American Renal Associates 10-Q 8 Aug 17 2017 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2017	Aug. 07, 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	Jun. 30, 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		31,285,465
Document Fiscal Year Focus	2,017
Document Fiscal Period Focus	Q2

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Assets
Cash	$ 74,933	$ 100,916
Accounts receivable, less allowance for doubtful accounts of $9,144 and $8,726, respectively	77,841	81,127
Inventories	4,960	4,676
Prepaid expenses and other current assets	23,150	18,498
Income tax receivable	10,254	5,163
Total current assets	191,138	210,380
Property and equipment, net of accumulated depreciation of $138,033 and $121,242, respectively	165,495	170,118
Intangible assets, net of accumulated amortization of $23,149 and $23,489, respectively	25,638	25,626
Other long-term assets	8,885	6,753
Goodwill	573,147	573,147
Total assets	964,303	986,024
Liabilities and Equity
Accounts payable	28,184	31,127
Accrued compensation and benefits	28,654	29,103
Accrued expenses and other current liabilities	60,663	45,286
Current portion of long-term debt	45,711	48,274
Total current liabilities	163,212	153,790
Long-term debt, less current portion	516,442	522,058
Income tax receivable agreement payable	15,600	21,200
Other long-term liabilities	13,859	11,670
Deferred tax liabilities	1,128	1,278
Total liabilities	710,241	709,996
Commitments and contingencies (Note 14 and Note 15)
Noncontrolling interests subject to put provisions	113,925	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; 31,283,812 and 30,894,962 issued and outstanding at June 30, 2017 and December 31, 2016, respectively	185	184
Additional paid-in capital	95,369	95,062
Receivable from noncontrolling interests	(415)	(544)
Accumulated deficit	(132,003)	(128,646)
Accumulated other comprehensive loss, net of tax	(1,420)	(100)
Total American Renal Associates Holdings, Inc. deficit	(38,284)	(34,044)
Noncontrolling interests not subject to put provisions	178,421	179,707
Total equity	140,137	145,663
Total liabilities and equity	$ 964,303	$ 986,024

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Statement of Financial Position [Abstract]
Accounts receivables, allowance for doubtful accounts	$ 9,144	$ 8,726
Accumulated depreciation on property and equipment	138,033	121,242
Accumulated amortization on intangible assets	$ 23,149	$ 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)	31,283,812	30,894,962
Common stock, shares outstanding (in shares)	31,283,812	30,894,962

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Income Statement [Abstract]
Patient service operating revenues	$ 187,602	$ 186,938	$ 366,234	$ 360,492
Provision for uncollectible accounts	(1,610)	(1,371)	(3,217)	(2,794)
Net patient service operating revenues	185,992	185,567	363,017	357,698
Operating expenses:
Patient care costs	118,059	109,779	238,360	215,234
General and administrative	26,381	31,942	57,625	53,441
Transaction-related costs (Notes 1 and 9)	717	2,215	717	2,239
Depreciation and amortization	9,382	8,252	18,456	15,929
Certain legal matters (Note 15)	4,297	0	8,233	0
Total operating expenses	158,836	152,188	323,391	286,843
Operating income	27,156	33,379	39,626	70,855
Interest expense, net	(7,188)	(8,941)	(14,797)	(21,199)
Loss on early extinguishment of debt	(526)	(4,708)	(526)	(4,708)
Income tax receivable agreement (expense) income	(2,641)	(7,835)	1,876	(7,835)
Income before income taxes	16,801	11,895	26,179	37,113
Income tax expense (benefit)	410	(1,147)	(3,114)	1,514
Net income	16,391	13,042	29,293	35,599
Less: Net income attributable to noncontrolling interests	(18,497)	(22,488)	(32,650)	(41,289)
Net loss attributable to American Renal Associates Holdings, Inc.	(2,106)	(9,446)	(3,357)	(5,690)
Less: Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests	(2,527)	(12,133)	(13,610)	(12,133)
Net loss attributable to common shareholders	$ (4,633)	$ (21,579)	$ (16,967)	$ (17,823)
Loss per share (Note 12):
Basic (in USD per share)	$ (0.15)	$ (0.76)	$ (0.55)	$ (0.70)
Diluted (in USD per share)	$ (0.15)	$ (0.76)	$ (0.55)	$ (0.70)
Weighted-average number of common shares outstanding
Basic (in shares)	30,986,689	28,406,999	30,947,304	25,344,510
Diluted (in shares)	30,986,689	28,406,999	30,947,304	25,344,510
Cash dividends declared per share (in USD per share)	$ 0	$ 1.30	$ 0	$ 1.30

Consolidated Statements of Comp

Consolidated Statements of Comprehensive (Loss) Income - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Statement of Comprehensive Income [Abstract]
Net income	$ 16,391	$ 13,042	$ 29,293	$ 35,599
Unrealized (loss) gain on derivative agreements, net of tax	(676)	100	(1,320)	200
Total comprehensive income	15,715	13,142	27,973	35,799
Less: Comprehensive income attributable to noncontrolling interests	(18,497)	(22,488)	(32,650)	(41,289)
Total comprehensive loss attributable to American Renal Associates Holdings, Inc.	$ (2,782)	$ (9,346)	$ (4,677)	$ (5,490)

Consolidated Statement of Chang

Consolidated Statement of Changes in Equity - 6 months ended Jun. 30, 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)	(3,357)	10,383				(3,357)		22,267
Stock-based compensation	13,731			13,731
Exercise of stock options (in shares)			161,892
Exercise of stock options	536		$ 1	535
Issuance of restricted stock (in shares)			226,958
Issuance of restricted stock	0			0
Cash dividend equivalents accrued on share-based payments	(2,544)			(2,544)
Distributions to noncontrolling interests		(12,221)						(26,321)
Contributions from noncontrolling interests	129	871			129			1,887
Purchases of noncontrolling interests	(5,980)	(19,774)		(5,980)				(253)
Reclassification/other adjustments		(1,134)						1,134
Change in fair value of derivative agreements, net of tax	(1,320)						(1,320)
Change in fair value of noncontrolling interests	(5,435)	5,435		(5,435)
Balance at end of period at Jun. 30, 2017	$ (38,284)	$ 113,925	$ 185	$ 95,369	$ (415)	$ (132,003)	$ (1,420)	$ 178,421
Balance at end of period (in shares) at Jun. 30, 2017			31,283,812

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016
Operating activities
Net income	$ 29,293	$ 35,599
Adjustments to reconcile net income to cash provided by operating activities:
Depreciation and amortization	18,456	15,929
Amortization of discounts, fees and deferred financing costs	1,065	1,807
Loss on extinguishment of debt	526	4,708
Stock-based compensation	13,731	10,565
Premium paid for interest rate cap agreements	(1,186)	0
Deferred taxes	729	(7,769)
Income tax receivable agreement income	(1,876)	7,835
Payment related to tax receivable agreement	(878)	0
Non-cash charge related to derivative agreements	173	850
Non-cash rent charges	431	920
Loss on disposal of assets	190	0
Change in operating assets and liabilities, net of acquisitions:
Accounts receivable	3,286	15
Inventories	(284)	(499)
Prepaid expenses and other current assets	(9,637)	1,305
Other assets	(552)	692
Accounts payable	(2,943)	944
Accrued compensation and benefits	(449)	2,965
Accrued expenses and other liabilities	2,285	13,363
Cash provided by operating activities	52,360	89,229
Investing activities
Purchases of property, equipment and intangible assets	(14,053)	(34,221)
Cash paid for acquisitions	0	(800)
Cash used in investing activities	(14,053)	(35,021)
Financing activities
Proceeds from issuance of common stock sold in initial public offering, net of underwriting discounts and offering expense	0	175,378
Proceeds from issuance of long-term debt	7,401	60,000
Cash paid for debt issuance and other financing costs	(8,542)	(1,350)
Proceeds from term loans, net of deferred financing costs	11,991	39,764
Payments on long-term debt	(21,734)	(255,806)
Dividends and dividend equivalents paid	(8,680)	(30,176)
Proceeds from exercise of stock options	536	0
Common stock repurchases for tax withholdings of net settlement equity awards	0	71
Distributions to noncontrolling interests	(38,542)	(43,973)
Contributions from noncontrolling interests	2,887	4,441
Purchases of noncontrolling interests	(9,507)	(277)
Proceeds from sales of additional noncontrolling interests	0	142
Cash used in financing activities	(64,190)	(51,928)
(Decrease) increase in cash and restricted cash	(25,883)	2,280
Cash and restricted cash at beginning of period	100,916	90,988
Cash and restricted cash at end of period	75,033	93,268
Supplemental Disclosure of Cash Flow Information
Cash paid for income taxes	1,320	5,376
Cash paid for interest	13,435	18,600
Supplemental Disclosure of Non-Cash Financing Activities
Accrued offering expense	0	314
Tax Receivable Agreement	0	23,400
Non-Cash Dividend	0	26,232
Accrued purchases of noncontrolling interests	16,500	0
Liability for accrued dividend equivalent payments	$ 2,544	$ 1,540

BASIS OF PRESENTATION AND ORGAN

BASIS OF PRESENTATION AND ORGANIZATION	6 Months Ended
	Jun. 30, 2017
Accounting Policies [Abstract]
BASIS OF PRESENTATION AND ORGANIZATION	1. BASIS OF PRESENTATION AND ORGANIZATION Business American Renal Associates Holdings, Inc. (“ARAH” or “the Company”) owns 100% of the membership units of its subsidiary American Renal Holdings Intermediate Company, LLC, which itself has no assets other than 100% of the shares of capital stock of American Renal Holdings Inc. All of our operating activities are conducted through American Renal Holdings Inc. and its operating subsidiaries (“ARH”). The Company is a national provider of kidney dialysis services for patients suffering from chronic kidney failure, also known as end stage renal disease, or ESRD. As of June 30, 2017 , the Company owned and operated 217 dialysis clinics treating 15,023 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 7 - 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 June 30, 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 analyzing the effect of the standard which includes reviewing current accounting policies and practices to identify potential differences that would result from applying the requirements under the new standard. Preliminarily, the Company does not expect the adoption of the new standard to have a material impact on its financial results, and continues to evaluate the impact it will have on its disclosures.

INITIAL PUBLIC OFFERING

INITIAL PUBLIC OFFERING	6 Months Ended
	Jun. 30, 2017
Initial Public Offering [Abstract]
INITIAL PUBLIC OFFERING	2. 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 then existing prior 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 $ 15,127 as of June 30, 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 $ 7,970 of such assigned clinic loans as of June 30, 2017 . Amendments to and Repayment of Credit Facility On April 26, 2016, the Company entered into the first amend ment (the “Amendment”) to its then existing 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 June 30, 2017 , the Company’s total liability under the TRA is estimated to be $19,360 , of which $3,760 is included as a component of other accrued expenses on the condensed consolidated balance sheet. For the six months ended June 30, 2017, the Company has paid $878 . 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 June 30, 2017 the Company has made payments equal to $1.30 per share, or $4,955 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 $1,859 . 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 $2,522 was paid to vested option holders as of June 30, 2017 and an immaterial amount 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, were recognized over a period of approximately 12 months from the time of the IPO. As a result, the Company recognized $11,749 in incremental compensation expense during the six months ended June 30, 2017 .

CASH

CASH	6 Months Ended
	Jun. 30, 2017
Cash and Cash Equivalents [Abstract]
CASH	3. 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. June 30, 2017 Cash $ 74,933 Restricted cash included in prepaid expenses and other current assets 100 Total cash and restricted cash shown in the statement of cash flows $ 75,033 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	6 Months Ended
	Jun. 30, 2017
Accounts, Notes, Loans and Financing Receivable, Gross, Allowance, and Net [Abstract]
ACCOUNTS RECEIVABLE	4. ACCOUNTS RECEIVABLE Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the ultimate collectability and net realizable value of the Company’s accounts receivable, the Company analyzes its historical cash collection experience and trends for each of its government payors and commercial payors to estimate the adequacy of the allowance for doubtful accounts and the amount of the provision for bad debts. Management regularly updates its analysis based upon the most recent information available to it to determine its current provision for bad debts and the adequacy of its allowance for doubtful accounts. For receivables associated with services provided to patients covered by government payors, like Medicare, the Company receives 80% of the payment directly from Medicare as established under the government’s bundled payment system and determines an appropriate allowance for doubtful accounts and provision for bad debts on the remaining balance due depending upon the Company’s estimate of the amounts ultimately collectible from other secondary coverage sources or from the patients. For receivables associated with services to patients covered by commercial payors that are either based upon contractual terms or for non-contracted health plan coverage, the Company provides an allowance for doubtful accounts and a provision for bad debts based upon its historical collection experience, potential inefficiencies in its billing processes and for which collectability is determined to be unlikely. Receivables where the patient is primary payor make up less than 2% of the Company’s accounts receivable. It is the Company’s policy to reserve for a portion of these outstanding accounts receivable balances based on historical collection experience and for which collectability is determined to be unlikely.

FAIR VALUE MEASUREMENTS

FAIR VALUE MEASUREMENTS	6 Months Ended
	Jun. 30, 2017
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENTS	5. FAIR VALUE MEASUREMENTS The Company’s interest rate swap and interest rate cap agreements, Tax Receivable Agreement (“TRA”) and noncontrolling interests subject to put provisions are accounted for at fair value on a recurring basis and are classified and disclosed in one of the following three categories: Level 1 : Financial instruments with unadjusted, quoted prices listed on active market exchanges. Level 2 : Financial instruments determined using prices for recently traded financial instruments with similar underlying terms, as well as directly or indirectly observable inputs, such as interest rates and yield curves that are observable at commonly quoted intervals. Level 3 : Financial instruments not actively traded on a market exchange. This category includes situations where there is little, if any, market activity for the financial instrument. The prices are determined using significant unobservable inputs or valuation techniques. The asset or liability fair value measurement level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. There were no changes in the methodologies used at June 30, 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 swap and interest rate cap 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 six months ended June 30, 2017 and the year ended December 31, 2016 . June 30, 2017 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 5 $ — $ 5 $ — Interest rate derivative agreements (included in Other long-term assets) 455 455 Total Assets $ 460 $ — $ 460 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 15,600 $ — $ — $ 15,600 Interest rate swap agreement (included in Other long-term liabilities) 1,640 — 1,640 — Total Liabilities $ 17,240 $ — $ 1,640 $ 15,600 Temporary Equity Noncontrolling interests subject to put provisions $ 113,925 $ — $ — $ 113,925 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 six months ended June 30, 2017 for the Tax receivable agreement liability, which is classified as a Level 3 financial instrument. Balance at December 31, 2016 $ 21,200 Options exercised and dividend equivalent payment vesting (3,724 ) Total realized/unrealized gains: Included in earnings and reported as Income tax receivable agreement income (1,876 ) Balance at June 30, 2017 $ 15,600 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 $435,600 as of June 30, 2017 as compared to the carrying amount of $440,000 . 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	6 Months Ended
	Jun. 30, 2017
Accounts Payable and Accrued Liabilities, Current [Abstract]
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	6. ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES Accrued compensation and benefits consist of the following: June 30, 2017 December 31, 2016 Accrued compensation $ 15,503 $ 18,077 Accrued vacation pay 13,151 11,026 $ 28,654 $ 29,103 Accrued expenses and other current liabilities consist of the following: June 30, 2017 December 31, 2016 Payor refunds and retractions $ 33,103 $ 32,902 Accrued purchases of noncontrolling interests 16,500 — Tax receivable agreement liability 3,760 914 Dividend equivalent payments 117 6,438 Other 7,183 5,032 $ 60,663 $ 45,286

VARIABLE INTEREST ENTITIES

VARIABLE INTEREST ENTITIES	6 Months Ended
	Jun. 30, 2017
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net [Abstract]
VARIABLE INTEREST ENTITIES	7. 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 June 30, 2017 , these condensed consolidated financial statements include total assets of VIEs of $17,329 and total liabilities of VIEs of $12,017 . 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	6 Months Ended
	Jun. 30, 2017
Temporary Equity Disclosure [Abstract]
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS	8. 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, which could accelerate time-based vesting. The Company has evaluated the applicable terms and determined the put provisions are not mandatorily redeemable. Some of these puts accelerated as a result of the Company’s initial public offering, of which some were exercised during the six months ended June 30, 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 ( 14.50% - 20.00% ) 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. As of June 30, 2017 As of December 31, 2016 Redemption value $ 5,215 $ 16,835 Estimated fair values for accounting purposes 12,211 24,239 Difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests $ 6,996 $ 7,404 As of June 30, 2017 As of December 31, 2016 Non controlling interest subject to put provisions - estimated fair values $ 106,929 $ 122,961 Difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests 6,996 7,404 Noncontrolling interests subject to put provisions - maximum redemption value $ 113,925 $ 130,365 For the Six Months Ended June 30, 2017 For the Year Ended December 31, 2016 Change in estimated fair values for accounting purposes $ (8,175 ) $ 13,536 Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests 13,610 7,404 Total change in fair value of noncontrolling interests subject to put provisions - maximum redemption $ 5,435 $ 20,940 16. 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 June 30, Six Months Ended June 30, 2017 2016 2017 2016 Net loss attributable to American Renal Holdings Associates, Inc. $ (2,106 ) $ (9,446 ) $ (3,357 ) $ (5,690 ) Increase in paid-in capital for the sales of noncontrolling interest — 59 — 59 Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (4,708 ) (216 ) (5,980 ) (216 ) Net transfers to/from noncontrolling interests (4,708 ) (157 ) (5,980 ) (157 ) Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests $ (6,814 ) $ (9,603 ) $ (9,337 ) $ (5,847 )

DEBT

DEBT	6 Months Ended
	Jun. 30, 2017
Debt Instruments [Abstract]
DEBT	9. DEBT Long-term debt consists of the following: June 30, 2017 December 31, 2016 First Lien Credit Agreement $ 440,000 $ 433,758 Term Loans (1) 121,915 118,503 Lines of Credit 7,626 19,360 Other 2,872 3,041 572,413 574,662 Less: discounts and fees, net of accumulated amortization (10,260 ) (4,330 ) Less: current maturities (45,711 ) (48,274 ) $ 516,442 $ 522,058 _____________________________ (1) Includes assigned clinic loans Scheduled maturities of long-term debt as of June 30, 2017 are as follows: 2017 (remainder) $ 26,768 2018 37,974 2019 35,506 2020 24,833 2021 17,380 Thereafter 429,952 $ 572,413 During the six months ended June 30, 2017 , the Company made mandatory principal payments of $1,159 under the First Lien Credit Agreement. As of June 30, 2017 , there were no borrowings outstanding under the Revolving Credit Facility as provided for under our First Lien Credit Agreement. Repayment of First Lien Credit Agreement and 2017 Credit Agreement On June 22, 2017, the Company entered into a new credit agreement (the “2017 Credit Agreement ” ) to refinance the credit facilities under the Company's existing First Lien Credit Agreement. The 2017 Credit Agreement provides the Company with (a) a $100,000 senior secured revolving credit facility (the “2017 Revolving Credit Facility ” ); (b) a $440,000 senior secured term B loan facility (the “2017 Term B Loan Facility ” ), and (c) an uncommitted incremental accordion facility equal to the sum of the greater of (i) $125,000 and (ii) 100% of Consolidated EBTIDA (as defined in the 2017 Credit Agreement) plus an amount such that certain leverage ratios will not be exceeded after giving pro forma effect to the increase. The Company borrowed the full amount of the 2017 Term B Loan Facility and used such borrowings to repay the outstanding balances under the First Lien Credit Agreement and to pay a portion of the transaction costs and expenses. The 2017 Revolving Credit Facility matures in June 2022 and the 2017 Term B Loan Facility matures in June 2024. The maturity date of each of the 2017 Revolving Credit Facility and the 2017 Term B Loan Facility is subject to extension with lender consent according to the terms of the 2017 Credit Agreement. The 2017 Credit Agreement provides that certain voluntary prepayments of the 2017 Term B Loan Facility prior to the six month anniversary of the closing date of the 2017 Credit Agreement are subject to a 1.00% soft-call prepayment premium. The 2017 Credit Agreement includes provisions requiring ARH to offer to prepay term B loans in an amount equal to (i) the net cash proceeds above certain thresholds received from (a) asset sales and (b) casualty events resulting in the receipt of insurance proceeds, subject to customary provisions for the reinvestment of such proceeds, (ii) the net cash proceeds from the incurrence of debt not otherwise permitted under the 2017 Credit Agreement, and (iii) a percentage of consolidated excess cash flow retained in the business from the preceding fiscal year minus voluntary prepayments. The term B loans under the 2017 Term B Loan Facility bear interest at a rate equal to, at the Company’s option, either (a) an alternate base rate equal to the higher of (1) the prime rate in effect on such day, (2) the federal funds effective rate plus 0.5% and (3) the Eurodollar rate applicable for a one-month interest period plus 1.0% , plus an applicable margin of 2.25% , (collectively, the “ABR Rate”) or (b) LIBOR, adjusted for changes in Eurodollar reserves, plus a margin of 3.25% . The Company is required to make amortization payments on the term B loans under the 2017 Term B Loan Facility in equal quarterly installments of $1,100 . As of June 30, 2017, interest payable quarterly was 4.47% per annum Any outstanding loans under the 2017 Revolving Credit Facility bear interest at a rate equal to at the Company’s option, the ABR Rate or LIBOR, plus, in each case, an applicable margin priced off a grid based upon the consolidated total net leverage ratio of the Company and its restricted subsidiaries. The initial rate under the 2017 Credit Agreement as of June 30, 2017 was LIBOR plus 2.50% . The commitment fee applicable to undrawn revolving commitments under the 2017 Revolving Credit Facility is also priced off a grid based upon the consolidated total net leverage ratio of the Company and its restricted subsidiaries, and as of June 30, 2017, the fee was 0.50% . The 2017 Credit Agreement contains customary events of default, the occurrence of which would permit the lenders to accelerate payment of the full amounts outstanding. Additionally, the 2017 Credit Agreement contains customary representations and warranties, affirmative covenants and negative covenants, including restrictive financial and operating covenants. These include covenants that restrict the Company’s and its restricted subsidiaries’ ability to complete acquisitions, pay cash dividends, incur indebtedness, make investments, sell assets and take certain other corporate actions. The obligations of the Company under the 2017 Credit Agreement are guaranteed by American Renal Holdings Intermediate Company, LLC and all of its existing and future wholly owned domestic subsidiaries (collectively, the “Guarantors”) and secured by a pledge of all of the Company’s capital stock and substantially all of the assets of the Company and the Guarantors, including their respective interests in their joint ventures. The Company incurred $9,259 of costs associated with these refinancing activities, of which $717 were charged as transactions costs and $8,542 were deferred upon execution of the 2017 Credit Agreement. The write-off of deferred financing fees and discounts in the amount of $526 were charged as early extinguishment of debt. 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 $440,000 of its variable-rate debt under the term B loans, with an effective date of March 31, 2018. The 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 six months ended June 30, 2017, 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 six months ended June 30, 2017. The 2013 Swaps matured on March 31, 2017. 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 $440,000 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	6 Months Ended
	Jun. 30, 2017
Income Tax Disclosure [Abstract]
INCOME TAXES	10. INCOME TAXES The income tax expense included in the accompanying consolidated statements of operations principally relates to the Company’s proportionate share of the pre-tax income of its joint venture subsidiaries. The determination of income tax expense for interim reporting purposes is based upon the estimated effective tax rate for the year adjusted for the impact of any discrete items which are accounted for in the period in which they occur. The Company’s effective income tax rate for the three months ended June 30, 2017 and 2016 was 2.4% and (9.6)% , respectively, and (11.9)% and 4.1% for the six months ended June 30, 2017 and 2016, 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 $730 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	6 Months Ended
	Jun. 30, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
STOCK-BASED COMPENSATION	11. STOCK-BASED COMPENSATION For the three and six months ended June 30, 2017 and 2016 , stock-based compensation expense was reflected in the accompanying consolidated statements of operations as follows: Three Months Ended June 30, Six Months Ended June 30, 2017 2016 2017 2016 Patient care costs $ 664 $ 1,580 $ 2,493 $ 1,673 General and administrative 2,979 8,612 11,238 8,905 Total stock-based compensation before tax $ 3,643 $ 10,192 $ 13,731 $ 10,578 Income tax benefit (1,457 ) (4,077 ) (5,492 ) (4,231 ) As of June 30, 2017 , the Company has 5,848,919 options outstanding. 2016 Omnibus Plan On April 7, 2016, the Company approved the 2016 Omnibus Incentive Plan (the “2016 Plan”). The 2016 Plan authorized the Company to issue options and other awards to directors, officers, employees, consultants and advisors to purchase up to a total of 4,000,000 shares of common stock. As of June 30, 2017 , options to purchase an aggregate of 3,295,502 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: Six Months Ended June 30, 2017 Expected volatility 30.00% Weighted average expected term in years 6.00 Weighted average risk-free interest rate 2.00 - 2.26% Expected annual dividend yield —% Weighted average grant-date fair value $5.81 Information concerning options activity under the 2016 Plan for options to acquire Common Shares is summarized as follows: Six Months Ended June 30, 2017 Number of Options Weighted-Average Exercise Price Outstanding, beginning of period 318,877 $ 21.90 Granted (1) 476,677 17.31 Forfeited (30,877 ) 19.67 Outstanding, end of period 764,677 $ 19.13 Options vested and expected to vest, end of period 722,959 $ 18.89 Options exercisable, end of period 41,718 $ 23.30 ____________________________ (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 six months ended June 30, 2017 , the Company granted 227,821 restricted stock awards to employees and directors, respectively, at a weighted average grant date fair value of $17.38 . These restricted stock awards vest over a weighted average period of 1.5 years from grant date. As of June 30, 2017 , a total of 201,654 shares of restricted stock were unvested and outstanding, which results in unamortized stock-based compensation of $3,027 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: Six Months Ended June 30, 2017 Number Outstanding Weighted Average Grant Date Fair Value per Award Balance at December 31, 2016 — — Granted 227,821 $ 17.38 Vested 25,304 $ 17.39 Forfeited (863 ) $ 17.39 Balance at June 30, 2017 201,654 $ 17.38

LOSS PER SHARE

LOSS PER SHARE	6 Months Ended
	Jun. 30, 2017
Earnings Per Share [Abstract]
LOSS PER SHARE	12. LOSS PER SHARE Basic 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 June 30, Six Months Ended June 30, 2017 2016 2017 2016 Basic Net loss attributable to American Renal Associates Holdings, Inc. $ (2,106 ) $ (9,446 ) $ (3,357 ) $ (5,690 ) Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests (2,527 ) (12,133 ) (13,610 ) (12,133 ) Net loss attributable to common shareholders for basic earnings per share calculation $ (4,633 ) $ (21,579 ) $ (16,967 ) $ (17,823 ) Weighted-average common shares outstanding used to calculate basic net loss per share 30,986,689 28,406,999 30,947,304 25,344,510 Loss per share, basic $ (0.15 ) $ (0.76 ) $ (0.55 ) $ (0.70 ) Diluted Net loss attributable to American Renal Associates Holdings, Inc. $ (2,106 ) $ (9,446 ) $ (3,357 ) $ (5,690 ) Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests (2,527 ) (12,133 ) (13,610 ) (12,133 ) Net loss attributable to common shareholders for diluted earnings per share calculation $ (4,633 ) $ (21,579 ) $ (16,967 ) $ (17,823 ) Weighted-average common shares outstanding, basic 30,986,689 28,406,999 30,947,304 25,344,510 Weighted-average effect of dilutive securities: Effect of assumed exercise of stock options — — — — Weighted-average common shares outstanding used to calculate diluted net loss per share 30,986,689 28,406,999 30,947,304 25,344,510 Loss per share, diluted $ (0.15 ) $ (0.76 ) $ (0.55 ) $ (0.70 ) Outstanding options excluded as impact would be anti-dilutive 3,291,722 555,329 2,303,407 336,133

RELATED PARTY TRANSACTIONS

RELATED PARTY TRANSACTIONS	6 Months Ended
	Jun. 30, 2017
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	13. 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 certain of our directors and executive officers own economic interests in Term Loan Holdings. As of June 30, 2017 , such assigned clinic loans aggregated $15,127 , had maturities ranging from October 2017 to July 2020, with a weighted average maturity of approximately 2.25 years (September 2019), and interest rates ranging from 3.46% to 8.08% , with a weighted average interest rate of 5.11% . 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 and six months ended June 30, 2017 is immaterial. Each assigned clinic loan is 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 $15,127 , of which we guaranteed $7,970 as of June 30, 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 June 30, 2017 and 2016 , the Company recorded $0 and $80 of expense related to this agreement, respectively. During the six months ended June 30, 2017 and 2016, the Company recorded $0 and $537 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 June 30, 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 June 30, 2017 , the remaining balance to be paid to the Company was $977 .

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	6 Months Ended
	Jun. 30, 2017
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	14. 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, as defined in the TRA, 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	6 Months Ended
	Jun. 30, 2017
Certain legal matters
CERTAIN LEGAL MATTERS	15. 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. On March 13, 2017, the Court granted leave to amend and that same day United filed its second amended complaint. 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. ARA OpCo and ARM moved to dismiss the second amended complaint on March 27, 2017. The Court held a hearing on ARA OpCo and ARM's motion to dismiss the second amended complaint on June 23, 2017. The second amended complaint relates 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. 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 second amended complaint seeks unspecified actual, consequential and punitive monetary damages, together with interest and costs, and declaratory and injunctive relief, as well as attorney's fees and court costs. The Company has moved to dismiss the second amended complaint in full 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. On May 18, 2017, the Company filed a motion to dismiss the amended complaint. On July 17, 2017, Lead Plaintiff filed a consolidated opposition to the motions to dismiss. The Company's reply in further support of the motion to dismiss is currently due in August 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 May 23, 2017, the board of directors received further correspondence from the purported shareholder requesting additional information concerning the board's determination to not pursue potential claims against individuals. On June 6, 2017, the Board sent a response letter to the purported shareholder declining to provide additional information. 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 has cooperated fully with the government and will continue to do so. 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	6 Months Ended
	Jun. 30, 2017
Noncontrolling Interest [Abstract]
CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES	8. 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, which could accelerate time-based vesting. The Company has evaluated the applicable terms and determined the put provisions are not mandatorily redeemable. Some of these puts accelerated as a result of the Company’s initial public offering, of which some were exercised during the six months ended June 30, 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 ( 14.50% - 20.00% ) 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. As of June 30, 2017 As of December 31, 2016 Redemption value $ 5,215 $ 16,835 Estimated fair values for accounting purposes 12,211 24,239 Difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests $ 6,996 $ 7,404 As of June 30, 2017 As of December 31, 2016 Non controlling interest subject to put provisions - estimated fair values $ 106,929 $ 122,961 Difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests 6,996 7,404 Noncontrolling interests subject to put provisions - maximum redemption value $ 113,925 $ 130,365 For the Six Months Ended June 30, 2017 For the Year Ended December 31, 2016 Change in estimated fair values for accounting purposes $ (8,175 ) $ 13,536 Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests 13,610 7,404 Total change in fair value of noncontrolling interests subject to put provisions - maximum redemption $ 5,435 $ 20,940 16. 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 June 30, Six Months Ended June 30, 2017 2016 2017 2016 Net loss attributable to American Renal Holdings Associates, Inc. $ (2,106 ) $ (9,446 ) $ (3,357 ) $ (5,690 ) Increase in paid-in capital for the sales of noncontrolling interest — 59 — 59 Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (4,708 ) (216 ) (5,980 ) (216 ) Net transfers to/from noncontrolling interests (4,708 ) (157 ) (5,980 ) (157 ) Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests $ (6,814 ) $ (9,603 ) $ (9,337 ) $ (5,847 )

BASIS OF PRESENTATION AND ORG24

BASIS OF PRESENTATION AND ORGANIZATION (Policies)	6 Months Ended
	Jun. 30, 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 7 - 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 June 30, 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 analyzing the effect of the standard which includes reviewing current accounting policies and practices to identify potential differences that would result from applying the requirements under the new standard. Preliminarily, the Company does not expect the adoption of the new standard to have a material impact on its financial results, and continues to evaluate the impact it will have on its disclosures.

CASH (Tables)

CASH (Tables)	6 Months Ended
	Jun. 30, 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. June 30, 2017 Cash $ 74,933 Restricted cash included in prepaid expenses and other current assets 100 Total cash and restricted cash shown in the statement of cash flows $ 75,033
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. June 30, 2017 Cash $ 74,933 Restricted cash included in prepaid expenses and other current assets 100 Total cash and restricted cash shown in the statement of cash flows $ 75,033

FAIR VALUE MEASUREMENTS (Tables

FAIR VALUE MEASUREMENTS (Tables)	6 Months Ended
	Jun. 30, 2017
Fair Value Disclosures [Abstract]
Schedule of the fair value of financial instruments	June 30, 2017 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 5 $ — $ 5 $ — Interest rate derivative agreements (included in Other long-term assets) 455 455 Total Assets $ 460 $ — $ 460 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 15,600 $ — $ — $ 15,600 Interest rate swap agreement (included in Other long-term liabilities) 1,640 — 1,640 — Total Liabilities $ 17,240 $ — $ 1,640 $ 15,600 Temporary Equity Noncontrolling interests subject to put provisions $ 113,925 $ — $ — $ 113,925 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 six months ended June 30, 2017 for the Tax receivable agreement liability, which is classified as a Level 3 financial instrument. Balance at December 31, 2016 $ 21,200 Options exercised and dividend equivalent payment vesting (3,724 ) Total realized/unrealized gains: Included in earnings and reported as Income tax receivable agreement income (1,876 ) Balance at June 30, 2017 $ 15,600

ACCRUED EXPENSES AND OTHER CU27

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Tables)	6 Months Ended
	Jun. 30, 2017
Accounts Payable and Accrued Liabilities, Current [Abstract]
Summary of accrued compensation and benefits	Accrued compensation and benefits consist of the following: June 30, 2017 December 31, 2016 Accrued compensation $ 15,503 $ 18,077 Accrued vacation pay 13,151 11,026 $ 28,654 $ 29,103
Summary of accrued expenses and other current liabilities	Accrued expenses and other current liabilities consist of the following: June 30, 2017 December 31, 2016 Payor refunds and retractions $ 33,103 $ 32,902 Accrued purchases of noncontrolling interests 16,500 — Tax receivable agreement liability 3,760 914 Dividend equivalent payments 117 6,438 Other 7,183 5,032 $ 60,663 $ 45,286

NONCONTROLLING INTERESTS SUBJ28

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS (Tables)	6 Months Ended
	Jun. 30, 2017
Temporary Equity Disclosure [Abstract]
Schedules of Noncontrolling Interests Subject to Put Provisions	As of June 30, 2017 As of December 31, 2016 Redemption value $ 5,215 $ 16,835 Estimated fair values for accounting purposes 12,211 24,239 Difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests $ 6,996 $ 7,404 As of June 30, 2017 As of December 31, 2016 Non controlling interest subject to put provisions - estimated fair values $ 106,929 $ 122,961 Difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests 6,996 7,404 Noncontrolling interests subject to put provisions - maximum redemption value $ 113,925 $ 130,365 For the Six Months Ended June 30, 2017 For the Year Ended December 31, 2016 Change in estimated fair values for accounting purposes $ (8,175 ) $ 13,536 Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests 13,610 7,404 Total change in fair value of noncontrolling interests subject to put provisions - maximum redemption $ 5,435 $ 20,940

DEBT (Tables)

DEBT (Tables)	6 Months Ended
	Jun. 30, 2017
Debt Instruments [Abstract]
Schedule of long-term debt	Long-term debt consists of the following: June 30, 2017 December 31, 2016 First Lien Credit Agreement $ 440,000 $ 433,758 Term Loans (1) 121,915 118,503 Lines of Credit 7,626 19,360 Other 2,872 3,041 572,413 574,662 Less: discounts and fees, net of accumulated amortization (10,260 ) (4,330 ) Less: current maturities (45,711 ) (48,274 ) $ 516,442 $ 522,058 _____________________________ (1) Includes assigned clinic loans
Schedule of maturities of long-term debt	Scheduled maturities of long-term debt as of June 30, 2017 are as follows: 2017 (remainder) $ 26,768 2018 37,974 2019 35,506 2020 24,833 2021 17,380 Thereafter 429,952 $ 572,413

STOCK-BASED COMPENSATION (Table

STOCK-BASED COMPENSATION (Tables)	6 Months Ended
	Jun. 30, 2017
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Schedule of stock-based compensation expense	For the three and six months ended June 30, 2017 and 2016 , stock-based compensation expense was reflected in the accompanying consolidated statements of operations as follows: Three Months Ended June 30, Six Months Ended June 30, 2017 2016 2017 2016 Patient care costs $ 664 $ 1,580 $ 2,493 $ 1,673 General and administrative 2,979 8,612 11,238 8,905 Total stock-based compensation before tax $ 3,643 $ 10,192 $ 13,731 $ 10,578 Income tax benefit (1,457 ) (4,077 ) (5,492 ) (4,231 )
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: Six Months Ended June 30, 2017 Expected volatility 30.00% Weighted average expected term in years 6.00 Weighted average risk-free interest rate 2.00 - 2.26% Expected annual dividend yield —% Weighted average grant-date fair value $5.81
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: Six Months Ended June 30, 2017 Number of Options Weighted-Average Exercise Price Outstanding, beginning of period 318,877 $ 21.90 Granted (1) 476,677 17.31 Forfeited (30,877 ) 19.67 Outstanding, end of period 764,677 $ 19.13 Options vested and expected to vest, end of period 722,959 $ 18.89 Options exercisable, end of period 41,718 $ 23.30 ____________________________ (1) Subject to vesting terms of three years.
Schedule of restricted stock award activity	summary of restricted stock award activity is as follows: Six Months Ended June 30, 2017 Number Outstanding Weighted Average Grant Date Fair Value per Award Balance at December 31, 2016 — — Granted 227,821 $ 17.38 Vested 25,304 $ 17.39 Forfeited (863 ) $ 17.39 Balance at June 30, 2017 201,654 $ 17.38

LOSS PER SHARE (Tables)

LOSS PER SHARE (Tables)	6 Months Ended
	Jun. 30, 2017
Earnings Per Share [Abstract]
Schedule of basic and diluted earnings per share	Three Months Ended June 30, Six Months Ended June 30, 2017 2016 2017 2016 Basic Net loss attributable to American Renal Associates Holdings, Inc. $ (2,106 ) $ (9,446 ) $ (3,357 ) $ (5,690 ) Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests (2,527 ) (12,133 ) (13,610 ) (12,133 ) Net loss attributable to common shareholders for basic earnings per share calculation $ (4,633 ) $ (21,579 ) $ (16,967 ) $ (17,823 ) Weighted-average common shares outstanding used to calculate basic net loss per share 30,986,689 28,406,999 30,947,304 25,344,510 Loss per share, basic $ (0.15 ) $ (0.76 ) $ (0.55 ) $ (0.70 ) Diluted Net loss attributable to American Renal Associates Holdings, Inc. $ (2,106 ) $ (9,446 ) $ (3,357 ) $ (5,690 ) Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests (2,527 ) (12,133 ) (13,610 ) (12,133 ) Net loss attributable to common shareholders for diluted earnings per share calculation $ (4,633 ) $ (21,579 ) $ (16,967 ) $ (17,823 ) Weighted-average common shares outstanding, basic 30,986,689 28,406,999 30,947,304 25,344,510 Weighted-average effect of dilutive securities: Effect of assumed exercise of stock options — — — — Weighted-average common shares outstanding used to calculate diluted net loss per share 30,986,689 28,406,999 30,947,304 25,344,510 Loss per share, diluted $ (0.15 ) $ (0.76 ) $ (0.55 ) $ (0.70 ) Outstanding options excluded as impact would be anti-dilutive 3,291,722 555,329 2,303,407 336,133

CHANGES IN OWNERSHIP INTEREST32

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES (Tables)	6 Months Ended
	Jun. 30, 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 June 30, Six Months Ended June 30, 2017 2016 2017 2016 Net loss attributable to American Renal Holdings Associates, Inc. $ (2,106 ) $ (9,446 ) $ (3,357 ) $ (5,690 ) Increase in paid-in capital for the sales of noncontrolling interest — 59 — 59 Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (4,708 ) (216 ) (5,980 ) (216 ) Net transfers to/from noncontrolling interests (4,708 ) (157 ) (5,980 ) (157 ) Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests $ (6,814 ) $ (9,603 ) $ (9,337 ) $ (5,847 )

BASIS OF PRESENTATION AND ORG33

BASIS OF PRESENTATION AND ORGANIZATION (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2017USD ($)state	Jun. 30, 2016USD ($)	Jun. 30, 2017USD ($)dialysis_clinicpatientstatesegment	Jun. 30, 2016USD ($)	Dec. 31, 2016USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Assets	$ 964,303,000		$ 964,303,000		$ 986,024,000
Number of dialysis clinics owned and operated | dialysis_clinic			217
Number of patients | patient			15,023
Number of states | state	25		25
Segment Information
Number of reportable segments | segment			1
New Accounting Pronouncements and Changes in Accounting Principles [Abstract]
Stock compensation expense	$ 3,643,000	$ 10,192,000	$ 13,731,000	$ 10,578,000
American Renal Holdings Intermediate Company, LLC
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Percentage ownership of subsidiary	100.00%		100.00%
Assets	$ 0		$ 0
Percentage ownership of parent	100.00%		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	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016	Dec. 31, 2016	Apr. 07, 2016
Schedule of Initial Public Offering [Line Items]
Proceeds from issuance of common stock sold in initial public offering, net of underwriting discounts and offering expense					$ 0	$ 175,378,000
Amendment of Certificate of Incorporation and Initial Public Offering
Common stock, shares authorized (in shares)			300,000,000		300,000,000		300,000,000	300,000,000
Common stock, par value (in USD per share)			$ 0.01		$ 0.01		$ 0.01	$ 0.01
Stock split ratio	2.29
Clinic Loan Assignment and Term Loan Holdings LLC Distribution
Assigned clinic loans			$ 15,127,000		$ 15,127,000
Clinic loan guarantee			7,970,000		7,970,000
Amendments to and Repayment of Credit Facility
Proceeds from terms loans, net of deferred financing costs					8,542,000	1,350,000
Transaction costs			717,000	$ 2,215,000	717,000	2,239,000
Proceeds from issuance of common stock sold in initial public offering, net of underwriting discounts and offering expense					0	175,378,000
Percentage tax savings payable to pre-IPO stockholders	85.00%
Income tax receivable agreement liability total		$ 23,400,000			19,360,000
Tax receivable agreement liability					3,760,000
Payments made for the income tax receivable agreement					878,000	$ 0
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			7,970,000		7,970,000
Clinic Loan
Clinic Loan Assignment and Term Loan Holdings LLC Distribution
Assigned clinic loans			$ 15,127,000		15,127,000
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
Proceeds from issuance of common stock sold in initial public offering, net of underwriting discounts and offering expense	$ 176,942,000
Amendments to and Repayment of Credit Facility
Proceeds from issuance of common stock sold in initial public offering, net of underwriting discounts and offering expense	176,942,000
Stock compensation due to modification					$ 11,749,000
IPO | Second Lien Credit Agreement
Schedule of Initial Public Offering [Line Items]
Proceeds from issuance of common stock sold in initial public offering, net of underwriting discounts and offering expense	165,635,000
Amendments to and Repayment of Credit Facility
Proceeds from issuance of common stock sold in initial public offering, net of underwriting discounts and offering expense	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					$ 4,955,000
Vested option stockholders | Term Loan Holdings LLC
Amendments to and Repayment of Credit Facility
Equitable adjustments in the form of cash dividend equivalent payments					2,522,000
Unvested option stockholders
Amendments to and Repayment of Credit Facility
Equitable adjustments in the form of cash dividend equivalent payments					$ 1,859,000

CASH (Details)

CASH (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016	Jun. 30, 2016	Dec. 31, 2015
Cash and Cash Equivalents [Abstract]
Cash	$ 74,933	$ 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	$ 75,033	$ 100,916	$ 93,268	$ 90,988

ACCOUNTS RECEIVABLE (Details)

ACCOUNTS RECEIVABLE (Details)	6 Months Ended
	Jun. 30, 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	2.00%

FAIR VALUE MEASUREMENTS (Detail

FAIR VALUE MEASUREMENTS (Details) - USD ($)	Jun. 30, 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	435,600,000	433,758,000
Carrying amount of long-term debt	$ 440,000,000	$ 433,758,000

FAIR VALUE MEASUREMENTS - Sched

FAIR VALUE MEASUREMENTS - Schedule of fair values (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Noncontrolling interests subject to put provisions	$ 113,925	$ 130,365
Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	460
Total Liabilities	17,240
Noncontrolling interests subject to put provisions	113,925	130,365
Recurring basis | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	0
Total Liabilities	0
Noncontrolling interests subject to put provisions	0	0
Recurring basis | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	460
Total Liabilities	1,640
Noncontrolling interests subject to put provisions	0	0
Recurring basis | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	0
Total Liabilities	15,600
Noncontrolling interests subject to put provisions	113,925	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	5	7
Prepaid expenses and other current assets | Recurring basis | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	0	0
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	5	7
Prepaid expenses and other current assets | Recurring basis | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	0	0
Other long-term assets | Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements asset	455
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	455
Income tax receivable agreement payable | Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Tax receivable agreement liability	15,600	21,200
Income tax receivable agreement payable | Recurring basis | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Tax receivable agreement liability	0	0
Income tax receivable agreement payable | Recurring basis | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Tax receivable agreement liability	0	0
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	15,600	$ 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	1,640
Other long-term liabilities | Recurring basis | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements liability	0
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	1,640
Other long-term liabilities | Recurring basis | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements liability	$ 0

FAIR VALUE MEASUREMENTS - Fair

FAIR VALUE MEASUREMENTS - Fair value rollforward for tax receivable agreement liability (Details) $ in Thousands	6 Months Ended
	Jun. 30, 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	(3,724)
Total realized/unrealized gains:
Included in earnings and reported as Income tax receivable agreement income	(1,876)
June 30, 2017	$ 15,600

ACCRUED EXPENSES AND OTHER CU40

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Accrued compensation and benefits:
Accrued compensation	$ 15,503	$ 18,077
Accrued vacation pay	13,151	11,026
Accrued compensation and benefits	28,654	29,103
Accrued expenses and other current liabilities:
Payor refunds and retractions	33,103	32,902
Accrued purchases of noncontrolling interests	16,500	0
Tax receivable agreement liability	3,760	914
Dividend equivalent payments	117	6,438
Other	7,183	5,032
Accrued expenses and other current liabilities	$ 60,663	$ 45,286

VARIABLE INTEREST ENTITIES (Det

VARIABLE INTEREST ENTITIES (Details) $ in Thousands	Jun. 30, 2017USD ($)
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net [Abstract]
Total assets of VIEs	$ 17,329
Total liabilities of VIEs	$ 12,017

NONCONTROLLING INTERESTS SUBJ42

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS (Details) - USD ($) $ in Thousands	6 Months Ended	12 Months Ended
	Jun. 30, 2017	Dec. 31, 2016
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Redemption value	$ 5,215	$ 16,835
Estimated fair values for accounting purposes	12,211	24,239
Difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests	6,996	7,404
Non controlling interest subject to put provisions - estimated fair values	106,929	122,961
Noncontrolling interests subject to put provisions - maximum redemption value	113,925	130,365
Total change in fair value of noncontrolling interests subject to put provisions - maximum redemption	$ (5,435)
Minimum
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Weighted average cost of capital	14.50%
Maximum
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Weighted average cost of capital	20.00%
Noncontrolling Interests subject to put provisions
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Change in estimated fair values for accounting purposes	$ (8,175)	13,536
Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests	13,610	7,404
Total change in fair value of noncontrolling interests subject to put provisions - maximum redemption	$ 5,435	$ 20,940

DEBT - Schedule of long-term de

DEBT - Schedule of long-term debt (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
LONG-TERM DEBT
Total long-term debt	$ 572,413	$ 574,662
Less: discounts and fees, net of accumulated amortization	(10,260)	(4,330)
Less: current maturities	(45,711)	(48,274)
Long-term debt, less current portion	516,442	522,058
First Lien Credit Agreement
LONG-TERM DEBT
Long-term debt, gross	440,000	433,758
Term Loans
LONG-TERM DEBT
Long-term debt, gross	121,915	118,503
Lines of Credit
LONG-TERM DEBT
Long-term debt, gross	7,626	19,360
Other
LONG-TERM DEBT
Long-term debt, gross	$ 2,872	$ 3,041

DEBT - Scheduled maturities of

DEBT - Scheduled maturities of long-term debt (Details) - USD ($) $ in Thousands	Jun. 30, 2017	Dec. 31, 2016
Scheduled maturities of long-term debt
2017 (remainder)	$ 26,768
2,018	37,974
2,019	35,506
2,020	24,833
2,021	17,380
Thereafter	429,952
Total long-term debt	$ 572,413	$ 574,662

DEBT - Narrative (Details)

DEBT - Narrative (Details)	Jun. 22, 2017USD ($)	Apr. 26, 2016USD ($)	Jun. 30, 2017USD ($)	Jun. 30, 2016USD ($)	Jun. 30, 2017USD ($)	Jun. 30, 2016USD ($)	Mar. 31, 2017USD ($)interest_rate_cap_agreement	May 31, 2013USD ($)interest_rate_swap_agreement
LONG-TERM DEBT
Costs incurred due to refinancing activities					$ 8,542,000	$ 1,350,000
Transaction costs			$ 717,000	$ 2,215,000	717,000	$ 2,239,000
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
2017 Credit Agreement
LONG-TERM DEBT
Costs incurred due to refinancing activities	$ 9,259,000
Transaction costs	717,000
Deferred financing costs	8,542,000
Write-off of deferred financing fees	526,000
Revolving Credit Facility
LONG-TERM DEBT
Revolving credit facility borrowings outstanding			$ 0		0
First Lien Credit Agreement
LONG-TERM DEBT
Principal payments					$ 1,159,000
Aggregate amount of borrowing capacity		$ 100,000,000
Costs incurred due to refinancing activities		2,700,000
Transaction costs		$ 1,350,000
Lines of Credit | Revolving Credit Facility | 2017 Credit Agreement
LONG-TERM DEBT
Aggregate amount of borrowing capacity	100,000,000
Uncommitted incremental accordion facility, amount	$ 125,000,000
Uncommitted incremental accordion facility, percentage of consolidated EBITDA	100.00%
Undrawn commitment fee					0.50%
Term loans | 2017 Credit Agreement
LONG-TERM DEBT
Debt face amount	$ 440,000,000
Voluntary prepayment period	6 months
Voluntary prepayment soft-call prepayment premium percentage	1.00%
Amortization payments, quarterly installment	$ 1,100,000
Interest rate	4.47%
Term loans | Term B loans
LONG-TERM DEBT
Debt face amount							$ 440,000,000	$ 400,000,000
Federal funds effective rate | Term loans | 2017 Credit Agreement
LONG-TERM DEBT
Interest rate margin	0.50%
Eurodollar one-month rate | Term loans | 2017 Credit Agreement
LONG-TERM DEBT
Interest rate margin	1.00%
ABR rate | Term loans | 2017 Credit Agreement
LONG-TERM DEBT
Interest rate margin	2.25%
LIBOR rate, adjusted for changes in Eurodollar reserves | Term loans | 2017 Credit Agreement
LONG-TERM DEBT
Interest rate margin	3.25%				2.50%

INCOME TAXES (Details)

INCOME TAXES (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Income Tax Disclosure [Abstract]
Effective income tax rate	2.40%	(9.60%)	(11.90%)	4.10%
Federal statutory rate			35.00%
Valuation allowance	$ 730		$ 730

STOCK-BASED COMPENSATION - Sche

STOCK-BASED COMPENSATION - Schedule of Expense (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation before tax	$ 3,643	$ 10,192	$ 13,731	$ 10,578
Income tax benefit	(1,457)	(4,077)	(5,492)	(4,231)
Patient care costs
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation before tax	664	1,580	2,493	1,673
General and administrative
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation before tax	$ 2,979	$ 8,612	$ 11,238	$ 8,905

STOCK-BASED COMPENSATION - Narr

STOCK-BASED COMPENSATION - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands	Apr. 07, 2016	Jun. 30, 2017	Dec. 31, 2016
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Options outstanding (in shares)		5,848,919
2016 Omnibus Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Options outstanding (in shares)		764,677	318,877
Authorized additional stock options (in shares)	4,000,000
Stock options to purchase outstanding (in shares)		3,295,502
Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Granted (in shares)		227,821
Granted (in USD per share)		$ 17.38
Vesting period (in years)		1 year 6 months
Unvested and outstanding (in shares)		201,654	0
Unrecognized compensation costs		$ 3,027
Unrecognized compensation costs recognition period		1 year 9 months 1 day

STOCK-BASED COMPENSATION - Assu

STOCK-BASED COMPENSATION - Assumptions used for options granted (Details)	6 Months Ended
	Jun. 30, 2017$ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected volatility	30.00%
Weighted average expected term in years	6 years
Weighted average risk-free interest rate minimum	2.00%
Weighted average risk-free interest rate maximum	2.26%
Expected annual dividend yield	0.00%
Weighted average grant-date fair value (in USD per share)	$ 5.81

STOCK-BASED COMPENSATION - Opti

STOCK-BASED COMPENSATION - Option activity (Details)	6 Months Ended
	Jun. 30, 2017$ / sharesshares
Number of Options
Outstanding, end of period (in shares)	5,848,919
2016 Omnibus Incentive Plan
Number of Options
Outstanding, beginning of period (in shares)	318,877
Granted (in shares)	476,677
Forfeited (in shares)	(30,877)
Outstanding, end of period (in shares)	764,677
Options vested and expected to vest, end of period (in shares)	722,959
Options exercisable, end of period (in shares)	41,718
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	17.31
Forfeited, weighted average exercise price (in USD per share) | $ / shares	19.67
Outstanding, weighted-average exercise price, end of period (in USD per share) | $ / shares	19.13
Options vested and expected to vest, weighted-average exercise price, end of period (in USD per share) | $ / shares	18.89
Options exercisable, weighted-average exercise price (in USD per share) | $ / shares	$ 23.30
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	6 Months Ended
	Jun. 30, 2017$ / sharesshares
Number Outstanding
Beginning balance (in shares) | shares	0
Granted (in shares) | shares	227,821
Vested (in shares) | shares	25,304
Forfeited (in shares) | shares	(863)
Ending balance (in shares) | shares	201,654
Weighted Average Grant Date Fair Value per Award
Beginning balance (in USD per share) | $ / shares	$ 0
Granted (in USD per share) | $ / shares	17.38
Vested (in USD per share) | $ / shares	17.39
Forfeited (in shares) | $ / shares	17.39
Ending balance (in USD per share) | $ / shares	$ 17.38

LOSS PER SHARE (Details)

LOSS PER SHARE (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Basic
Net loss attributable to American Renal Associates Holdings, Inc.	$ (2,106)	$ (9,446)	$ (3,357)	$ (5,690)
Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests	(2,527)	(12,133)	(13,610)	(12,133)
Net loss attributable to common shareholders	$ (4,633)	$ (21,579)	$ (16,967)	$ (17,823)
Weighted-average common shares outstanding, basic (in shares)	30,986,689	28,406,999	30,947,304	25,344,510
Loss per share, basic (in USD per share)	$ (0.15)	$ (0.76)	$ (0.55)	$ (0.70)
Diluted
Net loss attributable to American Renal Associates Holdings, Inc.	$ (2,106)	$ (9,446)	$ (3,357)	$ (5,690)
Change in the difference between the redemption value and estimated fair values for accounting purposes of the related noncontrolling interests	(2,527)	(12,133)	(13,610)	(12,133)
Net loss attributable to common shareholders for diluted earnings per share calculation	$ (4,633)	$ (21,579)	$ (16,967)	$ (17,823)
Weighted-average common shares outstanding, basic (in shares)	30,986,689	28,406,999	30,947,304	25,344,510
Weighted-average effect of dilutive securities:
Effect of assumed exercise of stock options (in shares)	0	0	0	0
Weighted-average common shares outstanding used to calculate diluted net loss per share (in shares)	30,986,689	28,406,999	30,947,304	25,344,510
Loss per share, diluted (in USD per share)	$ (0.15)	$ (0.76)	$ (0.55)	$ (0.70)
Outstanding options excluded as impact would be anti-dilutive (in shares)	3,291,722	555,329	2,303,407	336,133

RELATED PARTY TRANSACTIONS (Det

RELATED PARTY TRANSACTIONS (Details) - USD ($) $ in Thousands	May 07, 2010	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016	Dec. 31, 2016	Apr. 26, 2016
RELATED PARTY TRANSACTIONS
Assigned clinic loans		$ 15,127		$ 15,127
Period of weighted average maturity, clinic loans				2 years 3 months
Weighted average interest rate, clinic loans		5.11%		5.11%
Maximum potential liability for future payments		$ 15,127		$ 15,127
Clinic loan guarantee		$ 7,970		$ 7,970
Percentage tax savings payable to pre-IPO stockholders							85.00%
Sublease agreement
RELATED PARTY TRANSACTIONS
Interest rate		6.00%		6.00%
Total amount of initial financing						$ 1,044
Amount outstanding		$ 977		$ 977
Centerbridge | Advisory services agreement
RELATED PARTY TRANSACTIONS
Advisory services agreement fee	$ 550	$ 0	$ 80	$ 0	$ 537
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%		3.46%
Maximum
RELATED PARTY TRANSACTIONS
Interest rate		8.08%		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 INTEREST56

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2017	Jun. 30, 2016	Jun. 30, 2017	Jun. 30, 2016
Noncontrolling Interest [Abstract]
Net loss attributable to American Renal Associates Holdings, Inc.	$ (2,106)	$ (9,446)	$ (3,357)	$ (5,690)
Increase in paid-in capital for the sales of noncontrolling interest	0	59	0	59
Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest	(4,708)	(216)	(5,980)	(216)
Net transfers to/from noncontrolling interests	(4,708)	(157)	(5,980)	(157)
Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests	$ (6,814)	$ (9,603)	$ (9,337)	$ (5,847)