Goodwill

3 Months Ended

Mar. 31, 2022

Goodwill and Intangible Assets Disclosure [Abstract]

Changes in goodwill by reportable segments were as follows:


	U.S. dialysis		Other — Ancillary services		Consolidated
Balance at December 31, 2020	$	6,309,928	$	609,181	$	6,919,109
Acquisitions	91,979		81,265		173,244
Divestitures	(1,745)		—		(1,745)
Foreign currency and other adjustments	—		(44,367)		(44,367)
Balance at December 31, 2021	$	6,400,162	$	646,079	$	7,046,241
Acquisitions	—		4,442		4,442
Divestitures	—		—		—
Foreign currency and other adjustments	—		22,220		22,220
Balance at March 31, 2022	$	6,400,162	$	672,741	$	7,072,903

Balance at March 31, 2022:
Goodwill	$	6,400,162	$	796,684	$	7,196,846
Accumulated impairment charges	—		(123,943)		(123,943)
	$	6,400,162	$	672,741	$	7,072,903

The Company did not recognize any goodwill impairment charges during the three months ended March 31, 2022 and 2021.

As dialysis treatments are an essential, life-sustaining service for patients who depend on them, the Company's operations have continued and are currently expected to continue throughout the novel coronavirus (COVID-19) pandemic. However, the ultimate impact of the dynamic and evolving COVID-19 pandemic on the Company will depend on future developments that are highly uncertain and difficult to predict, including among others the ultimate severity and duration of the pandemic; further spread or resurgence of the virus, including as a result of the emergence of new strains of the virus such as the Omicron variant or Omicron BA2 subvariant; COVID-19's impact on the chronic kidney disease (CKD) patient population and the Company's patient population, including on the mortality of these patients; the availability, acceptance, impact and efficacy of COVID-19 vaccines, treatments, and therapies; the pandemic's continuing impact on the Company's revenue and non-acquired growth due to lower treatment volumes, the U.S. and global economies, unemployment, labor market conditions, inflation and monetary policies; the potential negative impact on the Company's commercial mix or the number of patients covered by commercial insurance plans; continued increased COVID-19-related costs; supply chain challenges and disruptions; the responses of the Company's competitors to the pandemic and related changes in the marketplace; the timing, scope and effectiveness of federal, state and local government responses to the continuing pandemic; and any potential changes to the extensive set of federal, state and local laws, regulations and requirements that govern the Company's business. While the Company does not currently expect a material adverse impact to its business as a result of this public health crisis, there can be no assurance that the COVID-19 pandemic will not have a material adverse impact on one or more of the Company's businesses.

Developments, events, changes in operating performance and other changes in circumstances since the dates of the Company’s last annual goodwill impairment assessments have not caused management to believe it is more likely than not that the fair values of any of the Company's reporting units would be less than their respective carrying amounts as of March 31,

2022. Except for the Company's Germany kidney care reporting unit as described further in Note 10 to the Company's consolidated financial statements included in the 2021 10-K, none of the Company's various other reporting units were considered at risk of significant goodwill impairment as of March 31, 2022.