American Renal Associates 10-Q 7 Aug 18 2018 Q2 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	6 Months Ended
	Jun. 30, 2018	Aug. 06, 2018
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, 2018
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Filer Category	Accelerated Filer
Entity Common Stock, Shares Outstanding		32,466,769
Document Fiscal Year Focus	2,018
Document Fiscal Period Focus	Q2

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Assets
Cash	$ 69,403	$ 71,521
Accounts receivable, less allowance for doubtful accounts of $1,834 and $6,757, respectively	91,508	79,662
Inventories	6,535	4,665
Prepaid expenses and other current assets	20,338	24,998
Income tax receivable	4,713	6,745
Total current assets	192,497	187,591
Property and equipment, net of accumulated depreciation of $183,077 and $167,390, respectively	167,621	168,537
Intangible assets, net of accumulated amortization of $23,819 and $23,419, respectively	24,966	25,368
Other long-term assets	19,639	9,285
Goodwill	570,946	573,427
Total assets	975,669	964,208
Liabilities and Equity
Accounts payable	52,849	33,421
Accrued compensation and benefits	30,881	28,985
Accrued expenses and other current liabilities	48,961	49,963
Current portion of long-term debt	46,660	44,534
Total current liabilities	179,351	156,903
Long-term debt, less current portion	509,983	515,554
Income tax receivable agreement payable	6,037	7,500
Other long-term liabilities	33,819	14,880
Deferred tax liabilities	4,696	8,991
Total liabilities	733,886	703,828
Commitments and contingencies (Note 14 and Note 15)
Noncontrolling interests subject to put provisions	145,500	139,895
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; 32,458,837 and 32,034,439 issued and outstanding at June 30, 2018 and December 31, 2017, respectively	195	193
Additional paid-in capital	69,170	67,853
Receivable from noncontrolling interests	(477)	(358)
Accumulated deficit	(142,493)	(123,789)
Accumulated other comprehensive income (loss), net of tax	1,227	(677)
Total American Renal Associates Holdings, Inc. deficit	(72,378)	(56,778)
Noncontrolling interests not subject to put provisions	168,661	177,263
Total equity	96,283	120,485
Total liabilities and equity	$ 975,669	$ 964,208

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Statement of Financial Position [Abstract]
Accounts receivables, allowance for doubtful accounts	$ 1,834	$ 6,757
Accumulated depreciation of property and equipment	183,077	167,390
Accumulated amortization of intangible assets	$ 23,819	$ 23,419
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)	32,458,837	32,034,439
Common stock, shares outstanding (in shares)	32,458,837	32,034,439

Consolidated Statements of Oper

Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Income Statement [Abstract]
Patient service operating revenues	$ 217,178	$ 185,992	$ 411,850	$ 363,017
Operating expenses:
Patient care costs	140,562	118,059	274,293	238,360
General and administrative	26,803	26,381	51,763	57,625
Transaction-related costs (Note 1)	0	717	856	717
Depreciation and amortization	9,814	9,382	19,437	18,456
Certain legal matters (Note 15)	32,546	4,297	36,649	8,233
Total operating expenses	209,725	158,836	382,998	323,391
Operating income	7,453	27,156	28,852	39,626
Interest expense, net	(8,131)	(7,188)	(15,588)	(14,797)
Loss on early extinguishment of debt	0	(526)	0	(526)
Income tax receivable agreement income (expense)	1,736	(2,641)	715	1,876
Income before income taxes	1,058	16,801	13,979	26,179
Income tax (benefit) expense	(1,219)	410	(2,011)	(3,114)
Net income	2,277	16,391	15,990	29,293
Less: Net income attributable to noncontrolling interests	(20,285)	(18,497)	(34,908)	(32,650)
Net loss attributable to American Renal Associates Holdings, Inc.	(18,008)	(2,106)	(18,918)	(3,357)
Less: Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests	(884)	(2,527)	(302)	(13,610)
Net loss attributable to common shareholders	$ (18,892)	$ (4,633)	$ (19,220)	$ (16,967)
Loss per share (Note 12):
Basic (in USD per share)	$ (0.59)	$ (0.15)	$ (0.60)	$ (0.55)
Diluted (in USD per share)	$ (0.59)	$ (0.15)	$ (0.60)	$ (0.55)
Weighted-average number of common shares outstanding
Basic (in shares)	31,932,705	30,986,689	31,877,286	30,947,304
Diluted (in shares)	31,932,705	30,986,689	31,877,286	30,947,304

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Statement of Comprehensive Income [Abstract]
Net income	$ 2,277	$ 16,391	$ 15,990	$ 29,293
Unrealized gain (loss) on derivative agreements, net of tax	467	(676)	2,118	(1,320)
Total comprehensive income	2,744	15,715	18,108	27,973
Less: Comprehensive income attributable to noncontrolling interests	(20,285)	(18,497)	(34,908)	(32,650)
Total comprehensive loss attributable to American Renal Associates Holdings, Inc.	$ (17,541)	$ (2,782)	$ (16,800)	$ (4,677)

Consolidated Statement of Chang

Consolidated Statement of Changes in Equity - 6 months ended Jun. 30, 2018 - 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, 2017	$ (56,778)	$ 139,895	$ 193	$ 67,853	$ (358)	$ (123,789)	$ (677)	$ 177,263
Balance at beginning of period (in shares) at Dec. 31, 2017			32,034,439
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(18,918)	9,248				(18,918)		25,660
Reclassification of stranded tax effects related to the Tax Cuts and Jobs Act of 2017						214	(214)
Stock-based compensation	2,927			2,927
Exercise of stock options (in shares)			92,750
Exercise of stock options	396		$ 2	394
Issuance of restricted stock awards (in shares)			348,708
Issuance of restricted stock awards	0
Forfeiture of restricted stock awards (in shares)			(719,000)
Vested restricted stock awards withheld on net share settlement (in shares)			(16,341,000)
Vested restricted stock awards withheld on net share settlement	(367)			(367)
Cash dividend equivalents accrued on share-based payments, net	517			517
Distributions to noncontrolling interests		(10,446)						(23,743)
Contributions from noncontrolling interests	(119)	676			(119)			1,963
Purchases of noncontrolling interests	(5,953)	(1,062)		(5,953)				(1,586)
Sales of noncontrolling interests	29			29				63
Reclassification/other adjustments	554	10,405		554				(10,959)
Change in fair value of derivative agreements, net of tax	2,118						2,118
Change in fair value of noncontrolling interests	3,216	(3,216)		3,216
Balance at end of period at Jun. 30, 2018	$ (72,378)	$ 145,500	$ 195	$ 69,170	$ (477)	$ (142,493)	$ 1,227	$ 168,661
Balance at end of period (in shares) at Jun. 30, 2018			32,458,837

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017
Operating activities
Net income	$ 15,990	$ 29,293
Adjustments to reconcile net income to cash provided by operating activities:
Depreciation and amortization	19,437	18,456
Amortization of discounts, fees and deferred financing costs	989	1,065
Loss on extinguishment of debt	0	526
Stock-based compensation	2,927	13,731
Premium paid for interest rate cap agreements	0	(1,186)
Deferred taxes	(5,014)	729
Income tax receivable agreement income	(715)	(1,876)
Non-cash charge related to derivative agreements	5	173
Non-cash rent charges	161	431
Loss on disposal of assets	279	190
Change in operating assets and liabilities, net of acquisitions:
Accounts receivable	(11,846)	3,286
Inventories	(1,870)	(284)
Prepaid expenses and other current assets	7,119	(9,637)
Other assets	(8,733)	(552)
Accounts payable	19,428	(2,943)
Accrued compensation and benefits	1,896	(449)
Accrued expenses and other liabilities	18,426	1,407
Cash provided by operating activities	58,479	52,360
Investing activities
Purchases of property, equipment and intangible assets	(18,418)	(14,053)
Proceeds from asset sales	2,500	0
Cash used in investing activities	(15,918)	(14,053)
Financing activities
Net proceeds from issuance of long-term debt	0	267,564
Cash paid for financing costs	0	(3,914)
Proceeds from term loans, net of deferred financing costs	28,946	11,991
Payments on long-term debt	(33,198)	(286,525)
Dividends and dividend equivalents paid	(278)	(8,680)
Proceeds from exercise of stock options	396	536
Vested restricted stock awards withheld on net share settlement	(367)	0
Distributions to noncontrolling interests	(34,189)	(38,542)
Contributions from noncontrolling interests	2,520	2,887
Purchases of noncontrolling interests	(8,601)	(9,507)
Proceeds from sales of additional noncontrolling interests	92	0
Cash used in financing activities	(44,679)	(64,190)
Decrease in cash and restricted cash	(2,118)	(25,883)
Cash and restricted cash at beginning of period	71,621	100,916
Cash and restricted cash at end of period	69,503	75,033
Supplemental Disclosure of Cash Flow Information
Cash paid for income taxes	1,525	1,320
Cash paid for interest	12,665	13,435
Supplemental Disclosure of Non-Cash Financing Activities
Accrued purchases of noncontrolling interests	0	16,500
Liability for accrued dividend equivalent payments, net	$ 517	$ 2,544

BASIS OF PRESENTATION AND ORGAN

BASIS OF PRESENTATION AND ORGANIZATION	6 Months Ended
	Jun. 30, 2018
Accounting Policies [Abstract]
BASIS OF PRESENTATION AND ORGANIZATION	BASIS OF PRESENTATION AND ORGANIZATION Business American Renal Associates Holdings, Inc. (“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 the Company's 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 (“ESRD”). As of June 30, 2018 , the Company owned and operated 233 dialysis clinics treating 16,018 patients in 26 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 (“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. The Company's 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 the Company's 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 consolidated 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 the Company's Form 10-K for the year ended December 31, 2017 . 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, 2018 , or decision-making group, in making decisions how to allocate resources and assess performance. 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. 2018 Secondary Offering The Company recognized $856 of transaction-related costs in the six months ended June 30, 2018 , reflecting expenses incurred for the registration statement and the secondary offering that was withdrawn in March 2018. These costs include legal, accounting, valuation and other professional or consulting fees. Recent Accounting Pronouncements In February 2018, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income. This amendment provides for the reclassification of the effect of remeasuring deferred tax balances related to items within accumulated other comprehensive income (“AOCI”) to retained earnings resulting from the Tax Cuts and Jobs Act of 2017. For public business entities, the ASU is effective for fiscal years beginning after December 15, 2018, and interim periods within those years, with early adoption permitted. Adoption of this ASU is to be applied either in the period of adoption or retrospectively to each period in which the effect of the change in the tax laws or rates were recognized. The Company elected to early adopt ASU 2018-02 during the first quarter of 2018, and elected to reclassify the income tax effects from the Tax Cuts and Jobs Act of 2017 from AOCI to retained earnings. The reclassification decreased AOCI and increased retained earnings by $214 . In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities , which amends and simplifies existing guidance in order to allow companies to more accurately present the economic effects of risk management activities in the financial statements. For public business entities, the ASU is effective for fiscal years beginning after December 15, 2018, and interim periods therein; however, early adoption by all entities is permitted. The Company does not believe this ASU will have a material impact on its financial statements. 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 of lessees on the balance sheet and disclosing key information about leasing arrangements in the financial statements. Since February 2016, the FASB has issued additional updates to serve as targeted improvements to the original standard update. 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 has engaged a professional services firm to assist in the implementation of ASU 2016-02. 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 does not expect any impact on the current debt covenants, as described in Note 9 - Debt . The guidance should be applied under a modified retrospective transition approach, with an option to apply the guidance either at the beginning of the earliest comparative period presented, or to apply the new guidance at the adoption date. The Company expects to apply the modified retrospective method at the beginning of the period of adoption after review of the analysis is performed. The Company is currently assessing the impact the adoption of ASU 2016-02 will have on the consolidated financial statements, and has implemented lease accounting systems which will ultimately assist in the application of the new standard. In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers (Topic 606) (“ASC 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. Since May 2014, the FASB has issued additional updates to serve as clarification to the original standard update. 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 Company adopted the new standard on January 1, 2018, using the modified retrospective transition method. As a practical expedient, the Company adopted using the portfolio approach, applying the ASU to a portfolio of contracts with similar characteristics. The Company reasonably expects that the effects on the financial statements of applying this guidance to the portfolio of contracts would not differ materially from applying this guidance to the individual contracts within the portfolio. Additionally, the Company elected the practical expedient that allows the recognition of revenue with each dialysis treatment, as that is when the Company has the right to invoice. The Company also adopted the practical expedient to only assess the recognition of revenue for open contracts during the transition period and there was no adjustment to the opening balance of retained earnings at January 1, 2018. The comparative information has not been restated and continues to be reported under the accounting standards in effect for that period. The adoption did not have a material impact to the timing of revenue recognition; however, a majority of the provision for uncollectible accounts is now recognized as a direct reduction to revenues, instead of separately as a deduction to arrive at net revenue. The Company no longer separately presents a provision for uncollectible accounts on the consolidated statement of operations as it is included in Patient care costs after the adoption of the new accounting standard. As a result of the Company’s election to apply the new standard only to contracts not substantially completed as of January 1, 2018, the Company continues to maintain an allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of the new accounting standards. Changes to this allowance for doubtful accounts, other than write-offs of uncollectible accounts, are recorded through the provision for uncollectible accounts in accordance with prior accounting standards. The Company's provision for uncollectible accounts was $1,610 and $3,217 for the three and six months ended June 30, 2017 . See Note 2 - Revenue for additional discussion of the Company's revenue recognition accounting policies and expanded disclosures required by the new standard.

REVENUE

REVENUE	6 Months Ended
	Jun. 30, 2018
Revenue from Contract with Customer [Abstract]
REVENUE	REVENUE The major component of the Company's revenues, which is included in patient service operating revenues, is derived from dialysis treatments and related services. Sources of revenues are principally from government-based programs, including Medicare, Medicaid and state workers' compensation programs, commercial insurance payors and other sources such as the U.S. Department of Veterans Affairs (the “VA”), hospitals as well as patient pay. Patient service operating revenue is reported at the amount that reflects the consideration to which the Company expects to be entitled in exchange for providing dialysis treatments and related services. These amounts are due from third-party payors, including government-based programs and commercial insurance payors, patients and others and may include variable consideration for discounts, price concessions and retroactive revenue adjustments due to new information obtained, such as actual payment receipt, as well as settlement of audits, reviews and investigations. Third-party payors, patients and other payors are generally billed at least monthly, typically in the month the dialysis treatment is performed, and payment is due upon receipt. Revenue is recognized as performance obligations are satisfied. A performance obligation is a promise in a contract to transfer a distinct good or service to the customer, and is defined as the unit of account under ASC 606. The Company has determined that one performance obligation exists, the dialysis treatment, which is satisfied over time as a dialysis treatment is provided. While the Company provides patients with other related services, they are considered a bundle of interrelated services with dialysis treatment as the primary service. Revenue is measured using the output method, which is based upon the delivery of a dialysis treatment to the patient. The Company believes that this method provides a faithful depiction of the satisfaction of the performance obligation. All performance obligations are satisfied at the end of each reporting period. A usual and customary fee schedule is maintained for dialysis treatment and other related services; however, the transaction price is typically at a discount to the fee schedule. The transaction prices for Medicare and Medicaid programs are based on predetermined net realizable rates per treatment that are established by statutes or regulation. The transaction prices for contracted payors are based on contracted rates. For other payors, the Company determines the transaction price based on usual and customary rates for services provided, reduced by contractual adjustments provided to third-party payors, discounts provided to uninsured patients in accordance with the Company’s policy, and/or implicit price concessions. The Company determines its estimates of contractual allowances and discounts based on contractual agreements, regulatory compliance, and historical collection experience. The Company determines its estimate of implicit price concessions based on its historical collection experience with each payor. Amounts billed that have not yet been collected and that meet the conditions for unconditional right to payment are presented as patient receivables. Contractual adjustments result from differences between the rates charged for services performed and expected reimbursements from third-party payors and are largely comprised of balances relating to services billed to non-contracted providers. Contractual adjustments and discounts with third-party payors are considered variable consideration and are included in the determination of the estimated transaction price for providing patient care. In assessing the probability of these claim payments, the Company reviews previous payment history and records a reserve that results in an estimate of expected revenue such that it is probable that a significant revenue reversal will not occur in future periods, at the payor level. This constraint on variable consideration is based on the probability of a reversal of an amount that is significant relative to the cumulative revenue recognized for the contract. Patient service operating revenues may be subject to adjustment of the estimated transaction price as a result of (i) new information obtained, such as actual payment receipt, (ii) examinations of the Company, or Medicare or Medicaid Managed Care programs that the Company serves, by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (iii) differing interpretations of government regulations by different fiscal intermediaries or regulatory authorities; (iv) differing opinions regarding a patient’s medical diagnosis or the medical necessity of service provided; (v) retroactive applications or interpretations of governmental requirements; and (vi) claims for refund from private payors, including as the result of government actions. Settlements with third-party payors for retroactive adjustments due to audits, reviews or investigations are considered variable consideration and are included in the determination of the estimated transaction price for providing dialysis treatments and related services. These settlements are estimated based on the terms of the payment agreement with the payor, correspondence from the payor and the Company’s historical settlement activity, including an assessment to ensure that it is probable that a significant reversal in the amount of cumulative revenue recognized will not occur when the uncertainty associated with the retroactive adjustment is subsequently resolved. Estimated settlements are adjusted in future periods as adjustments become known (i.e., new information becomes available), or as years are settled or are no longer subject to such audits, reviews, and investigations. The Company recorded $5,521 of revenue during the three and six months ended June 30, 2018 related to adjustments arising from a change in the transaction price in instances where the performance obligation was satisfied in a previous period related to a payor. Excluding the impact of this payor, adjustments arising from a change in the transaction price in instances where the performance obligation was satisfied in a previous period were immaterial for the three and six months ended June 30, 2018 . These changes in transaction price are mostly attributable to an adjustment for balances with non-contracted payors. The Company obtained new information, such as actual cash receipt, and adjusted the estimated transaction price at the patient level. Amounts pending approval from third-party payors associated with Medicare bad debt claims as of June 30, 2018 and December 31, 2017, other than standard monthly billing, consisted of approximately $14,214 and $10,744 , respectively. As of June 30, 2018 , $5,797 is classified as Prepaid and other current assets and $8,417 is classified as Other long-term assets. As of December 31, 2017, the entire balance is classified as Prepaid and other current assets. The composition of patient care service revenue by source is as follows: Three Months Ended June 30, Six Months Ended June 30, Source of Revenues: 2018 2017 2018 2017 Medicare and Medicare Advantage 63 % 58 % 63 % 59 % Commercial and other (1) 33 % 38 % 33 % 37 % Medicaid and Managed Medicaid 4 % 3 % 4 % 3 % Other (2) — % 1 % — % 1 % 100 % 100 % 100 % 100 % _____________________ (1) Principally commercial insurance companies and also includes the VA, which we refer to collectively as “Commercial and other.” (2) Other sources of revenues include hospitals and patient pay. “Patient pay” revenues consist of payments received directly from patients who are either uninsured or self-pay a portion of the bill.

CASH

CASH	6 Months Ended
	Jun. 30, 2018
Cash and Cash Equivalents [Abstract]
CASH	CASH The following table provides a reconciliation of cash and restricted cash reported within the balance sheet that sum to the total of the same such amounts shown in the statement of cash flows. June 30, 2018 Cash $ 69,403 Restricted cash included in other long-term assets 100 Total cash and restricted cash shown in the statement of cash flows $ 69,503 Restricted cash included in other long-term assets on the balance sheet represent those amounts required to be set aside by contractual agreement with a financial institution.

GOODWILL

GOODWILL	6 Months Ended
	Jun. 30, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
GOODWILL	GOODWILL Changes in goodwill were as follows: Balance at December 31, 2017 $ 573,427 Acquisitions — Divestitures (2,481 ) Balance at June 30, 2018 $ 570,946

FAIR VALUE MEASUREMENTS

FAIR VALUE MEASUREMENTS	6 Months Ended
	Jun. 30, 2018
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENTS	FAIR VALUE MEASUREMENTS The Company’s interest rate swap and interest rate cap agreements, Income Tax Receivable Agreement 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, 2018 . Noncontrolling interests subject to put provisions —See Note 8 - Noncontrolling Interests Subject to Put Provisions for a discussion of the Company’s methodology for estimating fair value of noncontrolling interest subject to put provisions. Derivative agreements —See Note 9 - Debt for a discussion of the Company’s methodology for estimating fair value of interest rate swap and interest rate cap agreements. Income Tax Receivable Agreement —The fair value of the Company's Income Tax Receivable Agreement, entered into on April 26, 2016 in connection with the Company's initial public offering (“TRA”), relies 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 the Company's 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 the Company's common stock, will impact the fair value for the TRA. See Note 13 - Related Party Transactions for further discussion of the TRA. 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, 2018 and the year ended December 31, 2017 . June 30, 2018 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 474 $ — $ 474 $ — Interest rate derivative agreements (included in Other long-term assets) 2,058 — 2,058 — Total Assets $ 2,532 $ — $ 2,532 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 6,400 $ — $ — $ 6,400 Temporary Equity Noncontrolling interests subject to put provisions $ 145,500 $ — $ — $ 145,500 December 31, 2017 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 46 $ — $ 46 $ — Interest rate derivative agreements (included in Other long-term assets) 255 — 255 — Total Assets $ 301 $ — $ 301 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 7,500 $ — $ — $ 7,500 Interest rate swap agreement (included in Accrued expenses and other current liabilities) 403 — 403 — Interest rate swap agreement (included in Other long-term liabilities) 198 — 198 — Total Liabilities $ 8,101 $ — $ 601 $ 7,500 Temporary Equity Noncontrolling interests subject to put provisions $ 139,895 $ — $ — $ 139,895 The following table provides the fair value rollforward for the six months ended June 30, 2018 for the TRA liability, which is classified as a Level 3 financial instrument. Balance at December 31, 2017 $ 7,500 Options exercised and dividend equivalent payment vesting (385 ) Total realized/unrealized gains: Included in earnings and reported as Income tax receivable agreement income (715 ) Balance at June 30, 2018 $ 6,400 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 to be $435,062 as of June 30, 2018 , compared to a carrying value of $436,700 . As of December 31, 2017 , the Company estimates the fair value of the first lien term loans approximates the carrying value at $437,800 .

ACCRUED EXPENSES AND OTHER CURR

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	6 Months Ended
	Jun. 30, 2018
Payables and Accruals [Abstract]
ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES Accrued compensation and benefits consist of the following: June 30, 2018 December 31, 2017 Accrued compensation $ 17,017 $ 17,987 Accrued vacation pay 13,864 10,998 $ 30,881 $ 28,985 Accrued expenses and other current liabilities consist of the following: June 30, 2018 December 31, 2017 Payor refunds and retractions $ 26,050 $ 28,935 Other 22,911 21,028 $ 48,961 $ 49,963

VARIABLE INTEREST ENTITIES

VARIABLE INTEREST ENTITIES	6 Months Ended
	Jun. 30, 2018
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net [Abstract]
VARIABLE INTEREST ENTITIES	VARIABLE INTEREST ENTITIES The Company relies on the operating activities of certain entities for which 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, 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 analysis upon which these consolidation determinations rest is complex, involves uncertainties, and requires significant judgment on various matters, some of which could be subject to different interpretations. As of June 30, 2018 , these consolidated financial statements include total assets of VIEs of $19,953 and total liabilities of VIEs of $10,706 . Term Loan Holdings The Company has determined that it is not the primary beneficiary under VIE accounting guidance for Term Loan Holdings LLC (“Term Loan Holdings”). Based on its involvement with Term Loan Holdings, the Company does 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 the Company's consolidated financial statements. 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 the Company guarantees. See Note 13 - Related Party Transactions .

NONCONTROLLING INTERESTS SUBJEC

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS	6 Months Ended
	Jun. 30, 2018
Temporary Equity Disclosure [Abstract]
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS	NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS The Company has potential obligations to purchase a portion or all of the noncontrolling interests held by third parties in certain of its consolidated subsidiaries. These obligations are in the form of put provisions and are exercisable at the third-party owners’ discretion within specified periods as outlined in each specific put provision. Additionally, the Company has certain put agreements which are exercisable upon the occurrence of specific events, including the sale of all or substantially all of the Company's assets, closure of the clinic, change of control, departure of key executives, third-party members’ death, disability, bankruptcy, retirement, or if third-party members are dissolved and other events, which could accelerate vesting of the put. The Company has evaluated the applicable terms and determined that the put provisions are not mandatorily redeemable. Some of these puts accelerated as a result of the Company’s IPO, of which some were exercised during the six months ended June 30, 2018 . If the remaining unexercised put provisions are 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 or redemption 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 ( 15.00% - 20.50% ) 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. The Company's computation of the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests as of June 30, 2018 and December 31, 2017 is set forth below: June 30, 2018 December 31, 2017 Redemption value $ 11,149 $ 12,211 Estimated fair value for accounting purposes 5,411 6,550 Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests $ 5,738 $ 5,661 In addition, the tables below set forth a reconciliation of noncontrolling interest subject to put provisions. June 30, 2018 December 31, 2017 Noncontrolling interest subject to put provisions - estimated fair value $ 139,762 $ 134,234 Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests 5,738 5,661 Noncontrolling interests subject to put provisions - maximum redemption value $ 145,500 $ 139,895 Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Change in estimated fair value for accounting purposes $ (4,674 ) $ (4,782 ) $ (3,518 ) $ (8,175 ) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests 884 2,527 302 13,610 Total change in fair value of noncontrolling interests subject to put provisions - maximum redemption $ (3,790 ) $ (2,255 ) $ (3,216 ) $ 5,435

DEBT

DEBT	6 Months Ended
	Jun. 30, 2018
Debt Disclosure [Abstract]
DEBT	DEBT Long-term debt consists of the following: June 30, 2018 December 31, 2017 2017 Credit Agreement $ 436,700 $ 437,800 Term Loans (1) 121,868 125,619 Lines of Credit 4,602 3,600 Other 2,323 2,601 565,493 569,620 Less: discounts and fees, net of accumulated amortization (8,850 ) (9,532 ) Less: current maturities (46,660 ) (44,534 ) $ 509,983 $ 515,554 _____________________________ (1) Includes assigned clinic loans Scheduled maturities of long-term debt as of June 30, 2018 are as follows: 2018 (remainder) $ 25,341 2019 41,366 2020 31,782 2021 24,706 2022 15,874 Thereafter 426,424 $ 565,493 During the six months ended June 30, 2018 , the Company made mandatory principal payments of $1,100 under the 2017 Credit Agreement (as defined below). As of June 30, 2018 , there were no borrowings outstanding under the Revolving Credit Facility as provided for under our 2017 Credit Agreement (as defined below). 2017 Credit Agreement and Repayment of First Lien Credit Agreement On June 22, 2017, ARH entered into a new credit agreement (the “2017 Credit Agreement ” ) to refinance the credit facilities under ARH's prior existing First Lien Credit Agreement. The 2017 Credit Agreement provides ARH 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 EBITDA (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. ARH 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 obligations of ARH 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 ARH’s capital stock and substantially all of the assets of ARH and the Guarantors, including their respective interests in their joint ventures. 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 ARH'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 2017 Credit Agreement events of default, representations and warranties, mandatory prepayments and affirmative and negative covenants are substantially the same as those under the prior first lien credit agreement; provided that the 2017 Credit Agreement contains additional exceptions to the negative covenants that increase the amount ARH and its restricted subsidiaries can use to make restricted payments and increases the flexibility for ARH and its restricted subsidiaries to undertake permitted acquisitions. As of June 30, 2018 , ARH is in compliance with these covenants. The Company incurred $9,259 of costs associated with these refinancing activities, of which $717 were charged as transaction costs in 2017, $4,628 represent debt discounts and $3,914 were deferred as financing costs upon the execution of the 2017 Credit Agreement. The write-off of deferred financing fees and discounts in the amount of $526 was charged as early extinguishment of debt in 2017. 2017 Term B Loan Facility The term B loans under the 2017 Term B Loan Facility bear interest at a rate equal to, at ARH'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% or (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% . As of June 30, 2018 , interest payable quarterly was 5.34% per annum. The 2017 Term B Loan Facility matures in June 2024. 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. There is no prepayment required as of June 30, 2018 . ARH 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 . 2017 Revolving Credit Facility The 2017 Revolving Credit Facility of $100,000 is available through its maturity date of June 2022. Any outstanding loans under the 2017 Revolving Credit Facility bear interest at a rate equal to, at ARH’s option, the ABR Rate or LIBOR, adjusted for changes in Eurodollar reserves, plus, in each case, an applicable margin priced off a grid based upon the consolidated total net leverage ratio of ARH and its restricted subsidiaries. There were no borrowings outstanding under the 2017 Revolving Credit Facility as of June 30, 2018 . 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 ARH and its restricted subsidiaries, and as of June 30, 2018 , the fee was 0.50% . Interest Rate Swap Agreements In March 2017, ARH 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 2017 Term B Loan Facility, 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 2017 Swap is 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 swap is 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. Neither the Company nor ARH uses derivative instruments for trading or speculative purposes. Interest Rate Cap Agreements In March 2017, ARH 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 2017 Term B Loan Facility. 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 produce gains and losses differently from the losses or gains being hedged, the ineffective portion is recognized in earnings, immediately. Hedge effectiveness is tested quarterly. Neither the Company nor ARH uses 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, 2018
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The income tax expense included in the accompanying consolidated statements of operations principally relates to the Company’s proportionate share of the pre-tax income of its joint venture subsidiaries. The determination of income tax expense for interim reporting purposes is based upon the estimated effective tax rate for the year adjusted for the impact of any discrete items which are accounted for in the period in which they occur. The Company’s effective income tax rate for the three months ended June 30, 2018 and 2017 was (115.2)% and 2.4% , respectively, and (14.4)% and (11.9)% for the six months ended June 30, 2018 and 2017 , respectively. These rates differ from the federal statutory rate of 21% and 35% , respectively, principally due to the portion of pre-tax income that is allocable to noncontrolling interests from the Company's joint venture subsidiaries, which are pass-through entities for income tax purposes, the valuation allowance, as well as the change in fair value of the TRA liability, which is not deductible for income tax purposes and also other non-deductible expenses. The Company has established a valuation allowance for certain deferred tax assets with respect to which the Company believes future taxable income levels would not be sufficient to realize the tax benefits. On December 22, 2017, the United States enacted tax reform legislation commonly known as the Tax Cuts and Jobs Act (the “2017 Tax Act”), resulting in significant modifications to existing law, which includes a reduction in the federal corporate tax rate from 35% to 21%. On December 22, 2017, Staff Accounting Bulletin No. 118 was issued by the Securities and Exchange Commission, which provides for a measurement period of one year from the enactment date to finalize the accounting for effects of the 2017 Tax Act. At June 30, 2018 , the Company has not completed its accounting for all of the tax effects of the 2017 Tax Act; however, the Company has made a reasonable estimate of the effects. For the six months ended June 30, 2018 there were no adjustments to the provisional amount initially recorded at December 31, 2017. The Company will continue to make and refine its calculations as additional analysis is completed and as the Company gains a more thorough understanding of the tax law. These changes could be material to income tax expense.

STOCK-BASED COMPENSATION

STOCK-BASED COMPENSATION	6 Months Ended
	Jun. 30, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION For the three and six months ended June 30, 2018 and 2017 , 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, 2018 2017 2018 2017 Patient care costs $ 285 $ 664 $ 442 $ 2,493 General and administrative 1,378 2,979 2,485 11,238 Total stock-based compensation before tax $ 1,663 $ 3,643 $ 2,927 $ 13,731 Income tax benefit (432 ) (1,457 ) (761 ) (5,492 ) As of June 30, 2018 , the Company had 5,294,711 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, 2018 , options to purchase an aggregate of 2,202,409 shares of common stock were available for future grants under the 2016 Plan. The assumptions used for options granted to acquire common stock during 2018 and the fair value at the date of grant under the 2016 Plan are noted in the following table: Six Months Ended June 30, 2018 Expected volatility 30-35% Weighted average expected term in years 6.00 Weighted average risk-free interest rate 2.74-2.84% Expected annual dividend yield —% Weighted average grant-date fair value $7.40 Information concerning options activity under the 2016 Plan for options to acquire common stock is summarized as follows: Six Months Ended June 30, 2018 Number of Options Weighted-Average Exercise Price Outstanding, beginning of period 5,280,261 $ 11.79 Granted (1) 158,883 20.93 Exercised (92,750 ) 4.25 Forfeited (51,683 ) 18.50 Outstanding, end of period 5,294,711 $ 12.13 Options vested and expected to vest, end of period 5,294,711 $ 12.13 Options exercisable, end of period 3,307,874 $ 7.73 ____________________________ (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. 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. In March 2018, the Company granted approximately 95,000 performance-based restricted stock awards to certain executives, with a weighted average grant date fair value per share of $22.33 . These awards will vest at the end of the three -year service period and the quantity of awards that vest is dependent upon the Company's achievement of defined performance metrics. The Company has determined that the performance conditions for these awards is probable of achievement as of June 30, 2018 . As of June 30, 2018 , a total of 508,560 shares of restricted stock were unvested and outstanding, which results in unamortized stock-based compensation of $9,107 to be recognized as stock-based compensation expense over the remaining weighted average vesting period of 1.79 years. A summary of restricted stock award activity is as follows: Six Months Ended June 30, 2018 Number Outstanding Weighted-Average Grant Date Fair Value per Award Unvested at December 31, 2017 252,307 $ 16.70 Granted (1) 348,708 $ 22.36 Vested (91,736 ) $ 17.37 Forfeited (719 ) $ 17.39 Unvested at June 30, 2018 508,560 $ 20.46 (1) Weighted average vesting of 3.5 years. Special Dividends and Stock Option Modification On April 26, 2016, the Company declared and paid a cash dividend to its 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, 2018 the Company has made payments equal to $1.30 per share, or $5,266 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 $1,529 . In connection with these dividends, equitable adjustments are required by the terms of some of the Company's 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 its 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 $9,104 in incremental compensation expense during the six months ended June 30, 2017 .

LOSS PER SHARE

LOSS PER SHARE	6 Months Ended
	Jun. 30, 2018
Earnings Per Share [Abstract]
LOSS PER SHARE	LOSS PER SHARE Basic loss per share is computed by dividing net loss attributable to American Renal Associates Holdings, Inc., net of the change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interest put provisions, by the weighted-average number of common shares outstanding during the applicable period, less unvested restricted stock. Diluted 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, 2018 2017 2018 2017 Basic Net loss attributable to American Renal Associates Holdings, Inc. $ (18,008 ) $ (2,106 ) $ (18,918 ) $ (3,357 ) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests (884 ) (2,527 ) (302 ) (13,610 ) Net loss attributable to common shareholders for basic earnings per share calculation $ (18,892 ) $ (4,633 ) $ (19,220 ) $ (16,967 ) Weighted-average common shares outstanding used to calculate basic net loss per share 31,932,705 30,986,689 31,877,286 30,947,304 Loss per share, basic $ (0.59 ) $ (0.15 ) $ (0.60 ) $ (0.55 ) Diluted Net loss attributable to American Renal Associates Holdings, Inc. $ (18,008 ) $ (2,106 ) $ (18,918 ) $ (3,357 ) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests (884 ) (2,527 ) (302 ) (13,610 ) Net loss attributable to common shareholders for diluted earnings per share calculation $ (18,892 ) $ (4,633 ) $ (19,220 ) $ (16,967 ) Weighted-average common shares outstanding, basic 31,932,705 30,986,689 31,877,286 30,947,304 Weighted-average effect of dilutive securities: Weighted-average common shares outstanding used to calculate diluted net loss per share 31,932,705 30,986,689 31,877,286 30,947,304 Loss per share, diluted $ (0.59 ) $ (0.15 ) $ (0.60 ) $ (0.55 ) Outstanding options and restricted stock excluded as impact would be anti-dilutive 3,716,353 3,291,722 3,487,078 2,303,407

RELATED PARTY TRANSACTIONS

RELATED PARTY TRANSACTIONS	6 Months Ended
	Jun. 30, 2018
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	RELATED PARTY TRANSACTIONS Term Loan Holdings The Company partly finances the de novo clinic development costs of some of its joint venture subsidiaries by providing intercompany term loans and revolving loans through its 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 its joint venture subsidiaries by ARA OpCo to a newly formed entity, 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 the Company's consolidated balance sheet . An entity affiliated with Centerbridge Capital Partners, L.P. (together with its affiliates, “Centerbridge”), 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, 2018 , such assigned clinic loans aggregated $7,705 , had maturities ranging from September 2018 to July 2020, with a weighted average maturity of approximately 1.3 years ( November 2019 ), and interest rates ranging from 4.25% to 8.08% , with a weighted average interest rate of 5.10% . 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 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 six months ended June 30, 2018 is immaterial. Each assigned clinic loan is guaranteed by the Company and the applicable joint venture partner or partners in proportion to the Company's respective ownership interests in the applicable joint venture with maturities consistent with the aggregate assigned clinic loans. The maximum potential liability for future payments under the assigned clinic loans, not including interest, is $7,705 , of which the Company guaranteed $4,254 as of June 30, 2018 . 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 its pre-IPO stockholders, including Centerbridge and its executive officers. The TRA provides for the payment by the Company to its 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 the Company actually realizes 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 the Company 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, 2018 , the Company’s total liability under the TRA was estimated to be $6,910 , of which $873 is included as a component of accrued expenses and other current liabilities on the consolidated balance sheet. For the six months ended June 30, 2018 , the Company paid $6,376 . Due from Related Party The Company entered into a sublease agreement with a clinic group, who are also noncontrolling interest shareholders, to provide for various facility buildouts. The total amount of initial financing was $ 1,760 . As of June 30, 2018 , the loans had an interest rate of 6% with maturities ranging from March 2026 through September 2032. Fixed principal and interest payments with respect to such loans are payable monthly. As of June 30, 2018 , the remaining balance to be paid to the Company was $1,606 . Software Services Kinetic Decision Solutions LLC (“Kinetic”), a company from which the Company licenses software relating to electronic medical record solutions, is owned 51% by an executive officer of the Company, and 2.5% by his spouse. The executive is also Co-Founder, Chief Executive Officer and Managing Partner of Kinetic. Under the terms of this arrangement, the Company paid an immaterial amount to Kinetic during three and six months ended June 30, 2018 and 2017 , respectively. Financing Transactions with Executive Officer An executive officer and his spouse, through a trust in which the executive officer's spouse is trustee and beneficiary, are partners in certain of the Company's clinic joint ventures. The clinics in which the executive officer and/or his spousal trust have an ownership interest all receive intercompany revolving loans made through the Company, and have a portion of their financing in the form of term loans held by Term Loan Holdings. As of June 30, 2018 , the aggregate principal amount outstanding of the intercompany revolving loans and assigned clinic loans made to the Company's joint ventures in which the executive officer and/or his spousal trust have an ownership interest was approximately $5,067 . As of June 30, 2018 , such loans had maturities ranging from February 2019 to August 2024 , with a weighted average maturity of approximately 2.26 years ( October 2020 ), and interest rates ranging from 3.31% to 6.30% , with a weighted average interest rate of 4.54% . Fixed principal and interest payments with respect to such loans are payable monthly. Each loan is secured by the assets of the applicable joint venture clinic and is, and will continue to be, guaranteed by the Company and the executive officer and/or his spousal trust in proportion to each party’s ownership interests in the applicable joint venture. Based on their proportionate ownership interest in such joint ventures, the executive officer and/or his spousal trust guaranteed approximately $810 of such outstanding loans as of June 30, 2018 .

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	6 Months Ended
	Jun. 30, 2018
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	COMMITMENTS AND CONTINGENCIES Income Tax Receivable Agreement As described in Note 13 - Related Party Transactions , the Company is a party to the TRA under which it is contractually committed to pay its 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 it actually realizes (or are deemed to realize in the case of an early termination payment by the Company, 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, 2018
Commitments and Contingencies Disclosure [Abstract]
CERTAIN LEGAL MATTERS	CERTAIN LEGAL MATTERS United Litigation As previously disclosed, the wholly owned operating subsidiary of ARA, American Renal Associates LLC (“ARA OpCo”), and its subsidiary, American Renal Management LLC (“ARM”), are defendants in lawsuits filed by affiliates of UnitedHealth Group Incorporated (“United”) in the United States District Court for the Southern District of Florida (Case Number 9:16-cv-81180-KAM) and the United States District Court for the District of Massachusetts (Case Number 1:18-cv-10622-ADB). On May 30, 2018, the Company and United engaged in a mediation, following which the parties continued to negotiate the terms of a potential settlement. On July 2, 2018, ARA OpCo and ARM executed a binding Settlement Term Sheet with the plaintiffs with respect to a settlement to resolve all ongoing litigation between the Company and United, and on August 1, 2018, the parties entered into a final settlement agreement (the “Settlement Agreement”) on substantially the same terms as provided in the Settlement Term Sheet. The Settlement Agreement includes a release of all claims arising from or related to the above-referenced litigations that were asserted or that could have been asserted against the Company or against the nephrologists or other healthcare providers who have entered into joint venture arrangements or medical directorships with the Company (the “Joint Venture Providers”) and the joint venture entities without any admission of liability or wrongdoing. Pursuant to the Settlement Agreement, the Company will make total settlement payments of $32,000 , inclusive of administrative fees and fees for plaintiffs’ counsel, in five installments, with a present value of $29,614 , which is included in Certain legal matters in the Statement of Operations during the three months ended June 30, 2018. As of June 30, 2018, $10,000 is classified as Accrued expenses and other current liabilities and $19,614 is classified in Other long-term liabilities. The Company paid the first installment in the amount of $10,000 on August 1, 2018, and expects to pay $8,000 on August 1, 2019, $7,000 on August 1, 2020, $3,500 on August 1, 2021 and $3,500 on August 1, 2022. The Company also agreed to share certain information with United and to follow certain procedures with respect to patients covered by United. Subject to the mutual releases provided in the Settlement Agreement, United also agreed to renew, reinstate, and/or not to terminate the network agreements for any Joint Venture Providers whose network agreements United terminated or chose not to renew from August 1, 2017 through the date of the Settlement Agreement. The Settlement Agreement includes customary terms and conditions. In connection with the Settlement Agreement, the Company also entered into a three -year national network agreement with United on August 1, 2018 that provides for specified reimbursement rates for patients covered by Medicare Advantage, Medicaid HMO and commercial insurance products over the term of the agreement. The Company recorded $29,614 as of June 30, 2018 in Certain legal matters, which is the present value of the settlement payments. As of June 30, 2018, $10,000 is classified as Accrued expenses and other current liabilities and $19,614 is classified in Other long-term liabilities. Certain Other Legal Matters On June 15, 2018, the United States District Court for the Southern District of New York approved the Stipulation of Settlement, entered into between the Company and Lead Plaintiff on January 30, 2018 in the matter captioned Esposito, et al. v. American Renal Associates Holdings, Inc., et al. , Case No. 16-cv-11797 (ADB). The Stipulation of Settlement provides for a total settlement payment of $4,000 , inclusive of administrative fees and fees for the lead plaintiff’s counsel. Substantially all of the settlement was funded by insurance proceeds. The settlement releases all claims asserted against the Company and the other named defendants in the action without any liability or wrongdoing attributed to them. In addition, on May 31, 2018, the United States District Court for the District of Massachusetts approved the settlement agreement, entered into between the Company and Steven Bushansky on March 29, 2018 in the matter captioned Stephen Bushansky, Derivatively on Behalf of American Renal Associates Holdings, Inc. v. Joseph A. Carlucci, et. al. , Case No. 17-cv-12091 (ADB). The settlement agreement provides for, among other things, a settlement payment of $350 , inclusive of attorney’s fees, and certain corporate governance changes. The payment was made by the Company’s insurer. The settlement resolves the claims asserted against all defendants in the action without any liability or wrongdoing attributed to them. 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. Other From time to time, we are subject to various legal actions and proceedings involving claims incidental to the conduct of our business, including contractual disputes and professional and general liability claims, as well as audits and investigations by various government entities, in the ordinary course of business. Based on information currently available, established reserves, available insurance coverage and other resources, we do not believe that the outcomes of any such pending actions, proceedings or investigations are likely to be, individually or in the aggregate, material to our business, financial condition, results of operations or cash flows. However, legal actions and proceedings are subject to inherent uncertainties and it is possible that the ultimate resolution of such matters, if unfavorable, may be materially adverse to our business, financial condition, results of operations or cash flows. Although we are not currently subject to any regulatory proceedings, in light of the heightened scrutiny with respect to the matters described above, there is no assurance that formal regulatory investigations or proceedings will not be commenced by any U.S. federal or state healthcare or other regulatory agencies. In addition, we may in the future be subject to additional inquiries, litigation or other proceedings or actions, regulatory or otherwise, arising in relation to the matters described above and related litigation and investigative matters. An unfavorable outcome of any such litigation or regulatory proceeding or action could have a material adverse effect on our business, financial condition and results of operations . We also record in Certain legal matters legal fees and other expenses relating to matters outside the ordinary course of our business.

CHANGES IN OWNERSHIP INTEREST I

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES	6 Months Ended
	Jun. 30, 2018
Noncontrolling Interest [Abstract]
CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES	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, 2018 2017 2018 2017 Net loss attributable to American Renal Holdings Associates, Inc. $ (18,008 ) $ (2,106 ) $ (18,918 ) $ (3,357 ) Increase in paid-in capital for the sales of noncontrolling interest — — 29 — Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (4,950 ) (4,708 ) (5,953 ) (5,980 ) Net transfers to/from noncontrolling interests $ (4,950 ) $ (4,708 ) $ (5,924 ) $ (5,980 ) Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests $ (22,958 ) $ (6,814 ) $ (24,842 ) $ (9,337 )

BASIS OF PRESENTATION AND ORG24

BASIS OF PRESENTATION AND ORGANIZATION (Policies)	6 Months Ended
	Jun. 30, 2018
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. The Company's 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 the Company's 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 consolidated 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 the Company's Form 10-K for the year ended December 31, 2017 . 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, 2018 , or decision-making group, in making decisions how to allocate resources and assess performance. 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 February 2018, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2018-02, Income Statement-Reporting Comprehensive Income (Topic 220): Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income. This amendment provides for the reclassification of the effect of remeasuring deferred tax balances related to items within accumulated other comprehensive income (“AOCI”) to retained earnings resulting from the Tax Cuts and Jobs Act of 2017. For public business entities, the ASU is effective for fiscal years beginning after December 15, 2018, and interim periods within those years, with early adoption permitted. Adoption of this ASU is to be applied either in the period of adoption or retrospectively to each period in which the effect of the change in the tax laws or rates were recognized. The Company elected to early adopt ASU 2018-02 during the first quarter of 2018, and elected to reclassify the income tax effects from the Tax Cuts and Jobs Act of 2017 from AOCI to retained earnings. The reclassification decreased AOCI and increased retained earnings by $214 . In August 2017, the FASB issued ASU 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities , which amends and simplifies existing guidance in order to allow companies to more accurately present the economic effects of risk management activities in the financial statements. For public business entities, the ASU is effective for fiscal years beginning after December 15, 2018, and interim periods therein; however, early adoption by all entities is permitted. The Company does not believe this ASU will have a material impact on its financial statements. 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 of lessees on the balance sheet and disclosing key information about leasing arrangements in the financial statements. Since February 2016, the FASB has issued additional updates to serve as targeted improvements to the original standard update. 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 has engaged a professional services firm to assist in the implementation of ASU 2016-02. 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 does not expect any impact on the current debt covenants, as described in Note 9 - Debt . The guidance should be applied under a modified retrospective transition approach, with an option to apply the guidance either at the beginning of the earliest comparative period presented, or to apply the new guidance at the adoption date. The Company expects to apply the modified retrospective method at the beginning of the period of adoption after review of the analysis is performed. The Company is currently assessing the impact the adoption of ASU 2016-02 will have on the consolidated financial statements, and has implemented lease accounting systems which will ultimately assist in the application of the new standard. In May 2014, the FASB issued ASU 2014-09, Revenue from Contracts with Customers (Topic 606) (“ASC 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. Since May 2014, the FASB has issued additional updates to serve as clarification to the original standard update. 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 Company adopted the new standard on January 1, 2018, using the modified retrospective transition method. As a practical expedient, the Company adopted using the portfolio approach, applying the ASU to a portfolio of contracts with similar characteristics. The Company reasonably expects that the effects on the financial statements of applying this guidance to the portfolio of contracts would not differ materially from applying this guidance to the individual contracts within the portfolio. Additionally, the Company elected the practical expedient that allows the recognition of revenue with each dialysis treatment, as that is when the Company has the right to invoice. The Company also adopted the practical expedient to only assess the recognition of revenue for open contracts during the transition period and there was no adjustment to the opening balance of retained earnings at January 1, 2018. The comparative information has not been restated and continues to be reported under the accounting standards in effect for that period. The adoption did not have a material impact to the timing of revenue recognition; however, a majority of the provision for uncollectible accounts is now recognized as a direct reduction to revenues, instead of separately as a deduction to arrive at net revenue. The Company no longer separately presents a provision for uncollectible accounts on the consolidated statement of operations as it is included in Patient care costs after the adoption of the new accounting standard. As a result of the Company’s election to apply the new standard only to contracts not substantially completed as of January 1, 2018, the Company continues to maintain an allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of the new accounting standards. Changes to this allowance for doubtful accounts, other than write-offs of uncollectible accounts, are recorded through the provision for uncollectible accounts in accordance with prior accounting standards. The Company's provision for uncollectible accounts was $1,610 and $3,217 for the three and six months ended June 30, 2017 . See Note 2 - Revenue for additional discussion of the Company's revenue recognition accounting policies and expanded disclosures required by the new standard.

REVENUE (Tables)

REVENUE (Tables)	6 Months Ended
	Jun. 30, 2018
Revenue from Contract with Customer [Abstract]
Sources of Revenue	The composition of patient care service revenue by source is as follows: Three Months Ended June 30, Six Months Ended June 30, Source of Revenues: 2018 2017 2018 2017 Medicare and Medicare Advantage 63 % 58 % 63 % 59 % Commercial and other (1) 33 % 38 % 33 % 37 % Medicaid and Managed Medicaid 4 % 3 % 4 % 3 % Other (2) — % 1 % — % 1 % 100 % 100 % 100 % 100 % _____________________ (1) Principally commercial insurance companies and also includes the VA, which we refer to collectively as “Commercial and other.” (2) Other sources of revenues include hospitals and patient pay. “Patient pay” revenues consist of payments received directly from patients who are either uninsured or self-pay a portion of the bill.

CASH (Tables)

CASH (Tables)	6 Months Ended
	Jun. 30, 2018
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, 2018 Cash $ 69,403 Restricted cash included in other long-term assets 100 Total cash and restricted cash shown in the statement of cash flows $ 69,503
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, 2018 Cash $ 69,403 Restricted cash included in other long-term assets 100 Total cash and restricted cash shown in the statement of cash flows $ 69,503

GOODWILL (Tables)

GOODWILL (Tables)	6 Months Ended
	Jun. 30, 2018
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of changes in goodwill	Changes in goodwill were as follows: Balance at December 31, 2017 $ 573,427 Acquisitions — Divestitures (2,481 ) Balance at June 30, 2018 $ 570,946

FAIR VALUE MEASUREMENTS (Tables

FAIR VALUE MEASUREMENTS (Tables)	6 Months Ended
	Jun. 30, 2018
Fair Value Disclosures [Abstract]
Schedule of the fair value of financial instruments	June 30, 2018 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 474 $ — $ 474 $ — Interest rate derivative agreements (included in Other long-term assets) 2,058 — 2,058 — Total Assets $ 2,532 $ — $ 2,532 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 6,400 $ — $ — $ 6,400 Temporary Equity Noncontrolling interests subject to put provisions $ 145,500 $ — $ — $ 145,500 December 31, 2017 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 46 $ — $ 46 $ — Interest rate derivative agreements (included in Other long-term assets) 255 — 255 — Total Assets $ 301 $ — $ 301 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 7,500 $ — $ — $ 7,500 Interest rate swap agreement (included in Accrued expenses and other current liabilities) 403 — 403 — Interest rate swap agreement (included in Other long-term liabilities) 198 — 198 — Total Liabilities $ 8,101 $ — $ 601 $ 7,500 Temporary Equity Noncontrolling interests subject to put provisions $ 139,895 $ — $ — $ 139,895
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, 2018 for the TRA liability, which is classified as a Level 3 financial instrument. Balance at December 31, 2017 $ 7,500 Options exercised and dividend equivalent payment vesting (385 ) Total realized/unrealized gains: Included in earnings and reported as Income tax receivable agreement income (715 ) Balance at June 30, 2018 $ 6,400

ACCRUED EXPENSES AND OTHER CU29

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Tables)	6 Months Ended
	Jun. 30, 2018
Payables and Accruals [Abstract]
Summary of accrued compensation and benefits	Accrued compensation and benefits consist of the following: June 30, 2018 December 31, 2017 Accrued compensation $ 17,017 $ 17,987 Accrued vacation pay 13,864 10,998 $ 30,881 $ 28,985
Summary of accrued expenses and other current liabilities	Accrued expenses and other current liabilities consist of the following: June 30, 2018 December 31, 2017 Payor refunds and retractions $ 26,050 $ 28,935 Other 22,911 21,028 $ 48,961 $ 49,963

NONCONTROLLING INTERESTS SUBJ30

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS (Tables)	6 Months Ended
	Jun. 30, 2018
Temporary Equity Disclosure [Abstract]
Schedules of Noncontrolling Interests Subject to Put Provisions	The Company's computation of the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests as of June 30, 2018 and December 31, 2017 is set forth below: June 30, 2018 December 31, 2017 Redemption value $ 11,149 $ 12,211 Estimated fair value for accounting purposes 5,411 6,550 Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests $ 5,738 $ 5,661 In addition, the tables below set forth a reconciliation of noncontrolling interest subject to put provisions. June 30, 2018 December 31, 2017 Noncontrolling interest subject to put provisions - estimated fair value $ 139,762 $ 134,234 Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests 5,738 5,661 Noncontrolling interests subject to put provisions - maximum redemption value $ 145,500 $ 139,895 Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Change in estimated fair value for accounting purposes $ (4,674 ) $ (4,782 ) $ (3,518 ) $ (8,175 ) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests 884 2,527 302 13,610 Total change in fair value of noncontrolling interests subject to put provisions - maximum redemption $ (3,790 ) $ (2,255 ) $ (3,216 ) $ 5,435

DEBT (Tables)

DEBT (Tables)	6 Months Ended
	Jun. 30, 2018
Debt Disclosure [Abstract]
Schedule of long-term debt	Long-term debt consists of the following: June 30, 2018 December 31, 2017 2017 Credit Agreement $ 436,700 $ 437,800 Term Loans (1) 121,868 125,619 Lines of Credit 4,602 3,600 Other 2,323 2,601 565,493 569,620 Less: discounts and fees, net of accumulated amortization (8,850 ) (9,532 ) Less: current maturities (46,660 ) (44,534 ) $ 509,983 $ 515,554 _____________________________ (1) Includes assigned clinic loans
Schedule of maturities of long-term debt	Scheduled maturities of long-term debt as of June 30, 2018 are as follows: 2018 (remainder) $ 25,341 2019 41,366 2020 31,782 2021 24,706 2022 15,874 Thereafter 426,424 $ 565,493

STOCK-BASED COMPENSATION (Table

STOCK-BASED COMPENSATION (Tables)	6 Months Ended
	Jun. 30, 2018
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Schedule of stock-based compensation expense	For the three and six months ended June 30, 2018 and 2017 , 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, 2018 2017 2018 2017 Patient care costs $ 285 $ 664 $ 442 $ 2,493 General and administrative 1,378 2,979 2,485 11,238 Total stock-based compensation before tax $ 1,663 $ 3,643 $ 2,927 $ 13,731 Income tax benefit (432 ) (1,457 ) (761 ) (5,492 )
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 during 2018 and the fair value at the date of grant under the 2016 Plan are noted in the following table: Six Months Ended June 30, 2018 Expected volatility 30-35% Weighted average expected term in years 6.00 Weighted average risk-free interest rate 2.74-2.84% Expected annual dividend yield —% Weighted average grant-date fair value $7.40
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 stock is summarized as follows: Six Months Ended June 30, 2018 Number of Options Weighted-Average Exercise Price Outstanding, beginning of period 5,280,261 $ 11.79 Granted (1) 158,883 20.93 Exercised (92,750 ) 4.25 Forfeited (51,683 ) 18.50 Outstanding, end of period 5,294,711 $ 12.13 Options vested and expected to vest, end of period 5,294,711 $ 12.13 Options exercisable, end of period 3,307,874 $ 7.73 ____________________________ (1) Subject to vesting terms of three years.
Schedule of restricted stock award activity	A summary of restricted stock award activity is as follows: Six Months Ended June 30, 2018 Number Outstanding Weighted-Average Grant Date Fair Value per Award Unvested at December 31, 2017 252,307 $ 16.70 Granted (1) 348,708 $ 22.36 Vested (91,736 ) $ 17.37 Forfeited (719 ) $ 17.39 Unvested at June 30, 2018 508,560 $ 20.46 (1) Weighted average vesting of 3.5 years.

LOSS PER SHARE (Tables)

LOSS PER SHARE (Tables)	6 Months Ended
	Jun. 30, 2018
Earnings Per Share [Abstract]
Schedule of basic and diluted loss per share	Three Months Ended June 30, Six Months Ended June 30, 2018 2017 2018 2017 Basic Net loss attributable to American Renal Associates Holdings, Inc. $ (18,008 ) $ (2,106 ) $ (18,918 ) $ (3,357 ) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests (884 ) (2,527 ) (302 ) (13,610 ) Net loss attributable to common shareholders for basic earnings per share calculation $ (18,892 ) $ (4,633 ) $ (19,220 ) $ (16,967 ) Weighted-average common shares outstanding used to calculate basic net loss per share 31,932,705 30,986,689 31,877,286 30,947,304 Loss per share, basic $ (0.59 ) $ (0.15 ) $ (0.60 ) $ (0.55 ) Diluted Net loss attributable to American Renal Associates Holdings, Inc. $ (18,008 ) $ (2,106 ) $ (18,918 ) $ (3,357 ) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests (884 ) (2,527 ) (302 ) (13,610 ) Net loss attributable to common shareholders for diluted earnings per share calculation $ (18,892 ) $ (4,633 ) $ (19,220 ) $ (16,967 ) Weighted-average common shares outstanding, basic 31,932,705 30,986,689 31,877,286 30,947,304 Weighted-average effect of dilutive securities: Weighted-average common shares outstanding used to calculate diluted net loss per share 31,932,705 30,986,689 31,877,286 30,947,304 Loss per share, diluted $ (0.59 ) $ (0.15 ) $ (0.60 ) $ (0.55 ) Outstanding options and restricted stock excluded as impact would be anti-dilutive 3,716,353 3,291,722 3,487,078 2,303,407

CHANGES IN OWNERSHIP INTEREST34

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES (Tables)	6 Months Ended
	Jun. 30, 2018
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, 2018 2017 2018 2017 Net loss attributable to American Renal Holdings Associates, Inc. $ (18,008 ) $ (2,106 ) $ (18,918 ) $ (3,357 ) Increase in paid-in capital for the sales of noncontrolling interest — — 29 — Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (4,950 ) (4,708 ) (5,953 ) (5,980 ) Net transfers to/from noncontrolling interests $ (4,950 ) $ (4,708 ) $ (5,924 ) $ (5,980 ) Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests $ (22,958 ) $ (6,814 ) $ (24,842 ) $ (9,337 )

BASIS OF PRESENTATION AND ORG35

BASIS OF PRESENTATION AND ORGANIZATION (Details)	3 Months Ended			6 Months Ended
	Jun. 30, 2018USD ($)state	Mar. 31, 2018USD ($)	Jun. 30, 2017USD ($)	Jun. 30, 2018USD ($)dialysis_clinicpatientstatesegment	Jun. 30, 2017USD ($)	Dec. 31, 2017USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Assets	$ 975,669,000			$ 975,669,000		$ 964,208,000
Number of dialysis clinics owned and operated | dialysis_clinic				233
Number of patients | patient				16,018
Number of states | state	26			26
Number of reportable segments | segment				1
Transaction costs	$ 0		$ 717,000	$ 856,000	$ 717,000
Reclassification of income tax effects of the Tax Cuts and Jobs Act from AOCI to retained earnings		$ 214,000
Provision for uncollectible accounts			$ 1,610,000		$ 3,217,000
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%

REVENUE (Details)

REVENUE (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017	Dec. 31, 2017
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Performance obligation satisfied in prior period	$ 5,521		$ 5,521
Medicare bad debt claims	$ 14,214		$ 14,214
Patient care service revenue	100.00%	100.00%	100.00%	100.00%
Medicare and Medicare Advantage
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Patient care service revenue	63.00%	58.00%	63.00%	59.00%
Commercial and other
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Patient care service revenue	33.00%	38.00%	33.00%	37.00%
Medicaid and Managed Medicaid
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Patient care service revenue	4.00%	3.00%	4.00%	3.00%
Other
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Patient care service revenue	0.00%	1.00%	0.00%	1.00%
Prepaid expenses and other current assets
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Medicare bad debt claims	$ 5,797		$ 5,797		$ 10,744
Other long-term assets
Revenue, Initial Application Period Cumulative Effect Transition [Line Items]
Medicare bad debt claims	$ 8,417		$ 8,417

CASH (Details)

CASH (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017	Jun. 30, 2017	Dec. 31, 2016
Cash and Cash Equivalents [Abstract]
Cash	$ 69,403	$ 71,521
Restricted cash included in other long-term assets	100
Total cash and restricted cash shown in the statement of cash flows	$ 69,503	$ 71,621	$ 75,033	$ 100,916

GOODWILL (Details)

GOODWILL (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2018USD ($)
Goodwill [Roll Forward]
Balance at December 31, 2017	$ 573,427
Acquisitions	0
Divestitures	(2,481)
Balance at June 30, 2018	$ 570,946

FAIR VALUE MEASUREMENTS - Sched

FAIR VALUE MEASUREMENTS - Schedule of fair values (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Noncontrolling interests subject to put provisions	$ 145,500	$ 139,895
Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate derivative agreements asset	2,532	301
Total Liabilities		8,101
Noncontrolling interests subject to put provisions	145,500	139,895
Recurring basis | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate derivative agreements asset	0	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 derivative agreements asset	2,532	301
Total Liabilities		601
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 derivative agreements asset	0	0
Total Liabilities		7,500
Noncontrolling interests subject to put provisions	145,500	139,895
Prepaid expenses and other current assets | Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate derivative agreements asset	474	46
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 derivative 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 derivative agreements asset	474	46
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 derivative 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 derivative agreements asset	2,058	255
Other long-term assets | Recurring basis | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate derivative agreements asset	0	0
Other long-term assets | Recurring basis | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate derivative agreements asset	2,058	255
Other long-term assets | Recurring basis | Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate derivative agreements asset	0	0
Income tax receivable agreement payable | Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Tax receivable agreement liability	6,400	7,500
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	$ 6,400	7,500
Accrued expense and other current liabilities | Recurring basis
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements liability		403
Accrued expense and other current liabilities | Recurring basis | Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements liability		0
Accrued expense and other current liabilities | Recurring basis | Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements liability		403
Accrued expense and other current liabilities | Recurring basis | Level 3
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
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Interest rate swap agreements liability		198
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		198
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, 2018USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance at December 31, 2017	$ 7,500
Options exercised and dividend equivalent payment vesting	(385)
Total realized/unrealized gains:
Included in earnings and reported as Income tax receivable agreement income	(715)
Balance at June 30, 2018	$ 6,400

FAIR VALUE MEASUREMENTS - Narra

FAIR VALUE MEASUREMENTS - Narrative (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying amount of long-term debt	$ 565,493	$ 569,620
First lien term loans
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value of debt	435,062	437,800
Carrying amount of long-term debt	$ 436,700	$ 437,800

ACCRUED EXPENSES AND OTHER CU42

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Accrued compensation and benefits:
Accrued compensation	$ 17,017	$ 17,987
Accrued vacation pay	13,864	10,998
Accrued compensation and benefits	30,881	28,985
Accrued expenses and other current liabilities:
Payor refunds and retractions	26,050	28,935
Other	22,911	21,028
Accrued expenses and other current liabilities	$ 48,961	$ 49,963

VARIABLE INTEREST ENTITIES (Det

VARIABLE INTEREST ENTITIES (Details) $ in Thousands	Jun. 30, 2018USD ($)
Variable Interest Entity, Nonconsolidated, Carrying Amount, Assets and Liabilities, Net [Abstract]
Total assets of VIEs	$ 19,953
Total liabilities of VIEs	$ 10,706

NONCONTROLLING INTERESTS SUBJ44

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017	Dec. 31, 2017
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Redemption value	$ 11,149		$ 11,149		$ 12,211
Estimated fair value for accounting purposes	5,411		5,411		6,550
Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests	5,738		5,738		5,661
Noncontrolling interest subject to put provisions - estimated fair value	139,762		139,762		134,234
Noncontrolling interests subject to put provisions - maximum redemption value	145,500		145,500		$ 139,895
Total change in fair value of noncontrolling interests subject to put provisions - maximum redemption			3,216
Noncontrolling Interests subject to put provisions
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Change in estimated fair value for accounting purposes	(4,674)	$ (4,782)	(3,518)	$ (8,175)
Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests	884	2,527	302	13,610
Total change in fair value of noncontrolling interests subject to put provisions - maximum redemption	$ (3,790)	$ (2,255)	$ (3,216)	$ 5,435
Minimum
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Weighted average cost of capital			15.00%
Maximum
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS
Weighted average cost of capital			20.50%

DEBT - Schedule of long-term de

DEBT - Schedule of long-term debt (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
LONG-TERM DEBT
Total long-term debt	$ 565,493	$ 569,620
Less: discounts and fees, net of accumulated amortization	(8,850)	(9,532)
Less: current maturities	(46,660)	(44,534)
Long-term debt, less current portion	509,983	515,554
2017 Credit Agreement
LONG-TERM DEBT
Long-term debt, gross	436,700	437,800
Term Loans
LONG-TERM DEBT
Long-term debt, gross	121,868	125,619
Lines of Credit
LONG-TERM DEBT
Long-term debt, gross	4,602	3,600
Other
LONG-TERM DEBT
Long-term debt, gross	$ 2,323	$ 2,601

DEBT - Scheduled maturities of

DEBT - Scheduled maturities of long-term debt (Details) - USD ($) $ in Thousands	Jun. 30, 2018	Dec. 31, 2017
Debt Disclosure [Abstract]
2018 (remainder)	$ 25,341
2,019	41,366
2,020	31,782
2,021	24,706
2,022	15,874
Thereafter	426,424
Total long-term debt	$ 565,493	$ 569,620

DEBT - Narrative (Details)

DEBT - Narrative (Details)	Jun. 22, 2017USD ($)	Jun. 30, 2018USD ($)	Jun. 30, 2017USD ($)	Jun. 30, 2018USD ($)	Jun. 30, 2017USD ($)	Dec. 31, 2017USD ($)	Mar. 31, 2017USD ($)interest_rate_cap_agreement
LONG-TERM DEBT
Transaction costs		$ 0	$ 717,000	$ 856,000	$ 717,000
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
Interest rate swap and cap agreements notional amount							$ 147,000,000
Number of interest rate swap agreements | interest_rate_cap_agreement							2
Revolving Credit Facility
LONG-TERM DEBT
Revolving credit facility borrowings outstanding		$ 0		0
2017 Credit Agreement
LONG-TERM DEBT
Principal payments				$ 1,100,000
2017 Credit Agreement
LONG-TERM DEBT
Costs associated with refinancing activities	$ 9,259,000
Transaction costs						$ 717,000
Debt discounts	4,628,000
Deferred financing costs	3,914,000
Write-off of deferred financing fees						$ 526,000
2017 Credit Agreement | Lines of Credit | Revolving Credit Facility
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%
2017 Credit Agreement | Term loans
LONG-TERM DEBT
Debt face amount	$ 440,000,000
Interest rate				5.34%
Required prepayment				$ 0
Amortization payments, quarterly installment	$ 1,100,000
2017 Credit Agreement | Federal funds effective rate | Term loans
LONG-TERM DEBT
Interest rate margin	0.50%
2017 Credit Agreement | Eurodollar one-month rate | Term loans
LONG-TERM DEBT
Interest rate margin	1.00%
2017 Credit Agreement | ABR rate | Term loans
LONG-TERM DEBT
Interest rate margin	2.25%
2017 Credit Agreement | LIBOR rate, adjusted for changes in Eurodollar reserves | Term loans
LONG-TERM DEBT
Interest rate margin	3.25%
Term B loans | Term loans
LONG-TERM DEBT
Debt face amount							$ 440,000,000

INCOME TAXES (Details)

INCOME TAXES (Details)	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Income Tax Disclosure [Abstract]
Effective income tax rate	(115.20%)	2.40%	(14.40%)	(11.90%)

STOCK-BASED COMPENSATION - Sche

STOCK-BASED COMPENSATION - Schedule of Expense (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation before tax	$ 1,663	$ 3,643	$ 2,927	$ 13,731
Income tax benefit	(432)	(1,457)	(761)	(5,492)
Patient care costs
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation before tax	285	664	442	2,493
General and administrative
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Total stock-based compensation before tax	$ 1,378	$ 2,979	$ 2,485	$ 11,238

STOCK-BASED COMPENSATION - Narr

STOCK-BASED COMPENSATION - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands	Apr. 26, 2016	Apr. 07, 2016	Mar. 31, 2018	Jun. 30, 2018	Jun. 30, 2017	Dec. 31, 2017
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Options outstanding (in shares)				5,294,711
Cash dividend (in USD per share)	$ 1.30
Cash dividend	$ 28,886
Unrecognized non-cash compensation costs	$ 38,877
Vested option stockholders
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
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				$ 5,266
Unvested option stockholders
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Equitable adjustments in the form of cash dividend equivalent payments				$ 1,529
IPO
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Stock compensation due to modification					$ 9,104
Stock options
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Vesting period (in years)				3 years
Unrecognized compensation costs recognition period	12 months
Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Granted (in shares)				348,708
Granted (in USD per share)				$ 22.36
Vesting period (in years)				3 years 6 months
Unvested and outstanding (in shares)				508,560		252,307
Unrecognized compensation costs				$ 9,107
Unrecognized compensation costs recognition period				1 year 9 months 16 days
Certain executives | Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Granted (in shares)			95,000
Granted (in USD per share)			$ 22.33
Vesting period (in years)			3 years
2016 Omnibus Incentive Plan
Share-based Compensation Arrangement by Share-based Payment Award, Compensation Cost [Line Items]
Options outstanding (in shares)				5,294,711		5,280,261
Stock options to purchase outstanding (in shares)				2,202,409
Authorized additional stock options (in shares)		4,000,000

STOCK-BASED COMPENSATION - Assu

STOCK-BASED COMPENSATION - Assumptions used for options granted (Details)	6 Months Ended
	Jun. 30, 2018$ / shares
Disclosure of Compensation Related Costs, Share-based Payments [Abstract]
Expected volatility (minimum)	30.00%
Expected volatility (maximum)	35.00%
Weighted average expected term in years	6 years
Weighted average risk free interest rate (minimum)	2.74%
Weighted average risk free interest rate (maximum)	2.84%
Expected annual dividend yield	0.00%
Weighted average grant-date fair value (in USD per share)	$ 7.40

STOCK-BASED COMPENSATION - Opti

STOCK-BASED COMPENSATION - Option activity (Details)	6 Months Ended
	Jun. 30, 2018$ / sharesshares
Number of Options
Outstanding, end of period (in shares)	5,294,711
2016 Omnibus Incentive Plan
Number of Options
Outstanding, beginning of period (in shares)	5,280,261
Granted (in shares)	158,883
Exercised (in shares)	(92,750)
Forfeited (in shares)	(51,683)
Outstanding, end of period (in shares)	5,294,711
Options vested and expected to vest, end of period (in shares)	5,294,711
Options exercisable, end of period (in shares)	3,307,874
Weighted-Average Exercise Price
Outstanding, weighted-average exercise price, beginning period (in USD per share) | $ / shares	$ 11.79
Granted, weighted average exercise price (in USD per share) | $ / shares	20.93
Exercised, weighted average exercise price (in USD per share) | $ / shares	4.25
Forfeited, weighted average exercise price (in USD per share) | $ / shares	18.50
Outstanding, weighted-average exercise price, end of period (in USD per share) | $ / shares	12.13
Options vested and expected to vest, weighted-average exercise price, end of period (in USD per share) | $ / shares	12.13
Options exercisable, weighted-average exercise price (in USD per share) | $ / shares	$ 7.73
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, 2018$ / sharesshares
Number Outstanding
Beginning balance (in shares) | shares	252,307
Granted (in shares) | shares	348,708
Vested (in shares) | shares	(91,736)
Forfeited (in shares) | shares	(719)
Ending balance (in shares) | shares	508,560
Weighted-Average Grant Date Fair Value per Award
Beginning balance (in USD per share) | $ / shares	$ 16.70
Granted (in USD per share) | $ / shares	22.36
Vested (in USD per share) | $ / shares	17.37
Forfeited (in shares) | $ / shares	17.39
Ending balance (in USD per share) | $ / shares	$ 20.46
Vesting period (in years)	3 years 6 months

LOSS PER SHARE (Details)

LOSS PER SHARE (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Basic
Net loss attributable to American Renal Associates Holdings, Inc.	$ (18,008)	$ (2,106)	$ (18,918)	$ (3,357)
Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests	(884)	(2,527)	(302)	(13,610)
Net loss attributable to common shareholders	$ (18,892)	$ (4,633)	$ (19,220)	$ (16,967)
Weighted-average common shares outstanding, basic (in shares)	31,932,705	30,986,689	31,877,286	30,947,304
Loss per share, basic (in USD per share)	$ (0.59)	$ (0.15)	$ (0.60)	$ (0.55)
Diluted
Net loss attributable to American Renal Associates Holdings, Inc.	$ (18,008)	$ (2,106)	$ (18,918)	$ (3,357)
Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests	(884)	(2,527)	(302)	(13,610)
Net loss attributable to common shareholders for diluted earnings per share calculation	$ (18,892)	$ (4,633)	$ (19,220)	$ (16,967)
Weighted-average common shares outstanding, basic (in shares)	31,932,705	30,986,689	31,877,286	30,947,304
Weighted-average effect of dilutive securities:
Weighted-average common shares outstanding used to calculate diluted net loss per share (in shares)	31,932,705	30,986,689	31,877,286	30,947,304
Loss per share, diluted (in USD per share)	$ (0.59)	$ (0.15)	$ (0.60)	$ (0.55)
Outstanding options and restricted stock excluded as impact would be anti-dilutive (in shares)	3,716,353	3,291,722	3,487,078	2,303,407

RELATED PARTY TRANSACTIONS (Det

RELATED PARTY TRANSACTIONS (Details) - USD ($) $ in Thousands	Apr. 20, 2016	Jun. 30, 2018	Dec. 31, 2016	Apr. 26, 2016
RELATED PARTY TRANSACTIONS
Assigned clinic loans		$ 7,705
Period of weighted average maturity, clinic loans		1 year 4 months 6 days
Weighted average interest rate, clinic loans		5.10%
Maximum potential liability for future payments		$ 7,705
Clinic loan guarantee		4,254
Percentage tax savings payable to pre-IPO stockholders				85.00%
Income tax receivable agreement liability total	$ 23,400	6,910
Tax receivable agreement liability		873
Payments made for the income tax receivable agreement		$ 6,376
Sublease agreement
RELATED PARTY TRANSACTIONS
Interest rate		6.00%
Total amount of initial financing			$ 1,760
Amount outstanding		$ 1,606
Executive | Software services agreement | Kinetic
RELATED PARTY TRANSACTIONS
Ownership percentage		51.00%
Executive | Financing transactions
RELATED PARTY TRANSACTIONS
Period of weighted average maturity, clinic loans		2 years 3 months 4 days
Weighted average interest rate, clinic loans		4.54%
Ownership interest in joint venture		$ 5,067
Loan guarantee outstanding		$ 810
Spouse of executive | Software services agreement | Kinetic
RELATED PARTY TRANSACTIONS
Ownership percentage		2.50%
Minimum
RELATED PARTY TRANSACTIONS
Interest rate		4.25%
Minimum | Executive | Financing transactions
RELATED PARTY TRANSACTIONS
Interest rate		3.31%
Maximum
RELATED PARTY TRANSACTIONS
Interest rate		8.08%
Maximum | Executive | Financing transactions
RELATED PARTY TRANSACTIONS
Interest rate		6.30%

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) - USD ($) $ in Thousands	Aug. 01, 2018	Mar. 29, 2018	Jan. 31, 2018	Jun. 30, 2018	Dec. 31, 2017
Certain Legal Matters
Accrued expenses and other current liabilities				$ 48,961	$ 49,963
Other long-term liabilities				33,819	$ 14,880
ARA, ARA OpCo And ARM vs UnitedHealth Group Inc.
Certain Legal Matters
Certain legal matters				29,614
Accrued expenses and other current liabilities				10,000
Other long-term liabilities				19,614
Installment payment on August 1, 2018				10,000
Installment payment on August 1, 2019				8,000
Installment payment on August 1, 2020				7,000
Installment payment on August 1, 2021				3,500
Installment payment on August 1, 2022				$ 3,500
Esposito, Et Al. v. American Renal Associates Holdings, Inc., Et Al
Certain Legal Matters
Settlement payment			$ 4,000
Bushansky On Behalf Of Company V. Board Of Directors
Certain Legal Matters
Settlement payment		$ 350
Subsequent Event | ARA, ARA OpCo And ARM vs UnitedHealth Group Inc.
Certain Legal Matters
Settlement payment	$ 32,000
Agreement term	3 years

CHANGES IN OWNERSHIP INTEREST58

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2018	Jun. 30, 2017	Jun. 30, 2018	Jun. 30, 2017
Noncontrolling Interest [Abstract]
Net loss attributable to American Renal Associates Holdings, Inc.	$ (18,008)	$ (2,106)	$ (18,918)	$ (3,357)
Increase in paid-in capital for the sales of noncontrolling interest	0	0	29	0
Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest	(4,950)	(4,708)	(5,953)	(5,980)
Net transfers to/from noncontrolling interests	(4,950)	(4,708)	(5,924)	(5,980)
Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests	$ (22,958)	$ (6,814)	$ (24,842)	$ (9,337)