American Renal Associates 10-Q 9 May 17 2017 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2017	May 08, 2017
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	Mar. 31, 2017
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		31,151,569
Document Fiscal Year Focus	2,017
Document Fiscal Period Focus	Q1

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2017	Dec. 31, 2016
Assets
Cash	$ 84,003	$ 100,916
Accounts receivable, less allowance for doubtful accounts of $9,227 and $8,726, respectively	77,495	81,127
Inventories	4,648	4,676
Prepaid expenses and other current assets	18,217	18,498
Income tax receivable	9,415	5,163
Total current assets	193,778	210,380
Property and equipment, net of accumulated depreciation of $129,540 and $121,242, respectively	167,338	170,118
Intangible assets, net of accumulated depreciation of $23,005 and $23,489, respectively	25,681	25,626
Other long-term assets	7,472	6,753
Goodwill	573,147	573,147
Total assets	967,416	986,024
Liabilities and Equity
Accounts payable	24,605	31,127
Accrued compensation and benefits	26,092	29,103
Accrued expenses and other current liabilities	45,075	45,286
Current portion of long-term debt	45,559	48,274
Total current liabilities	141,331	153,790
Long-term debt, less current portion	520,364	522,058
Income tax receivable agreement payable	16,683	21,200
Other long-term liabilities	12,826	11,670
Deferred tax liabilities	1,522	1,278
Total Liabilities	692,726	709,996
Commitments and contingencies (Note 14 and Note 15)
Noncontrolling interests subject to put provisions	132,465	130,365
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; 31,143,998 and 30,894,962 issued and outstanding at March 31, 2017 and December 31, 2016, respectively	184	184
Additional paid-in capital	93,596	95,062
Receivable from noncontrolling interests	(747)	(544)
Accumulated deficit	(129,897)	(128,646)
Accumulated other comprehensive loss, net of tax	(744)	(100)
Total American Renal Associates Holdings, Inc. deficit	(37,608)	(34,044)
Noncontrolling interests not subject to put provisions	179,833	179,707
Total equity	142,225	145,663
Total liabilities and equity	$ 967,416	$ 986,024

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2017	Dec. 31, 2016
Statement of Financial Position [Abstract]
Accounts receivables, allowance for doubtful accounts	$ 9,227	$ 8,726
Accumulated depreciation on property and equipment	129,540	121,242
Accumulated deprecation on intangible assets	$ 23,005	$ 23,489
Preferred stock, par value (in USD per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	1,000,000	1,000,000
Preferred stock, issued (in shares)	0	0
Common stock, par value (in USD per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	300,000,000	300,000,000
Common stock, shares issued (in shares)	31,143,998	30,894,962
Common stock, shares outstanding (in shares)	31,143,998	30,894,962

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Income Statement [Abstract]
Patient service operating revenues	$ 178,632	$ 173,554
Provision for uncollectible accounts	(1,607)	(1,423)
Net patient service operating revenues	177,025	172,131
Operating expenses:
Patient care costs	120,301	105,455
General and administrative	31,244	21,499
Transaction-related costs (Note 1)	0	24
Depreciation and amortization	9,074	7,677
Certain legal matters (Note 15)	3,936	0
Total operating expenses	164,555	134,655
Operating income	12,470	37,476
Interest expense, net	(7,609)	(12,258)
Income tax receivable agreement income	4,517	0
Income before income taxes	9,378	25,218
Income tax (benefit) expense	(3,524)	2,661
Net income	12,902	22,557
Less: Net income attributable to noncontrolling interests	(14,153)	(18,801)
Net (loss) income attributable to American Renal Associates Holdings, Inc.	$ (1,251)	$ 3,756
(Loss) earnings per share (Note 12):
Basic (in USD per share)	$ (0.40)	$ 0.17
Diluted (in USD per share)	$ (0.40)	$ 0.16
Weighted-average number of common shares outstanding
Basic (in shares)	30,907,482	22,213,967
Diluted (in shares)	30,907,482	22,785,670

Consolidated Statements of Comp

Consolidated Statements of Comprehensive (Loss) Income - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Statement of Comprehensive Income [Abstract]
Net income	$ 12,902	$ 22,557
Unrealized (loss) gain on derivative agreements, net of tax	(644)	100
Total comprehensive income	12,258	22,657
Less: Comprehensive income attributable to noncontrolling interests	(14,153)	(18,801)
Total comprehensive (loss) income attributable to American Renal Associates Holdings, Inc.	$ (1,895)	$ 3,856

Consolidated Statement of Chang

Consolidated Statement of Changes in Equity - 3 months ended Mar. 31, 2017 - USD ($) $ in Thousands	Total	Noncontrolling Interests subject to put provisions	Common Stock	Additional Paid-in Capital	Receivable from Noncontrolling Interest Holders	Retained Earnings (Deficit)	Accumulated Other Comprehensive Income (loss)	Noncontrolling Interests not subject to put provisions
Balance at beginning of period at Dec. 31, 2016	$ (34,044)	$ 130,365	$ 184	$ 95,062	$ (544)	$ (128,646)	$ (100)	$ 179,707
Balance at beginning of period (in shares) at Dec. 31, 2016			30,894,962
Net income (loss)	(1,251)	4,354				(1,251)		9,799
Stock-based compensation	10,088			10,088
Exercise of stock options (in shares)			28,786
Exercise of stock options	30			30
Issuance of restricted stock (in shares)			220,250
Issuance of restricted stock	0			0
Cash dividend equivalents paid on share-based payments	(271)			(271)
Cash dividend equivalents accrued on share-based payments	(1,563)			(1,563)
Distributions to noncontrolling interests		(6,889)						(12,155)
Contributions from noncontrolling interests	(203)	565			(203)			1,348
Purchases of noncontrolling interests	(1,272)	(3,274)		(1,272)				0
Reclassification/other adjustments		(1,134)						1,134
Change in fair value of derivative agreements, net of tax	(644)						(644)
Change in fair value of noncontrolling interests	(8,478)	8,478		(8,478)
Balance at end of period at Mar. 31, 2017	$ (37,608)	$ 132,465	$ 184	$ 93,596	$ (747)	$ (129,897)	$ (744)	$ 179,833
Balance at end of period (in shares) at Mar. 31, 2017			31,143,998

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Operating activities
Net income	$ 12,902	$ 22,557
Adjustments to reconcile net income to cash provided by operating activities:
Depreciation and amortization	9,074	7,677
Amortization of discounts, fees and deferred financing costs	530	797
Stock-based compensation	10,088	386
Premium paid for interest rate cap agreements	(1,186)	0
Deferred taxes	673	67
Income tax receivable agreement income	(4,517)	0
Non-cash charge related to derivative agreements	173	623
Non-cash rent charges	289	512
Loss on disposal of assets	57	0
Change in operating assets and liabilities, net of acquisitions:
Accounts receivable	3,632	1,088
Inventories	28	(1,224)
Prepaid expenses and other current assets	(3,870)	(152)
Other assets	(63)	(18)
Accounts payable	(6,522)	1,286
Accrued compensation and benefits	(3,011)	(1,008)
Accrued expenses and other liabilities	(1,755)	3,985
Cash provided by operating activities	16,522	36,576
Investing activities
Purchases of property, equipment and intangible assets	(6,406)	(16,396)
Cash used in investing activities	(6,406)	(16,396)
Financing activities
Proceeds from term loans, net of deferred financing costs	4,881	12,282
Payments on long-term debt	(9,689)	(7,462)
Dividends and dividend equivalents paid	(271)	0
Proceeds from exercise of stock options	30	0
Payments of deferred offering costs	0	(467)
Distributions to noncontrolling interests	(19,044)	(21,440)
Contributions from noncontrolling interests	1,710	1,884
Purchases of noncontrolling interests	(4,546)	0
Cash used in financing activities	(26,929)	(15,203)
(Decrease) increase in cash and restricted cash	(16,813)	4,977
Cash and restricted cash at beginning of period	100,916	90,988
Cash and restricted cash at end of period	84,103	95,965
Supplemental Disclosure of Cash Flow Information
Cash paid for income taxes	127	193
Cash paid for interest	6,832	10,581
Supplemental Disclosure of Non-Cash Financing Activities
Accrued offering expense	0	680
Liability for accrued dividend equivalent payments	$ 1,563	$ 0

BASIS OF PRESENTATION AND ORGAN

BASIS OF PRESENTATION AND ORGANIZATION	3 Months Ended
	Mar. 31, 2017
Accounting Policies [Abstract]
BASIS OF PRESENTATION AND ORGANIZATION	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 March 31, 2017 , the Company owned and operated 217 dialysis clinics treating 14,735 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. Basis 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 Consolidated Financial Statements and notes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2016 . 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. 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 as of March 31, 2017, 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 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 August 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-18, Statement of Cash Flows (Topic 230). The objective of this update is to provide additional guidance and reduce diversity in practice when classifying certain transactions within the statement of cash flows. In November 2016, the FASB issued ASU 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash. The new standard requires that the statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. These standards are effective for financial statements issued for fiscal years beginning after December 15, 2017, including interim periods within those fiscal years. Early application is permitted for all organizations. The Company adopted the provisions of ASU 2016-18 as of January 1, 2017 and applied it retrospectively for all periods presented, which did not have a material impact on the Company's financial statements. In March 2016, the FASB issued 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, and the Company adopted the provisions of ASU 2016-09 as of July 1, 2016. Upon early adoption, the Company elected to change its accounting policy to account for forfeitures as they occur. The change was applied on a modified retrospective basis resulting in an increase to stock compensation expense for the six months ended June 30, 2016 of $354 . Amendments related to accounting for excess tax benefits have been adopted prospectively, resulting in recognition of excess tax benefits against income tax expenses rather than additional paid-in capital of $225 for the six months ended June 30, 2016. Excess tax benefits for share-based payments are included in net operating cash rather than net financing cash, which is consistent with the Company’s current policy. In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842) – Leases: Amendments to the FASB Accounting Standards Codification. The amendments are expected to increase transparency and comparability by recognizing lease assets and liabilities from lessees on the balance sheet and disclosing key information about leasing arrangements in the financial statements. ASU 2016-02 is effective for fiscal years beginning after December 15, 2018, including interim periods within those fiscal years. Early application is permitted for all organizations. The Company expects a balance sheet extension due to the “on balance sheet” recognition of right of use assets and liabilities for agreed lease payment obligations related to certain leased clinics and buildings which are currently classified as operating leases. The impact on the Company will depend on the contract portfolio at the effective date, as well as the transition method. The Company expects to apply the modified retrospective method after review of the analysis is performed. We are currently assessing the impact the adoption of ASU 2016-02 will have on our consolidated financial statements. 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.

INITIAL PUBLIC OFFERING

INITIAL PUBLIC OFFERING	3 Months Ended
	Mar. 31, 2017
Initial Public Offering [Abstract]
INITIAL PUBLIC OFFERING	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 of 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 amended, and cash on hand. 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. Clinic Loan Assignment and Term Loan Holdings LLC Distribution 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 then existing intercompany term loans (“assigned clinic loans”) provided to our joint venture subsidiaries by ARA OpCo to a newly formed entity, Term Loan Holdings LLC (“Term Loan Holdings”), 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 Term Loan Holdings, 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 was $ 17,335 as of March 31, 2017. 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 $ 9,134 of such assigned clinic loans as of March 31, 2017. 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 applied $ 165,635 of the net proceeds 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. Income Tax Receivable Agreement On April 26, 2016, the Company entered into the Income Tax Receivable Agreement (“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 $23,400 based on the fair value of the TRA as of April 20, 2016. As of March 31, 2017, the Company’s total liability under the TRA is estimated to be $17,597 , of which $914 is included as a component of other accrued expenses on the condensed consolidated balance sheet. 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 become due upon vesting for unvested options. This resulted in a modification. Additionally, in connection with the cash dividend, as of March 31, 2017 the Company has made payments equal to $1.30 per share, or $1,445 in the aggregate, to option holders, and, in the case of some performance and market options, a future payment will be due upon vesting totaling $5,405 . In connection with the Term Loan Holdings Distribution, as described above, the Company also equitably adjusted the outstanding stock options by reducing exercise prices and making cash dividend equivalent payments, of which $176 was paid to vested option holders as of March 31, 2017 and $2,349 is payable to unvested option holders only if such unvested options become vested. Options were also equitably adjusted for the TRA, as described above. 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 $9,105 in incremental compensation expense during the three months ended March 31, 2017. As of March 31, 2017, the Company had $12,349 of unrecognized compensation costs related to unvested share-based compensation arrangements.

CASH

CASH	3 Months Ended
	Mar. 31, 2017
Cash and Cash Equivalents [Abstract]
CASH	CASH The following table provides a reconciliation of cash and restricted cash reported within the balance sheet that sum to the total of the same such amounts shown in the statement of cash flows. March 31, 2017 Cash $ 84,003 Restricted cash included in prepaid expenses and other current assets 100 Total cash and restricted cash shown in the statement of cash flows $ 84,103 Restricted cash included in prepaid expenses and other current assets on the balance sheet represent those amounts required to be set aside by contractual agreement with a financial institution.

ACCOUNTS RECEIVABLE

ACCOUNTS RECEIVABLE	3 Months Ended
	Mar. 31, 2017
Accounts, Notes, Loans and Financing Receivable, Gross, Allowance, and Net [Abstract]
ACCOUNTS RECEIVABLE	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 1% 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.

FAIR VALUE MEASUREMENTS

FAIR VALUE MEASUREMENTS	3 Months Ended
	Mar. 31, 2017
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENTS	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 March 31, 2017. Noncontrolling interests subject to put provisions —See Note 8 for a discussion of the Company’s methodology for estimating fair value of noncontrolling interest subject to put provisions. Derivative agreements —See Note 9 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 income or 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 2 – Initial Public Offering 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 three months ended March 31, 2017 and the year ended December 31, 2016 . March 31, 2017 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 1 $ — $ 1 $ — Interest rate derivative agreements (included in Other long-term assets) 795 — 795 — Total Assets $ 796 $ — $ 796 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 16,500 $ — $ — $ 16,500 Interest rate swap agreement (included in Other long-term liabilities) 849 — 849 — Total Liabilities $ 17,349 $ — $ 849 $ 16,500 Temporary Equity Noncontrolling interests subject to put provisions $ 132,465 $ — $ — $ 132,465 December 31, 2016 Total Level 1 Level 2 Level 3 Assets Interest rate swap agreements (included in Prepaid expenses and other current assets) $ 7 $ — $ 7 $ — Liabilities Tax Receivable Agreement Liability $ 21,200 $ — $ — $ 21,200 Temporary Equity Noncontrolling interests subject to put provisions $ 130,365 $ — $ — $ 130,365 The following table provides the fair value rollforward for the three months ended March 31, 2017 for the Tax receivable agreement liability, which is classified as a Level 3 financial instrument. Three Months Ended March 31, 2017 Balance at December 31, 2016 $ 21,200 Options exercised and dividend equivalent payment vesting (183 ) Total realized/unrealized gains: Included in earnings and reported as Income tax receivable agreement income (4,517 ) Balance at March 31, 2017 $ 16,500 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 $433,140 as of March 31, 2017 as compared to the carrying amount of $432,599 . The Company estimates the fair value of the first lien term loans approximates the carrying value at $433,758 as of December 31, 2016 . See Note 2 – Initial Public Offering 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	3 Months Ended
	Mar. 31, 2017
Accounts Payable and Accrued Liabilities, Current [Abstract]
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES Accrued compensation and benefits consist of the following: March 31, 2017 December 31, 2016 Accrued compensation $ 13,509 $ 18,077 Accrued vacation pay 12,583 11,026 $ 26,092 $ 29,103 Accrued expenses and other current liabilities consist of the following: March 31, 2017 December 31, 2016 Payor refunds and retractions $ 30,578 $ 32,902 Dividend equivalent payments 7,909 6,438 Other 6,588 5,946 $ 45,075 $ 45,286

VARIABLE INTEREST ENTITIES

VARIABLE INTEREST ENTITIES	3 Months Ended
	Mar. 31, 2017
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net [Abstract]
VARIABLE INTEREST ENTITIES	VARIABLE INTEREST ENTITIES The Company relies on the operating activities of certain entities that it does not have the majority voting interest, 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 contractual rights granted to it provide the Company with the ability to direct the most significant activities of these entities, including development, administrative and management services. In some cases, the contractual agreements include financial terms that may result in the Company absorbing more than an insignificant amount of the entities expected losses. 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. The analyses upon which these consolidation determinations rest are complex, involve uncertainties, and require significant judgment on various matters, some of which could be subject to different interpretations. As of March 31, 2017 , these condensed consolidated financial statements include total assets of VIEs of $16,231 and total liabilities of VIEs of $12,287 . Term Loan Holdings The Company has determined that we are not the primary beneficiary under VIE accounting guidance for Term Loan Holdings, as discussed in “Note 2—Initial Public Offering.” Based on our involvement with Term Loan Holdings, we do not have the power to direct the activities which most significantly impact Term Loan Holding’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 Term Loan Holdings is limited to the proportion of the assigned clinic loans which we guarantee. See “Note 13—Related Party Transactions.”

NONCONTROLLING INTERESTS SUBJEC

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS	3 Months Ended
	Mar. 31, 2017
Temporary Equity Disclosure [Abstract]
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS	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 accelerated as a result of the Company’s initial public offering, of which some were exercised during the three months ended March 31, 2017. If these put provisions were exercised, the Company would be required to purchase all or a portion of 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. The 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 Company 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 ( 13.50% - 19.00% ) 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. CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES The effects of changes in the Company's ownership interest on the Company's equity are as follows: Three Months Ended March 31, 2017 2016 Net (loss) income attributable to American Renal Holdings Associates, Inc. $ (1,251 ) $ 3,756 Increase in paid-in capital for the sales of noncontrolling interest — — Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (1,272 ) — Net transfers to noncontrolling interests (1,272 ) — Net (loss) income attributable to American Renal Holdings Associates, Inc., net of transfers to noncontrolling interests $ (2,523 ) $ 3,756

DEBT

DEBT	3 Months Ended
	Mar. 31, 2017
Debt Instruments [Abstract]
DEBT	DEBT Long-term debt consists of the following: March 31, 2017 December 31, 2016 First Lien Credit Agreement $ 432,599 $ 433,758 Term Loans (1) 126,991 118,503 Lines of Credit 7,301 19,360 Other 2,962 3,041 569,853 574,662 Less: discounts and fees, net of accumulated amortization (3,930 ) (4,330 ) Less: current maturities (45,559 ) (48,274 ) $ 520,364 $ 522,058 _____________________________ (1) Includes assigned clinic loans Scheduled maturities of long-term debt as of March 31, 2017 are as follows: 2017 (remainder) $ 36,431 2018 38,263 2019 455,425 2020 19,859 2021 12,159 Thereafter 7,716 $ 569,853 During the three months ended March 31, 2017 , the Company made mandatory principal payments of $1,159 under the First Lien Credit Agreement. As of March 31, 2017 , there were no borrowings outstanding under the Revolving Credit Facility as provided for under our First Lien Credit Agreement. Interest Rate Swap Agreements In May 2013, the Company entered into two interest rate swap agreements (the ‘‘2013 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 2013 Swaps were designated as a cash flow hedge, and terminated on March 31, 2017. In March 2017, the Company entered into a forward starting interest rate swap agreement (the “2017 Swap”) with a notional amount of $133,000 , as a means of fixing the floating interest rate component on $460,000 of its variable-rate debt under the Term B Loans, with an effective date of March 31, 2018. The forward starting 2017 Swap is designated as a cash flow hedge, with a termination date of March 31, 2021. As a result of the application of hedge accounting treatment, to the extent the 2013 Swaps and 2017 Swap 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. During the period ended March 31, 2017 the 2013 Swaps continue to be ineffective, which was determined as of March 31, 2016. Amounts previously recorded in accumulated other comprehensive loss related to the 2013 Swaps, totaling $501 , have been reclassified into earnings over the term of the previously hedged borrowing using the swaplet method. The Company reclassified $100 previously recorded in accumulated other comprehensive loss into interest expense during the three months ended March 31, 2017 . As of March 31, 2017, the 2017 Swaps are effective. Interest Rate Cap Agreements In March 2017, the Company entered into two interest rate cap agreements (the “Caps”) with notional amounts totaling $147,000 , as a means of capping the floating interest rate component on $460,000 of its variable‑rate debt under the Term B Loans. The Caps are designated as a cash flow hedge, with a termination date of March 31, 2021. As a result of the application of hedge accounting treatment, to the extent the Caps 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 Caps are ineffective and produces gains and losses differently from the losses or gains being hedged, the ineffective portion is recognized in earnings immediately. Hedge effectiveness is tested quarterly. The Company does not use derivative instruments for trading or speculative purposes. As more fully described within Note 5 - Fair Value Measurements, the Company uses a three‑level fair value hierarchy that prioritizes the inputs used to measure fair value. The fair value of the interest rate swap agreements and Caps 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, and 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.

INCOME TAXES

INCOME TAXES	3 Months Ended
	Mar. 31, 2017
Income Tax Disclosure [Abstract]
INCOME TAXES	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 March 31, 2017 and 2016 was (37.58)% and 10.55% , 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, the valuation allowance recorded on a discrete basis, as well as the change in fair value of the TRA liability, which is not deductible for income tax purposes. The Company has established a $673 valuation allowance for its charitable contributions that are expiring in 2017. The Company believes that future taxable income levels would be sufficient to realize the tax benefits and has not established any additional valuation on the remaining deferred tax assets. Should the Company determine that future realization of these tax benefits is not more likely than not, a valuation allowance would be established, which would increase our tax provision in the period of such determination.

STOCK-BASED COMPENSATION

STOCK-BASED COMPENSATION	3 Months Ended
	Mar. 31, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION For the three months ended March 31, 2017 and 2016 , stock-based compensation expense was reflected in the accompanying consolidated statements of operations as follows: Three Months Ended March 31, 2017 2016 Patient care costs $ 1,828 $ 93 General and administrative 8,260 293 Total stock-based compensation before tax $ 10,088 $ 386 Income tax benefit (4,035 ) (154 ) As of March 31, 2017 , the Company has 5,988,294 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 March 31, 2017, options to purchase an aggregate of 3,102,577 shares of common stock are available for future grants under the 2016 Plan. 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: Three months ended March 31, 2017 Expected volatility 30.00% Weighted average expected term in years 6.00 Weighted average risk-free interest rate 2.26% Expected annual dividend yield —% Weighted average grant-date fair value $5.85 Information concerning options activity under the 2016 Plan for options to acquire Common Shares is summarized as follows: Three months ended March 31, 2017 Number of Options Weighted-Average Exercise Price Outstanding, beginning of period 318,877 $ 21.90 Granted (1) 422,529 17.39 Forfeited (13,625 ) 19.40 Outstanding, end of period 727,781 $ 19.33 Options vested and expected to vest, end of period 727,781 $ 19.33 Options exercisable, end of period 22,131 $ 22.87 _____________________________ (1) Subject to vesting terms of three years. Restricted Stock Awards Employees and directors are eligible to receive grants of restricted stock, which entitle the holder to shares of common stock as the awards vest over time. The Company determines stock-based compensation expense using the fair value method. The fair value of restricted stock is equal to the closing sale price of the Company’s common stock on the date of grant. During the three months ended March 31, 2017, the Company granted 220,250 restricted stock awards to employees and directors, respectively, at a weighted average grant date fair value of $17.39 . These restricted stock awards vest over a weighted average period of 2.4 year from grant date. As of March 31, 2017, a total of 194,946 shares of restricted stock were unvested and outstanding, which results in unamortized stock-based compensation of $3,305 to be recognized as stock-based compensation expense over the remaining weighted average vesting period of 1.8 years. A summary of restricted stock award activity is as follows: Three Months Ended March 31, 2017 Number Outstanding Weighted Average Grant Date Fair Value per Award Balance at December 31, 2016 — — Granted 220,250 $ 17.39 Vested 25,304 $ 17.39 Balance at March 31, 2017 194,946 $ 17.39

(LOSS) EARNINGS PER SHARE

(LOSS) EARNINGS PER SHARE	3 Months Ended
	Mar. 31, 2017
Earnings Per Share [Abstract]
(LOSS) EARNINGS PER SHARE	(LOSS) EARNINGS 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, less unvested restricted stock. 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 March 31, 2017 2016 Basic Net (loss) income attributable to American Renal Associates Holdings, Inc. $ (1,251 ) $ 3,756 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 (11,083 ) — Net (loss) income attributable to American Renal Associates Holdings, Inc. for basic earnings per share calculation $ (12,334 ) $ 3,756 Weighted-average common shares outstanding used to calculate basic net income (loss) per share 30,907,482 22,213,967 (Loss) earnings per share, basic $ (0.40 ) $ 0.17 Diluted Net (loss) income attributable to American Renal Associates Holdings, Inc. $ (1,251 ) $ 3,756 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 (11,083 ) — Net (loss) income attributable to American Renal Associates Holdings, Inc. for diluted earnings per share calculation $ (12,334 ) $ 3,756 Weighted-average common shares outstanding, basic 30,907,482 22,213,967 Weighted-average effect of dilutive securities: Effect of assumed exercise of stock options — 571,703 Weighted-average common shares outstanding used to calculate diluted net income (loss) per share 30,907,482 22,785,670 (Loss) earnings per share, diluted $ (0.40 ) $ 0.16 Outstanding options excluded as impact would be anti-dilutive 1,315,091 116,937

RELATED PARTY TRANSACTIONS

RELATED PARTY TRANSACTIONS	3 Months Ended
	Mar. 31, 2017
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	RELATED PARTY TRANSACTIONS Term Loan Holdings In 2016, the Company transferred substantially all of the assigned clinic loans provided to our joint venture subsidiaries to Term Loan Holdings, as described in Note 2 – Initial Public Offering and Note 7 – Variable Interest Entities. A Centerbridge entity, which does not hold any economic interest in Term Loan Holdings, is the manager of Term Loan Holdings, and affiliates of Centerbridge and our executive officers own economic interests in Term Loan Holdings. As of March 31, 2017 , such assigned clinic loans aggregated $17,335 , had maturities ranging from June 2017 to July 2020, with a weighted average maturity of approximately 2.42 years (September 2019), and interest rates ranging from 3.46% to 8.08% , with a weighted average interest rate of 5.09% . Fixed 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 Term Loan Holdings (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 Term Loan Holdings. The quarterly fee charged for the three months ended March 31, 2017 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 $17,335 , of which we guaranteed $9,134 as of March 31, 2017 . 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. See Note 2—Initial Public Offering. 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 three months ended March 31, 2017 and 2016 , the Company recorded $0 and $457 of expense related to this agreement, respectively. Centerbridge was also entitled to receive an additional fee equal to 1% 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 2016, the Company entered into a sublease agreement with a clinic group, who are also noncontrolling interest shareholders, to provide financing for various facility buildouts. The total amount of initial financing provided by the Company was $1,044 . As of March 31, 2017 the loans had an interest rate of 6% with maturities ranging from March 2026 through August 2031. Fixed principal and interest payments with respect to such loans are payable monthly. As of March 31, 2017 the remaining balance to be paid to the Company was $989 .

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	3 Months Ended
	Mar. 31, 2017
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES.	COMMITMENTS AND CONTINGENCIES Income Tax Receivable Agreement As described in Note 2 – Initial Public Offering, 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 (as defined in the TRA). 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, changes in the income tax rate, whether and when any Relevant Stock Options are exercised and the value of our common stock at the time of such exercise. 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 the Company’s financial position, results of operations or cash flows. See Note 15—Certain Legal Matters. 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.

CERTAIN LEGAL MATTERS

CERTAIN LEGAL MATTERS	3 Months Ended
	Mar. 31, 2017
Certain legal matters
CERTAIN LEGAL MATTERS	CERTAIN LEGAL MATTERS As previously disclosed, American Renal Associates Holdings, Inc. (“ARA”) and its wholly owned operating subsidiary American Renal Associates LLC (“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 (the "Court") on July 1, 2016. On August 12, 2016, ARA and ARA OpCo each filed a motion to dismiss the action. On September 2, 2016, plaintiffs filed an amended complaint, dropping one of the United affiliates as a plaintiff. On September 30, 2016, ARA and ARA OpCo each filed a motion to dismiss the amended complaint. On January 17, 2017, plaintiffs filed a motion seeking to file a second amended complaint, which would add American Renal Management LLC ("ARM") as a defendant. ARA and ARA OpCo filed an opposition to the motion to further amend. On May 8, 2017, the Court granted ARA's motion to dismiss for lack of personal jurisdiction and dismissed ARA from the lawsuit without prejudice. The lawsuit remains pending against ARA OpCo and ARM with a hearing set on the motion to dismiss for June 23, 2017. The amended complaint and proposed second amended complaint relate to 30 patients who have received, and some of whom continue to receive, dialysis at 12 clinics in Florida and Ohio and who obtained coverage under one of United’s ACA-compliant individual marketplace plans, 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, healthcare kickbacks, patient brokering, and violations of the applicable commercial plan agreements in connection with, among other things, premium payment assistance by the American Kidney Fund (“AKF”). The amended complaint and proposed second amended complaint seek 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 has moved to dismiss the amended complaint in full, has opposed the motion to file a second amended complaint, and is vigorously defending itself in this legal matter. Jurisdictional discovery was completed and merits discovery has commenced. The Company has received letters from other insurance companies seeking information regarding matters relating to the insurance companies’ covered patients similar in nature to the matters underlying the United complaint. In addition, as previously disclosed, on July 26, 2016, the Staff of the SEC sent a letter to the Company stating that it is conducting an inquiry and requesting that the Company provide certain documents and information relating to the subject matter covered by the United complaint described above. The Company has subsequently received follow up and additional requests for documents and information with respect to the same subject matter. The Company has fully cooperated with the SEC Staff. On April 28, 2017, the Company was notified by the SEC Staff that the SEC had concluded its investigation and, based on the information it had as of that date, does not intend to recommend an enforcement action against the Company. On August 31, 2016 and September 2, 2016, putative shareholder class action complaints were filed in the United States District Court for the Southern District of New York and the United States District Court for the District of Massachusetts, respectively, against the Company and certain officers and directors of the Company. Both complaints asserted federal securities law claims against the Company and the individual defendants under Sections 10(b) and 20(a) of the Exchange Act and Rule 10b-5 promulgated thereunder by the SEC and in addition, the complaint filed in the United States District Court for the Southern District of New York asserted claims under Sections 11 and 15 of the Securities Act. The complaints alleged that the Company made material misstatements or omissions, including in connection with its initial public offering filings and other public filings. The complaints sought unspecified damages on behalf of the individuals or entities that purchased or otherwise acquired the Company’s securities from April 20, 2016 to August 18, 2016. On October 26, 2016, the complaint filed in the Southern District of New York was voluntarily dismissed by the plaintiff without prejudice. On November 30, 2016, Lead Plaintiff was appointed for the putative shareholder class action complaint pending in the United States District Court for the District of Massachusetts, captioned Esposito, et al. v. American Renal Associates Holdings, Inc., et al. , No. 16-cv-11797 (the “Esposito Action”). On February 1, 2017, Lead Plaintiff in the Esposito Action filed an amended complaint against the Company, certain former and current officers and directors of the Company, Centerbridge Capital Partners L.P., and certain of the underwriters in our initial public offering. The amended complaint asserts federal securities laws claims under Securities Act sections 11 and 15, as well as Exchange Act sections 10(b), 20(a), and SEC Rule 10b-5. The Company's response is currently due in May 2017. The Company intends to vigorously defend itself against these claims. In addition, the Company received a demand letter, dated January 27, 2017, from a purported shareholder relating to the subject matter covered by the United complaint and the class action complaints described above, which could lead to the initiation of a shareholder derivative lawsuit against the Company and its board of directors. By letter dated May 8, 2017, attorneys for the shareholder were informed that the Board of Directors had determined not to pursue potential claims against individuals as set forth in the demand letter. On January 3, 2017, the Company received a subpoena from the United States Attorney’s Office, District of Massachusetts, requesting information relating to the Company’s payments and other interactions with the AKF and any efforts to educate patients qualified or enrolled in Medicare or Medicaid about enrollment in ACA-compliant individual marketplace plans, among other related matters under applicable healthcare laws for the period from January 1, 2013 through the present. As it has done with the other regulators who have expressed interest in such matters, the Company is cooperating fully with the government. In the event that the United States Attorney’s Office, District of Massachusetts, were to find violations of any federal criminal or civil laws, our business, financial condition and results of operations could be materially adversely affected.

CHANGES IN OWNERSHIP INTEREST I

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES	3 Months Ended
	Mar. 31, 2017
Noncontrolling Interest [Abstract]
CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES	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 accelerated as a result of the Company’s initial public offering, of which some were exercised during the three months ended March 31, 2017. If these put provisions were exercised, the Company would be required to purchase all or a portion of 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. The 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 Company 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 ( 13.50% - 19.00% ) 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. CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES The effects of changes in the Company's ownership interest on the Company's equity are as follows: Three Months Ended March 31, 2017 2016 Net (loss) income attributable to American Renal Holdings Associates, Inc. $ (1,251 ) $ 3,756 Increase in paid-in capital for the sales of noncontrolling interest — — Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (1,272 ) — Net transfers to noncontrolling interests (1,272 ) — Net (loss) income attributable to American Renal Holdings Associates, Inc., net of transfers to noncontrolling interests $ (2,523 ) $ 3,756

BASIS OF PRESENTATION AND ORG24

BASIS OF PRESENTATION AND ORGANIZATION (Policies)	3 Months Ended
	Mar. 31, 2017
Accounting Policies [Abstract]
Basis of Presentation and Consolidation	Basis 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 Consolidated Financial Statements and notes thereto included in our Annual Report on Form 10-K for the year ended December 31, 2016 . 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.
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 as of March 31, 2017, 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 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 August 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-18, Statement of Cash Flows (Topic 230). The objective of this update is to provide additional guidance and reduce diversity in practice when classifying certain transactions within the statement of cash flows. In November 2016, the FASB issued ASU 2016-18, Statement of Cash Flows (Topic 230): Restricted Cash. The new standard requires that the statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. These standards are effective for financial statements issued for fiscal years beginning after December 15, 2017, including interim periods within those fiscal years. Early application is permitted for all organizations. The Company adopted the provisions of ASU 2016-18 as of January 1, 2017 and applied it retrospectively for all periods presented, which did not have a material impact on the Company's financial statements. In March 2016, the FASB issued 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, and the Company adopted the provisions of ASU 2016-09 as of July 1, 2016. Upon early adoption, the Company elected to change its accounting policy to account for forfeitures as they occur. The change was applied on a modified retrospective basis resulting in an increase to stock compensation expense for the six months ended June 30, 2016 of $354 . Amendments related to accounting for excess tax benefits have been adopted prospectively, resulting in recognition of excess tax benefits against income tax expenses rather than additional paid-in capital of $225 for the six months ended June 30, 2016. Excess tax benefits for share-based payments are included in net operating cash rather than net financing cash, which is consistent with the Company’s current policy. In February 2016, the FASB issued ASU 2016-02, Leases (Topic 842) – Leases: Amendments to the FASB Accounting Standards Codification. The amendments are expected to increase transparency and comparability by recognizing lease assets and liabilities from lessees on the balance sheet and disclosing key information about leasing arrangements in the financial statements. ASU 2016-02 is effective for fiscal years beginning after December 15, 2018, including interim periods within those fiscal years. Early application is permitted for all organizations. The Company expects a balance sheet extension due to the “on balance sheet” recognition of right of use assets and liabilities for agreed lease payment obligations related to certain leased clinics and buildings which are currently classified as operating leases. The impact on the Company will depend on the contract portfolio at the effective date, as well as the transition method. The Company expects to apply the modified retrospective method after review of the analysis is performed. We are currently assessing the impact the adoption of ASU 2016-02 will have on our consolidated financial statements. 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.

CASH (Tables)

CASH (Tables)	3 Months Ended
	Mar. 31, 2017
Cash and Cash Equivalents [Abstract]
Schedule of reconciliation of cash	The following table provides a reconciliation of cash and restricted cash reported within the balance sheet that sum to the total of the same such amounts shown in the statement of cash flows. March 31, 2017 Cash $ 84,003 Restricted cash included in prepaid expenses and other current assets 100 Total cash and restricted cash shown in the statement of cash flows $ 84,103
Schedule of reconciliation of restricted cash	The following table provides a reconciliation of cash and restricted cash reported within the balance sheet that sum to the total of the same such amounts shown in the statement of cash flows. March 31, 2017 Cash $ 84,003 Restricted cash included in prepaid expenses and other current assets 100 Total cash and restricted cash shown in the statement of cash flows $ 84,103

FAIR VALUE MEASUREMENTS (Tables

FAIR VALUE MEASUREMENTS (Tables)	3 Months Ended
	Mar. 31, 2017
Fair Value Disclosures [Abstract]
Schedule of the fair value of financial instruments	March 31, 2017 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 1 $ — $ 1 $ — Interest rate derivative agreements (included in Other long-term assets) 795 — 795 — Total Assets $ 796 $ — $ 796 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 16,500 $ — $ — $ 16,500 Interest rate swap agreement (included in Other long-term liabilities) 849 — 849 — Total Liabilities $ 17,349 $ — $ 849 $ 16,500 Temporary Equity Noncontrolling interests subject to put provisions $ 132,465 $ — $ — $ 132,465 December 31, 2016 Total Level 1 Level 2 Level 3 Assets Interest rate swap agreements (included in Prepaid expenses and other current assets) $ 7 $ — $ 7 $ — Liabilities Tax Receivable Agreement Liability $ 21,200 $ — $ — $ 21,200 Temporary Equity Noncontrolling interests subject to put provisions $ 130,365 $ — $ — $ 130,365
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 three months ended March 31, 2017 for the Tax receivable agreement liability, which is classified as a Level 3 financial instrument. Three Months Ended March 31, 2017 Balance at December 31, 2016 $ 21,200 Options exercised and dividend equivalent payment vesting (183 ) Total realized/unrealized gains: Included in earnings and reported as Income tax receivable agreement income (4,517 ) Balance at March 31, 2017 $ 16,500

ACCRUED EXPENSES AND OTHER CU27

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Tables)	3 Months Ended
	Mar. 31, 2017
Accounts Payable and Accrued Liabilities, Current [Abstract]
Summary of accrued compensation and benefits	Accrued compensation and benefits consist of the following: March 31, 2017 December 31, 2016 Accrued compensation $ 13,509 $ 18,077 Accrued vacation pay 12,583 11,026 $ 26,092 $ 29,103
Summary of accrued expenses and other current liabilities	Accrued expenses and other current liabilities consist of the following: March 31, 2017 December 31, 2016 Payor refunds and retractions $ 30,578 $ 32,902 Dividend equivalent payments 7,909 6,438 Other 6,588 5,946 $ 45,075 $ 45,286

DEBT (Tables)

DEBT (Tables)	3 Months Ended
	Mar. 31, 2017
Debt Instruments [Abstract]
Schedule of long-term debt	Long-term debt consists of the following: March 31, 2017 December 31, 2016 First Lien Credit Agreement $ 432,599 $ 433,758 Term Loans (1) 126,991 118,503 Lines of Credit 7,301 19,360 Other 2,962 3,041 569,853 574,662 Less: discounts and fees, net of accumulated amortization (3,930 ) (4,330 ) Less: current maturities (45,559 ) (48,274 ) $ 520,364 $ 522,058 _____________________________ (1) Includes assigned clinic loans
Schedule of maturities of long-term debt	Scheduled maturities of long-term debt as of March 31, 2017 are as follows: 2017 (remainder) $ 36,431 2018 38,263 2019 455,425 2020 19,859 2021 12,159 Thereafter 7,716 $ 569,853

STOCK-BASED COMPENSATION (Table

STOCK-BASED COMPENSATION (Tables)	3 Months Ended
	Mar. 31, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Schedule of stock-based compensation expense	For the three months ended March 31, 2017 and 2016 , stock-based compensation expense was reflected in the accompanying consolidated statements of operations as follows: Three Months Ended March 31, 2017 2016 Patient care costs $ 1,828 $ 93 General and administrative 8,260 293 Total stock-based compensation before tax $ 10,088 $ 386 Income tax benefit (4,035 ) (154 )
Schedule of assumptions used for options granted to acquire Common Stock and the fair value at the date of grant	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: Three months ended March 31, 2017 Expected volatility 30.00% Weighted average expected term in years 6.00 Weighted average risk-free interest rate 2.26% Expected annual dividend yield —% Weighted average grant-date fair value $5.85
Schedule of information concerning options activity for options to acquire Common Stock	Information concerning options activity under the 2016 Plan for options to acquire Common Shares is summarized as follows: Three months ended March 31, 2017 Number of Options Weighted-Average Exercise Price Outstanding, beginning of period 318,877 $ 21.90 Granted (1) 422,529 17.39 Forfeited (13,625 ) 19.40 Outstanding, end of period 727,781 $ 19.33 Options vested and expected to vest, end of period 727,781 $ 19.33 Options exercisable, end of period 22,131 $ 22.87 _____________________________ (1) Subject to vesting terms of three years.
Schedule of restricted stock award activity	A summary of restricted stock award activity is as follows: Three Months Ended March 31, 2017 Number Outstanding Weighted Average Grant Date Fair Value per Award Balance at December 31, 2016 — — Granted 220,250 $ 17.39 Vested 25,304 $ 17.39 Balance at March 31, 2017 194,946 $ 17.39

(LOSS) EARNINGS PER SHARE (Tabl

(LOSS) EARNINGS PER SHARE (Tables)	3 Months Ended
	Mar. 31, 2017
Earnings Per Share [Abstract]
Schedule of basic and diluted earnings per share	Three Months Ended March 31, 2017 2016 Basic Net (loss) income attributable to American Renal Associates Holdings, Inc. $ (1,251 ) $ 3,756 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 (11,083 ) — Net (loss) income attributable to American Renal Associates Holdings, Inc. for basic earnings per share calculation $ (12,334 ) $ 3,756 Weighted-average common shares outstanding used to calculate basic net income (loss) per share 30,907,482 22,213,967 (Loss) earnings per share, basic $ (0.40 ) $ 0.17 Diluted Net (loss) income attributable to American Renal Associates Holdings, Inc. $ (1,251 ) $ 3,756 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 (11,083 ) — Net (loss) income attributable to American Renal Associates Holdings, Inc. for diluted earnings per share calculation $ (12,334 ) $ 3,756 Weighted-average common shares outstanding, basic 30,907,482 22,213,967 Weighted-average effect of dilutive securities: Effect of assumed exercise of stock options — 571,703 Weighted-average common shares outstanding used to calculate diluted net income (loss) per share 30,907,482 22,785,670 (Loss) earnings per share, diluted $ (0.40 ) $ 0.16 Outstanding options excluded as impact would be anti-dilutive 1,315,091 116,937

CHANGES IN OWNERSHIP INTEREST31

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES (Tables)	3 Months Ended
	Mar. 31, 2017
Noncontrolling Interest [Abstract]
Schedule of effect of changes in Company's ownership interest on Company's equity	The effects of changes in the Company's ownership interest on the Company's equity are as follows: Three Months Ended March 31, 2017 2016 Net (loss) income attributable to American Renal Holdings Associates, Inc. $ (1,251 ) $ 3,756 Increase in paid-in capital for the sales of noncontrolling interest — — Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (1,272 ) — Net transfers to noncontrolling interests (1,272 ) — Net (loss) income attributable to American Renal Holdings Associates, Inc., net of transfers to noncontrolling interests $ (2,523 ) $ 3,756

BASIS OF PRESENTATION AND ORG32

BASIS OF PRESENTATION AND ORGANIZATION (Details)	3 Months Ended		6 Months Ended
	Mar. 31, 2017USD ($)dialysis_clinicpatientstatesegment	Mar. 31, 2016USD ($)	Jun. 30, 2016USD ($)	Dec. 31, 2016USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Assets	$ 967,416,000			$ 986,024,000
Number of dialysis clinics owned and operated | dialysis_clinic	217
Number of patients | patient	14,735
Number of states | state	25
Segment Information
Number of reportable segments | segment	1
New Accounting Pronouncements and Changes in Accounting Principles [Abstract]
Stock compensation expense	$ 10,088,000	$ 386,000
American Renal Holdings Intermediate Company, LLC
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Percentage ownership of subsidiary	100.00%
Assets	$ 0
Percentage ownership of parent	100.00%
ASU 2016-09 | Early adoption
New Accounting Pronouncements and Changes in Accounting Principles [Abstract]
Stock compensation expense			$ 354,000
Excess tax benefit for stock options exercised, net			$ 225,000

INITIAL PUBLIC OFFERING (Detail

INITIAL PUBLIC OFFERING (Details) - USD ($)	Apr. 26, 2016	Apr. 20, 2016	Mar. 31, 2017	Mar. 31, 2016	Dec. 31, 2016	Apr. 07, 2016
Amendment of Certificate of Incorporation and Initial Public Offering
Common stock, shares authorized (in shares)			300,000,000		300,000,000	300,000,000
Common stock, par value (in USD per share)			$ 0.01		$ 0.01	$ 0.01
Stock split ratio	2.29
Clinic Loan Assignment and Term Loan Holdings LLC Distribution
Assigned clinic loans			$ 17,335,000
Clinic loan guarantee			9,134,000
Amendments to and Repayment of Credit Facility
Transaction costs			0	$ 24,000
Percentage tax savings payable to pre-IPO stockholders	85.00%
Income tax receivable agreement liability total		$ 23,400,000	17,597,000
Income tax receivable agreement liability current			914,000
Cash dividend (in USD per share)	$ 1.30
Cash dividend	$ 28,886,000
Unrecognized non-cash compensation costs	38,877,000
Guaranteed Clinic Loan
Clinic Loan Assignment and Term Loan Holdings LLC Distribution
Clinic loan guarantee			9,134,000
Clinic Loan
Clinic Loan Assignment and Term Loan Holdings LLC Distribution
Assigned clinic loans			17,335,000
First Lien Credit Agreement
Amendments to and Repayment of Credit Facility
Increase in borrowing capacity	50,000,000
Aggregate amount of borrowing capacity	$ 100,000,000
Interest rate margin increase	0.25%
Proceeds from terms loans, net of deferred financing costs	$ 2,700,000
Transaction costs	1,350,000
Deferred finance costs	1,350,000
Term loans
Amendments to and Repayment of Credit Facility
Increase in borrowing capacity	$ 60,000,000
IPO
Schedule of Initial Public Offering [Line Items]
Number of shares sold in public offering (in shares)	8,625,000
Share price (in USD per share)	$ 22
Net proceeds to the Company	$ 176,942,000
Amendments to and Repayment of Credit Facility
Net proceeds to the Company	176,942,000
Stock compensation due to modification			$ 9,105,000
IPO | Second Lien Credit Agreement
Schedule of Initial Public Offering [Line Items]
Net proceeds to the Company	165,635,000
Amendments to and Repayment of Credit Facility
Net proceeds to the Company	165,635,000
Write-off of deferred financing fees	$ 4,708,000
Vested option stockholders
Amendments to and Repayment of Credit Facility
Equivalent adjustments in the form of cash dividend equivalent payments (in USD per share)			$ 1.30
Equitable adjustments in the form of cash dividend equivalent payments			$ 1,445,000
Vested option stockholders | Term Loan Holdings LLC
Amendments to and Repayment of Credit Facility
Equitable adjustments in the form of cash dividend equivalent payments			176,000
Unvested option stockholders
Amendments to and Repayment of Credit Facility
Equitable adjustments in the form of cash dividend equivalent payments			5,405,000
Unrecognized non-cash compensation costs			12,349,000
Unvested option stockholders | Term Loan Holdings LLC
Amendments to and Repayment of Credit Facility
Equitable adjustments in the form of cash dividend equivalent payments			$ 2,349,000

CASH (Details)

CASH (Details) - USD ($) $ in Thousands	Mar. 31, 2017	Dec. 31, 2016	Mar. 31, 2016	Dec. 31, 2015
Cash and Cash Equivalents [Abstract]
Cash	$ 84,003	$ 100,916
Restricted cash included in prepaid expenses and other current assets	100
Total cash and restricted cash shown in the statement of cash flows	$ 84,103	$ 100,916	$ 95,965	$ 90,988

ACCOUNTS RECEIVABLE (Details)

ACCOUNTS RECEIVABLE (Details)	3 Months Ended
	Mar. 31, 2017
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	1.00%

FAIR VALUE MEASUREMENTS (Detail

FAIR VALUE MEASUREMENTS (Details) - USD ($)	Mar. 31, 2017	Dec. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Transfers between Levels 1, 2 and 3	$ 0	$ 0
First lien term loans
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value of debt	433,140,000	433,758,000
Carrying amount of long-term debt	$ 432,599,000	$ 433,758,000

FAIR VALUE MEASUREMENTS - Sched

FAIR VALUE MEASUREMENTS - Schedule of fair values (Details) - USD ($) $ in Thousands	Mar. 31, 2017	Dec. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Noncontrolling interests subject to put provisions	$ 132,465	$ 130,365
Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	796
Total Liabilities	17,349
Noncontrolling interests subject to put provisions	132,465	130,365
Recurring basis | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	796
Total Liabilities	849
Recurring basis | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total Liabilities	16,500
Noncontrolling interests subject to put provisions	132,465	130,365
Prepaid expenses and other current assets | Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	1	7
Prepaid expenses and other current assets | Recurring basis | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	1	7
Other long-term assets | Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	795
Other long-term assets | Recurring basis | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	795
Income tax receivable agreement payable | Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Tax receivable agreement liability	16,500	21,200
Income tax receivable agreement payable | Recurring basis | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Tax receivable agreement liability	16,500	$ 21,200
Other long-term liabilities | Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements liability	849
Other long-term liabilities | Recurring basis | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements liability	$ 849

FAIR VALUE MEASUREMENTS - Fair

FAIR VALUE MEASUREMENTS - Fair value rollforward for tax receivable agreement liability (Details) $ in Thousands	3 Months Ended
	Mar. 31, 2017USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
December 31, 2016	$ 21,200
Options exercised and dividend equivalent payment vesting	(183)
Total realized/unrealized gains:
Included in earnings and reported as Income tax receivable agreement income	(4,517)
March 31, 2017	$ 16,500

ACCRUED EXPENSES AND OTHER CU39

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Details) - USD ($) $ in Thousands	Mar. 31, 2017	Dec. 31, 2016
Accrued compensation and benefits:
Accrued compensation	$ 13,509	$ 18,077
Accrued vacation pay	12,583	11,026
Accrued compensation and benefits	26,092	29,103
Accrued expenses and other current liabilities:
Payor refunds and retractions	30,578	32,902
Dividend equivalent payments	7,909	6,438
Other	6,588	5,946
Accrued expenses and other current liabilities	$ 45,075	$ 45,286

VARIABLE INTEREST ENTITIES (Det

VARIABLE INTEREST ENTITIES (Details) $ in Thousands	Mar. 31, 2017USD ($)
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net [Abstract]
Total assets of VIEs	$ 16,231
Total liabilities of VIEs	$ 12,287

NONCONTROLLING INTERESTS SUBJ41

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS (Details)	3 Months Ended
	Mar. 31, 2017
Minimum
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Weighted Average Cost of Capital	13.50%
Maximum
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Weighted Average Cost of Capital	19.00%

DEBT - Schedule of long-term de

DEBT - Schedule of long-term debt (Details) - USD ($) $ in Thousands	Mar. 31, 2017	Dec. 31, 2016
LONG-TERM DEBT
Total long-term debt	$ 569,853	$ 574,662
Less: discounts and fees, net of accumulated amortization	(3,930)	(4,330)
Less: current maturities	(45,559)	(48,274)
Long-term debt, less current portion	520,364	522,058
First Lien Credit Agreement
LONG-TERM DEBT
Long-term debt, gross	432,599	433,758
Term Loans
LONG-TERM DEBT
Long-term debt, gross	126,991	118,503
Lines of Credit
LONG-TERM DEBT
Long-term debt, gross	7,301	19,360
Other
LONG-TERM DEBT
Long-term debt, gross	$ 2,962	$ 3,041

DEBT - Scheduled maturities of

DEBT - Scheduled maturities of long-term debt (Details) - USD ($) $ in Thousands	Mar. 31, 2017	Dec. 31, 2016
Scheduled maturities of long-term debt
2017 (remainder)	$ 36,431
2,018	38,263
2,019	455,425
2,020	19,859
2,021	12,159
Thereafter	7,716
Total long-term debt	$ 569,853	$ 574,662

DEBT - Narrative (Details)

DEBT - Narrative (Details)	3 Months Ended
	Mar. 31, 2017USD ($)interest_rate_cap_agreement	May 31, 2013USD ($)interest_rate_swap_agreement
LONG-TERM DEBT
Amount reclassified from accumulated other comprehensive loss to interest expense	$ 100,000
Interest rate swap agreements
LONG-TERM DEBT
Number of interest rate swap agreements | interest_rate_swap_agreement		2
Interest rate swap and cap agreements notional amount		$ 320,000,000
Amount of accumulated other comprehensive loss reclassified to earnings	501,000
Interest rate swap agreements | Designated as hedge | Cash flow hedge
LONG-TERM DEBT
Interest rate swap and cap agreements notional amount	$ 133,000,000
Interest rate cap agreements | Designated as hedge | Cash flow hedge
LONG-TERM DEBT
Number of interest rate swap agreements | interest_rate_cap_agreement	2
Interest rate swap and cap agreements notional amount	$ 147,000,000
Revolving Credit Facility
LONG-TERM DEBT
Revolving credit facility borrowings outstanding	0
First Lien Credit Agreement
LONG-TERM DEBT
Principal payments	1,159,000
Term loans | Term B loans
LONG-TERM DEBT
Debt face amount	$ 460,000,000	$ 400,000,000

INCOME TAXES (Details)

INCOME TAXES (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Income Tax Disclosure [Abstract]
Effective income tax rate	(37.58%)	10.55%
Federal statutory rate	35.00%
Valuation allowance	$ 673

STOCK-BASED COMPENSATION - Sche

STOCK-BASED COMPENSATION - Schedule of Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation before tax	$ 10,088	$ 386
Income tax benefit	(4,035)	(154)
Patient care costs
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation before tax	1,828	93
General and administrative
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation before tax	$ 8,260	$ 293

STOCK-BASED COMPENSATION - Narr

STOCK-BASED COMPENSATION - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands	Apr. 07, 2016	Mar. 31, 2017	Dec. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Options outstanding (in shares)		5,988,294
2016 Omnibus Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Options outstanding (in shares)		727,781	318,877
Authorized additional stock options (in shares)	4,000,000
Stock options to purchase outstanding (in shares)		3,102,577
Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Granted (in shares)		220,250
Granted (in USD per share)		$ 17.39
Vesting period (in years)		2 years 4 months 24 days
Unvested and outstanding (in shares)		194,946	0
Unrecognized compensation costs		$ 3,305
Unrecognized compensation costs recognition period		1 year 9 months 18 days

STOCK-BASED COMPENSATION - Assu

STOCK-BASED COMPENSATION - Assumptions used for options granted (Details)	3 Months Ended
	Mar. 31, 2017$ / shares
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Expected volatility	30.00%
Weighted average expected term in years	6 years
Weighted average risk-free interest rate	2.26%
Expected annual dividend yield	0.00%
Weighted average grant-date fair value (in USD per share)	$ 5.85

STOCK-BASED COMPENSATION - Opti

STOCK-BASED COMPENSATION - Option activity (Details)	3 Months Ended
	Mar. 31, 2017$ / sharesshares
Number of Options
Outstanding, end of period (in shares)	5,988,294
2016 Omnibus Incentive Plan
Number of Options
Outstanding, beginning of period (in shares)	318,877
Granted (in shares)	422,529
Forfeited (in shares)	(13,625)
Outstanding, end of period (in shares)	727,781
Options vested and expected to vest, end of period (in shares)	727,781
Options exercisable, end of period (in shares)	22,131
Weighted-Average Exercise Price
Outstanding, weighted-average exercise price, beginning period (in USD per share) | $ / shares	$ 21.90
Granted, weighted average exercise price (in USD per share) | $ / shares	17.39
Forfeited, weighted average exercise price (in USD per share) | $ / shares	19.40
Outstanding, weighted-average exercise price, end of period (in USD per share) | $ / shares	19.33
Options vested and expected to vest, weighted-average exercise price, end of period (in USD per share) | $ / shares	19.33
Options exercisable, weighted-average exercise price (in USD per share) | $ / shares	$ 22.87
Vesting Period, 3 years | Stock options
Weighted-Average Exercise Price
Vesting period (in years)	3 years

STOCK-BASED COMPENSATION - Rest

STOCK-BASED COMPENSATION - Restricted stock awards (Details) - Restricted stock awards	3 Months Ended
	Mar. 31, 2017$ / sharesshares
Number Outstanding
Beginning balance (in shares) | shares	0
Granted (in shares) | shares	220,250
Vested (in shares) | shares	25,304
Ending balance (in shares) | shares	194,946
Weighted Average Grant Date Fair Value per Award
Beginning balance (in USD per share) | $ / shares	$ 0
Granted (in USD per share) | $ / shares	17.39
Vested (in USD per share) | $ / shares	17.39
Ending balance (in USD per share) | $ / shares	$ 17.39

(LOSS) EARNINGS PER SHARE (Deta

(LOSS) EARNINGS PER SHARE (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Basic
Net (loss) income attributable to American Renal Associates Holdings, Inc.	$ (1,251)	$ 3,756
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	(11,083)	0
Net (loss) income attributable to American Renal Associates Holdings, Inc. for basic earnings per share calculation	$ (12,334)	$ 3,756
Weighted-average common shares outstanding, basic (in shares)	30,907,482	22,213,967
Earnings (loss) per share, basic (in USD per share)	$ (0.40)	$ 0.17
Diluted
Net (loss) income attributable to American Renal Associates Holdings, Inc.	$ (1,251)	$ 3,756
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	(11,083)	0
Net (loss) income attributable to American Renal Associates Holdings, Inc. for diluted earnings per share calculation	$ (12,334)	$ 3,756
Weighted-average common shares outstanding, basic (in shares)	30,907,482	22,213,967
Weighted-average effect of dilutive securities:
Effect of assumed exercise of stock options (in shares)	0	571,703
Weighted-average common shares outstanding used to calculate diluted net income (loss) per share (in shares)	30,907,482	22,785,670
(Loss) earnings per share, diluted (in USD per share)	$ (0.40)	$ 0.16
Outstanding options excluded as impact would be anti-dilutive (in shares)	1,315,091	116,937

RELATED PARTY TRANSACTIONS (Det

RELATED PARTY TRANSACTIONS (Details) - USD ($)	May 07, 2010	Mar. 31, 2017	Mar. 31, 2016	Dec. 31, 2016	Apr. 26, 2016
RELATED PARTY TRANSACTIONS
Assigned clinic loans		$ 17,335,000
Period of weighted average maturity, clinic loans		2 years 5 months 1 day
Weighted average interest rate, clinic loans		5.09%
Maximum potential liability for future payments		$ 17,335,000
Clinic loan guarantee		$ 9,134,000
Percentage tax savings payable to pre-IPO stockholders					85.00%
Sublease agreement
RELATED PARTY TRANSACTIONS
Interest rate		6.00%
Total amount of initial financing				$ 1,044,000
Amount outstanding		$ 989,000
Centerbridge | Advisory services agreement
RELATED PARTY TRANSACTIONS
Advisory services agreement fee	$ 550,000	$ 0	$ 457,000
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%
Minimum
RELATED PARTY TRANSACTIONS
Interest rate		3.46%
Maximum
RELATED PARTY TRANSACTIONS
Interest rate		8.08%

COMMITMENTS AND CONTINGENCIES (

COMMITMENTS AND CONTINGENCIES (Details)	Apr. 26, 2016
Commitments and Contingencies Disclosure [Abstract]
Percentage tax savings payable to pre-IPO stockholders	85.00%

CERTAIN LEGAL MATTERS (Details)

CERTAIN LEGAL MATTERS (Details) - United States District Court	Sep. 02, 2016clinicpatientinsurance_product	Jul. 01, 2016affiliate
Certain Legal Matters
Number of affiliates | affiliate		3
Number of patients | patient	30
Number of clinics | clinic	12
Number of insurance products | insurance_product	1

CHANGES IN OWNERSHIP INTEREST55

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2017	Mar. 31, 2016
Noncontrolling Interest [Abstract]
Net (loss) income attributable to American Renal Associates Holdings, Inc.	$ (1,251)	$ 3,756
Increase in paid-in capital for the sales of noncontrolling interest	0	0
Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest	(1,272)	0
Net transfers to noncontrolling interests	(1,272)	0
Net (loss) income attributable to American Renal Holdings Associates, Inc., net of transfers to noncontrolling interests	$ (2,523)	$ 3,756