American Renal Associates 10-Q 9 Aug 16 2016 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2016	Aug. 08, 2016
Document and Entity Information
Entity Registrant Name	American Renal Associates Holdings, Inc.
Entity Central Index Key	1,498,068
Document Type	10-Q
Document Period End Date	Jun. 30, 2016
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Filer Category	Non-accelerated Filer
Entity Common Stock, Shares Outstanding		30,868,050
Document Fiscal Year Focus	2,016
Document Fiscal Period Focus	Q2

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Current assets:
Cash	$ 93,268	$ 90,988
Accounts receivable, less allowance for doubtful accounts of $8,867 and $7,435, respectively	76,904	76,919
Inventories	4,790	4,291
Prepaid expenses and other current assets	14,977	18,863
Income tax receivable	144	2,686
Total current assets	190,083	193,747
Property and equipment, net of accumulated depreciation of $151,367 and $138,163, respectively	160,887	142,701
Intangible assets, net of accumulated depreciation of $22,731 and $22,378, respectively	25,938	25,662
Other long-term assets	6,174	6,850
Goodwill	569,930	569,318
Total assets	953,012	938,278
Liabilities and Equity
Accounts payable	23,515	22,571
Accrued compensation and benefits	25,469	22,504
Accrued expenses and other current liabilities	45,642	26,788
Current portion of long-term debt	40,579	25,610
Total current liabilities	135,205	97,473
Long-term debt, less current portion	517,798	657,372
Income tax receivable agreement payable noncurrent	27,800
Other long-term liabilities	10,361	9,483
Deferred tax liabilities	7,169	15,029
Total Liabilities	698,333	779,357
Commitments and contingencies (Note 13)
Noncontrolling interests subject to put provisions	134,762	108,211
Equity:
Preferred stock, $0.01 par value, 1,000,000 shares authorized; none issued
Common stock, $0.01 par value; 300,000,000 shares authorized; 30,845,109 and 22,213,967 issued and outstanding at June 30, 2016 and December 31, 2015, respectively	184	98
Additional paid-in capital	72,405
Receivable from noncontrolling interests	(498)	(529)
Accumulated deficit	(133,597)	(128,261)
Accumulated other comprehensive loss, net of tax	(301)	(501)
Total American Renal Associates Holdings, Inc. deficit	(61,807)	(129,193)
Noncontrolling interests not subject to put provisions	181,724	179,903
Total equity	119,917	50,710
Total liabilities and equity	$ 953,012	$ 938,278

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
CONSOLIDATED CONDENSED BALANCE SHEETS
Accounts receivables, allowance for doubtful accounts	$ 8,867	$ 7,435
Accumulated depreciation on Property and equipment	151,367	138,163
Accumulated deprecation on intangible assets	$ 22,731	$ 22,378
Preferred stock, par value	$ 0.01	$ 0.01
Preferred stock, shares authorized	1,000,000	1,000,000
Preferred stock, issued	0	0
Common stock, par value	$ 0.01	$ 0.01
Common stock, shares authorized	300,000,000	300,000,000
Common stock, shares issued	30,845,109	22,213,967
Common stock, shares outstanding	30,845,109	22,213,967

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
CONSOLIDATED CONDENSED STATEMENTS OF OPERATIONS
Patient service operating revenues	$ 186,938	$ 162,585	$ 360,492	$ 312,929
Provision for uncollectible accounts	(1,371)	(1,084)	(2,794)	(2,105)
Net patient service operating revenues	185,567	161,501	357,698	310,824
Operating expenses:
Patient care costs	109,719	96,103	215,174	188,233
General and administrative	31,648	20,087	53,147	37,290
Transaction-related costs (Note 1)	2,215		2,239
Depreciation and amortization	8,252	7,431	15,929	15,172
Total operating expenses	151,834	123,621	286,489	240,695
Operating income	33,733	37,880	71,209	70,129
Interest expense, net	(8,941)	(11,361)	(21,199)	(22,823)
Loss on extinguishment of debt	(4,708)		(4,708)
Income tax receivable agreement expense	(7,835)		(7,835)
Income before income taxes	12,249	26,519	37,467	47,306
Income tax expense (benefit)	(1,147)	3,338	1,514	5,545
Net income	13,396	23,181	35,953	41,761
Less: Net income attributable to noncontrolling interests	(22,488)	(18,159)	(41,289)	(33,863)
Net income (loss) attributable to American Renal Associates Holdings Inc.	$ (9,092)	$ 5,022	$ (5,336)	$ 7,898
Earnings per share:
Basic (in dollars per share)	$ (0.75)	$ 0.23	$ (0.69)	$ 0.36
Diluted (in dollars per share)	$ (0.75)	$ 0.22	$ (0.69)	$ 0.35
Weighted-average number of common shares outstanding
Basic (in shares)	28,406,999	22,124,805	25,344,510	22,116,155
Diluted (in shares)	28,406,999	22,657,375	25,344,510	22,633,463
Cash dividends declared per share	$ 1.30		$ 1.30

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Consolidated Statements of Comprehensive Income (Loss)
Net income	$ 13,396	$ 23,181	$ 35,953	$ 41,761
Unrealized gain (loss) on interest rate swap, net of tax	100	(25)	200	(599)
Total comprehensive income	13,496	23,156	36,153	41,162
Less: Comprehensive income attributable to noncontrolling interests	(22,488)	(18,159)	(41,289)	(33,863)
Total comprehensive income attributable to American Renal Associates Holdings, Inc.	$ (8,992)	$ 4,997	$ (5,136)	$ 7,299

Consolidated Statements of Chan

Consolidated Statements of Changes in Equity - 6 months ended Jun. 30, 2016 - USD ($) $ in Thousands	Noncontrolling interests subject to put provisions	Common Stock	Additional Paid-In Capital	Receivable from noncontrolling interest holders	Retained Earnings	Accumulated Other Comprehensive Income(loss).	Noncontrolling interests not subject to put provisions	Total
Balance at beginning of period at Dec. 31, 2015	$ 108,211	$ 98		$ (529)	$ (128,261)	$ (501)	$ 179,903	$ (129,193)
Balance at beginning of period (in shares) at Dec. 31, 2015		22,213,967
Balance at end of period (in shares) at Jun. 30, 2016		30,845,109
Balance at beginning of period at Dec. 31, 2015								179,903
Net income (loss)	9,018				(5,336)		32,271	(5,336)
Exercise of stock option			$ (71)					(71)
Exercise of stock option (in shares)		6,142
Stock-based compensation			10,211					10,211
Excess tax benefits from stock option exercises			225					225
Issuance of common stock sold in initial public offering		8,625,000
Issuance of common stock sold in initial public offering, net of offering expense of $19,495		$ 86	170,169					170,255
Cash dividends, $1.30 per common share			(28,886)					(28,886)
Cash dividend equivalents paid on share-based payments			(1,290)					(1,290)
Cash dividend equivalents accrued on share-based payments			(1,540)					(1,540)
Non-cash dividend			(26,232)					(26,232)
Income tax receivable agreement			(23,400)					(23,400)
Distributions to noncontrolling interests	(11,002)						(32,971)
Contributions from noncontrolling interests	1,828			31			2,582	31
Purchase of noncontrolling interests			(216)				(61)	(216)
Sales of noncontrolling interests	83		59					59
Change in fair value of interest rate swaps, net of tax						200		200
Change in fair value of noncontrolling interests	26,624		(26,624)					(26,624)
Balance at end of period at Jun. 30, 2016	$ 134,762	$ 184	$ 72,405	$ (498)	$ (133,597)	$ (301)	$ 181,724	(61,807)
Balance at end of period at Jun. 30, 2016								$ 181,724

Consolidated Statements of Cha7

Consolidated Statements of Changes in Equity (Parenthetical) $ in Thousands	6 Months Ended
	Jun. 30, 2016USD ($)$ / shares
CONSOLIDATED CONDENSED STATEMENT OF SHAREHOLDERS' EQUITY
Offering costs | $	$ 19,495
Cash dividends, per common share | $ / shares	$ 1.30

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015
Operating activities
Net income	$ 35,953	$ 41,761
Adjustments to reconcile net income to cash provided by operating activities:
Depreciation and amortization	15,929	15,172
Amortization of discounts, fees and deferred financing costs	1,807	1,432
Loss on extinguishment of debt	4,708
Stock-based compensation	10,211	572
Excess tax benefit for stock options exercised, net	(225)
Deferred taxes	(7,769)	1,970
Income Tax Receivable Agreement Expense	7,835
Non-cash charge related to interest rate swap	850	494
Non-cash rent charges	920	354
Change in operating assets and liabilities, net of acquisitions:
Accounts receivable	15	(3,979)
Inventories	(499)	(7)
Prepaid expenses and other current assets	1,305	(1,864)
Other assets	692	(1,237)
Accounts payable	944	(684)
Accrued compensation and benefits	2,965	5,226
Accrued expenses and other liabilities	13,363	2,608
Cash provided by operating activities	89,004	61,818
Investing activities
Purchases of property, equipment and intangible assets	(34,221)	(27,892)
Cash paid for acquisitions	(800)	(600)
Cash used in investing activities	(35,021)	(28,492)
Financing activities
Proceeds from issuance of common stock sold in initial public offering, net of underwriting discounts and offering costs	175,378
Proceeds from issuance of long-term debt	60,000
Cash paid for debt issuance and other financing costs	(1,350)
Proceeds from term loans	39,764	34,485
Payments on long-term debt	(255,806)	(13,411)
Payments on capital lease obligations		(5)
Dividends paid	(30,176)
Proceeds from issuance of common stock		156
Excess tax benefit from stock option exercises	225
Common stock repurchases for tax withholdings of net settlement equity awards	(71)	(82)
Distributions to noncontrolling interests	(43,973)	(40,932)
Contributions from noncontrolling interests	4,441	2,416
Purchases of noncontrolling interests	(277)	(3,326)
Proceeds from sales of additional noncontrolling interests	142	329
Cash used in financing activities	(51,703)	(20,370)
Increase (Decrease) in cash	2,280	12,956
Cash at beginning of period	90,988	61,475
Cash at end of period	93,268	74,431
Supplemental Disclosure of Cash Flow Information
Cash paid for income taxes	5,376	4,262
Cash paid for interest	23,307	$ 20,758
Supplemental Disclosure of Non-Cash Flow Information
Tax Receivable Agreement	23,400
Non Cash Dividend	26,232
Liability for accrued dividend equivalent payments	(1,540)
Accrued offering costs	$ 314

BASIS OF PRESENTATION AND ORGAN

BASIS OF PRESENTATION AND ORGANIZATION	6 Months Ended
	Jun. 30, 2016
BASIS OF PRESENTATION AND ORGANIZATION
BASIS OF PRESENTATION AND ORGANIZATION	1. BASIS OF PRESENTATION AND ORGANIZATION Business American Renal Associates Holdings, Inc. (“ARAH” or “the Company”) owns 100% of the membership units of its subsidiary American Renal Holdings Intermediate Company, LLC, which itself has no assets other than 100% of the shares of capital stock of American Renal Holdings Inc. All of our operating activities are conducted through American Renal Holdings Inc. and its operating subsidiaries (“ARH”). The Company is a national provider of kidney dialysis services for patients suffering from chronic kidney failure, also known as end stage renal disease, or ESRD. As of June 30, 2016, the Company owned and operated 201 dialysis clinics treating 13,755 patients in 25 states and the District of Columbia. The Company’s operating model is based on shared ownership of its facilities with physicians, known as nephrologists, who specialize in treating kidney-related diseases in the local market served by the clinic. Each clinic is maintained as a separate joint venture, or JV, in which the Company has a controlling interest and its local nephrologist partners have noncontrolling interests. Initial Public Offering On April 26, 2016, the Company completed an initial public offering (the “IPO”) pursuant to which the Company sold an aggregate of 8,625,000 shares of common stock at a public offering price of $22.00 per share. The net proceeds to the Company from its sale of shares o f Common Stock in the IPO, after deducting underwriting discounts and before deducting offering expenses, amounted to $176,942 . The Company applied $165,635 of the net proceeds from the IPO toward repayment of outstanding amounts under its second lien credit facility, and funded the repayment in full of the outstanding balance with borrowings from its first lien credit facility, as amende d, and cash on hand. Refer to Note 8 – Long-Term Debt. In connection to the IPO and the debt repayment, the Company incurred $2,215 of transaction-related costs for various legal, accounting, valuation and other professional and consulting services during the three and six months ended June 30, 2016. B asis of Presentation and Consolidation The accompanying unaudited consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) regarding interim financial reporting. Accordingly, they do not include all of the information and footnotes required by accounting principles generally accepted in the United States of America (“U.S.”) for complete financial statements. Our consolidated financial statements include the accounts of the Company, its wholly owned subsidiaries and variable interest entities that operate its clinics (“joint ventures”). All significant intercompany balances and transactions of our wholly owned subsidiaries and joint ventures, including management fees from subsidiaries, are eliminated in consolidation. Refer to Note 6 – Variable Interest Entities. In the opinion of management, the Company has prepared the accompanying unaudited consolidated financial statements on the same basis as its audited financial statements, and these financial statements include all adjustments, consisting only of normal recurring adjustments, necessary for a fair presentation of the results of the interim periods presented. These unaudited consolidated financial statements should be read in conjunction with the audited consolidated financial statements as of December 31, 2015 and related notes included in our final prospectus for the IPO dated April 20, 2016 filed pursuant to Rule 424(b) under the Securities Act of 1933, as amended (the “Securities Act”), with the SEC (the “Prospectus”). Prior year balances and amounts have been reclassified to conform to the current year presentation. Operating results for the interim periods are not necessarily indicative of the results that may be expected for the full year. Amendment of Certificate of Incorporation On April 7, 2016, the Company’s board of directors authorized the amendment of its certificate of incorporation to increase the number of shares that the Company is authorized to issue to 300,000,000 shares of common stock, par value $0.01 per share. In addition, the amendment of the certificate of incorporation authorized the Company to effect a 2.29 -for-one stock split of its outstanding common stock. The amendment became effective on April 26, 2016. Accordingly, all common share and per share amounts in these condensed consolidated financial statements have been adjusted to reflect the 2.29 -for-one stock split as though it had occurred at the beginning of the initial period presented . Segment Information Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the chief operating decision-maker, or decision-making group, in making decisions how to allocate resources and assess performance. The Company’s chief decision-maker is a combination of the Chief Executive Officer, the Chief Operating Officer and the President. The Company views its operations and manages its business as one reportable business segment, the ownership and operation of dialysis clinics, all of which are located in the United States. Recent Accounting Pronouncements In March 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-09, Compensation – Stock Compensation (Topic 718) – Improvements to Employee Share-Based Payment Accounting. The ASU identifies areas for simplification involving several aspects of share-based payment transactions, including the income tax consequences, classification of awards as equity or liabilities, an option to recognize gross stock compensation expense with actual forfeitures recognized as they occur, as well as certain classifications on the statement of cash flows. ASU 2016-09 is effective for annual periods beginning after December 15, 2016, and interim periods within those annual periods. Early application is permitted for all organizations. We are currently assessing the impact the adoption of ASU 2016-09 will have on our consolidated financial statements. In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842) – Leases: Amendments to the FASB Accounting Standards Codification . The amendments require organizations that lease assets – referred to as “lessees” – to recognize on the balance sheet the assets and liabilities for the rights and obligations created by those leases with terms of more than twelve months. ASU 2016-02 is effective for fiscal years beginning after December 15, 2019, and for interim periods within fiscal years beginning after December 15, 2020. Early application is permitted for all organizations. We are currently assessing the impact the adoption of ASU 2016-02 will have on our consolidated financial statements. In August 2015, the FASB issued ASU 2015-15, Presentation and Subsequent Measurement of Debt Issuance Costs Associated with Line of Credit Arrangements . This ASU indicates that the guidance in ASU 2015-03 did not address presentation or subsequent measurement of debt issuance costs related to line of credit arrangements. Given the absence of authoritative guidance within ASU 2015-03, the SEC staff has indicated that they would not object to an entity deferring and presenting debt issuance costs as an asset and subsequently amortizing the costs ratably over the term of the line of credit arrangement, regardless of whether there are any outstanding borrowings on the line of credit arrangement. The Company adopted this standard in the first quarter ending March 31, 2016 and applied it retrospectively for all periods presented. Debt issuance costs associated with the line of credit arrangements of $709 are presented in Other long term assets on the Company’s Consolidated Balance Sheet as of December 31, 2015. In April 2015, the FASB issued ASU 2015-03, Interest—Imputation of Interest (Subtopic 835-30): Simplifying the Presentation of Debt Issuance Costs . The amendments require that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. The amendments are effective beginning January 1, 2016. Early adoption is permitted. The Company adopted this standard in the first quarter ending March 31, 2016 and applied it retrospectively for all periods presented. The impact of adopting the new accounting standard on the Company’s Consolidated Balance Sheet as of December 31, 2015, is a decrease in Other long-term assets and decrease in Long term debt of $1,191 . In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers (Topic 606) , which requires companies to recognize revenue when a customer obtains control rather than when companies have transferred substantially all risks and rewards of a good or service. The new standard also requires entities to enhance disclosures about the nature, amount, timing and uncertainty of revenue and cash flows arising from contracts with customers. The new standard allows for either a full retrospective or a modified retrospective transition method and is effective for fiscal years beginning after December 15, 2016. In July 2015 the FASB issued ASU 2015-14, which defers the effective date of ASU 2014-09 for one year, making ASU 2014-09 effective for annual reporting periods beginning on or after December 15, 2017 while also providing for early adoption but not before the original effective date. The FASB has issued additional updates to serve as clarification to the original standard update. The Company is currently assessing the impact the adoption of ASU 2014-09 will have on our consolidated financial statements.

ACCOUNTS RECEIVABLE

ACCOUNTS RECEIVABLE	6 Months Ended
	Jun. 30, 2016
ACCOUNTS RECEIVABLE
ACCOUNTS RECEIVABLE	2. ACCOUNTS RECEIVABLE Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the ultimate collectability and net realizable value of the Company’s accounts receivable, the Company analyzes its historical cash collection experience and trends for each of its government payors and commercial payors to estimate the adequacy of the allowance for doubtful accounts and the amount of the provision for bad debts. Management regularly updates its analysis based upon the most recent information available to it to determine its current provision for bad debts and the adequacy of its allowance for doubtful accounts. For receivables associated with services provided to patients covered by government payors, like Medicare, the Company receives 80% of the payment directly from Medicare as established under the government’s bundled payment system and determines an appropriate allowance for doubtful accounts and provision for bad debts on the remaining balance due depending upon the Company’s estimate of the amounts ultimately collectible from other secondary coverage sources or from the patients. For receivables associated with services to patients covered by commercial payors that are either based upon contractual terms or for non-contracted health plan coverage, the Company provides an allowance for doubtful accounts and a provision for bad debts based upon its historical collection experience, potential inefficiencies in its billing processes and for which collectability is determined to be unlikely. Receivables where the patient is primary payor make up less than 2% of the Company’s accounts receivable. It is the Company’s policy to reserve for a portion of these outstanding accounts receivable balances based on historical collection experience and for which collectability is determined to be unlikely.

ACQUISITIONS

ACQUISITIONS	6 Months Ended
	Jun. 30, 2016
ACQUISITIONS
ACQUISITIONS	3. ACQUISITIONS The Company periodically acquires the operating assets and liabilities of dialysis centers. The results of operations for these acquisitions are included in the Company’s consolidated statements of operations from their respective acquisition consummation dates. On April 11, 2016, the Company acquired the assets of a dialysis center in New York. The Company has a controlling interest in the joint venture. The cash consideration paid was allocated preliminarily based on the estimated fair value, as follows: Fixed Assets $ Noncompete agreements Goodwill Purchase price $ This acquisition was made to expand the Company’s market presence in New York. The goodwill arising from this acquisition consists largely of synergies expected from combining the individual dialysis center’s operations with the Company. This acquisition had an immaterial impact on the results of operations in this period. The Company also incurred $18 of post-closing adjustments to goodwill related to past acquisitions.

FAIR VALUE MEASUREMENTS

FAIR VALUE MEASUREMENTS	6 Months Ended
	Jun. 30, 2016
FAIR VALUE MEASUREMENTS
FAIR VALUE MEASUREMENTS	4. FAIR VALUE MEASUREMENTS The Company’s interest rate swap agreements, Tax Receivable Agreement (“TRA”) and noncontrolling interests subject to put provisions are accounted for at fair value on a recurring basis and are classified and disclosed in one of the following three categories: Level 1 : Financial instruments with unadjusted, quoted prices listed on active market exchanges. Level 2 : Financial instruments determined using prices for recently traded financial instruments with similar underlying terms, as well as directly or indirectly observable inputs, such as interest rates and yield curves that are observable at commonly quoted intervals. Level 3 : Financial instruments not actively traded on a market exchange. This category includes situations where there is little, if any, market activity for the financial instrument. The prices are determined using significant unobservable inputs or valuation techniques. The asset or liability fair value measurement level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. There were no changes in the methodologies used at June 30, 2016. Noncontrolling interests subject to put provisions —See Note 7 for a discussion of the Company’s methodology for estimating fair value of noncontrolling interest subject to put provisions. Interest rate swap agreements —See Note 8 for a discussion of the Company’s methodology for estimating fair value of interest rate swaps agreements. Tax Receivable Agreement —The fair value of the TRA relied upon both Level 2 data and Level 3 data. The liability is remeasured at fair value each reporting period with the change in fair value recognized as Income tax receivable agreement expense in the Company’s Consolidated Statements of Operations. The fair value is calculated using a Monte Carlo simulation-based approach that relies on significant assumptions about our stock price, stock volatility and risk-free rate as well as the timing and amounts of options exercised. Changes in assumptions based on future events, including the price of our common stock, will impact the fair value for the TRA. See Note 12 – Related Party Transactions for further discussion of the Tax Receivable Agreement. Transfers among levels are calculated on values as of the transfer date. There were no transfers between Levels 1, 2 and 3 during the six months ended June 30, 2016 and the year ended December 31, 2015. June 30, 2016 Total Level 1 Level 2 Level 3 Assets Interest rate swap agreements (included in Other long-term assets) $ $ — $ $ — Liabilities Tax Receivable Agreement Liability (included in Accrued expenses and other current liabilities and Income tax receivable agreement payable) $ $ — $ — $ Interest rate swap agreements (included in Accrued expenses and other current liabilities) — — Total Liabilities $ $ — $ $ Temporary Equity Noncontrolling interests subject to put provisions $ $ — $ — $ December 31, 2015 Total Level 1 Level 2 Level 3 Assets Interest rate swap agreements (included in Other long-term assets) $ $ — $ $ — Liabilities Interest rate swap agreements (included in Accrued expenses and other current liabilities $ $ — $ $ — Temporary Equity Noncontrolling interests subject to put provisions $ $ — $ — $ The following table provides the fair value rollforward for the six months ended June 30, 2016 for the Tax receivable agreement liability, which is classified as a Level 3 financial instrument. Balance at December 31, 2015 $ - Initial fair value as of April 20, 2016 Total realized/unrealized gains: Included in earnings and reported as Income tax receivable agreement expense Balance at June 30, 2016 $ The carrying amounts reported in the accompanying consolidated balance sheets for cash, accounts receivable, accounts payable and accrued liabilities approximate fair value because of their short-term nature. The fair value of the Company’s debt is estimated using Level 2 inputs based on the quoted market prices for the same or similar issues or on the current rates offered to the Company for debt of the same remaining maturities. The Company estimates the fair value of the first lien term loans at $ 425,174 as of June 30, 2016 as compared to the carrying amount of $436,076 . The Company estimates the fair value of the first lien term loans at $ 374,453 and s econd lien term loans at $ 237,963 as of December 31, 2015 compared to the carrying amounts of $378,235 and $238,559 . S ee Note 8 –Long-Term Debt for a discussion of the Company’s repayment of the second lien term loans.

ACCRUED EXPENSES AND OTHER CURR

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	6 Months Ended
	Jun. 30, 2016
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	5. ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES Accrued compensation and benefits consist of the following: June 30, 2016 December 31, 2015 Accrued compensation $ $ Accrued vacation pay $ $ Accrued expenses and other current liabilities consist of the following: June 30, 2016 December 31, 2015 Payor refunds and retractions $ $ Other $ $

VARIABLE INTEREST ENTITIES

VARIABLE INTEREST ENTITIES	6 Months Ended
	Jun. 30, 2016
VARIABLE INTEREST ENTITIES.
VARIABLE INTEREST ENTITIES	6. VARIABLE INTEREST ENTITIES The Company relies on the operating activities of certain 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 entities it is associated with that qualify as VIEs must be included in its consolidated financial statements. For its joint ventures, the Company has determined that a majority voting interest and/or contractual rights granted to it provide the Company with the ability to direct the activities of these entities and therefore the Company has determined that it is the primary beneficiary of these entities. Accordingly, the financial results of these joint ventures are fully consolidated into the Company’s operating results. The equity interests of the outside investors in the equity and results of operations of these consolidated entities are accounted for and presented as noncontrolling interests. NewCo We partly finance the de novo clinic development costs of some of our joint venture subsidiaries by providing intercompany term loans and revolving loans through our wholly owned operating subsidiary American Renal Associates LLC (“ARA OpCo”). On April 26, 2016, the Company transferred substantially all of the intercompany term loans (“assigned clinic loans”) provided to our joint venture subsidiaries by ARA OpCo to a newly formed entity, Term Loan Holdings LLC (“NewCo”), which ownership interest was distributed to our pre-IPO stockholders pro rata in accordance with their ownership in the Company. As a result of the distribution of membership interests in NewCo, the balance of such assigned clinic loans is reflected on our consolidated balance sheet beginning in the current reporting period. The balance of such assigned clinic loans wa s $23,643 as of June 30, 2016. Each assigned clinic loan is and will continue to be guaranteed by us and the applicable joint venture partner or partners in proportion to our respective ownership interests in the applicable joint venture. We guaranteed $12,529 of such assigned clinic loans as of June 30, 2016. The Company has determined that we are not the primary beneficiary under VIE accounting guidance for NewCo. Based on our involvement with NewCo, we do not have the power to direct the activities which most significantly impact NewCo’s economic performance, and therefore this entity is not included in our consolidated financials. The Company’s financial responsibility to repay the loans under its guarantee of a proportionate share of each clinic’s borrowing was not a factor in the Company’s assessment of the power criterion. The maximum exposure to loss with respect to NewCo is limited to the proportion of the assigned clinic loans which we guarantee. See Note 12 – Related Party Transactions.

NONCONTROLLING INTERESTS SUBJEC

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS	6 Months Ended
	Jun. 30, 2016
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS	7. NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS The Company has potential obligations to purchase a portion or all of the noncontrolling interests held by third parties in certain of its consolidated subsidiaries. These obligations are in the form of put provisions and are exercisable at the third-party owners’ discretion within specified periods as outlined in each specific put provision. Additionally, the Company has certain put agreements which are exercisable upon the occurrence of specific events, including third-party members’ death, disability, bankruptcy, retirement, or if third-party members are dissolved. Some of these puts have the potential to accelerate as a result of an initial public offering of the Company. If these put provisions were exercised, the Company would be required to purchase the third-party owners’ noncontrolling interests at the estimated fair value as defined within the put provisions. The majority of the put provisions are reported at the estimated fair value for accounting purposes, while some put provisions are stated at the contractual estimated fair value, as outlined in each specific put provision. T he put options of such noncontrolling interest holders were determined based on inputs that were not readily available in public markets or able to be derived from information available in publicly quoted markets. As such, the Compa ny categorized the put options of the noncontrolling interest holders as Level 3. The fair value of noncontrolling interests subject to puts is arrived at based on the respective merits of the Income, Market and Asset Based Approaches. The primary inputs associated with these valuation methods are Clinic forecasts, Weighted Average Cost of Capital ( 12.5% - 17.5% ) and EBITDA multiples. The estimated fair values of the noncontrolling interests subject to put provisions can also fluctuate and the implicit multiple of earnings at which these noncontrolling interest obligations may ultimately be settled could vary significantly from our current estimates depending upon market conditions including potential purchasers’ access to the credit and 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’ noncontrolling interests.

DEBT

DEBT	6 Months Ended
	Jun. 30, 2016
LONG-TERM DEBT.
LONG-TERM DEBT	8. DEBT Long-term debt consists of the following: June 30, 2016 December 31, 2015 First Lien Credit Agreement $ $ Second Lien Credit Agreement — Term Loans (1) Lines of Credit Other Less: discounts and fees, net of accumulated amortization Less: current maturities $ $ _____________________________ (1) Includes assigned clinic loans Scheduled maturities of long-term debt as of June 30, 2016 are as follows: 2016 (remainder) $ 2017 2018 2019 2020 Thereafter $ During the six months ended June 30, 2016, the Company made mandatory principal payments of $2,159 under the First Lien Credit Agreement. As of June 30, 2016, there were no borrowings outstanding under the Revolving Credit Facility as provided for under our First Lien Credit Agreement. The following describes changes to our long term debt since March 31, 2016. Amendments to and Repayment of Credit Facility On April 26, 2016, the Company entered into the first amendment (the “Amendment”) to the First Lien Credit Agreement. The Amendment increased the borrowing capacity under the first lien revolving credit facility by $50,000 to an aggregate amount of $100,000 , increased the interest rate margin by 0.25% on the first lien term loans, and provided for additional borrowings of $60,000 of incremental first lien term loans. The Company incurred $2,700 of costs associated with these refinancing activities, of which $1,350 were charged as transaction costs and $1,350 were deferred upon execution of the Amendment. The Company also ap plied $165,635 of the net proc eeds from the IPO and cash on hand to repay the outstanding balance on the second lien term loans. The write-off of deferred financing fees and discounts in the amount of $4,708 were charged as early extinguishment of debt upon repayment. Interest Rate Swap Agreements In May 2013, the Company entered into two interest rate swap agreements (the ‘‘Swaps’’) with notional amounts totaling $320,000 , as a means of fixing the floating interest rate component on $400,000 of its variable-rate debt under the Term B Loans. The Swaps are designated as a cash flow hedge, with a termination date of March 31, 2017. As a result of the application of hedge accounting treatment, to the extent the Swaps are effective the unrealized gains and losses related to the derivative instrument are recorded in accumulated other comprehensive income (loss) and are reclassified into operations in the same period in which the hedged transaction affects earnings and to the extent the Swaps are ineffective and produces gains and losses differently from the losses or gains being hedged, the ineffectiveness portion is recognized in earnings immediately. Hedge effectiveness is tested quarterly. We do not use derivative instruments for trading or speculative purposes. As of June 30, 2016 the interest rate swap continues to be ineffective, which was determined as of March 31, 2016. Amounts previously recorded in accumulated other comprehensive loss related to these interest rate swaps, totaling $501 , will be reclassified into earnings over the term of the previously hedged borrowing using the swaplet method. The Company reclassified $100 and $200 previously recorded in accumulated other comprehensive loss into interest expense during the three and six months ended June 30, 2016, respectively. The Company expects that the remaining $301 of unrealized losses will be reclassified out of accumulated other comprehensive loss and into interest expense, net over the next nine months. As more fully described within Note 4, Fair Value of Financial Instruments, the Company uses a three-level fair value hierarchy that prioritizes the inputs used to measure fair value. The fair value of the Swaps are recorded at fair value based upon 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. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate swaps would be materially different from the fair values currently reported. Clinic Loan Assignment and NewCo Distribution On April 26, 2016, the Company transferred substantially all of the assigned clinic loans provided to our joint venture subsidiaries by ARA OpCo to NewCo, which ownership interest was distributed to our pre-IPO stockholders pro rata in accordance with their ownership in the Company. The balance of such assigned clinic loans was $ 26,135 as of April 26, 2016 and $23,643 as of June 30, 2016. As a result of the distribution of membership interests in NewCo (the “NewCo Distributions”) , the balance of such assigned clinic loans was reflected on our consolidated balance sheet beginning on the date the assigned clinic loans were transferred. Each assigned clinic loan is and will continue to be guaranteed by us and the applicable joint venture partner or partners in proportion to our respective ownership interests in the applicable joint venture. We guaranteed $13,840 of such assigned clinic loans as of April 20, 2016, which is the record date set by the board of directors of the Company for this distribution, and $12,529 as of June 30, 2016.

INCOME TAXES

INCOME TAXES	6 Months Ended
	Jun. 30, 2016
INCOME TAXES
INCOME TAXES	9. INCOME TAXES The income tax expense included in the accompanying consolidated statements of operations principally relates to the Company’s proportionate share of the pre-tax income of its joint venture subsidiaries. The determination of income tax expense for interim reporting purposes is based upon the estimated effective tax rate for the year adjusted for the impact of any discrete items which are accounted for in the period in which they occur. The Company’s effective income tax rate for the three months ended June 30, 2016 and 2015 wa s (9.36%) a nd 12.59% , respectively, and 4.04% and 11.72% for the six months ended June 30, 2016 and 2015, respectively. These rates differ from the federal statutory rate of 35% principally due to the portion of pre-tax income that is allocable to noncontrolling interests from our joint venture subsidiaries which are pass-through entities for income tax purposes, as well as the change in fair value of the TRA liability, which is not deductible for income tax purposes.

STOCK-BASED COMPENSATION

STOCK-BASED COMPENSATION	6 Months Ended
	Jun. 30, 2016
STOCK-BASED COMPENSATION
STOCK-BASED COMPENSATION	10. STOCK-BASED COMPENSATION For the three and six months ended June 30, 2016 and 2015, stock-based compensation expense was reflected in the accompanying consolidated statements of operations as follows: Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Patient care costs $ $ $ $ General and administrative Total stock-based compensation before tax $ $ $ $ Income tax benefit As of June 30, 2016, the Company has 5,735,942 options outstanding. 2016 Omnibus Plan On April 7, 2016, the Company approved the 2016 Omnibus Incentive Plan (the “2016 Plan”). The 2016 Plan authorized the Company to issue options and other awards to directors, officers, employees, consultants and advisors to purchase up to a total of 4,000,000 shares of common stock. As of June 30, 2016, options to purchase an aggregate of 3,988,550 shares of common stock are available for future grants under the 2016 Plan. During the three and six months ended June 30, 2016, the Company granted options to purchase 11,450 shares of common stock under the 2016 Plan. The options are subject to vesting terms over three years and have a weighted average exercise price of $27.53 . The assumptions used for options granted to acquire Common Stock and the fair value at the date of grant under the 2016 Plan is noted in the following table: Six Months Ended June 30, 2016 Expected volatility 25.00% Expected term in years 6.0 Risk-free interest rate 1.20% Expected annual dividend yield 0% Weighted-average grant-date fair value $27.53 Special Dividends and Stock Option Modification On April 26, 2016, the Company declared and paid a cash dividend to our pre-IPO stockholders equal to $1.30 per share, or $28,886 in the aggregate. In connection with the dividend, all employees with outstanding options had their option exercise price reduced and in some cases were awarded a future dividend equivalent payment, which were paid on vested options and becomes due upon vesting for unvested options. This resulted in a modification. Additionally, in connection with the cash dividend, the Company has made payments to date equal to $1.30 per share, or $1,119 i n the aggregate, to option holders, and, in the case of some performance and market options, a future payment will be due upon vesting totaling $6,226 . In connection with the NewCo Distribution, as described in Note 8, the Company also equitably adjusted the outstanding stock options by reducing exercise prices and making cash dividend equivalent payments of $2,533 , of whic h $171 was paid to vested option holders and $2,362 is payable t o unvested option holders only if such unvested options become vested. Options were also equitably adjusted for the TRA, as described in Note 12. Options were adjusted by reducing exercise prices and, if necessary, increasing the number of shares subject to such stock options. In connection with these dividends, equitable adjustments are required by the terms of some of our equity incentive plans and for other plans were modified at the discretion of our Board of Directors. The Company also elected to modify the vesting conditions of certain market and performance-based stock options. These modifications are treated as an option modification and the Company accounted for the option modification under ASC Topic 718, Compensation – Stock Compensation. As a result of these modifications made to our outstanding market and performance-based stock options at the time of the IPO , the amount of the unrecognized non-cash compensation costs increased by approximately $38,877 . These compensation costs, after giving effect to the modifications, will be recognized over a period of approximately 12 months from the time of the IPO. As a result, the Company recognized $8,705 in incremental compensation expense and $743 of stock compensation expense due to transactions at the time of the IPO during the three months ended June 30, 2016. As of June 30, 2016, the Company had $44,487 of unrecognized compensation costs related to unvested share-based compensation arrangements.

EARNINGS PER SHARE

EARNINGS PER SHARE	6 Months Ended
	Jun. 30, 2016
EARNINGS PER SHARE
EARNINGS PER SHARE	11. EARNINGS (LOSS) PER SHARE Basic earnings (loss) per share is computed by dividing net income (loss) attributable to American Renal Associates Holdings, Inc., net of the change in the difference between the estimated fair values of contractual noncontrolling interest put provisions and estimated fair values for accounting purposes of the related noncontrolling interests, by the weighted-average number of common shares outstanding during the applicable period. Diluted earnings (loss) per share is computed using the weighted-average number of common shares outstanding during the applicable period, plus the dilutive effect of outstanding options, using the treasury stock method and the average market price of the Company’s common stock during the applicable period. Certain shares related to some of the Company’s outstanding stock options were excluded from the computation of diluted earnings per share because they were anti-dilutive in the periods presented, but could be dilutive in the future. Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Basic Net income (loss) attributable to American Renal Associates Holdings, Inc. $ $ $ $ Change in the difference between the estimated fair values of contractual noncontrolling interest put provisions and estimated fair values for accounting purposes of the related noncontrolling interests — — Net income (loss) attributable to American Renal Associates Holdings, Inc. for basic earnings per share calculation $ $ $ $ Weighted-average common shares outstanding Earnings (loss) per share, basic $ $ $ $ Diluted Net income (loss) attributable to American Renal Associates Holdings, Inc. $ $ $ $ Change in the difference between the estimated fair values of contractual noncontrolling interest put provisions and estimated fair values for accounting purposes of the related noncontrolling interests — — Net income (loss) attributable to American Renal Associates Holdings, Inc. for diluted earnings per share calculation $ $ $ $ Weighted-average common shares outstanding, basic Weighted-average effect of dilutive securities: Effect of assumed exercise of stock options — — Weighted-average common shares outstanding, diluted Earnings (loss) per share, diluted $ $ $ $ Outstanding options excluded as impact would be anti-dilutive

RELATED PARTY TRANSACTIONS

RELATED PARTY TRANSACTIONS	6 Months Ended
	Jun. 30, 2016
RELATED PARTY TRANSACTIONS
RELATED PARTY TRANSACTIONS	12. RELATED PARTY TRANSACTIONS NewCo In 2016, the Company transferred substantially all of the assigned clinic loans provided to our joint venture subsidiaries to NewCo, as described in Note 6 – Variable Interest Entities. A Centerbridge entity, which does not hold any economic interest in NewCo, is the manager of NewCo, and affiliates of Centerbridge and our executive officers own economic interests in NewCo. As of June 30, 2016, such assigned clinic loans aggregated $23,643 had maturities ranging from November 2016 to September 2020 , with a weighted average maturity of approximately 3.4 years (May 2019), and interest rates ranging from 3.46% to 8.08% , with a weighted average interest rate of 5.12% . F ixed principal and interest payments with respect to such assigned clinic loans are payable monthly. The Company will continue to administer and manage the assigned clinic loans as servicer pursuant to the terms of a loan servicing agreement as entered into between the Company and NewCo (the “Loan Servicing Agreement”). The Company is paid a quarterly fee for its services based on its reasonable costs and expenses, plus a specified percentage of such costs and expenses, which may be adjusted annually based on negotiations between the Company and NewCo. The quarterly fee charged for the three months ended June 30, 2016 is immaterial. Each assigned clinic loan guaranteed by us and the applicable joint venture partner or partners in proportion to our respective ownership interests in the applicable joint venture with maturities consistent with the aggregate assigned clinic loans. Our maximum potential liability for future payments, not including interest, is $23,643 , of which we guaranteed $12,529 as of June 30, 2016. These guarantees would become payable if the joint venture fails to meet its obligations under the applicable assigned clinic loan. Income Tax Receivable Agreement On April 26, 2016, the Company entered into the TRA for the benefit of our pre-IPO stockholders, including Centerbridge and our executive officers. The TRA provides for the payment by us to our pre-IPO stockholders on a pro rata basis of 85% of the amount of cash savings, if any, in U.S. federal, state and local income tax that we actually realize as a result of any deductions (including net operating losses resulting from such deductions) attributable to the exercise of (or any payment, including any dividend equivalent right or payment, in respect of ) any compensatory stock option issued by us that is outstanding (whether vested or unvested) as of April 20, 2016, which is the record date set by the board of directors of the Company for this distribution. The Company recorded an estimated liability of $2 3,400 based on the fair value of the TRA as of April 20, 2016. As of June 30, 2016, the Company’s total liability under the TRA is estimated to be $31,235 , of which $3,435 is in cluded as a component of other accrued expenses on the condensed consolidated balance sheet. Transaction Fee and Advisory Services Agreement The Company entered into a transaction fee and advisory services agreement, dated as of May 7, 2010 (the “Advisory Services Agreement”), with Centerbridge Advisors, LLC (together with its affiliates, “Centerbridge”). Under the Advisory Services Agreement, Centerbridge agreed to provide certain investment banking, management, consulting, and financing planning services on an ongoing basis. In consideration for these services, the Company pays Centerbridge an annual advisory services fee (payable quarterly) the greater of (i) an amount equal to the greater of (x) $550 or (y) the advisory services fee of the previous fiscal year or (ii) an amount equal to 1.25% of EBITDA (as defined in the agreement), minus a personnel expense deduction, if applicable. During the six months ended June 30, 2016 and 2015, the Company recorded $537 an d $970 o f expense related to this agreement, respectively. Centerbridge was also entitled to receive an additional fee equal to 1.0% of the enterprise value and/or aggregate value, as applicable, for any fundamental or significant transactions, both as defined, in which Centerbridge is involved. In connection with the IPO, the Advisory Services Agreement was terminated as of April 26, 2016 (other than the expense reimbursement and indemnification provisions). Due from Related Party In 2014, the Company entered into a revolving note agreement with an executive allowing for $2,000 of borrowing availability. The revolving note was recourse and was secured by a pledge of a portion of the Company’s common stock owned by the executive. The note provided for interest at the Eurodollar base rate subject to a floor of 1.25% plus a margin of 3.25% and a maturity of 2019. On August 28, 2015, the Company agreed to forgive all indebtedness and accrued interest thereunder, and canceled the revolving note agreement with the executive. There were approximately $2,105 in outstanding borrowings and accrued interest which was expensed as transaction-related costs

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	6 Months Ended
	Jun. 30, 2016
COMMITMENTS AND CONTINGENCIES.
COMMITMENTS AND CONTINGENCIES.	13. COMMITMENTS AND CONTINGENCIES Income Tax Receivable Agreement As described in Note 12 – Related Party Transactions, the Company is a party to the TRA under which we are contractually committed to pay our pre-IPO stockholders on a pro rata basis 85% of the amount of cash savings, if any, in U.S. federal, state and local income tax that we actually realize (or are deemed to realize in the case of an early termination payment by us, or a change of control, as discussed below) as a result of any Option Deductions. The actual amount and timing of any payments under the TRA will vary depending upon a number of factors, including the amount and timing of taxable income we generate in the future, whether and when any Relevant Stock Options are exercised and the value of our common stock at the time of such exercise. Professional Liability Coverage The Company maintains professional liability insurance coverage on a claims-made basis. Under this type of policy, claims based on occurrences during its term, but reported subsequently, will be uninsured should the policy not be renewed or replaced with other coverage. Management expects to be able to obtain renewal or other coverage in future periods, and has accrued the estimated cost associated with coverage of past occurrences reported in subsequent periods. Litigation The Company and its subsidiaries are defendants in various legal actions in the normal course of business. In the opinion of the Company’s management, based in part on the advice of outside counsel, the resolution of these matters will not have a material effect on its financial position, results of operations or cash flows. ARAH and ARA OpCo were named as defendants in a complaint filed by three affiliates of UnitedHealth Group Inc. (“United”) in the United States District Court for the Southern District of Florida on July 1, 2016. The complaint relates to 2 7 patients who have received, and some of whom continue to receive, dialysis at 12 clinics in Florida and Ohio and who elected to obtain coverage under one of United’s Affordable Care Act (“ACA”) insurance products, effective on or after January 1, 2016. The plaintiffs assert various state law claims and allege violations of certain state laws that prohibit false insurance claims, health care kickbacks, patient brokering, and violations of the applicable commercial plan agreements in connection with, among other things, premium payment assistance by a third party charitable organization. The complaint seeks unspecified actual, consequential and punitive monetary damages, together with interest and costs, and declaratory and injunctive relief, as well as attorney's fees and court costs. The Company believes this lawsuit is without merit and the Company intends to vigorously defend itself in this legal matter. On July 26, 2016, the Staff of the Securities and Exchange Commission (the “SEC”) sent a letter to the Company stating that it is conducting an inquiry and requesting that ARAH provide certain documents and information relating to the subject matter covered by the United complaint described above. The Company intends to respond to this request and to fully cooperate with SEC Staff. No assurance can be given as to the timing or outcome of these matters, nor can any assurance be given as to whether the filing of this lawsuit and any inquiries will affect the Company’s other relationships, or the Company’s business generally. Regulatory The healthcare industry is subject to numerous laws and regulations of federal, state, and local governments. Government activity has increased with respect to investigations and allegations concerning possible violations by healthcare providers of fraud and abuse statutes and regulations, which could result in the imposition of significant fines and penalties, as well as significant repayments for patient services previously billed. Compliance with such laws and regulations are subject to government review and interpretations, as well as regulatory actions unknown or unasserted at this time

SUBSEQUENT EVENTS

SUBSEQUENT EVENTS	6 Months Ended
	Jun. 30, 2016
SUBSEQUENT EVENTS
SUBSEQUENT EVENTS	14. SUBSEQUENT EVENTS The Company was named as a defendant in a complaint filed by three affiliates of UnitedHealth Group Inc. (“United”) in the United States District Court of the Southern District of Florida on July 1, 2016. Refer to Note 13 – “Commitments and Contingencies”.

BASIS OF PRESENTATION AND ORG23

BASIS OF PRESENTATION AND ORGANIZATION (Policies)	6 Months Ended
	Jun. 30, 2016
BASIS OF PRESENTATION AND ORGANIZATION
Basis of Presentation and Consolidation	B asis of Presentation and Consolidation The accompanying unaudited consolidated financial statements have been prepared pursuant to the rules and regulations of the Securities and Exchange Commission (“SEC”) regarding interim financial reporting. Accordingly, they do not include all of the information and footnotes required by accounting principles generally accepted in the United States of America (“U.S.”) for complete financial statements. Our consolidated financial statements include the accounts of the Company, its wholly owned subsidiaries and variable interest entities that operate its clinics (“joint ventures”). All significant intercompany balances and transactions of our wholly owned subsidiaries and joint ventures, including management fees from subsidiaries, are eliminated in consolidation. Refer to Note 6 – Variable Interest Entities. In the opinion of management, the Company has prepared the accompanying unaudited consolidated financial statements on the same basis as its audited financial statements, and these financial statements include all adjustments, consisting only of normal recurring adjustments, necessary for a fair presentation of the results of the interim periods presented. These unaudited consolidated financial statements should be read in conjunction with the audited consolidated financial statements as of December 31, 2015 and related notes included in our final prospectus for the IPO dated April 20, 2016 filed pursuant to Rule 424(b) under the Securities Act of 1933, as amended (the “Securities Act”), with the SEC (the “Prospectus”). Prior year balances and amounts have been reclassified to conform to the current year presentation. Operating results for the interim periods are not necessarily indicative of the results that may be expected for the full year.
Common stock split	Amendment of Certificate of Incorporation On April 7, 2016, the Company’s board of directors authorized the amendment of its certificate of incorporation to increase the number of shares that the Company is authorized to issue to 300,000,000 shares of common stock, par value $0.01 per share. In addition, the amendment of the certificate of incorporation authorized the Company to effect a 2.29 -for-one stock split of its outstanding common stock. The amendment became effective on April 26, 2016. Accordingly, all common share and per share amounts in these condensed consolidated financial statements have been adjusted to reflect the 2.29 -for-one stock split as though it had occurred at the beginning of the initial period presented .
Segment Information	Segment Information Operating segments are identified as components of an enterprise about which separate discrete financial information is available for evaluation by the chief operating decision-maker, or decision-making group, in making decisions how to allocate resources and assess performance. The Company’s chief decision-maker is a combination of the Chief Executive Officer, the Chief Operating Officer and the President. The Company views its operations and manages its business as one reportable business segment, the ownership and operation of dialysis clinics, all of which are located in the United States.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In March 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-09, Compensation – Stock Compensation (Topic 718) – Improvements to Employee Share-Based Payment Accounting. The ASU identifies areas for simplification involving several aspects of share-based payment transactions, including the income tax consequences, classification of awards as equity or liabilities, an option to recognize gross stock compensation expense with actual forfeitures recognized as they occur, as well as certain classifications on the statement of cash flows. ASU 2016-09 is effective for annual periods beginning after December 15, 2016, and interim periods within those annual periods. Early application is permitted for all organizations. We are currently assessing the impact the adoption of ASU 2016-09 will have on our consolidated financial statements. In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842) – Leases: Amendments to the FASB Accounting Standards Codification . The amendments require organizations that lease assets – referred to as “lessees” – to recognize on the balance sheet the assets and liabilities for the rights and obligations created by those leases with terms of more than twelve months. ASU 2016-02 is effective for fiscal years beginning after December 15, 2019, and for interim periods within fiscal years beginning after December 15, 2020. Early application is permitted for all organizations. We are currently assessing the impact the adoption of ASU 2016-02 will have on our consolidated financial statements. In August 2015, the FASB issued ASU 2015-15, Presentation and Subsequent Measurement of Debt Issuance Costs Associated with Line of Credit Arrangements . This ASU indicates that the guidance in ASU 2015-03 did not address presentation or subsequent measurement of debt issuance costs related to line of credit arrangements. Given the absence of authoritative guidance within ASU 2015-03, the SEC staff has indicated that they would not object to an entity deferring and presenting debt issuance costs as an asset and subsequently amortizing the costs ratably over the term of the line of credit arrangement, regardless of whether there are any outstanding borrowings on the line of credit arrangement. The Company adopted this standard in the first quarter ending March 31, 2016 and applied it retrospectively for all periods presented. Debt issuance costs associated with the line of credit arrangements of $709 are presented in Other long term assets on the Company’s Consolidated Balance Sheet as of December 31, 2015. In April 2015, the FASB issued ASU 2015-03, Interest—Imputation of Interest (Subtopic 835-30): Simplifying the Presentation of Debt Issuance Costs . The amendments require that debt issuance costs related to a recognized debt liability be presented in the balance sheet as a direct deduction from the carrying amount of that debt liability, consistent with debt discounts. The amendments are effective beginning January 1, 2016. Early adoption is permitted. The Company adopted this standard in the first quarter ending March 31, 2016 and applied it retrospectively for all periods presented. The impact of adopting the new accounting standard on the Company’s Consolidated Balance Sheet as of December 31, 2015, is a decrease in Other long-term assets and decrease in Long term debt of $1,191 . In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers (Topic 606) , which requires companies to recognize revenue when a customer obtains control rather than when companies have transferred substantially all risks and rewards of a good or service. The new standard also requires entities to enhance disclosures about the nature, amount, timing and uncertainty of revenue and cash flows arising from contracts with customers. The new standard allows for either a full retrospective or a modified retrospective transition method and is effective for fiscal years beginning after December 15, 2016. In July 2015 the FASB issued ASU 2015-14, which defers the effective date of ASU 2014-09 for one year, making ASU 2014-09 effective for annual reporting periods beginning on or after December 15, 2017 while also providing for early adoption but not before the original effective date. The FASB has issued additional updates to serve as clarification to the original standard update. The Company is currently assessing the impact the adoption of ASU 2014-09 will have on our consolidated financial statements.

ACQUISITIONS (Tables)

ACQUISITIONS (Tables)	6 Months Ended
	Jun. 30, 2016
ACQUISITIONS
Schedule of allocation of purchase price to the acquired assets	The cash consideration paid was allocated preliminarily based on the estimated fair value, as follows: Fixed Assets $ Noncompete agreements Goodwill Purchase price $

FAIR VALUE MEASUREMENTS (Tables

FAIR VALUE MEASUREMENTS (Tables)	6 Months Ended
	Jun. 30, 2016
FAIR VALUE MEASUREMENTS
Schedule of the fair value of financial instruments	June 30, 2016 Total Level 1 Level 2 Level 3 Assets Interest rate swap agreements (included in Other long-term assets) $ $ — $ $ — Liabilities Tax Receivable Agreement Liability (included in Accrued expenses and other current liabilities and Income tax receivable agreement payable) $ $ — $ — $ Interest rate swap agreements (included in Accrued expenses and other current liabilities) — — Total Liabilities $ $ — $ $ Temporary Equity Noncontrolling interests subject to put provisions $ $ — $ — $ December 31, 2015 Total Level 1 Level 2 Level 3 Assets Interest rate swap agreements (included in Other long-term assets) $ $ — $ $ — Liabilities Interest rate swap agreements (included in Accrued expenses and other current liabilities $ $ — $ $ — Temporary Equity Noncontrolling interests subject to put provisions $ $ — $ — $
Fair value rollforward for the Tax receivable agreement liability, which is classified as a Level 3 financial instrument	The following table provides the fair value rollforward for the six months ended June 30, 2016 for the Tax receivable agreement liability, which is classified as a Level 3 financial instrument. Balance at December 31, 2015 $ - Initial fair value as of April 20, 2016 Total realized/unrealized gains: Included in earnings and reported as Income tax receivable agreement expense Balance at June 30, 2016 $

ACCRUED EXPENSES AND OTHER CU26

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Tables)	6 Months Ended
	Jun. 30, 2016
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES
Summary of accrued compensation and benefits	June 30, 2016 December 31, 2015 Accrued compensation $ $ Accrued vacation pay $ $
Summary of accrued expenses and other current liabilities	June 30, 2016 December 31, 2015 Payor refunds and retractions $ $ Other $ $

DEBT (Tables)

DEBT (Tables)	6 Months Ended
	Jun. 30, 2016
LONG-TERM DEBT.
Schedule of long-term debt	June 30, 2016 December 31, 2015 First Lien Credit Agreement $ $ Second Lien Credit Agreement — Term Loans (1) Lines of Credit Other Less: discounts and fees, net of accumulated amortization Less: current maturities $ $ _____________________________ Includes assigned clinic loans
Schedule of maturities of long-term debt	Scheduled maturities of long-term debt as of June 30, 2016 are as follows: 2016 (remainder) $ 2017 2018 2019 2020 Thereafter $

STOCK-BASED COMPENSATION (Table

STOCK-BASED COMPENSATION (Tables)	6 Months Ended
	Jun. 30, 2016
STOCK-BASED COMPENSATION
Schedule of stock-based compensation expense	Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Patient care costs $ $ $ $ General and administrative Total stock-based compensation before tax $ $ $ $ Income tax benefit
Schedule of assumptions used for options granted to acquire Common Stock and the fair value at the date of grant	Six Months Ended June 30, 2016 Expected volatility 25.00% Expected term in years 6.0 Risk-free interest rate 1.20% Expected annual dividend yield 0% Weighted-average grant-date fair value $27.53

EARNINGS PER SHARE (Tables)

EARNINGS PER SHARE (Tables)	6 Months Ended
	Jun. 30, 2016
EARNINGS PER SHARE
Schedule of basic and diluted earnings per share	Three Months Ended June 30, Six Months Ended June 30, 2016 2015 2016 2015 Basic Net income (loss) attributable to American Renal Associates Holdings, Inc. $ $ $ $ Change in the difference between the estimated fair values of contractual noncontrolling interest put provisions and estimated fair values for accounting purposes of the related noncontrolling interests — — Net income (loss) attributable to American Renal Associates Holdings, Inc. for basic earnings per share calculation $ $ $ $ Weighted-average common shares outstanding Earnings (loss) per share, basic $ $ $ $ Diluted Net income (loss) attributable to American Renal Associates Holdings, Inc. $ $ $ $ Change in the difference between the estimated fair values of contractual noncontrolling interest put provisions and estimated fair values for accounting purposes of the related noncontrolling interests — — Net income (loss) attributable to American Renal Associates Holdings, Inc. for diluted earnings per share calculation $ $ $ $ Weighted-average common shares outstanding, basic Weighted-average effect of dilutive securities: Effect of assumed exercise of stock options — — Weighted-average common shares outstanding, diluted Earnings (loss) per share, diluted $ $ $ $ Outstanding options excluded as impact would be anti-dilutive

BASIS OF PRESENTATION AND ORG30

BASIS OF PRESENTATION AND ORGANIZATION (Details) $ / shares in Units, $ in Thousands	Apr. 26, 2016USD ($)$ / sharesshares	Jun. 30, 2016USD ($)$ / sharesshares	Jun. 30, 2016USD ($)segmentstateitem$ / sharesshares	Dec. 31, 2015USD ($)$ / sharesshares
Assets		$ 953,012	$ 953,012	$ 938,278
Number of dialysis clinics owned and operated | item			201
Number of patients | item			13,755
Number of states | state			25
Cash dividend	$ 28,886
Non cash dividend			$ 26,232
Transaction Costs		$ 2,215	$ 2,239
Amendment of Articles of Incorporation
Common stock, shares authorized | shares		300,000,000	300,000,000	300,000,000
Common stock, par value | $ / shares		$ 0.01	$ 0.01	$ 0.01
Stock split ratio			2.29	2.29
Segments
Number of reportable segments | segment			1
New Accounting Pronouncements and Changes in Accounting Principles [Abstract]
Other long-term assets		$ 6,174	$ 6,174	$ 6,850
Long-term debt		$ 517,798	$ 517,798	657,372
ASU 2015-03 | Adjustments
New Accounting Pronouncements and Changes in Accounting Principles [Abstract]
Other long-term assets				(1,191)
Long-term debt				(1,191)
Second Lien Credit Agreement
Proceeds from Issuance Initial Public Offering	$ 165,635
Unsecured revolving credit facility mature May 25, 2017 | ASU 2015-03 | Adjustments
New Accounting Pronouncements and Changes in Accounting Principles [Abstract]
Other long-term assets				$ 709
IPO
Number of shares sold in public offering | shares	8,625,000
Price per share | $ / shares	$ 22
Proceeds from Issuance Initial Public Offering	$ 176,942
IPO | Second Lien Credit Agreement
Proceeds from Issuance Initial Public Offering	$ 165,635
American Renal Holdings Intermediate Company, LLC
Percentage ownership of subsidiary		100.00%	100.00%
Assets		$ 0	$ 0
Percentage ownership of parent		100.00%	100.00%

ACCOUNTS RECEIVABLE (Details)

ACCOUNTS RECEIVABLE (Details)	6 Months Ended
	Jun. 30, 2016
Payments received | Medicare
ACCOUNTS RECEIVABLE
Concentration of risk as a percentage	80.00%
Accounts receivable. | Patients as primary payor | Maximum
ACCOUNTS RECEIVABLE
Concentration of risk as a percentage	2.00%

ACQUISITIONS (Details)

ACQUISITIONS (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2016	Apr. 11, 2016	Dec. 31, 2015
Purchase price for the acquisition
Goodwill	$ 569,930		$ 569,318
Post-closing adjustment to goodwill	$ 18
Dialysis center in New York
Purchase price for the acquisition
Inventory and other assets		$ 122
Noncompete agreements		48
Goodwill		630
Purchase price		$ 800

FAIR VALUE MEASUREMENTS (Detail

FAIR VALUE MEASUREMENTS (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2016	Apr. 20, 2016	Dec. 31, 2015
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Initial fair value as of April 20, 2016		$ 23,400
Included in earnings and reported as income tax receivable agreement expense	$ 7,400
Balance at end of period	30,800
FAIR VALUE MEASUREMENTS
Transfers between Levels 1, 2 and 3	0		$ 0
Term loans
FAIR VALUE MEASUREMENTS
Carrying amount of long-term debt	107,483		59,578
First lien term loans
FAIR VALUE MEASUREMENTS
Debt	425,174		374,453
Carrying amount of long-term debt	436,076		378,235
Second lien term loans
FAIR VALUE MEASUREMENTS
Debt			237,963
Carrying amount of long-term debt			238,559
Recurring basis
FAIR VALUE MEASUREMENTS
Tax receivable agreement liability	30,800
Financial Liabilities Fair Value Disclosure	31,620
Noncontrolling interests subject to put provisions	134,762		108,211
Recurring basis | Other long-term assets
FAIR VALUE MEASUREMENTS
Interest rate swap agreements asset	117		238
Recurring basis | Accrued expenses and other current liabilities
FAIR VALUE MEASUREMENTS
Interest rate swap agreements liability	820		426
Recurring basis | Significant Other Observable Inputs (Level 2)
FAIR VALUE MEASUREMENTS
Financial Liabilities Fair Value Disclosure	820
Recurring basis | Significant Other Observable Inputs (Level 2) | Other long-term assets
FAIR VALUE MEASUREMENTS
Interest rate swap agreements asset	117		238
Recurring basis | Significant Other Observable Inputs (Level 2) | Accrued expenses and other current liabilities
FAIR VALUE MEASUREMENTS
Interest rate swap agreements liability	820		426
Recurring basis | Level 3
FAIR VALUE MEASUREMENTS
Tax receivable agreement liability	30,800
Financial Liabilities Fair Value Disclosure	30,800
Noncontrolling interests subject to put provisions	$ 134,762		$ 108,211

ACCRUED EXPENSES AND OTHER CU34

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Dec. 31, 2015
Accrued compensation and benefits:
Accrued compensation	$ 13,177	$ 13,041
Accrued vacation pay	12,292	9,463
Accrued compensation and benefits	25,469	22,504
Accrued expenses and other current liabilities:
Payor refunds and retractions	33,705	20,506
Other	11,937	6,282
Accrued expenses and other current liabilities	$ 45,642	$ 26,788

VARIABLE INTEREST ENTITIES LOAN

VARIABLE INTEREST ENTITIES LOANS (Details) - USD ($) $ in Thousands	Jun. 30, 2016	Apr. 26, 2016
Clinic Loan Assignment
Assigned clinic loans	$ 23,643
Clinic loan guarantee	12,529
Guaranteed Clinic Loan
Clinic Loan Assignment
Clinic loan guarantee	12,529	$ 13,840
Clinic Loan
Clinic Loan Assignment
Assigned clinic loans	$ 23,643	$ 26,135

NONCONTROLLING INTERESTS SUBJ36

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS (Details)	6 Months Ended
	Jun. 30, 2016
Minimum
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Weighted Average Cost of Capital	12.50%
Maximum
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Weighted Average Cost of Capital	17.50%

DEBT (Details)

DEBT (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2016	Dec. 31, 2015
LONG-TERM DEBT
Debt, Long-term and Short-term, Combined Amount	$ 563,417	$ 692,717
Less: discounts and fees, net of accumulated amortization	(5,040)	(9,735)
Less: current maturities	(40,579)	(25,610)
Long-term debt excluding current maturities	517,798	657,372
Scheduled maturities of long-term debt
2016 (remainder)	19,419
2,017	42,828
2,018	35,589
2,019	448,487
2,020	12,302
Thereafter	4,792
Long term debt	563,417	692,717
Term loans
LONG-TERM DEBT
Long-term Debt, Gross	107,483	59,578
First Lien Credit Agreement
LONG-TERM DEBT
Long-term Debt, Gross	436,076	378,235
Principal payments	2,159
Second Lien Credit Agreement
LONG-TERM DEBT
Long-term Debt, Gross		238,559
Other Term Loans And Lines Of Credit
LONG-TERM DEBT
Long-term Debt, Gross	16,572	12,818
Other
LONG-TERM DEBT
Long-term Debt, Gross	$ 3,286	$ 3,527

DEBT - Credit And Interest Rate

DEBT - Credit And Interest Rate Swap Agreements (Details) $ in Thousands	Apr. 26, 2016USD ($)	Jun. 30, 2016USD ($)item	Mar. 31, 2016USD ($)	Jun. 30, 2016USD ($)item
LONG-TERM DEBT
Debt floor rate				3.46%
Amendments to and Repayment of Credit Facilities
Transaction Costs		$ 2,215		$ 2,239
Cash Dividend
Write-off of deferred financing fees	$ 4,708
Interest Rate Swap Agreement
Amount reclassified from accumulated other comprehensive income to interest expense			$ 100	200
Clinic Loan Assignment
Assigned clinic loans		23,643		23,643
Clinic loan guarantee		12,529		12,529
Guaranteed Clinic Loan
Clinic Loan Assignment
Clinic loan guarantee	13,840	12,529		12,529
Clinic Loan
Clinic Loan Assignment
Assigned clinic loans	26,135	23,643		23,643
Revolving Credit Facility
Revolving Credit Facility
Revolving credit facility borrowings outstanding		$ 0		$ 0
Interest Rate Swap Agreements
Interest Rate Swap Agreement
Number of interest rate swap agreements | item		2		2
Interest rate swap agreements notional amount		$ 320,000		$ 320,000
Amount of accumulated other comprehensive loss expected to be reclassified to earnings				501
Amount reclassified from accumulated other comprehensive income to interest expense				100
Expected amount of unrealized losses will be reclassified out of accumulated other comprehensive loss into interest expense				$ 301
Estimate of to transfer losses from accumulated other comprehensive loss to interest expense				9 months
Term B Loans due September 2019 | Interest Rate Swap Agreements
LONG-TERM DEBT
Debt face amount		$ 400,000		$ 400,000
Term loans
Amendments to and Repayment of Credit Facilities
Increase in borrowing capacity	60,000
First Lien Credit Agreement
Revolving Credit Facility
Revolving credit facility maximum borrowing capacity	100,000
Amendments to and Repayment of Credit Facilities
Increase in borrowing capacity	50,000
Aggregate amount of borrowing capacity	$ 100,000
Interest rate margin increase	0.25%
Refinancing costs	$ 2,700
Transaction Costs	1,350
Deferred Finance Costs, Current, Net	1,350
Second Lien Credit Agreement
Amendment of Certificate of Incorporation and Initial Public Offering
Net proceeds to the Company	$ 165,635

INCOME TAXES (Details)

INCOME TAXES (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
INCOME TAXES
Effective income tax rate	(9.36%)	12.59%	4.04%	11.72%
Federal statutory rate			35.00%

STOCK-BASED COMPENSATION (Detai

STOCK-BASED COMPENSATION (Details) - USD ($) $ / shares in Units, $ in Thousands	Apr. 26, 2016	Apr. 07, 2016	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
STOCK-BASED COMPENSATION
Stock-based compensation before tax			$ 9,838	$ 297	$ 10,224	$ 603
Income tax benefit			$ (3,935)	(119)	$ (4,090)	(241)
Options Outstanding			5,735,942		5,735,942
Cash dividend (in dollars per share)	$ 1.30
Cash dividend	$ 28,886
Stock options granted					11,450
Vesting period					3 years
Stock options granted exercise price					$ 27.53
Expected volatility					25.00%
Expected term					6 years
Risk-free rate					1.20%
Expected annual dividend yield					0.00%
Weighted-average grant-date fair value					$ 27.53
Unrecognized compensation costs			$ 38,877		$ 38,877
Share-based compensation expense accelerated due to transactions at the time of the IPO			743
Stock Compensation due to modification			8,705
Vested Option Stockholders
STOCK-BASED COMPENSATION
Equivalent adjustments in the form of cash dividend equivalent payments (in dollars per share)	$ 1.30
Equitable adjustments in the form of cash dividend equivalent payments	$ 1,119
Unvested Option Stockholders
STOCK-BASED COMPENSATION
Equitable adjustments in the form of cash dividend equivalent payments	6,226
Unrecognized compensation costs			$ 44,487		$ 44,487
2016 Omnibus Incentive Plan
STOCK-BASED COMPENSATION
Authorized additional stock options		4,000,000
Stock options to purchase outstanding			3,988,550		3,988,550
Patient care costs.
STOCK-BASED COMPENSATION
Stock-based compensation before tax			$ 1,520	67	$ 1,613	126
General and administrative
STOCK-BASED COMPENSATION
Stock-based compensation before tax			$ 8,318	$ 230	$ 8,611	$ 477
NewCo Distribution
STOCK-BASED COMPENSATION
Equitable adjustments in the form of cash dividend equivalent payments	2,533
NewCo Distribution | Vested Option Stockholders
STOCK-BASED COMPENSATION
Equitable adjustments in the form of cash dividend equivalent payments	171
NewCo Distribution | Unvested Option Stockholders
STOCK-BASED COMPENSATION
Equitable adjustments in the form of cash dividend equivalent payments	$ 2,362

EARNINGS PER SHARE (Details)

EARNINGS PER SHARE (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2016	Jun. 30, 2015	Jun. 30, 2016	Jun. 30, 2015
Basic
Net income (loss)	$ (9,092)	$ 5,022	$ (5,336)	$ 7,898
Change in the difference between the estimated fair values of contractual noncontrolling interest put provisions and estimated fair values for accounting purposes of the related noncontrolling interests	(12,133)		(12,133)
Net Income (Loss) Available to Common Stockholders, Basic	$ (21,225)	$ 5,022	$ (17,469)	$ 7,898
Weighted-average common shares outstanding (in shares)	28,406,999	22,124,805	25,344,510	22,116,155
Earnings per share, basic	$ (0.75)	$ 0.23	$ (0.69)	$ 0.36
Diluted
Net income (loss)	$ (9,092)	$ 5,022	$ (5,336)	$ 7,898
Change in the difference between the estimated fair values of contractual noncontrolling interest put provisions and estimated fair values for accounting purposes of the related noncontrolling interests	(12,133)		(12,133)
Net Income (Loss) Available to Common Stockholders, Diluted	$ (21,225)	$ 5,022	$ (17,469)	$ 7,898
Weighted-average common shares outstanding (in shares)	28,406,999	22,124,805	25,344,510	22,116,155
Weighted-average effect of dilutive securities:
Effect of assumed exercise of stock options		532,570		517,308
Weighted-average common shares outstanding, diluted	28,406,999	22,657,375	25,344,510	22,633,463
Earnings per share, diluted	$ (0.75)	$ 0.22	$ (0.69)	$ 0.35
Outstanding options excluded as impact would be anti-dilutive	555,329	10,541	336,133	9,558

RELATED PARTY TRANSACTIONS (Det

RELATED PARTY TRANSACTIONS (Details) - USD ($) $ in Thousands	Apr. 20, 2016	May 07, 2010	Jun. 30, 2016	Jun. 30, 2015	Dec. 31, 2014	Apr. 26, 2016	Aug. 28, 2015
RELATED PARTY TRANSACTIONS
Notes Payable Current And NonCurrent			$ 23,643
Period Of Weighted Average Maturity			3 years 4 months 24 days
Debt Instrument, Interest Rate, Stated Percentage Rate Range, Minimum			3.46%
Debt Instrument, Interest Rate, Stated Percentage Rate Range, Maximum			8.08%
Debt, Weighted Average Interest Rate			5.12%
Clinic loan guarantee			$ 12,529
Percentage tax savings payable to pre-IPO stockholders						85.00%
Income tax receivable agreement payable noncurrent			27,800
Income tax receivable agreement liability total	$ 23,400		31,235
Income tax receivable agreement liability current			3,435
Maximum
RELATED PARTY TRANSACTIONS
Notes Payable Current And NonCurrent			23,643
Advisory services agreement
RELATED PARTY TRANSACTIONS
Amount of outstanding borrowings and accrued interest charged to transaction expense							$ 2,105
Centerbridge | Advisory services agreement
RELATED PARTY TRANSACTIONS
Advisory services agreement fee		$ 550	$ 537	$ 970
Annual advisory services fee to Centerbridge, percentage of EBITDA			1.25%
Additional fee equal to a percentage of the enterprise value and/or aggregate value				1.00%
Executive | Revolving note agreement
RELATED PARTY TRANSACTIONS
Revolving note agreement					$ 2,000
Executive | Revolving note agreement | Eurodollar base rate
RELATED PARTY TRANSACTIONS
Debt Instrument, Interest Rate, Stated Percentage Rate Range, Minimum					1.25%
Applicable margin					3.25%

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Details)	Jul. 01, 2016plaintiffproductitemclinic	Apr. 26, 2016
Percentage tax savings payable to pre-IPO stockholders		85.00%
United Health Group Member | Subsequent Event.
Number of affiliates | plaintiff	3
Number of patients | item	2
Number of clinics | clinic	12
Number of insurance products | product	1

SUBSEQUENT EVENTS (Details)

SUBSEQUENT EVENTS (Details)	Jul. 01, 2016plaintiff
United Health Group Member | Subsequent Event.
Number of affiliates	3