Delaware | 51-0354549 | |
(State of incorporation) | (I.R.S. Employer Identification No.) |
Large accelerated filer | ☒ | Accelerated filer | ☐ |
Non-accelerated filer | ☐ (Do not check if a smaller reporting company) | Smaller reporting company | ☐ |
Emerging growth company | ☐ |
Page No. | ||||
PART I. FINANCIAL INFORMATION | ||||
Item 1. | ||||
Item 2. | ||||
Item 3. | ||||
Item 4. | ||||
PART II. OTHER INFORMATION | ||||
Item 1. | ||||
Item 1A. | ||||
Item 2. | ||||
Item 6. | ||||
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
Dialysis and related lab patient service revenues | $ | 2,591,074 | $ | 2,422,786 | |||
Provision for uncollectible accounts | 25,545 | (107,058 | ) | ||||
Net dialysis and related lab patient service revenues | 2,616,619 | 2,315,728 | |||||
Other revenues | 232,825 | 315,523 | |||||
Total revenues | 2,849,444 | 2,631,251 | |||||
Operating expenses and charges: | |||||||
Patient care costs and other costs | 2,035,585 | 1,852,045 | |||||
General and administrative | 266,529 | 262,895 | |||||
Depreciation and amortization | 142,799 | 132,884 | |||||
Equity investment income | (155 | ) | (677 | ) | |||
Provision for uncollectible accounts | (6,000 | ) | 1,910 | ||||
Investment and other asset impairments | — | 15,168 | |||||
Goodwill impairment charges | — | 24,198 | |||||
Gain on changes in ownership interests | — | (6,273 | ) | ||||
Gain on settlement, net | — | (526,827 | ) | ||||
Total operating expenses and charges | 2,438,758 | 1,755,323 | |||||
Operating income | 410,686 | 875,928 | |||||
Debt expense | (113,516 | ) | (104,397 | ) | |||
Other income, net | 4,582 | 3,986 | |||||
Income from continuing operations before income taxes | 301,752 | 775,517 | |||||
Income tax expense | 70,737 | 281,665 | |||||
Net income from continuing operations | 231,015 | 493,852 | |||||
Net (loss) income from discontinued operations, net of tax | (5,786 | ) | 6,433 | ||||
Net income | 225,229 | 500,285 | |||||
Less: Net income attributable to noncontrolling interests | (46,543 | ) | (52,588 | ) | |||
Net income attributable to DaVita Inc. | $ | 178,686 | $ | 447,697 | |||
Earnings per share: | |||||||
Basic net income from continuing operations per share attributable to DaVita Inc. | $ | 1.07 | $ | 2.29 | |||
Basic net income per share attributable to DaVita Inc. | $ | 1.00 | $ | 2.33 | |||
Diluted net income from continuing operations per share attributable to DaVita Inc. | $ | 1.05 | $ | 2.26 | |||
Diluted net income per share attributable to DaVita Inc. | $ | 0.98 | $ | 2.29 | |||
Weighted average shares for earnings per share: | |||||||
Basic | 178,957,865 | 192,376,735 | |||||
Diluted | 181,834,547 | 195,281,014 | |||||
Amounts attributable to DaVita Inc.: | |||||||
Net income from continuing operations | $ | 191,015 | $ | 440,905 | |||
Net (loss) income from discontinued operations | (12,329 | ) | 6,792 | ||||
Net income attributable to DaVita Inc. | $ | 178,686 | $ | 447,697 |
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
Net income | $ | 225,229 | $ | 500,285 | |||
Other comprehensive income, net of tax: | |||||||
Unrealized gains (losses) on interest rate cap agreements: | |||||||
Unrealized gains (losses) on interest rate cap agreements | 1,050 | (3,188 | ) | ||||
Reclassifications of net realized losses on interest rate cap agreements into net income | 1,537 | 1,265 | |||||
Unrealized gains on investments: | |||||||
Unrealized gains on investments | — | 1,557 | |||||
Reclassification of net investment realized gains into net income | — | (140 | ) | ||||
Unrealized gains on foreign currency translation: | |||||||
Foreign currency translation adjustments | 19,881 | 13,261 | |||||
Other comprehensive income | 22,468 | 12,755 | |||||
Total comprehensive income | 247,697 | 513,040 | |||||
Less: Comprehensive income attributable to noncontrolling interests | (46,543 | ) | (52,586 | ) | |||
Comprehensive income attributable to DaVita Inc. | $ | 201,154 | $ | 460,454 |
March 31, 2018 | December 31, 2017 | ||||||
ASSETS | |||||||
Cash and cash equivalents | $ | 358,874 | $ | 508,234 | |||
Restricted cash and equivalents | 88,744 | 10,686 | |||||
Short-term investments | 4,602 | 32,830 | |||||
Accounts receivable, net | 1,830,590 | 1,714,750 | |||||
Inventories | 125,555 | 181,799 | |||||
Other receivables | 415,914 | 372,919 | |||||
Income tax receivable | 18,660 | 49,440 | |||||
Prepaid and other current assets | 106,351 | 112,058 | |||||
Current assets held for sale | 5,724,265 | 5,761,642 | |||||
Total current assets | 8,673,555 | 8,744,358 | |||||
Property and equipment, net of accumulated depreciation of $3,230,717 and $3,103,662 | 3,185,223 | 3,149,213 | |||||
Intangible assets, net of accumulated amortization of $360,828 and $356,774 | 113,366 | 113,827 | |||||
Equity method and other investments | 245,564 | 245,534 | |||||
Long-term investments | 34,344 | 37,695 | |||||
Other long-term assets | 51,728 | 47,287 | |||||
Goodwill | 6,638,592 | 6,610,279 | |||||
$ | 18,942,372 | $ | 18,948,193 | ||||
LIABILITIES AND EQUITY | |||||||
Accounts payable | $ | 437,733 | $ | 509,116 | |||
Other liabilities | 544,846 | 552,662 | |||||
Accrued compensation and benefits | 526,183 | 616,116 | |||||
Current portion of long-term debt | 184,136 | 178,213 | |||||
Current liabilities held for sale | 1,254,625 | 1,185,070 | |||||
Total current liabilities | 2,947,523 | 3,041,177 | |||||
Long-term debt | 9,279,885 | 9,158,018 | |||||
Other long-term liabilities | 391,156 | 365,325 | |||||
Deferred income taxes | 507,226 | 486,247 | |||||
Total liabilities | 13,125,790 | 13,050,767 | |||||
Commitments and contingencies: | |||||||
Noncontrolling interests subject to put provisions | 1,034,501 | 1,011,360 | |||||
Equity: | |||||||
Preferred stock ($0.001 par value, 5,000,000 shares authorized; none issued) | |||||||
Common stock ($0.001 par value, 450,000,000 shares authorized; 182,660,712 and 182,462,278 shares issued and 178,463,408 and 182,462,278 shares outstanding, respectively) | 183 | 182 | |||||
Additional paid-in capital | 1,030,772 | 1,042,899 | |||||
Retained earnings | 3,820,767 | 3,633,713 | |||||
Treasury stock (4,197,304 and zero shares, respectively) | (298,377 | ) | — | ||||
Accumulated other comprehensive income | 27,335 | 13,235 | |||||
Total DaVita Inc. shareholders' equity | 4,580,680 | 4,690,029 | |||||
Noncontrolling interests not subject to put provisions | 201,401 | 196,037 | |||||
Total equity | 4,782,081 | 4,886,066 | |||||
$ | 18,942,372 | $ | 18,948,193 |
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
Cash flows from operating activities: | |||||||
Net income | $ | 225,229 | $ | 500,285 | |||
Adjustments to reconcile net income to net cash provided by operating activities: | |||||||
Depreciation and amortization | 142,799 | 190,206 | |||||
Impairment charges | — | 39,366 | |||||
Stock-based compensation expense | 9,685 | 9,601 | |||||
Deferred income taxes | 43,617 | 20,091 | |||||
Equity investment income, net | 3,564 | 1,423 | |||||
Other non-cash charges, net | 9,959 | 9,464 | |||||
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures: | |||||||
Accounts receivable | (63,701 | ) | 16,168 | ||||
Inventories | 57,621 | (8,909 | ) | ||||
Other receivables and other current assets | (34,120 | ) | (84,511 | ) | |||
Other long-term assets | 2,054 | (2,310 | ) | ||||
Accounts payable | (62,830 | ) | (26,214 | ) | |||
Accrued compensation and benefits | (62,550 | ) | (62,825 | ) | |||
Other current liabilities | 49,379 | (9,633 | ) | ||||
Income taxes | 30,772 | 258,490 | |||||
Other long-term liabilities | 11,061 | 14,479 | |||||
Net cash provided by operating activities | 362,539 | 865,171 | |||||
Cash flows from investing activities: | |||||||
Additions of property and equipment | (232,443 | ) | (214,535 | ) | |||
Acquisitions | (16,582 | ) | (77,236 | ) | |||
Proceeds from asset and business sales | 18,535 | 46,612 | |||||
Purchase of investments available for sale | (2,646 | ) | (2,358 | ) | |||
Purchase of investments held-to-maturity | (3,586 | ) | (121,645 | ) | |||
Proceeds from sale of investments available for sale | 5,151 | 4,025 | |||||
Proceeds from investments held-to-maturity | 31,454 | 116,285 | |||||
Purchase of equity investments | (2,476 | ) | (1,135 | ) | |||
Distributions received on equity investments | 2,465 | — | |||||
Net cash used in investing activities | (200,128 | ) | (249,987 | ) |
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
Cash flows from financing activities: | |||||||
Borrowings | 13,306,898 | 12,803,015 | |||||
Payments on long-term debt and other financing costs | (13,202,225 | ) | (12,839,156 | ) | |||
Purchase of treasury stock | (290,377 | ) | — | ||||
Stock award exercises and other share issuances, net | (1,185 | ) | 3,330 | ||||
Distributions to noncontrolling interests | (45,467 | ) | (43,316 | ) | |||
Contributions from noncontrolling interests | 12,009 | 17,989 | |||||
Purchases of noncontrolling interests | (2,200 | ) | (799 | ) | |||
Net cash used in financing activities | (222,547 | ) | (58,937 | ) | |||
Effect of exchange rate changes on cash, cash equivalents and restricted cash | 6,668 | 2,820 | |||||
Net (decrease) increase in cash, cash equivalents and restricted cash | (53,468 | ) | 559,067 | ||||
Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations | 17,834 | 24,493 | |||||
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations | (71,302 | ) | 534,574 | ||||
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 518,920 | 683,463 | |||||
Cash, cash equivalents and restricted cash of continuing operations at end of the period | $ | 447,618 | $ | 1,218,037 |
Non- controlling interests subject to put provisions | DaVita Inc. Shareholders’ Equity | Non- controlling interests not subject to put provisions | |||||||||||||||||||||||||||||||||||
Additional paid-in capital | Accumulated other comprehensive (loss) income | ||||||||||||||||||||||||||||||||||||
Common stock | Retained earnings | Treasury stock | |||||||||||||||||||||||||||||||||||
Shares | Amount | Shares | Amount | Total | |||||||||||||||||||||||||||||||||
December 31, 2016 | $ | 973,258 | 194,554 | $ | 195 | $ | 1,027,182 | $ | 3,710,313 | — | $ | — | $ | (89,643 | ) | $ | 4,648,047 | $ | 201,694 | ||||||||||||||||||
Comprehensive income: | |||||||||||||||||||||||||||||||||||||
Net income | 103,641 | 663,618 | 663,618 | 63,296 | |||||||||||||||||||||||||||||||||
Other comprehensive income | 102,878 | 102,878 | (2 | ) | |||||||||||||||||||||||||||||||||
Stock purchase shares issued | 360 | 22,131 | 22,131 | ||||||||||||||||||||||||||||||||||
Stock unit shares issued | 117 | (101 | ) | (101 | ) | ||||||||||||||||||||||||||||||||
Stock-settled SAR shares issued | 398 | — | — | ||||||||||||||||||||||||||||||||||
Stock-settled stock-based compensation expense | 34,981 | 34,981 | |||||||||||||||||||||||||||||||||||
Changes in noncontrolling interest from: | |||||||||||||||||||||||||||||||||||||
Distributions | (128,853 | ) | (82,614 | ) | |||||||||||||||||||||||||||||||||
Contributions | 52,911 | 21,641 | |||||||||||||||||||||||||||||||||||
Acquisitions and divestitures | 43,799 | (823 | ) | (823 | ) | (5,770 | ) | ||||||||||||||||||||||||||||||
Partial purchases | (397 | ) | (2,752 | ) | (2,752 | ) | (2,208 | ) | |||||||||||||||||||||||||||||
Fair value remeasurements | (32,999 | ) | 32,999 | 32,999 | |||||||||||||||||||||||||||||||||
Purchase of treasury stock | (12,967 | ) | (810,949 | ) | (810,949 | ) | |||||||||||||||||||||||||||||||
Retirement of treasury stock | (12,967 | ) | (13 | ) | (70,718 | ) | (740,218 | ) | 12,967 | 810,949 | — | ||||||||||||||||||||||||||
Balance at December 31, 2017 | $ | 1,011,360 | 182,462 | $ | 182 | $ | 1,042,899 | $ | 3,633,713 | — | $ | — | $ | 13,235 | $ | 4,690,029 | $ | 196,037 | |||||||||||||||||||
Cumulative effect of change in accounting principle | 8,368 | (8,368 | ) | — | |||||||||||||||||||||||||||||||||
Comprehensive income: | |||||||||||||||||||||||||||||||||||||
Net income | 24,107 | 178,686 | 178,686 | 22,436 | |||||||||||||||||||||||||||||||||
Other comprehensive income | 22,468 | 22,468 | |||||||||||||||||||||||||||||||||||
Stock unit shares issued | 4 | ||||||||||||||||||||||||||||||||||||
Stock-settled SAR shares issued | 195 | 1 | (4,887 | ) | (4,886 | ) | |||||||||||||||||||||||||||||||
Stock-settled stock-based compensation expense | 9,682 | 9,682 | |||||||||||||||||||||||||||||||||||
Changes in noncontrolling interest from: | |||||||||||||||||||||||||||||||||||||
Distributions | (26,166 | ) | (19,301 | ) | |||||||||||||||||||||||||||||||||
Contributions | 9,508 | 2,501 | |||||||||||||||||||||||||||||||||||
Acquisitions and divestitures | 688 | 76 | 76 | (66 | ) | ||||||||||||||||||||||||||||||||
Partial purchases | (1,994 | ) | (1,994 | ) | (206 | ) | |||||||||||||||||||||||||||||||
Fair value remeasurements | 15,004 | (15,004 | ) | (15,004 | ) | ||||||||||||||||||||||||||||||||
Purchase of treasury stock | (4,197 | ) | (298,377 | ) | (298,377 | ) | |||||||||||||||||||||||||||||||
Balance at March 31, 2018 | $ | 1,034,501 | 182,661 | $ | 183 | $ | 1,030,772 | $ | 3,820,767 | (4,197 | ) | $ | (298,377 | ) | $ | 27,335 | $ | 4,580,680 | $ | 201,401 |
1. | Condensed consolidated interim financial statements |
2. | Revenue recognition |
For the three months ended | |||||||||||||||||||||||
March 31, 2018 | March 31, 2017(1) | ||||||||||||||||||||||
U.S. dialysis and related lab services | Other - Ancillary services and strategic initiatives | Consolidated | U.S. dialysis and related lab services | Other - Ancillary services and strategic initiatives | Consolidated | ||||||||||||||||||
Patient service revenues: | |||||||||||||||||||||||
Medicare and Medicare Advantage | $ | 1,485,192 | $ | — | $ | 1,485,192 | $ | 1,272,595 | $ | — | $ | 1,272,595 | |||||||||||
Medicaid and Managed Medicaid | 157,496 | — | 157,496 | 144,585 | — | 144,585 | |||||||||||||||||
Other government | 107,119 | 82,537 | 189,656 | 91,993 | 47,761 | 139,754 | |||||||||||||||||
Commercial | 782,979 | 19,718 | 802,697 | 756,710 | 13,883 | 770,593 | |||||||||||||||||
Other revenues: | |||||||||||||||||||||||
Medicare and Medicare Advantage | — | 142,758 | 142,758 | — | 225,203 | 225,203 | |||||||||||||||||
Medicaid and Managed Medicaid | — | 15,791 | 15,791 | — | 18,595 | 18,595 | |||||||||||||||||
Commercial | — | 40,420 | 40,420 | — | 25,207 | 25,207 | |||||||||||||||||
Other(2) | 5,114 | 38,941 | 44,055 | 5,311 | 47,576 | 52,887 | |||||||||||||||||
Eliminations of intersegment revenues | (18,422 | ) | (10,199 | ) | (28,621 | ) | (11,799 | ) | (6,369 | ) | (18,168 | ) | |||||||||||
Total | $ | 2,519,478 | $ | 329,966 | $ | 2,849,444 | $ | 2,259,395 | $ | 371,856 | $ | 2,631,251 |
(1) | As noted above, prior period amounts have not been adjusted under the cumulative effect method. The Company's dialysis and related lab services revenues for the three months ended March 31, 2017 has been presented net of the provision for uncollectible accounts of $107,058 in this table to conform to the current period presentation. |
(2) | Other consists of management fees and revenue from the Company's ancillary services and strategic initiatives. |
3. | Earnings per share |
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
Numerators: | |||||||
Net income from continuing operations attributable to DaVita Inc. | $ | 191,015 | $ | 440,905 | |||
Net (loss) income from discontinued operations attributable to DaVita Inc. | (12,329 | ) | 6,792 | ||||
Net income attributable to DaVita Inc. for basic earnings per share calculation | $ | 178,686 | $ | 447,697 | |||
Basic: | |||||||
Weighted average shares outstanding during the period | 181,152 | 194,571 | |||||
Contingently returnable shares held in escrow for the DaVita HealthCare Partners merger | (2,194 | ) | (2,194 | ) | |||
Weighted average shares for basic earnings per share calculation | 178,958 | 192,377 | |||||
Basic net income from continuing operations per share attributable to DaVita Inc. | $ | 1.07 | $ | 2.29 | |||
Basic net (loss) income from discontinued operations per share attributable to DaVita Inc. | (0.07 | ) | 0.04 | ||||
Basic net income per share attributable to DaVita Inc. | $ | 1.00 | $ | 2.33 | |||
Diluted: | |||||||
Weighted average shares outstanding during the period | 181,152 | 194,571 | |||||
Assumed incremental shares from stock plans | 683 | 710 | |||||
Weighted average shares for diluted earnings per share calculation | 181,835 | 195,281 | |||||
Diluted net income from continuing operations per share attributable to DaVita Inc. | $ | 1.05 | $ | 2.26 | |||
Diluted net (loss) income from discontinued operations per share attributable to DaVita Inc. | (0.07 | ) | 0.03 | ||||
Diluted net income per share attributable to DaVita Inc. | $ | 0.98 | $ | 2.29 | |||
Anti-dilutive stock-settled awards excluded from calculation(1) | 3,453 | 3,427 |
(1) | Shares associated with stock-settled stock appreciation rights excluded from the diluted denominator calculation because they are antidilutive under the treasury stock method. |
4. | Restricted cash and equivalents |
5. | Short-term and long-term investments |
March 31, 2018 | December 31, 2017 | ||||||||||||||||||||||
Debt securities | Equity securities | Total | Debt securities | Equity securities | Total | ||||||||||||||||||
Certificates of deposit and other time deposits | $ | 3,402 | $ | — | $ | 3,402 | $ | 31,630 | $ | — | $ | 31,630 | |||||||||||
Investments in mutual funds and common stock | — | 35,544 | 35,544 | — | 38,895 | 38,895 | |||||||||||||||||
$ | 3,402 | $ | 35,544 | $ | 38,946 | $ | 31,630 | $ | 38,895 | $ | 70,525 | ||||||||||||
Short-term investments | $ | 3,402 | $ | 1,200 | $ | 4,602 | $ | 31,630 | $ | 1,200 | $ | 32,830 | |||||||||||
Long-term investments | — | 34,344 | 34,344 | — | 37,695 | 37,695 | |||||||||||||||||
$ | 3,402 | $ | 35,544 | $ | 38,946 | $ | 31,630 | $ | 38,895 | $ | 70,525 |
6. | Equity method and other investments |
7. | Goodwill |
U.S. dialysis and related lab services | Other-ancillary services and strategic initiatives | Consolidated total | |||||||||
Balance at January 1, 2017 | $ | 5,691,587 | $ | 323,788 | $ | 6,015,375 | |||||
Acquisitions | 485,434 | 131,598 | 617,032 | ||||||||
Divestitures | (32,260 | ) | (126 | ) | (32,386 | ) | |||||
Goodwill impairment charges | — | (36,196 | ) | (36,196 | ) | ||||||
Foreign currency and other adjustments | — | 46,454 | 46,454 | ||||||||
Balance at December 31, 2017 | $ | 6,144,761 | $ | 465,518 | $ | 6,610,279 | |||||
Acquisitions | 2,137 | 13,905 | 16,042 | ||||||||
Foreign currency and other adjustments | — | 12,271 | 12,271 | ||||||||
Balance at March 31, 2018 | $ | 6,146,898 | $ | 491,694 | $ | 6,638,592 | |||||
Balance at March 31, 2018: | |||||||||||
Goodwill | $ | 6,146,898 | $ | 562,214 | $ | 6,709,112 | |||||
Accumulated impairment charges | — | (70,520 | ) | (70,520 | ) | ||||||
$ | 6,146,898 | $ | 491,694 | $ | 6,638,592 |
Goodwill balance as of March 31, 2018 | Carrying amount coverage(1) | Sensitivities | |||||||||||
Reporting unit | Operating income(2) | Discount rate(3) | |||||||||||
Kidney Care Germany | $ | 337,619 | 13.7 | % | (1.6 | )% | (11.1 | )% | |||||
Kidney Care Portugal | $ | 48,066 | 16.9 | % | (1.9 | )% | (6.0 | )% | |||||
Kidney Care Poland | $ | 47,669 | 11.8 | % | (1.9 | )% | (6.0 | )% |
(1) | Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date. |
(2) | Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date. |
(3) | Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date. |
8. | Income taxes |
9. | Long-term debt |
March 31, 2018 | December 31, 2017 | ||||||
Senior secured credit facilities: | |||||||
Term Loan A | $ | 750,000 | $ | 775,000 | |||
Term Loan A-2 | 452,000 | — | |||||
Term Loan B | 3,368,750 | 3,377,500 | |||||
Revolver | — | 300,000 | |||||
Senior notes | 4,500,000 | 4,500,000 | |||||
Acquisition obligations and other notes payable | 151,167 | 150,512 | |||||
Capital lease obligations | 304,062 | 297,170 | |||||
Total debt principal outstanding | 9,525,979 | 9,400,182 | |||||
Discount and deferred financing costs | (61,958 | ) | (63,951 | ) | |||
9,464,021 | 9,336,231 | ||||||
Less current portion | (184,136 | ) | (178,213 | ) | |||
$ | 9,279,885 | $ | 9,158,018 |
2018 (remainder of the year) | 136,885 | |
2019 | 1,206,668 | |
2020 | 72,608 | |
2021 | 3,307,539 | |
2022 | 1,283,255 | |
2023 | 32,340 | |
Thereafter | 3,486,684 |
March 31, 2018 | December 31, 2017 | |||||||||||
Derivatives designated as hedging instruments | Balance sheet location | Fair value | Balance sheet location | Fair value | ||||||||
Interest rate cap agreements | Other long-term assets | $ | 2,446 | Other long-term assets | $ | 1,032 |
Amount of unrecognized gains (losses) in OCI on interest rate cap agreements | Location of losses reclassified from accumulated OCI into income | Amount of losses reclassified from accumulated OCI into income | |||||||||||||||
Three months ended March 31, | Three months ended March 31, | ||||||||||||||||
Derivatives designated as cash flow hedges | 2018 | 2017 | 2018 | 2017 | |||||||||||||
Interest rate cap agreements | $ | 1,414 | $ | (5,217 | ) | Debt expense | $ | 2,070 | $ | 2,070 | |||||||
Tax (benefit) expense | (364 | ) | 2,029 | Tax expense | (533 | ) | (805 | ) | |||||||||
Total | $ | 1,050 | $ | (3,188 | ) | $ | 1,537 | $ | 1,265 |
10. | Contingencies |
11. | Noncontrolling interests subject to put provisions and other commitments |
12. | Long-term incentive compensation |
13. | Share repurchases |
For the three months ended March 31, 2018 | For the three months ended March 31, 2017 | ||||||||||||||||||||||||||||||
Interest rate cap agreements | Investment securities | Foreign currency translation adjustments | Accumulated other comprehensive income (loss) | Interest rate cap agreements | Investment securities | Foreign currency translation adjustments | Accumulated other comprehensive (loss) income | ||||||||||||||||||||||||
Beginning balance | $ | (12,408 | ) | $ | 5,662 | $ | 19,981 | $ | 13,235 | $ | (12,029 | ) | $ | 2,175 | $ | (79,789 | ) | $ | (89,643 | ) | |||||||||||
Cumulative effect of change in accounting principle(1) | (2,706 | ) | (5,662 | ) | — | (8,368 | ) | — | — | — | — | ||||||||||||||||||||
Unrealized gains (losses) | 1,414 | — | 19,881 | 21,295 | (5,217 | ) | 2,113 | 13,261 | 10,157 | ||||||||||||||||||||||
Related income tax (expense) benefit | (364 | ) | — | — | (364 | ) | 2,029 | (554 | ) | — | 1,475 | ||||||||||||||||||||
1,050 | — | 19,881 | 20,931 | (3,188 | ) | 1,559 | 13,261 | 11,632 | |||||||||||||||||||||||
Reclassification from accumulated other comprehensive income into net income | 2,070 | — | — | 2,070 | 2,070 | (229 | ) | — | 1,841 | ||||||||||||||||||||||
Related income tax (expense) benefit | (533 | ) | — | — | (533 | ) | (805 | ) | 89 | — | (716 | ) | |||||||||||||||||||
1,537 | — | — | 1,537 | 1,265 | (140 | ) | — | 1,125 | |||||||||||||||||||||||
Ending balance | $ | (12,527 | ) | $ | — | $ | 39,862 | $ | 27,335 | $ | (13,952 | ) | $ | 3,594 | $ | (66,528 | ) | $ | (76,886 | ) |
(1) | Reflects the cumulative effect of a change in accounting principle for ASUs 2016-01 and 2018-03 on classification and measurement of financial instruments and ASU 2018-02 on remeasurement and reclassification of deferred tax effects in accumulated other comprehensive income associated with the 2017 Tax Act. |
15. | Acquisitions and divestitures |
Current assets | $ | 1,572 | |
Property and equipment | 1,643 | ||
Amortizable intangible and other long-term assets | 2,563 | ||
Goodwill | 16,042 | ||
Current liabilities | (2,392 | ) | |
Noncontrolling interests | (688 | ) | |
$ | 18,740 |
For the three months ended March 31, 2018 | |||
Beginning balance | $ | 6,388 | |
Remeasurement of fair value for contingent earn-out obligations | 174 | ||
Ending balance | $ | 6,562 |
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
Revenues | $ | 1,227,932 | $ | 1,086,985 | |||
Expenses | 1,226,407 | 1,074,452 | |||||
Income from discontinued operations before taxes | 1,525 | 12,533 | |||||
Income tax expense | 7,311 | 6,100 | |||||
Net (loss) income from discontinued operations, net of tax | $ | (5,786 | ) | $ | 6,433 |
March 31, 2018 | December 31, 2017 | ||||||
Assets | |||||||
Cash and cash equivalents | 192,399 | 179,668 | |||||
Other current assets | 768,388 | 826,608 | |||||
Property and equipment, net | 410,127 | 379,945 | |||||
Intangible assets, net | 1,316,462 | 1,316,550 | |||||
Other long-term assets | 155,385 | 178,894 | |||||
Goodwill | 2,881,504 | 2,879,977 | |||||
Total current assets held for sale | $ | 5,724,265 | $ | 5,761,642 | |||
Liabilities | |||||||
Other liabilities | 529,354 | 505,734 | |||||
Medical payables | 505,872 | 457,040 | |||||
Current portion of long-term debt | 2,735 | 2,845 | |||||
Long-term debt | 34,541 | 35,003 | |||||
Other long-term liabilities | 182,123 | 184,448 | |||||
Total current liabilities held for sale | $ | 1,254,625 | $ | 1,185,070 |
March 31, 2018 | March 31, 2017 | ||||
Net cash provided by operating activities from discontinued operations | 156,248 | 95,585 | |||
Net cash used in investing activities from discontinued operations | (33,068 | ) | (41,686 | ) |
17. | Variable interest entities |
18. | Fair values of financial instruments |
Total | Quoted prices in active markets for identical assets (Level 1) | Significant other observable inputs (Level 2) | Significant unobservable inputs (Level 3) | ||||||||||||
Assets | |||||||||||||||
Investments in mutual funds and common stock | $ | 35,544 | $ | 35,544 | $ | — | $ | — | |||||||
Interest rate cap agreements | $ | 2,446 | $ | — | $ | 2,446 | $ | — | |||||||
Liabilities | |||||||||||||||
Contingent earn-out obligations | $ | 6,562 | $ | — | $ | — | $ | 6,562 | |||||||
Temporary equity | |||||||||||||||
Noncontrolling interests subject to put provisions | $ | 1,034,501 | $ | — | $ | — | $ | 1,034,501 |
19. | Segment reporting |
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
Segment net revenues: | |||||||
U.S. dialysis and related lab services | |||||||
Patient service revenues: | |||||||
External sources | $ | 2,489,165 | $ | 2,360,861 | |||
Intersegment revenues | 18,422 | 11,799 | |||||
U.S. dialysis and related lab services patient service revenues | 2,507,587 | 2,372,660 | |||||
Provision for uncollectible accounts | 25,199 | (106,777 | ) | ||||
Net U.S. dialysis and related lab services patient service revenues | 2,532,786 | 2,265,883 | |||||
Other revenues(1) | 5,114 | 5,311 | |||||
Total U.S. dialysis and related lab services revenues | 2,537,900 | 2,271,194 | |||||
Other—Ancillary services and strategic initiatives | |||||||
Patient service revenues | 102,255 | 61,644 | |||||
Other external sources | 227,711 | 310,212 | |||||
Intersegment revenues | 10,199 | 6,369 | |||||
Total ancillary services and strategic initiatives revenues | 340,165 | 378,225 | |||||
Total net segment revenues | 2,878,065 | 2,649,419 | |||||
Elimination of intersegment revenues | (28,621 | ) | (18,168 | ) | |||
Consolidated revenues | $ | 2,849,444 | $ | 2,631,251 | |||
Segment operating margin: | |||||||
U.S. dialysis and related lab services | $ | 433,380 | $ | 944,740 | |||
Other—Ancillary services and strategic initiatives | (6,990 | ) | (58,220 | ) | |||
Total segment operating margin | 426,390 | 886,520 | |||||
Reconciliation of segment operating margin to consolidated income before income taxes: | |||||||
Corporate administrative support | (15,704 | ) | (10,592 | ) | |||
Consolidated operating income | 410,686 | 875,928 | |||||
Debt expense | (113,516 | ) | (104,397 | ) | |||
Other income, net | 4,582 | 3,986 | |||||
Consolidated income before income taxes | $ | 301,752 | $ | 775,517 |
(1) | Includes management fees for providing management and administrative services to dialysis centers that are wholly-owned by third parties and legal entities in which the Company owns a noncontrolling equity investment. |
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
U.S. dialysis and related lab services | $ | 134,776 | $ | 125,029 | |||
Other—Ancillary services and strategic initiatives | 8,023 | 7,855 | |||||
$ | 142,799 | $ | 132,884 |
March 31, 2018 | December 31, 2017 | ||||||
Segment assets | |||||||
U.S. dialysis and related lab services (including equity investments of $84,985 and $84,866, respectively) | $ | 11,798,202 | $ | 11,776,042 | |||
Other—Ancillary services and strategic initiatives (including equity investments of $160,579 and $160,668, respectively) | 1,419,905 | 1,410,509 | |||||
DMG—Held for sale (including equity investments of $11,642 and $10,321, respectively) | 5,724,265 | 5,761,642 | |||||
Consolidated assets | $ | 18,942,372 | $ | 18,948,193 |
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
U.S. dialysis and related lab services | $ | 189,049 | $ | 173,528 | |||
Other—Ancillary services and strategic initiatives | 12,345 | 13,219 | |||||
DMG—Held for sale | 31,049 | 27,788 | |||||
$ | 232,443 | $ | 214,535 |
20. | Changes in DaVita Inc.’s ownership interest in consolidated subsidiaries |
Three months ended March 31, | |||||||
2018 | 2017 | ||||||
Net income attributable to DaVita Inc. | $ | 178,686 | $ | 447,697 | |||
Changes in paid-in capital for: | |||||||
Sales of noncontrolling interests | 76 | — | |||||
Purchases of noncontrolling interests | (1,994 | ) | (423 | ) | |||
Net transfers to noncontrolling interests | (1,918 | ) | (423 | ) | |||
Net income attributable to DaVita Inc., net of transfers to noncontrolling interests | $ | 176,768 | $ | 447,274 |
21. | New accounting standards |
22. | Condensed consolidating financial statements |
DaVita Inc. | Guarantor subsidiaries | Non- Guarantor subsidiaries | Consolidating adjustments | Consolidated total | ||||||||||||||||
For The Three Months Ended March 31, 2018 | ||||||||||||||||||||
Patient services revenues | $ | — | $ | 1,790,188 | $ | 848,401 | $ | (47,515 | ) | $ | 2,591,074 | |||||||||
Provision for uncollectible accounts | — | 9,628 | 15,917 | — | 25,545 | |||||||||||||||
Net patient service revenues | — | 1,799,816 | 864,318 | (47,515 | ) | 2,616,619 | ||||||||||||||
Other revenues | 195,565 | 204,960 | 70,933 | (238,633 | ) | 232,825 | ||||||||||||||
Total net revenues | 195,565 | 2,004,776 | 935,251 | (286,148 | ) | 2,849,444 | ||||||||||||||
Operating expenses and charges | 133,356 | 1,791,094 | 800,456 | (286,148 | ) | 2,438,758 | ||||||||||||||
Operating income | 62,209 | 213,682 | 134,795 | — | 410,686 | |||||||||||||||
Debt expense | (114,334 | ) | (52,197 | ) | (7,375 | ) | 60,390 | (113,516 | ) | |||||||||||
Other income, net | 104,081 | 2,523 | 5,704 | (107,726 | ) | 4,582 | ||||||||||||||
Income tax expense | 14,387 | 48,944 | 7,406 | — | 70,737 | |||||||||||||||
Equity earnings in subsidiaries | 141,117 | 66,496 | — | (207,613 | ) | — | ||||||||||||||
Net income from continuing operations | 178,686 | 181,560 | 125,718 | (254,949 | ) | 231,015 | ||||||||||||||
Net (loss) income from discontinued operations, net of tax | — | (40,443 | ) | (12,679 | ) | 47,336 | (5,786 | ) | ||||||||||||
Net income | 178,686 | 141,117 | 113,039 | (207,613 | ) | 225,229 | ||||||||||||||
Less: Net income attributable to noncontrolling interests | — | — | — | (46,543 | ) | (46,543 | ) | |||||||||||||
Net income attributable to DaVita Inc. | $ | 178,686 | $ | 141,117 | $ | 113,039 | $ | (254,156 | ) | $ | 178,686 |
Guarantor subsidiaries | Non- Guarantor subsidiaries | Consolidating adjustments | Consolidated total | |||||||||||||||||
For The Three Months Ended March 31, 2017 | DaVita Inc. | |||||||||||||||||||
Patient service revenues | $ | — | $ | 1,530,726 | $ | 929,231 | $ | (37,171 | ) | $ | 2,422,786 | |||||||||
Provision for uncollectible accounts | — | (61,053 | ) | (46,005 | ) | — | (107,058 | ) | ||||||||||||
Net patient service revenues | — | 1,469,673 | 883,226 | (37,171 | ) | 2,315,728 | ||||||||||||||
Other revenues | 221,386 | 305,618 | 16,090 | (227,571 | ) | 315,523 | ||||||||||||||
Total net revenues | 221,386 | 1,775,291 | 899,316 | (264,742 | ) | 2,631,251 | ||||||||||||||
Operating expenses | 131,910 | 1,208,820 | 679,335 | (264,742 | ) | 1,755,323 | ||||||||||||||
Operating income | 89,476 | 566,471 | 219,981 | — | 875,928 | |||||||||||||||
Debt expense | (102,664 | ) | (47,643 | ) | (12,232 | ) | 58,142 | (104,397 | ) | |||||||||||
Other income | 100,337 | 2,803 | 3,586 | (102,740 | ) | 3,986 | ||||||||||||||
Income tax expense | 33,953 | 235,865 | 11,847 | — | 281,665 | |||||||||||||||
Equity earnings in subsidiaries | 394,501 | 162,615 | — | (557,116 | ) | — | ||||||||||||||
Net income from continuing operations | 447,697 | 448,381 | 199,488 | (601,714 | ) | 493,852 | ||||||||||||||
Net (loss) income from discontinued operations, net of tax | — | (53,880 | ) | 15,715 | 44,598 | 6,433 | ||||||||||||||
Net income | 447,697 | 394,501 | 215,203 | (557,116 | ) | 500,285 | ||||||||||||||
Less: Net income attributable to noncontrolling interests | — | — | — | (52,588 | ) | (52,588 | ) | |||||||||||||
Net income attributable to DaVita Inc. | $ | 447,697 | $ | 394,501 | $ | 215,203 | $ | (609,704 | ) | $ | 447,697 |
Guarantor subsidiaries | Non- Guarantor subsidiaries | Consolidating adjustments | Consolidated total | |||||||||||||||||
For The Three Months Ended March 31, 2018 | DaVita Inc. | |||||||||||||||||||
Net income | $ | 178,686 | $ | 141,117 | $ | 113,039 | $ | (207,613 | ) | $ | 225,229 | |||||||||
Other comprehensive income | 2,587 | — | 19,881 | — | 22,468 | |||||||||||||||
Total comprehensive income | 181,273 | 141,117 | 132,920 | (207,613 | ) | 247,697 | ||||||||||||||
Less: Comprehensive income attributable to noncontrolling interest | — | — | — | (46,543 | ) | (46,543 | ) | |||||||||||||
Comprehensive income attributable to DaVita Inc. | $ | 181,273 | $ | 141,117 | $ | 132,920 | $ | (254,156 | ) | $ | 201,154 |
Guarantor subsidiaries | Non- Guarantor subsidiaries | Consolidating adjustments | Consolidated total | |||||||||||||||||
For The Three Months Ended March 31, 2017 | DaVita Inc. | |||||||||||||||||||
Net income | $ | 447,697 | $ | 394,501 | $ | 215,203 | $ | (557,116 | ) | $ | 500,285 | |||||||||
Other comprehensive income | (506 | ) | — | 13,261 | — | 12,755 | ||||||||||||||
Total comprehensive income | 447,191 | 394,501 | 228,464 | (557,116 | ) | 513,040 | ||||||||||||||
Less: Comprehensive income attributable to the noncontrolling interests | — | — | — | (52,586 | ) | (52,586 | ) | |||||||||||||
Comprehensive income attributable to DaVita Inc. | $ | 447,191 | $ | 394,501 | $ | 228,464 | $ | (609,702 | ) | $ | 460,454 |
Guarantor subsidiaries | Non- Guarantor subsidiaries | Consolidating adjustments | Consolidated total | |||||||||||||||||
As of March 31, 2018 | DaVita Inc. | |||||||||||||||||||
Cash and cash equivalents | $ | 122,047 | $ | — | $ | 236,827 | $ | — | $ | 358,874 | ||||||||||
Restricted cash and equivalents | 1,003 | 9,421 | 78,320 | — | 88,744 | |||||||||||||||
Accounts receivable, net | — | 1,257,461 | 573,129 | — | 1,830,590 | |||||||||||||||
Other current assets | 35,555 | 368,131 | 267,396 | — | 671,082 | |||||||||||||||
Current assets held for sale | — | 5,004,717 | 719,548 | — | 5,724,265 | |||||||||||||||
Total current assets | 158,605 | 6,639,730 | 1,875,220 | — | 8,673,555 | |||||||||||||||
Property and equipment, net | 413,949 | 1,554,591 | 1,216,683 | — | 3,185,223 | |||||||||||||||
Intangible assets, net | 224 | 50,396 | 62,746 | — | 113,366 | |||||||||||||||
Investments in subsidiaries | 10,180,619 | 3,138,371 | — | (13,318,990 | ) | — | ||||||||||||||
Intercompany receivables | 3,593,688 | — | 1,488,211 | (5,081,899 | ) | — | ||||||||||||||
Other long-term assets and investments | 54,952 | 58,467 | 218,217 | — | 331,636 | |||||||||||||||
Goodwill | — | 4,730,205 | 1,908,387 | — | 6,638,592 | |||||||||||||||
Total assets | $ | 14,402,037 | $ | 16,171,760 | $ | 6,769,464 | $ | (18,400,889 | ) | $ | 18,942,372 | |||||||||
Current liabilities | $ | 247,486 | $ | 968,018 | $ | 477,394 | $ | — | $ | 1,692,898 | ||||||||||
Current liabilities held for sale | — | 759,020 | 495,605 | — | 1,254,625 | |||||||||||||||
Intercompany payables | — | 3,589,494 | 1,492,405 | (5,081,899 | ) | — | ||||||||||||||
Long-term debt and other long-term liabilities | 8,984,265 | 674,609 | 519,393 | — | 10,178,267 | |||||||||||||||
Noncontrolling interests subject to put provisions | 589,606 | — | — | 444,895 | 1,034,501 | |||||||||||||||
Total DaVita Inc. shareholders' equity | 4,580,680 | 10,180,619 | 3,138,371 | (13,318,990 | ) | 4,580,680 | ||||||||||||||
Noncontrolling interests not subject to put provisions | — | — | 646,296 | (444,895 | ) | 201,401 | ||||||||||||||
Total equity | 4,580,680 | 10,180,619 | 3,784,667 | (13,763,885 | ) | 4,782,081 | ||||||||||||||
Total liabilities and equity | $ | 14,402,037 | $ | 16,171,760 | $ | 6,769,464 | $ | (18,400,889 | ) | $ | 18,942,372 |
Guarantor subsidiaries | Non- Guarantor subsidiaries | Consolidating adjustments | Consolidated total | |||||||||||||||||
As of December 31, 2017 | DaVita Inc. | |||||||||||||||||||
Cash and cash equivalents | $ | 149,305 | $ | — | $ | 358,929 | $ | — | $ | 508,234 | ||||||||||
Restricted cash and equivalents | 1,002 | 9,384 | 300 | — | 10,686 | |||||||||||||||
Accounts receivable, net | — | 1,208,715 | 506,035 | — | 1,714,750 | |||||||||||||||
Other current assets | 67,025 | 595,066 | 86,955 | — | 749,046 | |||||||||||||||
Current assets held for sale | — | 4,992,067 | 769,575 | — | 5,761,642 | |||||||||||||||
Total current assets | 217,332 | 6,805,232 | 1,721,794 | — | 8,744,358 | |||||||||||||||
Property and equipment, net | 408,010 | 1,560,390 | 1,180,813 | — | 3,149,213 | |||||||||||||||
Intangible assets, net | 250 | 50,971 | 62,606 | — | 113,827 | |||||||||||||||
Investments in subsidiaries | 10,009,874 | 3,085,722 | — | (13,095,596 | ) | — | ||||||||||||||
Intercompany receivables | 3,677,947 | — | 1,313,213 | (4,991,160 | ) | — | ||||||||||||||
Other long-term assets and investments | 47,297 | 68,344 | 214,875 | — | 330,516 | |||||||||||||||
Goodwill | — | 4,732,320 | 1,877,959 | — | 6,610,279 | |||||||||||||||
Total assets | $ | 14,360,710 | $ | 16,302,979 | $ | 6,371,260 | $ | (18,086,756 | ) | $ | 18,948,193 | |||||||||
Current liabilities | $ | 238,706 | $ | 1,181,139 | $ | 436,262 | $ | — | $ | 1,856,107 | ||||||||||
Current liabilities held for sale | — | 739,294 | 445,776 | — | 1,185,070 | |||||||||||||||
Intercompany payables | — | 3,690,042 | 1,301,118 | (4,991,160 | ) | — | ||||||||||||||
Long-term debt and other long-term liabilities | 8,857,373 | 682,630 | 469,587 | — | 10,009,590 | |||||||||||||||
Noncontrolling interests subject to put provisions | 574,602 | — | — | 436,758 | 1,011,360 | |||||||||||||||
Total DaVita Inc. shareholders' equity | 4,690,029 | 10,009,874 | 3,085,722 | (13,095,596 | ) | 4,690,029 | ||||||||||||||
Noncontrolling interests not subject to put provisions | — | — | 632,795 | (436,758 | ) | 196,037 | ||||||||||||||
Total equity | 4,690,029 | 10,009,874 | 3,718,517 | (13,532,354 | ) | 4,886,066 | ||||||||||||||
Total liabilities and equity | $ | 14,360,710 | $ | 16,302,979 | $ | 6,371,260 | $ | (18,086,756 | ) | $ | 18,948,193 |
Guarantor subsidiaries | Non- Guarantor subsidiaries | Consolidating adjustments | Consolidated total | |||||||||||||||||
For The Three Months Ended March 31, 2018 | DaVita Inc. | |||||||||||||||||||
Cash flows from operating activities: | ||||||||||||||||||||
Net income | $ | 178,686 | $ | 141,117 | $ | 113,039 | $ | (207,613 | ) | $ | 225,229 | |||||||||
Changes in operating assets and liabilities and non-cash items included in net income | (82,391 | ) | 32,484 | (20,396 | ) | 207,613 | 137,310 | |||||||||||||
Net cash provided by operating activities | 96,295 | 173,601 | 92,643 | — | 362,539 | |||||||||||||||
Cash flows from investing activities: | ||||||||||||||||||||
Additions of property and equipment | (27,356 | ) | (125,375 | ) | (79,712 | ) | — | (232,443 | ) | |||||||||||
Acquisitions | — | (4,417 | ) | (12,165 | ) | — | (16,582 | ) | ||||||||||||
Proceeds from asset and business sales | — | 18,535 | — | — | 18,535 | |||||||||||||||
Proceeds (purchases) from investment sales and other items, net | 31,665 | (762 | ) | (541 | ) | — | 30,362 | |||||||||||||
Net cash provided by (used in) investing activities | 4,309 | (112,019 | ) | (92,418 | ) | — | (200,128 | ) | ||||||||||||
Cash flows from financing activities: | ||||||||||||||||||||
Long-term debt and related financing costs, net | 116,307 | (3,377 | ) | (8,257 | ) | — | 104,673 | |||||||||||||
Intercompany borrowing (payments) | 47,394 | (49,783 | ) | 2,389 | — | — | ||||||||||||||
Other items | (291,562 | ) | (2,200 | ) | (33,458 | ) | — | (327,220 | ) | |||||||||||
Net cash used in financing activities | (127,861 | ) | (55,360 | ) | (39,326 | ) | — | (222,547 | ) | |||||||||||
Effect of exchange rate changes on cash, cash equivalents and restricted cash | — | — | 6,668 | — | 6,668 | |||||||||||||||
Net (decrease) increase in cash, cash equivalents and restricted cash | (27,257 | ) | 6,222 | (32,433 | ) | — | (53,468 | ) | ||||||||||||
Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations | — | 6,185 | 11,649 | — | 17,834 | |||||||||||||||
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations | (27,257 | ) | 37 | (44,082 | ) | — | (71,302 | ) | ||||||||||||
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 150,307 | 9,384 | 359,229 | — | 518,920 | |||||||||||||||
Cash, cash equivalents and restricted cash of continuing operations at end of the period | $ | 123,050 | $ | 9,421 | $ | 315,147 | $ | — | $ | 447,618 |
Guarantor subsidiaries | Non- Guarantor subsidiaries | Consolidating adjustments | Consolidated total | |||||||||||||||||
For The Three Months Ended March 31, 2017 | DaVita Inc. | |||||||||||||||||||
Cash flows from operating activities: | ||||||||||||||||||||
Net income | $ | 447,697 | $ | 394,501 | $ | 215,203 | $ | (557,116 | ) | $ | 500,285 | |||||||||
Changes in operating assets and liabilities and non-cash items included in net income | (149,627 | ) | (142,597 | ) | 99,994 | 557,116 | 364,886 | |||||||||||||
Net cash provided by operating activities | 298,070 | 251,904 | 315,197 | — | 865,171 | |||||||||||||||
Cash flows from investing activities: | ||||||||||||||||||||
Additions of property and equipment | (30,580 | ) | (133,909 | ) | (50,046 | ) | — | (214,535 | ) | |||||||||||
Acquisitions | — | (70,237 | ) | (6,999 | ) | — | (77,236 | ) | ||||||||||||
Proceeds from asset and business sales, net of cash divested | — | 46,612 | — | — | 46,612 | |||||||||||||||
(Purchases) proceeds from investment sales and other items, net | (54,150 | ) | (1,951 | ) | 51,273 | — | (4,828 | ) | ||||||||||||
Net cash used in investing activities | (84,730 | ) | (159,485 | ) | (5,772 | ) | — | (249,987 | ) | |||||||||||
Cash flows from financing activities: | ||||||||||||||||||||
Long-term debt and related financing costs, net | (27,504 | ) | (4,616 | ) | (4,021 | ) | — | (36,141 | ) | |||||||||||
Intercompany borrowing (payments) | 338,984 | (71,541 | ) | (267,443 | ) | — | — | |||||||||||||
Other items | 3,330 | (799 | ) | (25,327 | ) | — | (22,796 | ) | ||||||||||||
Net cash used in financing activities | 314,810 | (76,956 | ) | (296,791 | ) | — | (58,937 | ) | ||||||||||||
Effect of exchange rate changes on cash, cash equivalents and restricted cash | — | — | 2,820 | — | 2,820 | |||||||||||||||
Net increase in cash, cash equivalents and restricted cash | 528,150 | 15,463 | 15,454 | — | 559,067 | |||||||||||||||
Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations | — | 15,438 | 9,055 | — | 24,493 | |||||||||||||||
Net increase in cash, cash equivalents and restricted cash from continuing operations | 528,150 | 25 | 6,399 | 534,574 | ||||||||||||||||
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 549,921 | 8,687 | 124,855 | — | 683,463 | |||||||||||||||
Cash, cash equivalents and restricted cash of continuing operations at end of the period | $ | 1,078,071 | $ | 8,712 | $ | 131,254 | $ | 1,218,037 |
23. | Supplemental data |
Consolidated Total | Physician Groups | Unrestricted Subsidiaries | Company and Restricted Subsidiaries(1) | |||||||||||||
For The Three Months Ended March 31, 2018 | ||||||||||||||||
Patient service operating revenues | $ | 2,591,074 | $ | — | $ | — | $ | 2,591,074 | ||||||||
Provision for uncollectible accounts | 25,545 | — | — | 25,545 | ||||||||||||
Net patient service operating revenues | 2,616,619 | — | — | 2,616,619 | ||||||||||||
Other revenues | 232,825 | — | — | 232,825 | ||||||||||||
Total net operating revenues | 2,849,444 | — | — | 2,849,444 | ||||||||||||
Operating expenses | 2,438,758 | — | — | 2,438,758 | ||||||||||||
Operating income | 410,686 | — | — | 410,686 | ||||||||||||
Debt expense, including refinancing charges | (113,516 | ) | — | — | (113,516 | ) | ||||||||||
Other income | 4,582 | — | — | 4,582 | ||||||||||||
Income tax expense | 70,737 | — | — | 70,737 | ||||||||||||
Net income from continuing operations | 231,015 | — | — | 231,015 | ||||||||||||
Net (loss) income from discontinued operations, net of tax | (5,786 | ) | 7,397 | 490 | (13,673 | ) | ||||||||||
Net income | 225,229 | 7,397 | 490 | 217,342 | ||||||||||||
Less: Net income attributable to noncontrolling interests | (46,543 | ) | (6,543 | ) | — | (40,000 | ) | |||||||||
Net income attributable to DaVita Inc. | $ | 178,686 | $ | 854 | $ | 490 | $ | 177,342 |
(1) | After elimination of the unrestricted subsidiaries and the physician groups. |
Consolidated Total | Physician Groups | Unrestricted Subsidiaries | Company and Restricted Subsidiaries(1) | |||||||||||||
For The Three Months Ended March 31, 2018 | ||||||||||||||||
Net income | $ | 225,229 | $ | 7,397 | $ | 490 | $ | 217,342 | ||||||||
Other comprehensive income | 22,468 | — | — | 22,468 | ||||||||||||
Total comprehensive income | 247,697 | 7,397 | 490 | 239,810 | ||||||||||||
Less: Comprehensive income attributable to the noncontrolling interests | (46,543 | ) | (6,543 | ) | — | (40,000 | ) | |||||||||
Comprehensive income attributable to DaVita Inc. | $ | 201,154 | $ | 854 | $ | 490 | $ | 199,810 |
(1) | After elimination of the unrestricted subsidiaries and the physician groups. |
Consolidated Total | Physician Groups | Unrestricted Subsidiaries | Company and Restricted Subsidiaries(1) | |||||||||||||
As of March 31, 2018 | ||||||||||||||||
Cash and cash equivalents | $ | 358,874 | $ | — | $ | — | $ | 358,874 | ||||||||
Restricted cash and equivalents | 88,744 | — | — | 88,744 | ||||||||||||
Accounts receivable, net | 1,830,590 | — | — | 1,830,590 | ||||||||||||
Other current assets | 671,082 | 133,199 | — | 537,883 | ||||||||||||
Current assets held for sale | 5,724,265 | 319,968 | 3,223 | 5,401,074 | ||||||||||||
Total current assets | 8,673,555 | 453,167 | 3,223 | 8,217,165 | ||||||||||||
Property and equipment, net | 3,185,223 | — | — | 3,185,223 | ||||||||||||
Amortizable intangibles, net | 113,366 | — | — | 113,366 | ||||||||||||
Other long-term assets | 331,636 | — | — | 331,636 | ||||||||||||
Goodwill | 6,638,592 | — | — | 6,638,592 | ||||||||||||
Total assets | $ | 18,942,372 | $ | 453,167 | $ | 3,223 | $ | 18,485,982 | ||||||||
Current liabilities | $ | 1,692,898 | $ | — | $ | — | $ | 1,692,898 | ||||||||
Current liabilities held for sale | 1,254,625 | 328,493 | — | 926,132 | ||||||||||||
Payables to parent | — | — | 3,223 | (3,223 | ) | |||||||||||
Long-term debt and other long-term liabilities | 10,178,267 | — | — | 10,178,267 | ||||||||||||
Noncontrolling interests subject to put provisions | 1,034,501 | — | — | 1,034,501 | ||||||||||||
Total DaVita Inc. shareholders’ equity | 4,580,680 | 124,674 | — | 4,456,006 | ||||||||||||
Noncontrolling interests not subject to put provisions | 201,401 | — | — | 201,401 | ||||||||||||
Shareholders’ equity | 4,782,081 | 124,674 | — | 4,657,407 | ||||||||||||
Total liabilities and shareholder’s equity | $ | 18,942,372 | $ | 453,167 | $ | 3,223 | $ | 18,485,982 |
(1) | After elimination of the unrestricted subsidiaries and the physician groups. |
Consolidated Total | Physician Groups | Unrestricted Subsidiaries | Company and Restricted Subsidiaries(1) | |||||||||||||
For The Three Months Ended March 31, 2018 | ||||||||||||||||
Cash flows from operating activities: | ||||||||||||||||
Net income | $ | 225,229 | $ | 7,397 | $ | 490 | $ | 217,342 | ||||||||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 137,310 | (20,189 | ) | (490 | ) | 157,989 | ||||||||||
Net cash provided by (used in) operating activities | 362,539 | (12,792 | ) | — | 375,331 | |||||||||||
Cash flows from investing activities: | ||||||||||||||||
Additions of property and equipment | (232,443 | ) | (1,165 | ) | — | (231,278 | ) | |||||||||
Acquisitions | (16,582 | ) | — | — | (16,582 | ) | ||||||||||
Proceeds from asset and business sales | 18,535 | — | — | 18,535 | ||||||||||||
Investments and other items | 30,362 | (541 | ) | — | 30,903 | |||||||||||
Net cash used in investing activities | (200,128 | ) | (1,706 | ) | — | (198,422 | ) | |||||||||
Cash flows from financing activities: | ||||||||||||||||
Long-term debt | 104,673 | — | — | 104,673 | ||||||||||||
Intercompany | — | 1,082 | — | (1,082 | ) | |||||||||||
Other items | (327,220 | ) | — | — | (327,220 | ) | ||||||||||
Net cash (used in) provided by financing activities | (222,547 | ) | 1,082 | — | (223,629 | ) | ||||||||||
Effect of exchange rate changes on cash, cash equivalents and restricted cash | 6,668 | — | — | 6,668 | ||||||||||||
Net decrease in cash, cash equivalents and restricted cash | (53,468 | ) | (13,416 | ) | — | (40,052 | ) | |||||||||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 17,834 | (13,416 | ) | — | 31,250 | |||||||||||
Net decrease in cash, cash equivalents and restricted cash from continuing operations | (71,302 | ) | — | — | (71,302 | ) | ||||||||||
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 518,920 | — | — | 518,920 | ||||||||||||
Cash, cash equivalents and restricted cash of continuing operations at end of the period | $ | 447,618 | $ | — | $ | — | $ | 447,618 |
(1) | After elimination of the unrestricted subsidiaries and the physician groups. |
Three months ended | ||||||||||||||||||||
March 31, 2018 | December 31, 2017 | March 31, 2017 | ||||||||||||||||||
(dollars in millions) | ||||||||||||||||||||
Revenues:(1) | ||||||||||||||||||||
Dialysis and related lab patient service revenues | $ | 2,591 | $ | 2,615 | $ | 2,423 | ||||||||||||||
Provision for uncollectible accounts | 26 | (149 | ) | (107 | ) | |||||||||||||||
Net dialysis and related lab patient service revenues | 2,617 | 2,465 | 2,316 | |||||||||||||||||
Other revenues | 233 | 316 | 316 | |||||||||||||||||
Total consolidated revenues | 2,849 | 100 | % | 2,781 | 100 | % | 2,631 | 100 | % | |||||||||||
Operating expenses and charges: | ||||||||||||||||||||
Patient care costs | 2,036 | 71 | % | 1,942 | 70 | % | 1,852 | 70 | % | |||||||||||
General and administrative | 267 | 9 | % | 265 | 10 | % | 263 | 10 | % | |||||||||||
Depreciation and amortization | 143 | 5 | % | 144 | 5 | % | 133 | 5 | % | |||||||||||
Provision for uncollectible accounts | (6 | ) | — | % | (6 | ) | — | 2 | — | % | ||||||||||
Equity investment loss (income) | — | — | % | 3 | — | (1 | ) | — | % | |||||||||||
Investment and other asset impairments | — | — | % | 280 | 10 | % | 15 | 1 | % | |||||||||||
Goodwill impairment charges | — | — | % | 2 | — | % | 24 | 1 | % | |||||||||||
Gain on changes in ownership interests, net | — | — | % | — | — | % | (6 | ) | — | % | ||||||||||
Gain on settlement, net | — | — | % | — | — | % | (527 | ) | (20 | )% | ||||||||||
Total operating expenses and charges | 2,439 | 86 | % | 2,631 | 95 | % | 1,755 | 67 | % | |||||||||||
Operating income | $ | 411 | 14 | % | $ | 150 | 5 | % | $ | 876 | 33 | % |
(1) | On January 1, 2018, we adopted Revenue from Contracts with Customers (Topic 606) using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results related to performance obligations satisfied beginning on and after January 1, 2018 are presented under Topic 606, while results related to the satisfaction of performance obligations in the prior period continue to be reported in accordance with our historical accounting under Revenue Recognition (Topic 605). |
Three months ended | |||||||||||
March 31, 2018 | December 31, 2017 | March 31, 2017 | |||||||||
(dollars in millions) | |||||||||||
Revenues:(1) | |||||||||||
U.S. dialysis and related lab services patient service revenues | $ | 2,508 | $ | 2,536 | $ | 2,373 | |||||
Provision for uncollectible accounts | 25 | (148 | ) | (107 | ) | ||||||
U.S. dialysis and related lab services net patient service revenues | 2,533 | 2,388 | 2,266 | ||||||||
Other revenues | 5 | 5 | 5 | ||||||||
Total U.S. dialysis and related lab services revenues | 2,538 | 2,393 | 2,271 | ||||||||
Other—Ancillary services and strategic initiatives other revenues | 238 | 316 | 316 | ||||||||
Other—Ancillary services and strategic initiatives patient service revenues | 102 | 95 | 62 | ||||||||
Total other—ancillary services and strategic initiatives revenues | 340 | 410 | 378 | ||||||||
Elimination of intersegment revenues | (29 | ) | (23 | ) | (18 | ) | |||||
Consolidated revenues | $ | 2,849 | $ | 2,781 | $ | 2,631 |
(1) | On January 1, 2018, we adopted Topic 606 using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results related to performance obligations satisfied beginning on and after January 1, 2018 are presented under Topic 606, while results related to the satisfaction of performance obligations in the prior period continue to be reported in accordance with our historical accounting under Revenue Recognition (Topic 605). |
Three months ended | |||||||||||
March 31, 2018 | December 31, 2017 | March 31, 2017 | |||||||||
(dollars in millions) | |||||||||||
Operating income: | |||||||||||
U.S. dialysis and related lab services | $ | 433 | $ | 459 | $ | 945 | |||||
Other—Ancillary services and strategic initiatives | (7 | ) | (296 | ) | (58 | ) | |||||
Corporate administrative support | (16 | ) | (12 | ) | (11 | ) | |||||
Total consolidated operating income | $ | 411 | $ | 150 | $ | 876 | |||||
Reconciliation of non-GAAP measures: | |||||||||||
Goodwill impairment charges | $ | — | $ | — | $ | 24 | |||||
Impairment of investments | — | 280 | — | ||||||||
Impairment of assets | — | — | 15 | ||||||||
Gain on settlement, net | — | — | (527 | ) | |||||||
Equity investment income related to gain on settlement | — | — | (3 | ) | |||||||
Gain on APAC JV ownership changes | — | — | (6 | ) | |||||||
Adjusted consolidated operating income(1) | $ | 411 | $ | 430 | $ | 380 |
(1) | For the periods presented in the table above adjusted operating income is defined as operating income before certain items which we do not believe are indicative of ordinary results, including goodwill impairment charges, investment and other asset impairments, a net settlement gain, and gains on ownership changes. Adjusted operating income as so defined is a non-GAAP measure and is not intended as a substitute for GAAP operating income. We have presented these adjusted amounts because management believes that these presentations enhance a user’s understanding of our normal consolidated operating income by excluding certain items which we do not believe are indicative of our ordinary results of operations. As a result, adjusting for these amounts allows for comparison to our normalized prior period results. |
Three months ended | |||||||||||
March 31, 2018 | December 31, 2017 | March 31, 2017 | |||||||||
(dollars in millions, except per treatment data) | |||||||||||
Revenues:(1) | |||||||||||
U.S. dialysis and related lab services patient service revenues | $ | 2,508 | $ | 2,536 | $ | 2,373 | |||||
Provision for uncollectible accounts | 25 | (148 | ) | (107 | ) | ||||||
U.S. dialysis and related lab services net patient service revenues | 2,533 | 2,388 | 2,266 | ||||||||
Other revenues | 5 | 5 | 5 | ||||||||
Total U.S. dialysis and related lab services revenues | 2,538 | 2,393 | 2,271 | ||||||||
Operating expenses and charges: | |||||||||||
Patient care costs | 1,779 | 1,619 | 1,548 | ||||||||
General and administrative | 196 | 186 | 188 | ||||||||
Depreciation and amortization | 135 | 134 | 125 | ||||||||
Equity investment income | (5 | ) | (5 | ) | (8 | ) | |||||
Gain on settlement, net | — | — | (527 | ) | |||||||
Total operating expenses and charges | 2,105 | 1,934 | 1,326 | ||||||||
Operating income | $ | 433 | $ | 459 | $ | 945 | |||||
Reconciliation of non-GAAP measures: | |||||||||||
Gain on settlement, net | — | — | (527 | ) | |||||||
Equity investment income related to gain on settlement | — | — | (3 | ) | |||||||
Adjusted operating income(2) | $ | 433 | $ | 459 | $ | 415 | |||||
Dialysis treatments | 7,174,026 | 7,244,555 | 6,804,384 | ||||||||
Average dialysis treatments per treatment day | 92,568 | 92,287 | 88,369 | ||||||||
Average dialysis and related lab services net revenue per treatment | $ | 353.05 | $ | 329.68 | $ | 333.00 |
(1) | On January 1, 2018, we adopted Topic 606 using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results related to performance obligations satisfied beginning on and after January 1, 2018 are presented under Topic 606, while results related to the satisfaction of performance obligations in the prior period continue to be reported in accordance with our historical accounting under Revenue Recognition Topic 605. |
(2) | For the periods presented in the table above adjusted operating income is defined as operating income before certain items which we do not believe are indicative of ordinary results, including a net settlement gain. Adjusted operating income as so defined is a non-GAAP measure and is not intended as a substitute for GAAP operating income. We have presented these adjusted amounts because management believes that these presentations enhance a user’s understanding of our normal consolidated operating income by excluding certain items which we do not believe are indicative of our ordinary results of operations. As a result, adjusting for these amounts allows for comparison to our normalized prior period results. |
Three months ended | |||||||||||
March 31, 2018 | December 31, 2017 | March 31, 2017 | |||||||||
(dollars in millions) | |||||||||||
U.S. revenues:(1) | |||||||||||
Other revenues | $ | 237 | $ | 316 | $ | 315 | |||||
Total | 237 | 316 | 315 | ||||||||
International revenues:(1) | |||||||||||
Dialysis patient service revenues | 102 | 94 | 62 | ||||||||
Other revenues | 1 | 1 | 1 | ||||||||
Total | 103 | 95 | 63 | ||||||||
Total net revenues(1) | $ | 340 | $ | 410 | $ | 378 | |||||
Operating expenses and charges: | |||||||||||
Operating and other general expenses | $ | 347 | $ | 426 | $ | 403 | |||||
Goodwill impairment | — | 2 | 24 | ||||||||
Investment and other asset impairments | — | 280 | 15 | ||||||||
Gain from APAC JV ownership changes | — | — | (6 | ) | |||||||
Total operating expenses and charges | 347 | 707 | 436 | ||||||||
Total ancillary services and strategic initiatives operating loss | $ | (7 | ) | $ | (296 | ) | $ | (58 | ) | ||
U.S. operating loss | $ | (5 | ) | $ | (2 | ) | $ | (53 | ) | ||
Reconciliation of non-GAAP: | |||||||||||
Goodwill impairment charges | — | — | 24 | ||||||||
Impairment of other assets | — | — | 15 | ||||||||
Adjusted operating loss(2) | $ | (5 | ) | $ | (2 | ) | $ | (14 | ) | ||
International operating loss | $ | (2 | ) | $ | (294 | ) | $ | (5 | ) | ||
Reconciliation of non-GAAP: | |||||||||||
Impairment of investment | — | 280 | — | ||||||||
Gain on APAC JV ownership changes | — | — | (6 | ) | |||||||
Adjusted operating loss(2) | $ | (2 | ) | $ | (14 | ) | $ | (11 | ) | ||
Total adjusted ancillary services and strategic initiatives operating loss(2) | $ | (7 | ) | $ | (16 | ) | $ | (25 | ) |
(1) | On January 1, 2018, we adopted Topic 606 using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results related to performance obligations satisfied beginning on and after January 1, 2018 are presented under Topic 606, while results related to the satisfaction of performance obligations in the prior period continue to be reported in accordance with our historical accounting under Revenue Recognition Topic 605. |
(2) | For the periods presented in the table above, adjusted operating loss is defined as operating loss before certain items which we do not believe are indicative of ordinary results, including goodwill impairment charges, investment and other asset impairments, and gains on ownership changes. Adjusted operating loss as so defined is a non-GAAP measure and is not intended as a substitute for GAAP operating loss. We have presented these adjusted amounts because management believes that these presentations enhance a user’s understanding of our normal consolidated operating income by excluding certain items which we do not believe are indicative of our ordinary results of operations. As a result, adjusting for these amounts allows for comparison to our normal prior period results. |
Goodwill balance as of March 31, 2018 | Carrying amount coverage(1) | Sensitivities | ||||||||
Reporting unit | Operating income(2) | Discount rate(3) | ||||||||
(in millions) | ||||||||||
Kidney Care Germany | $ | 338 | 13.7% | (1.6)% | (11.1)% | |||||
Kidney Care Portugal | $ | 48 | 16.9% | (1.9)% | (6.0)% | |||||
Kidney Care Poland | $ | 48 | 11.8% | (1.9)% | (6.0)% |
(1) | Excess of estimated fair value of the reporting unit over its carrying amount as of the latest assessment date. |
(2) | Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date. |
(3) | Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date. |
Remainder of 2018 | 1-3 years | 4-5 years | After 5 years | Total | |||||||||||||||
Scheduled payments under contractual obligations: | |||||||||||||||||||
Long-term debt | $ | 121 | $ | 4,520 | $ | 1,269 | $ | 3,312 | $ | 9,222 | |||||||||
Interest payments on the senior notes | 156 | 710 | 401 | 202 | 1,469 | ||||||||||||||
Interest payments on Term Loan B(1) | 119 | 387 | — | — | 506 | ||||||||||||||
Interest payments on Term Loan A(2) | 21 | 13 | — | — | 34 | ||||||||||||||
Interest payments on Term Loan A-2(2) | 10 | 6 | — | — | 16 | ||||||||||||||
Kidney Care capital lease obligations | 16 | 67 | 46 | 175 | 304 | ||||||||||||||
Kidney Care operating leases | 349 | 1,194 | 610 | 1,129 | 3,282 | ||||||||||||||
DMG capital lease obligations | 36 | — | — | — | 36 | ||||||||||||||
DMG operating leases | 66 | 215 | 101 | 248 | 630 | ||||||||||||||
$ | 894 | $ | 7,112 | $ | 2,427 | $ | 5,066 | $ | 15,499 | ||||||||||
Potential cash requirements under other commitments: | |||||||||||||||||||
Letters of credit | $ | 37 | $ | — | $ | — | $ | — | $ | 37 | |||||||||
Noncontrolling interests subject to put provisions | 651 | 202 | 94 | 88 | 1,035 | ||||||||||||||
Non-owned and minority owned put provisions | 28 | 28 | — | — | 56 | ||||||||||||||
Operating capital advances | 1 | 2 | 1 | 1 | 5 | ||||||||||||||
Purchase commitments | 320 | 875 | 251 | — | 1,446 | ||||||||||||||
$ | 1,037 | $ | 1,107 | $ | 346 | $ | 89 | $ | 2,579 |
(1) | Assuming no changes to LIBOR-based interest rates as Term Loan B currently bears interest at LIBOR plus an interest rate margin of 2.75%. |
(2) | Based upon current LIBOR-based interest rates in effect at March 31, 2018 plus an interest rate margin of 2.00% for Term Loan A and plus an interest rate margin of 1.00% for Term Loan A-2. |
Average interest rate | ||||||||||||||||||||||||||||||||||||||
Expected maturity date | Fair Value | |||||||||||||||||||||||||||||||||||||
2018 | 2019 | 2020 | 2021 | 2022 | 2023 | Thereafter | Total | |||||||||||||||||||||||||||||||
(dollars in millions) | ||||||||||||||||||||||||||||||||||||||
Long term debt: | ||||||||||||||||||||||||||||||||||||||
Fixed rate | $ | 30 | $ | 32 | $ | 28 | $ | 26 | $ | 1,275 | $ | 26 | $ | 3,485 | $ | 4,902 | 51.34 | % | $ | 4,835 | ||||||||||||||||||
Variable rate | $ | 107 | $ | 1,175 | $ | 45 | $ | 3,281 | $ | 8 | $ | 6 | $ | 2 | $ | 4,624 | 48.66 | % | $ | 4,670 |
Notional Amount | Contract maturity date | Fair Value | |||||||||||||||||||||||||||
2018 | 2019 | 2020 | 2021 | 2022 | Receive variable | ||||||||||||||||||||||||
(dollars in millions) | |||||||||||||||||||||||||||||
Cap agreements | $ | 7,000 | $ | 3,500 | $ | — | $ | 3,500 | $ | — | $ | — | LIBOR above 3.5% | $ | 2 |
• | Suspension or termination of our participation in government payment programs; |
• | Refunds of amounts received in violation of law or applicable payment program requirements; |
• | Loss of required government certifications or exclusion from government payment programs; |
• | Loss of licenses required to operate healthcare facilities or administer pharmaceuticals in some of the states in which we operate; |
• | Reductions in payment rates or coverage for dialysis and ancillary services and related pharmaceuticals; |
• | Criminal or civil liability, fines, damages or monetary penalties for violations of healthcare fraud and abuse laws, including the federal Anti-Kickback Statute, Stark Law violations, FCA or other failures to meet regulatory requirements; |
• | Enforcement actions by governmental agencies and/or state claims for monetary damages by patients who believe their protected health information (PHI) has been used, disclosed or not properly safeguarded in violation of federal or state patient privacy laws, including HIPAA and the Privacy Act of 1974; |
• | Mandated changes to our practices or procedures that significantly increase operating expenses; |
• | Imposition of and compliance with corporate integrity agreements that could subject us to ongoing audits and reporting requirements as well as increased scrutiny of our billing and business practices which could lead to potential fines; |
• | Termination of various relationships and/or contracts related to our business, including joint venture arrangements, medical director agreements, real estate leases and consulting agreements with physicians; and |
• | Harm to our reputation which could impact our business relationships, affect our ability to obtain financing and decrease access to new business opportunities, among other things. |
• | make it difficult for us to make payments on our debt securities; |
• | increase our vulnerability to general adverse economic and industry conditions; |
• | require us to dedicate a substantial portion of our cash flows from operations to payments on our indebtedness, thereby reducing the availability of our cash flow to fund working capital, capital expenditures, acquisitions and investments, repurchases of stock at the levels intended or announced, or at all, and other general corporate purposes; |
• | limit our flexibility in planning for, or reacting to, changes in our business and the markets in which we operate; |
• | expose us to interest rate volatility that could adversely affect our business, results of operations and financial condition, and our ability to service our indebtedness; |
• | place us at a competitive disadvantage compared to our competitors that have less debt; and |
• | limit our ability to borrow additional funds, or to refinance existing debt on favorable terms when otherwise available. |
• | the collapse or insolvency of our insurance carriers; |
• | further increases in premiums and deductibles; |
• | increases in the number of liability claims against us or the cost of settling or trying cases related to those claims; or |
• | an inability to obtain one or more types of insurance on acceptable terms, if at all. |
• | changes in the local economic environment; |
• | political instability, armed conflicts or terrorism; |
• | social changes; |
• | intellectual property legal protections and remedies; |
• | trade regulations; |
• | procedures and actions affecting approval, production, pricing, reimbursement and marketing of products and services; |
• | foreign currency; |
• | repatriating or moving to other countries cash generated or held abroad, including considerations relating to tax-efficiencies and changes in tax laws; |
• | export controls; |
• | lack of reliable legal systems which may affect our ability to enforce contractual rights; |
• | changes in local laws or regulations; |
• | potentially longer ramp-up times for starting up new operations and for payment and collection cycles; |
• | financial and operational, and information technology systems integration; |
• | failure to comply with U.S. laws, such as the FCPA, or local laws that prohibit us, our partners, or our partners’ or our intermediaries from making improper payments to foreign officials for the purpose of obtaining or retaining business; and |
• | data and privacy restrictions. |
• | Risk that our rates are reduced by CMS. Uncertainty about future payment rates remains a material risk to our business. Each year, CMS publishes a final rule for the PPS, which has been phasing in reductions to the PPS base rate mandated by the American Taxpayer Relief Act of 2012 as modified by the Protecting Access to Medicare Act of 2014. |
• | Risk that CMS, through its contracted Medicare Administrative Contractors (MACs) or otherwise, implements Local Coverage Determinations (LCDs) or other decisions that limit the frequency a provider can bill Medicare for home dialysis treatments or other rules that may impact reimbursement. Such coverage determinations could have an adverse impact on our revenue. There is also risk commercial insurers could incorporate the requirements or limitations associated with such LCDs into their contracted terms with dialysis providers, which could have an adverse impact on our revenue. |
• | Risk that a MAC, or multiple MACs, change their interpretations of existing regulations, manual provisions and/or guidance; or seek to implement or enforce new interpretations that are inconsistent with how we have interpreted existing regulations, manual provisions and/or guidance. |
• | Risk that increases in our operating costs will outpace the Medicare rate increases we receive. We expect operating costs to continue to increase due to inflationary factors, such as increases in labor and supply costs, including increases in maintenance costs and capital expenditures to improve, renovate and maintain our facilities, equipment and information technology to meet changing regulatory requirements, regardless of whether there is a compensating inflation-based increase in Medicare payment rates or in payments under the bundled payment rate system. |
• | Risk of federal budget sequestration cuts. As a result of the Budget Control Act of 2011 and the BBA, an annual 2% reduction to Medicare payments took effect on April 1, 2013 and has been extended through 2027. These across-the-board spending cuts have affected and will continue to adversely affect our business, results of operations and financial condition. |
• | Risk that, if our clinical systems fail to accurately capture the data we report to CMS in connection with claims for which at least part of the government’s payments to us is based on clinical performance or patient outcomes or co-morbidities, we might be over-reimbursed by the government, which could subject us to certain liability. For example, CMS published a final rule that implemented a provision of the ACA, requiring providers to report and return Medicare and Medicaid overpayments within the later of (a) 60 days after the overpayment is identified, or (b) the date any corresponding cost report is due, if applicable. An overpayment impermissibly retained under this statute could subject us to liability under the FCA, exclusion, and penalties under the federal Civil Monetary Penalty statute. |
• | the health status of members; |
• | higher than expected utilization of new or existing healthcare services or technologies; |
• | an increase in the cost of healthcare services and supplies, including pharmaceuticals, whether as a result of inflation or otherwise; |
• | changes to mandated benefits or other changes in healthcare laws, regulations and practices; |
• | periodic renegotiation of provider contracts with specialist physicians, hospitals and ancillary providers; |
• | periodic renegotiation of contracts with DMG’s affiliated primary care physicians and specialists; |
• | changes in the demographics of the participating members and medical trends; |
• | contractual or claims disputes with providers, hospitals or other service providers within and outside of a health plan’s network; |
• | the occurrence of catastrophes, major epidemics or acts of terrorism; and |
• | the reduction of health plan premiums. |
• | Maintain, at all times, a minimum tangible net equity (TNE); |
• | Submit periodic financial solvency reports to the DMHC containing various data regarding performance and financial solvency; |
• | Comply with extensive regulatory requirements; and |
• | Submit to periodic regulatory audits and reviews concerning DHPC operations and compliance with Knox-Keene. |
• | Maintain, at all times, a minimum cash-to-claims ratio (where cash-to-claims ratio means the organization’s cash, marketable securities and certain qualified receivables, divided by the organization’s total unpaid claims liability). The regulation currently requires a cash-to-claims ratio of 0.75. |
• | Submit periodic reports to the California DMHC containing various data and attestations regarding performance and financial solvency, including incurred but not reported calculations and documentation, and attestations as to whether or not the organization was in compliance with Knox-Keene requirements related to claims payment timeliness, had maintained positive TNE (i.e., at least $1.00) and had maintained positive working capital (i.e., at least $1.00). |
• | Medicare Advantage benchmarks for 2011 were frozen at 2010 levels. From 2012 through 2016, Medicare Advantage benchmark rates were phased down from prior levels. The new benchmarks were fully phased-in in 2017 and range between 95% and 115% of the Medicare Fee-for-Service (Medicare FFS) costs, depending on a plan’s geographic area. If our costs escalate faster than can be absorbed by the level of revenues implied by these benchmark rates, then it could have a material adverse effect on DMG’s business and results of operations. |
• | Rebates received by Medicare Advantage plans that were reduced, with larger reductions for plans failing to receive certain quality ratings. |
• | The Secretary of the HHS has been granted the explicit authority to deny Medicare Advantage plan bids that propose significant increases in cost sharing or decreases in benefits. If the bids submitted by plans contracted with DMG are denied, this could have a material adverse effect on DMG’s business and results of operations. |
• | Medicare Advantage plans with medical loss ratios below 85% are required to pay a rebate to the Secretary of HHS. The rebate amount is the total revenue under the contract year multiplied by the difference between 85% and the plan’s actual medical loss ratio. The Secretary of HHS will halt enrollment in any plan failing to meet this ratio for three consecutive years, and terminate any plan failing to meet the ratio for five consecutive years. If a DMG-contracting Medicare Advantage plan experiences a limitation on enrollment or is otherwise terminated from the Medicare Advantage program, it could have a material adverse effect on DMG’s business and results of operations. |
• | Prescription drug plans are required to provide coverage of certain drug categories on a list developed by the Secretary of HHS, which could increase the cost of providing care to Medicare Advantage enrollees, and thereby reduce DMG’s revenues and earnings. The Medicare Part D premium amount subsidized for high-income beneficiaries has been reduced, which could lower the number of Medicare Advantage enrollees, which would have a negative impact on DMG’s business and results of operations. |
• | CMS increased coding intensity adjustments for Medicare Advantage plans beginning in 2014 and continuing through 2018, which reduces CMS payments to Medicare Advantage plans, which in turn will likely reduce the amounts payable to DMG and its associated physicians, physician groups, and IPAs under its capitation agreements. |
• | As a result of the direct and indirect impacts of the ACA, many Medicare beneficiaries may decide that an original Medicare FFS program is more attractive than a Medicare Advantage plan. As a result, enrollment in the health plans DMG serves may decrease. |
• | Managed care companies offer alternative products such as regional preferred provider organizations (PPOs) and private FFS plans. Medicare PPOs and private FFS plans allow their patients more flexibility in selecting physicians than Medicare Advantage health plans, which typically require patients to coordinate care with a primary care physician. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 has encouraged the creation of regional PPOs through various incentives, including certain risk corridors, or cost reimbursement provisions, a stabilization fund for incentive payments, and special payments to hospitals not otherwise contracted with a Medicare Advantage plan that treat regional plan enrollees. The formation of regional Medicare PPOs and private FFS plans may affect DMG’s relative attractiveness to existing and potential Medicare patients in their service areas. |
• | The payments for the local and regional Medicare Advantage plans are based on a competitive bidding process that may indirectly cause a decrease in the amount of the PMPM fee or result in an increase in benefits offered. |
• | The annual enrollment process and subsequent lock-in provisions of the ACA may adversely affect DMG’s level of revenue growth as it will limit the ability of a health plan to market to and enroll new Medicare beneficiaries in its established service areas outside of the annual enrollment period. |
• | CMS allows Medicare beneficiaries who are enrolled in a Medicare Advantage plan with a quality rating of 4.5 stars or less to enroll in a 5-star rated Medicare Advantage plan at any time during the benefit year. Therefore, DMG may face a competitive disadvantage in recruiting and retaining Medicare beneficiaries. |
• | requiring DMG to change its products and services; |
• | increasing the regulatory, including compliance, burdens under which DMG operates, which, in turn, may negatively impact the manner in which DMG provides services and increase DMG’s costs of providing services; |
• | adversely affecting DMG’s ability to market its products or services through the imposition of further regulatory restrictions regarding the manner in which plans and providers market to Medicare Advantage enrollees; or |
• | adversely affecting DMG’s ability to attract and retain members. |
Total number of shares purchased | Average price paid per share | Total number of shares purchased as part of publicly announced plans or programs | Approximate dollar value of shares that may yet be purchased under the plans or programs (in millions) | ||||||||||
Period | |||||||||||||
January 1-31, 2018 | 519,227 | $ | 76.63 | 519,227 | $ | 1,079.3 | |||||||
February 1-28, 2018 | 937,180 | 73.63 | 937,180 | 1,010.3 | |||||||||
March 1-31, 2018 | 2,740,897 | 69.17 | 2,740,897 | 820.7 | |||||||||
Total | 4,197,304 | $ | 71.09 | 4,197,304 |
Exhibit | ||
Number | ||
Amendment to Stock Appreciation Rights Agreements, entered into effective as of March 1, 2018, by and between DaVita Inc. and Carol Anthony Davidson. ü* | ||
DaVita Inc. Non-Employee Director Compensation Policy, adopted on March 29, 2018. ü* | ||
Consulting Agreement, made and entered into as of April 9, 2018, by and between DaVita Inc. and Jeanine Jiganti. ü* | ||
Ratio of earnings to fixed charges. ü | ||
Certification of the Chief Executive Officer, dated May 3, 2018, pursuant to Rule 13a-14(a) or 15d-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. ü | ||
Certification of the Chief Financial Officer, dated May 3, 2018, pursuant to Rule 13a-14(a) or 15d-14(a), as adopted pursuant to Section 302 of the Sarbanes-Oxley Act of 2002. ü | ||
Certification of the Chief Executive Officer, dated May 3, 2018, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. ü | ||
Certification of the Chief Financial Officer, dated May 3, 2018, pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the Sarbanes-Oxley Act of 2002. ü | ||
101.INS | XBRL Instance Document. ü | |
101.SCH | XBRL Taxonomy Extension Schema Document. ü | |
101.CAL | XBRL Taxonomy Extension Calculation Linkbase Document. ü | |
101.DEF | XBRL Taxonomy Extension Definition Linkbase Document. ü | |
101.LAB | XBRL Taxonomy Extension Label Linkbase Document. ü | |
101.PRE | XBRL Taxonomy Extension Presentation, Linkbase Document. ü |
ü | Filed herewith. |
* | Management contract or executive compensation plan or arrangement. |
DAVITA INC. | |||
BY: | /s/ JAMES K. HILGER | ||
James K. Hilger | |||
Chief Accounting Officer* |
* | Mr. Hilger has signed both on behalf of the Registrant as a duly authorized officer and as the Registrant’s principal accounting officer. |
Grant Date | Number of SSAR Base Shares | Expiration Date |
June 17, 2013 | 24,000 | 6/17/2018 |
June 17, 2014 | 5,414 | 6/17/2019 |
June 16, 2015 | 4,662 | 6/16/2020 |
June 20, 2016 | 5,015 | 6/20/2021 |
June 16, 2017 | 7,178 | 6/16/2022 |
3. | The parties agree that the 2017 SSAR Agreement shall be amended such that after the amendment, the Vesting Schedule under the Primary Terms shall read in its entirety as follows: |
COMPANY | GRANTEE | ||
By | /s/ Chetan P. Mehta | /s/ Carol Anthony Davidson | |
Chetan P. Mehta | Carol Anthony Davidson | ||
Group Vice President, Finance |
• | to pay differentially higher compensation for higher levels of work, responsibility and performance; |
• | to provide a compensation structure that will attract highly competent candidates; and |
• | to provide a significant portion of compensation in the form of equity-based awards to align non-employee director compensation with increases in long-term shareholder value. |
2.2.1 | Grant Date: The SSARs shall be granted on May 15 of each year (the “Annual Grant Date”). |
2.2.2 | Amount: The number of SSARs to be granted shall be the nearest whole number of shares determined by dividing $95,000 by twenty percent (20%) of the closing market price of the Company’s common stock as listed on the New York Stock Exchange on the Annual Grant Date, and if the Annual Grant Date does not fall on a trading day, then on the last trading day prior to the Annual Grant Date. |
2.2.3 | Vesting: The SSARs shall vest one hundred percent (100%) on the one year anniversary following the Annual Grant Date. |
2.2.4 | Expiration: The SSARs shall expire five years following the Annual Grant Date. |
2.3.1 | Grant Date: The DSIs shall be granted on the last calendar day of each fiscal quarter. |
2.3.2 | Amount: The number of DSIs to be granted shall be the nearest whole number of shares as determined by dividing $23,750 by the closing market price of the Company’s common stock as listed on the New York Stock Exchange on the last trading day of each fiscal quarter. |
DAVITA INC. | EMPLOYEE | |
/s/ Kent J.Thiry | /s/ Charles G. Berg | |
By: Kent J. Thiry, Chief Executive Officer | Charles G. Berg, in his individual capacity | |
DAVITA MEDICAL MANAGEMENT, LLC | ||
/s/ Joseph C. Mello | ||
By: Joseph C. Mello, President | ||
Approved by DaVita Inc. as to form | ||
/s/ Kathleen A. Waters | ||
Kathleen A. Waters | ||
Chief Legal Officer |
Three months ended March 31, 2018 | Year ended December 31, | ||||||||||||||||||||||
2017 | 2016 | 2015 | 2014 | 2013 | |||||||||||||||||||
(dollars in thousands) | |||||||||||||||||||||||
Earnings adjusted for fixed charges: | |||||||||||||||||||||||
Income from continuing operations before income taxes | $ | 301,752 | $ | 1,399,786 | $ | 1,623,105 | $ | 688,387 | $ | 1,094,322 | $ | 692,438 | |||||||||||
Add: | |||||||||||||||||||||||
Debt expense | 113,516 | 430,634 | 414,116 | 408,380 | 410,223 | 429,938 | |||||||||||||||||
Interest portion of rent expense | 46,856 | 171,842 | 154,901 | 143,311 | 130,640 | 120,398 | |||||||||||||||||
Less: Noncontrolling interests | (40,088 | ) | (175,176 | ) | (159,404 | ) | (158,304 | ) | (140,949 | ) | (124,438 | ) | |||||||||||
120,284 | 427,300 | 409,613 | 393,387 | 399,914 | 425,898 | ||||||||||||||||||
$ | 422,036 | $ | 1,827,086 | $ | 2,032,718 | $ | 1,081,774 | $ | 1,494,236 | $ | 1,118,336 | ||||||||||||
Fixed charges: | |||||||||||||||||||||||
Debt expense | 113,516 | 430,634 | 414,116 | 408,380 | 410,223 | 429,938 | |||||||||||||||||
Interest portion of rent expense | 46,856 | 171,842 | 154,901 | 143,311 | 130,640 | 120,398 | |||||||||||||||||
Capitalized interest | 6,121 | 19,176 | 12,990 | 9,723 | 7,888 | 6,408 | |||||||||||||||||
$ | 166,493 | $ | 621,652 | $ | 582,007 | $ | 561,414 | $ | 548,751 | $ | 556,744 | ||||||||||||
Ratio of earnings to fixed charges | 2.53 | 2.94 | 3.49 | 1.93 | 2.72 | 2.01 |
/S/ KENT J. THIRY |
Kent J. Thiry |
Chief Executive Officer |
/S/ Joel Ackerman |
Joel Ackerman |
Chief Financial Officer |
1. | The Periodic Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and |
2. | The information contained in the Periodic Report fairly presents, in all material respects, the financial condition and results of operations of the Company. |
/S/ KENT J. THIRY |
Kent J. Thiry |
Chief Executive Officer |
May 3, 2018 |
1. | The Periodic Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and |
2. | The information contained in the Periodic Report fairly presents, in all material respects, the financial condition and results of operations of the Company. |
/S/ Joel Ackerman |
Joel Ackerman |
Chief Financial Officer |
May 3, 2018 |
5;D?ARTZ___ !C=7)V D ()"[L>&3D*6U"$<[FT__\
M &-UY[:5EH ZYK6N]?9QM@&W_:
M;D_@!6316]+%5:$91IRY5+=K?3M]YG4H0J.+DK\NW85V+G+')/.3WI**,UAJ
M[W=VWN]S1*VG0!3HXS,P11DDX IF:V]!L=H\]QC/"@_J?Z5T8/#/$UE#9;R?
MD98BJJ,'+KT]34MH1;QK&/X0!GU]34M%%?5)**26B2LCPV[N[ZA1113 ****
M "BBB@ HHHH **** "BBB@ HHHH **** "BBB@ HHHH **** "BBB@ HHHH
M**** "BBB@ HHHH **** "BBB@ HHHH **** "BBB@ HHHH **** "BBB@ H
MHHH **** "BBB@ HHHH **** "BBB@ HHHH **** "BBB@ HHHH **:[K&I9
MB ,DDX 'UKD-<^(,-MNCL0)6Y'F'[@^@ZM_+ZU=.E.J[15S.I5A15YNWYG5
MW5W#91F2:144=2Q %
A>"_%IOL6=VW[P#Y'/\0'\)_P!KT]?KU\S%
M8/V:YX;=5V/3PF,]HU"I\71]SL:***XCO"BBB@ HHHH **** "BBB@ HHHH
MH:]_R#KS_KUG_P#1;5XU7LNO?\@Z\_Z]9_\ T6U>-5Z67?#4]4>9F7Q0]&%%
M%%=YYP4444 %=G\-/^/FY_ZY+_Z%7&5V?PT_X^;G_KDO_H5<^-_@2^7YG3@O
MX\/G^1Z#1117C'MA1110 4444 %%%% !1110!'/"EQ&\;C*NI4CU!C&H6
M;:?<2V[YS&[+GIG!QGW!'(KVNO-/B'9?9]0$P'$L:DG_ &E^7^@KMR^IRU''
M^9?BCAS&GS4U/K%_@SEJ***]0\D**** "M+P]?'3M0MILX E ;MPWRGZ\&LV
ME'^>U3.//&4>Z:^\J$N249=FG]Q[G1572KK[;:03YSOA1B?
P>)K ZEIMQ"HRVS
>HR\!W?\!/#?T/X5YE7N,L2S(R.,JRD$>H(P17C.JV#:7=2V[?P.
M5^HZ@_B,'\:]/+ZMXNF_LZKT?_!/+S&E:2J+[6C]45****[CSPHHHH *U_"V
MH_V7J4$A/REMC=?NOP3^>#^%9%%14@IPE%]4RZ
Document and Entity Information - shares shares in Millions |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Apr. 30, 2018 |
|
Document And Entity Information [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Mar. 31, 2018 | |
Document Fiscal Year Focus | 2018 | |
Document Fiscal Period Focus | Q1 | |
Trading Symbol | DVA | |
Entity Registrant Name | DAVITA INC. | |
Entity Central Index Key | 0000927066 | |
Current Fiscal Year End Date | --12-31 | |
Entity Filer Category | Large Accelerated Filer | |
Entity Common Stock, Shares Outstanding | 174.5 |
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (unaudited) - USD ($) $ in Thousands |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Statement of Comprehensive Income [Abstract] | ||
Net income | $ 225,229 | $ 500,285 |
Unrealized gains (losses) on interest rate cap agreements: | ||
Unrealized gains (losses) on interest rate cap agreements | 1,050 | (3,188) |
Reclassifications of net realized losses on interest rate cap agreements into net income | 1,537 | 1,265 |
Unrealized gains on investments: | ||
Unrealized gains on investments | 0 | 1,557 |
Reclassification of net investment realized gains into net income | 0 | (140) |
Unrealized gains on foreign currency translation: | ||
Foreign currency translation adjustments | 19,881 | 13,261 |
Other comprehensive income | 22,468 | 12,755 |
Total comprehensive income | 247,697 | 513,040 |
Less: Comprehensive income attributable to noncontrolling interests | (46,543) | (52,586) |
Comprehensive income attributable to DaVita Inc. | $ 201,154 | $ 460,454 |
CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($) $ in Thousands |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Statement of Financial Position [Abstract] | ||
Property and equipment, accumulated depreciation | $ 3,230,717 | $ 3,103,662 |
Intangible assets, accumulated amortization | $ 360,828 | $ 356,774 |
Preferred stock, par value (usd per share) | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized (in shares) | 5,000,000 | 5,000,000 |
Preferred stock, issued (in shares) | 0 | 0 |
Common stock, par value (usd per share) | $ 0.001 | $ 0.001 |
Common stock, shares authorized (in shares) | 450,000,000 | 450,000,000 |
Common stock, shares issued (in shares) | 182,660,712 | 182,462,278 |
Common stock, shares outstanding (in shares) | 178,463,408 | 182,462,278 |
Treasury Stock, Common, Shares | 4,197,304 | 0 |
CONSOLIDATED STATEMENTS OF EQUITY (unaudited) - USD ($) $ in Thousands |
Total |
Total |
Total
Restricted Stock Units
|
Total
Stock Appreciation Rights
|
Non- controlling interests subject to put provisions |
Common stock |
Common stock
Restricted Stock Units
|
Common stock
Stock Appreciation Rights
|
Additional paid-in capital |
Additional paid-in capital
Restricted Stock Units
|
Additional paid-in capital
Stock Appreciation Rights
|
Retained earnings |
Treasury stock |
Accumulated other comprehensive (loss) income |
Non- controlling interests not subject to put provisions |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Beginning balance at Dec. 31, 2016 | $ 4,648,047 | $ 973,258 | $ 195 | $ 1,027,182 | $ 3,710,313 | $ 0 | $ (89,643) | $ 201,694 | |||||||
Beginning Balance (in shares) at Dec. 31, 2016 | 194,554,000 | 0 | |||||||||||||
Comprehensive income: | |||||||||||||||
Other comprehensive income (loss) | $ 12,755 | ||||||||||||||
Beginning balance at Dec. 31, 2016 | 4,648,047 | 973,258 | $ 195 | 1,027,182 | 3,710,313 | $ 0 | (89,643) | 201,694 | |||||||
Beginning Balance (in shares) at Dec. 31, 2016 | 194,554,000 | 0 | |||||||||||||
Comprehensive income: | |||||||||||||||
Net income | 663,618 | 103,641 | 663,618 | 63,296 | |||||||||||
Other comprehensive income (loss) | 102,878 | 102,878 | (2) | ||||||||||||
Stock purchase shares issued (in shares) | 360,000 | ||||||||||||||
Stock purchase shares issued | 22,131 | 22,131 | |||||||||||||
Stock unit shares issued (in shares) | 117,000 | 398,000 | |||||||||||||
Stock unit shares issued | $ (101) | $ 0 | $ 101 | $ 0 | |||||||||||
Stock-settled stock-based compensation expense | 34,981 | 34,981 | |||||||||||||
Changes in noncontrolling interest from: | |||||||||||||||
Distributions | (128,853) | (82,614) | |||||||||||||
Contributions | 52,911 | 21,641 | |||||||||||||
Acquisitions and divestitures | (823) | 43,799 | (823) | (5,770) | |||||||||||
Partial purchases | (2,752) | (397) | (2,752) | (2,208) | |||||||||||
Fair value remeasurements | 32,999 | (32,999) | 32,999 | ||||||||||||
Purchase of treasury stock (in shares) | (12,967,000) | ||||||||||||||
Purchase of treasury stock | (810,949) | $ (810,949) | |||||||||||||
Retirement of treasury stock | (12,967,000) | 12,967,000 | |||||||||||||
Retirement of treasury stock | 0 | $ (13) | (70,718) | (740,218) | $ 810,949 | ||||||||||
Ending balance at Dec. 31, 2017 | $ 4,886,066 | 4,690,029 | 1,011,360 | $ 182 | 1,042,899 | 3,633,713 | $ 0 | 13,235 | 196,037 | ||||||
Ending Balance (in shares) at Dec. 31, 2017 | 182,462,278 | 182,462,000 | 0 | ||||||||||||
Increase (Decrease) in Stockholders' Equity [Roll Forward] | |||||||||||||||
Cumulative Effect of New Accounting Principle in Period of Adoption | 0 | 8,368 | (8,368) | ||||||||||||
Comprehensive income: | |||||||||||||||
Net income | 178,686 | 24,107 | 178,686 | 22,436 | |||||||||||
Other comprehensive income (loss) | $ 22,468 | 22,468 | 22,468 | ||||||||||||
Stock unit shares issued (in shares) | 4,000 | 195,000 | |||||||||||||
Stock unit shares issued | $ (4,886) | $ 1 | $ 4,887 | ||||||||||||
Stock-settled stock-based compensation expense | 9,682 | 9,682 | |||||||||||||
Changes in noncontrolling interest from: | |||||||||||||||
Distributions | (26,166) | (19,301) | |||||||||||||
Contributions | 9,508 | 2,501 | |||||||||||||
Acquisitions and divestitures | 76 | 688 | 76 | (66) | |||||||||||
Partial purchases | (1,994) | (1,994) | (206) | ||||||||||||
Fair value remeasurements | (15,004) | 15,004 | (15,004) | ||||||||||||
Purchase of treasury stock (in shares) | (4,197,000) | (4,197,000) | |||||||||||||
Purchase of treasury stock | $ (298,377) | (298,377) | $ (298,377) | ||||||||||||
Ending balance at Mar. 31, 2018 | $ 4,782,081 | $ 4,580,680 | $ 1,034,501 | $ 183 | $ 1,030,772 | $ 3,820,767 | $ (298,377) | $ 27,335 | $ 201,401 | ||||||
Ending Balance (in shares) at Mar. 31, 2018 | 178,463,408 | 182,661,000 | (4,197,000) |
Condensed consolidated interim financial statements |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Accounting Policies [Abstract] | |
Condensed consolidated interim financial statements | Condensed consolidated interim financial statements The condensed consolidated interim financial statements included in this report are prepared by the Company without audit. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, contingencies, impairments of goodwill and investments, accounting for income taxes, long-term variable compensation accruals, consolidation of variable interest entities and certain fair value estimates. The results of operations for the three months ended March 31, 2018 are not necessarily indicative of the operating results for the full year. The condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2017. Prior year balances and amounts have been reclassified to conform to the current year presentation. The Company has evaluated subsequent events through the date these condensed consolidated financial statements were issued and has included all necessary adjustments and disclosures. |
Revenue Recognition Revenue Recognition |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Text Block [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Revenue Recognition [Text Block] | Revenue recognition On January 1, 2018, the Company adopted Financial Accounting Standards Board (FASB) Accounting Standards Codification Topic 606 Revenue from Contracts with Customers (Topic 606) using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results for reporting periods beginning on and after January 1, 2018 are presented under Topic 606, while prior period amounts continue to be presented in accordance with the Company's historical accounting under Revenue Recognition (Topic 605). The adoption of this new standard primarily changed the Company’s presentation of revenues, provision for uncollectible accounts and allowance for doubtful accounts. Topic 606 requires revenue to be recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Accordingly, for performance obligations satisfied after the adoption of Topic 606, the Company no longer separately presents a provision for uncollectible accounts on the consolidated income statement and no longer presents the related allowance for doubtful accounts on the consolidated balance sheet. However, as a result of the Company’s election to apply Topic 606 only to contracts not substantially completed as of January 1, 2018, the Company continues to maintain an allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of Topic 606. Changes to this allowance for doubtful accounts, other than write-offs of uncollectible accounts, are recorded through the provision for uncollectible accounts on the consolidated income statement in accordance with Topic 605. The Company’s allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of Topic 606 was $162,516 and $218,399 as of March 31, 2018 and December 31, 2017, respectively. There are significant risks associated with estimating revenue, which generally take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues including determining applicable primary and secondary coverage, changes in patient coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. As a result of changes in these estimates, additional revenue was recognized during the three months ended March 31, 2018 associated with performance obligations satisfied in years prior to the adoption of Topic 606 of $67,410, which includes a benefit of $24,000 from electing to apply Topic 606 only to contracts not substantially completed as of January 1, 2018. The following table summarizes the Company's segment revenues by primary payor source:
Dialysis and related lab patient service revenues Dialysis and related lab services patient service revenues are recognized in the period services are provided. Revenues consist primarily of payments from Medicare, Medicaid and commercial health plans for dialysis and related lab services provided to patients. A usual and customary fee schedule is maintained for the Company’s dialysis treatments and related lab patient services; however, actual collectible revenue is normally recognized at a discount from the fee schedule. Revenues associated with Medicare and Medicaid programs are estimated based on: (a) the payment rates that are established by statute or regulation for the portion of payment rates paid by the government payor (e.g., 80% for Medicare patients) and (b) for the portion not paid by the primary government payor, estimates of the amounts ultimately collectible from other government programs paying secondary coverage (e.g., Medicaid secondary coverage), the patient’s commercial health plan secondary coverage, or the patient. The Company’s reimbursements from Medicare are subject to certain variations under Medicare’s single bundled payment rate system, whereby reimbursements can be adjusted for certain patient characteristics and other factors. The Company’s revenue recognition is estimated based on its judgment regarding its ability to collect, which depends upon its ability to effectively capture, document and bill for Medicare’s base payment rate as well as these other variable factors. Under Medicare’s bundled payment rate system, services covered by Medicare are subject to estimating risk, whereby reimbursements from Medicare can vary significantly depending upon certain patient characteristics and other variable factors. Even with the bundled payment rate system, Medicare payments for bad debt claims as established by cost reports require evidence of collection efforts. As a result, billing and collection of Medicare bad debt claims can be delayed significantly and final payment is subject to audit. Medicaid payments, when Medicaid coverage is secondary, can also be difficult to estimate. For many states, Medicaid payment terms and methods differ from Medicare, and may prevent accurate estimation of individual payment amounts prior to billing. Revenues associated with commercial health plans are estimated based on contractual terms for the patients under healthcare plans with which the Company has formal agreements, non-contracted health plan coverage terms if known, estimated secondary collections, historical collection experience, historical trends of refunds and payor payment adjustments (retractions), inefficiencies in the Company’s billing and collection processes that can result in denied claims for payments, and regulatory compliance matters. Commercial revenue recognition also involves significant estimating risks. With many larger, commercial insurers the Company has several different contracts and payment arrangements, and these contracts often include only a subset of the Company’s centers. It is often not possible to determine which contract, if any, should be applied prior to billing. In addition, for services provided by non-contracted centers, final collection may require specific negotiation of a payment amount, typically at a significant discount from the Company’s usual and customary rates. Other revenues Other revenues consist of the revenues associated with the ancillary services and strategic initiatives, management and administrative support services that are provided to outpatient dialysis centers that the Company does not own or in which the Company owns a noncontrolling interest, and administrative and management support services to certain other non-dialysis joint ventures in which the Company owns a noncontrolling interest. Revenues associated with pharmacy services are estimated as prescriptions are filled and shipped to patients. Revenues associated with dialysis management services, disease management services, medical consulting services, clinical research programs, physician services, end stage renal disease (ESRD) seamless care organizations, and comprehensive care are estimated in the period services are provided. Revenues associated with direct primary care are estimated over the membership period. |
Earnings per share |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Earnings Per Share [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Earnings per share | Earnings per share Basic earnings per share is calculated by dividing net income attributable to the Company, adjusted for any change in noncontrolling interests redemption rights in excess of fair value, by the weighted average number of common shares, net of shares held in escrow that under certain circumstances may be returned to the Company. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights (SSARs) and unvested stock units (under the treasury stock method) as well as shares held in escrow that the Company expects will remain outstanding. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows:
|
Restricted Cash Restricted Cash |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Restricted Cash [Abstract] | |
Cash and Cash Equivalents Disclosure [Text Block] | Restricted cash and equivalents The Company had restricted cash and cash equivalents of $88,744 and $10,686 at March 31, 2018 and December 31, 2017, respectively. Approximately $78,320 of the balance at March 31, 2018 represents restricted cash equivalents held in trust to satisfy insurer and state regulatory requirements related to the Company's self-insurance for professional and general liability and workers' compensation risks administered by wholly-owned captive insurance entities. Prior to the first quarter of 2018, these requirements were satisfied by a letter of credit rather than restricted cash held in trust. The remaining restricted cash and equivalents held at March 31, 2018 and December 31, 2017 primarily represent cash pledged to third parties in connection with two of the Company's ancillary and strategic initiatives businesses. |
Investments in debt and equity securities |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Investments, Debt and Equity Securities [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Investments in debt and equity securities | Short-term and long-term investments Effective January 1, 2018, the Company adopted ASU No. 2016-01, Financial Instruments - Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities. The amendments in this ASU revise accounting related to (i) the classification and measurement of investments in equity securities and (ii) the presentation of certain fair value changes for financial liabilities at fair value. The Company also adopted ASU 2018-03 which provides related technical corrections and improvements. The principal effect of ASUs 2016-01 and 2018-03 on the Company's consolidated financial statements is that, prior to adoption of ASU 2016-01, changes in the fair values of investments in equity securities with readily determinable fair values or redemption values were recognized in other comprehensive income until realized, while under ASU 2016-01 all changes in the fair values of these equity securities are recognized in current earnings. The adoption of these ASUs did not have a material impact on these condensed consolidated financial statements. Effective January 1, 2018, the Company recognized a cumulative effect of change in accounting principle upon adoption of ASUs 2016-01 and 2018-03, in conjunction with ASU 2018-02, the effect of which was to decrease accumulated other comprehensive income, and to increase retained earnings, by $5,662 in after-tax unrealized gains accumulated in other comprehensive income through December 31, 2017 from equity securities classified as available-for-sale investments prior to adoption of ASU 2016-01. From January 1, 2018, equity securities that have readily determinable fair values or redemption values are recorded at estimated fair value with changes in their value recognized in current earnings. The Company classifies its debt securities as held-to-maturity and records them at amortized cost based on its intentions and strategy concerning those investments. The Company classifies these debt and equity investments as "Short-term investments" or "Long-term investments" on its consolidated balance sheet, as applicable, based on the characteristics of the financial instrument or the Company's intentions or expectations for the investment. The Company’s investments in these short-term and long-term debt and equity investments consist of the following:
Debt securities: The Company's short-term debt investments are principally comprised of bank certificates of deposit with contractual maturities longer than three months but shorter than one year. These debt securities are accounted for as held to maturity and recorded at amortized cost, which approximates their fair values at March 31, 2018 and December 31, 2017. Equity securities: The Company's equity investments in mutual funds and common stock are held within a trust to fund existing obligations associated with several of the Company’s non-qualified deferred compensation plans. During the three months ended March 31, 2018, the Company recognized pre-tax net gains of $86 in the income statement associated with changes in the fair value of these equity securities, comprised of pre-tax realized gains of $3,746 and a net decrease in unrealized gains of $3,660. During the three months ended March 31, 2017, the Company recognized pre-tax realized gains on the sale or redemption of equity securities of $229, or $140 after-tax, which was previously recorded in other comprehensive income. |
Equity method and other investments |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Equity Method Investments and Joint Ventures [Abstract] | |
Equity method and other investments | Equity method and other investments Equity investments in nonconsolidated investees over which the Company maintains significant influence, but which do not have readily determinable fair values, are carried on the equity method. As described in Note 5 to these condensed consolidated financial statements, effective January 1, 2018, the Company adopted ASU 2016-01 and related ASU 2018-03 concerning recognition and measurement of financial assets and financial liabilities. In adopting this new guidance, the Company has made an accounting policy election to adopt an adjusted cost method measurement alternative for investments in equity securities without readily determinable fair values. Specifically, under this measurement alternative, unless elected otherwise for a particular investment, the Company initially records equity investments that qualify for the measurement alternative at cost but remeasures them to fair value through earnings when there is an observable transaction involving the same or a similar investment with the same issuer or upon an impairment. The Company maintains equity method and minor adjusted cost method investments in the private securities of certain other healthcare and healthcare-related businesses. The Company classifies these investments as "Equity method and other investments" on its consolidated balance sheet. Total equity method and other investments in nonconsolidated businesses were $245,564 and $245,534 at March 31, 2018 and December 31, 2017, respectively. During the three months ended March 31, 2018 and 2017, the Company recognized equity investment income of $155 and $677, respectively, from equity method investments in nonconsolidated businesses. The Company's largest equity method investment is its ownership interest in DaVita Care Pte. Ltd. (the APAC JV), which was carried at $160,535 and $160,481 at March 31, 2018 and December 31, 2017, respectively. The Company recognized a non-cash other-than-temporary impairment on this investment of $280,066 in the fourth quarter of 2017. As of March 31, 2018 and December 31, 2017, the Company holds a 60% voting interest and a 73.3% current economic interest in the APAC JV. Based on the governance structure and voting rights established for the APAC JV at its formation on August 1, 2016, certain key decisions affecting the joint venture’s operations are not subject to the unilateral discretion of the Company, but rather are shared with the other noncontrolling investors. These other noncontrolling investors currently collectively hold a 40% voting interest and a 26.7% economic interest in the APAC JV, and their economic interests are expected to increase to match their voting interests in the joint venture as they make additional subscribed capital contributions through August 1, 2019. The total carrying amount of equity investments carried under the adjusted cost method measurement alternative at March 31, 2018 was $5,386. Through March 31, 2018, there have been no meaningful impairments or other downward or upward valuation adjustments recognized on these investments. |
Goodwill |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Goodwill | Goodwill Changes in goodwill by reportable segment were as follows:
The Company elected to early adopt ASU No. 2017-04, Intangibles-Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment, effective January 1, 2017. The amendments in this ASU simplify the test for goodwill impairment by eliminating the second step in the assessment. All goodwill impairment tests performed during 2017 and 2018 have been performed under this new guidance. Each of the Company’s operating segments described in Note 19 to these condensed consolidated financial statements represents an individual reporting unit for goodwill impairment testing purposes, except that each sovereign jurisdiction within the Company’s international operating segments is considered a separate reporting unit. Within the U.S. dialysis and related lab services operating segment, the Company considers each of its dialysis centers to constitute an individual business for which discrete financial information is available. However, since these dialysis centers have similar operating and economic characteristics, and the allocation of resources and significant investment decisions concerning these businesses are highly centralized and the benefits broadly distributed, the Company has aggregated these centers and deemed them to constitute a single reporting unit. The Company has applied a similar aggregation to the vascular access service centers in its vascular access reporting unit, to the physician practices in its physician services and direct primary care reporting units, and to the dialysis centers within each international reporting unit. For the Company’s other operating segments, discrete business components below the operating segment level constitute individual reporting units. During the three months ended March 31, 2018, the Company did not recognize any goodwill impairment charges. During the three months ended March 31, 2017, the Company recognized a goodwill impairment charge of $24,198 at the Company’s vascular access reporting unit. This charge resulted primarily from changes in the Company's outlook as the Company's partners and operators continued to evaluate potential changes in operations, including termination of their management services agreements and center closures, as a result of recent changes in Medicare reimbursement. There is no goodwill remaining at the Company's vascular access reporting unit. For the reporting units considered at risk as of December 31, 2017 listed in the table below, there have been no major changes in the business, prospects, or expected future results of these reporting units from their latest assessment date through March 31, 2018. Based on the most recent assessments, the Company determined that reductions in reimbursement rates, changes in actual or expected growth rates, or other significant adverse changes in expected future cash flows or valuation assumptions could result in goodwill impairment charges in the future for the following reporting units, which remain at risk of goodwill impairment as of March 31, 2018:
Except as described above, none of the Company's various other reporting units were considered at risk of significant goodwill impairment as of March 31, 2018. Since the dates of the Company's last annual goodwill impairment tests, there have been certain developments, events, changes in operating performance and other changes in key circumstances that have affected the Company's businesses. However, these changes did not cause management to believe it is more likely than not that the fair value of any of the Company's reporting units would be less than their respective carrying amounts as of March 31, 2018. |
Income taxes |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Income Tax Disclosure [Abstract] | |
Income taxes | Income taxes As of March 31, 2018, the Company’s total liability for unrecognized tax benefits relating to tax positions that do not meet the more-likely-than-not threshold was $33,880, all of which would impact the Company’s effective tax rate if recognized. This balance represents an increase of $1,104 from the December 31, 2017 balance of $32,776. The Company recognizes accrued interest and penalties related to unrecognized tax benefits in its income tax expense. At March 31, 2018 and December 31, 2017, the Company had approximately $3,971 and $4,195, respectively, accrued for interest and penalties related to unrecognized tax benefits, net of federal tax benefits. The Company performed a provisional analysis of the Tax Cuts and Jobs Act of 2017 (2017 Tax Act) and recorded a reasonable estimate of its effect for the year ended December 31, 2017. The Company is in the process of completing its analysis with respect to the 2017 Tax Act and will record any adjustments to its estimate on or before December 22, 2018, with any adjustments to be recorded to income tax expense in the period when the adjustments are determined. As of March 31, 2018, the Company has not made any material adjustments to the December 31, 2017 estimates. The 2018 effective tax rate reduction is primarily due to the impact of the 2017 Tax Act which reduced the federal tax rate from 35% to 21%. |
Long-term debt |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Long-term debt | Long-term debt Long-term debt was comprised of the following:
Scheduled maturities of long-term debt at March 31, 2018 were as follows:
On March 29, 2018, the Company entered into an Increase Joinder No. 1 (Increase Joinder Agreement) under its existing senior secured credit facilities. Pursuant to this Increase Joinder Agreement, the Company entered into an additional $995,000 Term Loan A-2. The new Term Loan A-2 bears interest at LIBOR plus an interest rate margin of 1.00%. As of March 31, 2018, the Company has initially drawn $452,000 of the Term Loan A-2, and the Company can draw up to an incremental $543,000 on Term Loan A-2 through its maturity date in June 2019. During the first three months of 2018, the Company made mandatory principal payments under its senior secured credit facilities totaling $25,000 on Term Loan A and $8,750 on Term Loan B. As of March 31, 2018, the Company maintains several active and forward interest rate cap agreements that have the economic effect of capping the Company's maximum exposure to LIBOR variable interest rate changes on specific portions of the Company's floating rate debt, as described below. The cap agreements are designated as cash flow hedges and, as a result, changes in the fair values of these cap agreements are reported in other comprehensive income. The amortization of the original cap premium is recognized as a component of debt expense on a straight-line basis over the terms of the cap agreements. The cap agreements do not contain credit-risk contingent features. As of March 31, 2018, the Company maintains several currently effective interest rate cap agreements that were entered into in November 2014 with notional amounts totaling $3,500,000. These cap agreements became effective September 30, 2016 and have the economic effect of capping the LIBOR variable component of the Company’s interest rate at a maximum of 3.50% on an equivalent amount of the Company’s debt. These cap agreements expire on June 30, 2018. As of March 31, 2018, these cap agreements had an immaterial fair value. During the three months ended March 31, 2018, the Company recognized debt expense of $2,070 from these caps. During the three months ended March 31, 2018, the Company recorded an immaterial loss in other comprehensive income due to a decrease in unrealized fair value of these cap agreements. As of March 31, 2018, the Company also maintains several forward interest rate cap agreements that were entered into in October 2015 with notional amounts totaling $3,500,000. These forward cap agreements will become effective June 29, 2018 and will have the economic effect of capping the LIBOR variable component of the Company’s interest rate at a maximum of 3.50% on an equivalent amount of its debt. These cap agreements expire on June 30, 2020. As of March 31, 2018, the total fair value of these cap agreements was an asset of approximately $2,446. During the three months ended March 31, 2018, the Company recorded a gain of $1,414 in other comprehensive income due to an increase in the unrealized fair value of these forward cap agreements. The following table summarizes the Company’s derivative instruments as of March 31, 2018 and December 31, 2017:
The following table summarizes the effects of the Company’s interest rate cap agreements for the three months ended March 31, 2018 and 2017:
As of March 31, 2018, the Company’s Term Loan B debt bears interest at LIBOR plus an interest rate margin of 2.75%. Term Loan B is subject to interest rate caps if LIBOR should rise above 3.50%. Term Loan A bears interest at LIBOR plus an interest rate margin of 2.00%. The capped portion of Term Loan A is $131,250 if LIBOR should rise above 3.50%. In addition, the uncapped portion of Term Loan A, which is subject to the variability of LIBOR, is $618,750. Term Loan A-2 is subject to the variability of LIBOR plus an interest rate margin of 1.00%. Interest rates on the Company’s senior notes are fixed by their terms. The Company’s weighted average effective interest rate on the senior secured credit facilities at the end of the quarter was 4.67%, based on the current margins in effect of 2.00% for Term Loan A, 1.00% for Term Loan A-2, and 2.75% for Term Loan B, as of March 31, 2018. The Company’s overall weighted average effective interest rate during the quarter ended March 31, 2018 was 4.87% and as of March 31, 2018 was 4.98%. As of March 31, 2018, the Company’s interest rates are fixed on approximately 51.34% of its total debt. As of March 31, 2018, the Company had undrawn revolving credit facilities totaling $1,000,000, of which approximately $14,355 was committed for outstanding letters of credit. The remaining amount is unencumbered. The Company also has approximately $22,351 of additional outstanding letters of credit related to its Kidney Care business and $211 of committed outstanding letters of credit related to DaVita Medical Group (DMG), which is backed by a certificate of deposit. |
Contingencies |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | Contingencies The majority of the Company’s revenues are from government programs and may be subject to adjustment as a result of: (i) examination by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (ii) differing interpretations of government regulations by different Medicare contractors or regulatory authorities; (iii) differing opinions regarding a patient’s medical diagnosis or the medical necessity of services provided; and (iv) retroactive applications or interpretations of governmental requirements. In addition, the Company’s revenues from commercial payors may be subject to adjustment as a result of potential claims for refunds, as a result of government actions or as a result of other claims by commercial payors. The Company operates in a highly regulated industry and is a party to various lawsuits, claims, qui tam suits, governmental investigations and audits (including investigations resulting from its obligation to self-report suspected violations of law) and other legal proceedings. The Company records accruals for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. As of March 31, 2018 and December 31, 2017, the Company’s total recorded accruals, including DMG, with respect to legal proceedings and regulatory matters, net of anticipated third party recoveries, were immaterial. While these accruals reflect the Company’s best estimate of the probable loss for those matters as of the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters, and any anticipated third party recoveries for any such losses may not ultimately be recoverable. Additionally, in some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal proceedings and regulatory matters, which also may be impacted by various factors, including that they may involve indeterminate claims for monetary damages or may involve fines, penalties or non-monetary remedies; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; are in the early stages of the proceedings; or result in a change of business practices. Further, there may be various levels of judicial review available to the Company in connection with any such proceeding. The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject. Inquiries by the Federal Government and Certain Related Civil Proceedings 2015 U.S. Office of Inspector General (OIG) Medicare Advantage Civil Investigation: In March 2015, JSA HealthCare Corporation (JSA), a subsidiary of DMG, received a subpoena from the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) requesting documents and information for the period from January 1, 2008 through December 31, 2013, for certain MA plans for which JSA provided services. It also requests information regarding JSA’s communications about patient diagnoses as they relate to certain MA plans generally, and more specifically as related to two Florida physicians with whom JSA previously contracted. The Company is producing the requested information and is cooperating with the government’s investigation. In addition to the subpoena described above, in June 2015, the Company received a civil subpoena from the OIG covering the period from January 1, 2008 through the present and seeking production of a wide range of documents relating to the Company’s and its subsidiaries’ (including DMG’s and its subsidiary JSA’s) provision of services to MA plans and related patient diagnosis coding and risk adjustment submissions and payments. The Company believes that the request is part of a broader industry investigation into MA patient diagnosis coding and risk adjustment practices and potential overpayments by the government. The information requested includes information relating to patient diagnosis coding practices for a number of conditions, including potentially improper historical DMG coding for a particular condition. With respect to that condition, the guidance related to that coding issue was discontinued following the Company’s November 1, 2012 acquisition of HealthCare Partners (now known as the Company's DMG business), and the Company notified Centers for Medicare and Medicaid Services (CMS) in April 2015 of the coding practice and potential overpayments. In that regard, the Company has identified certain additional coding practices which may have been problematic, some of which were the subject of the previously disclosed and dismissed Swoben Private Civil Suit, and is in discussions with the DOJ relating to those practices. The Company is cooperating with the government. In addition, the Company is continuing to review other DMG coding practices to determine whether there were any improper coding issues. In connection with the Company's acquisition of DMG in 2012, the Company has certain indemnification rights against the sellers and an escrow was established as security for the indemnification. The Company has submitted an indemnification claim against the sellers secured by the escrow for any and all liabilities incurred relating to these matters and intends to pursue recovery from the escrow. However, the Company can make no assurances that the indemnification and escrow will cover the full amount of the Company’s potential losses related to these matters. 2016 U.S. Attorney Texas Investigation: In early February 2016, the Company announced that its pharmacy services’ wholly-owned subsidiary, DaVita Rx, LLC, (DaVita Rx) received a Civil Investigative Demand (CID) from the U.S. Attorney’s Office for the Northern District of Texas. The government is conducting a federal False Claims Act (FCA) investigation concerning allegations that DaVita Rx presented or caused to be presented false claims for payment to the government for prescription medications, as well as into the Company’s relationship with pharmaceutical manufacturers. The CID covers the period from January 1, 2006 through the present. In the spring of 2015, the Company initiated an internal compliance review of DaVita Rx during which it identified potential billing and operational issues, including potential write-offs and discounts of patient co-payment obligations, and credits to payors for returns of prescription drugs related to DaVita Rx. The Company notified the government in September 2015 that it was conducting this review of DaVita Rx and began providing regular updates of its review. Upon completion of its review, the Company filed a self-disclosure with the OIG in February 2016 and has been working to address and update the practices it identified in the self-disclosure, some of which overlap with information requested by the U.S. Attorney’s Office. The OIG informed the Company in February 2016 that its submission was not accepted. They indicated that the OIG is not expressing an opinion regarding the conduct disclosed or the Company’s legal positions. In connection with the Company’s ongoing efforts working with the government the Company learned that a qui tam complaint had been filed covering some of the issues in the CID and the Company’s self-disclosure. In December 2017, the Company finalized and executed a settlement agreement with the government and relators in the qui tam matter and that included total monetary consideration of $63,700, as previously announced, of which $41,500 was an incremental cash payment and $22,200 was for amounts previously refunded, and all of which was previously accrued. The government’s investigation into the Company's relationship with pharmaceutical manufacturers is ongoing and the Company is continuing to cooperate with the government in this investigation. 2017 U.S. Attorney Massachusetts Investigation: In January 2017, the Company was served with an administrative subpoena for records by the United States Attorney’s Office, District of Massachusetts, relating to an investigation into possible federal health care offenses. The subpoena covers the period from January 1, 2007 through the present, and seeks documents relevant to charitable patient assistance organizations, particularly the American Kidney Fund, including documents related to efforts to provide patients with information concerning the availability of charitable assistance. The Company is cooperating with the government. 2017 U.S. Attorney Colorado Investigation: In November 2017, United States Attorney’s Office, District of Colorado informed the Company of an investigation it was conducting into possible federal health care offenses involving DaVita Kidney Care, as well as several of the Company's wholly-owned subsidiaries, including DMG, DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). There is overlap between the Colorado investigation and the other reported investigations concerning DMG and DaVita Rx. The Company is cooperating with the government. 2017 U.S. Attorney Florida Investigation: In November 2017, United States Attorney’s Office, Southern District of Florida informed the Company of an investigation it was conducting into possible federal healthcare offenses involving the Company's wholly-owned subsidiary, Lifeline. The Company is cooperating with the government. 2018 U.S. Attorney Florida Investigation: In March 2018, DaVita Labs, received two CIDs from the United States Attorney’s Office, Middle District of Florida that were identical in nature but directed to the two different labs. According to the face of the CIDs, the U.S. Attorney’s Office is conducting an investigation as to whether the Company's subsidiary submitted claims for blood, urine, and fecal testing, where there were insufficient test validation or stability studies to ensure accurate results, in violation of the False Claims Act. The Company is cooperating with the government. * * * Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as described above), it is not unusual for inquiries such as these to continue for a considerable period of time through the various phases of document and witness requests and on-going discussions with regulators and to develop over the course of time. In addition to the inquiries and proceedings specifically identified above, the Company frequently is subject to other inquiries by state or federal government agencies and/or private civil qui tam complaints filed by relators. Negative findings or terms and conditions that the Company might agree to accept as part of a negotiated resolution of pending or future government inquiries or relator proceedings could result in, among other things, substantial financial penalties or awards against the Company, substantial payments made by the Company, harm to the Company’s reputation, required changes to the Company’s business practices, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, possible criminal penalties, any of which could have a material adverse effect on the Company. Shareholder and Derivative Claims Peace Officers’ Annuity and Benefit Fund of Georgia Securities Class Action Civil Suit: On February 1, 2017, the Peace Officers’ Annuity and Benefit Fund of Georgia filed a putative federal securities class action complaint in the U.S. District Court for the District of Colorado against the Company and certain executives. The complaint covers the time period of August 2015 to October 2016 and alleges, generally, that the Company and its executives violated federal securities laws concerning the Company’s financial results and revenue derived from patients who received charitable premium assistance from an industry-funded non-profit organization. The complaint further alleges that the process by which patients obtained commercial insurance and received charitable premium assistance was improper and "created a false impression of DaVita’s business and operational status and future growth prospects." In November 2017, the court appointed the lead plaintiff and an amended complaint was filed on January 12, 2018. On March 27, 2018, the Company and various individual defendants filed a motion to dismiss. The Company disputes these allegations and intends to defend this action accordingly. In re DaVita Inc. Stockholder Derivative Litigation: On August 15, 2017, the U.S. District Court for the District of Delaware consolidated three previously disclosed shareholder derivative lawsuits: the Blackburn Shareholder action filed on February 10, 2017, the Gabilondo Shareholder action filed on May 30, 2017, and the City of Warren Police and Fire Retirement System Shareholder action filed on June 9, 2017. The complaint covers the time period from 2015 to present and alleges, generally, breach of fiduciary duty, unjust enrichment, abuse of control, gross mismanagement, corporate waste, and misrepresentations and/or failures to disclose certain information in violation of the federal securities laws in connection with an alleged practice to direct patients with government-subsidized health insurance into private health insurance plans to maximize the Company’s profits. An amended complaint was filed in September 2017, and on December 18, 2017 the Company filed a motion to dismiss and a motion to stay proceedings in the alternative. The plaintiffs filed an opposition to the motion to dismiss on March 9, 2018. The Company disputes these allegations and intends to defend this action accordingly. Other Proceedings In addition to the foregoing, from time to time the Company is subject to other lawsuits, demands, claims, governmental investigations and audits and legal proceedings that arise due to the nature of its business, including contractual disputes, such as with payors, suppliers and others, employee-related matters and professional and general liability claims. From time to time, the Company also initiates litigation or other legal proceedings as a plaintiff arising out of contracts or other matters. Resolved Matters 2011 Suit against the U.S. Department of Veterans Affairs: As previously disclosed, the Company had a pending lawsuit in the U.S. Court of Federal Claims against the federal government which was originally filed in May 2011. The lawsuit related to the U.S. Department of Veterans Affairs (VA) underpayment of dialysis services the Company provided from 2005 through 2011 to veterans pursuant to VA regulations. In the first quarter of 2017, the Company received a payment of $538,000 related to the settlement with the VA. The Company's consolidated entities recognized a net gain of $527,000 on this settlement. The Company's nonconsolidated and managed entities recognized a gain of $9,000, of which the Company's equity investment share was $3,000. The net effect was a net increase of $530,000 to the Company's operating income. * * * Other than as described above, the Company cannot predict the ultimate outcomes of the various legal proceedings and regulatory matters to which the Company is or may be subject from time to time, including those described in this Note 10 to these condensed consolidated financial statements, or the timing of their resolution or the ultimate losses or impact of developments in those matters, which could have a material adverse effect on the Company’s revenues, earnings and cash flows. Further, any legal proceedings or regulatory matters involving the Company, whether meritorious or not, are time consuming, and often require management’s attention and result in significant legal expense, and may result in the diversion of significant operational resources, or otherwise harm the Company’s business, financial results or reputation. |
Noncontrolling interests subject to put provisions and other commitments |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Commitments and Contingencies Disclosure [Abstract] | |
Noncontrolling interests subject to put provisions and other commitments | Noncontrolling interests subject to put provisions and other commitments The Company has potential obligations to purchase the equity interests held by third parties in several of its majority-owned joint ventures and other nonconsolidated entities. These obligations are in the form of put provisions that are exercisable at the third-party owners’ discretion within specified periods as outlined in each specific put provision. If these put provisions were exercised, the Company would be required to purchase the third-party owners’ equity interests at either the appraised fair market value or a predetermined multiple of earnings or cash flows attributable to the equity interests put to the Company, which is intended to approximate fair value. The methodology the Company uses to estimate the fair values of noncontrolling interests subject to put provisions assumes the higher of either a liquidation value of net assets or an average multiple of earnings, based on historical earnings, patient mix and other performance indicators that can affect future results, as well as other factors. The estimated fair values of noncontrolling interests subject to put provisions are a critical accounting estimate that involves significant judgments and assumptions and may not be indicative of the actual values at which the noncontrolling interests may ultimately be settled, which could vary significantly from the Company’s current estimates. The estimated fair values of noncontrolling interests subject to put provisions can fluctuate and the implicit multiple of earnings at which these noncontrolling interests obligations may be settled will vary significantly depending upon market conditions including potential purchasers’ access to the capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses, the economic performance of these businesses and the restricted marketability of the third-party owners’ equity interests. The amount of noncontrolling interests subject to put provisions that employ a contractually predetermined multiple of earnings rather than fair value are immaterial. The Company has certain other potential commitments to provide operating capital to a number of dialysis centers that are wholly-owned by third parties or businesses in which the Company maintains a noncontrolling equity interest as well as to physician-owned vascular access clinics or medical practices that the Company operates under management and administrative services agreements of approximately $5,542. Certain consolidated joint ventures are originally contractually scheduled to dissolve after terms ranging from 10 to 50 years. While noncontrolling interests in these limited life entities qualify as mandatorily redeemable financial instruments, they are subject to a classification and measurement scope exception from the accounting guidance generally applicable to other mandatorily redeemable financial instruments. Future distributions upon dissolution of these entities would be valued below the related noncontrolling interest carrying balances in the consolidated balance sheet. |
Long-term incentive compensation |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |
Long-term incentive compensation | Long-term incentive compensation Long-term incentive program (LTIP) compensation includes both stock-based awards (principally stock-settled stock appreciation rights, restricted stock units, and performance stock units) as well as long-term performance-based cash awards. Long-term incentive compensation expense, which was primarily general and administrative in nature, was attributed to the Company’s U.S. dialysis and related lab services business, corporate administrative support, and ancillary services and strategic initiatives. The Company’s stock-based compensation awards are measured at their estimated fair values on the date of grant if settled in shares or at their estimated fair values at the end of each reporting period if settled in cash. The value of stock-based awards so measured is recognized as compensation expense on a cumulative straight-line basis over the vesting terms of the awards, adjusted for expected forfeitures. During the three months ended March 31, 2018, the Company granted 11 stock-settled stock appreciation rights with an aggregate grant-date fair value of $200 and a weighted-average expected life of approximately 3.7 years and 60 stock units with an aggregate grant-date fair value of $3,995 and a weighted-average expected life of approximately 1.0 years. For the three months ended March 31, 2018 and 2017, the Company recognized $15,215 and $15,254, respectively, in total LTIP expense, of which $9,155 and $8,425, respectively, represented stock-based compensation expense for stock appreciation rights, restricted stock units, and discounted employee stock plan purchases, which are primarily included in general and administrative expense. The estimated tax benefits recorded for stock-based compensation for the three months ended March 31, 2018 and 2017 was $2,088 and $2,922, respectively. As of March 31, 2018, the Company had $91,823 of total estimated but unrecognized compensation expense for outstanding LTIP awards, including $62,013 related to stock-based compensation arrangements under the Company’s equity compensation and employee stock purchase plans. The Company expects to recognize the performance-based cash component of these LTIP costs over a weighted average remaining period of 1.1 years and the stock-based component of these LTIP costs over a weighted average remaining period of 1.3 years. For the three months ended March 31, 2018 and 2017, the Company recognized $4,895 and $1,091, respectively, in actual tax benefits upon the exercise of stock awards. |
Share repurchases |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Equity [Abstract] | |
Share repurchases | Share repurchases During the three months ended March 31, 2018, the Company repurchased a total of 4,197 shares of its common stock for $298,377 at an average price of $71.09 per share. The Company also repurchased 4,350 shares of its common stock for $275,992 at an average price of $63.44 per share, subsequent to March 31, 2018 through May 2, 2018. On October 10, 2017, the Company's Board of Directors approved an additional share repurchase authorization in the amount of $1,252,961. This share repurchase authorization was in addition to the $247,039 remaining at that time under the Company’s Board of Directors’ prior share repurchase authorization announced in July 2016. Accordingly, as of May 2, 2018, the Company has a total of $544,747 available under the current Board repurchase authorizations for additional share repurchases. Although these share repurchase authorizations do not have expiration dates, the Company remains subject to share repurchase limitations under the terms of its senior secured credit facilities and the indentures governing its senior notes. |
Comprehensive income |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Statement of Comprehensive Income [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Comprehensive income | Other comprehensive income
Net realized losses on interest rate cap agreements that are reclassified into income are recorded as debt expense in the corresponding consolidated statements of operations. See Note 9 to these condensed consolidated financial statements for further details. Net realized gains on investment securities reclassified into income for the three months ended March 31, 2017 were recognized in other income in the corresponding consolidated statements of operations. See Note 5 to these condensed consolidated financial statements for further details. |
Acquisitions and divestitures |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Business Combinations [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Acquisitions and divestitures | Acquisitions and divestitures Routine acquisitions During the three months ended March 31, 2018, the Company acquired dialysis businesses consisting of one dialysis center located in the U.S. and four dialysis centers located outside the U.S. for a total of $15,677 in net cash, $655 in deferred purchase price obligations, and $2,408 in liabilities assumed. The assets and liabilities for these acquisitions were recorded at their estimated fair values at the dates of the acquisitions and are included in the Company’s condensed consolidated financial statements, as are their operating results, from the designated effective dates of the acquisitions. The initial purchase price allocations for these transactions have been recorded at estimated fair values based on the best information available to management and will be finalized when certain information arranged to be obtained has been received. In particular, certain income tax amounts are pending final evaluation and quantification of pre-acquisition tax contingencies and filing of final tax returns. In addition, valuation of certain working capital items, fixed assets and intangibles are pending final audits and related valuation reports. The following table summarizes the assets acquired and liabilities assumed in these transactions at their estimated acquisition date fair values:
Amortizable intangible assets acquired during the first three months of 2018 primarily represent non-compete agreements which had weighted-average estimated useful lives of approximately five years. The total estimated amount of goodwill deductible for tax purposes associated with these acquisitions was approximately $15,383. Contingent earn-out obligations The Company has several contingent earn-out obligations associated with acquisitions that could result in the Company paying the former owners of acquired companies a total of up to $11,555 if certain EBITDA, operating income performance targets or quality margins are met primarily over the next one to six years. Contingent earn-out obligations are remeasured at fair value at each reporting date until the contingencies are resolved with changes in the liability due to the remeasurement recorded in earnings. See Note 18 to these condensed consolidated financial statements for further details. As of March 31, 2018, the Company has estimated the fair value of these contingent earn-out obligations to be $6,562, of which a total of $222 is included in other liabilities and the remaining $6,340 is included in other long-term liabilities in the Company’s consolidated balance sheet. The following is a reconciliation of changes in liabilities for contingent earn-out obligations:
|
Held for Sale and Discontinued Operations Held for Sale and Discontinued Operations |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Held for Sale and Discontinued Operations [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Disposal Groups, Including Discontinued Operations, Disclosure [Text Block] | Held for sale and discontinued operations DaVita Medical Group In December 2017, the Company entered into an equity purchase agreement to sell its DMG division to Collaborative Care Holdings, LLC (Optum), a subsidiary of UnitedHealth Group Inc., for $4,900,000 in cash, subject to net working capital and other customary adjustments. The transaction is expected to close in 2018 and is subject to regulatory approvals and other customary closing conditions. As a result of this pending transaction, the DMG business has been classified as held for sale and its results of operations are reported as discontinued operations for all periods presented. The following table presents the financial results of discontinued operations related to DMG:
The following table presents the financial position of discontinued operations related to DMG:
The following table presents cash flows of discontinued operations related to DMG:
DMG acquisitions During the first quarter of 2018, the Company's DMG business acquired one medical business for a total of $905 in cash and deferred purchase price of $99. Certain income tax amounts are pending final evaluation and quantification of any pre-acquisition tax contingencies. In addition, valuation of medical claims liabilities and certain other working capital items relating to acquisitions are pending final quantification. The assets and liabilities for all acquisitions were recorded at their estimated fair values at the dates of the acquisitions and are included in the Company’s current held for sale assets and liabilities. |
Variable interest entities |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Variable interest entities | Variable interest entities The Company relies on the operating activities of certain legal entities that it does not directly own or control, but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to the consolidation guidance applicable to variable interest entities (VIEs). Under U.S. generally accepted accounting principles (GAAP), VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The Company has determined that substantially all of the legal entities it is associated with that qualify as VIEs must be included in its consolidated financial statements. A number of these VIEs are within the Company's DMG business, which is classified as held for sale and as a discontinued operation in these condensed consolidated financial statements. The Company manages these entities and provides operating and capital funding as necessary for these entities to accomplish their operational and strategic objectives. A number of these entities are subject to nominee share ownership or share transfer restriction agreements that effectively transfer the majority of the economic risks and rewards of their ownership to the Company. In other cases the Company’s management agreements with these entities include both financial terms and protective and participating rights to the entities’ operating, strategic and non-clinical governance decisions which transfer substantial powers over and economic responsibility for the entities to the Company. In some cases such entities are subject to broad exclusivity or noncompetition restrictions that benefit the Company. Further, in some cases the Company has contractual arrangements with its related party nominee owners that effectively indemnify these parties from the economic losses from, or entitle the Company to the economic benefits of, these entities. The analyses upon which these consolidation determinations rest are complex, involve uncertainties, and require significant judgment on various matters, some of which could be subject to different interpretations. At March 31, 2018, these condensed consolidated financial statements include total assets of VIEs of $852,912 and total liabilities and noncontrolling interests of VIEs to third parties of $507,962, including assets of $580,039 and liabilities and noncontrolling interests of $345,926 related to the Company's DMG business classified as held for sale. The Company also sponsors certain deferred compensation plans whose trusts qualify as VIEs and the Company consolidates these plans as their primary beneficiary. The assets of these plans are recorded in short-term or long-term investments with matching offsetting liabilities recorded in accrued compensation and benefits and other long-term liabilities. See Note 5 to these condensed consolidated financial statements for disclosures on the assets of these consolidated non-qualified deferred compensation plans. |
Fair value of financial instruments |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fair Value Disclosures [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fair value of financial instruments | Fair values of financial instruments The Company measures the fair value of certain assets, liabilities and noncontrolling interests subject to put provisions (temporary equity) based upon certain valuation techniques that include observable or unobservable inputs and assumptions that market participants would use in pricing these assets, liabilities, temporary equity and commitments. The Company has also classified certain assets, liabilities and temporary equity that are measured at fair value into the appropriate fair value hierarchy levels as defined by the FASB. The following table summarizes the Company’s assets, liabilities and temporary equity that are measured at fair value on a recurring basis as of March 31, 2018:
Investments in mutual funds and common stock represent equity securities that are recorded at estimated fair value based upon quoted redemption prices reported by each mutual fund. See Note 5 to these condensed consolidated financial statements for further discussion. Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 9 to these condensed consolidated financial statements for further discussion. The estimated fair value of contingent earn-out obligations are primarily based on unobservable inputs including projected EBITDA. The estimated fair value of these contingent earn-out obligations is remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company credit risk-adjusted rate that is used to discount the obligations to present value. See Note 15 to these condensed consolidated financial statements for further discussion. See Note 11 to these condensed consolidated financial statements for a discussion of the Company’s methodology for estimating the fair value of noncontrolling interests subject to put obligations. The carrying balance of the Company’s senior secured credit facilities totaled $4,546,990 as of March 31, 2018, and the fair value was approximately $4,616,019 based upon quoted market prices, a level 2 input. The carrying balance of the Company’s senior notes was $4,461,802 as of March 31, 2018 and their fair value was approximately $4,433,500, based upon quoted market prices, a level 2 input. Other financial instruments consist primarily of cash and cash equivalents, accounts receivable, accounts payable, other accrued liabilities and debt. The balances of the Company's financial instruments other than the senior secured credit facilities and the senior notes are presented in the condensed consolidated financial statements at March 31, 2018 at their approximate fair values due to the short-term nature of their settlements. |
Segment reporting |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Segment Reporting [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Segment reporting | Segment reporting The Company has consisted of two major divisions, DaVita Kidney Care (Kidney Care) and DMG. The Kidney Care division is comprised of the Company’s U.S. dialysis and related lab services business, various ancillary services and strategic initiatives, including its international operations, and the Company’s corporate administrative support. The Company’s U.S. dialysis and related lab services business is its largest line of business and is a leading provider of kidney dialysis services in the U.S. for patients suffering from chronic kidney failure, also known as ESRD. The Company’s ancillary services and strategic initiatives consist primarily of pharmacy services, disease management services, vascular access services, clinical research programs, physician services, direct primary care, ESRD seamless care organizations and comprehensive care, as well as the Company’s international operations. The Company’s DMG division is a patient- and physician-focused integrated healthcare delivery and management company with over two decades of providing coordinated outcomes-based medical care in a cost-effective manner. In December 2017, the Company entered into an equity purchase agreement to sell its DMG division to Optum, a subsidiary of UnitedHealth Group Inc. The transaction is expected to close in 2018 and is subject to regulatory approvals and other customary closing conditions. As a result of this pending transaction, the DMG business has been classified as held for sale and its results of operations are reported as discontinued operations for all periods presented in these condensed consolidated financial statements. See Note 16 to these condensed consolidated financial statements for further discussion. The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer. The Company’s separate operating segments include its U.S. dialysis and related lab services business, each of its ancillary services and strategic initiatives, its consolidated international kidney care operations in each country and under the Saudi Ministry of Health charter, its equity method investment in the Asia Pacific joint venture, and its other health operations in Europe. The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other ancillary services and strategic initiatives operating segments, including the international operating segments, have been combined and disclosed in the other segments category. The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to allocate resources and assess the financial performance of the Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive-based compensation expenses of certain departments which provide support to all of the Company’s various operating lines of business, except to the extent that such costs are charged to and borne by certain ancillary services and strategic initiatives via internal management fees. These corporate administrative support costs are reduced by internal management fees received from the Company’s ancillary lines of business. The following is a summary of segment net revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes:
Depreciation and amortization expense by reportable segment was as follows:
Assets by reportable segment were as follows:
Expenditures for property and equipment by reportable segment were as follows:
|
Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Noncontrolling Interest [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries | Changes in DaVita Inc.’s ownership interest in consolidated subsidiaries The effects of changes in DaVita Inc.’s ownership interest in consolidated subsidiaries on the Company’s equity were as follows:
|
New accounting standards |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Accounting Changes and Error Corrections [Abstract] | |
New accounting standards | New accounting standards On May 28, 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606), which requires an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised goods or services to customers. In 2015, 2016 and 2017, the FASB issued ASU 2015-14, ASU 2016-08, ASU 2016-10, ASU 2016-11, ASU 2016-12, and ASU 2017-10, each of which amends the guidance in ASU 2014-09. These ASUs replaced most existing revenue recognition guidance in GAAP. The Company adopted these ASUs beginning January 1, 2018. See Note 2 for further details. In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments - Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities. In February 2018, the FASB issued ASU 2018-03, which provides various related technical corrections and improvements. The Company adopted these ASUs beginning January 1, 2018. See Note 5 for further details. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842). The amendments in this ASU revise the accounting related to lessee accounting. Under the new guidance, lessees will be required to recognize a lease liability and a right-of-use asset for substantially all leases with lease terms in excess of twelve months. The new lease guidance also simplifies the accounting for sale and leaseback transactions primarily because lessees must recognize lease assets and lease liabilities. The amendments in this ASU are effective for the Company beginning on January 1, 2019 and are to be applied through a modified retrospective transition approach for leases existing at, or entered into after, the beginning of the earliest comparative period presented in the financial statements. Early adoption is permitted. The Company has assembled an internal lease task force that meets regularly to discuss and evaluate the overall impact of this guidance on its consolidated financial statements and related disclosures, as well as the expected timing of adoption. The Company is currently gathering and evaluating information from its existing leases and believes that the new standard will have a material impact on its consolidated balance sheet but will not have a material impact on its results of operations or liquidity. The Company expects to adopt this ASU on January 1, 2019, and continues to evaluate the effect that the implementation of this ASU will have on its consolidated financial statements, related disclosures and controls. In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments. The amendments in this ASU clarify how certain cash receipts and cash payments should be classified on the statement of cash flows. In November 2016, the FASB issued ASU No. 2016-18, Statement of Cash Flows (Topic 230): Restricted cash. The amendments in this ASU require that the statement of cash flows explains the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. The adoption of these ASUs did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2018. In October 2016, the FASB issued ASU No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory. The amendments in this ASU allow entities to recognize the income tax consequences of an intra-entity transfer of an asset other than inventory when the transfer occurs. The current guidance does not allow recognition until the asset has been sold to an outside party. The amendments in this ASU are effective for the Company beginning on January 1, 2018 and are to be applied on a modified retrospective basis. The adoption of this ASU did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2018. In August 2017, the FASB issued ASU No. 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. The amendments in this ASU better align an entity’s risk management activities and financial reporting for hedging relationships through changes to both the designation and measurement guidance for qualifying hedging relationships and the presentation of hedge results. The amendments in the new ASU are effective for the Company on January 1, 2019 and are to be applied prospectively. The adoption of this ASU is not expected to have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2019. In February 2018, the FASB issued ASU No. 2018-02, Income Statement - Reporting Comprehensive Income (Topic 220), Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income, which allows for the reclassification of certain income tax effects related to the Tax Cuts and Jobs Act between “Accumulated other comprehensive income” and “Retained earnings.” This ASU relates to the requirement that adjustments to deferred tax liabilities and assets related to a change in tax laws or rates to be included in “Income from continuing operations”, even in situations where the related items were originally recognized in “Other comprehensive income” (rather than in “Income from continuing operations”). The amendments in this ASU are effective for all entities for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years, with early adoption permitted. The Company elected to early adopt this ASU on January 1, 2018 and applied the change in the period of adoption. The adoption of this ASU resulted in the reclassification of an immaterial amount of deferred tax effects from accumulated other comprehensive income to retained earnings via accumulative change in accounting principle effective January 1, 2018. See Note 14 for more details. |
Condensed consolidating financial statements |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed consolidating financial statements | Condensed consolidating financial statements The following information is presented in accordance with Rule 3-10 of Regulation S-X. The operating and investing activities of the separate legal entities included in the Company’s condensed consolidated financial statements are fully interdependent and integrated. Revenues and operating expenses of the separate legal entities include intercompany charges for management and other administrative services. The Company’s senior notes are guaranteed by a substantial majority of its domestic subsidiaries as measured by revenue, income and assets. The subsidiary guarantors have guaranteed the senior notes on a joint and several basis. However, a subsidiary guarantor will be released from its obligations under its guarantee of the senior notes and the indentures governing the senior notes if, in general, there is a sale or other disposition of all or substantially all of the assets of such subsidiary guarantor, including by merger or consolidation, or a sale or other disposition of all of the equity interests in such subsidiary guarantor held by the Company and its restricted subsidiaries, as defined in the indentures; such subsidiary guarantor is designated by the Company as an unrestricted subsidiary, as defined in the indentures, or otherwise ceases to be a restricted subsidiary of the Company, in each case in accordance with the indentures; or such subsidiary guarantor no longer guarantees any other indebtedness, as defined in the indentures, of the Company or any of its restricted subsidiaries, except for guarantees that are contemporaneously released. The senior notes are not guaranteed by certain of the Company’s domestic subsidiaries, any of the Company’s foreign subsidiaries, or any entities that do not constitute subsidiaries within the meaning of the indentures, such as corporations in which the Company holds capital stock with less than a majority of the voting power, joint ventures and partnerships in which the Company holds less than a majority of the equity or voting interests, non-owned entities and third parties. Condensed Consolidating Statements of Operations
Condensed Consolidating Statements of Comprehensive Income
Condensed Consolidating Balance Sheets
Condensed Consolidating Statements of Cash Flows
|
Supplemental data |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Supplemental data | Supplemental data The following information is presented as supplemental data as required by the indentures governing the Company’s senior notes. Condensed Consolidating Statements of Income
Condensed Consolidating Statements of Comprehensive Income
Condensed Consolidating Balance Sheets
Condensed Consolidating Statements of Cash Flows
|
Condensed consolidated interim financial statements (Policies) |
3 Months Ended |
---|---|
Mar. 31, 2018 | |
Accounting Policies [Abstract] | |
Condensed consolidated interim financial statements | The condensed consolidated interim financial statements included in this report are prepared by the Company without audit. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these condensed consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, contingencies, impairments of goodwill and investments, accounting for income taxes, long-term variable compensation accruals, consolidation of variable interest entities and certain fair value estimates. The results of operations for the three months ended March 31, 2018 are not necessarily indicative of the operating results for the full year. The condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2017. Prior year balances and amounts have been reclassified to conform to the current year presentation. The Company has evaluated subsequent events through the date these condensed consolidated financial statements were issued and has included all necessary adjustments and disclosures. |
Earnings per share | Basic earnings per share is calculated by dividing net income attributable to the Company, adjusted for any change in noncontrolling interests redemption rights in excess of fair value, by the weighted average number of common shares, net of shares held in escrow that under certain circumstances may be returned to the Company. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights (SSARs) and unvested stock units (under the treasury stock method) as well as shares held in escrow that the Company expects will remain outstanding. |
Investments in debt and equity securities | From January 1, 2018, equity securities that have readily determinable fair values or redemption values are recorded at estimated fair value with changes in their value recognized in current earnings. The Company classifies its debt securities as held-to-maturity and records them at amortized cost based on its intentions and strategy concerning those investments. The Company classifies these debt and equity investments as "Short-term investments" or "Long-term investments" on its consolidated balance sheet, as applicable, based on the characteristics of the financial instrument or the Company's intentions or expectations for the investment. |
Income taxes | The Company recognizes accrued interest and penalties related to unrecognized tax benefits in its income tax expense. |
Long-term debt | the Company maintains several active and forward interest rate cap agreements that have the economic effect of capping the Company's maximum exposure to LIBOR variable interest rate changes on specific portions of the Company's floating rate debt, as described below. The cap agreements are designated as cash flow hedges and, as a result, changes in the fair values of these cap agreements are reported in other comprehensive income. The amortization of the original cap premium is recognized as a component of debt expense on a straight-line basis over the terms of the cap agreements. The cap agreements do not contain credit-risk contingent features. |
Noncontrolling interests subject to put provisions and other commitments | The Company has potential obligations to purchase the equity interests held by third parties in several of its majority-owned joint ventures and other nonconsolidated entities. These obligations are in the form of put provisions that are exercisable at the third-party owners’ discretion within specified periods as outlined in each specific put provision. If these put provisions were exercised, the Company would be required to purchase the third-party owners’ equity interests at either the appraised fair market value or a predetermined multiple of earnings or cash flows attributable to the equity interests put to the Company, which is intended to approximate fair value. The methodology the Company uses to estimate the fair values of noncontrolling interests subject to put provisions assumes the higher of either a liquidation value of net assets or an average multiple of earnings, based on historical earnings, patient mix and other performance indicators that can affect future results, as well as other factors. The estimated fair values of noncontrolling interests subject to put provisions are a critical accounting estimate that involves significant judgments and assumptions and may not be indicative of the actual values at which the noncontrolling interests may ultimately be settled, which could vary significantly from the Company’s current estimates. The estimated fair values of noncontrolling interests subject to put provisions can fluctuate and the implicit multiple of earnings at which these noncontrolling interests obligations may be settled will vary significantly depending upon market conditions including potential purchasers’ access to the capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses, the economic performance of these businesses and the restricted marketability of the third-party owners’ equity interests. The amount of noncontrolling interests subject to put provisions that employ a contractually predetermined multiple of earnings rather than fair value are immaterial. |
Long-term incentive compensation | The Company’s stock-based compensation awards are measured at their estimated fair values on the date of grant if settled in shares or at their estimated fair values at the end of each reporting period if settled in cash. The value of stock-based awards so measured is recognized as compensation expense on a cumulative straight-line basis over the vesting terms of the awards, adjusted for expected forfeitures. |
Comprehensive income | Net realized losses on interest rate cap agreements that are reclassified into income are recorded as debt expense in the corresponding consolidated statements of operations. See Note 9 to these condensed consolidated financial statements for further details. Net realized gains on investment securities reclassified into income for the three months ended March 31, 2017 were recognized in other income in the corresponding consolidated statements of operations. See Note 5 to these condensed consolidated financial statements for further details. |
Variable interest entities | The Company relies on the operating activities of certain legal entities that it does not directly own or control, but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to the consolidation guidance applicable to variable interest entities (VIEs). Under U.S. generally accepted accounting principles (GAAP), VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The Company has determined that substantially all of the legal entities it is associated with that qualify as VIEs must be included in its consolidated financial statements. A number of these VIEs are within the Company's DMG business, which is classified as held for sale and as a discontinued operation in these condensed consolidated financial statements. The Company manages these entities and provides operating and capital funding as necessary for these entities to accomplish their operational and strategic objectives. A number of these entities are subject to nominee share ownership or share transfer restriction agreements that effectively transfer the majority of the economic risks and rewards of their ownership to the Company. In other cases the Company’s management agreements with these entities include both financial terms and protective and participating rights to the entities’ operating, strategic and non-clinical governance decisions which transfer substantial powers over and economic responsibility for the entities to the Company. In some cases such entities are subject to broad exclusivity or noncompetition restrictions that benefit the Company. Further, in some cases the Company has contractual arrangements with its related party nominee owners that effectively indemnify these parties from the economic losses from, or entitle the Company to the economic benefits of, these entities. The analyses upon which these consolidation determinations rest are complex, involve uncertainties, and require significant judgment on various matters, some of which could be subject to different interpretations. |
Fair value of financial instruments | Investments in mutual funds and common stock represent equity securities that are recorded at estimated fair value based upon quoted redemption prices reported by each mutual fund. See Note 5 to these condensed consolidated financial statements for further discussion. Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 9 to these condensed consolidated financial statements for further discussion. The estimated fair value of contingent earn-out obligations are primarily based on unobservable inputs including projected EBITDA. The estimated fair value of these contingent earn-out obligations is remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company credit risk-adjusted rate that is used to discount the obligations to present value. |
New accounting standards | On May 28, 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606), which requires an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised goods or services to customers. In 2015, 2016 and 2017, the FASB issued ASU 2015-14, ASU 2016-08, ASU 2016-10, ASU 2016-11, ASU 2016-12, and ASU 2017-10, each of which amends the guidance in ASU 2014-09. These ASUs replaced most existing revenue recognition guidance in GAAP. The Company adopted these ASUs beginning January 1, 2018. See Note 2 for further details. In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments - Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities. In February 2018, the FASB issued ASU 2018-03, which provides various related technical corrections and improvements. The Company adopted these ASUs beginning January 1, 2018. See Note 5 for further details. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842). The amendments in this ASU revise the accounting related to lessee accounting. Under the new guidance, lessees will be required to recognize a lease liability and a right-of-use asset for substantially all leases with lease terms in excess of twelve months. The new lease guidance also simplifies the accounting for sale and leaseback transactions primarily because lessees must recognize lease assets and lease liabilities. The amendments in this ASU are effective for the Company beginning on January 1, 2019 and are to be applied through a modified retrospective transition approach for leases existing at, or entered into after, the beginning of the earliest comparative period presented in the financial statements. Early adoption is permitted. The Company has assembled an internal lease task force that meets regularly to discuss and evaluate the overall impact of this guidance on its consolidated financial statements and related disclosures, as well as the expected timing of adoption. The Company is currently gathering and evaluating information from its existing leases and believes that the new standard will have a material impact on its consolidated balance sheet but will not have a material impact on its results of operations or liquidity. The Company expects to adopt this ASU on January 1, 2019, and continues to evaluate the effect that the implementation of this ASU will have on its consolidated financial statements, related disclosures and controls. In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments. The amendments in this ASU clarify how certain cash receipts and cash payments should be classified on the statement of cash flows. In November 2016, the FASB issued ASU No. 2016-18, Statement of Cash Flows (Topic 230): Restricted cash. The amendments in this ASU require that the statement of cash flows explains the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. The adoption of these ASUs did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2018. In October 2016, the FASB issued ASU No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory. The amendments in this ASU allow entities to recognize the income tax consequences of an intra-entity transfer of an asset other than inventory when the transfer occurs. The current guidance does not allow recognition until the asset has been sold to an outside party. The amendments in this ASU are effective for the Company beginning on January 1, 2018 and are to be applied on a modified retrospective basis. The adoption of this ASU did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2018. In August 2017, the FASB issued ASU No. 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. The amendments in this ASU better align an entity’s risk management activities and financial reporting for hedging relationships through changes to both the designation and measurement guidance for qualifying hedging relationships and the presentation of hedge results. The amendments in the new ASU are effective for the Company on January 1, 2019 and are to be applied prospectively. The adoption of this ASU is not expected to have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2019. In February 2018, the FASB issued ASU No. 2018-02, Income Statement - Reporting Comprehensive Income (Topic 220), Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income, which allows for the reclassification of certain income tax effects related to the Tax Cuts and Jobs Act between “Accumulated other comprehensive income” and “Retained earnings.” This ASU relates to the requirement that adjustments to deferred tax liabilities and assets related to a change in tax laws or rates to be included in “Income from continuing operations”, even in situations where the related items were originally recognized in “Other comprehensive income” (rather than in “Income from continuing operations”). The amendments in this ASU are effective for all entities for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years, with early adoption permitted. The Company elected to early adopt this ASU on January 1, 2018 and applied the change in the period of adoption. The adoption of this ASU resulted in the reclassification of an immaterial amount of deferred tax effects from accumulated other comprehensive income to retained earnings via accumulative change in accounting principle effective January 1, 2018. See Note 14 for more details. |
Revenue Recognition Segment revenue by major payor (Tables) |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Revenues by major payor [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Revenue Sources, Health Care Organization [Table Text Block] | The following table summarizes the Company's segment revenues by primary payor source:
|
Earnings per share (Tables) |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Earnings Per Share [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Earnings Per Share | The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows:
|
Investments in debt and equity securities (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Investments, Debt and Equity Securities [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Investments | The Company’s investments in these short-term and long-term debt and equity investments consist of the following:
|
Goodwill (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Goodwill and Intangible Assets Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Changes in Goodwill by Reportable Segments | Changes in goodwill by reportable segment were as follows:
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Schedule of Reporting Units Goodwill Balances |
|
Long-term debt (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Debt Disclosure [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Long-term Debt | Long-term debt was comprised of the following:
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Scheduled Maturities of Long-term Debt | Scheduled maturities of long-term debt at March 31, 2018 were as follows:
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Derivative Instruments | The following table summarizes the Company’s derivative instruments as of March 31, 2018 and December 31, 2017:
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Effects of Interest Rate Swap and Cap Agreements | The following table summarizes the effects of the Company’s interest rate cap agreements for the three months ended March 31, 2018 and 2017:
|
Comprehensive income (Tables) |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Statement of Comprehensive Income [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Comprehensive income |
|
Acquisitions and divestitures (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||
Business Acquisition [Line Items] | |||||||||||||||||||||||||||||||||||||
Reconciliation of Changes in Contingent Earn-Out Obligations | The following is a reconciliation of changes in liabilities for contingent earn-out obligations:
|
||||||||||||||||||||||||||||||||||||
Dialysis and other businesses | |||||||||||||||||||||||||||||||||||||
Business Acquisition [Line Items] | |||||||||||||||||||||||||||||||||||||
Assets Acquired and Liabilities Assumed in Business Acquisitions | The following table summarizes the assets acquired and liabilities assumed in these transactions at their estimated acquisition date fair values:
|
Held for Sale and Discontinued Operations (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Discontinued Operations and Disposal Groups [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Disposal Groups, Including Discontinued Operations [Table Text Block] | The following table presents the financial results of discontinued operations related to DMG:
The following table presents the financial position of discontinued operations related to DMG:
The following table presents cash flows of discontinued operations related to DMG:
|
Fair value of financial instruments (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Fair Value Disclosures [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis | The following table summarizes the Company’s assets, liabilities and temporary equity that are measured at fair value on a recurring basis as of March 31, 2018:
|
Segment reporting (Tables) |
3 Months Ended | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Segment Reporting [Abstract] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes | The following is a summary of segment net revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summary of Depreciation and Amortization Expense by Reportable Segment | Depreciation and amortization expense by reportable segment was as follows:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summary of Assets by Reportable Segment | Assets by reportable segment were as follows:
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summary of Expenditures for Property and Equipment by Reportable Segment | Expenditures for property and equipment by reportable segment were as follows:
|
Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Noncontrolling Interest [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Effects of Changes in DaVita Inc's Ownership Interest on Company's Equity | The effects of changes in DaVita Inc.’s ownership interest in consolidated subsidiaries on the Company’s equity were as follows:
|
Condensed Consolidating financial statements (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed Consolidating Statements of Operations | Condensed Consolidating Statements of Operations
Condensed Consolidating Statements of Income
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed Consolidating Statements of Comprehensive Income | Condensed Consolidating Statements of Comprehensive Income
Condensed Consolidating Statements of Comprehensive Income
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed Consolidating Balance Sheets | Condensed Consolidating Balance Sheets
Condensed Consolidating Balance Sheets
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed Consolidating Statements of Cash Flows | Condensed Consolidating Statements of Cash Flows
Condensed Consolidating Statements of Cash Flows
|
Supplemental Data (Tables) |
3 Months Ended | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mar. 31, 2018 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed Consolidating Statements of Operations | Condensed Consolidating Statements of Operations
Condensed Consolidating Statements of Income
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed Consolidating Statements of Comprehensive Income | Condensed Consolidating Statements of Comprehensive Income
Condensed Consolidating Statements of Comprehensive Income
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed Consolidating Balance Sheets | Condensed Consolidating Balance Sheets
Condensed Consolidating Balance Sheets
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Condensed Consolidating Statements of Cash Flows | Condensed Consolidating Statements of Cash Flows
Condensed Consolidating Statements of Cash Flows
|
Revenue Recognition Revenue Recognition (Detail) - USD ($) $ in Thousands |
3 Months Ended | ||
---|---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
Dec. 31, 2017 |
|
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] | |||
Allowance for Doubtful Accounts Receivable | $ 162,516 | $ 218,399 | |
Contract with Customer, Performance Obligation Satisfied in Previous Period | 67,410 | ||
Provision for uncollectible accounts | (25,545) | $ 107,058 | |
Difference between Revenue Guidance in Effect before and after Topic 606 [Member] | |||
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] | |||
Contract with Customer, Performance Obligation Satisfied in Previous Period | $ 24,000 | ||
Medicare | |||
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] | |||
Percent of revenue paid by a payor | 80.00% |
Restricted Cash (Details) - USD ($) $ in Thousands |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Restricted Cash [Abstract] | ||
Restricted cash and equivalents | $ 88,744 | $ 10,686 |
Assets Held-in-trust, Current | $ 78,320 |
Investments in debt and equity securities (Detail) - USD ($) $ in Thousands |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Investment Holdings [Line Items] | ||
Held to maturity | $ 3,402 | $ 31,630 |
Available for sale | 35,544 | 38,895 |
Total | 38,946 | 70,525 |
Held to maturity, short-term investments | 3,402 | 31,630 |
Available for sale, short-term investments | 1,200 | 1,200 |
Total, short-term investments | 4,602 | 32,830 |
Held to maturity, long-term investments | 0 | 0 |
Available for sale, long-term investments | 34,344 | 37,695 |
Total, long-term investments | 34,344 | 37,695 |
Certificates of deposit and other time deposits | ||
Investment Holdings [Line Items] | ||
Held to maturity | 3,402 | 31,630 |
Available for sale, equity securities | 0 | 0 |
Total | 3,402 | 31,630 |
Investments in mutual funds and common stock | ||
Investment Holdings [Line Items] | ||
Held to maturity | 0 | 0 |
Available for sale, equity securities | 35,544 | 38,895 |
Total | $ 35,544 | $ 38,895 |
Investments in debt and equity securities - Additional Information (Detail) - USD ($) $ in Thousands |
3 Months Ended | |||
---|---|---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
Jan. 01, 2018 |
Jan. 01, 2017 |
|
Schedule Of Trading Securities And Other Trading Assets [Line Items] | ||||
Equity securities realized gain loss before tax | $ 3,746 | |||
Equity securities investments gross pre-tax unrealized gain (loss) | 3,660 | |||
Pre tax reclassification of net investment realized gain (loss) into net income | $ 229 | |||
Reclassification of net investment realized gain (loss) into net income, net tax | $ 140 | |||
Certificates of deposit and other time deposits | ||||
Schedule Of Trading Securities And Other Trading Assets [Line Items] | ||||
Income (Loss), Unrealized Holding Gain (Loss) on Securities Arising During Period, before Tax | $ 86 | |||
Investment securities | ||||
Schedule Of Trading Securities And Other Trading Assets [Line Items] | ||||
Cumulative Effect of New Accounting Principle in Period of Adoption | $ (5,662) | $ 0 |
Equity method and other investments - Additional Information (Details) - USD ($) |
3 Months Ended | ||
---|---|---|---|
Mar. 31, 2018 |
Dec. 31, 2017 |
Mar. 31, 2017 |
|
Noncontrolling Interest [Line Items] | |||
Equity investments in nonconsolidated businesses | $ 245,564,000 | $ 245,534,000 | |
Equity investment income | 155,000 | $ 677,000 | |
Equity Method Investment, Other than Temporary Impairment | 0 | ||
Cost method total carrying amount of equity investments | $ 5,386,000 | ||
Parent Company And Restricted Subsidiaries | |||
Noncontrolling Interest [Line Items] | |||
Voting interest (in percent) | 60.00% | ||
Current economic interest in DaVita Care Pte. Ltd. | 73.30% | ||
Deconsolidated Noncontrolling Entity | |||
Noncontrolling Interest [Line Items] | |||
Equity investments in nonconsolidated businesses | $ 160,535,000 | 160,481,000 | |
Equity Method Investment, Other than Temporary Impairment | $ 280,066,000 | ||
Voting interest (in percent) | 40.00% | ||
Current economic interest in APAC JV | 26.70% |
Goodwill - Changes in Goodwill by Reportable Segments (Detail) - USD ($) |
3 Months Ended | 12 Months Ended | ||
---|---|---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
Dec. 31, 2017 |
Mar. 31, 2018 |
|
Goodwill [Roll Forward] | ||||
Beginning balance | $ 6,610,279,000 | $ 6,015,375,000 | $ 6,015,375,000 | |
Acquisitions | 16,042,000 | 617,032,000 | ||
Divestitures | (32,386,000) | |||
Goodwill impairment charges | 0 | (24,198,000) | (36,196,000) | |
Foreign currency and other adjustments | 12,271,000 | 46,454,000 | ||
Ending balance | 6,638,592,000 | 6,610,279,000 | ||
Goodwill | $ 6,709,112,000 | |||
Accumulated impairment charges | (70,520,000) | |||
Total goodwill by reportable segments | 6,610,279,000 | 6,015,375,000 | 6,015,375,000 | 6,638,592,000 |
U.S. dialysis and related lab services | ||||
Goodwill [Roll Forward] | ||||
Beginning balance | 6,144,761,000 | 5,691,587,000 | 5,691,587,000 | |
Acquisitions | 2,137,000 | 485,434,000 | ||
Divestitures | (32,260,000) | |||
Goodwill impairment charges | 0 | |||
Foreign currency and other adjustments | 0 | 0 | ||
Ending balance | 6,146,898,000 | 6,144,761,000 | ||
Goodwill | 6,146,898,000 | |||
Accumulated impairment charges | 0 | |||
Total goodwill by reportable segments | 6,144,761,000 | 5,691,587,000 | 5,691,587,000 | 6,146,898,000 |
Other—Ancillary services and strategic initiatives | ||||
Goodwill [Roll Forward] | ||||
Beginning balance | 465,518,000 | 323,788,000 | 323,788,000 | |
Acquisitions | 13,905,000 | 131,598,000 | ||
Divestitures | (126,000) | |||
Goodwill impairment charges | (36,196,000) | |||
Foreign currency and other adjustments | 12,271,000 | 46,454,000 | ||
Ending balance | 491,694,000 | 465,518,000 | ||
Goodwill | 562,214,000 | |||
Accumulated impairment charges | (70,520,000) | |||
Total goodwill by reportable segments | $ 465,518,000 | $ 323,788,000 | $ 323,788,000 | $ 491,694,000 |
Goodwill - Narrative (Details) - USD ($) |
3 Months Ended | 12 Months Ended | |
---|---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
Dec. 31, 2017 |
|
Goodwill [Line Items] | |||
Goodwill impairment charges | $ 0 | $ 24,198,000 | $ 36,196,000 |
Vascular Access Clinic | |||
Goodwill [Line Items] | |||
Goodwill impairment charges | $ 24,198,000 |
Goodwill - Schedule of Reporting Units Goodwill Balances (Details) - USD ($) $ in Thousands |
3 Months Ended | ||
---|---|---|---|
Mar. 31, 2018 |
Dec. 31, 2017 |
Dec. 31, 2016 |
|
Goodwill [Line Items] | |||
Goodwill | $ 6,638,592 | $ 6,610,279 | $ 6,015,375 |
Percentage Change In Operating Income Used To Evaluate Fair Value Of Reporting Unit For Goodwill Assessment | 3.00% | ||
Percentage Change In Discount Rate Used To Evaluate Fair Value Of Reporting Unit For Goodwill Assessment | 1.00% | ||
GERMANY | |||
Goodwill [Line Items] | |||
Goodwill | $ 337,619 | ||
Carrying amount coverage | 13.70% | ||
Sensitivities, operating income | (1.60%) | ||
Sensitivities, discount rate | (11.10%) | ||
PORTUGAL | |||
Goodwill [Line Items] | |||
Goodwill | $ 48,066 | ||
Carrying amount coverage | 16.90% | ||
Sensitivities, operating income | (1.90%) | ||
Sensitivities, discount rate | (6.00%) | ||
POLAND | |||
Goodwill [Line Items] | |||
Goodwill | $ 47,669 | ||
Carrying amount coverage | 11.80% | ||
Sensitivities, operating income | (1.90%) | ||
Sensitivities, discount rate | (6.00%) |
Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Dec. 31, 2017 |
|
Income Tax Disclosure [Abstract] | ||
Liability for unrecognized tax benefits | $ 33,880 | $ 32,776 |
Increase in liability for unrecognized tax benefits | 1,104 | |
Accrued interest and penalties related to unrecognized tax benefits, net of federal tax benefits | $ 3,971 | $ 4,195 |
Long-term debt (Detail) - USD ($) $ in Thousands |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Debt Instrument [Line Items] | ||
Senior notes | $ 4,500,000 | $ 4,500,000 |
Acquisition obligations and other notes payable | 151,167 | 150,512 |
Capital lease obligations | 304,062 | 297,170 |
Total debt principal outstanding | 9,525,979 | 9,400,182 |
Discount and deferred financing costs | (61,958) | (63,951) |
Total amount of long-term debt | 9,464,021 | 9,336,231 |
Less current portion | (184,136) | (178,213) |
Long-term debt | 9,279,885 | 9,158,018 |
Term Loan A | ||
Debt Instrument [Line Items] | ||
Senior Secured Credit Facilities | 750,000 | 775,000 |
Term Loan A-2 | ||
Debt Instrument [Line Items] | ||
Senior Secured Credit Facilities | 452,000 | 0 |
Term Loan B | ||
Debt Instrument [Line Items] | ||
Senior Secured Credit Facilities | 3,368,750 | 3,377,500 |
Revolver | ||
Debt Instrument [Line Items] | ||
Senior Secured Credit Facilities | $ 0 | $ 300,000 |
Long-term debt - Scheduled Maturities of Long-term Debt (Detail) $ in Thousands |
Mar. 31, 2018
USD ($)
|
---|---|
Debt Disclosure [Abstract] | |
2018 (remainder of the year) | $ 136,885 |
2019 | 1,206,668 |
2020 | 72,608 |
2021 | 3,307,539 |
2022 | 1,283,255 |
2023 | 32,340 |
Thereafter | $ 3,486,684 |
Long-term debt - Derivative Instruments (Detail) - USD ($) $ in Thousands |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Designated as Hedging Instrument | Interest rate cap agreements | Other long-term assets | ||
Derivative [Line Items] | ||
Derivative assets, Fair value | $ 2,446 | $ 1,032 |
Long-term debt - Effects of Interest Rate Swap and Cap Agreements (Detail) - Cash Flow Hedging - USD ($) $ in Thousands |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Derivative Instruments Gain Loss [Line Items] | ||
Amount of unrecognized gains (losses) in OCI on interest rate cap agreements | $ 1,050 | $ (3,188) |
Amount of losses reclassified from accumulated OCI into income | 1,537 | 1,265 |
Tax benefit | ||
Derivative Instruments Gain Loss [Line Items] | ||
Amount of unrecognized gains (losses) in OCI on interest rate cap agreements | (364) | 2,029 |
Amount of losses reclassified from accumulated OCI into income | (533) | (805) |
Interest rate cap agreements | Debt Expense (Including Refinancing Charges) | ||
Derivative Instruments Gain Loss [Line Items] | ||
Amount of unrecognized gains (losses) in OCI on interest rate cap agreements | 1,414 | (5,217) |
Amount of losses reclassified from accumulated OCI into income | $ 2,070 | $ 2,070 |
Noncontrolling interests subject to put provisions and other commitments - additional information (Detail) $ in Thousands |
3 Months Ended |
---|---|
Mar. 31, 2018
USD ($)
| |
Minimum | |
Other Commitments [Line Items] | |
Scheduled dissolution term of joint ventures | 10 years |
Maximum | |
Other Commitments [Line Items] | |
Scheduled dissolution term of joint ventures | 50 years |
Commitments to provide operating capital | |
Other Commitments [Line Items] | |
Other potential commitments to provide operating capital to several dialysis centers | $ 5,542 |
Share repurchases (Details) - USD ($) $ / shares in Units, shares in Thousands, $ in Thousands |
1 Months Ended | 3 Months Ended | |
---|---|---|---|
May 02, 2018 |
Mar. 31, 2018 |
Oct. 10, 2017 |
|
Equity, Class of Treasury Stock [Line Items] | |||
Repurchase of common stock (in shares) | 4,197 | ||
Value of treasury stock acquired | $ 298,377 | ||
Average cost of treasury stock (usd per share) | $ 71.09 | ||
Stock repurchase additional authorization amount | $ 1,252,961 | ||
Prior shares under repurchase authorization (in shares) | 247,039 | ||
Subsequent Event | |||
Equity, Class of Treasury Stock [Line Items] | |||
Repurchase of common stock (in shares) | 4,350 | ||
Value of treasury stock acquired | $ 275,992 | ||
Average cost of treasury stock (usd per share) | $ 63.44 | ||
Remaining repurchase authorized amount | $ 544,747 |
Acquisitions and divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($) $ in Thousands |
Mar. 31, 2018 |
Dec. 31, 2017 |
Dec. 31, 2016 |
---|---|---|---|
Business Acquisition [Line Items] | |||
Goodwill | $ 6,638,592 | $ 6,610,279 | $ 6,015,375 |
Dialysis and other businesses | |||
Business Acquisition [Line Items] | |||
Current assets | 1,572 | ||
Property and equipment | 1,643 | ||
Amortizable intangible and other long-term assets | 2,563 | ||
Goodwill | 16,042 | ||
Current liabilities | (2,392) | ||
Noncontrolling interests | (688) | ||
Aggregate purchase price | $ 18,740 |
Acquisitions and divestitures - Reconciliation of Changes in Contingent Earn-Out Obligations (Detail) $ in Thousands |
3 Months Ended |
---|---|
Mar. 31, 2018
USD ($)
| |
Contingent Earn-Out Obligations [Roll Forward] | |
Beginning balance | $ 6,388 |
Remeasurement of fair value for contingent earn-out obligations | 174 |
Ending balance | $ 6,562 |
Held for Sale and Discontinued Operations Schedule of Financial Results of DMG's Discontinued Operations (Details) - USD ($) $ in Thousands |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||
Net (loss) income from discontinued operations, net of tax | $ (5,786) | $ 6,433 |
DMG | Discontinued Operations, Held-for-sale | ||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||
Revenues | 1,227,932 | 1,086,985 |
Expenses | 1,226,407 | 1,074,452 |
Income from discontinued operations before taxes | 1,525 | 12,533 |
Income tax expense | $ 7,311 | $ 6,100 |
Held for Sale and Discontinued Operations Schedule of Cash Flows of Discontinued Operations Related to DMG (Details) - USD ($) $ in Thousands |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||
Net cash provided by operating activities from discontinued operations | $ 156,248 | $ 95,585 |
Net cash used in investing activities from discontinued operations | $ (33,068) | $ (41,686) |
Variable interest entities - Additional Information (Detail) $ in Thousands |
Mar. 31, 2018
USD ($)
|
---|---|
Variable Interest Entity [Line Items] | |
Total assets of variable interest entities | $ 852,912 |
Total liabilities of variable interest entities | 507,962 |
DMG | |
Variable Interest Entity [Line Items] | |
Total assets of variable interest entities | 580,039 |
Total liabilities of variable interest entities | $ 345,926 |
Fair Value of financial instruments - Additional Information (Detail) $ in Thousands |
Mar. 31, 2018
USD ($)
|
---|---|
Estimate of Fair Value Measurement | Senior Secured Credit Facilities | |
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | |
Long-term debt value | $ 4,616,019 |
Estimate of Fair Value Measurement | Senior Notes | |
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | |
Long-term debt value | 4,433,500 |
Reported Value Measurement | Senior Secured Credit Facilities | |
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | |
Long-term debt value | 4,546,990 |
Reported Value Measurement | Senior Notes | |
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | |
Long-term debt value | $ 4,461,802 |
Segment reporting - Additional Information (Detail) |
3 Months Ended |
---|---|
Mar. 31, 2018
Segment
| |
Segment Reporting [Abstract] | |
Number of operating segments | 2 |
Segment reporting - Summary of Depreciation and Amortization Expense by Segment (Detail) - USD ($) $ in Thousands |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Segment Reporting Information [Line Items] | ||
Depreciation and amortization | $ 142,799 | $ 132,884 |
U.S. dialysis and related lab services | ||
Segment Reporting Information [Line Items] | ||
Depreciation and amortization | 134,776 | 125,029 |
Other—Ancillary services and strategic initiatives | ||
Segment Reporting Information [Line Items] | ||
Depreciation and amortization | $ 8,023 | $ 7,855 |
Segment reporting - Summary of Assets by Segment (Detail) - USD ($) $ in Thousands |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
ASSETS | ||
Total assets | $ 18,942,372 | $ 18,948,193 |
U.S. dialysis and related lab services | ||
ASSETS | ||
Total assets | 11,798,202 | 11,776,042 |
Other—Ancillary services and strategic initiatives | ||
ASSETS | ||
Total assets | 1,419,905 | 1,410,509 |
DMG held for sale | ||
ASSETS | ||
Total assets | $ 5,724,265 | $ 5,761,642 |
Segment reporting - Summary of Assets by Segment (Phantom) (Detail) - USD ($) $ in Thousands |
Mar. 31, 2018 |
Dec. 31, 2017 |
---|---|---|
Segment Reporting Information [Line Items] | ||
Equity method and other investments | $ 245,564 | $ 245,534 |
U.S. dialysis and related lab services | ||
Segment Reporting Information [Line Items] | ||
Equity method and other investments | 84,985 | 84,866 |
Other—Ancillary services and strategic initiatives | ||
Segment Reporting Information [Line Items] | ||
Equity method and other investments | 160,579 | 160,668 |
DMG held for sale | ||
Segment Reporting Information [Line Items] | ||
Equity method and other investments | $ 11,642 | $ 10,321 |
Segment reporting - Summary of Expenditures for Property and Equipment by Segment (Detail) - USD ($) $ in Thousands |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Segment Reporting Information [Line Items] | ||
Expenditures for property and equipment | $ 232,443 | $ 214,535 |
U.S. dialysis and related lab services | ||
Segment Reporting Information [Line Items] | ||
Expenditures for property and equipment | 189,049 | 173,528 |
Other—Ancillary services and strategic initiatives | ||
Segment Reporting Information [Line Items] | ||
Expenditures for property and equipment | 12,345 | 13,219 |
DMG held for sale | ||
Segment Reporting Information [Line Items] | ||
Expenditures for property and equipment | $ 31,049 | $ 27,788 |
Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries - Effects of Changes in DaVita Inc's Ownership Interest on Company's Equity (Detail) - USD ($) $ in Thousands |
3 Months Ended | |
---|---|---|
Mar. 31, 2018 |
Mar. 31, 2017 |
|
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items] | ||
Net income attributable to DaVita Inc. | $ 178,686 | $ 447,697 |
Sales of noncontrolling interests | 76 | 0 |
Purchases of noncontrolling interests | 1,994 | 423 |
Net transfers to noncontrolling interests | (1,918) | (423) |
Net income attributable to DaVita Inc., net of transfers to noncontrolling interests | 176,768 | 447,274 |
DaVita Inc. | Reportable Legal Entities | ||
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items] | ||
Net income | 178,686 | |
Net income attributable to DaVita Inc. | $ 178,686 | $ 447,697 |
[3MM&:3XTT_OR"V/./B+U!+ P04
M " "]BZ-,TMM*']P! !!0 &0 'AL+W=OSU?$<)OT+;9W )P*_
M(K Q4:S\J_ B3ZT9B!UGWXEPQ=L]Q]D4(1A'$?]A\0ZCYSQ)MBD[!Z$)N17[5XAHFN4K"
M%C-58.NX38X4IM=QDQ?1>6'O>+R3-_BX[3^%K5OMR,EXO-DX_\H8#UC*Y@97
MJ,$'-CL2*A_,SVC;<D%L?L;Y/U!+ P04 " "]BZ-,EKDX>]L!
M !!0 &0 'AL+W=OA)6M7+G2OAI?BE$MM &G2D!/]1>5K\\S5"@PJAZ*BM2A8[7!Z7+EKN-Q!
MI D&\;N@K1C-'9W*GK$WO?A^6+F>CHB6-)-:@JCA0K>T++62BN-O+^H./C5Q
M/+^J?S7)JV3V1- M*_\4!YFOW-AU#O1(SJ5\8>TWVB<4N$Z?_0]ZH:6"ZTB4
MCXR5PGR=["PDJWH5%4I%WKNQJ,W8]OI7FIV >@(:",KW9P2_)_@?!/PI ?<$
M/"& +A53FQV1)$TX:QW>;6]#]"F"2ZRJGVFC*;;YI\HCE/62^A@GX**%>LRF
MPZ 1!@X(H-0'%\CF8H-F='3K8&M!!+>0W1P2A?8@?&N>ON'[-WD&=@%L%PIF7+R@(\&0#M^&\-E[D!;$]FL@:361)^HY ;!6('S\%"ZO
MXH&R+^;;BSWO3MFA9[^6GL71G0,"[]QL^'BRT'ISUQ#-HPB\Z>M@ TT?"#!Z
MCRK*3^:M%T[&SK74UWID'?K)VK23B7T#E]NN*WS(=$WJ)^&GHA;.GDGU6IHW
M[
?6U.(1]
M_,]S4>[R.OXL7V;5H0SYJFVTV\YDEIG9+M_LIXMY>^VQ7,R+UWJ[V8?'1
MW,>L_&+X=F'/I35N]5822G-\\T(3YFG$I M,^C?B>(_8[V8(=@9F%^FFBS3P
MR;)#0K<%R*8 "0+9TL"[58H10@-$!@BE^RQ;);E')?&._B-,MNDEN_-"Z-I,
M=M=F3TD:K]K@Q2GZ5_65Z4LG3716UEV(<&R-4A:<8OS@KFKK'O)<<&BLG^[=
M7(_7>2RLZJ>7BN>_B_(/4$L#!!0 ( +V+HTR+$Z.YY0( )@, 9
M>&PO=V]R:W-H965T