniken GmbH, the second-largest hospital operator in Schleswig-Holstein, has been a Sana Kliniken AG
company since 2010 – and a very active one, too. In cooperation with the homelessness charity run by the
German church organisation “Diakonisches Werk” and the Medical Aid for the Homeless Association, its “Regio
Mobile” scheme, the only one of its kind in Germany, provides human and financial resources for out-patient care
of homeless people in the Hamburg area. With the opening of the long-planned construction of a hospice at the
beginning of 2012, Sana is fulfilling a pledge in the acquisition agreement. Working parents also receive support:
33 places are available at the hospital’s own in-house crèche in Wedel. In Elmshorn, parents can use 20 contractually secured places at the German Workers’ Welfare Association (AWO) crèche. Following the acquisition of a
nursing school with 60 students and seven teachers that was threatened with closure, nursing and geriatric care
training posts in the region have been safeguarded. And as help knows no borders, the Regio Kliniken are
involved in medical assistance for sick children in the context of the partnership between Pinneberg district council
and the Russian town of Zelenogradsk. For instance, a severely disabled girl was successfully operated on in
2010 and can now walk as a result of the operation.
MILESTONES
• Free out-patient medical care for homeless people
in the Hamburg area
• Construction of a new hospice
• Provision of in-house and local child care
for working parents
• Medical assistance in the context of an aid
project for the treatment of sick Russian children
• Retention of the closure-threatened nursing school,
thus safeguarding training posts in the region
v
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www.regiokliniken.de
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20
21
From the company
Highlights from the company
From the company
Highlights 2011
January
Physician assistants:
Sana establishes
a new career group
The first physician assistants at Sana
have successfully completed their threeyear course. They went straight on to
support doctors at the Sana hospitals in
various roles. In conjunction with Steinbeis
University in Berlin, Sana Kliniken AG
decided to establish the new occupational
profile around three years ago and
financed the first in-service physician
assistant training course in Germany.
July
September
Sana purchasing association
continues to grow
Ground-breaking ceremony
for Inselklinik Fehmarn
The Sana purchasing association continues
to build on its strong position. For the first
time, more than 500 facilities are now purchasing jointly. With an annual purchasing
volume of over EUR 1 billion, the Sana
purchasing association is one of the largest
hospital purchasing associations for medical
consumables, drugs, capital goods, food
and services. It is open to all hospital, rehabilitation facilities and nursing facilities –
regardless of their ownership.
Start of construction work on Fehmarn: The Sana
Kliniken Ostholstein are ensuring the provision of
medical care on the Baltic island with the construction
of the island hospital. From April 2012, a 30-bed
ward complete with a modern x-ray system and
operating theatre will be available to patients. The
medical services are focused on surgery, internal
medicine and anaesthesia.
October
Award for outstanding
patient satisfaction
June
Increase in equity
At the annual shareholders’ meeting on 21 June, the 31 shareholders
from among the leading private health insurance companies approved an
equity increase amounting to EUR 160 million. Consequently, the equity
base has increased to EUR 530 million.
August
February
Sana wins seal of approval as
“Munich’s best employer 2011”
Sana Kliniken AG was rewarded for its
outstanding quality and attractiveness
as an employer at the employer awards
held for the first time in the Munich area.
Sana achieved top marks for commitment to performance, quality and
customer service. The team spirit and
sound cooperation between employees
were also highly commended.
22
November
Top position for Pinneberg
rehabilitation centre
The Regio Kliniken rehabilitation centre in
Pinneberg is one of the best rehabilitation
facilities in Germany. The German statutory
pension insurance scheme (DRV) reached
this conclusion in its quality assurance
report. With 91.9 points out of a possible
100, the rehabilitation centre is way above
the German average of 75.5 points. Thera
peutic care was rated particularly highly.
Eight hospitals in the Sana Group won Techniker
Krankenkasse’s “Klinikus award” for above-average
patient satisfaction. The Sana hospitals in Benrath,
Nuremberg, Regensburg, Solln, Sommerfeld, Stuttgart, Schwarzenbruck and Wedel scored well above
the German average in all five relevant categories.
Overall, more than 204,000 patients took part in the
survey.
Sana hospitals receive
“GenoFutura Award”
The Sana Kliniken Ostholstein and the Sana
Klinikum Hof were two of the ten organisations
in Germany to receive the “GenoFutura Award”
for innovative solutions in collaboration between
public-sector institutions, regional business
and local people. The Sana Kliniken Ostholstein
were awarded the prize for the forward-looking,
cooperative design of the Inselklinik Fehmarn,
and the Sana Klinikum Hof received it for its
regional lighthouse project “Forum Gesundheit”
(Forum Health).
December
Sana impresses with its
family-oriented staff policy
The “Local Alliance for Families in Rügen”, with
over 30 partners, named the Sana Krankenhaus
Rügen the “most family-friendly company”. In
particular, the jury was impressed by the individual
working time models and the efforts to set up a
local day-care centre for children with extended
opening hours in Bergen. An employee-friendly
and family-oriented staff policy is part of Sana’s
business philosophy and one of the key factors
in competition for qualified specialist staff.
23
From the company
Foreword by the Chairman of the Supervisory Board
Report of the Supervisory Board
Report of the
Supervisory Board
“It’s all about
the balance”
Foreword by the Chairman
of the Supervisory Board
Dr Josef Beutelmann
Chairman of the Supervisory Board of Sana Kliniken AG
Whenever the coffers are supposedly full, the wish-lists in the healthcare sector always seem to get longer. A
multibillion health fund always triggers a reflex in hospitals, independent doctors, pharmacies and industry to point
to past savings and ask for extra funding. Apart from the fact that reserves in the health fund are probably only
there for a short while, what tends to be forgotten is that people are stretched to the limit with contributions to
finance healthcare services. This applies to those with statutory and private health insurance alike, and to the
state as a potential financier, at least if declarations regarding the debt limit are taken seriously.
The possibilities on the credit side are therefore limited, and patients and their relatives are uncompromising in
their expectations regarding performance, quality and service. Waiting times at doctors’ surgeries and emergency
rooms is a subject which is under discussion again and again. People come out onto the street if “their” hospital
is threatened with closure. Some might say that this sense of entitlement is exaggerated, especially in view of
healthcare systems in other countries. However, the debate is ultimately futile, as it cannot be resolved politically
and those affected cannot be expected to lower their expectations. The product of “healthcare” follows its own
rules, which are different from those of the other public services. Medical progress goes the extra mile to constantly
push back the boundaries of possibility.
What we need, then, are players who face up to this situation of rising expectations and costs on the one hand
and limited funds on the other, push through structural alternatives even in the face of resistance and constantly
balance the complex interests of patients, customers, employees and the public.
Sana Kliniken managed this superbly once again in 2011. The Group’s hospitals did not need any taxpayers’
money to wipe out deficits. On the contrary: the company pays taxes itself. Our hospitals have improved the range
and quality of their services even more. Our commitment to transparency is embodied in our quality portal. And
acceptable solutions have been found, including to difficult questions regarding the balance between economic
necessity and the justified interests of staff.
More entrepreneurship, more private involvement, clear values – these are all viable answers to the pressing
questions concerning the future of our healthcare system.
Sana Kliniken AG again performed successfully in a challenging hospital environment in 2011. In addition to
integration of the facilities purchased in the previous year, business activities in the financial year were centred on
the continuation and initiation of optimisation programmes in existing facilities. Corporate development in the past
year was also characterised by establishment of the essential equity conditions for further growth.
In 2011, the Supervisory Board again fulfilled its statutory monitoring obligation and also advised the Management
Board on the strategic enhancement of the Group and on key individual measures. At four meetings and in
additional written and verbal reports, the Management Board promptly and extensively informed the Supervisory
Board on the results, financial position, business policy, acquisition plans, staff development issues, risk management, quality management and corporate planning of the companies of the Group. On the basis of documents
sent out in advance, the Supervisory Board intensively prepared for the meetings and examined, questioned and
assessed the issues presented. On the basis of the detailed submissions of the Management Board, advice was
given and decisions made regarding all legal transactions that required the approval of the Supervisory Board by
law or in accordance with the articles of association. Individual urgent resolutions were passed by means of the
circulation procedure. In addition, the Chairman of the Supervisory Board and the Chairman of the Management
Board regularly exchanged information on current developments and the business situation of Sana Kliniken AG.
Work of the committees
In addition to the work carried out within the entire Supervisory Board, specific issues were discussed and dealt
with in the context of the established committees. In the Personnel Committee, which met three times in the financial
year, matters including the employment contracts of the members of the Management Board were discussed and
corresponding resolution proposals were submitted to the Supervisory Board. Dr Markus Müschenich asked for
his contract to be terminated with effect from 30 June 2012. We would like to thank him for all that he has done.
The Audit Committee met once per half-year in the presence of the auditor. The first meeting focused on discussion of the 2010 annual financial statements as well as the annual reports of the audit and risk management
departments. At the second meeting, key issues relating to the audit of the annual financial statements were
coordinated with the auditor, and progress regarding the effectiveness of the internal control system and enhancement of audit activities and risk management were discussed. The auditor reported on the positive results of the
voluntary audit of the Group’s risk management system pursuant to Section 91 of the German Stock Corporation
Act. According to these results, Sana Kliniken AG fully complies with the statutory requirements.
Implementation of the compliance system carried out by the Management Board in 2011 was also discussed.
The Audit Committee examined the independence of the auditor and requested and received declarations of independence from the consolidated annual financial statements and from the auditing companies of the subsidiaries.
No meetings of the Mediation Committee formed in accordance with Section 27 (3) of the German Co-determination Act were required again this year.
Main focal points of deliberations
Yours sincerely
Dr Josef Beutelmann
Chairman of the Supervisory Board of Sana Kliniken AG
Chairman of the Board of Directors of Barmenia Versicherungen
24
The discussions of the Supervisory Board and Management Board centred on the opportunities and risks of
business development at Sana Kliniken AG. In intensive deliberations regarding the strategic alignment of the
Group, the key pillars were discussed with the Management Board. These included preparations for the biggest
capital increase measure in the history of Sana Kliniken AG. On the recommendation of the Management Board
and Supervisory Board, an equity increase of EUR 160 million was adopted at the ordinary annual shareholders’
meeting on 16 June 2011. Consequently, Sana Kliniken AG has a very sound financial base for future growth and
acquisitions regardless of the challenging capital market environment.
25
From the company
Report of the Supervisory Board
Executive bodies
With regard to the development of business operations, deliberations focused on the EHEC crisis and particularly
its impact on the Sana hospitals in the north of Germany. The economic impact was considerable. In its quarterly
reports, the Management Board set out the measures with which it is countering these and other challenges in
order to safeguard the results of the facilities affected.
In addition, the Group’s activities on the acquisition market and the strategic positioning of the investment portfolio
of Sana Kliniken AG featured in the discussions. At November’s meeting, the company’s multi-annual planning
process was explained by the Management Board and discussed and adopted by the committee.
In view of the worsening shortage of specialist staff, particularly in the area of medical and nursing staff, the Supervisory Board also dealt with the company’s personnel management in 2011. Particular reference is made to the
conclusion of pay negotiations with the trade unions here.
Changes to the make-up of the Supervisory Board
All shareholder representatives were re-elected to the Supervisory Board at the annual shareholders’ meeting on
16 June 2011. The long-standing member of the Supervisory Board of Sana Kliniken AG and Deputy Chairman,
Mr Günter Dibbern, was succeeded by Ms Silke Lautenschläger, member of the Management Board of DKV
Deutsche Krankenversicherung AG. We would like to take this opportunity to thank Mr Dibbern for his many years
of loyal and constructive commitment. Mr Wilfried Johannßen and Mr Axel Kampmann also stepped down from the
Supervisory Board. Our thanks also go to them for all that they have done. They were succeeded by Mr Christian
Molt, member of the Management Board of Allianz Private Krankenversicherungs-AG, and Mr Wolfgang Reif,
member of the Management Board of Bayerische Beamtenkrankenkasse AG.
Our Supervisory Board member and associated professor Dr Mohammad Maghsudi passed away in October after
a short illness. Dr Stefan Paech, head of the Medical Strategy division of Sana Kliniken AG, was appointed by the
court as his successor for the remainder of his term. The Supervisory Board and Management Board wish to
express their gratitude for Dr Maghsudi’s contribution to the company. He will be greatly missed.
The separate and consolidated financial statements, the management report and the Group management report
have been examined and issued with an unqualified audit opinion by the auditor, Ernst & Young GmbH Wirtschafts
prüfungsgesellschaft, Stuttgart.
The cited documents and the proposal of the Management Board for appropriation of the net profit were submitted
by the Management Board in good time. They were discussed in-depth by the Audit Committee on 27 March 2012.
The audit reports of Ernst & Young GmbH Wirtschaftsprüfungsgesellschaft, Stuttgart, were available to the
members of the Supervisory Board and were discussed extensively at the accounts meeting of the Supervisory
Board on 17 April 2012 in the presence of the auditor, who reported on the material results of his audit.
We agree with the results of the audit of the financial statements. No objections were raised against the final
results of the audit by the Audit Committee or our own examination.
We approve the separate financial statements and consolidated financial statements prepared by the Management Board. The annual financial statements of Sana Kliniken AG are thereby adopted. After the audit, the Supervisory Board endorsed the proposal of the Management Board on the appropriation of net profit.
In the 2011 financial year, Sana Kliniken AG again followed up the successful performance of previous years. The
business model constitutes a convincing alternative for municipal and non-profit hospital operators. As part of the
Sana Group, the facilities are constantly advancing both medically and economically. Foundations for forwardlooking hospitals are laid with a clear commitment to quality and transparency. The outstanding commitment of
our employees is the essential ingredient here.
We would therefore like to thank everyone who contributed to our success in 2011 for their work and dedication in
the past financial year.
Ismaning, April 2012
For the Supervisory Board
Audit of the separate and consolidated financial statements
The Management Board prepared the annual financial statements and management report of Sana Kliniken AG
in line with German accounting standards. In addition, it prepared the consolidated financial statements and
Group management report in accordance with Section 315a of the German Commercial Code on the basis of the
international financial reporting standards (IFRS).
Dr Josef Beutelmann
Chairman of the Supervisory Board
Executive bodies
Management Board Supervisory Board
Dipl-Kfm Dr Michael Philippi,
(CEO), Cologne
Dipl-Kfm Thomas Lemke,
(CFO), Dresden
Dr med. Markus Müschenich,
Member of the Management Board,
Berlin (until 31 January 2012)
Mag. rer. soc. oec. Jan Stanslowski,
and Labour Relations Director,
Dresden
26
Chairman
Director General
Dr h. c. Josef Beutelmann,
Chairman of the Management Board,
Barmenia Krankenversicherung a.G.,
Businessman, Wuppertal
1st Deputy Chairman
Gabriele Gröschl-Bahr,
Trade Union Secretary,
ver.di Bundesverwaltung, Berlin
2nd Deputy Chairman
Director (retired) Günter Dibbern,
Economist,
Cologne (until 16 June 2011)
2nd Deputy Chairman
Director Silke Lautenschläger,
DKV
Deutsche Krankenversicherung AG,
Lawyer, Modautal (from 16 June 2011)
Bodo Bachmann,
Anaesthetist, Klein Wesenberg
Margitta Bergmann,
Specialist Surgical Nurse,
Bergen/Rügen
Director Dr Karl-Josef Bierth,
Signal Krankenversicherung a.G.,
Mathematician, Herdecke
Wolfram Ferse,
Trade Union Secretary,
ver.di Bundesverwaltung, Berlin
Director (retired) Axel Kampmann,
Insurance expert,
Schwanstetten (until 16 June 2011)
Dr Stefan Paech,
Consultant Surgeon,
Erkelenz (from 17 November 2011)
Beate Fleischmann,
Specialist in Anaesthesia
and Intensive Care Nurse, Oldenburg
Christian Ketterl,
Anaesthesia Nurse, Oberkotzau
Director Wolfgang Reif,
Bayerische Beamtenkrankenkasse AG,
Lawyer, Munich (from 16 June 2011)
Director Rolf Florian,
Debeka
Krankenversicherungsverein a.G.,
Businessman, Dieblich
Director Wilfried Johannßen,
Allianz
Private Krankenversicherungs-AG,
Mathematician
Munich (until 16 June 2011)
Ramona Linne,
Lecturer in Medicine, Berlin
PD Dr Mohammad Maghsudi,
Head Physician, Eutin
(until 16 October 2011)
Director Heinz Jürgen Scholz,
Continentale Krankenversicherung a.G.,
Mathematician, Zirndorf
Director Christian Molt,
Allianz
Private Krankenversicherungs-AG,
Business Mathematician,
Munich (from 16 June 2011)
Director Professor
Dr Ernst-Wilhelm Zachow,
Chairman of the Management Board,
Landeskrankenhilfe V.V.a.G.,
Mathematician, Lüneburg
27
From the company
Shareholders
Shareholders
of Sana Kliniken AG
Unique on the German hospital market
With 31 private health insurance companies as shareholders, Sana Kliniken AG has a special place on the German
hospital market. In the 1970s, soaring costs and deficits in the hospital sector made private health insurance
companies realise that action was required to counter this development with Sana’s help. Sana Kliniken was
established in 1976 with the enduring aim of being a hospital group that succeeds through integration and cooperation. Its strategy is centred on sustainable operations at all levels. Private health insurance companies believe
that patients should expect a fair return for the insurance premiums that they pay. The success story of Sana is
closely linked with that of the German Association of Private Health Insurers (PKV). This is an umbrella organisation of 43 health insurance companies that provide their policyholders with a diverse, integrated and stable
network of health services.
Commitment born of conviction
The high level of responsibility when dealing with the conflicting priorities of healthcare is reflected by the principle
of value-oriented corporate management. There is a long tradition of social involvement both at Sana Kliniken and
among its shareholders. The private health insurance companies have been committed to AIDS prevention and
better living conditions for patients infected by HIV since the 1980s. The PKV is a founder member of the German
Aids Foundation, which was created in 1987 and continues to help sufferers individually and through project funding amounting to almost EUR 35 million. Since 2005, the private health insurance companies have also been the
main supporter of the Aids prevention campaigns of the German Federal Centre for Health Education (BZgA).
Between them, this federal agency and the German AIDS Foundation receive EUR 3.5 million from the PKV for
their work. With this commitment to combating the further spread of the Aids virus, the private health insurance
companies and the BZgA are also an internationally respected example of an effective public-private partnership.
In recent years, rates of new infections in Germany have stabilised at a high level: together with Finland, Germany
has the lowest rates of new infections in Europe.
With Sana Kliniken as a strategic holding, the private health insurance companies play a crucial role in enhancing
healthcare provision. Patient-oriented, economically efficient and high-quality management of hospitals will
continue to form the basis for Sana’s corporate success in future. We would like to thank our shareholders for the
confidence they have shown in us for the past 30 years.
Major impetus for innovations
As well as a guarantor of high quality, the PKV also regards itself as a source of impetus for innovations. Good
ideas are actively encouraged and pursued. One example of a corporate success story is the development of
Sana’s purchasing association (Sana Einkaufsverbund). With an annual purchasing volume of over EUR 1 billion,
it has become a major purchasing association for capital goods, medical consumables, drugs, food and services.
In view of falling public investment subsidies, the Sana purchasing association uses its management potential to
make high-end medical technologies economically viable in rural regions, thus strengthening the hospitals’
competitive position. Market-oriented contract negotiations with suppliers and service providers ensure attractive
purchasing conditions for the hospitals. In addition, the Sana purchasing association makes a major contribution
to increased efficiency at the hospitals with process optimisation projects. The quality of the medical technology
and pharmaceutical products is closely linked with the high level of medical treatment provided by all our hospitals
throughout Germany. For this reason, the Sana purchasing association insists on using highly efficient partners in
its dealings with manufacturers, thus ensuring continuity, supply capability and investment security at all times.
28
Shareholder structure of SANA Kliniken AG
21.7 % DKV
14.5 % SIGNAL
13.8 % Allianz Private
10.1 % Continentale
10.1 % Debeka
4.2 % Deutscher Ring
3.7 % Barmenia
21.9 % 24 other private health insurance companies
29
From the company
Highlights from medicine and science
From medicine and science
Highlights 2011
February
September
First use of a selfdissolving implant
New approaches to a cure for breast cancer
At the Sana-Herzzentrum Cottbus,
a biodegradable double-umbrella
system was used to treat a hole in
the cardiac septum of a stroke
patient for the first time ever. In this
procedure, under ultrasound and x-ray
control, a folded mini-umbrella was pushed
via a thin catheter through the venous blood
vessel in the groin through to the atrium, where it is opened up
in order to completely occlude the defect. When the double-umbrella
system has become settled in the cardiac septum and has been covered
by body tissue, it almost completely dissolves within two years. This
is expected to lead to fewer reactions from foreign bodies.
July
Clinic for paediatric
surgery opened
The Sana Klinikum Lichtenberg opened
a new clinic for paediatric surgery. It particularly specialises in operations on newborn
and premature babies as well as paediatric
urology. The paediatric surgery clinic works
closely with the hospital for paediatric and
adolescent medicine in Lindenhof. The
medical and nursing team has an interdisciplinary make-up in order to ensure optimum care for the young patients.
March
The University Clinic for Obstetrics and Gynaecology at CaritasKrankenhaus St Josef and the Clinic for Radiotherapy at the University Hospital in Regensburg established a new method for breast
cancer treatment: radiotherapy is performed during the operation in
the surgical cavity. Consequently, depending on the risk situation,
the otherwise common partial breast radiotherapy can either be
ended altogether or at least reduced over a period of seven weeks.
October
Award for the Sana Klinikum Hof
The German Society of Urology again awarded
a 1st prize to the Sana Klinikum Hof. This time,
an operating procedure for treatment of urethral
disorders developed in Hof was rewarded. Since
1997, the urological team headed by senior consultant
Dr Hansjörg Keller has already won ten scientific awards –
all for the new development or improvement of operating
procedures for prostate cancer and urethral stricture.
New minimally invasive method
to combat cerebral haemorrhage
Innovative operating technique
with a gentle saline solution
September
EHEC: Sana Kliniken demonstrates
outstanding capabilities
The EHEC virus posed a challenge to the Sana hospitals in northern
Germany. The Regio Kliniken, the Sana Kliniken Lübeck, Ostholstein
and Rügen, the OsteMed Kliniken and the imland hospitals in Rendsburg
and Eckernförde were involved in crisis management for the care of EHEC
patients between mid-May and the end of July. More than 300 patients
underwent in-patient treatment at the Regio Kliniken alone in this period.
Thanks to the dedicated work of the employees at all hospitals, the crisis
management proved successful in spite of all the challenges.
30
23 Sana doctors on the
Focus doctors list in 2011
Every year, in close collaboration with
specialist medical firms, Focus magazine
names the top 1,500 doctors in Germany
in various categories such as heart, joints,
cancer and high blood pressure. 23 doctors in the Sana Group were on the list in
2011. The evaluations were based on
over 27,800 recommendations from doctors and patients, interviews with experts,
self-help and sport rehabilitation groups
as well as physiotherapists. Focus also
assessed the medical specialist articles
in the international medical database
PubMed on the past five years.
Award of the Sana
Science Prize in 2011
A new operating method at the Sana-Klinikum Remscheid called the
coiling technique enables minimally invasive interventions in the brain
under x-ray control. In this way, life-threatening eversions on the
brain cell walls can be treated without the patient having to undergo
a complex brain operation.
June
November
Premiere: live broadcast
of a heart operation to China
A heart operation in Germany was broadcast live to China for the first time ever.
Two patients received a new heart valve
via the leg artery at the cardiovascular
centre in Oberallgäu-Kempten at the
Immenstadt location. Around 50 doctors
at Tongji University in Shanghai followed
the operations by video conference.
“Percutaneous aortic valve replacement”
has only been performed twice in China
to date, in Beijing.
“Salient seal” is the name of a new operating technique that is gentler
and less painful and ensures faster recovery. To date, only two joint
surgery hospitals in Germany use this gentle operating concept. One
of them is the hospital for endoprosthetics and joint surgery in Bad
Wildbad. Wounds can be sealed better than before with “salient seal”
because the instrument significantly reduces bleeding.
Sana-Klinikum Remscheid expands TCM
The Sana-Klinikum Remscheid is the Academic Teaching Hospital
of Zhejiang Chinese Medical University in the megacity of Hangzhou,
one of the most prestigious universities
in China. The teaching hospitals there
specialise in traditional Chinese medicine (TCM). With this cooperation, the
Sana hospital is responding to many
people’s desire to integrate recognised
alternative medicine methods in traditional healthcare.
Awarded annually since 2009, the Sana
Science Prize recognises work in the fields
of clinical, care, nursing or basic research.
In 2011, it went to two outstanding doctors
and their teams from the Herzzentrum
Dresden University Hospital and the Sana
Kliniken Sommerfeld. Prof. Ruth
Strasser and Dr Alexander
Beier were rewarded for
their forward-looking
research projects in the
fields of cardiology and
endoprosthetics.
31
From the company
Quality and innovation management
Quality and innovation
management
Demographic development in Germany up to 2060
100
100
100.0
97.5
8080
94.3
90.0
84.6
78.8 1)
6060
4040
2020
0
1)
le
inab
a
t
s
Su
cal
medi egy
t
stra
Medical targets, strategies
and spheres of activity
Proactive portfolio management as a success factor
Demand for medical care of the population is rising and changing dynamically. Combined with fast-paced innovation and intense competitive pressure, this requires hospitals to enhance their processes, services and supply
structures proactively and consistently. Sana Kliniken AG is meeting these challenges with a sustainable medical
strategy.
Staying forward-looking and competitive as a hospital in the long term means optimising the use of resources and
taking up a position as an attractive employer. Another crucial factor is continuous portfolio and innovation
management that takes demographic change, medical technology development and changing socio-economic
conditions into account through demand-oriented services. Medical factors critical to success include:
• Innovative
examination and treatment methods (non-invasive diagnostics, interventional and minimally
invasive treatment methods and telemedicine)
• Creation of focal points and centres
• Interdisciplinary patient management and highly efficient processes (admission and discharge management,
diagnostics and operations)
• Availability and retention of highly qualified staff (doctors, medical assistance professions, specialist nursing
and nursing assistance professions/service staff)
• Integration with upstream and downstream service providers.
20.4
23.3
2008
2020
28.8
32.1
33.1
34.0
2030
2040
2050
2060
Total population in %
65+ in total population in %
Source: German Federal Statistical Office, 2009
Trends and challenges for the medical services offered by hospitals can be derived from this:
1. E
nhancement and adaptation of the range of services and supply structures to the special
needs of older patients
2. Significant increase in malignant new growths (in particular prostate cancer, bowel cancer
and breast cancer), resulting in the need for enhancement of centre structures and multimodal
treatment concepts
3. Increase in interventional/minimally invasive procedures and interdisciplinary care concepts
in cardiovascular medicine
4. G
rowing need for care in the case of neurological and psychiatric illness (especially stroke,
depression, geriatric psychiatry) and consequently the expansion of specialised care structures
(in particular stroke unit and teleneurology)
5. Increase in holistic, early mobilisation therapy methods (fast-track concepts) in abdominal
surgery and orthopaedics (endoprosthetics and spinal column therapy)
6. Increasingly widespread use of modern and innovative monitoring and assist systems,
especially in local basic and standard care through use of technologies such as telemedicine,
telemonitoring and telenursing
Change in the range of In-patient services up to 2030
Total diseases
Cardiovascular diseases
Neoplasms
Digestive diseases
Injuries and poisoning
Musculoskeletal disorders
Respiratory diseases
– 7.2 %
– 22.4 %
11.8 %
34.2 %
20.9 %
13.7 %
10.0 %
9.9 %
11.5 %
Psychological and behavioural disorders
Pregnancy, Birth, Postpartum period
The growing demand for in-patient hospital services chiefly results from the substantial increase in chronically
ill elderly population groups (80+), often with pre-existing secondary diseases and restrictions. There are also
socio-demographic factors and lifestyle changes (increase in obesity, diabetes and lack of exercise), the advancement of medical technology and rising expectations of the quality of medical care.
32
33
From the company
Continuous medical strategy process
To support implementation of the strategic aims in the Sana facilities on a long-term basis, a continuous medical
strategy process has been established at Group level. This comprises the annual structured analysis, evaluation
and data provision for the facilities with regard to the range of services, performance development, care structures
and competitive position. Medical technology trends are also taken into account in the context of a portfolio
analysis.
mum
Maxi al
c
medi ncy
ie
effic
The medical strategy process, first introduced in 2009 as part of the Group-wide corporate development, is now
firmly established as a management and controlling tool at Group and facility level, and is continuously enhanced.
For instance, in 2011, a specially developed analysis and monitoring tool (called the Sana management cluster),
based on the DRG settlement system (Diagnosis Related Groups) was introduced. It groups together medically
homogeneous DRG profiles and delivers key advantages when analysing the range of medical services in terms
of medical strategy.
The aim is a 360° view of the hospitals. To achieve this, we expand and complete the analysis horizon in the interest of integrated strategic reporting. Action is still required here in putting together the results of the efficiency and
portfolio analysis with further data sources on the quality of structures, processes and results (for example, data
on quality assurance, outcome parameters and patient and referring physician satisfaction).
To support the demanding change processes at the facilities, we have established a central project group (cardiovascular medicine strategy team) and charged it with setting up a holistic, future-oriented cardiovascular medicine
care concept. This includes the enhancement of regionally integrated cardiovascular medicine services and care
structures, and combines the various requirements from university medicine to basic and standard care in an
interdisciplinary approach.
Medical change based on the example of Sana Cardiac Medicine
Treatment of cardiovascular diseases accounts for a large proportion of Sana’s range of services.
The central areas of development and innovation of Sana Kliniken in cardiovascular medicine include minimally
invasive operating techniques and interventional procedures in heart valve therapy as well as new approaches to
the treatment of severe heart failure. 2011 saw the world’s first clinically successful use of a postoperatively
adjustable mitral valve ring – a milestone in interventional cardiology.
Cardiovascular medicine Sana 2011
Range of services
Share of revenue
78.9 % Sana total
17.7% Cardiology
3.4% Angiology
Heart diseases:
operative
conservative
interventional
Vascular diseases:
operative
conservative
interventional
36%
23%
25%
13%
2%
1%
In view of its great significance to patient care, a standalone stroke concept has been developed in the area
of cardiovascular medicine by an interdisciplinary project group. This focuses on the further expansion of comprehensive stroke treatment (only 45 per cent of the 11,000 stroke patients in 2010 received comprehensive treatment) as well as improved diagnostics including links between teleneurology and teleradiology centres in order to
ensure high-quality, extensive care. Sana Kliniken facilities are particularly involved in developing and introducing
innovative interventional catheter techniques for the treatment and removal of intracranial clots or vascular
occlusions. One example of this is the work of Prof. Brassel at the Klinikum Duisburg.
Geriatric medicine as an example of medical change
Demand for in-patient services is set to rise considerably in cardiovascular medicine this decade. This particularly
relates to chronic heart failure, heart attack, stroke, cardiac arrhythmia and valvular heart diseases. In terms of
vascular diseases, the number of peripheral blood flow disorders and constrictions of the carotid artery requiring
treatment is rising significantly.
In addition to a major increase in capacity requirements in diagnostics and treatment, further challenges stem
from the dynamic enhancement and spread of minimally invasive and telemedicine technologies and innovations
in cardiovascular medicine and from the intensification of interdisciplinary collaboration of cardiology and cardiac
surgery, for which the essential structural elements have already been put in place with the early establishment of
hybrid operating theatres at the Sana cardiac centres.
34
As a result of demographic change, the number of elderly patients is set to rise sharply in future. Back in 2010,
with this development in mind, we used our geriatric medicine care concept to define the need for adaptation and
action at the Sana facilities with regard to services and care structures in order to respond to the special requirements of older patients.
There is key potential for improvement in identifying patients with special geriatric medicine care requirements as
early as possible. For this reason, we have developed a corresponding screening procedure with which this
patient group can be identified at a very early stage, ideally at the time of admission. The procedure is currently
being evaluated in two pilot projects. We mainly expect optimisations in the quality of medical treatment and processes, resulting in reductions in complications and stays in hospital and improvements in discharge management.
35
From the company
Added value through integrated care
In view of population trends, specialist staff shortages and the current situation of the healthcare industry, there is
a growing need for integrative care forms. Sana is already extremely active in this area. The following examples
show projects from the medical care centres (MCC)/health centres, obesity treatment with self-help, cooperations
with doctors’ networks, private and statutory health insurance companies to strengthen regional care structures,
and telemedicine.
1. Rinteln MCC: out-patient medical care in the countryside
and family-friendly part-time working models
Gesundheitseinrichtungen Hameln-Pyrmont GmbH and the Sana Kliniken Hameln-Pyrmont are strengthening
comprehensive healthcare in more rural regions through the Medical Care Centre (MCC) in Rinteln. Because the
hospital is integrated with the MCC, the population receives local care from specialist hospital staff on a long-term
basis. The MCC covers the two fields of obstetrics/gynaecology and orthopaedics/accident surgery.
Both specialist doctors work on the basis of part-time working models in the hospital and at the MCC, approximately 25 kilometres away. This service approach is supplemented by the two female specialist doctors who work
in the obstetrics department on a 50 per cent in-patient and out-patient basis. Therefore, all specialist doctors at
the MCC can also work with their patients at the hospital. This care approach is very well received by everyone
involved, and benefits the hospital and the MCC both medically and commercially.
“Dünkeloh” cottage hospital
2. Development of the “Dünkeloh” cottage hospital
by the Sana-Klinikum Remscheid
With the purchase of the 100-year-old Dünkeloh hospital in the centre of the city of Remscheid in 2010, the
Sana-Klinikum Remscheid faced the challenge of continuing the tradition of the hospital with a new direction. The
concept of the health centre at Dünkeloh hospital combines modern out-patient care forms with the previous
specialist fields of the hospital.
At the Dünkeloh hospital, Sana now runs its own MCC, several specialist group practices and the “Bergisches
Land Obesity Centre”. In the area of in-patient proctological care, the “Coloproctology Centre” has been established with the Sana hospital. There has been an extremely positive response from patients as well as the local
general practitioners and specialist doctors.
In this way, Sana is making an innovative contribution to safeguarding local out-patient care with improved in-patient
support with the reorganised Dünkeloh hospital.
orks
w
t
e
N
he
or t
f
t
i
f
re
futu
“Sana slim and healthy” – the anti-obesity programme
The “Obesity Centre – A Pilot Project of Sana Kliniken AG Bergisches Land” started work at the former Dünkeloh
hospital in Remscheid in 2010/11. A multimodal programme that fully prepares participants for an obesity operation
was developed with the doctors of the Sana-Klinikum Remscheid.
Throughout the 12-month programme, the coordinator of the obesity centre is the contact for all doctors, therapists,
cost units and participants involved. In addition, the centre is a meeting place for self-help groups, a point of contact
for interested parties and the communication and information headquarters for obesity issues. More than 20
patients have been operated on so far, and more than 70 patients are being prepared for an operation.
A key factor in successful implementation of the programme is the build-up of very close cooperation with independent doctors and therapists. This enables delivery of cross-sector care that incorporates conservative out-patient
treatment throughout the programme as well as the in-patient operation.
For 2012, there are plans to establish obesity centres at further Sana locations in North Rhine-Westphalia with
self-help groups and patient advice.
36
37
From the company
3. S
ana as a development partner for a regional care network of doctors,
health insurance companies and cost units
In its reports, the German Advisory Council for Concerted Action in Healthcare constantly concludes that the lack
of interdisciplinary care is one of the biggest problems with the German healthcare system. To provide a solution
to this problem in future, independent doctors grouped together in a development association and Sana Kliniken
Ostholstein GmbH set up a health network called Gesundheitsnetz östliches Holstein Management GmbH (GÖH).
The development association and Sana Kliniken Ostholstein each have a 50 per cent stake in GÖH. The
Ostholstein district is situated in eastern Schleswig-Holstein and has around 204,000 inhabitants.
ative s
v
o
n
e
In
logi
o
n
h
tec
The regional players in the healthcare industry are systematically integrated in GÖH. Together with the service
providers in the region, it identifies regional care deficits, develops cross-sector care concepts and conducts
related financing negotiations with the health insurance companies.
Examples of projects in 2011:
• Improved care of depressed patients through treatment paths coordinated between the out-patient
and in-patient service providers (integrated care contract). These paths lead to earlier detection
and targeted treatment of depression.
• Development of a drug recommendation list coordinated between the out-patient and in-patient
prescribers with approximately 400 preparations and defined decision-making criteria. This coordination
of preparations increases prescription consistency and saves costs (care contract with AOK North-West
and the Schleswig-Holstein Association of Statutory Health Insurance Physicians).
• Opening of a nursing advisory body that offers advice on coordination of local nursing care as well
as regularly organising information events and projects on various aspects of nursing.
4. Telemedicine for a basic care hospital
The Sana Krankenhaus Templin shows how basic care facilities can also have a modern approach. One successful example is the use of telemedicine. The diagnostic and therapeutic possibilities in a sparsely populated rural
area are considerably increased with telemedicine.
365 days a year, 24 hours a day, findings from radiological scans are prepared at tremendous speed, in no less
than an hour. Teleradiology in Templin is based on digital medical records and x-ray and CT scans. The scans and
findings can be viewed on every computer in the hospital.
The “heart” of teleneurology is the video conference workstation at the Templin rescue centre, through which
stroke patients receive help four or five times a month by means of videoconferencing. A connection with
colleagues at Trauma Hospital Berlin (UKB) is set up in just a few minutes. In this way, the Sana Krankenhaus
Templin draws on the expertise of a national stroke unit with experienced vascular and neurosurgical specialists
who carry out approximately 7,000 diagnoses per year.
ient
Effic ital
hosp sses
e
proc
38
The UKB neurologist focuses the high-resolution camera on the workstation at the Templin rescue centre. He can
zoom in on the patients so closely that even their pupil reactions can be examined, among other things. Having
an expert and doctor on site thus saves valuable time for treatment.
Older patients in particular appreciate being treated locally and close to their relatives instead of having to be
relocated. The key argument in favour of Sana’s teleneurology activities is the increase in treatment quality.
The teleneurology link-up of the Sana Krankenhaus Templin is also reflected in DRG revenue and is therefore
economically viable. Through the collaboration with the UKB, the Sana hospital now has a fully utilised special
stroke patient room with two beds in the internal medicine unit.
39
From the company
Patient safety as a success factor –
quality and clinical risk management in 2011
evel
l
High tient
a
of p ety
saf
Sustainable quality and clinical risk management is increasingly becoming a strategic success factor for hospitals.
Increasing patient safety during hospital treatment is currently a big issue worldwide. The facilities of Sana
Kliniken AG started introducing a clinical risk management system back in 2007 following an inventory with initial
risk audits.
Systematic quality development
Key elements such as complaint management, representative patient and referring physician surveys or an audit
system are established at all hospitals. Since 2008, all hospitals have had a certified quality management system
in line with the KTQ procedure. Quality is thus verifiably documented from patient admission to discharge at every
hospital. The first six hospitals were recertified by the end of 2011. All the others already have an agreed date for
recertification.
To improve on the level attained, the hospitals are being prepared for certification in line with DIN EN ISO 9001
after KTQ recertification. In this respect, we are incorporating the management processes of the hospital more
intensively and combining the introduction process with the establishment of an internal control system. Conceptual preparations for this are complete and an implementation plan is in place.
Patient safety in the Group
The hospitals have been improving continuously since the initial risk audits were performed. This was proved
emphatically in the 12 clinical risk audits completed in 2011. In all hospitals, 1,786 additional preventive measures
were undertaken in order to make clinical processes increasingly safe.
One example of a high level of patient safety in the Sana Group is the Sana Klinik Pegnitz. It was honoured for its
successful implementation of preventive measures in the context of patient safety by the risk consultants GBR. In
particular, the auditors praised the high standards in emergency admissions and the organisation of operations.
Patient safety is mapped on the basis of 21 of the relevant issues in the online portal Qualitätskliniken.de. Since
the results were published for the first time in 2010, the Group-wide overall score has risen from a 69.0 per cent
attainment rate to 86.4 per cent.
The improvement in the single indicator “morbidity and mortality conferences” was particularly impressive.
Morbidity and mortality conferences constitute a highly significant tool for improving patient safety, albeit one that
is still relatively uncommon in Germany. They are used for retrospective interdisciplinary critical processing of
severe and complicated disease progressions or unexpected deaths. Measures to improve safety in patient care
are derived for the future from the findings jointly obtained here.
A maximum score of 100 points is possible in a single indicator such as “morbidity and mortality conferences”. The
Group figure of 22.8 points, already above the German average, has been increased by a factor of 2.8 to 64.4
points. It must be taken into account here that in some hospitals, introduction of this tool is not as important as in
acute care hospitals due to the special treatment spectrum, and it therefore has a corresponding influence on the
Group average.
Group-wide average figure for morbidity
and mortality conferences
ified
Cert ity
qual
80
Score for indicator
64.4
60
40
22.8
20
2nd quarter 2010
40
4th quarter 2011
41
From the company
Group-wide implementation of CIRS
In a critical incident reporting system (CIRS), near incidents in patient treatment are anonymously recorded within
the hospital and made available to a panel of experts. This panel identifies relevant problem areas and draws on
them to devise recommendations on improvement on patient safety in the processes concerned. Introduction of a
CIRS is an element of the clinical risk management system. In 2011, 20 hospitals already had a CIRS, and another
six are implementing one. A CIRS will be established in all hospitals by the end of 2012.
Intragroup quality information system (QuIS)
The “Extensive Quality Assessment” project involves compiling and publishing available quality data, compressing
it to ensure it can be assessed, and especially continuous benchmarking in a quality information system (QuIS).
The aim is to enable cutoff date-specific service group, department and hospital comparisons as well as a time
series comparison of each of these levels. The following results are to be published on the basis of approximately
400 indicators:
• Quality of medical outcomes
• Patient safety
• Patient satisfaction
• Referring doctor satisfaction
• Hygiene and nosocomial infections
• Clinical risk management
• Quality management system
In 2011, for the “quality of medical outcomes” subsection, an evaluation was prepared with the assistance of a
prototype and made available to all hospitals.
Shaping the hospital of the future
in a sustainable way
Structural investment ensures performance and competitiveness
In view of the social change, the increasing scarcity of resources and the challenges involved maintaining and
extending the performance and competitiveness of a hospital, the condition of the hospital building is also a crucial
factor. With intelligent planning, interdisciplinary care processes and structures within the hospital can be supported by means of structural investment. Our construction and investment projects in 2011 therefore include
plans and building work to enhance our future prospects. They ensure sustainable development:
• Reduced use of resources increases process and cost efficiency.
• Greater patient comfort is conducive to the healing environment and therefore the recovery process.
• Better workflows in optimised functional areas ensure more employee satisfaction.
Changes to the general conditions and processes require a new
architecture that creates a balance between a high level of patient
satisfaction, economic efficiency and an optimum framework for
diagnosis, treatment and rehabilitation. In this context, architecture
not only refers to the outcome of construction planning encased in
concrete, but also to the necessary structural and process-related
adjustments.
Proactive measures in hygiene
Hygiene management has been structured across the Group in the context of a project. Over 60 uniform process
descriptions that cover key topics such as outbreak management, hand disinfection and dealing with problematic
germs such as MRSA for all hospitals are in use. Hygiene management at all hospitals is audited and assessed
annually by independent auditors on the basis of mutual audits. Evaluation is carried out using a specially
developed requirements catalogue with criteria such as hygiene organisational structure, implementation of all
key hygiene processes and disinfection procedures. Sana Kliniken performs extremely well here with an average
score of 11 out of a possible 12 points.
With all its hospitals, Sana is the first major hospital operator in Germany to participate in the nationwide recording
of internal infections (KISS) by the National Reference Centre in Berlin. In the context of Sana-wide benchmarking,
the results have been used to verify tested procedures at numerous facilities and to define and implement improvement measures where necessary. In 2011, Sana Kliniken AG already met the requirements set out for 2013 in the
new German Infection Protection Amendment Act.
The mission statement of Sana Kliniken AG
In 2010, a group of managers of Sana Kliniken AG drew up a new mission statement, which was presented to the
management conference in November 2010.
It contains commitments on
• Forward-looking, integrated patient care respecting the individuality of every patient
• Open and traceable quality of services for patients, customers and employees
• Responsibility as an integrated part of society
• Partnership on a level playing field with all players in the healthcare industry
• Internal and external transparency
• Commitment to high-quality training
Our mission statement creates the binding organisational framework that aligns the conduct and actions of individual employees with the joint pursuit of our tasks and attainment of our aims. Every employee of Sana Kliniken
undertakes to act in accordance with these, our values and principles.
42
The main planned and completed construction and property projects
of Sana Kliniken AG in 2011 (extract)
Sana Klinik München-Sendling
Project
Sana healthcare campus
Total investment
EUR 50,700,000
Brief description
Sana Kliniken Solln Sendling GmbH is a specialist orthopaedic hospital with two locations, both
of which have structural deficiencies. To rectify these, utilise synergies for sustainable enhancement and thus ensure competitiveness, a healthcare campus is being built. It comprises construction of a new hospital with modern hospital processes, expansion of the in-patient and
out-patient rehabilitation department in the existing hospital building and enhancement of the
collaboration in the out-patient sector with the independent doctors at the location in Sendling,
Munich. Commissioning of the new building is planned for the first quarter of 2015, and that of
the restructured existing building is planned for the first quarter of 2016.
Aim
The construction measures optimise the structure of the location. The aim is to eliminate
duplication of resources and attain more efficient and economical processes. At the same
time, improved admission and diagnostic areas are to be created.
43
From the company
Sana Klinikum Hof
Several construction measures are being undertaken at the
same time at the Sana Klinikum Hof:
Project
Construction of a central patient admissions unit (CPA)
Total investment
Approx. EUR 5,700,000
Brief description
To make care procedures run even more smoothly, departments in which admission and diagnosis processes take
place are to be combined in a central patient admissions unit
based on the ground floor of the hospital, next to functional
areas such as the x-ray department. The new CPA incorporates emergency admissions, elective admissions and consultations for specialist departments as well as the emergency care surgery of the German Association of Statutory
Health Insurance Physicians.
The patients undergo medical and administrative admission
immediately. The admission interview, blood sample, ECG
and ultrasound scan are carried out in one room, and the
pre-anaesthetic meeting with the anaesthetist takes place
next door, also in the CPA. In addition, the CPA acts as a
service centre for all formalities and contacts for special
matters. Inauguration took place in November 2011.
The concept impressed the Bavarian Ministry of Social
Affairs and the government of Upper Franconia so much that
an unusually high proportion of subsidies has been
approved.
Aim
The main aim is satisfied patients. To optimise care even
further, the conversion work also involves organisational
changes. The main innovations are:
• Scheduling of all elective patients (patients with a planned
stay in hospital) by the cross-departmental central occupancy management unit (CBM)
• Consolidation of all admission processes in a central
office
• Medical and administrative admission in one process step
and examination room
• Strict separation of the emergency and elective patients.
For planned admissions, the patient or referring doctor
arranges an appointment with the CBM in advance in person
or by telephone. This means that there is hardly any waiting
time. When making appointments,
central capacity of operating theatres, operating staff and intensive
care beds etc. is taken into account.
This saves the patient having to wait
a long time before the operation.
44
Project
Construction of a sixth operating theatre
Total investment
Brief description
At the beginning of September, the Sana Klinikum Hof commissioned its sixth operating theatre. A fully equipped operating theatre with state-of-the-art endoscopy technology and
imaging procedures for minimally invasive and endoscopic
operations and a new recovery room have been built on an
approximately 300 m2 site. The walls of the surgery room are
made of blue laminated glass with indirect lighting and integrated monitors, which is why the operating theatre is also
called the “blue room”.
Aim
The lighting in the “blue room” ensures that the surgeons and
their employees feel at ease. Only around 25 facilities in Germany have installed such a concept to date – and it has proved
successful. The Sana Klinikum Hof therefore serves as a reference hospital for the market leader in the field of minimally
invasive and endoscopic operations. For example, the modern
technology enables the doctor to communicate with colleagues
outside the operating theatre – especially in the endoscopy
unit – via a monitor.
Project
Conversion of a nursing ward
to a palliative care ward
Sana Kliniken Ostholstein GmbH
Sana Kliniken Düsseldorf GmbH
Project
Construction of Inselklinik Fehmarn
Project
Construction of Sana
Krankenhaus Gerresheim
Total investment
Brief description
Considerable structural defects led to the closure of the
old island hospital. Therefore, a new single-storey modular building with 30 beds is being constructed at another
location on Fehmarn, including the following functional
units: emergency admissions, radiology, endoscopy,
functional diagnostics and operating department as well
as on-call rooms and doctors’ offices. Completion is
scheduled for spring 2012.
Aim
Inselklinik Fehmarn is the only hospital on the island.
The new hospital, subsidised by the state of SchleswigHolstein, will deliver medical care for the island’s residents and holidaymakers.
Total investment
EUR 61,400,000
Brief description
Gerresheim hospital was commissioned in 1971, and
originally had 510 beds. After a service life of over
35 years, the hospital no longer meets the structural or
functional requirements of a modern hospital. To improve
care for the population in the catchment area of the hospital, a totally new building is being erected, enabling
optimum functional processes and incorporating stateof-the-art medical equipment. In a “healing environment”
created on the basis of scientific research, patient rooms
will have only one or two beds in future. Following the
start of construction in 2010, the new hospital is set to
open in August 2012.
Aim
In particular, the planned reorganisation and requirement
adjustments optimise functional processes and units, the
nursing units and the care and discharge units. The creation of a central patient admissions unit improves and
accelerates the admission procedure for patients. Ideal
use of the space available enables targeted bed planning for statutory and private health insurance company
areas.
Total investment
Approx. EUR 850,000
Brief description
In addition to the treatment of physical ailments, holistic care
also includes consideration of mental, spiritual, religious and
social needs as well as support of relatives. Ever since it
opened on 1 August 2011, the palliative care ward at the Sana
Klinikum Hof has been closing a gap in the care of critically ill
and dying people in the region of northern Upper Franconia. A
highly specialised, interdisciplinary team provides care there
for patients with severe, advanced diseases that are no longer
treatable and require relief of excruciating symptoms.
Aim
Holistic care of critically ill people requires lots of specialist
staff – and this is certainly the case with the palliative care
team made up of specially qualified doctors, specialist nursing
staff, physiotherapists, psychologists, chaplains, social workers, transitional care staff and hospice assistants. After their
condition improves, the patients are returned to their normal
surroundings as quickly as possible.
Wholesome environment at the RKU Ulm,
university and rehabilitation hospitals
What makes a curative experience for patients?
Construction of a new hospital presents planners with major challenges in terms of the scale and complexity of
the construction project. In the past, the focus was usually on functionality. This resulted in the construction of
“soulless” hospitals, which have also been dismissed as “sick buildings” for several years. Scientific examinations
confirm the positive influences of the colour, climate and structure of a building and its rooms on the healing
process. These findings are taken into account in hospital planning at Sana Kliniken AG. Combining functionality
with a design that incorporates the effect of materials, shapes, colours, light, air and connections with the perceivable surroundings creates a healing atmosphere and a house for recovery. Buildings and rooms that enhance
the recovery process through interactions between the psyche and the environment give patients a sense of
security and protection. To create a positive ambience, the architecture and design are deliberately used as a
healthcare resource. If the psychological, biological and physiological effects of shape, colour and light are
rigorously used when building a “house for recovery”, this paves the way for a “green hospital”.
45
From the company
Staff report
The healthcare industry is already Germany’s biggest employer. By 2030, one in five jobs in this country will be in
the healthcare industry. Ensuring that the diverse career groups with all their individual requirements continue to
be staffed by qualified people on appropriate terms is one of the biggest challenges for healthcare companies.
Organisational structures and content of personnel management must be developed in line with changing circumstances. Therefore, central units of Sana Kliniken AG are working closely with the local Human Resources
departments. New strategic approaches are devised in close cooperation with our hospitals and nursing facilities.
They are implemented on site in Group-wide programmes, projects and individual action plans in keeping with the
situation at the location.
In this process, we take into account changes in the workforce and on the labour market. For instance, the
proportion of women has increased not only in nursing, but in all career groups in the hospitals.
e
ctiv
a
r
t
At
oyer
empl
WOMEN IN MANAGEMENT POSITIONS
As at 31 December 2011
Total
employees
Of which
female
in %
944
266
28
219
31
14
65
8
12
111
38
34
67
38
57
45
21
47
437
130
30
Medical services (medical directors,
head and senior physicians)
Surgery
Staff report
Orthopaedics
Internal medicine
Obstetrics and gynaecology
Sustainable personnel management:
Putting people first
Our employees are upholders of sustainable value creation and the commercial success of Sana Kliniken. Highly
motivated employees who are committed to their task and identify with the aims of their company on a long-term
basis provide modern medical care that is firmly focused on patients. Sustainable personnel management has
therefore become a key competitive factor. Sana Kliniken AG won several awards for its achievements in 2011.
However, we have no intention of resting on our laurels. We will continue the Sana Kliniken tradition of paying
special attention to an employee-focused approach and our corporate culture, and will also keep on pursuing our
aim of being one of the best.
DEVELOPMENT OF AVERAGE
HEADCOUNT FOR THE YEAR
2010
2009
Medical services
2,984
2,745
2,255
Nursing services
8,839
8,386
7,198
Medical technical services
3,073
2,855
2,277
Functional services
2,465
2,258
1,848
Business and supply services
Technical services
Administrative services
46
392
395
275
2,865
2,655
2,593
414
399
333
2,017
2,090
1,716
Special services
136
136
123
Other services
441
564
530
23,626
22,483
19,148
Total
Other
Managing director
67
24
36
Head of department/ward
668
543
81
Further senior consultants
550
318
58
At the same time, there is also a growing desire among male employees to find a suitable balance between career
and family. Here, we find models that enable this and allow working patterns to be adapted more flexibly to the
respective stage of the employees’ life. This is particularly important where we deliberately deploy younger and
older employees together in line with their experience and skills. Furthermore, the proportion of foreign employees
in Germany is rising as a result of the shortage of specialist staff. We are increasingly attracting them to our
hospitals and integrating them in our workforce.
Proportion of employees by age and gender
2011
Clinical hospital services
Paediatrics
to 20
from 20 to 29
0.4 %
1.8 %
3.6 %
13.0 %
5.3 %
from 30 to 39
16.1 %
6.6 %
from 40 to 49
23.6 %
5.1 %
from 50 to 59
60 or over
19.0 %
1.5 %
4.0 %
Male (total: 22.4 %)
Female (total: 77.6 %)
47
From the company
Staff report
The aim of all actions is to individually encourage and maintain the performance and motivation of our employees.
As a result of a positive corporate culture characterised by ongoing communication and a respectful, motivating
management style, we retain our employees for many years and are an attractive employer in the market for forwardlooking specialist staff. The size and strong growth of the Group provides all employees throughout the Group with
wide-ranging development opportunities that we are expanding in a targeted manner.
Pension provision
Constructive collaboration with corporate and social partners is an essential element here. The local and Group
works councils are important points of contact for employees and employers. Many projects are supported at
Group level in accordance with co-determination legislation and can be implemented throughout the Group.
So that employers can act on their own initiative and have a directly calculable influence on the level of their
pension provision, Sana Kliniken AG offers the Sana provision compass (Sana Versorgungskompass). The individual facilities provided information on this private provision scheme at wide-ranging events in 2011. Personal
consultations also help employees to define individual provision packages.
The local Sana hospitals are a key economic factor and part of society in their region. They take their social
responsibility seriously, create wealth and provide modern – and especially safe – jobs in conurbations and rural
regions. Constant training of employees and the creation of new occupational profiles at the hospital give us the
edge that we need for our corporate success.
Remuneration and provision:
Attractive terms as a competitive advantage
Transparent, performance-oriented remuneration system
The Sana Group collective agreements in place since 2008/2009 were renegotiated with the two major unions
ver.di and Marburger Bund in a spirit of partnership. Fair, performance-oriented pay in line with market conditions
and further employee-oriented arrangements have been agreed, setting Sana Kliniken apart from competitors as
an attractive employer.
Following the tradition of municipal hospital operators to supplement the public-sector pension scheme Sana
Kliniken makes its contribution where applicable to the ongoing existence of this type of pension provision.
However, not all care gaps that arise due to the changes to the state pension insurance scheme can be covered
by this.
To support private pension provision by employees, Sana Kliniken AG decided to conclude a separate Group
collective agreement on deferred compensation. With the insurance product “KlinikRente”, we offer our employees
a provision model that goes beyond the legal requirement.
In addition to these attractive options, we support our employees with an employer’s contribution to setting up their
private pension scheme. Overall, the Group spent EUR 33 million on this in 2011.
Occupational health and safety
Effective occupational health and safety is a constant focus of attention at Sana Kliniken and therefore has a
preventive effect. The primary purpose of occupational health and safety at the hospitals is to prevent accidents
at work, occupational diseases and work-related health risks. The facilities in the healthcare sector are particularly
affected by the demographic challenges of the labour market. Sana Kliniken AG is countering the change on the
labour market with an in-house health management scheme at the facilities.
For instance, as well as adjusting basic remuneration, we also agreed measures to offset individual negative
effects for individual employee groups as a result of special working hours or areas of activity. This is reflected in
changed valuations of on-call hours as well as an adapted classification and allowance system. Sana Kliniken AG
is thus taking into account the increased demands on individual career groups.
The collective agreements for the public sector (TVöD) and for doctors (TV-Ärzte VKA), negotiated by the German
Confederation of Municipal Employers and the trade unions, are in place at several hospitals.
Sharing in the company’s success
A key element in performance-oriented pay with the aim of employee motivation loyalty is the collectively agreed
profit-participation scheme for the workforce. In contrast to pure profit-sharing schemes, the Sana Group collective agreement provides for a payout of the variable facility-specific remuneration component if the company
achieves the earnings target set at the start of each financial year. The variable remuneration amounts to 75 per
cent of the average monthly remuneration paid in the previous year. If the target is exceeded or not met, the
amount is increased or reduced accordingly in a range from 51 per cent to 143 per cent. The profit participation
payouts have risen steadily in recent years in line with the performance increases of the hospitals. Variable
remuneration of EUR 9.0 million was distributed on this basis in 2011. The average target attainment rate in 2011
was 103 per cent.
Fair g
kin
wor ions
it
cond
In addition to profit participation of employees covered by collective agreements, the target agreement system for
managers is an important control instrument. The “Sana TARGET COMPASS” (Sana ZIELEKOMPASS) combines
financial, organisational and personal targets. We thus reflect personal performance as well as the commercial
situation, success and future prospects of the company in a long-term, transparent remuneration arrangement.
48
49
From the company
Staff report
Career and family:
Forward-looking concepts at Sana
Jobs in the healthcare sector are confined to one location. The hospitals increasingly face the challenge of
responding to the changing labour market and the expectations and requirements of employees and applicants.
Creating an attractive working environment in a highly challenging professional sector is the difference between
success and failure when recruiting staff. Young employees now set different priorities than 15 or 20 years ago.
For many, their career no longer comes first. They are mainly more family-oriented and want to be able to plan
their personal lives as well as their careers. However, older employees are also increasingly burdened by the
need to care for relatives. The employee-friendly and family-oriented staff policy of Sana Kliniken AG is one of the
key factors in competition for qualified specialist and management staff. Our life phase-oriented staff policy also
makes us more efficient as a company. Sana Kliniken therefore works to reconcile the duties of its employees
more closely with their family requirements.
The berufundfamilie gGmbH, an initiative of the non-profit Hertie Foundation under the patronage of the German
Federal Minister of Family Affairs and the German Federal Finance Minister assigns the berufundfamilie certificate
to companies that implement a long-term family-focused staff policy.
In 2011, around 80 per cent of the Sana hospitals as well as Sana Group headquarters had started or already
completed the work and family audit (audit berufundfamilie). All facilities are set to obtain the certificate by the end
of 2012 at the latest.
Group-wide implementation of the audits has given Sana Kliniken the opportunity to benefit jointly from the findings obtained. For instance, the facilities can share their experiences and reflect on the implementation of existing
measures.
The development of measures in particular is not only about making raising children as compatible with work as
possible, but also about taking the care of relatives into account. We are already making a vital contribution to a
family-friendly culture within the company with flexible working hours and conditions.
“The ‘audit berufundfamilie’ certificate and the
measures derived from it are key elements of
our staff recruitment and retention strategy!”
Dr Ingo Hüttner, Managing Director of Sana Herzchirurgie Stuttgart
Flexible structuring of working hours is a major factor in organising the reconciliation of career and family.
Examples of this are part-time options in all career groups, family-oriented structuring of duty rosters and holiday
planning, opportunities to take leave in the event of family emergencies and, in particular, work organisation
measures.
Sana also achieves better reconciliation of career and family by including special regulations in the Group collective agreements. For instance, doctors receive two work-free weekends per month. In addition, all employees
have the opportunity of working part-time for family reasons for up to five years.
Child care
Good care for their children during working hours matters
a great deal to every parent. Parents are reliant on
organisation of child care outside office hours and also in
emergencies.
Sana helps employees with children by providing suitable
child-care places with local providers. In addition, the
facilities grant financial support of up to EUR 100 for child
care, depending on the collective agreements.
In 2011, the number of fathers on parental leave was up
around 46 per cent on the 2010 calendar year. Of the
fathers who took parental leave in this period, approximately 54 per cent work in the medical services and
23 per cent in the nursing and functional services.
PROPORTION OF FULL-TIME/PART-TIME EMPLOYEES
in % per service type
Full-time
Part-time
Medical services
80
20
Nursing services
48
52
56
44
Functional services
57
43
Clinical hospital services
21
79
35
65
Technical services
90
10
70
30
Other services
70
30
Total
55
45
Parental leave
Parental leave is part of the career development of our
employees with young children. Although the proportion
of women who take parental leave after the birth of their
child is higher, fathers are increasingly taking parental
leave or reducing their working hours to spend more time
looking after their children. This has also been shown to
be feasible by employees in responsible managerial
posts.
Emma Charlotte
Real-life example
Mario Andres Lieberei, resident physician in the internal
medicine department of the Regio Klinikum Elmshorn:
“ At the end of April 2011, around the first birthday of my younger daughter Pauline Johanna, I decided to take a
career break in which I could devote myself fully to my family. I had already used this opportunity about two years
ago to spend quality time with my daughter Emma Charlotte, who is now three-and-a-half years old. These
periods were crucial to building up a close relationship with my daughters, as I would otherwise go to work when
the kids were still asleep and often not get back until they were already on their way to bed.”
The existing measures are systematically reviewed at the hospitals. This includes identifying strengths and weaknesses of the family-oriented staff measures so that we can carry out organisation-specific and requirementoriented measures. The senior consultant and ward manager career group has a key role in implementing the
packages of measures. Consequently, they are involved in the organisational development process at a very early
stage with a strategy workshop.
50
51
From the company
Staff report
Diversity at Sana:
working together for the patients
Personnel development:
career opportunities through targeted training
Outstanding medical care means teamwork. In all areas of the hospitals from admission through to discharge, our
patients come into contact with a large number of teams who look after them in the operating theatre, in the ward
or in the treatment rooms. These teams must function and get on, even though they are generally made up of very
different characters. Men and women, employees in different career and age groups and with different cultural
and religious backgrounds work alongside each other.
Sana Kliniken AG believes in long-term personnel measures. The concept of skills development starts with initial
training and induction of new employees. In the course of professional careers at Sana Kliniken AG, we apply
individualised staff development concepts.
Sana sees real benefits in this diversity and a wide range of opportunities to learn from each other and become
even more tolerant. However, these structures also bring challenges that the hospitals are facing up to.
Employees from over 97 nations work for the companies of Sana Kliniken AG. We can only continue to recruit
sufficient numbers of suitably qualified staff by taking on foreign migrant specialist employees in all career groups.
Integration of foreign employees is therefore a top priority. Fast acquisition of language skills and cultural integration
of foreign employees ensure mutual success. By signing the Diversity Charter (Charta der Vielfalt) in 2010 and
living out the values and standards that it contains in line with the mission statement of Sana Kliniken AG, the
facilities are actively adapting to the changing situation. The potential here has been identified and is being utilised
through targeted programmes and measures to the benefit of patients, hospitals and employees.
The proportion of older employees is rising, which is why it is increasingly important to deploy older and younger
people alongside each other in teams. Older employees thus pass on their experience and knowledge, whilst the
younger ones can make up for any age-related limitations. The multidisciplinary “50+ working group” submitted its
final report on this issue in 2011, recommending six central areas to be acted on. These will be coordinated in the
Group and implemented individually in accordance with the needs of the individual hospitals. Achieving understanding among all employees and raising awareness of the importance of demographic trends in each individual
working environment are at the forefront here. This is the only way in which the necessary measures in the areas
of labour organisation and workplace design as well as knowledge management and healthcare provision can
take effect.
Skills-oriented training for new nursing staff
Sana provides training in all hospital careers. With over 80 per cent of training posts, the focus is on training
nurses. Training (paediatric) nurses prepares the employees for further specialisation and qualifications in the
specialist nursing fields later in their career. To make this skilled occupation more attractive to young people, the
schools are providing innovative and challenging training content. Skills-oriented teaching and examination methods
in the training centres are at the forefront. Additional importance is now being given to higher quality of training
with regard to personal and social skills following the amendment of the German Nursing Act (Section 3 KrPflG).
Due to the shortage of specialist staff, we are creating training posts for nursing assistants, which also provide
future-oriented hospital career prospects for applicants with few academic qualifications.
At an early stage, we lay the foundation for perception of a career as a member of the treatment team, which also
involves compatibility with the individual’s health preservation. We provide language training and remedial teaching at all training centres as standard for the growing number of trainees who do not speak German as their first
language. To arouse young people’s interest in secure hospital careers, “girls’ and boys’ days” are held at the
hospitals, with increasing levels of success.
NUMBER OF TRAINEES BY PROFESSION
(Paediatric) nurse
2011
2010
1,158
903
Geriatric nurse
55
52
Midwife
24
34
Doctor's assistant
15
30
Operation assistant
29
27
Commercial careers
56
45
Other careers
31
15
1,368
1,106
Total
Advanced training and qualifications in nursing
eted
g
r
a
T
ort
supp
52
In addition to conventional advanced training as a specialist nurse for geriatric psychiatric nursing, the endoscopy
and operation service, anaesthesia and intensive care nursing, psychiatric nursing, nephrology, palliative and
hospice nursing, oncology nursing, rehabilitation and long-term nursing, clinical geriatrics and as a specialist
nurse and paediatric nurse, e.g. for anaesthesia and intensive care and as a hygiene specialist, the range of
advanced training courses on offer has also been extended academically. For instance, Sana now offers the
recently developed Bachelor of Physician Assistance, which bridges the gap between medical and nursing
careers. Advanced training specialisms such as nursing teacher, nursing manager and certified nursing and functional unit manager lead employees into teaching and nursing management posts.
53
From the company
Staff report
Skilled doctors
Our hospitals provide doctors with structured advanced training opportunities in almost all specialist areas. Within
the Group structures, exchange is carried out between academic research at our teaching hospitals and clinical
practice through job-shadowing and rotation opportunities. Expansion of cooperation structures between the
primary medical and clinical sectors is encouraged through the existing training associations in general medicine.
Optimisation of advanced general practitioner training ensures high-quality training of general practitioners who
provide skilled GP care in a hospital environment.
Language trainer Roswitha Hartung
(on the right in the picture) on site with
two doctor colleagues
Advanced training authorisations in the Group
Over 400 people authorised to carry out advanced medical training ensure appropriate advanced training, thus
making the facilities of Sana Kliniken AG more attractive employers for young doctors. The Group thus ensures
that specialist medical posts are filled by the right people on a long-term basis.
Academic teaching hospitals in the Sana Group
At the academic teaching hospitals, Sana promotes the opportunities for advanced training and careers in the
Sana Group by targeting doctors at an early stage in their practical year.
Skills-oriented language training for doctors
In addition to advanced training of German doctors, it is becoming increasingly important for Sana Kliniken to
attract foreign doctors to our hospitals. Sound language skills and cultural integration are the essential requirements for successful patient-oriented activity and career development. Sana Kliniken supports this in a targeted
manner with individual measures. For example, doctors who do not speak German as their first language can use
a range of innovative ways to develop their language skills. Language trainers accompany the doctors in their
day-to-day work. A direct insight into hospital language enables the language trainers to give the doctors language
tuition appropriate to their work situation and improve their communication skills quickly in individual and group
exercises. Support ranges from coaching in conversation with patients and relatives and reflection on visits
through formulation of doctor’s letters and improvement of telephone calls with other departments, hospitals or
relatives to preparation of lectures in the context of advanced training.
The doctors regard this as an optimum solution for enhancing their language development in a targeted manner
whilst also accelerating their social integration.
Senior consultant recruitment centre of excellence
From the outset, with specially structured job interviews, the senior consultant recruitment centre of excellence
has given senior consultants the opportunity to enhance their skills, for example in the form of management
coaching for the initial phase of their career with the Group.
ified
Qual and
c
basi ced
n
adva ing
n
trai
In the German healthcare system, the senior consultant is traditionally regarded as the person who shapes the
reputation of a department and, in many cases, a whole hospital. At the same time, modern hospital management
places high demands on senior consultants in terms of their medical capabilities and their management and leadership skills. Combining health economic considerations and medical treatment indication to provide patients with
the best possible care is increasingly one of the most challenging tasks facing the senior consultants of today.
A major challenge for Sana Kliniken is to fill all these posts with extremely well-qualified people who also meet the
respective requirements of the hospital and the department to be run. Since 2009, the centre of excellence has
applied a standardised procedure for filling senior consultant vacancies in conjunction with the hospitals. 56 of
these procedures were carried out in 2011. The appointment process has been noticeably optimised by the overall central control. The close collaboration with the local hospital management team and the medical experts of
the Group has proved its worth here.
Approaching suitable external candidates remains a key factor in replacing departed senior consultants. However,
the senior consultant recruitment centre of excellence is also increasingly developing and implementing programmes that promote skills development of today’s medical staff in hospitals and preparing them for further tasks
as senior consultants or in other leadership roles. Highlighting internal career prospects for senior consultants
therefore makes advancement within the Group more attractive than before. Incorporating promising staff in the
Group’s appointment procedure constitutes a significant competitive advantage here and reduces the costintensive fluctuation among specialist doctors on a long-term basis.
54
55
From the company
Staff report
Careers in the Sana Group – 2 examples
Training or studying in technical and commercial fields
The training of young people at the facilities and Group headquarters covers a wide range of different careers
in all areas of the hospital. In addition to the nursing occupations, over 20 other training courses in medicaltechnical, commercial and manual areas are available.
With its range of training posts, the hospitals are not only meeting their social responsibility as a major healthcare
employer, but also ensuring that vacancies in the Group are filled by high-quality staff. Sana offers a job within the
Group to trainees with a grade point average of 2.0 or better in line with the collective agreement.
In addition to the professions, at individual facilities, Sana provides the opportunity to combine study and hands-on
learning in the commercial and technical fields in the context of dual training.
Starting out and promotion
The path to becoming a “pain manager” // Sonja Vidmar-Danilovic
Individual career paths of employees in all career disciplines are supported and lived out on a hospital-specific
basis. The potential detected in the employee interview determines the further development.
The trained nurse and psychology graduate of Slovenian nationality came to Germany in the 1990s with the aim
of starting a new life. Sonja Vidmar-Danilovic, born in 1963, started work at Karl-Olga-Krankenhaus in Stuttgart in
1994, and took the opportunity to gain the grant-funded Bachelor of Physician Assistance qualification at the age
of 44. Today, she is responsible for implementing pain management at the Sana Kliniken Solln Sendling (Munich)
and can draw on all her expertise.
To ensure motivated performance and identification with the corporate targets, internal skills training is carried out.
In addition to an increase in knowledge and expertise, the basis for a lively management and staff culture is
created through active integration of medical and commercial managers.
Graduates familiarise themselves with the core business areas of the hospitals in 18 months in the Sana management trainee programme. They acquire skills through practical application and develop them in the context of
projects. 12 trainees started out in 2011.
“I am very happy and thankful that I am now combining my two
interests in my job and can make a contribution to increasing
quality and patient satisfaction.”
The potential development programme gives young employees in all career groups the opportunity to demonstrate
their abilities with innovative project ideas and prepare themselves for their next career step.
Wide g
n
i
rang er
care tur
oppoies
nit
The path to commercial responsibility // Dr Barbara Kempe
As an authorised representative of Sana Kliniken Ostholstein GmbH, Dr Barbara Kempe heads the Corporate
Development & Communications department for three acute-care hospitals in Eutin, Oldenburg and Fehmarn in
east Schleswig-Holstein. After completing her business studies degree, she joined the Acquisitions department of
Sana Kliniken AG in 2002. One reason why she opted for Sana is because it gave her the opportunity to write
an in-service, practically-oriented dissertation on attractive terms. From 2003 to 2004, she worked at Group headquarters in Munich as an aide to the Chairman of the management team before moving to a Group hospital in
Ostholstein in 2005.
“At Sana, I can be actively involved in Group-wide issues and
learn from colleagues at other locations. My husband, our nearly
three-year-old daughter and I fully appreciate the fact that at Sana
and as a manager, I can structure my working hours so flexibly
that it is possible to reconcile family life and a responsible job.”
56
57
From the company
General and business conditions
Overview of the 2011 financial year
Group
management
report
Crisis-resistant, largely non-cyclical business model
In the 2011 financial year, Sana Kliniken AG again posted double-digit growth with consolidated net revenue of
EUR 1,629.2 million. The consolidated net income came to EUR 52.8 million, up 10.9 per cent on the previous year.
With this performance, we generated a double-digit increase in revenue and income for the fourth successive year.
Our business model has proved to be crisis-resistant, largely unaffected by the sovereign debt and financial markets
crisis and largely non-cyclical.
Double-digit growth
both in revenue and
income
The successful business development and substantial growth were also achieved without additional acquisitions this
year. Instead, the overall revenue growth of approximately 10 per cent results from the acquisitions in the previous
year of Krankenhaus Rummelsberg gGmbH and Klinikum Dahme Spreewald GmbH, which were consolidated for a
full financial year for the first time in 2011, and from moderate organic growth.
The positive earnings development is to be regarded as a major success in view of the EHEC crisis in the second
quarter of the past financial year. This hit the hospitals in northern Germany particularly hard. In medical and nursing
terms, the EHEC crisis was handled as a result of the outstanding work of all employees on the ground, especially at
the Regio Kliniken, the Sana Kliniken Lübeck and the Sana Kliniken Ostholstein. However, in economic terms, the
Group faced exceptional charges totalling approximately EUR 1.6 million, which have not yet been compensated
despite a firm government commitment.
Capital increase to secure future growth
Financially, Sana Kliniken AG is now better equipped for the future. Shareholders have also underlined their confidence in the business model and strategic orientation of Sana Kliniken AG. For instance, the biggest capital increase
in the company’s history was approved in 2011. Shareholders are injecting a total of EUR 160.0 million into Sana.
Together with the option of additional borrowing, this forms the financial basis for further successful growth.
Capital injection
of EUR 160 million
59 General and business conditions
59 Overview of the 2011 financial year
60 Overview of the organisation and operations
61 Organisational and management structure
62 Corporate strategy and control
64 Macroeconomic factors
65 Sector-specific situation
67 The 2011 financial year – financial overview
70 Earnings, asset and financial situation
79 Supplementary report
80 Opportunity and risk report
86 Forecast report
58
59
From the company
The Sana Group – overview of the organisation and operations
Business model
Consolidated net revenue
of EUR 1.63 billion
Germany’s fourth-largest private hospital operator
Sana Kliniken AG is one of Germany’s leading providers of integrated healthcare services. 31 private health insurance
companies have provided a stable and reliable group of shareholders for almost 35 years. With consolidated net
revenue of EUR 1.63 billion and 43 hospitals, 1,470,000 patients treated and over 23,600 employees, Sana is the
fourth-largest private operator of acute-care and specialist hospitals. We also run medical care centres (MCC),
rehabilitation clinics and nursing homes.
Distribution of facilities
30 Acute-care hospitals
Sana is financially stable and sound
The company is characterised by financial stability and soundness. The strong earnings situation forms the basis for
sound, sustainable financing structures of Sana Kliniken AG. Borrowing costs, dividends and investments are financed
from cash flow from operations. A low leverage ratio and last year’s capital increase mean that we are well-placed to
finance further acquisitions.
Well-placed to finance
further acquisitions
The value of the goodwill arising from the purchase of hospitals is assessed in annual impairment tests. Very strict
criteria are applied to these tests. On the basis of rolling long-term planning, cash-flow potential is first derived for the
facilities concerned and then subjected to various stress tests in a second step. No goodwill impairment has been
required so far.
Starting points for enhancing profitability
Regardless of the positive development of the Sana Group in recent years, there is further rationalisation potential to
improve profitability. These improvements are centred on achieving an even higher level of standardisation procurement and continuous optimisation of processes at the hospitals. Examples are the creation of shared service centres
for more efficient processing of administrative tasks.
3 Cardiac centres
7 Specialist orthopaedic clinics
3 Rehabilitation clinics
12 Nursing homes
18 Medical Care Centres (MCC)
Procurement and logistics services added to our range
Services for patients have always been and still are our main area of expertise. These are supplemented by our
activities in the care sector. We are rigorously expanding the area of procurement and logistics services, which we
also provide for external hospitals. In the past financial year, we handled a procurement volume of approximately
EUR 1.3 billion based on a portfolio with more than 500 customers. The uniqueness of integrated offerings in the
care sector enables the Sana Group to realise extra growth potential. In particular, there is growing demand from
our customers for linking procurement and logistics services to optimise material management.
In the 2011 financial year, we generated revenue of EUR 48.4 million from procurement and logistics services (previous year: EUR 46.9 million). This equates to a 3.2 per cent increase year-on-year.
Strengths of our business model
Sana is characterised by strong growth and an attractive return
Sana Kliniken AG is a very fast-growing company with above-average growth rates. This dynamic growth enables us
to meet actively the challenges posed by the changes to the German healthcare system and be involved in shaping
these changes. In addition, our strong growth is an essential condition for leveraging further efficiency potential in the
company. The constant build-up of expertise and our rigorous benchmarking help to ensure this development. All of
this makes Sana more attractive as an employer for managerial staff in the medical and care sector as well as in
commercial posts.
By adding procurement and logistics solutions for other hospitals to our range of integrated healthcare services, the
company is able to keep on generating an attractive return in future. We can offer customised solutions to public and
charitable hospital operators via flexible participation models. The corporate development of Sana Kliniken AG is
therefore relatively unaffected by the general trend in terms of the intensity of privatisation cycles on the German
healthcare market.
Integrated services
open up additional
potential for growth
60
Our unique range of integrated services in the care sector (expert procurement and logistics services) opens up
further growth potential for the Sana Group.
Organisational and management structure
Sana Kliniken AG is the operating holding company for the Sana Group companies. The Sana Group consists of Sana
Kliniken AG and a further 90 companies over which we have effective control. The company is based in Germany, with
its headquarters in Ismaning, Munich.
Shareholder structure ensures independence and potential of business model
All the equity is held by 31 private health insurance firms. This ownership structure ensures the corporate independence
of the Sana Kliniken AG and enables the management to utilise the strengths of the business model for sustainable,
long-term, profitable growth.
Clear management structure with decentralised profit and loss responsibility
The Supervisory Board of Sana Kliniken AG acts as the ultimate control and monitoring body in the context of stock
corporation regulations. It advises and monitors the Group management and appoints the members of the Executive
Board.
The Sana Group is managed by a four-strong Executive Board. In addition to the Chief Executive Officer (CEO) and
Chief Financial Officer (CFO), the board also includes directors responsible for Medicine and Care and HR and
Purchasing.
The fully authorised representatives are also part of the top management structure of the Group. They are responsible
for operational management of business activities at the facilities on the basis of a regional principle.
Regional principle applied
to operational management
Group management structure
Monitoring
and control
Group
management
Operational
management
Supervisory Board
Executive Board
CEO
CFO
Medicine
and Care
HR and
Purchasing
Fully authorised representatives
East
North-East
North-West
South-East
South-West
61
From the company
The management teams of the individual facilities are responsible for delivering a high standard of medical and nursing care and service quality. They are responsible for the financial results of the legally independent care subsidiaries.
Corporate strategy and control
We aim to make active use of the opportunities of hospital privatisation …
The management of Sana Kliniken AG plans to remain actively involved in the healthcare services privatisation
process in Germany in the years ahead. In this respect, our aim is to continue to improve our market position by providing high-quality medical and nursing care for patients. One core element of this strategy is further strengthening
our position as a reliable partner for local authorities and other regional administrative bodies. Therefore, flexibility
and individuality in terms of local authorities’ requirements will continue to determine our actions in future.
… and expand our care-related services for third parties
In the next few years, we will also be focusing on procurement and logistics services for hospitals outside the Sana
Group. The potential is attractive and there is firm demand. Our external customers are asking us to offer these
services on an even more extensive and holistic basis than before. We regard this as both an incentive and a positive
challenge.
Focus on revenue
growth and profitability
Additional information
from page 46
Profitable growth keeps us fit for the future
Sana pursues a strategy of sustainable, profitable growth, focusing on revenue growth and profitability. Constant
improvement of profitability and generation of long-term cash flow are essential requirements for the company’s financial
independence, corporate scope for action and investment capability.
Hospital operators in Germany must meet future challenges such as the increasing shortage of specialist medical and
care staff as well as the feminisation of the medical profession. We will face up to these trends by rigorously expanding our family-friendly workplace structures. Our aim is for all our hospitals to be certified by the Hertie Foundation’s
“work and family audit” by the end of 2012. We also offer attractive training opportunities for our employees. This is
becoming increasingly important for junior doctors. In this way, we create a more attractive working environment, thus
giving our employees even more job satisfaction.
To protect the interests of our shareholders and lenders in the long term and to enable measurement of the corporate
aims described above, we control the Group on the basis of a fixed system of key performance indicators. In addition
to the economic key ratios described below, the Group’s controlling is also focused on non-financial performance
indicators.
Financial control parameters
Sana is rigorously
geared to expansion
62
Growth
Double-digit growth remains a long-term aim
Our commitment to ensuring high-quality patient care in future despite ongoing restrictions in terms of resources
requires robust concepts for efficient use of available means. One key element here is growth, as it enables use of
economies of scale. Sana is therefore rigorously geared towards expansion. In addition to organic growth, we are very
strongly pursuing a strategy of inorganic growth through hospital purchases. We measure our success using the
CAGR (compound annual growth rate). This shows our average revenue growth with reference to our defined base
year, 2000. The company has set itself the target of continuing to expand with double-digit growth rates in the long term.
Capital efficiency
The return on capital employed should be at least half of the cost of capital
The efficient use of capital is becoming a more crucial competitive factor than ever. In future, the companies must
counter the impacts of the European debt and financial markets crisis and the challenges of financing investment
requirements in the German healthcare sector even more intensively than before with a high level of capital efficiency.
With the corporate targets being geared towards sustainability and value enhancement, the return on invested capital is
at the heart of the Sana Group’s controlling strategy. Efficient and sustainable use of capital is also a major evaluation
criterion for our lenders. The RoCE (return on capital employed) shows the return on capital invested on a long-term
basis. Assets tied up on a short-term basis are not included in this key ratio.
Efficient and sustainable
use of capital
The RoCE is calculated as a quotient of pre-tax profit and capital tied up on a long-term basis. Aligned to the equity
and liabilities side of the balance sheet, invested capital consists of equity, financial liabilities less cash, pensions and
other non-current provisions and liabilities. For our internal controlling, we rigorously eliminate goodwill, as this
represents the assets financed with subsidies in the context of company acquisitions.
Sana Kliniken AG aims to achieve an RoCE of at least 1.5 times the cost of capital. Temporary fluctuations are
possible here as a result of newly acquired hospitals.
Capital structure and debt
Maximum limit for net gearing of 100 per cent
Sana’s long-standing strategy means that the financing structures will have to keep on creating sufficient flexibility and
scope to utilise growth potential in future. Interest-bearing net debt is a key factor here. We control the debt ratios in
relation to earnings before interest, depreciation and taxes (EBITDA). For internal controlling of the Group, we have
also set ourselves an upper limit for net gearing (ratio of interest-bearing debt to equity) of 100 per cent. In general, we
remain well below this level. This upper limit will only be breached temporarily and in exceptional cases as a result of
major acquisitions.
Liquidity controlling
Investment for value retention and value enhancement
Generating a growing cash flow is of crucial importance to the Sana Group. In our controlling, we focus primarily on
free cash flow (FCF) and funds from operations (FFO) to total debt. FFO reflects generated consolidated net income
before non-cash components (e.g. depreciation and amortisation). This cash flow is available for dividend payments
and investment. As a result of the sustainable business approach of Sana Kliniken AG, a substantial proportion of the
cash flow can be used for investment to maintain and enhance enterprise value in the long term.
Sustainable
business approach
The free cash flow is available to the company after investment and distribution. It is therefore calculated from FFO
less investment and dividends.
We are targeting an “FFO / total debt” ratio between 15 per cent and 30 per cent and an “FCF / total debt” ratio between
5 per cent and 20 per cent.
63
From the company
GDP grew by
2.5 per cent year-on-year
Macroeconomic factors
Sector-specific situation
Further growth for the German economy in 2011
Despite the deepening of the sovereign debt and financial crisis, particularly in the euro zone, Germany remained
Europe’s pillar of stability and growth driver in 2011. The German economy continued to grow in 2011, although the
pace of growth slowed down significantly as the year progressed. According to the German Federal Statistics Office,
after adjustments for price, seasonal and calendar effects, gross domestic product (GDP) in the third quarter of 2011
was up 0.5 percent on the previous quarter and 2.5 percent on the previous year. In its economic forecast for 2011
updated in January 2012, the International Monetary Fund (IMF) calculated real GDP growth of 3.0 percent, in line
with the estimates of the OECD, the Bundesbank and leading economic research institutes. Throughout the year,
positive impetus mainly stemmed from growth in private consumption expenditure.
The situation in the hospital sector is being significantly influenced by changes to existing laws and introduction of new
ones. The German Act for Sustainable and Socially Balanced Financing of Statutory Health Insurance (GKV-FinG)
came into force on 1 January 2011.
Private consumption as a key pillar of the economy
The GfK Consumer Confidence Index was stable in 2011. Consumer confidence actually increased slightly despite
the crisis and associated recession fears. With this development, domestic economic activity constitutes a key pillar
of economic development in Germany.
German economic growth continued, albeit at a distinctly slower pace. Against this background, the labour market
again showed very positive development in 2011, with the crisis having a less significant impact on the German population than in other countries in the euro zone. Unemployment had fallen to 2,713,000 in November 2011, the lowest
figure for 20 years. In December, 2,780,000 people were registered unemployed in Germany. Compared with the
same month of the previous year, employment was down by 231,000 or just under 8 per cent. At the end of 2011,
a record number of 41.5 million people were in work in Germany (peak figure in November: 41.582 million). The
unemployment rate based on the entire civilian labour force stood at 6.6 per cent in December. This is 0.5 percentage
points lower than the previous December.
Inflation rate well
over 2 per cent
For hospitals, two key measures have been passed to limit increases in expenditure and to stabilise expenditure:
1.The rate of change, which is decisive for the adjustment of the state basic case value, was reduced by 0.25 percentage points to 0.9 per cent in 2011 and will be reduced by 0.5 percentage points to 1.48 per cent in 2012. This
results in a saving of around EUR 150 million in the statutory health insurance expenditure volume for German
hospitals.
2.Hospitals paid an anticipated payment of 30 per cent for contractually agreed additional services in 2011. From
2012, the level of the anticipated payment for additional services is to be agreed by the contracting parties. A
savings volume of EUR 350 million will thus be generated.
Surplus for statutory health insurance companies in the first nine months of 2011
The statutory health insurance companies posted extremely positive financial development in 2011. After generating
a surplus of EUR 277 million in the first nine months of 2010, the health insurance companies increased the surplus
to EUR 3.9 billion in the first three quarters of 2011. With expenditure of around EUR 133.7 billion, the health insurance
companies generated income of around EUR 137.7 billion.
In the first three quarters of 2011, allocations from the health fund to the health insurance companies totalled around
EUR 134.2 billion. Health fund income from contributions and federal grants amounted to EUR 135.6 billion.
The government crises in Greece and, more recently, Italy have stoked up uncertainty on the future economic development in the euro zone in the last few months. This is a likely factor in the downgrading of economic forecasts. The
ifo World Economic Climate Indicator showed an even gloomier picture in the fourth quarter of 2011. The ifo economic
climate for the euro zone deteriorated for the second time in succession, and is now well below its long-term average.
This suggests that the economic situation in the euro zone will take a significant turn for the worse in the months
ahead.
Overall, the surpluses of the health fund and the statutory health insurance companies produced a positive result of
EUR 5.3 billion for the statutory health insurance companies in the first nine months of 2011.
Sharp rise in energy costs swells inflation rate
In Germany, the consumer price index was up 2.3 per cent on the previous year in 2011. Consequently, the inflation
rate – measured according to the development of consumer prices – is well over the 2 per cent mark. In recent
months, the inflation rate has been strongly affected by the rise in energy costs. For hospital operators, this is having
a noticeable impact on material costs that cannot be offset by hospital reimbursement. Compared with the previous
year, consumers paid 10.0 per cent more for energy. This was mainly due to the rise in costs for domestic fuel oil.
Prices here were up 25 per cent year-on-year. In addition, prices for costs allocations for central heating and district
heating (+ 8.0 per cent), electricity (+ 7.3 per cent) and gas (+ 4.6 per cent) rose sharply year-on-year. Without this
increase in energy costs, the inflation rate would have been just 1.3 per cent in 2011.
The proportion of people covered by statutory health insurance in the Germany healthcare sector is around 90 per
cent. Therefore, most of the income of German hospitals is based on payments from the statutory health insurance
companies. In relation to the current positive financial development of the statutory health insurance companies, there
is discussion of reducing charges for hospitals.
Due to the current uncertainty surrounding economic prospects in the euro zone – with substantial reductions in
growth forecasts for 2012 recently – the new President of the European Central Bank (ECB), Mario Draghi, cut base
rates from 1.50 per cent to 1.00 per cent in two steps in November and December 2011. Mario Draghi described risks
to the outlook for inflation as “broadly balanced”.
According to the publications of the statutory health insurance company assessors dated 12 October 2011, the health
insurance companies will generate earnings of EUR 1.4 billion in 2011. This equates to a cover ratio (allocations from
the health fund minus statutory health insurance company expenditure) of just over 100 per cent.
The benefit expenditure of the health insurance funds rose by 2.5 per cent per person insured between January and
September 2011. According to the statutory health insurance company assessors on 12 October 2011, a 3.6 per cent
increase in total health insurance company expenditure is expected for 2011.
Increase in total state
health insurance expenditure
of 3.6 per cent
In terms of expenditure increases in the first three quarters of 2011, sick pay saw the sharpest increase per person
insured (+ 9.4 per cent), followed by the hospital sector (+ 4.2 per cent), medical early detection measures (+ 3.8 per
cent) and out-patient treatment (+ 2.3 per cent). Applied to the in-patient sector, this rate of change would equate to an
increase of approximately EUR 1.7 billion for 2011 as a whole. Although the state basic case value only rose by a very
moderate average of 0.3 per cent in 2011, increases in the benefit volumes are again leading to a significant rise in the
expenditure of the health insurance companies. In contrast, as a result of the German Act on the Reorganisation of the
Pharmaceuticals Market in Statutory Health Insurance (AMNOG), expenditure reductions by 5.7 per cent (on the basis
of January to September 2011) were posted for the first time in 2011 after several years of unbridled expenditure
growth.
The federal basic case value for 2011 amounted to EUR 2,963.82 (+ 0.96 per cent compared with the 2010 figure).
This contrasted with rising staff costs in the form of collective wage agreement increases and other cost increases,
particularly for energy and food.
64
65
From the company
The 2011 financial year – financial overview
Proportion of private hospitals rises, key to secure nursing care for in the countryside
From 1996 to 2007, the number of privately operated hospitals increased by 40.6 per cent. The current market share
is around 28 per cent. In contrast, the number of hospitals with independent non-profit operators decreased by
18.8 per cent and the number of publicly operated hospitals by 31.3 per cent in this reference period.
Privatisation of hospitals
will ensure patient care
in rural regions
According to a study by the RWI in Essen and the Institute for Health Economics (IfG) in Munich commissioned by the
German Federal Association of Private Hospitals (BDPK) in Berlin, privatisation of hospitals will ensure patient care,
especially in rural regions. The proportion of privately operated rural hospitals is higher than that of those run by
independent non-profit operators, and continues to rise.
German hospital services are characterised by dual financing. Investment costs are financed by the states. In 2009,
the states provided subsidies totalling around EUR 2.86 billion in accordance with Section 9 of the German Hospital
Financing Act (KHG). In the last ten years, KHG subsidies have been reduced by around 29 per cent, adjusted for
price changes. Compared with 1991, the real decrease is as much as 45 per cent.
In 1991, KHG subsidies amounted to 0.24 per cent of gross domestic product (GDP). This figure fell by half to
0.12 per cent by 2009. The chart below shows the development of KHG subsidies compared with GDP from 1991
to 2009.
Changes arising from the Act on the Stabilisation of Structural Reform in Germany from 2012 (GKV-VStG)
The GKV-VStG came into force on 1 January 2012. The changes therein largely relate to out-patient care. However,
they also impact on in-patient care.
One major change for hospitals is that, in future, services in the context of out-patient operations pursuant to Section
115b of German Social Security Code (SGB) V can also be performed on the basis of contracts between hospitals and
independent panel doctors in the hospital on an out-patient basis.
The legislation also entails further cost increases, as hospitals will also have to organise secondary care of patients
as well as conventional discharge management in future.
In addition, higher fees may not be charged for general hospital services for private hospitals that are located in the
vicinity of the hospital and have an organisational link with it. However, this does not present a revenue risk for the
hospitals of Sana Kliniken AG, as higher fees were not charged anyway.
The savings for the statutory health insurance companies at the expense of the German hospitals, which were introduced with the GKV-FinG in 2011, remain despite the sound financial situation of the statutory health insurance companies. These include the 0.5 percentage-point reduction in the rate of change for 2012, the anticipated payment for
additional services and the delay in introducing the benchmark value.
Trend in KHG subsidies and gross
domestic product (GDP) 1)
170
The 2011 financial year –
financial overview
1991 = 100
150
130
110
KHG subsidies
90
70
1)
GDP
1991
2009
As a result of the gradual decline in KHG subsidies, according to a survey by the medical technology industry association Spectaris, the investment backlog in German hospitals is some EUR 50 billion.
Sana Kliniken AG’s measures to combat shortage of specialist staff
The shortage of specialist hospital staff remains one of the biggest challenges in in-patient care. In addition to our
facilities in rural regions, hospitals in highly competitive regions are increasingly affected by this. The Sana Group is
already prepared for the nationwide trend of doctor shortages that affects all types of operator. As well as attractive
and transparent remuneration, one focal point here is the continuous improvement of working conditions and working
environment. Targeted support of medical managerial staff in the form of a dedicated centre of competence, integration
in nationwide and regional clusters of experts, creation of essential requirements for medical and medical technology
investments, promotion of training and establishment of family-friendly working conditions are elements of the corresponding strategic concept, which is being constantly enhanced within the Sana Group.
66
Further increases in a challenging environment
Sana continued its successful business development in 2011. Despite a challenging general situation, double-digit
growth was achieved once again. With an approximately 10 per cent rise in revenue year-on-year, earnings after
tax improved by 10.9 per cent to EUR 52.8 million, thus exceeding the earnings target.
Rise in revenue of
approx. 10 per cent
Source: German Hospital Federation (DKG), 2010.
Cut in KHG subsidies leads to investment backlog
With reference to the hospital spending of the statutory health insurance companies and private health insurers, the
investment rate based on KHG subsidies was as high as 10.0 per cent in 1991, but just 4.6 per cent in 2008. Due to
the ongoing squeeze on state budgets, the trend is set to continue or even intensify in the years ahead.
Investment backlog of
some EUR 50 billion
Business developments
Focus on integration of new hospitals in 2011
Business operations during the year were mainly centred on integrating the previous year’s acquisitions. One highlight
here is the successfully completed integration of Klinikum Dahme-Spreewald GmbH into the Group. The company,
fully consolidated for the first time on 31 December 2010, has already implemented key Sana structures whilst
improving its earnings.
Despite considerable additional negative impacts due to the EHEC crisis, the Regio Kliniken posted a very positive
development. Rigorous dismantling of the previous complex structures resulted in increased transparency for management and improved processes. Intricate ownership structures have been reduced by means of mergers or disposal.
The medical profile of the three locations has been strengthened in a targeted manner. Consequently, breakeven was
reached in just the second year after acquisition.
In contrast, integration of the Krankenhaus Rummelsberg initially proved more difficult. Despite sound cooperation
with the seller, taking out the hospital from the individual complex integrated structures of its ecclesiastical owners was
extremely challenging. However, foundations of a successful turnaround have already been laid through the recruitment
of new key medical staff, such as a renowned senior consultant in the foot surgery department.
67
From the company
The 2011 financial year – financial overview
Further vindication of the
change in strategy
Organic growth of 3 per cent in acute in-patient care
As well as successful integration of new hospitals, organic growth of existing business is an important factor in our
ability to achieve our growth targets. Our large hospitals (maximum and specialist care hospitals) and our specialist
clinics for cardiovascular diseases played a key role in this performance. This is further vindication of our change of
strategy in 2006 / 2007, when we prioritised the acquisition of maximum and specialist care hospitals. For a more
detailed analysis, please refer to the statements in the following section on revenue and performance development.
Our internal benchmark for the growth of the Sana Group is the compound annual growth rate (CAGR) of revenue
(with reference to the base year, 2000). The development of this figure in the past few years is set out below:
Further increase in EBITDA despite non-recurring charges
One of our key financial control parameters, and an indicator of a company’s operating profitability, is earnings before
interest, taxes, depreciation and amortisation (EBITDA). We increased EBITDA to EUR 151.9 million in the 2011
financial year. This corresponds to a 2.8 per cent improvement on the previous year. Negative contribution margins of
the acquired hospitals, unscheduled negative impacts of the EHEC crisis as well as reorganisation expenses for individual hospitals, especially in structurally weak regions, caused the EBITDA margin to fall slightly from 10.0 per cent
to 9.3 per cent.
Increase in EBITDA
to EUR 151.9 million
Development of EBITDA
Compound Annual Growth Rate
20
1,700
19.2
19.2
19
1,500
20
1,629.2
18.4
18.3
19
18.3
18
18
1,300
1,063.5
17
1,100
1,254.0
1,484.9
17.5
17
Revenue in EUR million
16
Compound Annual
Growth Rate in %
946.0
16
900
791.2
15
2006
2007
2008
2009
2010
160
12
140
10
120
8
100
80
6
60
4
40
2
20
0
10.8
10.3
9.7
12
10.0
9.6
9.3
85.8
2006
97.5
2007
103.0
2008
119.9
2009
147.8
2010
151.9
10
8
6
4
EBITDA in EUR million
2
EBITDA margin in %
2011
2011
We again met our growth targets with our performance in 2011.
A further indicator of the highly positive growth situation is the number of patients that we treated at our facilities.
Patients treated
Declining profit margins show that cost increases that are not directly reflected in the remuneration system cannot be
offset indefinitely. The increase in the allocation pursuant to the German Renewable Energies Act (EEG) of over 70 per
cent to 3.52 cents per kWh, which was higher than experts expected, alone resulted in an extra charge of approximately EUR 1.7 billion for the Sana Group. In addition, there is still no compensation in the DRG system for the higher
remuneration level of external staff compared with payroll doctors and carers. In the past financial year, our expenses
for external staff amounted to EUR 50.7 million (previous year: EUR 46.6 million). Use of external medical staff is
currently unavoidable, especially in smaller facilities in structurally weak regions, and therefore puts extra pressure on
margins.
1,500,000
1500000
1,334,000
1100000
1,100,000
1,150,000
900000
900,000
700000
700,000
500000
Despite intensive reorganisation measures, the care facilities continued to generate negative contribution margins. In
the past financial year, a loss of EUR 0.7 million (previous year: EUR – 2.3 million) was generated from revenue of just
EUR 46.8 million. This fact highlights that in our core areas, we are generating even higher profitability in our core
businesses than the overall consolidated net income figure suggests.
1,470,000
1,300,000
1300000
975,000
Number of
patients treated
880,000
2007
2008
2009
2010
2011
Higher profitability in
our core businesses
Internal financial strength increased further
It is particularly pleasing that cash flow from operations was increased to EUR 131.9 million (previous year:
EUR 113.6 million). The increased internal financial strength was one reason why EUR 129.0 million was invested in
future-oriented construction measures and innovative medical technology, with over 60 per cent coming from the
company’s own funds.
The increases attained in in-patient care (8.4 per cent) as well as out-patient care (10.8 per cent) illustrate the interlinking
of both sectors within the range of services of our hospitals. In addition, local cooperations as well as our 18 medical
care centres (MCC), which we operate ourselves and are geared towards individual and regional requirements,
supplement our cross-sector collaboration.
68
69
From the company
Earnings, asset and financial situation
The tables below show the development of the fully in-patient DRG cases (settlement in line with the “diagnosis-related
group” flat-rate payment system) and of the equivalent case-mix items (cost weight) in the year under review compared
with the previous year. It can be seen that the DRG cases increased by 0.6 per cent and the service items in the existing
business increased by 1.5 per cent.
Consolidated income statement – key data
Case-mix items, fully in-patient
DRG cases, fully in-patient
Revenue and performance development
420,000
Increase in revenue characterised by external growth
The development of revenue in the Group is set out below:
390,000
Change
in EUR million
2011
2010
absolute
in %
1,378.6
1,249.8
128.8
10
Retirement home and care services
49.4
48.0
1.4
3
Optional services
28.6
27.5
1.1
4
Hospital services
Out-patient clinic
44.5
38.7
5.8
15
Royalties
31.0
28.3
2.7
10
Procurement and logistics services
48.4
46.9
1.5
3
MCC
25.8
25.3
0.5
2
Others
22.9
20.4
2.5
12
1,629.2
1,484.9
144.3
10
Consolidated net revenue
The substantial revenue growth in revenues from hospital services is attributable to the first-time consolidation of the
hospitals of the Dahme-Spreewald district and the full-year inclusion of the Krankenhaus Rummelsberg.
Increased use of highperformance medicine
Of the EUR 128.8 million revenue upturn in the in-patient area, EUR 95.0 million is attributable to the first-time new and
full inclusion of the facilities purchased at the end of the previous year and EUR 33.8 million to the existing hospitals. This
equates to organic growth of approximately 3 per cent. This organic growth masks inconsistent performance development at the hospitals. In particular, some of our smaller hospitals in rural regions posted a slight decrease. In contrast,
our specialist care hospitals performed very well. This also reflects the increased use of high-performance medicine by
patients.
To enable better management of the services of our facilities, we have structured them into different clusters. We now
distinguish between the specialist hospitals for cardiovascular diseases (H) and those specialising in orthopaedic care
(O). In addition, we have set up clusters for maximum and specialist care hospitals (G) and basic and standard-care
providers of different sizes (M and K). The revenue share of the various clusters is set out below:
360,000
330,000
)
2%
)
5
,90
31
337,036
2,794
334,242
2,113
5%
(9.
,80
34
380,094
3,781
368,941
9.
4(
5,525 (1.5
414,898
33,060
%)
32,586
)
(0.6 %
336,355
2010
376,313
381,838
2010
2011
Existing business
Acquisitions
2011
Change
The number of patients treated as out-patients rose by 4.3 per cent in existing business and, in conjunction with the
patients of the facilities included for the first time, the number increased to 1.07 million. This illustrates the trend whereby
patients are increasingly receiving out-patient treatment.
Other operating income
Income from auxiliary and supporting operations of EUR 29.3 million (previous year: EUR 24.3 million) is continuous
and recurring income. At EUR 19.0 million (previous year: EUR 16.2 million), income from our pharmacies accounts
for most of this.
Income from remuneration and reimbursement also increased to EUR 31.7 million (previous year: EUR 27.0 million).
Staff costs
Staff costs developed as follows:
Staff costs
Staff costs ratio
2011
2010
in EUR million
973.9
892.7
in %
59.8
60.1
Share of revenue attributable to the different clusters
A breakdown of the increase in staff costs is set out below:
51 % Cluster G: Maximum and specialist care hospitals
12 % Cluster M: Basic and standard care suppliers (medium-sized hospitals)
9 % Cluster K: Basic and standard care suppliers (smaller hospitals)
in EUR million
Effect of first-time consolidation of hospitals in the financial year
65.4
Existing business at Sana
15.8
9 % Cluster H: Specialist clinics for cardiovascular diseases
11 % Cluster O: Specialist orthopaedic clinics
8 % Other
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From the company
Staff costs ratio has
fallen below 60 per cent
Slight decrease in the staff costs ratio
The staff costs ratio fell back to just below the 60 per cent mark in the past financial year. The staff costs ratio of the
facilities that were fully integrated in the Group for the first time in the financial year currently stands at approximately
62 per cent. The staff costs ratio of the existing facilities is 59.5 per cent.
Amortisation and depreciation
in EUR million
Amortisation of intangible assets
Depreciation of property, plant and equipment
Regarding staff costs, the increases for medical and nursing services compared with other types of service must be
emphasised here. This corresponds to the performance development at our facilities.
Of which unscheduled amortisation
and depreciation
2011
2010
4.3
3.8
55.9
58.6
60.2
62.4
0.0
6.7
As described, expenses for external employees increased. This primarily relates to medical services, which are also
an expression of new ways of working. Many of our facilities in structurally weak regions are very heavily reliant on
these.
An appropriate allocation of these expenses of EUR 50.7 million (previous year: EUR 46.6 million) to staff costs would
result in an adjusted staff cost ratio of 62.9 per cent.
Increase in scheduled amortisation and depreciation due to growth
If the unscheduled amortisation and depreciation carried out in the previous year is factored out, an increase in
scheduled amortisation and depreciation of EUR 4.5 million is obtained, EUR 3.7 million of which is attributable to the
first-time inclusion of the acquired facilities.
Cost of materials
in EUR million
Cost of materials
Of which expenses for raw materials
and consumables
Of which purchased services
2011
2010
439.4
399.3
309.1
281.1
130.3
118.2
Slight increase in cost of materials ratio due to acquisitions
Overall, the cost of materials ratio is 27.0 per cent (previous year: 26.9 per cent). In addition to increased costs in the
form of fees for external staff, higher expenses for raw materials and consumables also had an impact, in particular
increased energy costs. At 19.0 per cent, the raw materials and consumables ratio is almost at the same level as the
previous year (18.9 per cent).
In line with the alternative allocation of costs for external employees to staff costs described above, an adjusted cost
of materials ratio of 23.9 per cent (previous year. 23.8 per cent) would be obtained.
Adjusted cost of materials
ratio is 25.7 per cent
One special feature of the Sana Group’s business model is logistics services. The cost of materials ratio adjusted for
logistics expenses is 25.7 per cent (previous year: 25.5 per cent).
Financial result
in EUR million
2011
2010
Interest income
3.9
2.9
Interest expenses
31.6
28.9
– 27.7
– 26.0
Successful interest management
The increase in interest expenses results from the following effect: for the promissory note loan issued in April 2010,
the interest payments for twelve months are included for the first time in the 2011 reporting year.
As a result of successful interest optimisation using interest hedges, the effective interest rate on liabilities to banks
has been reduced to 4.56 per cent (previous year: 4.79 per cent).
Taxes
in EUR million
2011
2010
Current taxes
14.9
17.0
Deferred taxes
– 3.8
– 5.2
11.1
11.8
A breakdown of the increase in the cost of materials is set out below:
in EUR million
Effect of first-time consolidation of hospitals in the financial year
Share of the logistics segment
Existing business at Sana
28.5
0.7
10.9
Despite the expansion of our services in terms of severity, particularly at the material-intensive specialist hospitals
(orthopaedics and cardiovascular diseases), the cost development of the hospitals that have been part of the Group
for longer has been reduced in proportion to the revenue growth. The substantial increase in the cost of materials in
the 2011 financial year stems from the new hospitals and illustrates the potential for further improvements next year.
In the 2011 financial year, current tax payments fell year-on-year, as tax loss carryforwards were increasingly deducted.
Consequently, the tax rate has been reduced from 20 per cent to 17 per cent.
Tax rate reduced
to 17 per cent
Margin development
Newly acquired hospitals initially have a negative impact on the operating margin in the Group
As a result of the fast inorganic growth of recent years, several acquired hospitals are still in the process of redevelopment and diluting Group margins due to their below-average profitability. EBITDA was increased by 2.8 per cent to
EUR 151.9 million in the reporting period (previous year: EUR 147.8 million). With regard to the EBITDA margin of
9.3 per cent (previous year: 10.0 per cent), the significant exceptional charges arising from the EHEC crisis in northern
Germany and the reorganisation costs of the acquired facilities had a major impact.
Other operating expenses
Other operating expenses increased to a greater extent than revenue in the reporting period, even though key items
such as administration costs at EUR 28.4 million (previous year: EUR 28.9 million) and maintenance expenses at
EUR 28.2 million (previous: EUR 29.0 million) decreased. This was mainly due to write-downs on receivables of
EUR 9.9 million (previous year: EUR 8.2 million).
72
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From the company
Against this background, it is important to distinguish between the dilution effects resulting from the purchase of lossmaking hospitals and the potential of the facilities that have been part of the Sana Group for some time. Despite
considerable reorganisation success at the hospitals in Rummelsberg and the Dahme-Spreewald district that were fully
included in the consolidated financial statements for the first time in 2011, the profit margins of both hospitals initially
have a negative impact on the Group margin. Excluding the two acquisitions, the Group EBITDA margin would have
been 0.4 percentage points higher at 9.7 per cent. The rigorous continuation of our integration operations at the newly
acquired hospitals will help to ensure sustained earnings development within the Group. One example of this is the
significant improvement in the EBITDA figures of the facilities opened in 2009 in Hameln and Hoyerswerda. As early as
the second year after acquisition, the EBITDA margin of the two facilities rose significantly compared with the previous
year by a further 3.0 percentage points to 9.7 per cent, thus coming close to the adjusted Group average very quickly.
Furthermore, the Group’s operating margin is negatively impacted by the below-average earnings contribution of the
retirement and care facilities. Although the pro rata EBITDA margin of these facilities improved from 3.8 per cent in the
previous year to 5.9 per cent in 2011, it continues to lag far behind our core areas.
EBIT margin
is 5.6 per cent
Throughout the Group, earnings before interest and taxes (EBIT) were up 7.4 per cent to EUR 91.7 million. The EBIT
is 5.6 per cent, compared with 5.8 per cent in the previous year.
Despite the above-average growth and associated dilution effects, the earnings margin remained at the same level as
the previous year at 3.2 per cent.
Financial position
in EUR million
Conservative financing structure
The Sana Group continues to pursue very conservative targets in the context of its financing strategy. Ensuring liquidity and maximum planning security in terms of refinancing costs are the key focal points here. A sound investment
policy not solely geared toward returns and a long-term financing structure are core elements of this strategy. One
central task of the Treasury department is liquidity controlling, which ensures sufficient liquidity to meet ongoing commitments and provides the necessary financial means to finance growth.
In addition, in the context of the promissory note loan issues, Sana Kliniken AG has undertaken to adhere to specific
debt service cover ratios. This commitment and several targets ensure that growth is financed on a sustainable basis
and specific ratios between equity and borrowing are adhered to. For the existing financing from the promissory note
loans, standard covenants are in place, geared towards the ratio of EBITDA to net debt. On the basis of current planning, the Executive Board assumes that these will also be adhered to in the subsequent period.
Strengthening of equity reinforces our financing basis for future growth
In the 2011 financial year, our shareholders approved a EUR 160.0 million equity increase. EUR 80 million of this
was paid in in 2011. With this capital measure, we strengthened our capital structure and equipped our company for
further growth.
Double-digit increase in cash flow from operations
Cash flow from operations (net cash flow from operating activities before taxes) was up 16 per cent year-on-year from
EUR 113.6 million to EUR 131.9 million. Successful measures to improve working capital management have led to
a lower increase in net current assets, partly as a result of optimised receivables management. On the other hand,
cash reorganisation expenses for the companies acquired in recent years had a negative impact on cash flow from
operations.
2011
2010
131.9
113.6
– 8.5
– 7.7
Net cash flow from operating activities
123.4
105.9
Debt
Purchase of noncurrent assets
– 77.7
– 73.2
Payments for business combinations less cash acquired
– 26.8
– 55.3
Leverage ratio reduced
Net debt was reduced by EUR 64.3 million in the past financial year. This largely results from cash receipts from the
equity increase.
4.9
– 12.9
Net cash flow from investing activities
– 99.6
– 141.4
Proceeds from shareholder contributions
79.3
0.2
0.0
214.0
Income tax paid
Other cash flow from investing activities
Cash receipts from new loans
Loan repayments
– 35.1
– 120.7
Interest paid
– 28.6
– 24.0
Dividends paid
– 15.2
– 10.3
Other cash flow from financing activities
– 4.4
– 4.2
Net cash flow from financing activities
– 4.0
55.0
Net increase of funds
19.8
19.5
Funds at 1 January
179.7
160.2
Funds at 31 December
199.5
179.7
Growth financed on
a sustainable basis
increased by 16 per cent
to EUR 131.9 million
Capital expenditure of EUR 77.7 million, dividends of EUR 15.2 million and borrowing costs of EUR 28.6 million were
financed from cash flow from operations.
On the basis of commitments to promissory note holders, known as covenants, we adhered to the debt ratio “interestbearing net debt / EBITDA” with a limit value of 3:1.
At 31 December 2011, net debt stood at EUR 237.0 million. The resultant leverage ratio of 1.56 in relation to EBITDA
is well below the agreed limit.
Much-improved cash flow control parameters
The development of the cash flow ratios “FFO / total debt” and “FCF / total debt” is set out below:
in %
2011
2010
Defined
target range
FFO / total debt
43.9
32.4
15 – 30
FCF / total debt
6.3
5.8
5 – 10
The low debt level has a positive impact on these two key ratios, and consequently the “FFO / total debt” ratio is well
below our target range.
“FCF / total debt” is certainly within the target range, although this year much of the cash flow was again invested in
maintaining the value of our company’s infrastructure and making it fit for the future.
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From the company
Net asset situation
Capital expenditure
Balance sheet structure
31.12.2011
in EUR million
31.12.2010
in %
in EUR million
in %
Assets
Non-current assets
Current assets
1,059.0
66.9
1,040.1
524.7
33.1
500.9
67.5
32.5
1,583.7
100.0
1,541.0
100.0
530.4
33.5
413.2
26.9
59.1
3.7
60.0
3.9
614.1
38.8
656.7
42.6
Liabilities
Shareholders' equity
Shareholder loans
Non-current liabilities
Current liabilities
380.1
24.0
411.1
26.8
1,583.7
100.0
1,541.0
100.0
In the context of the acquisitions of the past few years, ongoing investment commitments have been entered into with
a view to structuring and positioning the facilities to make them fit for the future. The Sana standards in terms of the
medical and building services infrastructure are thus being gradually implemented through the integration of these
new companies in the Group.
EUR 129.0 million was invested throughout the Group in the 2011 financial year, compared with EUR 119.0 million in
the previous year. EUR 77.7 million of capital expenditure was financed from own funds. At over 70 per cent, the bulk
of investing activities were focused on developing the clinical locations of the maximum and specialist care hospitals,
for example EUR 26.3 million for the newly built hospital in Dusseldorf. Other major single investments include
measures in Berlin (EUR 5.7 million), the Dahme-Spreewald district and Hof (EUR 5.0 million each) and Lübeck
(EUR 4.9 million).
Investment of
EUR 129.0 million
As a result of the high proportion of individual subsidies for the construction project in Berlin-Lichtenberg received in
the 2011 financial year, the Group has a subsidies ratio of 40 per cent related to the financial year. In future, increasingly high proportions of capital expenditure will have to be financed from own funds due to further declines in subsidy
ratios. At 31 December 2011, the proportion of subsidy-financed fixed assets was just 30 per cent.
Non-financial performance indicators
Equity strengthened and debt reduced
Due to the adjustment of the opening IFRS statement of financial position of Krankenhaus Rummelsberg gGmbH, the
corresponding figures for the previous year differ from the figures published in the 2010 annual financial statements
(cf. Note – 3. Business Combinations). Total assets only increased slightly in the comparison of the two years, as
Kliniken Dahme-Spreewald GmbH was already included in the consolidated balance sheet at the end of the previous
year. The biggest change stems from the equity injection of EUR 80.0 million, which enabled us to pay off long-term
loans on an unscheduled basis in addition to the normal loan repayments. At 33.5 per cent, the equity ratio is still
above the 2009 figure.
Matching maturities of non-current and current assets is in line with our sound finance and accounting policy.
Non-current assets particularly included a EUR 23.6 million increase in property, plant and equipment and intangible
assets. This resulted from the investment measures undertaken for the ongoing development of our clinical locations,
such as the newly built hospital in Dusseldorf.
Adjusted equity ratio
of 34.7 per cent
Receivables of EUR 69.6 million and liabilities of EUR 56.5 million from granting subsidies are reported under assets
and liabilities respectively. These are to be regarded as transitory items and, from a business viewpoint, must
be eliminated when calculating the equity ratio. Against this background, an adjusted equity ratio of 34.7 per cent
is obtained.
Net gearing, the ratio of interest-bearing net debt to equity, improved from 72.9 per cent to 44.7 per cent in the 2011
financial year. This development resulted from payment of the first tranche of the equity increase of EUR 80.0 million.
RoCE stood at 9.9 per cent in the past financial year (previous year: 10.3 per cent), 1.7 x our cost of capital. We thus
exceeded our internal target of generating 1.5 times our cost of capital once again.
76
In addition to the financial control parameters with which we measure company’s performance, other aspects crucial
to the future development of the Sana Group are particularly important.
Research and innovation management
We set new standards in patient care at our facilities. To achieve this, we create an environment for active participation
in research and innovation for our employees. We rigorously promote scientific involvement at our non-university
facilities. This is also reflected in the Sana science promotion programme, which supported dissertations, postdoctoral
theses and numerous scientific publications once again in 2011.
from page 32
Sana rewards doctors for outstanding research projects
For the third time, Sana Kliniken AG has rewarded outstanding work in the fields of clinical research, care, nursing and
basic research. A central element of the programme, the Sana Science Prize was this year awarded to two outstanding doctors and their teams: Herzzentrum Dresden / University Hospital at the Technical University of Dresden and the
Sana Kliniken Sommerfeld. Prize-winners Prof. Ruth Strasser and Dr Alexander Beier received the award for their
forward-looking research projects in the fields of cardiology and endoprosthetics.
To complement its science promotion, Sana Kliniken AG pursues sustainable innovation management. The aim is to
identify “real” medical innovations that demonstrably improve patient care as early as possible and to implement them
in clinical practice in a structured, responsible way. With our commitment to quality and operating efficiency, we create
the essential conditions for sustainable enterprise value. In addition to introducing state-of-the-art diagnostic and
therapeutic technologies, this also includes enhancing network structures and centres of competence (connected by
telemedicine) for highly specialised services as well as providing internal training programmes.
At the Sana Klinikum Lichtenberg, a patient’s gall bladder was removed by means of a new minimally invasive pro
cedure with three-dimensional viewing for the first time. The instruments, just 3 mm thick and fitted with a camera,
provide a view of the entire operating field as in open surgery. Every detail can be seen clearly, right down to the
smallest blood vessels. Quality of operation outcome is improved significantly, thus reducing the possibility of complications, e.g. bleeding. In addition to the possible reduction of operating times and the lower probability of complications,
the healing process can be accelerated in many cases with this new procedure.
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From the company
Supplementary report
At the Sana-Herzzentrum Cottbus, the range of minimally invasive surgery has been extended to such an extent that
it is now boosting patient numbers beyond the state of Brandenburg. With the fast introduction of state-of-the-art
reconstruction aids (adjustable annuloplasty rings) into the minimally invasive valve surgery range, the Sana cardiac
centre in Cottbus is one of the first five hospitals in the world to embrace this innovative concept.
Sana strategy teams for implementing innovations in hospital operation
At the Sana Group, conceptual preparation of innovative care structures is carried out by the Sana strategy teams. In
these interdisciplinary working groups, experts from Sana facilities analyse and assess clinically significant innovations for various fields with the aim of formulating specific action recommendations for introducing innovations
throughout the company. One example is cardiovascular medicine. For instance, in the 2011 financial year, new
interventional procedures in the treatment of valvular heart diseases and cardiac arrhythmia and new integrative
approaches to the treatment of severe heart failure were particularly identified as key innovation areas. Furthermore,
the relevance of the innovation spectrum is ensured through continuous monitoring and regular evaluation of specialist
scientific developments in cardiovascular medicine.
Sana invested approximately 0.9 per cent of revenue from in-patient care in research and research-related projects in
the 2011 financial year. In addition, we again invested heavily in innovative diagnostic and therapeutic technologies.
Quality and transparency of medical services
Sana quality offensive stepped up
In the context of the quality offensive that we launched in 2010, Sana Kliniken is one of the initiators of the hospital
portal “Qualitätskliniken.de”. This portal, now one of the biggest of its kind in Germany, contains the results of all
hospitals of Sana Kliniken AG in the various quality dimensions, thus enabling transparent quality competition. As well
as the quality dimensions of medical outcome quality and patient and referring physician satisfaction, patient safety is
also a high priority. Numerous improvements of risk-seeking patient-related processes are based on this. To achieve
lasting improvements in the dimension of quality of medical outcomes, concepts for peer reviews have been developed
and implemented as pilot projects in the medical and nursing areas. A new quality information system will support
clinical quality and risk management with the further increase in quality of medical outcomes.
Professional purchasing
One important factor in reducing or containing costs at companies is the systematic, well-structured procurement of
equipment. Close collaboration between a central professional strategic purchasing department based within the
holding company and the decentralised operational purchasing departments enables us to get the best possible price
through bundling, standardisation and price comparisons. Above and beyond bundling of the requirements of the
facilities that we run, the Sana Group is able to generate substantial purchasing advantages through procurement
services for third parties. These benefit us and our customers. The products negotiated by the strategic purchasing
department also include services such as laundry.
Substantial purchasing
advantages through bundling
In the course of capital goods procurement, all costs incurred are analysed and taken into account, including downstream operating costs. The Sana purchasing department cooperates closely with Sana service providers TGmed
(facility management), property management and the Sana Medical Service Centre here.
Overall statement by the Executive Board
on the economic situation
2011 was a successful financial year for the Sana Group. Sana ended the financial year with double-digit increases in
revenue and earnings for the fourth time in a row. This is an impressive achievement, as unscheduled negative
impacts were encountered in the 2011 financial year. Growth rates for revenue and income remained above the sector
average, reflecting the strengths and soundness of our business model.
One positive factor here is the fact that integration of the newly acquired hospitals is progressing more quickly than
originally planned. In this respect, it is very pleasing that the Regio Kliniken purchased at the start of 2010 have
broken even after just two years.
Financial and capital resources have been boosted further through the biggest capital increase in the history of
Sana Kliniken AG totalling EUR 160.0 million. On the basis of high cash flow and our optimised capital structure, we
significantly improved all relevant debt ratios.
Biggest capital increase
in the history of Sana
Employees
from page 46
Sana supports its employees and shares the proceeds of its success with them
Employees are the key factor in the provision of modern medical care for patients in hospitals. This is also reflected
by the staff cost ratio of just under 60 per cent.
A stable dividend of up to 8 per cent in relation to paid-in equity and servicing profit participation certificates at the
same level are not only ensured for the past financial year, but are also likely for the 2012 financial year. We will share
some of the proceeds of the sound earnings for 2011 with our shareholders with an appropriate distribution.
Training of young people is a top priority at Sana. For all employees, tailored training programmes are available on a
centralised and decentralised basis for and across the various career groups. The innovative new occupational
profiles are already being successfully deployed at our hospitals. In this way, we are not only fostering employee
development, but also ensuring that vacancies are filled by appropriately qualified staff.
Supplementary report
An attractive working environment encompasses many aspects. For instance, the facilities must be run in such a way
that they make family life easier for employees. All facilities of the Sana Group either went through the Hertie Foundation’s “work and family audit” in 2011 or will do so in 2012, and are being adapted to the new requirements by means
of this structured process.
With our Group collective agreement, we are creating transparency and can ensure fair remuneration. Employees
share in the company’s success on the basis of the bonus arrangement included in this agreement.
After the end of the reporting period, we received acceptance of bids to purchase further hospitals. On 11 January
2012, the district council in Cham, Bavaria, approved the purchase of 74.9 per cent of the shares of Kliniken des
Landkreises Cham gGmbH by Sana Kliniken AG. The district council retains a 25.1 per cent stake. In addition, on
19 January 2012, the local council of the Hanseatic town of Wismar unanimously voted in favour of a participation by
Sana in Hanseklinikum Wismar. The 94.0 per cent stake in Hanseklinikum Wismar GmbH previously held by Damp
Kliniken AG can thus be purchased. The remaining 6.0 per cent of the shares in the 500-bed specialist care hospital
remains in the hands of the Hanseatic town of Wismar.
Dr Markus Müschenich resigned from the Executive Board of Sana Kliniken AG with effect from 31 January 2012. The
areas for which Dr Müschenich was previously responsible will be taken on by the other Executive Board members.
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79
From the company
Opportunity and risk report
Rigorous monitoring of opportunities and potential risks
Corporate management always means adopting a balanced approach to opportunities and risks. The Sana Group
attempts to attain corporate targets, identify opportunities relating to improving its competitive position at an early
stage, assess them and utilise them responsibly. Entrepreneurial action also requires a willingness to assume the
associated risks. As a counterpart to the opportunities, potential risks are identified at an early stage, analysed and
managed in a structured way at the Sana Group.
RISK MANAGEMENT – POLICY, ORGANISATION AND PROCESS
Long-term safeguarding of
quality, operating efficiency
and investment capability
Holistic risk management system to safeguard the company
A holistic risk management system that is applied by all Group companies and thus forms the main basis for long-term
corporate success is established in the Sana Group. Throughout the Group, Sana has formulated and implemented
binding risk policy principles from its values and strategy. The ultimate premise of these principles is that no action or
decision may involve a risk that threatens the company’s existence. To enable us to rule out developments that could
endanger the Group’s existence, we counter risks in a targeted manner with suitable control measures. Here we also
essentially support the long-term safeguarding of quality, operating efficiency and investment capability. The foundation of rigorous risk controlling is a deeply engrained awareness of risk. Given the constantly changing conditions
in the healthcare industry, this awareness of risk is continuously intensified at Sana Kliniken AG.
• Assessment / aggregation
Systematic summarising and evaluation of identified risks
At the level of the respective individual company, all identified risks are regularly quantified with regard to the
parameters of impact on earnings and probability. This is followed by a two-stage aggregation process in which
identified risks are summarised and assessed, first at the level of the regions and then at Group level. In the aggregation process, correlations between the individual matters impacting risk are given due consideration if required.
• Control
Instrument mix to minimise risk
To control as many risks as possible, suitable measures are taken in the form of an instrument mix, taking materiality
into account. These include measures for risk prevention, risk transfer and risk reduction as well as acceptance of
a limited residual risk.
Path to minimise risk
Prevent
Pass on
Reduce
Acceptance
The Group risk management guideline defines and sets the requirements for risk detection, analysis and control
throughout the Group. This guideline was approved by the Executive Board. It is reviewed each year and amended
as required.
A risk management organisation with a structure that ensures dialogue-oriented interpersonal cooperation between
all those involved in risk management is established in the Sana Group.
An administrative department that reports directly to the Chief Executive Officer of Sana Kliniken AG is responsible for
central coordination, enhancement and monitoring of the risk management process. It also determines and describes
the overall risk situation of the Group. The operational risk managers and the management of the associated companies
are directly responsible for early identification and analysis of potential risks and for instigating suitable control measures.
Furthermore, the risk situation of the Sana Group and the individual Group companies is discussed by a control,
management and monitoring body, the Risk Management committee.
The cycle of the risk management process consists of the following steps: risk identification, risk assessment, risk
control and risk reporting.
•Identification
Bottom-up process for identifying potential risks
Risk identification is based on a bottom-up process in which specific instruments are used depending on the individual
risk situation. Analytical methods and heuristic techniques are applied here on the basis of internal and external
information sources as well as macroeconomic scenarios. Another central element in the identification of potential
risks is the central risk atlas, maintained within the risk management software, which sets out all known material
risks within the Group in detail.
80
Overall risk
Residual risk
In accordance with the bottom-up process of risk identification, the individual companies are responsible for prompt
implementation of these measures. If correlating risks exist within the Group, the necessary control measures are
stipulated and coordinated centrally.
• Reporting
Transparent and regular risk reporting for all decision-makers
The Sana Group has implemented quarterly risk reporting. This ensures that all decision-makers are informed of
risk matters promptly and in full. By means of multistage reporting geared towards defined risk thresholds, it is also
ensured that all risks are mapped in accordance with responsibilities and to the necessary extent. Quarterly reports
regarding risks that are material to the Group are prepared for the Supervisory Board and the Executive Board. Risk
reporting is regularly discussed by the Audit Committee. If risks arise suddenly and unexpectedly, the scheduled
quarterly risk reports are supplemented by separate ad-hoc reports.
Quarterly reporting to
the Supervisory Board
Strategic risk management is supported by the central action area officers, who assess the risk and success factors
for their assigned risk area each year on a Group-wide basis. At the same time, the effectiveness of control
measures is also comprehensively monitored in this process.
Regular audit of the risk management system
The risk management system (RMS) is of crucial importance to all major decisions in the Sana Group. For this
reason, the appropriateness, viability and efficiency of the implemented risk management processes as well as
adherence to the regulations defined in the Group risk management guideline are regularly audited by the internal
audit department and commissioned independent third parties. In the context of the process audit, the auditor
assesses the risk early detection system integrated in the risk management system with regard to its fundamental
suitability to identify developments that could jeopardise the continued existence of the company at an early stage.
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From the company
The installed risk management system ensures that material entrepreneurial risks are identified at an early stage
and that the Group is thus able to counter potential risks actively and effectively. The implemented system therefore
fulfils the statutory requirements for a risk early detection system.
Description of the internal control system (ICS)
Close interaction between
the internal control system
and risk management
Clear, comprehensible stipulations for day-to-day operations
The internal control system to be applied at all levels of the Sana Group interacts closely with the risk management
system. Process-integrated and non-process-dependent controls are used to monitor and reduce risks in the areas of
compliance and financial reporting as well as in the operational and strategic areas of the Sana Group. Reduction of
risks to business operations and attainment of corporate targets are carried out on the basis of central stipulations.
The methodological framework and key premises of the ICS in the Sana Group are set out in a Group guideline and
published in a binding manner. Firm and comprehensible stipulations for day-to-day operations are created through
the definition of minimum requirements for the control system with regard to key risk-laden processes. A minimum
control level is thus stipulated, and adherence to it throughout the Group can be tracked centrally.
The Sana Group has identified the definition of tasks, responsibilities and competences and the determination of
secure workflows and IT controls as key control measures. Taking into account appropriate organisational means,
the organisational and process structure ensures that decisions by the management are complied with, principles
of regularity are adhered to and opportunities to bypass controls are minimised.
Risk areas of the Sana Groups
Risks that may have a material impact on the asset, financial and earnings situation of the Sana Group are assigned
to the risk areas listed below:
•
•
•
•
•
Market and strategy
Financial management
Staff
Infrastructure
Performance management
Market and Strategy
Standardisation, specialisation and focus on core business
The Sana Group pursues a strategy of profitable, sustainable growth combined with top quality standards for our
medical patient care and nursing and with regard to our care-related services. Strategy development and implementation are carried out with particular consideration of associated risk sources. Potential hazards can arise here
particularly in relation to acquisition and integration processes and from changing conditions in the healthcare sector.
These risks are recorded through ongoing preparation and evaluation of relevant factors and information.
The in-house specialist departments and qualified experts are used to assess and determine suitable control measures.
This ensures that all major decisions are taken on the basis of extensive legal, tax and commercial advice.
The growing decline in prices for in-patient medical services is reflected by pressure to increase efficiency of clinical
processes and treatment quality. Sana is facing up to this challenge with efficient process management and highquality DRG revenue management.
82
We attain optimum structuring of potential and the service volume by rigorously aligning our range of services to our
core business. In doing so, Sana applies standardisation and specialisation, thus enabling efficient deployment of
human resources and modern cost management.
The Sana Group companies thus attain differentiation from competitors in the health market who have less optimum
cost structures, and this differentiation generates significant competitive advantages.
By means of our long-term planning of construction and maintenance measures, uneconomic investments and
inappropriate capital commitment are avoided. Sound project management geared towards avoidance of contentrelated, time-related and financial project risks is a key factor in successful completion of our projects.
Financial Management
Conservative financing strategy
In the context of its financing strategy, the Sana Group continues to pursue highly conservative targets. The focus
here is on ensuring liquidity and maximum planning security in terms of refinancing costs. This is particularly reflected
in our conservative investment policy not solely geared towards returns, and a long-term financing structure.
In connection with the promissory note loan issues, Sana Kliniken AG has made a commitment to the capital markets
to adhere to specific debt service cover ratios. Consequently, standard covenants relating to the ratio of EBITDA to
net debt are in place for financing the promissory note loans. On the basis of current planning, the Executive Board
assumes that the covenants will continue to be adhered to in the 2012 financial year.
Credit risk
In view of the financing system for German healthcare, the health insurance companies are the main business partners of the Sana Group. The health insurance companies cover the majority of receivables from services provided.
There is no associated creditworthiness risk. The Sana Group maintains corresponding adjustment accounts for
selected long-standing receivables in order to recognise corresponding risks.
Financing and liquidity risks
Liquidity risks can arise if there is insufficient finance available to meet due liabilities promptly or in full. Furthermore,
for the Sana Group, there is a risk of having to accept unfavourable financing terms due to liquidity bottlenecks. At the
Sana Group, the liquidity risk is controlled by the Group treasury department. At the end of the reporting period, cash
and cash equivalents totalled EUR 199.5 million (previous year: EUR 179.7 million). In addition, the Group can draw
on credit lines amounting to EUR 70.0 million.
In view of the liquidity available to us and our stable business model, we assess the probability of financing and liquidity
risks as very low.
Interest rate risks
Fixed-interest loans or loans secured by simple interest rate swaps continue to account for more than 90 per cent of
financial liabilities of the Sana Group. Consequently, the interest risk was again minimal in the 2011 financial year.
The cash and cash equivalents available to the Group in the short term have predominantly been invested in the form
of time deposit investments, fixed-interest securities and interest-bearing current accounts with core banks. We generated average interest of 1.56 per cent on the current funds invested in the 2011 financial year. The return attained was
again above the average three-month EURIBOR for 2011 of 1.39 per cent. Sana will continue to follow the conservative
investment and financing strategies stipulated by the Executive Board, which are set down in the context of Group
guidelines.
Average interest
of 1.56 per cent
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From the company
In accordance with the requirements of IFRS 7 (Financial Instruments: Disclosures) we have analysed the impact
of changes to our most important interest rates on net income and equity. Interest rate risks from the fair values of
promissory note loans hedged with cash flow hedges were also taken into account here. The changes in fair value
of the hedged items and the interest rate hedging instruments had no impact on the income statement in the 2011
financial year.
We have also performed an interest rate sensitivity analysis.
In our view, the interest rate analysis according to IFRS 7 constitutes a realistic assessment of our current interest
rate risk.
The operations of the Sana Group are solely focused on Germany. Consequently, there are no currency risks.
Like other market players, the Sana Group is confronted by increasingly stringent refinancing terms for future
financing on the capital markets. This environment will tend to lead to higher financing costs. However, as a result of
fluctuations in the market interest rate level and the risk spreads, we assume that we will be able to compensate for
significant effects.
Price risks
Prices for our services are largely determined by the development of state basic case values. Setting of these basic
case values is the responsibility of the relevant state associations and is heavily subject to the regulatory environment.
We refer here to the statements in the “Sector-specific situation” section. The basic case values on which our plans
are based are selected very conservatively and are predominantly in line with the set prices.
Staff
Measures to combat shortage of specialist staff
Sana Kliniken AG pays special attention to identifying risks relating to employment and social law. Compliance with
legal standards is continuously examined and sources of potential infringements of the law are identified at an early
stage through ongoing preparation and evaluation of relevant factors and information.
Flexible working time and
remuneration models
Due to the high staffing levels required on the healthcare market, the development of wages and salaries is very
important to the Sana Group. Sana counters this risk through flexible working time and remuneration models. In
addition, there is the option to introduce hospital-specific collective or company regulations resulting from constructive
talks with the unions and management.
The lack of qualified specialist staff, the preferences of potential and permanent employees in terms of working
environment and demographic trends are reflected by increasingly high requirements in recruiting and keeping
qualified employees. Risks here result from the intensifying competition for employees and performance risks arising
from unfilled vacancies. The medical industry is particularly affected by this, and also faces the danger that when
qualified staff leave, the level of performance and expertise in the company cannot be adequately compensated for
by the remaining staff. To support recruitment in the medical sector, Sana has therefore established the senior consultant
recruitment centre of competence. Furthermore, ongoing control measures such as further strengthening the employer
brand and staff recruitment are being rigorously undertaken. There are also plans to implement specific cover and
succession regulations and to enhance and introduce new career groups, e.g. the physician assistant. The 50-plus
working group and the planned build-up of internal hospital expertise management are particular priorities. A Sana
expertise model that will be continuously enhanced and extended has been introduced as a tool for Group-wide staff
development.
84
Infrastructure
New requirements as a result of the energy transition
The infrastructure required for running healthcare companies and service companies must meet normative requirements and quality standards of efficient service provision. The energy transition presents major new changes in the
context of future rulings by the German federal government and the EU Commission. For instance, the 2012 German
Energy Saving Ordinance is expected to introduce stricter rules aimed at cutting primary energy consumption. Other
challenges stem from necessary reorganisation and maintenance measures in connection with changed utilisation
requirements for the Sana infrastructure. The need for investment relates to the building stock and technical equipment as well as medical technology and IT of individual subsidiaries. The need for action and investment is determined
in the context of regular checks focused on the viability, safety and economic efficiency of the infrastructure and is a
key element of the planning process in the Sana Group. Therefore, safety and an optimum level of quality, service,
price and follow-up costs are ensured for all concerned. One measure based on this is the systematic monitoring and
evaluation of our structural infrastructure on the basis of a land register. This evaluation is used as a basis for decisionmaking on reorganisation and construction measures.
To reduce potential risks of interruptions of operations due to an IT failure or data loss, the Sana Group has set up a
system of preventive physical and logical security measures. In this respect, special attention is given to the sensitive
clinical systems and data that require an extremely highly level of security.
High level of security for
clinical systems and data
The impact of an interruption of operations is reduced by the existing insurance cover as well as defined security
standards that require the provision of emergency plans.
Performance Management
High standards for quality and economic efficiency
In keeping with the political environment, the social value of health is leading to increasing requirements in the healthcare
sector. With an experienced management team, Sana is countering these through a conscious awareness of future
needs. The Sana Group has implemented a compliance organisation and a code of conduct. Consequently, binding
rules and principles for legally correct and responsible action by employees are formulated and must be adhered to.
Undesirable developments such as inadequate quality awareness or a lack of process efficiency can put patients at
risk and lead to economically inefficient actions. Sana counters these risks through high standards for quality and
economic efficiency in structuring clinical and administrative processes and through a rigorous focus on patients’
needs.
These challenges are managed in the Sana Group by specialist organisational units that support all Group hospitals
centrally with regard to budget developments, service range developments and process optimisations as well as
adherence to medical quality standards.
Specialist organisational
units support Group
hospitals
Group-wide minimum standards ensure stability and clear continuity of processes.
Current media reports clearly illustrate the public’s sensitivity to healthcare issues. The growing range of communication
channels is a potential source of danger to the image of Sana Kliniken. Modern media enables people to criticise the
quality of the company’s treatment, nursing and other services unchallenged and unchecked. Therefore, the ongoing
debate surrounding the issue of “social media” must also be mentioned in the context of risk control. Regular monitoring of social media platforms enables us to respond quickly to information that is potentially harmful to our image.
85
From the company
Forecast report
OVERALL ASSESSMENT OF THE RISK SITUATION
High level of demand
for specialist staff set to
continue in 2012
The capital agreement of EUR 160.0 million approved in the past financial year and the positive cash flow from
operations enable Sana Kliniken AG to continue its sustainable growth strategy. In addition to acquisitions, there will
be further targeted investment in a modern infrastructure and state-of-the-art medical equipment, which form the basis
for further efficiency-enhancing process and quality improvements for the benefit of patients. We will also meet our
commitment to finance the necessary investments from cash flow from operations in 2012.
No discernible risk to the company’s existence
If one or more of the above risks occur, there may be detrimental effects on the Group’s operations and earnings,
asset and financial situation. On the basis of the risk management system implemented in the Sana Group, the
Executive Board states that, with regard to the identified individual risks and the aggregated risks, there are currently
no existing or discernible risks within the Sana Group that threaten the continued existence or the earnings, asset and
financial situation of the Sana Group according to its assessment. The implemented risk management system ensures
full control of the risks identified and described.
Overall, the range of services of Sana Kliniken AG is geared towards the future and will continue to grow in a profitable
manner. We expect EBITDA of up to EUR 160.0 million for 2012. Providing that no facilities requiring reorganisation
are to be integrated in the Group, we are targeting a further increase in earnings for 2013.
Forecast report
Our control activities are geared towards the long term and towards value enhancement. Consequently, we will continue
to focus on the parameters relating to capital efficiency and debt as well as cash flow optimisation in future. In turn, we
expect to achieve an RoCE figure in the region of our target, 1.5 x the cost of capital. In addition, we will continue to
adhere to the debt service cover ratios in the context of our financial strategy targets.
Economic and sector-specific challenges
Macroeconomic development in Germany is likely to slow down further in 2012 due to the ongoing sovereign debt and
financial crisis. The German federal government has continuously reduced its forecast for 2012 in recent months,
although it still expects GDP growth of 0.7 per cent at present. Leading German economic research institutes are now
much more sceptical, forecasting GDP growth in the region of just 0.4 per cent (ifo Institute) to 0.5 per cent (HWWI).
The International Monetary Fund (IMF) even expects growth of just 0.3 per cent in Germany for 2012. However, the
common consensus is that there is no likely negative effect on the labour market. The high level of demand for specialist
staff is therefore set to continue in 2012.
One major sector-specific challenge in 2012 is the fact that the financing volume of the nursing jobs programme
agreed for each hospital for 2009 to 2011 is likely to be charged as a national supplementary fee via the DRG
remuneration system from 2012. For the hospitals of Sana Kliniken AG, this financing volume amounted to approximately EUR 8.6 million in 2011. As a result of complex subsequent entries in the documentation, the foundations for
the fullest possible settlement of the supplementary fees in 2012 were laid at the facilities of Sana Kliniken AG in the
past financial year. However, full compensation for the reduction in financing as a result of the removal of the nursing
jobs programme with no impact on income is unlikely to be achieved.
Further efficiencyenhancing process and
quality improvements
We still intend to pay our shareholders a dividend in line with market conditions for 2012 and 2013.
Reorganisation and optimisation measures as a response to substantial cost increases
Due to the expected significant cost increases for energy, water, food and consumables as well as high wage demands
from the unions for medical and nursing staff combined with stagnating or falling revenues, pressure on profit margins
in the entire hospital industry is expected to grow even further. At some hospitals, far-reaching structural changes will
be required in future in order to meet these challenges. In addition, we will continue to optimise the processes and
structures of our hospitals in terms of effectiveness and efficiency and utilise the potential synergies within the Group.
We firmly believe that this approach creates value for our shareholders, our patients and our employees.
Munich, 29 February 2012
Dr M. Philippi T. Lemke J. Stanslowski
Our strategy of increasing the independence of the Group from the privatisation tendencies of the publicly operated
hospitals has been highly successful for several years. Our willingness to respond flexibly to market requirements has
also been a factor in this. One special feature of the Sana Group here is the fact that we offer the public sector a wide
range of alternative approaches to hospital privatisation with various participation models. However, we are increasingly
noticing that what we deem to be unreasonable prices are currently being charged on the hospital market. We will
therefore not pursue a strategy of growth at any price.
Significant, profitable growth remains our aim
Regardless of the turbulent macroeconomic situation and the sector-specific challenges, we remain optimistic regarding
our growth prospects. This is one reason for our ambitious growth targets for 2012 and 2013. Irrespective of various
sector-specific challenges, we intend to post strong growth. Due to stagnating or slightly declining prices and the
additional negative impacts from the removal of the nursing jobs programme, we expect organic growth of 2 per cent
to 4 per cent for 2012. Furthermore, we envisage a growth contribution from newly acquired facilities. Overall, we
expect revenue of approximately EUR 1.75 billion for the 2012 financial year with no changes to holdings.
86
87
From the company
Consolidated financial statements
Further information
Consolidated income statement
Consolidated statement of comprehensive income
for financial year 2011
Consolidated
Financial
Statements
in EUR k
Note
2011
2010
Revenue
4
1,629,210
1,484,860
4
106,975
100,486
Income from associates
4
1,019
266
1,737,204
1,585,612
Staff costs
973,887
892,709
Cost of materials
439,436
399,254
171,940
145,883
151,941
147,766
Depreciation and impairment
60,210
62,359
Operating profit (EBIT)
91,731
85,407
Total revenue and operating income
Other operating expenses
4
EBITDA
Financial income
4
3,856
2,873
Financial expenses
4
31,601
28,866
63,986
59,414
11,146
11,754
52,840
47,660
49,892
44,053
2,948
3,607
52,840
47,660
2011
2010
52,840
47,660
– 2,243
1,000
718
– 320
Subtotal components of profit or loss recognised in equity
– 1,525
680
Total comprehensive income
51,315
48,340
48,367
44,733
Earnings before taxes
Income tax expense
CONSOLIDATED NET INCOME FOR THE PERIOD
5
Of the net income for the period, the following amounts are attributable to:
Shareholders of the parent company
Non-controlling interests
89 Consolidated income statement
89 Consolidated statement
90 Consolidated statement of financial position
Consolidated statement
in EUR k
92 Consolidated statement of changes in equity
Consolidated Net Income for the Period
93 Consolidated statement of cash flows
Components of profit or loss recognised in equity
94 Notes to the consolidated financial statements
Thereof effective portion of hedging instruments for hedging cash flow
Thereof income taxes attributable thereto
Of the total comprehensive income, the following amounts are attributable to:
Shareholders of the parent company
Non-controlling interests
88
2,948
3,607
51,315
48,340
89
From the company
Further information
Consolidated statement of financial position
Consolidated statement
of financial position
1)
as at 31 December 2011
ASSETS in EUR k
Note
2011
2010
Property, plant and equipment
7
739,603
722,779
Investment property
8
1,129
Intangible assets
9
228,955
229,405*
10
24,589
23,571
Non-current assets
Investments accounted for using the equity method
Tax assets
Deferred tax assets
11
5
1,172
48,598
50,110
813
1,171
4,455
5,243
10,835
1,058,977
Trade and other receivables
12
13
Tax assets
Cash and cash equivalents
2010
Subscribed capital
200,000
120,000
Capital reserves
19,173
19,173
215,961
179,972
Other reserves
– 8,428
– 6,903
Profit participation certificates
63,559
63,589
490,265
375,831
Retained earnings
15
Non-controlling interests in equity
Total equity
40,100
37,380
530,365
413,211
Financial liabilities
Receivables resulting from the Krankenhausfinanzierungsgesetz
(German Hospital Financing Act)
Other financial assets
2011
6,668
1,040,119*
Current assets
Inventories
Note
Equity attributable to parent shareholders
Receivables resulting from the Krankenhausfinanzierungsgesetz
Other financial assets
LIABILITIES in EUR k
11
14
49,342
45,363
225,435
225,073
20,969
26,330
3,289
4,350
26,152
20,056
199,491
179,739
524,678
500,911
Liabilities to banks
16
415,030
457,158
Other financial liabilities
16
120,428
125,220
Pensions and similar obligations
17
16,489
17,356
Liabilities resulting from the Krankenhausfinanzierungsgesetz
18
11,758
10,553
Negative market values of derivative financial instruments
19
12,394
11,824
Other provisions
20
7,897
12,409
Other liabilities
21
77,690
70,329*
5
11,498
11,855
Deferred tax liabilities
673,184
716,704*
37,680
26,463
Current liabilities
Financial liabilities
BALANCE SHEET TOTAL
1)
90
1,583,655
1,541,030*
16
16
4,894
5,136
Tax liabilities
17,117
15,061
Trade payables
87,710
90,198
44,741
45,987
Liabilities resulting from the Krankenhausfinanzierungsgesetz
18
Other provisions
20
34,652
31,717
Other liabilities
21
153,312
196,553*
380,106
411,115*
Total liabilities
1,053,290
1,127,819*
BALANCE SHEET TOTAL
1,583,655
1,541,030*
Items marked * differ from the annual financial statements because of the restatement of the IFRS
opening balance sheet of Krankenhaus Rummelsberg gGmbH, cf. Note – 3 Business combinations.
91
From the company
Further information
Consolidated statement of changes in equity
Consolidated statement of cash flows
Consolidated statement of changes in equity
Consolidated statement of cash flows
Equity attributable to parent shareholders
Subscribed
capital
in EUR k
Balance as at
31 December 2009/
1 January 2010
Components of
profit or loss
recognised in equity
Capital
reserves
Retained
earnings
Other
reserves
Profit participation
certificates
Total
Noncontrolling
interests
Total
equity
Depreciation and impairment
120,000
0
19,173
159,317
– 7,583
63,403
354,310
33,622
387,932
Profit / loss on the disposal of fixed assets
Excess from initial consolidation recognised in profit or loss
0
0
0
0
680
0
680
0
680
0
44,053
0
0
44,053
3,607
47,660
0
0
0
44,053
680
0
44,733
3,607
48,340
Dividend payments
0
0
0
– 9,600
0
0
– 9,600
0
– 9,600
Capital contributions
0
0
0
0
0
186
186
0
186
Share in the profit or loss of associates
63,986
59,414
60,210
62,359
– 540
– 270
0
– 6,215
4
– 1,019
– 266
27,745
25,993
20/17
– 3,443
– 1,681
Net interest expense
Change in non-current provisions and provisions for pensions
Change in net current assets
Increase in receivables and inventories
Decrease in liabilities
Income taxes paid
Net cash flow from operating activities
Subsidiaries’
dividend payments
0
0
0
0
0
0
0
– 682
– 682
Other changes
0
0
0
– 13,798
0
0
– 13,798
833
– 12,965
120,000
0
19,173
179,972
– 6,903
63,589
375,831
37,380
413,211
Revenues from the sale of non-current assets
– 68,270
– 4,065
– 4,952
0
0
– 1,525
0
– 1,525
0
– 1,525
0
0
0
49,892
0
0
49,892
2,948
52,840
Total comprehensive
income for the period
0
0
0
49,892
– 1,525
0
48,367
2,948
51,315
Acquisition of subsidised assets
Government grants received
0
79,322
333
79,655
0
0
0
0
0
– 200
– 200
0
– 200
4,273
– 73,666
0
0
2,118
9
0
– 678
– 7,764
105,858
7
Net income
for the period
0
– 8,522
123,347
Acquisition of intangible assets
Payments for business combinations after deduction of the cash and cash equivalents acquired
– 80,000
– 15,138
– 10,574
Acquisition of plant, property and equipment
Acquisition of other non-current financial assets
160,000
– 4,024
– 11,046
Investing activities
Components of profit
or loss recognised
direct in equity
Acquisition of non-controlling interests
Interest received
Change in other current financial assets
11
Net cash flow from investing activities
– 322
– 1,122
– 26,846
– 55,252
0
– 1,109
2,415
2,968
– 6,096
– 16,835
– 51,223
– 45,824
58,113
44,787
– 99,572
– 141,336
79,322
186
– 200
0
Financing activities
Tax effect from
payment of interest
on profit participation
certificates
0
0
0
1,631
0
0
1,631
0
1,631
Allocation to profit
participation certificates
0
0
0
– 5,099
0
5,099
0
0
0
Dividend payments
0
0
0
– 9,600
0
– 5,099
– 14,699
0
– 14,699
Subsidiaries’ dividend
payments
0
0
0
0
0
0
0
– 548
– 548
Other changes
0
0
0
– 157
0
170
13
– 13
0
Balance as at
31 December 2011
2010
Non-cash:
0
Capital repayment
2011
Adjustments to the reconciliation of earnings before taxes to net cash flow
0
Capital contributions
Note
Earnings before taxes
Total comprehensive
income for the period
1)
in EUR k
Operating activities
Net income
for the period
Balance as at
31 December 2010/
1 January 2011
1)
Unpaid
contributions to
subscribed
capital
280,000
– 80,000
19,173
215,961
– 8,428
Other net changes from the previous year include negative non-controlling interests from business combinations of
EUR 7,824 thousand and the revaluation of the Regio Kliniken option measured at fair value of EUR 4,126.
63,559
490,265
40,100
530,365
Inflow from contributions by shareholders and holders of profit participation certificates
(less transaction costs)
Repayment of profit participation certificates
Repayment of finance lease debt
– 4,149
– 4,195
0
214,000
Repayment of loans
– 35,135
– 120,713
Interest paid
– 28,616
– 24,012
– 14,699
– 9,600
– 548
– 682
Net cash flow from financing activities
– 4,025
54,984
Net increase in cash and cash equivalents
19,750
19,506
Inflows from raising loans
Dividends paid to parent shareholders and holders of profit participation certificates
Dividends paid to shareholders without a controlling interest
6
Cash and cash equivalents as at 1 January
179,739
160,233
Cash and cash equivalents as at 31 December
199,489
179,739
199,491
179,739
Composition of cash and cash equivalents
Current liabilities with financial institutions
Cash and cash equivalents as at 31 December
92
–2
0
199,489
179,739
93
From the company
Further information
Notes to the consolidated financial statements
Notes to the consolidated
financial statements
Subsidiaries are fully consolidated from the date on which the Group obtains control. Inclusion in the consolidated
financial statements ends as soon as control by the parent company is lost.
Changes to the Company’s equity interest in a subsidiary, which do not lead to control being lost or obtained, are
recognised as an equity transaction with no impact on profit or loss.
1. Information on the company
The financial statements of subsidiaries are prepared using uniform accounting and measurement policies on the
same reporting date as the financial statements of the parent company.
Sana Kliniken AG (hereinafter “Sana” or “Company”) and its subsidiaries (together “Sana Group”) operate hospital
companies specialising in various fields in Germany, in particular, acute care hospitals and rehabilitation clinics as well
as retirement homes.
Sana is a joint stock company incorporated under German law, whose shares are not traded publicly. The company’s
registered office and business address is Oskar-Messter-Strasse 24 in Ismaning, Germany.
As the ultimate parent company, Sana essentially functions as an operating holding company for companies in the
Sana Group.
The consolidated financial statements of Sana Kliniken AG, which encompass the financial year from 1 January to 31
December, were released for transfer to the Supervisory Board on 29 February 2012 by resolution of the Management
Board.
All intragroup balances, transactions, income, expenses, profits and losses from intragroup transactions, which are
included in the carrying amounts of assets, are eliminated completely.
Non-controlling interests are shown separately in the consolidated income statement and in the consolidated balance
sheet. In the consolidated balance sheet, they are shown separately within equity, separate from the equity attributable
to the parent shareholders. Total comprehensive income is also allocated to the parent shareholders and the noncontrolling interests, if this leads to the non-controlling interests showing a negative balance.
A list of equity holdings is presented in note 26 of the notes to the consolidated financial statements.
Business combinations and goodwill or a gain on a bargain purchase as of 1 January 2010
Business combinations are accounted for using the purchase method.
The identifiable assets acquired and debts assumed are measured at fair value on acquisition.
2. Accounting and measurement policies
For each business combination all non-controlling interests in the acquired entity are either measured at fair value or
at the corresponding share of the identified net assets of the acquired entity.
2.1 Basis of preparation of the financial statements
The consolidated financial statements are prepared on the basis of uniform accounting and measurement policies,
which were continued consistently. The consolidated financial statements are prepared in euro. Unless stated otherwise, all figures are rounded up to EUR thousands. The nature of expense method was chosen for the presentation of
the income statement. Because the Group operates exclusively in Germany, there are no foreign currency transactions.
As part of a business combination, the identifiable assets acquired and debts assumed are – if necessary – classified
or determined on acquisition, so that other IFRS can be applied subsequently. The classification and determination are
based on contractual conditions, economic conditions, operating policy or the accounting methods and other relevant
conditions applicable on acquisition.
Statement of compliance with IFRS
Use has been made of the option permitted under section 315 a (3) of the HGB (German Commercial Code) and the
consolidated financial statements of Sana Kliniken AG and its subsidiaries as at 31 December 2011 have been
prepared in accordance with the provisions of International Financial Reporting Standards (IFRS) and the interpretations of the International Financial Reporting Committee (IFRIC) issued by the International Accounting Standards
Board (IASB) up to 31 December 2011 and applicable in the European Union. The supplementary commercial
regulations to be observed under section 315 a (1) of the German Commercial Code (HGB) were also applied.
As part of a business combination achieved in stages, the equity interests held will be remeasured at the fair value on
acquisition. Any resultant profit or loss will be recognised in the income statement.
2.2 Principles of consolidation
The consolidated financial statements comprise the financial statements of Sana Kliniken AG and the subsidiaries it
controls as at 31 December of each financial year.
Accordingly, control of an entity is the power to govern its financial and operating policies. As a rule, this is accompanied by a share of voting rights of more than 50 per cent. To determine whether an entity has control, account is taken
of the existence and effect of potential voting rights, which can be exercised or converted at present. In the Sana
Group, there are cases where control exists despite not having the majority of the voting rights because of contractual
agreements with the formal majority shareholder to appoint the management and to govern financial and operating
policies.
94
Transferred contingent considerations are evaluated at fair value on acquisition. Subsequent changes to the fair value
of a contingent consideration after the acquisition date within the measurement period permitted by IFRS 3.45 are
recognised in this period as a correction. Subsequent changes to the fair value of a contingent consideration outside
the measurement period in the classification as an asset or liability are measured at fair value in accordance with
IAS 39 and either recognised in profit or loss or in other income. Contingent considerations, which are not covered by
IAS 39, are accounted for in accordance with IAS 37 or other standards used. Contingent considerations classified as
equity are not remeasured and are accounted for in equity once they have been fulfilled.
Contingent liabilities as part of a business combination are measured at fair value when recognised for the first time.
They are subsequently measured in accordance with IFRS 3.23 in conjunction with IFRS 3.56 until the liability is
settled, extinguished or expires.
95
From the company
Further information
Under IFRS 3.32, goodwill results from a positive balance from the following clauses 1. and 2. or a profit from an
acquisition at a price below market value results from a negative balance from the following clauses 1. and 2.:
1.Total of
• transferred consideration measured at fair value on acquisition
• the amount of all non-controlling interests in the acquired entity measured in accordance with IFRS
• if applicable, the fair value of those interests in the acquired entity, which were already held by Sana
before the acquisition date.
2. Balance of the amounts of acquired identifiable assets and liabilities measured in accordance with IFRS 3 at the
acquisition date.
Following first-time recognition, goodwill is measured at cost less accumulated impairment losses. In subsequent
periods, it is tested for impairment at least once a year and whenever facts or changes in circumstances indicate that
the carrying amount could be impaired.
If the net assets acquired exceed the cost (acquisition at a price below market value) on acquisition, there is a
reassessment of the correct and complete identification of all assets and liabilities in accordance with IFRS 3.36. The
measurement methods used are also reviewed to guarantee that the information taken into account on acquisition was
complete.
Any difference remaining after the reassessment is immediately released through profit or loss in accordance with
IFRS 3.34.
Where business combinations are incomplete at the end of the reporting period, provisional amounts must be stated
for the items where accounting is incomplete.
For business combinations of less than 100 per cent of the shares, where the vendor is granted a right or an option to
sell the shares still held at any time, this right /option is accounted for as borrowings. As a result, this right /option
constitutes an obligation to acquire own equity instruments and is shown as a financial liability at the present value of
the redemption amount in accordance with IAS 32.23. In the event that the Group already has the status of owner, no
non-controlling interests will be shown for the interest in question. Conversely, on the premise that the option is exercised at the balance sheet date, it is reclassified into liabilities with no impact on the income statement.
The costs associated with business combinations are recognised as expense on an accrual basis. No costs for the
issue of debt instruments and equity securities were incurred in the financial year.
Business combinations and goodwill before 1 January 2010
Business combinations were accounted for using the purchase method.
When recognised for the first time, goodwill was measured at cost, which is calculated as the amount by which the
cost of the business combination exceeds the Group’s share in the fair values of the identifiable assets, liabilities and
contingent liabilities acquired.
Following first-time recognition, goodwill was measured at cost less accumulated impairment losses and was tested
for impairment at least once a year or when facts or changes in circumstances indicated that the carrying amount
could be impaired.
If the acquired net assets exceeded the costs on acquisition, the assets, liabilities and contingent liabilities are
reassessed in accordance with IFRS 3.56a (old version). Any remaining difference following the reassessment was
released immediately through profit or loss in accordance with IFRS 3.56b (old version).
96
Interest in an associate
The interest in an associated company is accounted for using the equity method at cost plus any changes in the
Group’s share of the associate’s net assets that occurred after acquisition. The goodwill relating to an associate is
included in the carrying amount of the interest and is not subject to scheduled depreciation. The income statement
contains the Group’s share in the associate’s profit or loss. Changes in the associate’s other income are recognised
in the amount of shares and in Sana’s other income.
The reporting date and the accounting and measurement policies for similar transactions and events are identical for
the associate and the Group.
Application of new standards in financial year 2011
“Improvements to IFRS” (May 2010)
In May 2010, the IASB published amendments to the following standards and interpretations as part of the annual
improvements project.
IFRS 3, Business Combinations
IFRS 7, IAS 32 and IAS 39 corresponding to the amendments to IFRS 3
IAS 21, IAS 36 and IAS 31 corresponding to the amendments to IAS 27
IFRS 1, First-time Adoption of International Financial Reporting Standards
IFRS 7, Financial Instruments: Disclosures
IAS 1, Presentation of Financial Statements
IAS 34, Interim Reporting
IFRIC 13, Customer Loyalty Programmes
These improvements were announced by the European Union on 19 February 2011 and their application is consequently mandatory for all financial years commencing after 30 June 2010 (IFRS 3, IAS 27 and amendments
associated therewith) and for all financial years commencing after 31 December 2010 (retrospective).
The amendments encompass both clarifications, impact on recognition, measurement and the recognition of transactions as well as terminological and editorial corrections. For the Sana Group, the new regulations mentioned resulting
from the improvements project will have no material impact on future financial statements.
Amendments to IAS 32: “Financial Instruments: Classification of Rights Issues”
With the revisions to IAS 32 “Financial Instruments: Presentation – Classification of Rights Issues”, the definition of a
financial liability is being amended to allow entities to classify rights issues and specific options and warrants as equity
instruments. The revised standard is mandatory for the first time for financial years commencing on or after 1 February
2010. Application of this new regulation for the first time will have no impact on the consolidated financial statements
since there are no rights issues of this kind.
Amendment of IAS 24: “Related Party Disclosures”
With the revisions to IAS 24 “Related Party Disclosures” (amended), the definition of related parties is being clarified
to simplify identification of related parties of this kind and to rectify inconsistencies in application. The revised standard
must be applied retrospectively for financial years commencing on or after 1 January 2011. First-time application of
this new regulation will have no impact on the results and financial position.
Amendment of IFRIC 14: “Prepayments as part of Minimum Funding Requirements”
The amendment applies in the event that an entity is subject to minimum funding requirements and prepays funding
contributions. Following the change, an entity is now allowed to present the benefit of a prepayment of this kind as an
asset. Retrospective application of the amendment is mandatory for financial years commencing on or after 1 January
2011. First-time application of this new regulation will have no impact on Sana’s consolidated financial statements.
97
From the company
Further information
IFRIC 19: “Extinguishing Financial Liabilities with Equity Instruments”
IFRIC 19 provides guidelines for accounting for equity instruments which a debtor issues after renegotiating the conditions of a financial liability so as to extinguish it completely or partially. Retrospective application of the interpretation
is mandatory for the first time for financial years commencing on or after 1 July 2010. First-time application of this new
regulation will have no impact on the consolidated financial statements.
New standards and interpretations that are not yet effective or have not been endorsed by the EU as part of
the comitology process
In May 2011, the International Accounting Standards Board (IASB) published the standards IFRS 10 “Consolidated
Financial Statements”, IFRS 11 “Joint Arrangements”, IFRS 12 “Disclosure of Interests in Other Entities” and IFRS 13
“Fair Value Measurement” as part of a comprehensive reform project.
Retrospective application of the new standards is mandatory for financial years commencing on or after 1 January
2013. Earlier application is permissible. The interpretation has not yet been endorsed by the EU.
Impact on future consolidated financial statements: the new standards are currently being examined as to their future
impact on the Sana Group.
IFRS 10 “Consolidated Financial Statements”
In addition to regulating fundamental questions of consolidation, which contain no material changes, the newly published IFRS 10 creates a uniform definition for the concept of control and consequently a uniform basis for judging the
existence of a parent-subsidiary relationship and the definition of the scope of consolidation associated therewith.
Accordingly, control exists if the investor involved in the components of profit or loss is in a position based on legal
positions to influence the operating activities of the (subsidiary) entity that are key to its economic success. The new
standard replaces the previously relevant IAS 27 (2008) “Consolidated and Separate Financial Statements” and
SIC-12 “Consolidation – Special Purpose Entities”. Amendments to the scope of consolidation based on the new
regulation must in principle be shown retrospectively.
IFRS 11 “Joint Arrangements”
The new IFRS 11 regulates how circumstances in which an entity exercises joint control over a joint venture or a joint
operation must be accounted for. Proportionate consolidation of joint ventures is being abolished. The new standard
replaces IAS 31 “Interests in Joint Ventures” and SIC-13 “Jointly Controlled Entities – Non-Monetary Contributions by
Venturers” as the provisions previously of relevance when accounting for joint ventures.
IFRS 12 “Disclosure of Interests in Other Entities”
IFRS 12 covers the disclosures in the notes on corporate relationships in the consolidated financial statements and
joint arrangements.
IFRS 13 “Fair Value Measurement”
The objective of the new IFRS 13 is to standardise the definition of fair value and the disclosures associated with fair
value measurement. The standard offers help in establishing fair value if this is prescribed as a measure according to
other IFRSs.
IFRS 9 “Financial Instruments”
The newly published IFRS 9 on the classification and measurement of financial instruments constitutes the first phase
of a three-phase project to replace IAS 39 “Financial Instruments: Recognition and Measurement”. IFRS 9 introduces new provisions on the classification and measurement of financial assets. Application of the standard is
mandatory from 1 January 2013. Premature application is permissible. The draft standard on the postponement of the
date for the initial application of IFRS 9 published by the IASB in August 2011 proposes postponing the initial application date for financial years commencing on or after 1 January 2015 (retrospective). IFRS 9 contains new provisions
on the classification and measurement of financial assets and liabilities.
Impact on future consolidated financial statements: in its future application, the new standard will have an impact on
the recognition, measurement and classification of financial assets and liabilities. The new standard will also increase
the level of disclosure required in the consolidated financial statements. A precise analysis of the impact will be carried
out when the other phases are completed.
Amendment to IFRS 7 “Disclosures on the Transfer of Financial Assets”
The amended standard requires additional disclosures on transferred financial assets that have not been derecognised and is applicable retrospectively to financial years commencing on or after 1 July 2011.
Impact on future consolidated financial statements: in the Sana Group, financial assets are derecognised when they
are transferred. This amendment will therefore have no practical application.
A supplement to IFRS 7 regarding the netting of financial instruments and details of the transition to IFRS 9 was also
published in December.
Amendment to IAS 12 “Deferred Tax: Recovery of Underlying Assets”
The amendment provides for deferred tax assets and liabilities for certain assets accounted for in accordance with the
revaluation method being measured on the assumption that the carrying amount of these assets will be recovered in
full through a sale. The revised standard must be applied retrospectively for financial years commencing on or after
1 January 2012.
Impact on future consolidated financial statements: in the Sana Group, application of this amendment is expected to
have no impact on the results and financial position.
Amendment to IAS 1 “Presentation of Financial Statements”
As a result of the amendment of IAS 1, the IFRS income statement will in future only consist of one single statement,
the “Statement of Profit or Loss and Other Comprehensive Income”. Formally speaking, the division of the future
combined income statement into two sections, a profit and loss account and a statement with other comprehensive
income will remain mandatory. In future, the income variable “other comprehensive income” (OCI) must be split
according to whether the income and expenses recorded therein are subsequently recycled into the income statement. The option of presenting OCI before or after taxes remains. However, if pre-tax presentation is chosen, taxes
must be split according to whether they relate to items that can be recycled or items that cannot.
The amended version of IAS 1 is applicable retrospectively from 1 January 2012.
Standards IAS 27 and IAS 28 were revised in connection with the publication of the new standards IFRS 10, 11, 12
and 13:
IAS 27 (2011) “Separate Financial Statements”
IAS 27 now only contains the unchanged provisions on separate IFRS financial statements.
IAS 28 (2011) “Investments in Associates and Joint Ventures”
The changes to IAS 28 (2011) include the adjustment to the new standards IFRS 10, 11 and 12.
The amended standards IAS 27 and IAS 28 must both be applied retrospectively for financial years commencing on
or after 1 January 2013.
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Impact on future consolidated financial statements: presentation of the IFRS income statement will be changed
accordingly from 2012.
Amendment to IAS 19 (2011) “Post-retirement Benefits / Pensions”
In June 2011, the IASB published amendments to IAS 19. Accordingly, actuarial gains and losses must be recognised
immediately in other comprehensive income in future.
Retrospective application of the amendment is mandatory for financial years commencing on or after 1 January 2013.
Earlier application is permissible. The interpretation has not yet been endorsed by the EU.
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Impact on future consolidated financial statements: equity will be subject to increased volatility as a result of the choice
between immediate recognition in other comprehensive income or the application of the corridor method being
discontinued.
IFRIC 20 “Stripping Costs in the Production Phase of a Surface Mine”
IFRIC 20, which was published by the IASB, is concerned with accounting for the costs of waste removal incurred in
the development phase of a surface mine.
Retrospective application of the interpretation is mandatory for financial years commencing on or after 1 January
2013. Earlier application is permissible. The interpretation has not yet been endorsed by the EU.
This interpretation will have no impact on Sana’s future consolidated income statements.
2.3 Summary of key accounting and measurement policies
2.3.1 General principles
Assets and liabilities are presented in the balance sheet as current or non-current items based on their maturity. Assets
and liabilities are classified as current if they are realised or due within twelve months of the end of the reporting period.
Inventories as well as trade receivables and trade payables are shown as current items.
The consolidated financial statements are prepared using the historical cost system with the exception of derivatives,
available-for-sale financial assets and assets, which are measured at fair value through profit or loss, which are mainly
recognised at their fair values.
2.3.2 Property, plant and equipment
Property, plant and equipment are stated at cost less accumulated scheduled depreciation and accumulated impairment losses. Repair and maintenance expenses are recognised as expense at the time they are incurred. Major
renewals and improvements are capitalised. In the process, the component approach specified in IAS 16 is applied.
When carrying out any larger measure, the costs are recognised in the carrying amount of the property, plant or
equipment as a replacement if the recognition criteria are met.
Scheduled, straight-line depreciation is based on the following useful lives:
•
•
•
•
Buildings
Other buildings
Technical equipment and machinery
Other equipment, operating and office equipment
15 to 33 years
15 to 30 years
5 to 15 years
3 to 12 years
The residual values, useful lives and methods of depreciation are reviewed at the end of each financial year and
adjusted if necessary.
2.3.3 Investment property
Investment property is measured at cost when recognised for the first time. Subsequently, the Group applies the cost
model and measures properties in accordance with the provisions of IAS 16.
2.3.4 Intangible assets
Individually acquired intangible assets are measured at cost when recognised for the first time. The cost of an
intangible asset, which was acquired through a business combination, equates to its fair value on acquisition. Having
been recognised for the first time, intangible assets are stated at cost less any accumulated depreciation and all
accumulated impairment costs.
Scheduled, straight-line depreciation is based on the following useful lives:
• Standard programmes
• Individual programmes
3 years
5 years
For an intangible asset with a limited useful life, the depreciation period and the method of depreciation are reviewed at
the end of each financial year.
Intangible assets with unlimited useful lives comprise acquired goodwill. This also includes places in doctors’ practices.
2.3.5 Other financial assets
Depending on the individual case, financial assets are measured as financial assets measured at fair value through
profit or loss, as loans and receivables, as held-to-maturity investments or as financial assets available-for-sale for the
purposes of IAS 39. When recognised for the first time, financial assets are measured at fair value. In the case of
financial assets that are not measured at fair value through profit or loss, transaction costs are also included, which
are directly attributable to the acquisition of the financial asset.
The fair value of financial investments, which are traded on organised markets, is established with reference to the bid
price listed on the stock exchange on the balance sheet date. The fair value of financial investments for which there
is no active market is estimated using valuation methods. If no value can be established, they are recognised at cost.
The Group stipulates the classification of its financial assets when they are recognised for the first time and reviews
this allocation at the end of each financial year to the extent this is permissible and appropriate. Tests are also carried
out on each balance sheet date to establish whether a financial asset or a group of financial assets is impaired. Any
write-downs required are posted direct against the carrying amount.
Regular way purchases and revenue of financial assets are accounted for on the settlement date.
Financial assets at fair value through profit or loss –
“Financial instruments held for trading”
Financial assets measured at fair value through profit or loss mainly comprise assets held-for-trading. For the category “financial assets measured at fair value through profit or loss”, any transaction costs are recognised in the income
statement. In any subsequent valuation, fluctuations in market value are recognised directly in the income statement.
The fair value of financial instruments traded on organised financial market is determined by the market price (bid
price) listed on the balance sheet date. The fair value of financial investments for which there is no active market is
established using valuation methods. The valuation methods include using the most recent transactions between
knowledgeable, willing parties in an arm’s length transaction, a comparison with the current fair value of another
financial instrument that is essentially identical and the use of discounted cash flow methods.
Financial investments held-to-maturity
Non-derivative financial assets with payment amounts that are fixed or can at least be determined and a fixed maturity
date are classified as held-to-maturity financial investments if the Group intends and is in a position to hold these
assets until maturity. Having been recognised for the first time, held-to-maturity financial investments are measured at
amortised cost using the effective interest rate method. Profits and losses from financial investments stated at
amortised cost are recorded in the profit or loss for the period when the financial investments are derecognised or
impaired and as part of amortisation.
Intangible assets with limited useful lives are depreciated over their economic lives.
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Loans and receivables
Loans and receivables are non-derivative financial assets with payments that are fixed or can be determined and are
not listed in an active market. These assets are measured at amortised cost using the effective interest rate method.
Profits and losses are recognised in the profit or loss for the period when loans and receivables are derecognised and
as part of amortisation.
Available-for-sale assets
Available-for-sale financial assets are non-derivative financial assets, which are determined as available-for-sale or
were classified neither as loans and receivables nor as held-to-maturity investments or financial assets, which are
measured at fair value through profit or loss.
If there is objective evidence that an impairment loss has occurred, the amount of the loss is measured as the difference between the asset’s carrying value and the present value of estimated future cash flow, discounted at the financial asset’s original effective interest rate. The carrying amount of the asset is reduced by the loss and recognised in
equity. An objective indication of impairment is provided by a significant or sustained fall in price. If the amount of the
write-down is reduced in one of the subsequent reporting periods and this reduction can be objectively attributed to
circumstances that occurred after the impairment loss was recognised, the write-down recognised previously will be
reversed. A subsequent reversal is recognised in equity if the carrying amount of the asset at the time of the reversal
does not exceed the amortised cost.
Derecognition of financial assets
A financial asset is derecognised when one of the following three preconditions are fulfilled:
• The contractual rights to cash flow from a financial asset have expired.
• The Group retains the contractual rights to receive cash flow from financial assets, but assumes a contractual
obligation to pay the cash flow without material delays to a third party as part of an agreement, which fulfils the
conditions of IAS 39.19 (pass-through arrangement).
• The Group has transferred its contractual rights to cash flow from a financial asset and has (a) in essence transferred all risks and opportunities associated with ownership of the financial asset or has (b) in essence neither
transferred nor retained all risks and opportunities associated with ownership of the financial asset but has transferred control over the asset.
2.3.6 Inventories
Inventories are measured at the lower of cost or net realisable value. Net realisable value is the estimated revenue
proceeds achievable in the ordinary course of business less the estimated selling costs still to be incurred. A reversal
is posted if the reasons no longer apply.
The cost of materials and supplies is established in accordance with the weighted average cost method.
Work in progress relates to so-called “bed-blockers” in hospital and includes services supplied at the balance sheet
date that are not yet chargeable, which are measured at cost. To calculate the cost, an average rate per measurement
ratio is established for the costs of relevance to in-patient care. This is allocated to the individual patients present on
the balance sheet day by multiplication with the relevant CMI (case-mix index), whereby the CMI percentage for the
main service was allocated to the year in which the service was actually supplied. The remaining percentage is
subsequently allocated to the respective financial years in line with the number of days spent in hospital.
2.3.7 Trade and other receivables
Trade receivables, which have a term of 30-60 days as a rule, are measured at the original invoice amount less a
write-down for doubtful receivables. Receivables are written-down if there is objective, substantial evidence that the
Group will not be in a position to collect the receivables. Receivables are derecognised as soon as they are not recoverable. In principle, a case-by-case approach is adopted when calculating write-downs. For receivables from public
sector cost units, the default risk is also taken into consideration on the basis of the type of service supplied, which
means that cases are considered as a group at times. Furthermore, receivables from public sector cost units are also
written down as a rule if trade receivables are at least 180 days past due.
2.3.8 Receivables resulting from the Krankenhausfinanzierungsgesetz (German Hospital Financing Act)
Receivables resulting from the Krankenhausfinanzierungsgesetz (German Hospital Financing Act) contain receivables from funding promised by the authorities, which are accounted for when the commitment to provide funding has
been received. The liabilities to be accounted for in this connection are consumed as the funds are used for their
intended purpose.
2.3.9 Cash and cash equivalents
Cash and short-term deposits in the balance sheet comprise cash in hand, credit balances with banks and short-term
deposits with financial institutions with an original term of up to three months.
For the purposes of the consolidated cash flow statement, cash and cash equivalents comprise the cash and shortterm deposits defined above.
2.3.10 Profit participation certificates
The profit participation certificates issued are accounted for as a component of equity in accordance with IAS 32, if it
is clear from the conditions that they are subordinated, bearer participation certificates paying a variable / fixed fee,
with no maturity date and no right of cancellation on the part of the participation certificate creditors. The interest payment is not recognised within interest expense but is treated similarly to a dividend obligation. Tax effects from the
payment of interest are also recorded in equity with no impact on the income statement.
2.3.11 Financial liabilities
When loans are recognised for the first time, they are measured at the fair value of the consideration received after
deducting the transaction costs associated with borrowing the funds.
Having been recognised for the first time, interest-bearing loans are subsequently measured at amortised cost using
the effective interest rate method.
Profits and losses are recognised in the profit or loss for the period when debts are derecognised and as part of amortisation.
A financial liability is derecognised, when the obligation on which this liability is based is fulfilled or extinguished.
2.3.12 Pensions and other post-employment benefits
Firstly, the Group has defined benefit plans where the Group’s obligation consists in granting a promised benefit and,
secondly, defined contribution plans where the Group pays fixed contributions to an independent entity and is not
obliged either de jure or de facto to provide other benefits beyond the payment of contributions.
The actuarial measurement of pension provisions for defined benefit plans is based on the projected unit credit
method prescribed in IAS 19 and equals the present value of defined benefit obligations (DBO) and the actuarial gains
and losses not recognised through profit or loss less the not yet recognised past service cost and the fair value of the
plan assets available to fulfil the obligations immediately.
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The expenses for benefits granted as part of defined benefit plans are calculated separately for each plan using the
projected unit credit method. The present value of the DBO is calculated by discounting anticipated future cash outflow
with the interest rate of high quality corporate bonds, whose maturities match those of the pension obligation. Actuarial gains and losses are recognised as income or expense if the balance of the accumulated unrecognised actuarial
gains and losses for each individual plan at the end of the previous reporting period exceeds the higher of the amounts
from 10 per cent of the defined benefit obligation or from 10 per cent of the fair value of the plan assets at this date.
These profits or losses are realised over the anticipated average remaining working lives of the employees covered by
the plan.
Finance leases where all opportunities and risks associated with ownership of the transferred asset are transferred to
the Group, are capitalised at the fair value of the leased asset or the present value of the minimum lease payments,
if this figure is lower, at the beginning of the lease. Liabilities under finance leases are reported on the liabilities side
at the present value of the minimum lease payments at the start of the lease and are subsequently shown at amortised
cost under financial liabilities. The lease payments are divided into their components, namely finance costs and repayment of the lease debt, in such a way that interest is charged on the remaining residual carrying amount of the lease
debt at a constant rate. Future lease payments are recognised as a liability at their present value. Finance costs are
recognised as expense immediately.
The past service cost is recognised on a straight-line basis over the average period until the benefits become vested.
If benefits become vested immediately a pension plan is introduced or amended, the past service cost is recognised
in the income statement immediately.
If transfer of title to the Group at the end of the lease term is not sufficiently certain, capitalised leased assets are fully
amortised over the shorter of the term of the lease or the useful life.
Lease payments for operating leases are recognised in the income statement on a straight-line basis.
For defined contribution plans, the ongoing amounts are recognised as expense. Overdue contributions are deferred
through profit or loss. As part of the provisions governing collective pay, the Sana Group pays contributions to the
Versorgungsanstalt des Bundes and der Länder (VBL = Pension Institution of the Federal Republic and the Länder) or
public sector supplementary pension plans (ZVK) for a defined group of employees. Because employers have a legal
claim to statutory benefits independent of their contributions actually paid, these retirement benefits must be classified
as a defined benefit pension plan in accordance with IAS 19. In principle, this results in a commitment to subsidiarity
on the part of the Sana Group, since the employees’ claim is related to the VBL or ZVK. If the assets of the VBL or ZVK
were not sufficient to cover the obligation, a provision would have to be reported on the liabilities side at the Sana
Group. No disclosures on the possible gap in cover as defined in IAS 19 for the beneficiaries attributed to the Sana
Group were provided by the VBL and ZVK. These plans were therefore accounted for as defined contribution plans.
In addition, as an employer, Sana makes contributions to the statutory pension insurance fund and to direct insurance
companies, which are accounted for as defined contribution plans.
2.3.13 Other provisions
A provision is recognised if the Group has a present (de jure or de facto) obligation based on a past event, it is probable that an outflow of resources embodying economic benefits will be required to settle the obligation and a reliable
estimate of the amount of the estimate is possible. If the Group anticipates that a provision created on the liabilities
side will be reimbursed at least in part (by an insurance policy, for instance), the reimbursement is only recognised as
a separate asset when reimbursement is as good as certain. The expense relating to the provision is recognised in the
income statement net of the amount recognised for the reimbursement. If the impact of the time value of money is
material, provisions are discounted at a tax rate before taxes, which reflects the specific risks for the debt if applicable.
In the event of a discount, the increase in the provisions caused by the passage of time is recognised as interest
expense.
2.3.16 Recognition of revenue
Revenues are recognised when it is probable that the economic benefit will accrue to the Group and the amount of
revenue can be reliably determined. The following recognition criteria must also be met for realisation of the revenue:
Realisation of revenue
The Sana Group’s hospitals are subject to the statutory regulations of the Krankenhausentgeltgesetz (German Law
on Hospital Fees) and the Bundespflegesatzverordnung (German Federal Ordinance on Hospital and Nursing
Charges). Charges for in-patient and out-patient hospital services are set as part of agreed budgets. Cost units are
charge for services on the basis of flat rate fees (so-called Diagnosis Related Groups) and on the basis of daily nursing charges in specific areas.
The fee agreements had not received final approval at most of the Sana Group’s hospitals for financial year 2011.
Where payments were above or below budget within the agreement term, so-called revenue equalisations were calculated and reported on the balance sheet date, as permitted by law. In hospitals where the fee agreement had not
been completed, sufficient account was taken of any possible budget risks resulting from this.
The provisions for structural adjustments were mainly created for risks connected with the plan to relinquish the
charitable status of those subsidiaries that still have charitable status.
Supply of services
Hospital services are realised at the time at which the services are supplied. If the outcome of a transaction involving
the rendering of services cannot be estimated reliably, revenue must only be recognised to the extent to which the
expenses incurred can be reimbursed.
2.3.14 German phased retirement (Altersteilzeit)
Within the Sana Group, there are obligations in individual institutions resulting from partial retirement arrangements
based on collective agreements. During partial retirement, the employee’s compensation is topped up by a top-up
amount equal to 20 per cent of the compensation for working part-time. The top-up amounts are severance obligations
as defined in IAS 19.7, the present value of which is established in accordance with actuarial principles.
Revenue of merchandise
Revenue is recognised when the significant opportunities and risks associated with ownership of the goods sold have
been transferred to the purchaser.
2.3.15 Leases
Determination of whether an agreement is or contains a lease is made on the basis of the economic content of the
agreement and requires an assessment of whether fulfilment of the contractual agreement depends on use of a
specific asset or specific assets and whether the agreement grants a right to use the asset.
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If a sale-and-leaseback transaction leads to an operating lease relationship and the transaction is undertaken at fair
value, any possible profit or loss is recognised immediately. If the sale price is below fair value, a loss is deferred and
amortised in proportion to the lease payments over the period for which the asset is expected to be used, if this loss
will be offset by future lease payments below the market price. Any other profit or loss from the transaction is recognised immediately. If the sale price exceeds fair value, the amount in excess of fair value is deferred and amortised
over the period for which the asset is expected to be used.
Interest income
Income is recorded if the interest has accrued (using the effective interest rate method, i.e. the calculatory interest rate
with which anticipated future cash inflow is discounted over the anticipated term of the financial instrument to the net
carrying amount of the financial assets).
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Rental income
Rental income from investment property is recognised on a straight-line basis over the term of the tenancy agreements.
Net gains
Net gains and losses as defined in IFRS 7 are income and expenses from the measurement and disposal of financial
instruments for all categories according to IAS 39. At Sana, these are mainly write-downs and income or expenses
from the sale of financial instruments. Current interest income and expense as well as dividend income are included.
2.3.17 Government grants
Government grants are recognised if it is sufficiently certain that the grants will be provided and the company will fulfil
the conditions associated therewith. In the case of resource-related grants, these are recognised on a scheduled
basis as income over the period, which is required to offset these with the matching expenses, for which these are
supposed to compensate. If the grant relates to an asset, it is deducted from the cost of the subsidised asset and
released (indirectly via the reduced amortisation of the asset) over the anticipated useful life of the asset in question.
2.3.18 Taxes
Actual tax assets and tax liabilities
Actual tax assets and tax liabilities for the current period and previous period must be measured at the amount at
which reimbursement from the taxation authorities or payment to the taxation authorities is anticipated. The
calculation of the amount is based on the tax rates and tax laws, which apply on the balance sheet date or which will
apply shortly.
Deferred taxes
Deferred taxes are recognised on all temporary differences between the carrying amount of an asset or liability in the
balance sheet and the taxable carrying amount on the balance sheet date using the balance sheet-related liability
method. The tax rates that are expected to apply at the time the deferred tax asset is realised or the deferred tax
liability settled are used. When calculating deferred taxes, a corporation tax rate of 15 per cent plus solidarity
surcharge of 5.5 per cent is taken into account. A tax rate of 30 per cent or 32 per cent is applied to Group companies
that are liable for trade tax.
There are the following exceptions with regard to deferred tax liabilities:
• T
he deferred tax liability from the first-time recognition of goodwill or an asset or a liability from a transaction that is
not a business combination and has no impact on either the accounting profit or loss in the period or the taxable
profit or loss at the time of the transaction.
• The deferred tax liability from temporary differences associated with holdings in subsidiaries and associates if the
timing of the reversal of the temporary differences can be controlled and it is likely that the temporary differences
will not be reversed for the foreseeable future.
• D
eferred tax assets from taxable temporary differences associated with holdings in subsidiaries and associates are
only recognised to the extent to which it is likely that the temporary differences will reverse in the foreseeable future
and sufficient taxable profit will be available against which the temporary differences can be used.
The carrying value of deferred tax assets is reviewed on each balance sheet date and reduced to the extent to which
it is no longer likely that sufficient taxable profit will be available against which the deferred tax asset can be used at
least in part. Previously unrecognised deferred tax assets are reviewed on each balance sheet date and recognised
to the extent to which it has become likely that a future taxable profit will allow realisation of the deferred tax asset.
Only the planned taxable results of the next three years are taken into account for the deferred tax assets from loss
carryforwards.
Income taxes, which relate to items recognised directly in equity, are recognised in equity and not in the income
statement.
Deferred tax assets and deferred tax liabilities are offset against each other if the Group has a legally enforceable right
to set off actual tax assets against actual tax liabilities and these relate to income taxes on the same tax entity levied
by the same tax authorities.
Sales tax
Revenue, expenses and assets are recognised net of sales taxes. There are the following exceptions to this:
• If sales tax accrued when purchasing goods or services cannot be collected by the tax authorities, the sales tax is
recognised as part of the cost of the asset or as part of the expenses.
• Receivables and debts are recognised with the amount of sales tax included therein. The amount of sales tax reimbursed by or transferred to the taxation authorities is recognised under the assets or liabilities in the balance sheet.
2.3.19 Derivative financial instruments and hedging transactions
The Group uses interest rate swaps as derivative financial instruments to hedge against interest rate risks. These
derivative financial instruments are recognised at the time the contract in question is concluded, initially at their fair
values and subsequently re-measured at their fair values. Derivative financial instruments are recognised as assets if
their fair value is positive and as liabilities if their fair value is negative. Derivative instruments are classified in the
measurement category “measured at fair value through profit or loss” and are classified there as “held-for-trading”.
Only those derivatives, which were designated as hedging instruments in an effective hedge, constitute exceptions.
The fair value of interest rate swap contracts is established with reference to the market values of similar instruments
(using accepted valuation models as part of bank reports). The instruments are also classified in the fair value hierarchy
level 1 to 3 as part of the subsequent measurement of the fair value.
Hedging transactions, which meet the stringent criteria for accounting for hedges, are accounted for as follows:
Deferred tax assets are recognised for all deductible temporary differences, unused tax loss carryforwards and
unused tax credits to the extent to which it is likely that taxable income will be available against which the deductible
temporary differences and the unused tax loss carryforwards and the tax credits can be used. There are the following
exceptions to this:
• Deferred tax assets from deductible temporary differences, which arise from the first-time recognition of an asset or
a liability from a transaction that is not a business combination and has no impact on either the accounting profit or
loss in the period or the taxable profit or loss at the time of the transaction.
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Cash flow hedges
Hedging transactions are classified as cash flow hedges, if they hedge the risks of fluctuating cash flow, which can be
allocated to a recognised asset, a recognised liability or a planned transaction and could have an impact on the profit
or loss for the period. The effective part of the profit or loss from a hedging instrument is recognised directly in equity,
while the ineffective part is recognised through profit or loss.
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The amounts recognised in equity are recognised in the period in the income statement in which the hedged transaction
affects the profit or loss for the period, e.g. are recognised in the hedged financial income or expenses or in which a
planned sale or purchase is carried out.
If the planned transaction is no longer expected to occur, the amounts previously recognised in equity are recognised
in the profit or loss for the period. If the hedging instrument expires or is sold, terminated or is exercised without being
replaced or rolled over into another hedging instrument or if the Group withdraws the designation of a hedging
instruments, the amounts previously shown will remain as a separate item in equity until the planned transaction has
occurred. If the anticipated transaction is no longer expected to occur, the amount is recognised through profit or loss.
2.3.20 Borrowing costs
In principle, borrowing costs are recognised as expenditure in the period in which they were incurred. The only
exceptions are borrowing costs, which can be allocated directly to the acquisition, construction or manufacture of a
qualified asset. These are capitalised as part of the cost of the asset in question.
2.3.21 Research and development costs
Research costs are recognised as expenditure in the period in which they were incurred. There are no development
expenses that have to be capitalised.
2.3.22 Impairment of assets
On each balance sheet day, the Group assesses whether there are indications that an asset might be impaired. If
there are such indications or an annual test of an asset for impairment is required, the Group estimates the recoverable amount.
Aside from assets with an indefinite useful life (goodwill), a previously recognised impairment loss must be reversed
if there has been a change to the estimates, which were used when determining the recoverable amount, since the
last impairment loss was recognised. The recoverable amount is estimated on the basis of the value in use or fair
value less selling costs. If this is the case, the carrying amount of the asset must be increased to its recoverable
amount. This increased carrying amount may not exceed the carrying amount, which would result after taking account
of depreciation, if no impairment losses had been recognised in previous years. A reversal of this kind is recognised
immediately in the profit or loss for the period.
2.3.23 Financial guarantees
Financial guarantees extended by the Group are contracts, which impose the obligation to make payments, which
reimburse the holder for a loss that arises because a specific debtor fails to comply on time with his payment obligations in accordance with the conditions of a debt instrument. These financial guarantees are treated as insurance
contracts in the sense of IFRS 4, i.e. the financial guarantees will be accounted for as contingent liabilities until it is
likely that they will be called. If this is the case, a corresponding obligation will be reported.
Sana uses the net method when accounting for financial guarantees.
2.4 Material judgements, estimates and assumptions
In preparing the consolidated financial statements, management make judgements, estimates and assumptions,
which will have an impact on the amount of income, expenses, assets and liabilities shown on the reporting date and
the disclosure of contingent liabilities. However, due to the uncertainty associated with these assumptions and estimates, outcomes could arise, which will lead to considerable adjustments to the carrying amounts of the assets and
liabilities in question in future periods.
Estimates and assumptions
All estimates and assumptions made by the Group are reviewed on an ongoing basis, based on experience and other
factors influencing developments. Account is also taken of the probability of future possible events.
In essence, the Group’s estimates made in relation to the future relate to the following:
•
•
•
•
•
Parameters of the impairment test for goodwill
Assumptions regarding pension obligations
Estimates of provisions and the probability of their being required
Estimates of the risk of default on trade receivables
Use of tax loss carryforwards
Key assumptions concerning the future and other key sources of estimation uncertainty at the balance sheet date, on
the basis of which there is a significant risk that a material adjustment to the carrying amounts of assets and liabilities
could be necessary within the next financial year, are explained below.
Judgements
When applying the accounting and measurement policies, management made the following judgements which have
a material impact on the amounts in the consolidated financial statements:
Impairment of goodwill
The Group checks whether goodwill is impaired at least once a year. This requires an estimate of the value in use of the
cash generating units to which the goodwill is allocated. To estimate the value in use, the Group must estimate the
anticipated future cash flow from the cash generating units and also select an appropriate discount rate to establish the
present value of this cash flow. As at 31 December 2011, the carrying amount of goodwill amounted to EUR 217.2 million (previous year: EUR 209.1 million).
Secondary liability from the municipal equalisation (Kommunaler Schadenausgleich KSA)
Provisions of EUR 5.9 million (previous year: EUR 10.1 million) were reported for probable payment obligations from
the KSA secondary liability. Even after its withdrawal from the Kommunaler Schadenausgleich association, the Group
is liable for claims, which arose before the date of its withdrawal. In this respect, the Group will be burdened with a
corresponding secondary liability levy for claims, which arose up to the date of its withdrawal over the next few years.
It is difficult to estimate how expenditure on KSA claims and the Group’s secondary liability resulting from this will
evolve. The provisions were created on the basis of an exponential decrease in the probability of possible claims.
Repayment claims from the cost units
Provisions of EUR 19.9 million (previous year: EUR 17.4 million) were created for possible repayment claims from
cost units, which may arise because of reviews by the Medizinischer Dienst der Krankenkassen (MDK = Medical
Service of the Health Insurance Companies).
Pensions and other post-retirement benefits
Expenses from defined benefit plans and other medical benefits post-retirement are established with the help of actuarial calculations. Actuarial measurement takes place on the basis of assumptions regarding discount rates, anticipated income from plan assets, future increases in wages and salaries, mortality and future pension increases. In
line with the long-term focus of these plans, estimates of these kinds are subject to significant uncertainty. As at
31 December 2011, the provision for pensions and similar obligations amounted to EUR 16.5 million (previous year:
EUR 17.4 million). Further details are provided in note 19.
108
109
From the company
Further information
3. Business combinations
4. Operating income and expenses
There were no new business combinations in financial year 2011.
4.1 Revenue
Revenue in the Group developed as follows:
Business combinations after the balance sheet date
In January 2012, 74.9 per cent of the shares and voting rights in Klinikgesellschaft des Landkreis Cham (Cham district)
and 94.0 per cent of the shares and voting rights in Hanse-Klinikum Wismar were acquired from the Damp Group.
Details on the fair values of the identifiable assets and liabilities as well as the previous carrying amounts could not be
provided until the Sana consolidated financial statements for 2011 were released for publication because annual
financial statements for the two companies as at 31 December 2011 had not yet been prepared.
in EUR k
2011
2010
1,482,676
1,344,244
824,947
793,111
Medium-sized
196,158
125,165
Small
136,900
142,045
Orthopaedics
139,263
130,977
Cardiovascular diseases
185,408
152,946
Services for retirement homes and care homes
49,398
48,031
Procurement and logistics
48,440
46,885
Medical care centres
25,756
25,324
Revenue from operating hospitals
Thereof (Cluster): Large
Subsequent correction of the first-time accounting in accordance with IFRS 3
As at 1 September 2010, 100 per cent of the shares in Krankenhaus Rummelsberg gGmbH were acquired by Sana
Kliniken AG. The company was consolidated for the first time on 1 September 2010 on the basis of provisional fair
values for the identifiable assets and liabilities. The measurement period in accordance with IFRS 3.45 extended until
31 August 2011. The interim report as at 30 June 2011 stated that new information on facts and circumstances had
been obtained within the measurement period provided for in IFRS 3.45, which would have influenced the amounts
recognised at the acquisition date, had they been known at the time the opening balance sheet was prepared. As a
result, the opening balance sheet was adjusted retrospectively in this respect.
Other
Total
22,940
20,376
1,629,210
1,484,860
As a result, the net assets acquired at the acquisition date break down as follows:
Adjustment
Property, plant and equipment
7,297
0
7,297
in EUR k
Trade receivables
5,531
0
5,531
348
0
348
1,913
0
1,913
0
0
0
in EUR k
Fair value
at the
acquisition
date
In addition to revenue from hospital services, revenue from the operation of hospitals include revenue from optional
services, revenue from out-patient care and user fees.
Previous fair
value at the
acquisition
date
4.2 Other operating income
Assets
Other assets
Deferred taxes
2011
2010
Fees, reimbursement and other income
31,702
26,996
Income from auxiliary and supporting facilities
29,342
24,294
Other income from prior periods
16,222
10,517
Income from letting and leasing
10,176
9,970
Liabilities
Compensation from previous financial years
7,776
14,133
Trade payables
– 603
0
– 603
Income from the reversal of provisions
5,923
3,934
Other liabilities
– 8,509
– 3,149
– 11,658
Government grants and subsidies
3,619
3,321
Income from the disposal of fixed assets
1,253
1,091
962
15
0
6,215
106,975
100,486
Deferred taxes
– 922
0
– 922
Net assets acquired at fair value
5,055
– 3,149
1,906
Transferred consideration at fair value
– 45,205
– 4,068
– 49,273
Excess from initial consolidation recognised in
profit or loss
Goodwill
– 40,150
– 7,217
– 47,367
Own work capitalised
Income from fees and reimbursement includes income from the reimbursement of personnel costs of EUR 4,247 thousand (previous year: EUR 4,150 thousand).
110
111
From the company
Further information
Income from auxiliary and supporting facilities mainly contains income from pharmacists, at EUR 19,041 thousand
(previous year: EUR 16,228) and income from emergency doctors’ deployments, at EUR 5,032 thousand (previous
year: EUR 3,170 thousand).
Other income from previous periods includes income from the reduction of specific impairment allowances of
EUR 2,470 thousand (previous year: EUR 463 thousand) and inflow from written-down receivables of EUR 243 thousand (previous year: EUR 311 thousand).
Government grants and subsidies are granted for ongoing operating expenses. There are no unfulfilled conditions or
other uncertainties associated with these grants.
4.6 Interest and similar expenses
in EUR k
2011
2010
21,418
21,255
Expense from compounding or discounting
3,487
1,523
Interest paid on shareholder loans
3,096
3,000
Interest on dept from finance leases
2,838
3,027
Interest paid to financial institutions
and other interest
Interest on additional tax demands
4.3 Income from associates
762
61
31,601
28,866
Income from associates breaks down as follows:
in EUR k
Pro rata profit or loss for the period
Write-down of the holding to fair value
2011
2010
5,132
3,183
– 4,113
– 2,917
1,019
266
4.4 Other operating expenses
in EUR k
In the financial year, EUR 21,779 thousand (previous year: EUR 20,860 thousand) is attributable to the net profit of
the category “liabilities measured at amortised cost”.
4.7 Research and development costs
Expenses for research and development amount to approximately 1 per cent of revenue from in-patient care and are
shown pro rata in other operating expenses as well as in personnel expenses in the income statement. There were no
development costs requiring capitalisation.
5. Income Taxes
2011
2010
Administrative requirements
28,423
28,874
Maintenance
28,180
29,033
Allocation to MDK provision
14,995
11,493
Fees and audit costs
13,190
10,199
Expenses for prior periods
10,359
7,926
Insurance policies and contributions
10,347
9,689
Depreciation and write-downs on receivables
9,903
8,201
Adjustments to actual income taxes incurred
in previous years
IT expenses
8,426
7,291
Deferred income taxes
Levies and fees
4,501
3,873
Other taxes
1,154
255
930
2,556
41,532
26,493
171,940
145,883
Expenses for training centres
Other ordinary expenses
The key components of income tax expenses for financial years 2011 and 2010 break down as follows:
in EUR k
2011
2010
– 12,800
– 14,673
– 2,152
– 2,293
Occurrence and reversal of temporary differences
2,126
5,372
Change from deferred taxes to tax loss
carryforwards
1,680
– 160
– 11,146
– 11,754
Tax income (previous year: expense) from net loss
(previous year: profit) from the remeasurement of
hedging transactions to hedge cash flow
718
– 320
Income tax income (previous year: expense)
recognised in equity
718
– 320
Actual income taxes
Actual income tax expense
Income tax expense recognised
in the consolidated income statement
Statement of changes in Group equity
4.5 Interest and similar income
Financial income mainly relates to interest received on credit balances with banks. Of the interest income of
EUR 3,856 thousand, EUR 2,900 thousand (previous year: EUR 1,870 thousand) is attributable to assets not
accounted for at fair value. Interest income also includes EUR 485 thousand (previous year: EUR 247 thousand),
which is the result of discounting liabilities and is included in the net profit of the category “Liabilities measured at
amortised cost”.
112
Deferred income taxes in relation to items
which were debited from or credited directly
to equity
113
From the company
Further information
Consolidated
balance sheet
Tax cuts of EUR 1,631 thousand (previous year: EUR 0) for the payment of participation certificates were recorded in
equity with no impact on the income statement.
in EUR k
The reconciliation between income tax expense and the product from the profit or loss for the period reported in the
balance sheet and the Group’s tax rate to be applied for financial years 2011 and 2010 breaks down as follows:
in EUR k
Earnings before income taxes
Income tax expense at the tax rate in Germany
of 15.825 % (previous year: 15.825 %)
2011
2010
63,986
59,414
– 10,126
(corporation tax plus solidarity surcharge)
Tax increases due to the trade tax burden
(services companies)
– 1,335
536
429
161
1,026
Tax expenses for prior periods
268
– 2,293
Non-recognition of deferred taxes from
loss carryforwards
– 717
– 628
Recognition of deferred taxes on loss
carryforwards existing in the previous year
1,743
0
Utilisation of previously unrecognised loss
carryforwards
221
334
Non-deductible expenses
– 103
– 79
Other deviations
– 236
194
– 11,146
– 11,754
Income tax expense recognised in the
consolidated income statement at an effective
income tax rate of 17 % (previous year: 20 %)
2011
2010
Current assets
Liabilities
Interest rate swap
Netting
114
2010
4,615
5,670
0
15
– 1,055
2,224
2,507
0
2
– 1,232
1,003
14,863
12,854
0
6,995
2,009
– 4,953
Tax loss carryforwards
3,060
1,380
0
0
1,680
– 160
Interest rate swap
3,967
3,784
183
215
27,780
26,195
183
7,227
– 16,945
– 19,527
0
– 6,785
10,835
6,668
183
442
0
1,402
– 1,886
3,806
5,212
In the financial year, EUR 718 thousand (previous year: EUR 858 thousand) was realised from the capitalised tax loss
carryforwards from previous years. In Germany, tax gains can be fully netted off against tax loss carryforwards up to
an amount of EUR 1.0 million each year, thereafter at 60 per cent.
There are tax loss carryforwards, for which no deferred taxes were recognised, of EUR 19.9 million (previous year:
EUR 18.7 million), which the Group can offset without restriction against the future taxable earnings of companies in
which the losses were incurred. Taking account of the anticipated earnings of the companies in question over the next
three years, deferred tax assets will be capitalised for loss carryforwards from previous years of EUR 1,743 thousand
(previous year: EUR 698 thousand). At two subsidiaries, deferred tax assets totalling EUR 1,160 were recognised
on loss carryforwards despite operating losses in the past since the earnings situation at these companies is
expected to improve. As in the previous year, no deferred income tax liabilities for taxes on non-transferred profits of
subsidiaries or associates were recognised as at 31 December 2011 because:
• the Group has stipulated that the previously undistributed profits of its subsidiaries will not be distributed
for the foreseeable future;
• the associates currently have charitable status, meaning that the profits of associates will not be distributed
until this is – subject to approval by Sana – revoked.
There are non-reported deferred income taxes from the dividend liability of approximately EUR 2,220 thousand (previous year: approximately EUR 1,557 thousand) on the retained profits.
Payment of dividends by Sana Kliniken AG to the shareholders does not have any consequences in terms of income tax.
6. Paid and proposed dividends
Changes recognised
in equity
2011
Consolidated income
statement
2010
2011
2010
Deferred income tax liabilities
Non-current assets
2011
1,275
Deferred income tax income
Deferred income taxes
On the balance sheet date, deferred income taxes break down as follows:
in EUR k
2010
Non-current assets
Netting
The statutory corporation tax rate in Germany amounted to 15 per cent for the assessment period 2011 (previous
year: 15 per cent) plus a solidarity surcharge of 5.5 per cent. When trade tax is taken into account, this results in a tax
burden of approximately 32 per cent (previous year: 32 per cent for various services companies. Individual companies
are tax-exempt because they still have charitable status.
Consolidated
balance sheet
2011
Current assets
Liabilities
Excess from initial consolidation recognised in
profit or loss, earnings of associates and excess
on the acquisition of non-controlling shares
(tax-free income)
Thereof from associates EUR 161 thousand
(previous year: EUR 42 thousand)
2010
Consolidated income
statement
Deferred income tax assets
– 9,402
– 2,893
Impact of hospital companies that still have
charitable status
2011
Changes recognised
in equity
– 26,831
– 27,059
0
– 11,916
228
7,853
– 145
– 1,386
0
– 993
1,241
368
– 1,467
– 2,402
0
2
935
– 1,123
0
– 535
535
– 535
0
0
– 28,443
– 31,382
535
– 13,442
2,404
7,098
16,945
19,527
0
6,785
– 11,498
– 11,855
535
– 6,657
in EUR k
Dividend per share paid during the financial year:
8.00 cents (previous year: 8.00 cents)
Dividend per share proposed to the
annual shareholders’ meeting for approval:
8.00 cents (previous year: 8.00 cents)
2011
2010
9,600
9,600
16,000
9,600
Interest paid on profit participation certificates is based on the proposed dividend per share. EUR 5,099 thousand was
paid out in the financial year.
115
From the company
Further information
7. Property, plant and equipment
31 December 2011
in EUR k
Land, land
rights and buildings including
buildings on
third-party land
Technical
equipment
736,820
104,248
0
9,652
Operating
and office
equipment
Total
203,147
51,604
1,095,819
0
0
0
0
3,401
17,009
46,185
76,247
Additions
Disposals
in EUR k
Additions from business
combinations 1)
Additions
Disposals
Reclassifications
6,527
439
9,970
3,975
20,911
20,917
2,149
5,872
– 29,116
– 178
760,862
109,359
216,058
64,698
1,150,977
As at 1 January 2011
Write-downs
Disposals
Technical
equipment
Operating
and office
equipment
Advance
payments
and assets
under
development
Total
599,422
93,111
168,916
47,293
908,742
Additions from business
combinations 1)
Reclassifications
97,326
6,874
22,567
3,473
130,240
9,550
1,226
17,407
41,829
70,012
2,381
826
9,351
60
12,618
32,903
3,863
3,608
– 40,931
– 557
736,820
104,248
203,147
51,604
1,095,819
175,485
41,044
102,826
3,629
322,984
24,408
6,237
21,213
0
51,858
Cumulative scheduled
depreciation and impairment
Cumulative scheduled depreciation and impairment
Additions
Land, land
rights and buildings including
buildings on
third-party land
Cost
Cost
31 December 2010
Advance
payments
and assets
under
development
202,868
46,211
117,170
6,791
373,040
25,799
6,753
23,322
0
55,874
0
0
0
0
0
5,866
366
9,374
1,930
17,536
Additions
Write-downs
Disposals
0
0
4,950
6,668
811
841
6,815
0
8,467
60
79
4,718
– 4,861
–4
2,068
– 229
– 54
– 1,788
–3
222,861
52,677
135,836
0
411,374
202,868
46,211
117,170
6,791
373,040
Net carrying amount
as at 1 January 2011
533,952
58,037
85,977
44,813
722,779
Net carrying amount
as at 1 January 2010
423,937
52,067
66,090
43,664
585,758
Net carrying amount
538,001
56,682
80,222
64,698
739,603
Net carrying amount
533,952
58,037
85,977
44,813
722,779
Reclassifications
1)
At the time control was assumed.
Reclassifications
1,718
1)
The Group has subsidised assets of EUR 412,131 thousand (previous year: EUR 396,948 thousand). The subsidy
ratio for investment undertaken within the Group amounts to 30 per cent (previous year: 29 per cent).
Land and buildings are mortgaged to secure bank loans with a total carrying amount of EUR 81,133 thousand
(previous year: EUR 99,389 thousand).
Leased assets, which must be attributed to Sana economically speaking in accordance with IAS 17, amount to
EUR 36,829 thousand, 5.0 per cent on 31 December 2011 (previous year: EUR 41,316 thousand, 7.0 per cent). Of
the leased assets, EUR 34,589 thousand (previous year: EUR 36,608 thousand) are attributable to land and buildings,
EUR 870 thousand (previous year: EUR 1,043 thousand) to technical equipment and EUR 1,370 thousand (previous
year: EUR 3,665 thousand) to furniture, fittings and equipment.
No compensation was received for impaired or lost property, plant and equipment in the financial year (previous year:
EUR 4 thousand).
In financial year 2011, interest expense totalling EUR 1,270 thousand (previous year: EUR 187 thousand) was
capitalised at a capitalisation rate of 5.9 per cent (previous year: 5.5 per cent).
In the financial year, a plot of land was sold from property, plant and equipment at standard market conditions. The
lease-back of the land and building was classified as an operating lease.
Own work of EUR 962 thousand (previous year: EUR 15 thousand) was capitalised in the financial year.
116
117
From the company
Further information
8. Investment property
in EUR k
9. Intangible assets
2011
2010
Acquisition costs
As at 1 January
Disposals
31 December 2011
in EUR k
5,625
5,625
0
0
5,625
5,625
Patents
and
licences
Goodwill
Total
Acquisition costs
33,009
216,355
249,364
Additions
2,893
995
3,888
Depreciation and amortisation
Disposals
145
130
275
As at 1 January
Reclassifications
178
0
178
35,935
217,220
253,155
19,959
0
19,959
4,294
0
4,294
As at 31 December
4,453
4,411
43
42
As at 31 December
4,496
4,453
Carrying amount as at 1 January
1,172
1,214
Carrying amount as at 31 December
1,129
1,172
Additions
Cumulative scheduled depreciation
and impairment
Additions
Write-downs
Investment property is recognised in accordance with the cost model. Investment property is depreciated on a
straight-line basis over a useful life of 33 years.
Disposals
Reclassifications
0
0
0
57
0
57
4
0
4
24,200
0
24,200
The fair value as at 31 December 2011 is marginally more than the carrying amount.
Net carrying amount as at 1 January 2011
13,050
216,355
229,405
Rental income from the properties in question amounts to EUR 433 thousand (previous year: EUR 881 thousand) for
the financial year. Operating expenses of EUR 468 thousand (previous year: EUR 647 thousand) were incurred in
connection with the rental income.
Net carrying amount as at 31 December 2011
11,735
217,220
228,955
29,873
137,475
167,348
31 December 2010
The amounts shown relate solely to property financed from equity.
Acquisition costs
Additions from business combinations
1,677
77,633
79,310
Additions
3,282
1,113
4,395
Disposals
2,146
100
2,246
1 )
Reclassifications
323
234
557
33,009
216,355
249,364
16,232
0
16,232
3,775
0
3,775
Write-downs
16
0
16
Disposals
67
0
67
3
0
3
19,959
0
19,959
Net carrying amount as at 1 January 2010
13,641
137,475
151,116
Net carrying amount as at 31 December 2010
13,050
216,355
229,405
Cumulative scheduled depreciation
and impairment
Additions
Reclassifications
1)
2)
118
119
From the company
Further information
Goodwill
As at 31 December 2011, there were no indications that intangible assets were impaired.
Goodwill is subject to an annual impairment test for its respective cash generating units (each hospital). These impairment tests are carried out every year once the 3-year planning process is completed in October / November. A review
of economic circumstances and the legal framework conditions is carried out once more via the Management Board
to validate the impairment test at the year-end. No deviations emerged for financial year 2011.
As part of the impairment test, the carrying amount of the cash generating unit is compared with the recoverable
amount of the unit. The recoverable amount is the higher of fair value less selling costs and the value in use of a cash
generating unit. In financial year 2011, all cash generating units’ values in use exceeded their fair values.
A cash flow-oriented discounted cash flow method is used to establish the value in use. The relevant present value is
calculated on the basis of a multi-annual planning process taking account of perpetuity and a growth discount of
1.0 per cent (previous year: 1.0 per cent). The standard discount rate (after taxes) amounts to 5.9 per cent in financial
year 2011 (previous year: 6.4 per cent).
Of the additions in the financial year, EUR 995 thousand (previous year: EUR 1,113 thousand) relates to places in
doctors’ practices acquired for a fee. If there are indications of impairment, the goodwill on places in doctors’ practices
is immediately checked for impairment. These figures are also subject to an annual impairment test which is, according to the Group, carried out in the individual companies.
There are no restrictions of title or disposal.
A sensitivity analysis of goodwill involving changes to the discount rate of 5.9 per cent resulted in the following
impairment:
Difference
between value
in use
and carrying
amount
in EUR k
Krankenhaus Rummelsberg gGmbH
The 3-year planning process is a fundamental component of corporate planning and reflects management expectations, which do not differ materially from external data, in the context of the general legal conditions for each unit. Here,
the key focus of the multi-annual planning process lies in performance and revenue planning, cash flow and investment planning. In the process, macroeconomic planning premises specified by management, which are based on
current legal, macroeconomic and market-specific developments and general conditions as well as an assessment of
their future development, are prescribed and must be taken into account by the Group’s institutions. The respective
state-wide base rates are established centrally for the service and revenue planning and prescribed for each state.
The assumptions used for the trend in costs are based on the economic operating capability of the institutions and
social framework conditions. For investment, pending replacements are projected with the help of the Group’s own
specialists for buildings and medical technology. With new companies, the infrastructure is gradually brought up to
Sana standards, which follow in part from the investment obligations contained in the purchase agreement.
The following table shows the most significant goodwill compared with the total carrying amount:
in EUR k
2010
Gesundheitseinrichtungen
Hameln-Pyrmont GmbH
49,620
49,620
Krankenhaus Rummelsberg gGmbH 1)
47,367
47,367*
Regio Kliniken GmbH
29,739
29,739
Klinikum Duisburg GmbH
29,098
29,098
Herzzentrum Dresden GmbH-University
Hospital Dresden
28,013
28,013
Other goodwill
33,383
32,518
217,220
216,355*
1)
120
2011
Impairment
from an
increase in
the discount
rate of
Perpetual
cash flow
Impairment
from a
reduction
in the perpetual
cash flow of
5,211
1,649
in % points
26,762
1.8
Regio Kliniken GmbH
79,865
4.2
11,680
–
53,018
2.8
11,448
3,084
There is no other change to a key assumption considered possible that would lead to a write-down for other goodwill.
10. Investments accounted for using the equity method
On the balance sheet date, the Group holds shares in Krankenhausbetriebsgesellschaft Bad Oeynhausen mbH, Bad
Oeynhausen, which has charitable status, in Vereinigte Gesundheitseinrichtungen Mittelsachsen GmbH, Freiberg,
and a holding in Gesundheitsnetz östliches Holstein Management GmbH, Eutin, which was acquired in 2010, which
are accounted for using the equity method.
As a result of the acquisition in Klinikum Dahme-Spreewald GmbH, Lübben, which has charitable status, on the balance sheet date 31 December 2010 this entity has been included in the consolidated financial statements as a fully
consolidated subsidiary of Sana Kliniken AG since this date in accordance with IFRS 3. In contrast to the previous
year, pro rata revenues accruing to Sana Kliniken AG and the company’s net income for the period are therefore no
longer shown under revenue and profits for the period of associates in the financial year.
With regard to the voting rights acquired, please refer to our explanations in the section entitled ‘List of Shareholdings’.
Other holdings in excess of 20 per cent are not accounted for using the equity method since no significant influence
is exerted.
Acquired on 1 September 2010, item marked *) differs from the annual financial statements because
of the restatement of the IFRS opening balance sheet of Krankenhaus Rummelsberg gGmbH,
cf. Note – 3 Business combinations.
121
From the company
Further information
The following table contains summary financial information about the holdings accounted for using the equity method:
in EUR k
Measurement categories for financial assets:
in EUR k
2011
2010
Current assets
58,897
58,496
Non-current financial assets
Non-current assets
21,186
20,772
Balance sheet total
80,083
79,268
Available-for-sale securities
(Available for Sale (AfS)) 1)
Current liabilities
– 20,593
– 25,831
– 23,814
– 23,112
Total liabilities
– 44,407
– 48,943
35,676
30,325
Pro rata net assets
Share of the revenue and profits
for the period of associates:
Revenue
Carrying amount of the holdings
Measured at fair value through profit or loss
Fair Value through Profit and Loss (FVTPL)
– held for trading purposes
108,575
5,132
3,183
24,589
23,571
The difference between the pro rata net assets and the carrying amount of the holdings is based on the write-down of
the holding in Krankenhausbetriebsgesellschaft Bad Oeynhausen mbH to fair value.
As a result of their charitable status, the indirect and direct holdings in the hospital companies may not pay any
dividends.
2010
3,056
2,517
674
574
3,730
3,091
26,152
20,033
0
23
26,152
20,056
Current financial assets
Held-to-maturity
98,120
Profits for the period
Loans and receivables
2011
1)
djustment to the previous year’s figures: the holdings of EUR 2,517 thousand, which were allocated to the
A
measurement category “measured at fair value through profit or loss”, were reclassified into the measurement
category “available-for-sale securities”. The derivative financial instruments did not have to be allocated to a
category in the previous year since they were classified as a cash flow hedge. The previous year’s figures
were therefore adjusted accordingly.
The holdings shown under the measurement category “available-for-sale securities” are measured at cost, since the
fair value cannot be reliably established. The holdings are mainly holdings in medical supply centres. The fair value
cannot be reliably established since there are no market values. The Group does not intend to sell the holdings.
The net profit from financial assets measured at fair value and held-for-trading comes to EUR 471 thousand (previous year: EUR 756 thousand). The expenses of EUR 0 thousand (previous year: EUR 203 thousand) and income
of EUR 471 thousand (previous year: EUR 959 thousand) are recognised in the income statement as part of the
financial result.
There are no contingent liabilities resulting from the shares in associates.
11. Other financial assets
2011
2010
The net profit from the measurement category “loans and receivables” comes to EUR 37 thousand (previous year:
EUR 27 thousand).
3,056
2,517
12. Inventories
323
401
0
1,673
224
111
Non-current security deposits 1)
127
62
Prepaid expenses 2)
725
479
4,455
5,243
26,152
20,056
26,152
20,056
in EUR k
Non-current financial assets
Holding
Loans
1)
Derivative financial instruments
Other non-current receivables
1)
in EUR k
2011
2010
Materials and supplies
28,625
27,097
Work in progress
18,542
16,218
Merchandise
2,175
2,048
49,342
45,363
Current financial assets
Securities
1)
2)
Work in progress refers to treatment services for patients, whose treatment was not yet completed on the balance
sheet date. Materials, supplies and merchandise are owned by the Sana Group. There are no assignments or pledges.
The fair value equals the carrying values.
Not within the scope of IFRS 7.
The change in securities in the financial year consists of inflow of EUR 2,000 thousand (previous year: EUR 2,000 thousand) and outflow of EUR 8,096 thousand (previous year: EUR 18,835 thousand).
122
123
From the company
Further information
13.Trade and other receivables (current)
in EUR k
2011
2010
Prepaid expenses
919
724
3,969
3,441
4,888
4,165
The following fall within the measurement
category loans and receivables:
Trade receivables
Receivables resulting from the German
hospital financing legislation
Receivables from shareholders
Other miscellaneous receivables
Total trade and other receivables
in EUR k
Neither past due nor impaired at the balance
sheet date
The following do not fall within
the scope of IFRS 7:
Receivables from the tax authorities
Presentation of the credit risks contained in trade receivables:
187,520
193,612
2011
2010
142,360
136,166
Not impaired on the balance sheet date and past
due in the following time bands
Less than 30 days
25,273
37,839
Between 30 and 60 days
3,945
5,669
3,926
5,028
5,931
6,093
324
264
18,936
13,458
1,053
160
More than 365 days
1,450
23
40,849
54,916
13,038
13,678
24,622
21,771
220,547
220,908
Write-downs attributable thereto
– 20,311
– 19,241
225,435
225,073
Carrying amount of trade receivables
187,520
193,612
Impaired trade receivables (gross)
Trade and other receivables do not include any financial instruments held-to-maturity, held-for-trading or availablefor-sale. Trade and other receivables are therefore allocated to the category loans and receivables in their entirety.
There were no indications that write-downs were required for non-impaired trade receivables on the balance sheet
date.
The fair values match the reported carrying amounts.
In the financial year, trade receivables totalling EUR 3,167 thousand (previous year: EUR 1,951 thousand) were
derecognised and charged to the income statement. These charges were offset by incoming payments on receivables
that had already been written-down of EUR 243 thousand (previous year: EUR 311 thousand) and interest income on
receivables of EUR 109 thousand (previous year: EUR 41 thousand).
Receivables resulting from German hospital financing legislation (essentially Krankenhausentgeltgesetz (German
Law on Hospital Fees) and Bundespflegesatzverordnung (German Federal Ordinance on Hospital and Nursing
Charges)) include undisputed receivables from previous years where settlement is imminent.
Other miscellaneous receivables include receivables from doctors’ pools, creditors with debtor balances and other
receivables. Of this figure, EUR 1,003 thousand (previous year: EUR 1,567 thousand) were past due on the balance
sheet date. EUR 152 thousand (previous year: EUR 1 thousand) were up to one month past due and not written-down,
of the receivables, which were over one month past due, EUR 32 thousand (previous year: EUR 23 thousand) were
not written-down. In total, other miscellaneous receivables contain write-downs totalling EUR 173 thousand (previous
year: EUR 110 thousand) on the balance sheet date.
There have been the following changes to write-downs on trade receivables:
in EUR k
2010
19,241
13,387
Consumption
3,132
1,635
Reversals
2,470
463
Allocations
As at 31 December
14. Cash and cash equivalents
in EUR k
2011
As at 1 January
As a result of this, the net profit from the measurement category loans and receivable comes to EUR – 7,080 thousand
(previous year: EUR – 7,280 thousand) allowing from expenses and income from write-downs. The expenses of
EUR 9,903 (previous year: EUR 8,095 thousand) and income of EUR 2,823 thousand (previous year: EUR 815 thousand) are recognised as part of the income statement.
6,672
7,952
20,311
19,241
2011
2010
Credit balances with financial institutions
and cash in hand
80,925
78,791
Current deposits originally < three months
118,566
100,948
199,491
179,739
Cash and cash equivalents are allocated to the category loans and receivables.
Interest is paid on credit balances with financial institutions at variable interest rates for call money. Current deposits
are placed for different periods and interest is paid at the interest rates applicable to current deposits at the time. In
principle, current deposits are subject to minor fluctuations in value and constitute cash available at any time.
The fair value of cash and cash equivalents matches the carrying amount.
124
125
From the company
Further information
As at 31 December 2011, the Group had unutilised overdraft facilities of EUR 70,000 thousand (previous year:
EUR 81,500 thousand).
Of the cash and cash equivalents, EUR 19,773 thousand (previous year: EUR 17,951 thousand) is attributable to
three Group companies, which will retain their charitable status for the foreseeable future. As a result of this charitable
status, there are restrictions on the extent to which the Group can make use of these funds.
The net profit from loans and receivables amounts to EUR 2,144 thousand (previous year: EUR 1,805 thousand).
16. Financial liabilities
The Group’s financial liabilities must, with the exception of liabilities under finance leases, be allocated in their entirety
to the measurement category “measured at amortised cost”. There are no liabilities held for trading purposes.
in EUR k
2011
2010
415,030
457,158
46,409
49,816
Shareholder loans
59,119
60,006
Other interest bearing loans
14,900
15,398
120,428
125,220
535,458
582,378
37,680
26,463
Liabilities under finance leases
3,406
4,147
Shareholder loans
1,340
667
Non-current financial liabilities
Liabilities to banks / debt instruments
15. Equity
The annual shareholders’ meeting of Sana Kliniken AG on 16 June 2011 resolved to increase the share capital of
EUR 120,000,000, which is divided into 120,000,000 no-par registered shares by up to EUR 160,000,000 to up to
EUR 280,000,000 in return for cash contributions. All shareholders of Sana Kliniken AG made full use of their right to
subscribe for new shares, meaning that all 160,000,000 new shares are subscribed. The capital increase was registered in the Commercial Register on 29 August 2011. EUR 80,000,000 was previously paid in, meaning that the share
capital has increased to EUR 200,000,000 in the financial year.
Liabilities under finance leases
Current financial liabilities
The transaction costs of the capital increase of EUR 678 thousand were accounted for as a deduction from retained
earnings.
In the year under review, EUR 750 thousand from the net income for the financial year was allocated to legal reserves
in accordance with section 150 of the German Companies Act (AktG) to ensure that this together with the capital
reserve of EUR 19,173 thousand amounts to one tenth of the share capital. The articles of association of Sana
Kliniken AG do not provide for a different, larger amount.
Of the retained earnings, which have accumulated from retained profits, EUR 23,800 thousand (previous year:
EUR 22,144 thousand) is attributable to longstanding charitable Group companies. As a result of this charitable status,
there are restrictions on the extent to which the Group can make use of this part of retained earnings.
Other reserves contain all the unrealised losses (previous year: profits) resulting from interest rate swaps used to
hedge interest rate risks and measured at fair value. In the financial year, EUR 3,982 thousand (previous year:
EUR 3,950 thousand) was transferred into the income statement before tax and a pre-tax loss of EUR 6,225 thousand
(previous year: EUR 2,949 thousand) was transferred to equity with no impact on the income statement. The balance
after taxes amounts to EUR – 1,525 thousand (previous year: EUR 680 thousand).
The Management Board is authorised by virtue of the resolution by the annual shareholders’ meeting on 21 December 2009 to place profit participation certificates worth up to EUR 100.0 million with existing shareholders and related
parties. The profit participation certificate is designed as an equity instrument and fulfils the requirements of IAS 32 for
classification as equity. Key features here relate to the fact that the profit participation certificates cannot be cancelled
by holders of the certificates, the annual interest rate of 8 per cent (at least 6 per cent) is linked to the dividend payment
of Sana Kliniken AG and the financial instruments are subordinate. Profit participation certificates EUR 63,559 thousand (previous year: EUR 63,759 thousand) were placed up to 31 December 2011.
Other interest bearing loans
Total financial liabilities
148
322
4,894
5,136
42,574
31,599
578,032
613,977
The liabilities to banks totalling EUR 452,710 thousand (previous year: EUR 483,621 thousand) contain borrowings of
EUR 243,000 thousand (previous year: EUR 256,200 thousand), consisting of a promissory note loan of EUR 120,000
thousand and a tranche of the promissory note loan issued in April 2010 of EUR 123,000 thousand. These liabilities
are not secured by mortgages. The resultant interest rate risks are largely hedged through interest rate swaps of
EUR 195,000 thousand. The carrying amount of the floating rate financial liabilities matches the fair value.
The carrying amount of fixed rate liabilities to banks, shareholder loans and other fixed rate loans of EUR 281,012 thousand compares with a fair value of EUR 284,387 thousand.
Of the liabilities to banks, EUR 39,847 thousand (previous year: EUR 36,393 thousand) is attributable to loans subsidised in accordance with the German Hospital Financing Act.
There are unsecured overdraft facilities of EUR 70,000 thousand in total.
The shareholder loans are available to Sana long-term. For EUR 29,000 thousand, there are also unilateral options to
extend until financial year 2023 and 2025 respectively.
The other interest bearing loans contain a loan from Provinzial Rheinland of EUR 14,425 thousand entered into in
connection with the takeover of Kliniken Duisburg. It could not be recognised under the item for shareholder loans
because of the lack of a direct link to the shareholder Provinzial Krankenversicherung Hannover AG.
126
127
From the company
Further information
The interest rate risks are as follows:
31.12.2011
Interest rate1)
in %
31.12.2010
Carrying
amount
in EUR k
Interest rate1)
in %
Carrying
amount
in EUR k
Liabilities to banks 2)
Current
Non-current
4.56
37,680
4.79
26,463
4.56
415,030
4.79
457,158
452,710
483,621
The key conditions and the term of the interest rate swap contracts were negotiated in line with the conditions of the
underlying obligations under the notes. The hedging transactions are rated as highly effective. An unrealised loss after
taxes of EUR 1,525 thousand (previous year: profit of EUR 680 thousand) from this hedging instrument was therefore
recognised in equity.
The derivative financial instruments are stated at market values based on accepted valuation models using current
market data. The Treasury department monitors and manages these in close consultation with the Management
Board.
2011
Fair value
Term
Liabilities under finance leases 3)
Current
Non-current
5.59
3,406
5.68
4,147
5.59
46,409
5.68
49,816
49,815
53,963
Interest rate
swap liability
Shareholder loans 3)
Current
Non-current
5.18
1,340
4.42
667
5.18
59,119
5.20
60,006
60,459
60,673
Other interest-bearing loans 3)
Current
Non-current
5.41
148
5.32
322
5.41
14,900
5.32
15,398
Total amount
1)
2)
3)
15,048
15,720
578,032
613,977
Weighted average.
Including floating rate liabilities to banks of EUR 48,000 thousand.
Fixed interest.
in EUR k
2011
2010
2011
–
59,759
2012
65,105
60,693
2013
116,897
116,558
2014
107,199
114,455
2015
223,502
223,695
2016
29,554
29,284
2017
34,575
37,936
Thereafter
91,983
82,260
668,815
724,640
The cash outflow shown in the above time bands contain repayments for subsidised loans totalling EUR 39,847 thousand (previous year: EUR 36,393 thousand) and interest totalling EUR 90,783 thousand (previous year: EUR 110,663
thousand).
Hedging transactions to hedge cash flow
As at 31 December 2011, there are nine interest rate swaps totalling EUR 195,000 thousand, which are classified
as hedging transactions. These serve in the amount of EUR 120,000 thousand to hedge the interest cash flow
of the promissory note facilities issued in 2007. The Group receives 6-month Euribor from these six interest rate
swaps and pays a fixed interest rate of 4.12 per cent on average in return. Three interest rate swaps amounting to
EUR 75,000 thousand serve to hedge interest cash flow on the promissory note loan issued in April 2010. Here, too,
the Group receives 6-month Euribor and pays a fixed interest rate of 1.7 per cent p.a.
128
Maximum interest rate or
fixed interest
Reference
amount
31.12.2011
in EUR k
from
to
in %
in %
in EUR k
– 303
24.08.2010
13.04.2015
1.771
1.700
30,000
– 298
24.08.2010
13.04.2015
1.771
1.700
35,000
– 85
24.08.2010
13.04.2015
1.771
1.700
10,000
– 504
31.12.2007
15.02.2013
1.726
4.187
12,000
– 4,133
15.08.2007
15.08.2015
1.726
4.440
35,000
– 1,285
31.12.2007
31.12.2014
1.640
4.223
15,000
– 1,256
31.12.2007
30.12.2014
1.640
4.218
15,000
– 1,926
31.12.2007
30.12.2014
1.640
4.218
23,000
– 2,604
31.12.2007
30.12.2014
1.640
3.25 or 6.25
1)
20,000
2010
Cash outflow from the financial instruments recognised under financial liabilities in accordance with IFRS 7 are as
follows:
Reference
interest rate
31.12.2011
Interest rate
swap asset
Interest rate
swap liability
1)
31.12.2010
31.12.2010
669
24.08.2010
13.04.2015
1.204
1.700
30,000
781
24.08.2010
13.04.2015
1.204
1.700
35,000
223
24.08.2010
13.04.2015
1.204
1.700
10,000
– 791
31.12.2007
15.02.2013
1.154
4.187
12,000
– 3,808
15.08.2007
15.08.2015
1.154
4.440
35,000
– 1,195
31.12.2007
31.12.2014
1.035
4.223
15,000
– 1,185
31.12.2007
30.12.2014
1.035
4.218
15,000
– 1,817
31.12.2007
30.12.2014
1.035
4.218
23,000
– 2,215
31.12.2007
30.12.2014
1.035
3.25 or 6.25 1)
20,000
– 812
03.05.2004
30.09.2014
0.880
4.040
13,200
3.25 % on fulfilment of the digital condition, otherwise 6.25 %.
The Group uses the following hierarchy to determine and to recognise the fair values of financial instruments per
measurement process:
• Level 1: Listed (unadjusted) prices on active markets for assets or liabilities of the same type.
• Level 2: Procedure where all input parameters, which have a material impact on the recognised fair value, are
observable either directly or indirectly.
• Level 3: Procedures, which use the input parameters that have a material impact on the recognised fair values and
are not based on observable market data.
In the Sana Group, securities with a carrying amount of EUR 3,886 thousand (previous year: EUR 0) fall under level 1
and of EUR 22,266 thousand (previous year: EUR 20,056 thousand) under level 2. As in the previous year, all
derivatives must be allocated to level 2.
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From the company
Further information
17.Pensions and other post-retirement
benefit schemes
The Group has established defined benefit pension schemes for employees in six hospitals, a services company and
in Sana Holding. In essence, they are direct commitments to pay old age, invalidity and surviving dependants’ benefits
on the basis of the German civil service regulations, the pension scheme and works agreements. The Group’s
payments vary depending on the features of the pension scheme and, as a rule, are dependent on the time the
employee spends working for the Group and how much he / she earns. Internally, the obligations are financed by
allocations to provisions based on actuarial calculations.
In addition, the Sana Group pays contributions to the Versorgungsanstalt des Bundes und der Länder (VBL = Pension
Institution of the Federal Republic and the Länder) or public sector supplementary pension plans (ZVK) and other
defined contribution benefits. In the financial year, these contributions were recognised in the income statement in the
amount of EUR 35,113 thousand (previous year: EUR 33,857 thousand). In the financial year, the employer contributions
to the statutory pension insurance fund amounted to EUR 61,055 thousand (previous year: EUR 55,467 thousand).
The defined benefit obligation (DBO) has developed as follows:
in EUR k
Defined benefit obligation as at 1 January
Current service cost
Interest expense for acquired pension rights
Pension payments made
Actuarial losses / gains
Defined benefit obligation as at 31 December
2011
2010
17,784
18,919
11
153
830
901
– 1,738
– 2,020
1,177
– 169
18,064
17,784
The actuarial losses include experience-based adjustments of EUR 426 thousand (previous year: EUR 73 thousand).
The fair value of the plan assets has developed as follows:
The components of the expenses for defined benefits recognised in the consolidated income statement and the
amounts stated in the consolidated balance sheet for the respective plans are presented in the following table:
in EUR k
638
694
Expenses for benefits included in staff costs
Pension payments from the plan assets
0
– 85
Anticipated income from the plan assets
29
31
0
–2
667
638
in EUR k
Current service cost
Interest expense
Changes to pension plans
Netted actuarial losses / gains
Anticipated income from the plan assets
2011
2010
11
153
830
901
0
0
83
– 25
– 29
– 30
895
999
Fair value of the plan assets as at 1 January
Actuarial losses
Fair value of the plan assets
as at 31 December
2011
2010
The Group is not expecting to make any further contributions to defined-benefit pension plans in 2012.
The plan assets consist of reinsurance agreements. The anticipated return on the plan assets amounts to 4.35 per
cent (previous year: 4.50 per cent).
The basic assumptions for calculating the pension obligations from the Group’s pension plans are shown below:
Liabilities from defined benefit obligations
Reconciliation of the defined benefit obligation (DBO) with the provision for pensions:
in EUR k
Defined benefit obligations (DBO)
Fair value of the plan assets
Unrecognised actuarial losses / gains
Provision for pensions
130
2011
2010
18,064
17,784
– 667
– 638
17,397
17,146
– 908
210
16,489
17,356
in %
2011
2010
Actuarial interest rate
4.7
5.3
Salary trend
2.2
2.2
Pension trend
1.5
1.5
The Heubeck mortality tables 2005 G are used for mortality and invalidity. Probable staff turnover was calculated
specifically for the Group.
131
From the company
Further information
The defined benefit obligations and the plan assets break down as follows for the current and previous reporting periods:
in EUR k
Defined benefit obligation
not financed with plan assets
Defined benefit obligation
financed with plan assets
Plan assets
2011
2010
2009
2008
2007
16,163
15,981
17,020
15,324
18,101
1,901
1,803
1,899
2,195
1,770
667
638
694
1,079
731
20. Other provisions
Non-current provisions
in EUR k
Anniversaries
Total
10,130
2,279
12,409
Utilisation
3,434
264
3,698
Reversal
1,259
318
1,577
395
144
539
Allocation
18.Liabilities resulting from
the Krankenhausfinanzierungsgesetz
Secondary
liability risks
KSA 1)
Time value of money
59
165
224
5,891
2,006
7,897
MDK risks1)
Structural
adjustments
Total
17,408
14,309
31,717
Utilisation
8,791
422
9,213
Reversal
3,676
660
4,336
Allocation
14,995
1,489
16,484
19,936
14,716
34,652
2011
20101)
1)
Municipal equalisation.
Current provisions
In essence, liabilities under the Krankenhausfinanzierungsgesetz (German Hospital Financing Act) relate to unspent
individual subsidies for construction measures, which are expected to be spent as follows:
in EUR k
in EUR k
2011
2011
2010
–
46,355
2012
45,099
8,112
2013
8,822
633
2014
2,727
536
1)
2015
206
1,488
2016
220
0
57,074
57,124
The cash outflow in the above time bands contain interest totalling EUR 575 thousand (previous year: EUR 584
thousand).
19.Negative market values of derivative
financial instruments
There are no derivative financial instruments apart from hedging transactions classified as cash flow hedges and
recognised in equity at their fair value.
The maturity analysis of derivative financial instruments’ cash flow (previous year net cash flow) is assumed to be as
follows as at 31 December 2011:
in EUR k
21. Other liabilities
in EUR k
Non-current other financial liabilities
Outstanding purchase price payments
50,252
51,179*
Other miscellaneous financial liabilities
14,786
4,813
4,891
5,774
Public sector supplementary
pension plan liabilities
Liabilities resulting from the Krankenhausfinanzierungsrecht (German Hospital Financing Act)
4,809
2,153
74,738
63,919*
Employee-related liabilities
64,406
70,632
Other miscellaneous financial liabilities
25,831
34,214*
20,367
24,820
17,779
39,754*
1,583
3,996
Current other financial liabilities
2011
2010
2011
–
3,795
Liabilities resulting from the Krankenhausfinanzierungsrecht (German Hospital Financing Act)
2012
3,933
3,273
Outstanding purchase price payments
2013
4,525
2,382
Liabilities from third-party funds
2014
3,688
1,932
Advance payments received
2015
932
442
13,078
11,824
Total other financial liabilities
1)
Derivative financial instruments have a carrying value of EUR 12,394 thousand (previous year: EUR 11,824 thousand).
132
Medical Service of the Health Funds.
429
430
130,395
173,846*
205,133
237,765*
133
From the company
Further information
The Group’s other financial liabilities must be allocated in their entirety to the measurement category “measured at
amortised cost”. There are no other financial liabilities held for trading purposes.
22.Contingencies and other obligations
Obligations under operating leases – Group as lessee
The fair value equals the carrying values reported on the liabilities side.
The Group has concluded hire agreements and leases for various vehicles, operating and office equipment and for
medical equipment. The leases have an average term of between 3 and 5 years and do not include any options to
extend. There are also various tenancy agreements covering land and buildings as well as leasehold agreements with
a term of up to 99 years.
Other liabilities not falling within the scope of IFRS 7
in EUR k
2011
2010
2,952
6,410
17,171
17,166
Deferred income
4,712
4,795
Liabilities to social security organisations
1,034
746
22,917
22,707
25,869
29,117
Non-current
Liabilities under partial retirement agreements
Current
Liabilities to the tax authorities
Total
in EUR k
Cash outflow from the financial instruments recognised under other liabilities in accordance with IFRS 7 are
planned as follows:
in EUR k
2011
2010 1)
2011
–
173,846*
2012
130,395
24,899*
2013
26,484
5,483*
2014
5,235
5,404*
2015
8,043
7,742
2016
2,437
2,379
2017
1,510
1,864
2018
Thereafter
1)
On the balance sheet date, the following minimum lease payments are owed on operating leases that cannot be
cancelled:
1,490
1,705
32,387
27,087
207,981
250,409*
Within one year
Between one and five years
Over five years
2011
2010
16,568
11,582
51,213
35,392
105,336
70,991
173,117
117,965
In the year under review, payments under leases of EUR 17,857 thousand (previous year: EUR 16,436 thousand) are
recognised as expense. Contingent payments of EUR 1,374 thousand (previous year: EUR 1,139 thousand) were
also made under tenancies and leases. These are offset by incoming payments from sub-tenancies of EUR 592 thousand (previous year: EUR 566 thousand).
Obligations under operating leases – Group as lessor
The Group has concluded leases covering the commercial letting of its investment property. Investment property
comprises two apartment buildings, an office building that is let, an undeveloped plot of land as well as a former hospital building plus land. The leases are both unlimited and limited in term and have residual terms of one year that can
be cancelled.
On the balance sheet date, the Group is owed the following future minimum lease payments on operating leases that
cannot be cancelled:
in EUR k
Within one year
2011
2010
433
881
0
0
433
881
The cash outflow in the above time bands contain interest totalling EUR 2,848 thousand (previous year: EUR 12,644
thousand).
134
135
From the company
Further information
Obligations under finance leases and hire purchase agreements
23.Related party disclosures
The Group has concluded finance leases and hire purchase agreements for buildings, technical equipment as well as
operating and office equipment. The agreements contain options to extend but no purchase options and escalation
clauses. The legal entity in possession of the leased asset always has the option to extend.
The following table contains the total amounts from transactions between related parties for the financial year in question and the previous year:
The minimum future lease payments under finance leases and hire purchase agreements can be reconciled with their
present values as follows:
2011
Minimum
lease
payments
in EUR k
Within one year
Minimum
lease
payments
3,406
7,127
5,994
Present
value of
the minimum
lease
payments
21,193
11,895
22,391
12,477
Over five years
46,983
34,514
51,850
37,339
Interest included
Present value of the minimum lease payments
74,170
49,815
81,368
– 24,355
– 27,405
49,815
53,963
Revenues from
services agreements and other
transactions
53,963
Expenses
from other
transactions
Associates
Klinikum Dahme-Spreewald GmbH, Lübben
(associate until 30.12.2010)
Kreiskrankenhaus Freiberg gGmbH, Freiberg
4,147
Total minimum lease payments
Revenues from
management
agreements
in EUR k
2010
Present
value of
the minimum
lease
payments
Related parties
Vereinigte Gesundheitseinrichtungen
Mittelsachsen GmbH
Gesundheitsnetz östliches Holstein
Management GmbH
2011
0
0
0
2010
791
2
– 10
2011
0
0
0
2010
0
0
–1
2011
1,251
0
0
2010
1,033
0
0
2011
0
1
0
2010
0
0
0
Remuneration is paid at standard market conditions.
The obligations under finance leases also contain immaterial obligations from the utilisation of services as part of IT
service agreements in accordance with IFRIC 4.
Receivables from related parties amount to EUR 0 thousand on the balance sheet date (previous year: EUR 1 thousand) and are unsecured, non-interest bearing and there are no guarantees of any kind. There are liabilities of
EUR 900 thousand (previous year: EUR 420 thousand) from advance payments on profit-related compensation.
Obligations to acquire plant, property and equipment
As at 31 December 2011, there is a purchase obligation for the acquisition of property, plant and equipment of
EUR 22,720 thousand (previous year: EUR 29,588 thousand). There are also contractually agreed investment obligations of EUR 78,360 thousand (previous year: EUR 134,244 thousand).
Guarantees
From the perspective of the Sana Group, there were the following contingent liabilities at the balance sheet date:
• from guarantee lines of EUR 1,857 thousand (previous year: EUR 1,550 thousand)
• from guarantees of EUR 495 thousand (previous year: EUR 559 thousand)
There are no additional financial guarantees.
Contingent obligation to repay subsidies
The special items from subsidies received in accordance with the German Hospital Financing Act, which were
not reported on the liabilities side as part of the purchase price allocation since they are not debts, amount to
EUR 279,437 thousand as at 31 December 2011 (previous year: EUR 302,162 thousand). In the event of the hospitals
in question withdrawing from the hospital plan, the funds would have to be repaid to the respective authority that
provided the subsidy. Withdrawal from the hospital plan has been ruled out by Sana.
As at 31 December 2011, the Group has not written down any receivables from related parties (previous year:
EUR 0 thousand). The need to recognise impairment is checked every year when the financial position of the related
party and the market in which it operates is reviewed.
24.Objectives and methods of
financial risk management
The key financial instruments used by the Group – with the exception of derivative financial instruments – comprise
notes, bank loans and overdrafts, finance leases and hire purchase agreements as well as cash and cash equivalents
and short-term deposits. The main purpose of these financial instruments is to finance the Group’s operating activities.
The Group has various other financial assets and liabilities such as trade receivables and trade payables, which arise
directly from its operating activities.
The Group also enters into derivative transactions to a limited extent, namely solely in the form of interest rate hedging
transactions, which must be approved by the Management Board of Sana. The purpose of these derivative financial
instruments is to manage the interest rate risks that result from the Group’s operating activities and its funding sources.
The amount and term of the interest rate hedging transactions is based on the planned interest payments. Hedging
measures are carried out centrally by Sana’s Treasury department.
The Sana Group does not trade in financial instruments as a matter of policy.
136
137
From the company
Further information
The major risks to which the Group is exposed from financial risks are:
Attention is focused here on minimising use of operating credit lines in addition to optimising the investment of credit
balances.
• Interest-related cash flow risks,
• Liquidity risks and
• Default risks.
IFRS 7 requires sensitivity analyses to demonstrate the risks of interest rates changing. These show the repercussions of a hypothetical change in market interest rates on the net income for the period and equity.
There are no foreign currency risks, since the Sana Group operates solely in Germany. The Management Board
prepares and reviews guidelines on managing each of these risks. Please refer to the explanations in note 2 in these
notes with regard to the Group’s accounting and measurement methods for derivatives.
Changes in the market rates of financial instruments which were designed as part of a cash flow hedge to hedge interest rate-related fluctuations in cash flow, have repercussions on the hedging reserve in equity and are therefore taken
into consideration in the equity-related sensitivity calculations.
Interest-related cash flow risks
Profits and losses on derivative financial instruments, which are classified as interest rate hedges, are recognised in
equity with the effective portion of the hedge in accordance with IAS 39 (95). The following sensitivity analysis of the
risks of interest rates changing shows the repercussions on the fair value of financial instruments and equity:
The risk of changes in interest rates to which the Group is exposed mainly arises from non-current, floating rate financial liabilities.
The funding requirement within the Sana Group is established as part of the annual planning process. Medium and
long-term funding is secured through shareholder loans, notes and bank loans. The Group’s interest expense is
managed through a combination of fixed rate and floating rate borrowings. To structure this combination of fixed rate
and floating rate borrowings cost-effectively, the Group concludes interest rate swaps in individual cases, under which
the Group swaps the difference established with reference to an agreed nominal amount between floating rate and
variable rate amounts with the other party at specific intervals. The underlying borrowing and the interest flow resulting
therefrom are hedged with these interest rate swaps.
Default risk
Essentially, the Group supplies services to members of the statutory social security system and also, to a lesser
extent, to patients insured with private health insurance schemes. Hospital services are subject to the statutory regulations governing fees and are usually settled within the deadline prescribed by law. Default risks are also taken into
account through individual write-downs and lump-sum write-downs. Receivables are monitored on an ongoing basis
meaning that the Group is not exposed to any material default risk. There are no significant concentrations of default
risk within the Group.
In the event of a counterparty defaulting, the maximum default risk from the Group’s other financial assets, which
contain cash and cash equivalents is the carrying amount of the instrument in question.
Basis point
change
Increase of
100 basis points
Value as at
31.12.2011
in EUR k
Deferred
taxes
in EUR k
Effects on
equity
in EUR k
Value as at
31.12.2010
in EUR k
Deferred
taxes
in EUR k
Effects on
equity
in EUR k
– 6,658
– 1,836
3,900
– 3,149
– 2,241
4,761
As at 31.12.
– 12,394
–
–
– 10,151
–
–
Reduction of
100 basis points
– 15,704
1,059
– 2,251
– 18,262
2,595
– 5,515
When all interest rate-sensitive items in the balance sheet are considered, an increase of 100 basis points would
improve the net income for the period before taxes by EUR 872 thousand. On the other hand, a reduction of 100 basis
points would reduce the profit for the period before taxes by EUR 872 thousand.
The Sana Group pursues very conservative targets as part of its funding strategy. These are focused most notably on
securing liquidity and the highest degree of planning certainty regarding funding costs. Starting from a rolling multi
annual planning process, the Group’s capital requirement including funding to finance growth is derived. The ratios
used to manage debt and capital efficiency form the framework of a continuous capital management process.
Liquidity risk
The Group’s liquidity is managed, secured and its entire funding activity coordinated via a central Treasury system.
The daily financial status is calculated within the system, as is the monthly liquidity reporting based on anticipated
cash flow from operating activities as well as financial investment taking maturities into account. Regular deviation
analyses are carried out at both subsidiary and Group level using liquidity reports. The CFO of Sana Kliniken AG
subsequently receives an aggregate Group liquidity report. The Supervisory Board is also informed of the trend in
liquidity every quarter. In the process, explanations of selected items from the aggregate liquidity report are provided.
The Group aims to achieve a balance between covering its funding requirement continuously and securing flexibility
in the form of overdrafts, loans and leases. The Group’s internal Treasury directive stipulates that at least 50 per cent
of financial liabilities must be hedged with a fixed rate agreement or an adequate derivative. As at 31 December 2011,
more than 90 per cent benefit from quasi fixed rates (as was the case in the previous year).
The RoCE (return on capital employed) reflects the return on capital invested long-term. Assets committed short-term
are not taken into account in this ratio. The RoCE is calculated as a quotient of EBIT after taxes and invested capital.
The invested capital consists of equity, financial liabilities less cash and cash equivalents, pensions and other noncurrent provisions and liabilities. For our internal management we consistently deduct goodwill, since this represents
assets financed with subsidies as part of corporate acquisitions. Sana aims to achieve an RoCE of at least 1.5 times
the cost of capital employed. The acquisition of new hospitals can lead to fluctuations here. An RoCE of 9.9 per cent
has been achieved for the financial year (previous year: 10.3 per cent).
The path of profitable growth taken by Sana can only be implemented if the financing structures provide sufficient
flexibility and scope to exploit the potential for growth. Firstly, net gearing plays a role in this connection. Secondly, the
gearing ratio is managed in relation to operating earnings before depreciation and amortisation (EBITDA).
For the Group’s internal management a ceiling of 100 per cent has been set for net gearing, although this is only to
apply in exceptional cases, i.e. as a consequence of the takeover of major acquisitions.
138
139
From the company
Further information
25. Other disclosures
Employees
On average, the Sana Group employed the following staff over the year:
in EUR k
2011
2010
Medical services
2,954
2,698
Nursing services
7,742
7,463
2,824
2,621
Functional services
2,433
2,247
580
779
Hospitals
Technical services
Other staff
Services companies
Retirement homes
Total
177
180
1,447
1,259
706
610
3,819
3,669
944
957
23,626
22,483
The Sana Group employs 1,368 trainees (previous year: 1,106) in various types of service.
Executive bodies
Members
Bodo Bachmann, Anaesthetist, Klein Wesenberg
Margitta Bergmann, Specialist Surgical Nurse, Bergen / Rügen
Dr Karl-Joseph Bierth (Director), Member of the Management Board, Signal Krankenversicherung a. G.,
Mathematician, Herdecke
Wolfram Ferse, Trade Union Secretary, ver.di Bundesverwaltung, Berlin
Beate Fleischmann, Specialist Anaesthesia and Intensive Care Nurse, Oldenburg
Rolf Florian (Director), Member of the Management Board, Debeka Krankenversicherungsverein a. G.,
Businessman, Dieblich
Wilfried Johannßen (Director), Member of the Management Board,
Allianz Private Krankenversicherungs-AG, Munich (until 16 June 2011)
Axel Kampmann (Director (retired)), Schwanstetten (until 16 June 2011)
Christian Ketterl, Anaesthesia Nurse, Oberkotzau
Ramona Linne, Lecturer in Medicine, Berlin
PD Dr Mohammad Maghsudi, Head Physician, Eutin (until 16 October 2011)
Christian Molt (Director), Member of the Management Board, Allianz Private Krankenversicherungs-AG,
Business Mathematician, Munich (from 16 June 2011)
Dr Stefan Paech, Consultant Surgeon, Erkelenz (from 17 November 2011)
Wolfgang Reif (Director), Member of the Management Board, Bayerische Beamtenkrankenkasse AG,
Lawyer, Munich (from 16 June 2011)
Heinz Jürgen Scholz (Director), Member of the Management Board,
Continentale Krankenversicherung a.G., Mathematician, Zirndorf
Prof. Dr Ernst-Wilhelm Zachow (Director), Chairman of the Management Board, Landeskrankenhilfe V.V.a.G.,
Mathematician, Lüneburg
Management Board
Dr Michael Philippi, Businessman, Cologne
Thomas Lemke, Businessman, Dresden
Dr med. Markus Müschenich, Doctor, Berlin (until 31 January 2012)
Jan Stanslowski, graduate in Economic and Social Sciences, Dresden
Current payments due to employees amount to EUR 2,043 thousand (previous year: EUR 1,825 thousand). Pension
obligations come to EUR 1,342 thousand (previous year: EUR 1,275 thousand) for former members of the legal predecessor’s management.
Supervisory Board
The Supervisory Board received total emoluments of EUR 230 thousand (previous year: EUR 231 thousand).
Chairman
Director General Dr h.c. Josef Beutelmann, Chairman of the Management Board,
Barmenia Krankenversicherung a. G., Businessman, Wuppertal
Auditor’s total fee
1st Deputy Chairman
Gabriele Gröschl-Bahr, Trade Union Secretary, ver.di Bundesverwaltung, Berlin
Compensation paid to persons in key positions in the Group
The total fee charged by the auditor for the financial year comes to EUR 1,441 thousand (previous year: EUR 1,527 thousand) for auditing services and to EUR 138 thousand (previous year: EUR 170 thousand) for confirmation services.
No tax advisory services or other services were received in financial year 2011 (previous year: EUR 0 thousand).
Exemption from disclosure
2nd Deputy Chairman
Günter Dibbern (Director (retired)), Economist, Cologne (until 16 June 2011)
Silke Lautenschläger (Director), Member of the Management Board,
DKV Deutsche Krankenversicherung AG, Lawyer, Modautal (from 16 June 2011)
140
Use was made of the exemption from the duty of disclosure permitted in section 264 (3) of the German Commercial Code
(HGB) for the following subsidiaries for financial year 2011 by virtue of a shareholder resolution:
• Herzzentrum Dresden GmbH
• Sana-Herzzentrum Cottbus GmbH
• Sana-Krankenhaus Rügen GmbH
• Sana-Medizintechnisches Servicezentrum GmbH
• Sana Personal Service GmbH
• Sana IT Services GmbH
• Sana Ohre-Klinikum GmbH
• Sana Arztpraxen Magdeburg GmbH
• Sana Herzchirurgie Stuttgart GmbH
• Sana Gesundheitscampus Wilhelmstraße GmbH
141
From the company
Further information
26. List of shareholdings
Name
Registered
office
Name
Ownership
in %
Affiliates
Ausbildungszentrum für Berufe im Gesundheitswesen GmbH
(OKAZ)
Eutin
94.80 1)
Berufsfachschule für Krankenpflegehilfe am
Schwarzenbruck
100.00 1)
Betriebs- und Verwaltungsgesellschaft mbH
am Seenland Klinikum
Hoyerswerda
49.00
Ismaning
91.00
Berlin
75.13
Schwendi
60.00
clinic.log Logistik- und Dienstleistungsgesellschaft mbH
CoMedServ GmbH
Fachklinik für Neurologie Dietenbronn GmbH
Akademisches Krankenhaus of the University of Ulm
Gesundheits-Akademie-Rügen GmbH
1)
51.00 1)
Gesundheitscampus Wilhelmstraße GmbH
Hameln
100.00
Gesundheitseinrichtungen Hameln-Pyrmont GmbH
Hameln
51.00
Gesundheitseinrichtungen Hameln-Pyrmont Service GmbH
Hameln
51.00 1)
Dresden
100.00
Johannes Hospiz gGmbH
Uetersen
55.43 1)
Karl-Olga-Krankenhaus GmbH
Stuttgart
74.00
Lübben
49.00 1) 2)
Klinikum Dahme-Spreewald GmbH
Lübben
49.00 2)
Klinikum Dahme-Spreewald Reinigungsgesellschaft mbH
Lübben
49.00 1) 2)
Krankenhaus vom Roten Kreuz Bad Cannstatt GmbH
Duisburg
Schwarzenbruck
Stuttgart
49.00 2)
100.00
54.76 1)
Hoyerswerda
49.00 1) 2)
Lausitz Clean GmbH
Hoyerswerda
49.00 1) 2)
Lausitz Med GmbH
Hoyerswerda
49.00 1) 2)
Lausitzer Seenland Klinikum GmbH
Hoyerswerda
49.00 2)
Medizinisches Versorgungszentrum GmbH
am Seenland Klinikum
Duisburg
49.00 1) 2)
Hoyerswerda
49.00 1) 2)
MVZ Elmshorn GmbH
Uetersen
74.90
MVZ Management GmbH
Uetersen
74.90 1)
MVZ Norderstedt GmbH
Uetersen
74.90 1)
MVZ Pinneberg GmbH
Uetersen
74.90 1)
MVZ Quickborn GmbH
Uetersen
74.90 1)
MVZ Uetersen GmbH
Uetersen
74.90 1)
Regio Alten- und Pflegeheim Elbmarsch GmbH
Uetersen
74.90 1)
Regio Ambulanter Pflegedienst GmbH
Uetersen
74.90 1)
Regio Kliniken GmbH
Uetersen
74.90
Regio Privatklinik GmbH
Uetersen
74.90 1)
Regio Reha GmbH
Uetersen
74.90 1)
Regio Sanitätshaus GmbH
Uetersen
74.90 1)
RKU Ambulante Rehabilitation und Therapie gGmbH
Ulm
50.00 1) 2)
RKU Invest GmbH
Ulm
50.00 2)
RKU-Universitäts- und Rehabilitationskliniken Ulm gGmbH
Ulm
50.00 2)
Sana Arztpraxen Magdeburg GmbH
Haldensleben
100.00 1)
Sana Arztpraxen Remscheid GmbH
Remscheid
94.90 1)
Bergen auf Rügen
100.00 1)
Berlin
75.13 1)
Sana Berlin-Brandenburg Immobilienmanagement GmbH
Hameln
60.00
Sana DGS GmbH
Ismaning
60.00
Sana DGS pro.service GmbH
Ismaning
60.00 1)
Berlin
75.13 1)
Hof
100.00 1)
Hameln
75.13 1)
Sana Gesundheitszentren Berlin-Brandenburg GmbH
Sana Gesundheitszentrum Hof GmbH
Sana Gesundheitszentrum Niedersachsen GmbH
Sana Herzchirurgie Stuttgart GmbH
Sana Holding Bad Oeynhausen GmbH
Lausitz Catering GmbH
Medizinisches Versorgungszentrum Duisburg Süd GmbH
Uetersen
sana centru.medis GmbH
Klinikum Dahme-Spreewald Dienstleistungsgesellschaft mbH
1)
74.90 1)
Ownership
in %
RAS Regio Arbeitsmedizin und Service GmbH
Sana Arztpraxen Rügen GmbH
Herzzentrum Dresden GmbH University Hospital
142
Bergen auf Rügen
1) 2)
Registered
office
Sana IT Services GmbH
Sana Klinik Pegnitz GmbH
Sana Kliniken Lübeck GmbH
Stuttgart
100.00
Bad Oeynhausen
100.00
Ismaning
100.00
Pegnitz
100.00
Dusseldorf
51.00
Lübeck
94.80
Eutin
94.80
Munich
100.00
Sana Klinikum Hof GmbH
Hof
100.00
Sana Klinikum Hof Schulen gGmbH
Hof
100.00 1)
Sana Managementgesellschaft mbH
Ismaning
Sana Kliniken Solln Sendling GmbH
Sana Medizinisches Versorgungszentrum Düsseldorf GmbH
100.00
Dusseldorf
51.00 1)
Sana mobil GmbH
Haldensleben
60.00 1)
Sana Ohre-Klinikum GmbH
Haldensleben
100.00
Ismaning
100.00
Bad Wildbad
100.00
Remscheid
100.00
Sana Personal Service GmbH
Sana Realinvest GmbH
Neurologisches Rehabilitationszentrum Quellenhof
in Bad Wildbad GmbH
Bad Wildbad
55.00
OsteMed Kliniken und Pflege GmbH
Bremervörde
49.90
OsteMed Service GmbH
Zeven
49.90
Paritätische Gesundheitszentrum GmbH
Berlin
75.13 1)
Sana TGmed GmbH
Ismaning
51.00
PKS Pinneberger Kliniken Servicegesellschaft mbH
Uetersen
74.90 1)
Sana-Catering-Service GmbH
Ismaning
77.00
PNZ GmbH
Stuttgart
54.76 1)
Sana-Herzzentrum Cottbus GmbH
Cottbus
100.00
PTS Pinneberger Textil-Service GmbH
Uetersen
30.60
Sana-Klinik Nürnberg GmbH - Am Birkenwald
Nuremberg
100.00
Sana Rechnungswesen GmbH
2)
Sana Rehabilitationsklinik Sommerfeld GmbH
1) 2)
Sana Rheumazentrum Rheinland-Pfalz AG Bad Kreuznach
1) 2)
Kremmen
Bad Kreuznach
75.13 1)
88.84
143
From the company
Further information
Auditor’s report
Auditor’s report
Name
Sana-Klinik Zollernalb GmbH
Sana-Kliniken Bad Wildbad GmbH
Sana Kliniken Berlin-Brandenburg GmbH
Sana-Klinikum Remscheid GmbH
Sana-Krankenhaus Hürth GmbH
Registered
office
Ownership
in %
Albstadt-Truchtelfingen
100.00
Bad Wildbad
100.00
Berlin
75.13
Remscheid
94.90
Hürth
100.00
Bergen auf Rügen
100.00
Sana-Medizintechnisches Servicezentrum GmbH
Stuttgart
100.00
Städtische Seniorenheime Duisburg GmbH
Duisburg
Sana-Krankenhaus Rügen GmbH
Uni-Cor GmbH
Berlin
49.00 1) 2)
Berlin
25.00
Ambulante GesundheitsService GmbH Mittelsachsen
Freiberg
26.00 1) 3)
Evangelisches Bildungszentrum für Gesundheitsberufe Stuttgart
gGmbH
Stuttgart
25.12 1)
Hof
25.00 1)
Forum Gesundheit gemeinnützige GmbH
Gesundheitsnetz östliches Holstein Management GmbH
HDZ-Service GmbH
Herzkatheterlabor GbR Hof
Eutin
47.40 1) 3)
Bad Oeynhausen
50.00 1) 3)
Hof
Krankenhausbetriebsgesellschaft Bad Oeynhausen mbH
50.00 1)
Bad Oeynhausen
50.00 1) 3)
Kreiskrankenhaus Freiberg gGmbH
Freiberg
26.00 1) 3)
Kreiskrankenhaus Freiberg Service GmbH
Freiberg
26.00 1) 3)
Medizinisches Versorgungszentrum Freiberg GmbH
Freiberg
26.00 1) 3)
Bad Oeynhausen
50.00 1) 3)
Medizinisches Versorgungszentrum HDZ-NRW GmbH
MRT-Kooperations-GmbH
Dresden
33.00 1)
Reha-Tagesklinik im Forum Pankow GmbH
Berlin
18.78 1)
Reha-Tagesklinik im Forum Pankow GmbH & Co. Betriebs KG
Berlin
18.78 1)
Leverkusen
49.90 1)
Pegnitz
50.00 1)
Freiberg
26.00 3)
RNR-Sana Medizinisches Versorgungszentren GmbH
Sana Klinik Pegnitz MVZ GbR
Vereinigte Gesundheitseinrichtungen Mittelsachsen GmbH
1)
2)
3)
“We audited the consolidated financial statements prepared by Sana Kliniken AG, Ismaning – consisting of the income
statement, the statement of comprehensive income, the balance sheet, the statement of changes in equity and the
cash flow statement and the notes to the consolidated financial statements – as well as the Group management report
for the financial year from 1 January to 31 December 2011. The preparation of the consolidated financial statements
and the Group management report in accordance with IFRS, as adopted by the European Union, and the additional
regulations of the German Commercial Code (HGB) pursuant to section 315a (1) HGB are the responsibility of the
legal representatives of the company. Our responsibility is to express an opinion on the consolidated financial statements and on the Group management report based on our audit.
75.13 1)
Other holdings
4QD-Qualitätskliniken.de GmbH
We have issued the following auditor’s report on the consolidated financial statements and the Group management
report:
We conducted our audit of the consolidated financial statements in accordance with section 317 HGB and German
generally accepted standards for the audit of financial statements promulgated by the Institut der Wirtschaftsprüfer
[Institute of Public Auditors in Germany] (IDW). Those standards require that we plan and perform the audit such that
misstatements materially affecting the presentation of the net assets, financial position and results of operations in the
consolidated financial statements in accordance with the applicable financial reporting framework and in the Group
management report are detected with reasonable assurance. Knowledge of the business activities and the economic
and legal environment of the Group and expectations as to possible misstatements are taken into account in the
determination of audit procedures. The effectiveness of the accounting-related internal control system and the
evidence supporting the disclosures in the consolidated financial statements and the Group management report are
examined primarily on a test basis within the framework of the audit. The audit includes assessing the annual financial
statements of those entities included in consolidation, the determination of entities to be included in consolidation, the
accounting and consolidation principles used and significant estimates made by management, as well as evaluating
the overall presentation of the consolidated financial statements and Group management report. We believe that our
audit provides a reasonable basis for our opinion.
Our audit has not led to any reservations.
In our opinion, based on the findings of our audit, the consolidated financial statements comply with IFRS, as adopted
by the EU and the additional requirements of German commercial law pursuant to Section 315a(1) HGB and give a true
and fair view of the net assets, financial position and results of operations of the Group in accordance with these
requirements. The Group management report is consistent with the consolidated financial statements and as a whole
provides a suitable view of the Group’s position and suitably presents the opportunities and risks of future development.”
Interest reflects the indirect holding.
Control as per IAS 27.13.
Accounted for using the equity method.
Stuttgart, 29 February 2012
Ernst & Young GmbH
Wirtschaftsprüfungsgesellschaft
Munich, 29 February 2012
Dr M. PhilippiT. Lemke
144
J. Stanslowski
SöhnleDr Jungblut
Wirtschaftsprüfer
Wirtschaftsprüfer
(German Public Auditor)
(German Public Auditor)
145
From the company
Addresses
Addresses of the Sana facilities
Hospitals operated by Sana
Hospitals in which Sana has a minority stake
Fachklinik für Neurologie
Dietenbronn GmbH
Dietenbronn 7
D-88477 Schwendi
Tel. +49 (0)7353 989-0
Fax +49 (0)7353 989-112
[email protected]
RKU – Universitäts- und
Rehabilitationskliniken Ulm gGmbH
Oberer Eselsberg 45
D-89081 Ulm
Tel. +49 (0)731 177-0
Fax +49 (0)731 177-1005
[email protected]
Hameln-Pyrmont GmbH
Sana Klinikum Hameln-Pyrmont
Saint-Maur-Platz 1
D-31785 Hameln
Tel. +49 (0)5151 97-0
Fax +49 (0)5151 97-1155
[email protected]
Sana Hanse-Klinikum Wismar 1)
Störtebekerstraße 6
D-23966 Wismar
Telefon 03841 330
[email protected]
Herzzentrum Dresden GmbH
Universitätsklinik an der Technischen
Universität Dresden
Fetscherstraße 76
D-01307 Dresden
Tel. +49 (0)351 450-0
Fax +49 (0)351 450-1552
[email protected]
Karl-Olga-Krankenhaus GmbH
Hackstraße 61
D-70190 Stuttgart
Tel. +49 (0)711 2639-0
Fax +49 (0)711 2639-2212
[email protected]
Rummelsberg 71
D-90592 Schwarzenbruck
Telefon 09128 50-40
Fax 09128 50-43051
[email protected]
Krankenhaus vom Roten Kreuz
Bad Cannstatt GmbH
Badstraße 35 – 37
D-70372 Stuttgart
Tel. +49 (0)711 5533-0
Fax +49 (0)711 5533-1262
[email protected]
Neurologisches Rehabilitationszentrum
Quellenhof in Bad Wildbad GmbH
Kuranlagenallee 2
D-75323 Bad Wildbad
Tel. +49 (0)7081 173-0
Fax +49 (0)7081 173-230
[email protected]
Regio Kliniken GmbH
Regio Klinikum Pinneberg
Fahltskamp 74
D-25421 Pinneberg
Tel. +49 (0)4101 217-0
Fax 04101 217-789
[email protected]
Regio Klinikum Elmshorn
Agnes-Karll-Allee
D-25337 Elmshorn
Tel. +49 (0)4121 798-0
Fax 04121 798-181
[email protected]
Regio Klinikum Wedel
Holmer Straße 155
D-22880 Wedel
Tel. +49 (0)4103 962-0
Fax 04103 962-1 97
[email protected]
Sana Herzchirurgie Stuttgart GmbH
Herdweg 2
D-70174 Stuttgart
Tel. +49 (0)711 278-36110
Fax +49 (0)711 278-36159
[email protected]
Sana Klinik Pegnitz GmbH
Langer Berg 12
D-91257 Pegnitz
Tel. +49 (0)9241 981-0
Fax +49 (0)9241 981-222
[email protected]
Sana Klinikum Hof GmbH
Eppenreuther Straße 9
D-95032 Hof
Tel. +49 (0)9281 98-0
Fax +49 (0)9281 98-2735
[email protected]
Sana Krankenhaus Gerresheim
Gräulinger Straße 120
D-40625 Düsseldorf
Tel. +49 (0)211 2800-01
Fax +49 (0)211 2800-971
[email protected]
Sana Ohre-Klinikum GmbH
Kiefholzstraße 27
D-39340 Haldensleben
Tel. +49 (0)3904 474-0
Fax +49 (0)9281 98-2735
[email protected]
Sana Krankenhaus Benrath
Urdenbacher Allee 83
D-40593 Düsseldorf
Tel. +49 (0)211 997-02
Fax +49 (0)211 997-1930
[email protected]
Sana Kliniken Lübeck GmbH
Kronsforder Allee 71 – 73
D-23560 Lübeck
Tel. +49 (0)451 585-01
Fax 0451 585-1234
[email protected]
Sana Rheumazentrum Rheinland-Pfalz AG
Rheumakrankenhaus
Kaiser-Wilhelm-Straße 9 - 11
D-55543 Bad Kreuznach
Tel. +49 (0)671 93-0
Fax +49 (0)671 93-1999
[email protected] Karl-Aschoff Klinik mit Dependance
Prieger Klinik
Kaiser-Wilhelm-Straße 19a
D-55543 Bad Kreuznach
Tel. +49 (0)671 93-3331
Fax +49 (0)671 93-4999
[email protected]
Sana Kliniken Berlin-Brandenburg GmbH
Sana Krankenhaus Templin
Robert-Koch-Straße 24
D-17268 Templin
Tel. +49 (0)3987 42-0
Fax +49 (0)3987 42-249
[email protected]
Praxisklinik Travemünde
Am Dreilingsberg 7
D-23570 Lübeck-Travemünde
Tel. +49 (0)4502 800-0
Fax +49 (0)4502 800-100
[email protected]
Sana Kliniken Sommerfeld
Hellmuth-Ulrici-Kliniken
Waldhausstraße 44
D-16766 Kremmen / OT Sommerfeld
Tel. +49 (0)33055 5-0
Fax +49 (0)33055 5-1111
[email protected]
Klinik Eutin
Hospitalstraße 22
D-23701 Eutin
Tel. +49 (0)4521 787-0
Fax +49 (0)4521 787-1809
[email protected]
Sana-Kliniken Bad Wildbad GmbH
König-Karl-Straße 5
D-75323 Bad Wildbad
Tel. +49 (0)7081 179-0
Fax +49 (0)7081 179-109
[email protected]
Sana Rehabilitationsklinik
Sommerfeld GmbH
Waldhausstraße 44
D-16766 Kremmen / OT Sommerfeld
Tel. +49 (0)33055 5-0
Fax +49 (0)33055 5-1111
[email protected]
Klinik Oldenburg
Mühlenkamp 5
D-23758 Oldenburg i. Holst.
Tel. +49 (0)4361 513-0
Fax +49 (0)4361 1359
[email protected]
Sana-Klinik Nürnberg GmbH
Weiltinger Straße 11
D-90449 Nürnberg
Tel. +49 (0)911 6808-0
Fax +49 (0)911 6808-110
[email protected]
Inselklinik Fehmarn
Mummendorfer Weg 12
D-23769 Fehmarn
Telefon 04371 504-0
[email protected]
Sana-Klinik Zollernalb GmbH
Robert-Koch-Straße 26
D-72461 Albstadt
Tel. +49 (0)7432 169-0
Fax +49 (0)7432 169-1009
[email protected]
Sana Klinikum Lichtenberg
Fanningerstraße 32
D-10365 Berlin
Tel. +49 (0)30 5518-0
Fax +49 (0)30 5518-4004
[email protected]
Sana Kliniken des Landkreises
Cham GmbH 1)
Krankenhaus Cham
August-Holz-Str. 1
D-93413 Cham
Telefon 09971 409-0
Fax 09971 40-547
[email protected]
Krankenhaus Bad Kötzting
Hauser Str. 42
D-93444 Bad Kötzting
Telefon 09941 20-0
Fax 09941 8013
[email protected]
1)
146
Krankenhaus Roding
Arnulfstraße 1
D-93426 Roding
Telefon 09461 400-0
Fax 09461 1229
[email protected]
Sana-Herzzentrum Cottbus GmbH
Leipziger Straße 50
D-03048 Cottbus
Tel. +49 (0)355 480-0
Fax +49 (0)355 480-1001
[email protected]
Sana Kliniken Solln Sendling GmbH
Sana Klinik München-Sendling
Plinganserstraße 122
D-81369 München
Tel. +49 (0)89 72403-0
Fax +49 (0)89 72403-260
[email protected]
Sana-Klinikum Remscheid GmbH
Burger Straße 211
D-42859 Remscheid
Tel. +49 (0)2191 13-0
Fax +49 (0)2191 13-3009
[email protected]
Sana Klinik München-Solln
Bertelestraße 75
D-81479 München
Tel. +49 (0)89 79101-0
Fax +49 (0)89 79101-112
[email protected]
Sana-Krankenhaus Hürth GmbH
Krankenhausstraße 42
D-50354 Hürth
Tel. +49 (0)2233 594-0
Fax +49 (0)2233 594-357
[email protected]
New acquisition in 2012, not included in the 2011 annual financial statements.
Sana-Krankenhaus Rügen GmbH
Calandstraße 7 / 8
D-18528 Bergen / Rügen
Tel. +49 (0)3838 39-0
Fax +49 (0)3838 39-1015
[email protected]
Herz- und Diabeteszentrum
Nordrhein-Westfalen
Universitätsklinik der Ruhr-Universität
Bochum
Georgstraße 11
D-32545 Bad Oeynhausen
Tel. +49 (0)5731 97-0
Fax +49 (0)5731 97-2300
[email protected]
Klinikum Dahme-Spreewald GmbH
Achenbach-Krankenhaus Königs
Wusterhausen
Köpenicker Straße 29
D-15711 Königs Wusterhausen
Tel. +49 (0)3375 288-0
Fax +49 (0)3375 290694
[email protected]
Spreewaldklinik Lübben
Schillerstraße 29
D-15907 Lübben
Tel. +49 (0)3546 75-0
Fax +49 (0)3546 75-366
[email protected]
Kreiskrankenhaus Freiberg gGmbH
Donatsring 20
D-09599 Freiberg
Tel. +49 (0)3731 77-0
Fax +49 (0)3731 77-2299
[email protected]
Zu den Rehwiesen 9
D-47055 Duisburg
Tel. +49 (0)203 733-0
Fax +49 (0)203 733-1002
[email protected]
Lausitzer Seenland Klinikum GmbH
Maria-Grollmuß-Straße 10
D-02977 Hoyerswerda
Tel. +49 (0)3571 44-0
Fax +49 (0)3571 44-2264
[email protected]
OsteMed Martin-LutherKrankenhaus Zeven
Dr.-Otto-Straße 2
D-27404 Zeven
Tel. +49 (0)4281 711-0
Fax +49 (0)4281 711-205
[email protected]
OsteMed Klinik Bremervörde
Gnarrenburger Straße 117
D-27432 Bremervörde
Tel. +49 (0)4761 980-0
Fax +49 (0)4761 980-210
[email protected]
Hospitals managed by Sana
Buchberg-Klinik Bad Tölz
Wengleinstraße 20
D-83646 Bad Tölz
Tel. +49(0)8041 803-0
Fax +49 (0)8041 803-793
[email protected]
Caritas-Krankenhaus St. Josef
Landshuter Straße 65
D-93053 Regensburg
Tel. +49 (0)941 782-2010
Fax +49 (0)941 782-2005
[email protected]
imland gGmbH
imland Klinik Rendsburg
Lilienstraße 20 – 28
D-24768 Rendsburg
Tel. +49 (0)4331 200-0
Fax +49 (0)4331 200-9010
[email protected]
imland Klinik Eckernförde
Schleswiger Straße 114 – 116
D-24340 Eckernförde
Tel. +49 (0)4351 882-0
Fax +49 (0)4351 882-228
[email protected]
Klinik Oberstdorf
Trettachstraße 16
D-87561 Oberstdorf
Tel. +49 (0)8322 703-0
Fax +49 (0)8322 703-402
[email protected]
Kliniken Oberallgäu gGmbH
Klinik Immenstadt
Im Stillen 3
D-87509 Immenstadt
Tel. +49 (0)8323 910-0
Fax +49 (0)8323 910-350
[email protected]
Klinikum Kempten-Oberallgäu gGmbH
Robert-Weixler-Straße 50
D-87493 Kempten
Tel. +49 (0)831 530-0
Fax +49 (0)831 530-3533
[email protected]
Klinik Sonthofen
Prinz-Luitpold-Straße 1
D-87527 Sonthofen
Tel. +49 (0)8321 804-0
Fax +49 (0)8321 804-119
[email protected]
MediCare Flughafen München
Medizinisches Zentrum GmbH
AirportClinic M
Terminal 1 Ebene 03
D-85326 München-Flughafen
Tel. +49 (0)89 975-63328
Fax +49 (0)89 975-63327
[email protected]
Städtisches Klinikum
Wolfenbüttel gGmbH
Alter Weg 80
D-38302 Wolfenbüttel
Tel. +49 (0)5331 934-0
Fax +49 (0)5331 934-1502
[email protected]
Nursing homes
Alten- und Pflegeheim Wiblingen
Schloßstraße 34
D-89079 Ulm
Tel. +49 (0)731 94625-0
Fax +49 (0)731 94625-19
[email protected]
imland Seniorenhaus Nortorf
Große Mühlenstraße 52
D-24589 Nortorf
Tel. +49 (0)4392 4026-0
Fax +49 (0)4392 4026-15
[email protected]
Altenzentrum Goldbach GmbH
Bahnhofstraße 15
D-88416 Ochsenhausen
Tel. +49 (0)7352 949-0
Fax +49 (0)7352 949-112
[email protected]
imland Seniorenhaus Jevenstedt
Am Altenheim 1
D-24808 Jevenstedt
Tel. +49 (0)4337 919-13
Fax +49 (0)4337 919-149
[email protected]
Hameln-Pyrmont GmbH
Sana Seniorenheim Zur Höhe
Holtenser Landstraße 1
D-31787 Hameln
Tel. +49 (0)5151 955-60
Fax +49 (0)5151 955-650
[email protected]
OsteMed Seniorensitz und Pflegeheim
Dr.-Otto-Straße 2
D-27404 Zeven
Tel. +49 (0)4281 711-320
Fax +49 (0)4281 711-555
[email protected]
imland gGmbH
imland Seniorenhaus Eckernförde
Schleswiger Straße 114 – 116
D-24340 Eckernförde
Tel. +49 (0)4351 882-500
Fax +49 (0)4351 882-579
[email protected]
OsteMed Haus im Park –
Wohnen und Pflege
Bremer Straße 29
D-27432 Bremervörde
Tel. +49 (0)4761 864-0
Fax +49 (0)4761 864-220
[email protected]
Regio Kliniken GmbH
Pflegezentrum Elbmarsch
Agnes-Karll-Allee 21
D-25337 Elmshorn
Tel. +49 (0)4121 294-0
Fax +49 (0)4121 294-118
[email protected]
Städtische Seniorenheime Duisburg
Seniorenzentrum Rheinhausen
Lindenallee 23
D-47229 Duisburg
Tel. +49 (0)2065 9290-0
Fax +49 (0)2065 9290-15
[email protected]
Pflegezentrum Kummerfeld
Bundesstraße 39
D-25495 Kummerfeld
Tel. +49 (0)4101 705-0
Fax 04101 714 76
[email protected]
Seniorenzentrum Hamborn
Aachenerstraße 27
D-47169 Duisburg
Tel. +49 (0)203 50004-0
Fax +49 (0)203 50004-15
[email protected]
Sana Seniorenzentrum Benrath
Kohlhagenstraße 15
D-40593 Düsseldorf
Tel. +49 (0)211 977-1777
Fax +49 (0)211 977-1717
[email protected]
Städtisches Seniorenzentrum
Großenbaum
Zu den Wiesen 62
D-47229 Duisburg
Tel. +49 (0)203 7100-0
Fax +49 (0)203 7100-415
[email protected]
Sana Seniorenzentrum Gallberg
Blanckertzstraße 24
D-40629 Düsseldorf
Tel. +49 (0)211 2800-03
Fax +49 (0)211 2800-7071
[email protected]
147
Imprint
For further information, please contact:
Sana Kliniken AG
Oskar-Messter-Straße 24
85737 Ismaning
Germany
Tel.
+49 (0)89 678204-0
Fax
+49 (0)89 678204-179
E-mail [email protected]
Concept, advice & design
HGB Hamburger Geschäftsberichte GmbH & Co. KG,
Hamburg, Germany
Photos
Sana Kliniken AG (p. 3, 5, 8, 9, 13, 17, 21, 22,
23, 30, 31, 37, 39, 43, 44, 45, 49, 51, 55, 57)
Barmenia Versicherungen (p. 24)
Michael Kuhlmann (p. 22)
Ludmilla Behr (p. 23)
Nordbayerische Nachrichten (p. 40)
Dr Jelko Benters, Boehringer Ingelheim (p. 57)
Plainpicture (p. 1, 6, 7, 10, 11, 12, 14, 15,
16, 20, 32, 35, 36, 38, 46, 54, 56, 58, 88)
Getty Images (p. 41, 52)
Veer (p. 18, 19)
Printing
Mediahaus Biering GmbH, Munich, Germany
Printed on Circlesilk Premium White
(100% recycled paper, awarded the
EU Ecolabel, license number FR/11/003)
Certified QM system
DIN EN ISO 9001:2008
legal notice
Certificate no.
FS 539291/8274D
148
this information contains future-oriented statements which are based on our current assumptions and forecasts.
Known and unknown risks, uncertainties and influences may cause the actual events, financial situation or development
to differ from the assessments given here. We are under no obligation to update future-oriented statements.

HOSpItAl WItH A sana Kliniken aG

Transcription

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