85 We financed cash used in 2008 for investment activities ( 275.3 million), hospital acquisitions ( 3.6 million) as well as dividends to shareholders and minorities ( 32.3 million) out of operating cash flow ( 213.8 million) and a rise in net debt to banks by 100.1 million to 605.8 million. Net debt to banks corresponds to approximately 2.3 times (previous year: 2.0 times) our EBITDA. Our equity capital grew by 78.4 million (9.7%) to reach 889.3 million. The equity ratio rose from 39.1% to 41.5%. In our inpatient structures we continued our strategy successfully pursued in the past of achieving growth on the back of acquisitions and strong organic growth, and are also putting big emphasis on greater integration between outpatient and inpatient struc- tures. In organic growth we consistently and stead- fastly pursue quantitative and qualitative expansion and further development of our medical offerings at each of our Group sites. For this we are moreover increasingly availing ourselves of Group resources and medical performance networks. In external growth we continue to follow our dual strategy of "competence and reliability in acquisitions" as well as "quality before quantity". The precondition for any commitment and employment of our financial resources in future acquisitions is to have both a defined scope of entrepreneurial freedom and purchase prices giving us the certainty of being able to recoup the capital invested within reasonable periods. In 2009 our revenues ­ excluding additional acquisitions ­ will result in organic growth by roughly 6% on the back of rising case numbers and the greater severity of cases. We expect revenues of 2.3 billion and a net consolidated profit of roughly 130 million which, given the current remuneration and wage situation that cannot yet be gauged conclusively, can fluctuate within a range of 125 million to 135 million. ECONOMIC AND LEGAL ENVIRONMENT macroeconomic trend The year 2008 will go down in history as the year of the global financial markets crisis. In the US, risky speculative real estate transactions and their securitisation triggered credit rating and liquidity problems with US mortgage lenders when it turned out that debtors were no longer able to meet their obligations and the securitised papers were found to be worthless. Since such "subprime" securities were issued worldwide, the loss in value infected the international financial markets. The global write- down requirement that ensued led to a loss of trust, especially within the banking sector, and thus to an ­ at time complete ­ collapse in interbank trading, the contraction of the capital markets and lastly to difficulties in supplying the economy with liquidity. This was followed by domino effects and chain reactions on the stock markets as investors fled risky securities and later also safe ones. All over the world, governments launched rescue packages and umbrella schemes to preserve systemic banks and credit institutions, but these were unable to prevent the financial markets crisis from spreading to the real economies of the world's most important economic regions. A slump in economic activity and the first recessionary trends could not be stopped. Germany did not escape these developments. To prevent the worst impacts, all major nations have launched economic stimulus programmes on a hitherto unprecedented scale. economic and legal environment management report Sylvia Schäfer, Krankenhaus Waltershausen-Friedrichroda "The whole hospital is always friendly. The concerns of patients are taken seriously by the doctors. You have the feeling of being well cared for. "