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Leases Leases
6 Months Ended
Jun. 30, 2019
Leases [Abstract]  
Leases of Lessee Disclosure [Text Block]
Leases
The majority of the Company’s facilities are leased under non-cancellable operating leases ranging in terms from five years to fifteen years and which contain renewal options of five years to ten years at the fair rental value at the time of renewal. These renewal options are included in the Company’s determination of the right-of-use assets and related lease liabilities when renewal is considered reasonably certain at the commencement date. Certain of the Company’s leases are subject to periodic consumer price index increases or contain fixed escalation clauses. The Company also leases certain facilities and equipment under finance leases. The Company has elected the practical expedient to not separate lease components from non-lease components related to its real estate financing and operating leases.
Financing and operating right-of-use assets are recognized based on the net present value of lease payments over the lease term at the commencement date. Since most of the Company's leases do not provide an implicit rate of return, the Company uses its incremental borrowing rate based on information available at the commencement date in determining the present value of lease payments.
As of June 30, 2019 and December 31, 2018, assets recorded under finance leases were $246,261 and $367,164, respectively, and accumulated amortization associated with finance leases was $15,525 and $131,971, respectively, included in property and equipment, net, on the Company's consolidated balance sheet.
In certain markets, the Company acquires and develops dialysis centers. Upon completion, the Company sells the center to a third party and leases the space back with the intent of operating the center on a long term basis. Both the sale and leaseback terms are generally market terms. The lease terms are consistent with the Company's other operating leases with the majority of the leases under non-cancellable operating leases ranging in terms from five years to fifteen years and which contain renewal options of five years to ten years at the fair rental value at the time of renewal.
The Company adopted Topic 842, Leases beginning on January 1, 2019 through a modified retrospective approach for leases existing at the adoption date with a cumulative effect adjustment. Consequently, financial information was not updated for dates and periods before January 1, 2019. 
The components of lease expense were as follows:
Lease cost
 
Three months ended
June 30, 2019
 
Six months ended
June 30, 2019
Operating lease cost(1):
 
 
 

Fixed lease expense
 
$
130,946

 
$
259,056

Variable lease expense
 
29,907

 
58,478

Financing lease cost:
 
 
 
 
Amortization of leased assets
 
5,703

 
11,529

Interest on lease liabilities
 
3,715

 
7,490

Net lease cost
 
$
170,271

 
$
336,553

 
(1)
Includes short-term lease expense and sublease income, which are immaterial.
Other information related to leases was as follows:
Lease term and discount rate
 
June 30, 2019
Weighted average remaining lease term (years):
 
 
Operating leases
 
9.1

Finance leases
 
10.6

Weighted average discount rate:
 
 
Operating leases
 
4.2
%
Finance leases
 
5.4
%
Other information
 
Six months ended
June 30, 2019
Gain on sale leaseback, net
 
$
10,336

Cash paid for amounts included in the measurement of lease liabilities:
 
 
Operating cash flows from operating leases
 
$
309,115

Operating cash flows from finance leases
 
$
10,585

Financing cash flows from finance leases
 
$
16,910

Net operating lease assets obtained in exchange for new or modified operating lease liabilities
 
$
195,771


Future minimum lease payments under non-cancellable leases as of June 30, 2019 were as follows:
 
Operating leases
 
Finance leases
2019 (remainder of the year)
$
259,928

 
$
16,493

2020
490,779

 
37,805

2021
463,495

 
33,317

2022
426,182

 
33,599

2023
380,070

 
33,709

2024
326,541

 
33,723

Thereafter
1,375,473

 
175,202

Total future minimum lease payments
$
3,722,468

 
$
363,848

Less portion representing interest
(660,594
)
 
(86,268
)
Present value of lease liabilities
$
3,061,874

 
$
277,580


Future minimum lease payments under non-cancellable leases as of December 31, 2018 were as follows:
 
Operating leases
 
Capital leases
2019
$
483,488

 
$
36,754

2020
462,154

 
41,044

2021
432,950

 
34,026

2022
395,462

 
33,690

2023
349,649

 
33,845

Thereafter
1,589,949

 
194,611

 
$
3,713,652

 
373,970

Less portion representing interest
 
 
(91,233
)
Total capital lease obligations, including current portion
 
 
$
282,737