American Renal Associates 10-Q 10 Aug 20 2020 Q2 Quarterly report Financial data

Cover Page

Cover Page - shares	6 Months Ended
	Jun. 30, 2020	Aug. 09, 2020
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2020
Document Transition Report	false
Entity File Number	001-37751
Entity Registrant Name	American Renal Associates Holdings, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	27-2170749
Entity Address, Address Line One	500 Cummings Center
Entity Address, City or Town	Beverly,
Entity Address, State or Province	MA
Entity Address, Postal Zip Code	01915
City Area Code	978
Local Phone Number	922-3080
Title of 12(b) Security	Common Stock, $0.01 par value
Trading Symbol	ARA
Security Exchange Name	NYSE
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Accelerated Filer
Entity Small Business	true
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		34,607,729
Entity Central Index Key	0001498068
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q2

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Assets
Cash	$ 131,976	$ 34,494
Restricted cash (Note 1)	16,758	0
Accounts receivable, net	91,678	102,150
Inventories	8,154	7,752
Prepaid expenses and other current assets	24,829	22,268
Income tax receivable	6,926	3,251
Current assets held for sale	49,197	50,099
Total current assets	329,518	220,014
Property and equipment, net of accumulated depreciation of $232,711 and $215,471, respectively	146,407	151,175
Operating lease right-of-use assets (Note 9)	135,078	133,899
Intangible assets, net of accumulated amortization of $25,502 and $25,087, respectively	24,078	24,486
Other long-term assets	26,009	18,608
Goodwill	538,609	538,609
Total assets	1,199,699	1,086,791
Liabilities and Equity
Accounts payable	47,060	49,539
Accrued compensation and benefits	37,737	37,196
Accrued expenses and other current liabilities	173,614	37,593
Current portion of long-term debt	36,047	38,779
Current portion of operating lease liabilities (Note 9)	23,201	22,061
Current liabilities held for sale	4,210	5,767
Total current liabilities	321,869	190,935
Long-term debt, less current portion	549,100	548,835
Long-term operating lease liabilities, less current portion (Note 9)	124,058	123,792
Income tax receivable agreement payable	352	3,000
Other long-term liabilities	10,876	6,501
Deferred tax liabilities	3,964	2,706
Total liabilities	1,010,219	875,769
Commitments and contingencies (Note 14 and Note 15)
Noncontrolling interests subject to put provisions	110,405	126,483
Equity:
Common stock, $0.01 par value; 300,000,000 shares authorized; 34,488,565 and 32,976,416 issued and outstanding at June 30, 2020 and December 31, 2019, respectively	208	197
Additional paid-in capital	111,884	100,744
Receivable from noncontrolling interests	(2,301)	(531)
Accumulated deficit	(184,680)	(178,241)
Accumulated other comprehensive loss, net of tax	(2,389)	(1,619)
Total American Renal Associates Holdings, Inc. deficit	(77,278)	(79,450)
Noncontrolling interests not subject to put provisions	156,353	163,989
Total equity	79,075	84,539
Total liabilities and equity	$ 1,199,699	$ 1,086,791

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Accumulated depreciation of property and equipment	$ 232,711	$ 215,471
Accumulated amortization of intangible assets	$ 25,502	$ 25,087
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)	34,488,565	32,976,416
Common stock, shares outstanding (in shares)	34,488,565	32,976,416

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Income Statement [Abstract]
Patient service operating revenues	$ 205,148	$ 213,252	$ 398,330	$ 405,014
Revenue, Product and Service [Extensible List]	us-gaap:HealthCarePatientServiceMember	us-gaap:HealthCarePatientServiceMember	us-gaap:HealthCarePatientServiceMember	us-gaap:HealthCarePatientServiceMember
Operating expenses:
Patient care costs	$ 146,882	$ 153,016	$ 301,104	$ 301,197
Cost, Product and Service [Extensible List]	us-gaap:HealthCarePatientServiceMember	us-gaap:HealthCarePatientServiceMember	us-gaap:HealthCarePatientServiceMember	us-gaap:HealthCarePatientServiceMember
General and administrative	$ 22,665	$ 23,927	$ 47,570	$ 49,526
Depreciation, amortization and impairment	8,974	10,299	17,501	20,365
Certain legal and other matters (Note 15)	841	8,381	3,128	13,672
Total operating expenses	179,362	195,623	369,303	384,760
Operating income	25,786	17,629	29,027	20,254
Other income - CARES Act	1,474	0	1,474	0
Interest expense, net	(9,721)	(11,541)	(20,733)	(20,291)
Change in fair value of income tax receivable agreement	(356)	(304)	1,343	1,378
Income before income taxes	17,183	5,784	11,111	1,341
Income tax expense (benefit)	2,349	644	(1,395)	1,346
Net income (loss)	14,834	5,140	12,506	(5)
Less: Net income attributable to noncontrolling interests	(14,039)	(13,318)	(18,945)	(18,652)
Net income (loss) attributable to American Renal Associates Holdings, Inc.	795	(8,178)	(6,439)	(18,657)
Less: Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests	(444)	1,025	(703)	284
Net income (loss) attributable to common shareholders	$ 351	$ (7,153)	$ (7,142)	$ (18,373)
Earnings (loss) per share (Note 12):
Basic (in USD per share)	$ 0.01	$ (0.22)	$ (0.22)	$ (0.57)
Diluted (in USD per share)	$ 0.01	$ (0.22)	$ (0.22)	$ (0.57)
Weighted-average number of common shares outstanding
Basic (in shares)	32,862,637	32,275,807	32,661,238	32,232,004
Diluted (in shares)	34,612,591	32,275,807	32,661,238	32,232,004

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Comprehensive Income (Loss) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Statement of Comprehensive Income [Abstract]
Net income (loss)	$ 14,834	$ 5,140	$ 12,506	$ (5)
Unrealized gain (loss) on derivative agreements, net of tax	147	(1,024)	(770)	(1,809)
Total comprehensive income (loss)	14,981	4,116	11,736	(1,814)
Less: Comprehensive income attributable to noncontrolling interests	(14,039)	(13,318)	(18,945)	(18,652)
Total comprehensive income (loss) attributable to American Renal Associates Holdings, Inc.	$ 942	$ (9,202)	$ (7,209)	$ (20,466)

Condensed Consolidated Statem_3

Condensed Consolidated Statement of Changes in Equity - 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, 2018	$ (58,970)	$ 129,099	$ 196	$ 105,715	$ (506)	$ (164,451)	$ 76	$ 168,881
Balance at beginning of period (in shares) at Dec. 31, 2018			32,603,846
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(18,657)	4,000				(18,657)		14,652
Stock-based compensation	2,251			2,251
Exercise of stock options (in shares)			8,807
Exercise of stock options	67			67
Forfeiture of restricted stock awards (in shares)			(20,456)
Vested restricted stock awards withheld on net share settlement (in shares)			(32,154)
Vested restricted stock awards withheld on net share settlement	(338)		$ 1	(339)
Cash dividend equivalents accrued on share-based payments	(27)			(27)
Distributions to noncontrolling interests		(5,631)						(15,998)
Contributions from noncontrolling interests	386	1,343			386			6,861
Purchases of equity of noncontrolling interests	(7,540)	168		(7,540)				(623)
Redemptions of equity of noncontrolling interests	(1,328)			(1,328)				(3,538)
Change in fair value of derivative agreements, net of tax	(1,809)						(1,809)
Change in fair value of noncontrolling interests	4,483	(4,483)		4,483
Balance at end of period at Jun. 30, 2019	(81,482)	124,496	$ 197	103,282	(120)	(183,108)	(1,733)	170,235
Balance at end of period (in shares) at Jun. 30, 2019			32,560,043
Balance at beginning of period at Mar. 31, 2019	(71,576)	129,134	$ 197	104,401	(535)	(174,930)	(709)	173,866
Balance at beginning of period (in shares) at Mar. 31, 2019			32,562,784
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(8,178)	3,544				(8,178)		9,774
Stock-based compensation	850			850
Exercise of stock options (in shares)			1,086
Exercise of stock options	(3)			(3)
Forfeiture of restricted stock awards (in shares)			(3,827)
Distributions to noncontrolling interests		(3,480)						(13,399)
Contributions from noncontrolling interests	415	493			415			617
Purchases of equity of noncontrolling interests	(7,590)	441		(7,590)				(623)
Change in fair value of derivative agreements, net of tax	(1,024)						(1,024)
Change in fair value of noncontrolling interests	5,636	(5,636)		5,636
Balance at end of period at Jun. 30, 2019	(81,482)	124,496	$ 197	103,282	(120)	(183,108)	(1,733)	170,235
Balance at end of period (in shares) at Jun. 30, 2019			32,560,043
Balance at beginning of period at Dec. 31, 2019	(79,450)	126,483	$ 197	100,744	(531)	(178,241)	(1,619)	163,988
Balance at beginning of period (in shares) at Dec. 31, 2019			32,976,416
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(6,439)	5,419				(6,439)		13,526
Stock-based compensation	4,240			4,240
Exercise of stock options (in shares)			900,180
Exercise of stock options	$ 872		$ 8	864
Issuance of restricted stock (in shares)	843,015
Forfeiture of restricted stock awards (in shares)			(176,503)
Vested restricted stock awards withheld on net share settlement (in shares)			(54,543)
Vested restricted stock awards withheld on net share settlement	$ (428)		$ 3	(431)
Cash dividend equivalents accrued on share-based payments	(7)			(7)
Distributions to noncontrolling interests		(6,964)						(15,997)
Contributions from noncontrolling interests	(1,770)	1,509			(1,770)			2,284
Purchases of equity of noncontrolling interests	(886)	177		(886)
Redemptions of equity of noncontrolling interests	3,448			3,448				(7,519)
Reclassification/other adjustments	4,181	(16,488)		4,181				71
Change in fair value of derivative agreements, net of tax	(770)						(770)
Change in fair value of noncontrolling interests	(269)	269		(269)
Balance at end of period at Jun. 30, 2020	(77,278)	110,405	$ 208	111,884	(2,301)	(184,680)	(2,389)	156,353
Balance at end of period (in shares) at Jun. 30, 2020			34,488,565
Balance at beginning of period at Mar. 31, 2020	(86,591)	127,737	$ 199	102,789	(1,568)	(185,475)	(2,536)	160,341
Balance at beginning of period (in shares) at Mar. 31, 2020			33,736,896
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	795	4,038				795		10,001
Stock-based compensation	1,517			1,517
Exercise of stock options (in shares)			855,955
Exercise of stock options	718		$ 8	710
Issuance of restricted stock (in shares)			18,679
Forfeiture of restricted stock awards (in shares)			(122,849)
Vested restricted stock awards withheld on net share settlement (in shares)			(116)
Vested restricted stock awards withheld on net share settlement	(1)		$ 1	(2)
Distributions to noncontrolling interests		(3,844)						(8,370)
Contributions from noncontrolling interests	(733)	203			(733)			1,017
Purchases of equity of noncontrolling interests	(886)	177		(886)
Redemptions of equity of noncontrolling interests								(4,550)
Reclassification/other adjustments	4,181	(14,331)		4,181				(2,086)
Change in fair value of derivative agreements, net of tax	147						147
Change in fair value of noncontrolling interests	3,575	(3,575)		3,575
Balance at end of period at Jun. 30, 2020	$ (77,278)	$ 110,405	$ 208	$ 111,884	$ (2,301)	$ (184,680)	$ (2,389)	$ 156,353
Balance at end of period (in shares) at Jun. 30, 2020			34,488,565

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Operating activities
Net income (loss)	$ 12,506	$ (5)
Adjustments to reconcile net income to cash provided by operating activities:
Depreciation, amortization and impairment	17,501	20,365
Amortization of discounts, fees and deferred financing costs	1,617	1,205
Stock-based compensation	4,240	2,251
Deferred taxes	1,574	(138)
Change in fair value of income tax receivable agreement	(1,343)	(1,378)
Other non-cash charges, net	208	(1,189)
Loss (gain) on disposal of assets	432	(395)
Change in operating assets and liabilities, net of acquisitions:
Accounts receivable	10,471	(8,021)
Inventories	(405)	4,020
Prepaid expenses and other current assets	(6,369)	(3,121)
Other assets	(7,192)	(1,275)
Right-of-use assets and operating lease liabilities	(54)	(1,518)
Accounts payable	(3,415)	(1,434)
Accrued compensation and benefits	541	240
Accrued expenses and other liabilities	120,650	(1,859)
Cash provided by operating activities	150,962	7,748
Investing activities
Purchases of property, equipment and intangible assets	(11,756)	(14,169)
Proceeds from sale of clinics	0	3,300
Cash paid for acquisitions	0	(6,590)
Cash used in investing activities	(11,756)	(17,459)
Financing activities
Proceeds from revolving credit facility and term loans, net of discounts and fees	45,989	73,551
Payments on long-term debt	(50,081)	(23,069)
Dividends and dividend equivalents paid	(11)	(25)
Proceeds from exercise of stock options	1,212	67
Repurchase of vested restricted stock awards withheld on net share settlement	(430)	(338)
Distributions to noncontrolling interests	(22,961)	(21,629)
Contributions from noncontrolling interests	2,023	3,935
Purchases of equity of noncontrolling interests	(707)	(7,995)
Cash (used in) provided by financing activities	(24,966)	24,497
Increase in cash and restricted cash	114,240	14,786
Cash and restricted cash at beginning of period	34,494	55,300
Cash and restricted cash at end of period	148,734	70,086
Supplemental Disclosure of Cash Flow Information
Cash paid for income taxes	166	173
Cash paid for interest	14,323	15,292
Supplemental Disclosure of Non-Cash Financing Activities
Non-cash equity impacts of the sale or closure of clinics	(4,071)	(4,866)
Non-cash equity contributions	1,770	386
Change in liability accrued for dividend equivalent payments	7	27
Liability established for IPO Put liability (Note 5)	16,685	0
Non-cash purchases of property and equipment	$ 1,079	$ 0

BASIS OF PRESENTATION, ORGANIZA

BASIS OF PRESENTATION, ORGANIZATION AND RECENT EVENTS	6 Months Ended
	Jun. 30, 2020
Accounting Policies [Abstract]
BASIS OF PRESENTATION, ORGANIZATION AND RECENT EVENTS	BASIS OF PRESENTATION, ORGANIZATION AND RECENT EVENTS Business American Renal Associates Holdings, Inc. (“the Company”) owns 100% of the membership units of its subsidiary American Renal Holdings Intermediate Company, LLC, whose only assets are 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”) and other kidney diseases. As of June 30, 2020, the Company owned and operated 251 dialysis clinics treating 17,356 patients in 27 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. Substantially all clinics are maintained as separate joint ventures (“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 condensed 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. GAAP”) for complete financial statements. The Company’s condensed consolidated financial statements include the accounts of the Company, its wholly owned subsidiaries and variable interest entities (“VIEs”) that operate its clinics (“joint ventures”). For its joint ventures, the Company has determined that a majority voting interest and/or contractual rights granted to it provide the Company with the ability to direct the activities of these entities, and therefore the Company has determined that it is the primary beneficiary of these entities. Accordingly, the financial results of these joint ventures are fully consolidated into the Company’s operating results. The equity interests of the outside investors in the equity and results of operations of these consolidated entities are accounted for and presented as noncontrolling interests. 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 6 — Variable Interest Entities.” In the opinion of management, the Company has prepared the accompanying unaudited condensed 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 condensed 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, 2019 (“Form 10-K”). Operating results for the interim periods are not necessarily indicative of the results that may be expected for the full year. Use of Estimates The preparation of financial statements in conformity with U.S GAAP requires the use of estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities and contingencies. Although actual results in subsequent periods will differ from these estimates, such estimates are developed based on the best information available to management and management’s best judgments at the time made. All significant assumptions and estimates underlying the reported amounts in the consolidated financial statements and accompanying notes are regularly reviewed and updated. Changes in estimates are reflected in the financial statements based upon ongoing actual experience, trends or subsequent settlements and realizations, depending on the nature and predictability of the estimates and contingencies. The most significant assumptions and estimates underlying these financial statements and accompanying notes involve revenue recognition and provisions for uncollectible accounts, impairments and valuation adjustments, the useful lives of property and equipment, fair value measurements, accounting for income taxes, acquisition accounting valuation estimates, commitments and contingencies and stock-based compensation. Specific risks and contingencies related to these estimates are further addressed within the notes to the condensed consolidated financial statements. Segment Information Accounting pronouncements establish standards for the manner in which public companies report information about operating segments in annual and interim financial statements. Operating segments are identified as components of an enterprise for which separate discrete financial information is evaluated regularly by the chief operating decision-maker in making decisions about how to allocate resources and assess performance. Based on its operating management and financial reporting structure, the Company has determined that it is operating as one reportable business segment, the ownership and operation of dialysis clinics, all of which are located in the United States. Accounting Pronouncements to be Adopted In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes , to reduce complexity in accounting for income taxes by removing certain exceptions to the general principles in Topic 740. The amendments also improve consistent application of and simplify U.S. GAAP for other areas of Topic 740 by clarifying and amending existing guidance. The ASU is effective for public business entities for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2020, and early application is permitted. The Company is still evaluating certain aspects of this ASU as well as the impact it may have on its condensed consolidated financial statements and related disclosures. In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , and related clarifying standards, which replaces the incurred loss impairment methodology in current U.S. GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to inform credit loss estimates. The FASB issued ASU 2019-10, which updated the effective date for smaller reporting companies to fiscal years beginning after December 15, 2022, with early adoption permitted. The Company is still evaluating certain aspects of this ASU as well as the impacts it may have on its condensed consolidated financial statements and related disclosures. COVID-19 Pandemic In December 2019, there was an outbreak of a new strain of coronavirus (“COVID-19”). In March 2020, the World Health Organization declared the outbreak of COVID-19 a pandemic. As a provider of essential healthcare services, the Company is significantly exposed to the health and economic effects of COVID-19 and has seen a significant impact on its e mployees, patients and business operations. During March, 2020, the Company determined that the economic disruptions and unprecedented market volatilities and uncertainties resulting from the COVID-19 outbreak represented indicators of impairment for its indefinite-life and long-lived assets, including its tradename. As a result, the Company performed interim impairment tests of its indefinite-life and long-lived assets during March, 2020, which resulted in no impairment. The Company is carefully monitoring the impact of the COVID-19 pandemic on its operating and financial performance. The amounts and types of revenue, expense, and cash flow impacts will be dependent on numerous factors, including the nature of the COVID-19 pandemic’s current outbreaks and activity levels, such as its rate of spread, duration, and geographic coverage; the legal, regulatory, and administrative developments related to the pandemic at federal, state, and local levels; and the Company’s infectious disease prevention and control efforts. The Company performed a qualitative assessment of its indefinite life and long lived assets for impairment as of June 30, 2020 considering these factors, which resulted in no impairment. CARES Act Provider Relief Fund On March 27, 2020, the Coronavirus Aid, Relief, and Economic Security Act (“the CARES Act ” ) was enacted in response to the COVID-19 pandemic. The CARES Act includes $100 billion in funds to be provided to hospitals and other healthcare providers to support healthcare-related expenses or lost revenue attributable to COVID-19 and to ensure uninsured individuals are able to obtain testing and treatment for COVID-19. On April 10, 2020, the Centers for Medicare and Medicaid Services (“CMS”), which is part of the United States Department of Health and Human Services (“HHS”), began distribution of $30 billion of the funds to providers based on the provider’s share of total Medicare fee-for-service reimbursements in 2019. As part of this distribution, the Company’s facilities received approximately $26,595 of grant funds during April 2020. HHS requires providers, within 90 days of receipt of these funds, to submit an attestation accepting certain terms and conditions, including that the funds may only be used to offset lost revenue and increased expenses attributable to the COVID-19 pandemic. As of June 30, 2020, the Company has utilized approximately $9,800 of these funds and expects to use the remainder of these funds during future periods in 2020. The Company’s ability to utilize and retain some or all of the provider relief grant funds will depend on the magnitude, timing and nature of the impact of COVID-19, as well as the guidelines and rules of the program, which will ultimately determine how these funds can be used to offset lost revenue and increased expenses associated with the COVID-19 pandemic. For the three and six months ended June 30, 2020, we incurred an additional $7,310 and $8,612, respectively, in operating expenses as a result of the measures we have taken in response to COVID-19, of which $8,368 of these additional expenses were offset by grant funds received under the CARES Act. In addition, during the three and six months ended June 30, 2020, Company recognized other income of $1,474 by applying grant funds on account of lost treatments. Temporary Suspension of the Automatic 2% Reduction of Medicare Program Payments, Known as “Sequestration” The CARES Act suspended for the period from May 2020 through December 2020 the 2% Medicare reimbursement reduction that has been in place since April 1, 2013. For the three months ended June 30, the Company received patient service operating revenues of $1,123 from this suspension. Medicare Accelerated and Advance Payment Program In March 2020, in an action unrelated to the CARES Act, CMS expanded its existing Accelerated and Advance Payment Program to a broader group of Medicare providers and suppliers for the duration of the COVID-19 public health emergency. Payments under this program are intended to provide necessary funds when there is a disruption in Medicare claims submission and/or claims processing. The Company’s facilities requested 100% of the Medicare fee-for-service payment amount for a three-month period. CMS approved the Company ’ s requests for substantially all of the clinics. Repayment of advance payments will commence 120 days after the date the payment is issued and will be effectuated via an automatic 100% offset against future claims payments. The Company ’ s facilities that use this program will have 210 days to repay the advance payment. As of June 30, 2020, the Company ’ s facilities applied for and received an aggregate of $83,193

REVENUE

REVENUE	6 Months Ended
	Jun. 30, 2020
Revenue from Contract with Customer [Abstract]
REVENUE	REVENUE Patient service operating revenues, the major component of the Company’s revenues are derived from dialysis treatments and related services. Sources of payment 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 self-pay. Patient service operating revenues are reported at the amounts that reflect the consideration to which the Company expects to be entitled in exchange for providing dialysis treatments and related services. Amounts may include variable consideration for discounts, price concessions and retroactive 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. 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, Revenue from Contracts with Customers . The Company has determined that one performance obligation exists, a single 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 reflects the satisfaction of the performance obligation. The Company maintains a usual and customary fee schedule for dialysis treatments and other related services. However, the transaction price is typically recorded 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 regulations. For Medicare programs, the Company receives 80% of the payment directly from Medicare as established under the United States government’s bundled payment system. 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 and other adjustments which result from differences between the rates charged for services performed and expected reimbursements from 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 estimates of implicit price concessions based on its historical collection experience with each payor, and when no prior experience exists, it considers information from the patient’s health plan. Amounts billed that have not yet been collected and that meet the conditions for unconditional right to payment are presented as net accounts receivable on the accompanying condensed consolidated balance sheets. Contractual and other adjustments as well as 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 considers previous payment history when recording a reserve, generally at the patient level, that results in an estimate of expected revenue such that it is probable that a significant revenue reversal will not occur in future periods. There are significant challenges associated with estimating revenue, with certain transactions taking several years to resolve. Estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, determining applicable primary and secondary coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. 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 periods end and 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. Net adjustments arising from a change in the transaction price in instances when the performance obligation was satisfied prior to January 1, 2020 were immaterial for the three and six months ended June 30, 2020. Net adjustments arising from a change in the transaction price in instances where the performance obligation was satisfied prior to January 1, 2019 were immaterial for the three and six months ended June 30, 2019. These changes in transaction price are mostly attributable to an adjustment for balances with non-contracted payors. When the Company obtains new information, such as actual cash receipts, it adjusts the estimated transaction price. Amounts pending approval from third-party payors associated with Medicare recovery claims as of June 30, 2020 and December 31, 2019 , other than standard monthly billing, consisted of $20,541 and $17,509, respectively. As of June 30, 2020, $4,956 is classified as Prepaid expenses and other current assets and $15,585 is classified as Other long-term assets. As of December 31, 2019 , $9,284 is classified as Prepaid expenses and other current assets and $8,225 is classified as Other long-term assets. The composition of patient care service revenue by payment source is as follows: Three Months Ended June 30, Six Months Ended June 30, Percentage of Revenues by Payor: 2020 2019 2020 2019 Medicare and Medicare Advantage 69 % 70 % 69 % 70 % Commercial and other(1) 26 % 26 % 27 % 25 % Medicaid and Managed Medicaid 4 % 4 % 4 % 4 % Other(2) 1 % — % — % 1 % 100 % 100 % 100 % 100 % ___________________ (1) Principally commercial insurance companies and also includes the VA. (2) Other payments of revenues by payor include hospitals and patient self-pay. “Patient self-pay” revenues consist of payments received directly from patients who are either uninsured or self-pay a portion of the bill.

ASSETS HELD FOR SALE

ASSETS HELD FOR SALE	6 Months Ended
	Jun. 30, 2020
Discontinued Operations and Disposal Groups [Abstract]
ASSETS HELD FOR SALE	ASSETS HELD FOR SALE As of June 30, 2020 and December 31, 2019, the Company presented certain clinics in Pennsylvania, Ohio and New Jersey and other property that met the criteria as held for sale as a single asset and liability in its financial statements and recognized a valuation allowance, as necessary, to recognize the net carrying amount at the lower of cost or fair value, less cost to sell. The Company determined that there was an increase in the valuation allowance of $7 and a reduction of $498 for the three and six months ended June 30, 2020, respectively, which are included as a reduction to Depreciation, amortization and impairment on the Consolidated Statement of Operations. The Company classified the combined carrying value of all assets that met the criteria of held for sale of $49,197 and $50,099 as of June 30, 2020 and December 31, 2019, respectively, to Current assets held for sale on the Condensed Consolidated Balance Sheets and classified the combined carrying value of all liabilities that met the criteria of held for sale of $4,210 and $5,767 as of June 30, 2020 and December 31, 2019, respectively, to Current liabilities held for sale on the Condensed Consolidated Balance Sheets. These assets and liabilities held for sale include certain clinics in Pennsylvania, Ohio and New Jersey accounted for, in the aggregate, $6,846 and $13,619 of the Company’s patient service operating revenues for the three and six months ended June 30, 2020, respectively. The following is a summary of the major categories of assets and liabilities that have been reclassified to held for sale on the Condensed Consolidated Balance Sheets: As of June 30, 2020 As of December 31, 2019 Inventories $ 333 $ 265 Prepaid expenses and other current assets 18 20 Property and equipment, net 11,054 11,245 Operating lease right-of-use assets 3,897 5,408 Goodwill 34,184 34,184 Valuation allowance on disposal group(1) (289) (1,023) Total assets held for sale $ 49,197 $ 50,099 Operating lease liabilities $ 4,210 $ 5,767 Total liabilities held for sale $ 4,210 $ 5,767 (1) The Company adjusted the carrying value to fair value less costs to sell for certain held for sale assets.

FAIR VALUE MEASUREMENTS

FAIR VALUE MEASUREMENTS	6 Months Ended
	Jun. 30, 2020
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENTS	FAIR VALUE MEASUREMENTS The Company’s derivatives (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 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, 2020. Derivative agreements —See “Note 8 — 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 Change in fair value of income tax receivable agreement in the Company’s Condensed 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. Noncontrolling interests subject to put provisions —See “Note 7 — Noncontrolling Interests Subject to Put Provisions” for a discussion of the Company’s methodology for estimating fair value of noncontrolling interests subject to put provisions. Transfers among levels are calculated on values as of the transfer date. There were no transfers into or out of Level 3 during the six months ended June 30, 2020 and the year ended December 31, 2019. June 30, 2020 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 9 $ — $ 9 $ — Total Assets $ 9 $ — $ 9 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable with a portion included in Accrued expenses and other current liabilities) $ 520 $ — $ — $ 520 Interest rate swap agreement (included in Accrued expense and other current liabilities) 2,036 — 2,036 — Interest rate swap agreement (included in Other long-term liabilities) 632 — 632 — Total Liabilities $ 3,188 $ — $ 2,668 $ 520 Temporary Equity Noncontrolling interests subject to put provisions $ 110,405 $ — $ — $ 110,405 December 31, 2019 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 143 $ — $ 143 $ — Total Assets $ 143 $ — $ 143 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 3,000 $ — $ — $ 3,000 Interest rate swap agreement (included in Accrued expenses and other current liabilities) 783 — 783 — Interest rate swap agreement (included in Other long-term liabilities) 725 — 725 — Total Liabilities $ 4,508 $ — $ 1,508 $ 3,000 Temporary Equity Noncontrolling interests subject to put provisions $ 126,483 $ — $ — $ 126,483 The following table provides the fair value rollforward for the six months ended June 30, 2020 for the TRA liability, which is classified as a Level 3 financial instrument: Balance at December 31, 2019 $ 3,000 Options exercised and dividend equivalent payment vesting (1,137) Total realized/unrealized losses: Included in earnings and reported as Change in fair value of income tax receivable agreement (1,343) Balance at June 30, 2020 $ 520 There are no unrealized gains or losses reported in Other Comprehensive Income related to Level 3 financial instruments. The carrying amounts reported in the accompanying Condensed Consolidated Balance Sheets for cash, accounts receivable, accounts payable and accrued liabilities approximate fair value because of their short-term nature.

ACCRUED EXPENSES AND OTHER CURR

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES	6 Months Ended
	Jun. 30, 2020
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, 2020 December 31, 2019 Accrued compensation $ 20,299 $ 24,526 Accrued vacation pay 17,438 12,670 $ 37,737 $ 37,196 Accrued expenses and other current liabilities consist of the following: June 30, 2020 December 31, 2019 Refunds due to payors $ 28,166 $ 20,085 Deferred revenue - advanced payments from CMS 83,193 — Grant funds escrow 16,758 — Accrued settlements (Note 15) 12,714 6,573 IPO put liability (Note 7) 16,685 — Other 16,098 10,935 $ 173,614 $ 37,593

VARIABLE INTEREST ENTITIES

VARIABLE INTEREST ENTITIES	6 Months Ended
	Jun. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
VARIABLE INTEREST ENTITIES	VARIABLE INTEREST ENTITIES The Company has determined that all of the entities it is associated with that qualify as VIEs must be included in its condensed 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. Under U.S. GAAP, VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The 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. The Company relies on the operating activities of certain entities for which it does not own 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 V IEs. As of June 30, 2020 , these consolidated financial statements include total assets of these VIEs of $20,759 and total liabilities of these VIEs to third parties of $19,760. 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 condensed 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, 2020
Temporary Equity Disclosure [Abstract]
NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS	NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS The Company is party to agreements which contain put provisions which require the Company to purchase a portion or all of the noncontrolling interests held by third parties in certain of its consolidated subsidiaries. These put provisions are exercisable at the third-party owners’ discretion either within specified periods or, in certain cases, 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 none of the put rights are mandatorily redeemable. Some of these put rights accelerated as a result of the Company’s IPO. If the remaining unexercised put rights were exercised, the Company would be required to purchase all or a portion of the third-party owners’ noncontrolling interests at the estimated fair value as defined within the put provisions. The majority of the noncontrolling interests subject to put provisions are reported at the greater of the carrying value or estimated fair value for accounting purposes, while some of the noncontrolling interests subject to put provisions is stated at the contractual estimated fair value, as outlined in each specific put provision (“redemption value”). The put rights of such noncontrolling interest holders were determined based on inputs that are 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 the noncontrolling interests subject to these put provisions is estimated using the Income, Market and Asset Based approaches. The fair value derived from the methods used is evaluated and weighted, as appropriate, considering the reasonableness of the range of values indicated. Under the Income approach, fair value may be determined by utilizing a Weighted Average Cost of Capital (14.50% - 20.00%) to discount the expected cash flows to a single present value amount using current expectations about those future amounts. Under the Market approach, fair value may be determined by reference to multiples of market-comparable companies or transactions, including revenue and earnings before interest, taxes, depreciation and amortization (“EBITDA”). The estimated fair values of the interests subject to these put provisions can fluctuate, and the implicit multiples at which these obligations may be settled may vary depending upon market conditions and access to the credit and capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses and the economic performance of these businesses. As of December 31, 2019, the Company had recorded within Noncontrolling Interests Subject to Put Provisions certain noncontrolling interests with an estimated redemption value of $16,240. In July 2020, the Company redeemed those noncontrolling interests. In connection with the redemption the Company recorded $444 of additional redemption value and subsequently reclassified the balance from Noncontrolling Interests Subject to Put Provisions to Accrued Expenses and Other Current Liabilities as of June 30, 2020. See “Note 5 — Accrued Expenses and Other Current Liabilities.” 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, 2020 and December 31, 2019 is set forth below: June 30, 2020 December 31, 2019 Redemption value $ — $ 17,303 Estimated fair values for accounting purposes — 1,647 Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests $ — $ 15,656 In addition, the tables below set forth a reconciliation of noncontrolling interests subject to put provisions: June 30, 2020 December 31, 2019 Noncontrolling interests subject to put provisions stated at estimated fair value for accounting purposes $ 110,405 $ 110,827 Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests — 15,656 Noncontrolling interests subject to put provisions stated at maximum redemption value $ 110,405 $ 126,483 In addition, the tables below set forth a reconciliation of noncontrolling interests subject to put provisions. Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Change in estimated fair value for accounting purposes $ (4,019) $ (4,611) $ (434) $ (4,199) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests 444 (1,025) 703 (284) Total change in fair value of noncontrolling interests subject to put provisions stated at maximum redemption $ (3,575) $ (5,636) $ 269 $ (4,483)

DEBT

DEBT	6 Months Ended
	Jun. 30, 2020
Debt Disclosure [Abstract]
DEBT	DEBT Long-term debt consists of the following: June 30, 2020 December 31, 2019 2017 Credit Agreement - Term B Loan Facility $ 424,600 $ 429,000 2017 Credit Agreement - Revolving Credit Facility 73,000 64,500 Assigned Clinic Loans due to Term Loan Holdings 26 866 Other Term Loans 86,929 92,958 Other Lines of Credit 3,917 5,006 Finance Lease Obligations 7,594 7,780 596,066 600,110 Less: discounts and fees, net of accumulated amortization (10,919) (12,496) Less: current maturities (36,047) (38,779) $ 549,100 $ 548,835 Scheduled maturities of long-term debt as of June 30, 2020 are as follows: 2020 (remainder) $ 22,187 2021 28,135 2022 94,949 2023 19,181 2024 419,030 Thereafter 12,584 $ 596,066 During the six months ended June 30, 2020, the Company made mandatory principal payments of $4,400 under the 2017 Credit Agreement (as defined below). 2017 Credit Agreement On June 22, 2017, ARH and American Renal Holdings Intermediate Company, LLC (“ARHIC”) entered into a new credit agreement (the “2017 Credit Agreement ” ) to refinance the credit facilities under ARH ’ s then existing prior 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 or (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. The 2017 Revolving Credit Facility is scheduled to mature in June 2022, and the 2017 Term B Loan Facility is scheduled to mature in June 2024. The maturity dates under the 2017 Revolving Credit Facility and the 2017 Term Loan Facility are subject to extension with lender consent according to the terms of the 2017 Credit Agreement. ARH borrowed the full amount of the 2017 Term B Loan Facility and used such borrowings to repay the outstanding balances under the existing prior 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 ARHIC 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. On April 26, 2019, ARH entered into an amendment (the “Amendment”) to the 2017 Credit Agreement, waiving certain actual or potential defaults and amending certain covenants and other provisions. Among other things, the waiver addressed actual or potential defaults that may have resulted from the Company’s failure to (i) satisfy the maximum consolidated net leverage ratio when required, and (ii) deliver when required certain prior period financial information prepared in accordance with GAAP. In connection with the Amendment, the Company pa id $6,021 of fees during the three months ended June 30, 2019 and agreed to increase the interest rate on borrowings under the 2017 Credit Agree ment. 2017 Term B Loan Facility 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, 2020. ARH is required to make principal payments under the 2017 Term B Loan Facility in equal quarterly installments of $2,200 beginning January 1, 2020. The 2017 Term B Loan Facility is scheduled to mature in June 2024. The principal amount of the term B loans under the 2017 Term B Loan Facility (“term B loan”) amortize in equal quarterly installments in an aggregate annual amount of (i) 1.00% of the original principal amount of such term B loans through December 31, 2019 and (ii) 2.00% the reafter. For the period from April 26, 2019 until September 4, 2019, the date on which ARH has delivered the condensed consolidated unaudited financial statements for the fiscal quarter ended March 31, 2019 (the “Covenant Reversion Date”), the term B loans under the 2017 Term B Loan Facility bore 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 0.50% or (3) the Eurodollar rate applicable for a one-month interest period plus 1.00% (collectively, the “ABR Rate”), plus an applicable margin of 4.50% (increased from 2.25% prior to the Amendment), or (b) LIBOR, adjusted for changes in Eurodollar reserves (“Eurodollar Rate”), plus an applicable margin of 5.50% (increased from 3.25% prior to the Amendment). From and after the Covenant Reversion Date, the applicable margin on term B loans is 4.00% for ABR Rate loans and 5.00% for Eurodollar rate loans. As of June 30, 2020, interest payable quarte rly was 5.18% per annum. 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. 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, 2020, the fee was 0.50%. In the three months ended June 30, 2020, the Company paid down $27,000 under its 2017 Revolving Credit Facility for a total of $73,000 of borrowings outstanding as of June 30, 2020, which had an interest rate of 4.94%. For the period from April 26, 2019 until the Covenant Reversion Date, outstanding loans under the 2017 Revolving Credit Facility bore interest at a rate equal to, at ARH’s option, either (a) the ABR Rate, plus an applicable margin of 4.25%, or (b) the Eurodollar Rate, plus an applicable marg in of 5.25%, instead of pricing each such margin off a grid based upon the consolidated net leverage ratio of ARH and its restricted subsidiaries. From and after the Covenant Reversion Date, any outstanding loans under the revolving credit facility bear interest at a rate equal to, at ARH’s option, either the ABR Rate or the Eurodollar Rate, plus, in each case, an applicable margin priced off a grid based upon the consolidated net leverage ratio of ARH and its restricted subsidiaries, which margin is 1.75% higher than the applicable margin prior to the Amendment. Prior to the Amendment, the commitment fee applicable to undrawn revolving commitments under the 2017 Revolving Credit Facility was priced off a grid based upon the consolidated net leverage ratio of ARH and its restricted subsidiaries. For the period from April 26, 2019 until the Covenant Reversion Date, the commitment fee applicable to undrawn revolving commitments under the 2017 Revolving Credit Facility was 0.50% without regard to the consolidated net leverage ratio. 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, 2020, ARH was in compliance with all covenants. The 2017 Credit Agreement includes a springing maximum consolidated net leverage ratio financial covenant of 6:1 for the benefit of the lenders under the 2017 Revolving Credit Facility (the “Revolver Financial Covenant”) and, following the Amendment a maximum consolidated net leverage ratio maintenance financial covenant of 7:1 for the benefit of the lenders under both the 2017 Revolving Credit Facility and the 2017 Term B Loan Facility. As of June 30, 2020, the Company was in compliance with the applicable consolidated net leverage ratio. The Amendment also waived any default or events of default that may have resulted from ARH underpaying any interest payments or letter of credit fees based on the application of a lower applicable rate due to the delivery, prior to the effective date of the Amendment, of inaccurate financial statements if such inaccuracy arose out of the Inaccurate Matters (as defined below). ARH paid accrued interest and letter of credit fees that were ultimately determined to be payable but for such lower applicable rate. The Amendment waived inaccuracies of certain representations and warranties previously made to the extent that the inaccuracies were a result of (i) inaccuracies or errors in financial reporting, accounting and related metrics described in the Current Report on Form 8-K filed by ARAH with the Securities and Exchange Commission on March 27, 2019 (the “March 27 Form 8-K”) or otherwise identified pursuant to, or as a result of, the review of the audit committee of the board of directors of ARAH described in the March 27 Form 8-K, and (ii) any weaknesses in internal control over financial reporting related to the foregoing (together, the “Inaccurate Matters”). The Company’s clinic-level debt including third-party term loans and lines of credit, as well as the Assigned Clinic Loans totaling $90,846 as of June 30, 2020 had maturities ranging from July 2020 to December 2028 and interest rates ranging from 3.10% to 7.68%. The loan documents for these clinic-level loans generally include representations and warranties, affirmative covenants and negative covenants, including restrictive financial and operating covenants. The Company has in the past and may in the future be required to seek waivers or amendments to the loan documents for one or more of the Company’s clinics as a result of clinic performance issues or otherwise. For example, due to the factors that led to the restatement of previously issued consolidated financial statements (the “Restatement”) and the Company’s material weaknesses, the Company failed to, among other things, timely deliver certain financial statements to these lenders as required, resulting in defaults under the applicable loan documents. The Company obtained individual waivers or forbearances for the Assigned Clinic Loans and substantially all of its third-party clinic lenders. More recently, the Company entered into agreements on May 6, 2020 with certain of its third-party clinic lenders waiving defaults arising from certain financial covenants at the clinic level. Pursuant to these agreements, the Company agreed to prepay up to an aggregate of $7,589 during 2020 and up to an aggregate of $10,506 during the second quarter of 2021 of the outstanding clinic-level debt, depending on the satisfaction of certain financial covenants for these clinic loans. Of these amounts, the Company is responsible for up to $4,274 and $5,318, respectively, and the Company’s physician partners are responsible for the remainder. Interest Rate Swap Agreement 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. As a result of adopting ASU 2017-12, beginning in the first quarter of 2019, the entire change in the fair value of the hedging instrument included in the assessment of hedge effectiveness is recorded in accumulated other comprehensive income (loss). Those amounts are reclassified to earnings in the same income statement line item that is used to present the earnings effect of the hedged item when the hedged item affects earnings. Hedge effectiveness is tested quarterly. As of June 30, 2020, the instruments were perfectly effective and no amounts were reclassified from accumulated other comprehensive income (loss) into income during the three months ended June 30, 2020. Neither the Company nor ARH uses derivative instruments for trading or speculative purposes. The unrealized pretax (gain) loss of $(198) and $1,950 related to the interest rate swap agreement was recorded in accumulated other comprehensive loss during the three and six months ended June 30, 2020, respectively, and the unrealized pretax losses of $1,241 and $1,102 related to the interest rate swap agreement was recorded in accumulated other comprehensive loss during the three and six months ended June 30, 2019, respectively. See “Note 4 — Fair Value Measurements” for the fair value of the derivative instruments and location on the balance sheet as of June 30, 2020 and December 31, 2019. Effective May 7, 2019, the Company obtained an amendment and waiver related to the 2017 Interest Rate Swap Agreement. The amendment waived any defaults or potential default under the Swap Agreement arising from ARH’s prior delivery of certain inaccurate financial statements, any associated breach of representations and warranties regarding the accuracy of such financial statements, and the delay in the Company’s filing of its Annual Report on Form 10-K for the year ended December 31, 2018. 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. As a result of adopting ASU 2017-12, beginning in the first quarter of 2019, the entire change in the fair value of the hedging instrument included in the assessment of hedge effectiveness is recorded in accumulated other comprehensive income (loss). Those amounts are reclassified to earnings in the same income statement line item that is used to present the earnings effect of the hedged item when the hedged item affects earnings. Hedge effectiveness is tested quarterly. As of June 30, 2020, the instruments were perfectly effective for accounting purposes, and no amounts were reclassified from accumulated other comprehensive income (loss) into income during the three months ended June 30, 2020. Neither the Company nor ARH uses derivative instruments for trading or speculative purposes. The associated unrealized pretax loss o f $1 and $1,058 were recorded in accumulated other comprehensive loss during the three and six months ended June 30, 2020, respectively. The associated unrealized pretax losses of $136 and $1,025 were recorded in accumulated other comprehensive loss during the three and six months ended June 30, 2019, respectively. See “Note 4 — Fair Value Measurements” for the fair value of the derivative instruments and location on the balance sheet as of June 30, 2020 and December 31, 2019. Effective May 16, 2019, the Company obtained an amendment and waiver related to the 2017 Interest Rate Cap Agreements. The amendment waived any defaults or potential default under the Cap Agreements arising from ARH’s prior delivery of certain inaccurate financial statements, any associated breach of representations and warranties regarding the accuracy of such financial statements, and the delay in the Company’s filing of its Annual Report on Form 10-K for the year ended December 31, 2018.

LEASES

LEASES	6 Months Ended
	Jun. 30, 2020
Leases [Abstract]
LEASES	LEASES The Company adopted ASU 2016-02 effective January 1, 2019. The Company’s lease portfolio primarily consists of real estate leases for its corporate headquarters, regional corporate offices and its facilities which are leased under noncancellable operating and finance leases expiring in various years through 2035. Most lease agreements cover periods from five five Certain of the Company’s lease agreements include rental payments adjusted periodically for the consumer price index and real estate taxes. The Company’s lease agreements do not contain any material residual value guarantees or material restrictive covenants. The Company has lease agreements with lease and non-lease components and has elected to determine by asset class whether to separate these components. The Company has elected not to separate lease and non-lease components for real estate leases. Because the Company’s current leases do not provide an implicit rate of return, the Company utilizes its incremental borrowing rate in determining the present value of lease payments. The incremental borrowing rate represents the rate of interest that the Company would have to pay to borrow an amount equal to the lease payments on a collateralized basis over a similar term based on the information available at the commencement date of the lease. The Company leases certain facilities from noncontrolling interest members or entities under the control of noncontrolling interest members. Rent expense under these lease arrangements was $2,944 and $2,818 in the three months ended June 30, 2020 and 2019, respectively. Rent expense under these lease arrangements was $5,772 and $5,653 in the six months ended June 30, 2020 and 2019, respectively. The Company subleases space at certain of these facilities to the noncontrolling interest members. Rental income under these sublease arrangements, which extended to 2033, amounted to $233 and $257 in the three months ended June 30, 2020 and 2019, respectively. Rental income under these sublease arrangements, which extend to 2033, amounted to $465 and $514 in the six months ended June 30, 2020 and 2019, respectively. Future income of $3,905 due from these related parties are included in sublease income presented below. The Company subleases space in certain of its facilities to nephrologist partners at market values under non-cancelable operating leases expiring in various years through 2033. Rental income under all subleases, including those noted above, was $473 and $465 in the three months ended June 30, 2020 and 2019, respectively. Rental income under all subleases, including those noted above, was $936 and $903 in the six months ended June 30, 2020 and 2019, respectively. The components of lease expense were as follows: Three Months Ended Six Months Ended Lease Cost June 30, 2020 June 30, 2019 June 30, 2020 June 30, 2019 Operating lease cost $ 8,204 $ 7,881 $ 16,465 $ 15,715 Finance lease cost: Amortization of right-of-use assets 165 144 330 289 Interest on lease liabilities 177 140 355 280 Short-term lease cost (1) 85 76 171 148 Variable lease cost 2,671 2,645 5,702 5,207 Less: Sublease income (473) (465) (936) (903) Total lease cost $ 10,829 $ 10,421 $ 22,087 $ 20,736 _____ (1) Short-term leases are leases having a term of twelve months or less. The Company elected to recognize short-term leases on a straight-line basis and does not record a related lease asset or liability for such leases. Supplemental cash flow information related to leases was as follows: Six Months Ended Other Information June 30, 2020 June 30, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 16,585 $ 15,858 Operating cash flows from finance leases 355 280 Financing cash flows from finance leases 175 101 Right-of-use assets obtained in exchange for new or modified lease obligations: Operating leases 10,914 8,889 Finance leases — — Supplemental balance sheet information related to leases was as follows: As of June 30, 2020 As of December 31, 2019 Operating Leases Operating lease right-of-use assets $ 135,078 $ 133,899 Current portion of operating lease liabilities $ 23,201 $ 22,061 Long-term operating lease liabilities, less current portion 124,058 123,792 Total operating lease liabilities $ 147,259 $ 145,853 Finance Leases Property and equipment, at cost $ 7,488 $ 7,499 Accumulated depreciation (918) (588) Property and equipment, net $ 6,570 $ 6,911 Current portion of long-term debt $ 413 $ 390 Long-term debt, less current portion 7,181 7,390 Total finance lease liabilities $ 7,594 $ 7,780 Weighted Average Remaining Lease Term Operating leases 7.0 years 7.1 years Finance leases 10.5 years 10.9 years Weighted Average Discount Rate Operating leases 7.0 % 7.0 % Finance leases 9.8 % 9.7 % Future minimum lease payments under noncancelable operating leases, net of sublease receipts and finance leases as of June 30, 2020, are as follows: Year Ended December 31, Operating Less: Net Operating Finance Leases 2020 (excluding the six months ended June 30, 2020) $ 16,943 $ 740 $ 16,203 $ 547 2021 32,892 1,555 31,337 1,107 2022 30,562 1,575 28,987 1,123 2023 26,056 1,116 24,940 1,140 2024 21,614 603 21,011 1,188 Thereafter 66,120 2,454 63,666 7,532 Total minimum lease payments $ 194,187 $ 8,043 $ 186,144 $ 12,637 Less: amount representing interest 42,718 5,043 Present value of lease liabilities held for sale 4,210 — Present value of lease liabilities $ 147,259 $ 7,594 Future minimum lease payments under noncancelable operating leases, net of sublease receipts and finance leases as of December 31, 2019, are as follows: Year Ended December 31, Operating Less: Net Operating Finance Leases 2020 $ 32,691 $ 1,607 $ 31,084 $ 1,093 2021 31,105 1,641 29,464 1,108 2022 28,637 1,662 26,975 1,123 2023 24,242 1,142 23,100 1,141 2024 19,844 607 19,237 1,188 Thereafter 57,893 2,575 55,318 7,495 Total minimum lease payments $ 194,412 $ 9,234 $ 185,178 $ 13,148 Less: amount representing interest 42,792 5,368 Present value of lease liabilities held for sale 5,767 — Present value of lease liabilities $ 145,853 $ 7,780
LEASES	LEASES The Company adopted ASU 2016-02 effective January 1, 2019. The Company’s lease portfolio primarily consists of real estate leases for its corporate headquarters, regional corporate offices and its facilities which are leased under noncancellable operating and finance leases expiring in various years through 2035. Most lease agreements cover periods from five five Certain of the Company’s lease agreements include rental payments adjusted periodically for the consumer price index and real estate taxes. The Company’s lease agreements do not contain any material residual value guarantees or material restrictive covenants. The Company has lease agreements with lease and non-lease components and has elected to determine by asset class whether to separate these components. The Company has elected not to separate lease and non-lease components for real estate leases. Because the Company’s current leases do not provide an implicit rate of return, the Company utilizes its incremental borrowing rate in determining the present value of lease payments. The incremental borrowing rate represents the rate of interest that the Company would have to pay to borrow an amount equal to the lease payments on a collateralized basis over a similar term based on the information available at the commencement date of the lease. The Company leases certain facilities from noncontrolling interest members or entities under the control of noncontrolling interest members. Rent expense under these lease arrangements was $2,944 and $2,818 in the three months ended June 30, 2020 and 2019, respectively. Rent expense under these lease arrangements was $5,772 and $5,653 in the six months ended June 30, 2020 and 2019, respectively. The Company subleases space at certain of these facilities to the noncontrolling interest members. Rental income under these sublease arrangements, which extended to 2033, amounted to $233 and $257 in the three months ended June 30, 2020 and 2019, respectively. Rental income under these sublease arrangements, which extend to 2033, amounted to $465 and $514 in the six months ended June 30, 2020 and 2019, respectively. Future income of $3,905 due from these related parties are included in sublease income presented below. The Company subleases space in certain of its facilities to nephrologist partners at market values under non-cancelable operating leases expiring in various years through 2033. Rental income under all subleases, including those noted above, was $473 and $465 in the three months ended June 30, 2020 and 2019, respectively. Rental income under all subleases, including those noted above, was $936 and $903 in the six months ended June 30, 2020 and 2019, respectively. The components of lease expense were as follows: Three Months Ended Six Months Ended Lease Cost June 30, 2020 June 30, 2019 June 30, 2020 June 30, 2019 Operating lease cost $ 8,204 $ 7,881 $ 16,465 $ 15,715 Finance lease cost: Amortization of right-of-use assets 165 144 330 289 Interest on lease liabilities 177 140 355 280 Short-term lease cost (1) 85 76 171 148 Variable lease cost 2,671 2,645 5,702 5,207 Less: Sublease income (473) (465) (936) (903) Total lease cost $ 10,829 $ 10,421 $ 22,087 $ 20,736 _____ (1) Short-term leases are leases having a term of twelve months or less. The Company elected to recognize short-term leases on a straight-line basis and does not record a related lease asset or liability for such leases. Supplemental cash flow information related to leases was as follows: Six Months Ended Other Information June 30, 2020 June 30, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 16,585 $ 15,858 Operating cash flows from finance leases 355 280 Financing cash flows from finance leases 175 101 Right-of-use assets obtained in exchange for new or modified lease obligations: Operating leases 10,914 8,889 Finance leases — — Supplemental balance sheet information related to leases was as follows: As of June 30, 2020 As of December 31, 2019 Operating Leases Operating lease right-of-use assets $ 135,078 $ 133,899 Current portion of operating lease liabilities $ 23,201 $ 22,061 Long-term operating lease liabilities, less current portion 124,058 123,792 Total operating lease liabilities $ 147,259 $ 145,853 Finance Leases Property and equipment, at cost $ 7,488 $ 7,499 Accumulated depreciation (918) (588) Property and equipment, net $ 6,570 $ 6,911 Current portion of long-term debt $ 413 $ 390 Long-term debt, less current portion 7,181 7,390 Total finance lease liabilities $ 7,594 $ 7,780 Weighted Average Remaining Lease Term Operating leases 7.0 years 7.1 years Finance leases 10.5 years 10.9 years Weighted Average Discount Rate Operating leases 7.0 % 7.0 % Finance leases 9.8 % 9.7 % Future minimum lease payments under noncancelable operating leases, net of sublease receipts and finance leases as of June 30, 2020, are as follows: Year Ended December 31, Operating Less: Net Operating Finance Leases 2020 (excluding the six months ended June 30, 2020) $ 16,943 $ 740 $ 16,203 $ 547 2021 32,892 1,555 31,337 1,107 2022 30,562 1,575 28,987 1,123 2023 26,056 1,116 24,940 1,140 2024 21,614 603 21,011 1,188 Thereafter 66,120 2,454 63,666 7,532 Total minimum lease payments $ 194,187 $ 8,043 $ 186,144 $ 12,637 Less: amount representing interest 42,718 5,043 Present value of lease liabilities held for sale 4,210 — Present value of lease liabilities $ 147,259 $ 7,594 Future minimum lease payments under noncancelable operating leases, net of sublease receipts and finance leases as of December 31, 2019, are as follows: Year Ended December 31, Operating Less: Net Operating Finance Leases 2020 $ 32,691 $ 1,607 $ 31,084 $ 1,093 2021 31,105 1,641 29,464 1,108 2022 28,637 1,662 26,975 1,123 2023 24,242 1,142 23,100 1,141 2024 19,844 607 19,237 1,188 Thereafter 57,893 2,575 55,318 7,495 Total minimum lease payments $ 194,412 $ 9,234 $ 185,178 $ 13,148 Less: amount representing interest 42,792 5,368 Present value of lease liabilities held for sale 5,767 — Present value of lease liabilities $ 145,853 $ 7,780

INCOME TAXES

INCOME TAXES	6 Months Ended
	Jun. 30, 2020
Income Tax Disclosure [Abstract]
INCOME TAXES	INCOME TAXES The income tax expense included in the accompanying Condensed Consolidated Statements of Operations principally relates to the Com pany’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. In prior years, the Company 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. The Company’s effective income tax rate for the three months ended June 30, 2020 and 2019 were 13.7% and 11.1%, respectively, and (12.7)% and 100.4% for the six months ended June 30, 2020 and 2019, respectively. These rates differ from the federal statutory rate of 21% principally due to the Company’s adoption of alternate tax methods as more fully described below, 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 CARES Act increases the tax deduction for net operating losses from 80% to 100% for 2018 through 2020, allows net operating losses generated in 2018 through 2020 to be carried back up to five years and increases the deductible interest expense limit from 30% to 50% of taxable EBITDA. The CARES Act also permits the acceleration of tax depreciation related to certain classes of assets placed in service in prior years and increased the charitable contribution limitation from 10% to 25% for the year ended December 31, 2020. As a result of these statutory changes, during the six months ended June 30, 2020, the Company determined it will be able to carry its forecasted 2019 net operating losses of $16,289 back to tax years when the statutory tax rate was 35% resulting in an income tax benefit of $2,281, which is included in income tax benefit in the accompanying Condensed Consolidated Statements of Operations. As a result of the CARES Act, the Company released $3,210 of valuation allowance during the six months ended June 30, 2020. The Company continues to evaluate the impact of the CARES Act and takes into consideration the impact it may have on its overall tax provision.

STOCK-BASED COMPENSATION

STOCK-BASED COMPENSATION	6 Months Ended
	Jun. 30, 2020
Share-based Payment Arrangement [Abstract]
STOCK-BASED COMPENSATION	STOCK-BASED COMPENSATION For the three and six months ended June 30, 2020 and 2019, stock-based compensation expense was reflected in the accompanying Condensed Consolidated Statements of Operations as follows: Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Patient care costs $ 171 $ 164 $ 383 $ 348 General and administrative 1,346 687 3,857 1,904 Total stock-based compensation before tax $ 1,517 $ 851 $ 4,240 $ 2,252 Stock Options 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, 2020, options to purchase an aggregate of 1,295,818 shares of common stock were available for future grants under the 2016 Plan. Additionally, there were stock options outstanding under previous stock option plans as of June 30, 2020. The assumptions used for options granted to acquire common stock during 2020 and the fair value at the date of grant under the 2016 Plan are noted in the following table: Six Months Ended June 30, 2020 Expected Volatility 60% Weighted average expected terms in years 6.0 Weighted average risk-free interest rate 0.94% Expected annual dividend yield —% Weighted average grant-date fair value $4.17 Information concerning options activity for options under all option plans to acquire common stock is summarized as follows: Six Months Ended June 30, 2020 Number Weighted-average Options outstanding as of January 1, 2020 4,803,146 $ 12.29 Granted 96,765 7.58 Exercised (900,180) 1.41 Forfeited/Canceled (163,935) 9.76 Options outstanding as of June 30, 2020 3,835,796 $ 14.83 Vested and expected to vest as of June 30, 2020 3,835,796 $ 14.83 Exercisable as of June 30, 2020 2,393,293 $ 13.11 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 certain of the performance conditions for these awards have not been achieved as a result of the Restatement and the Company’s operating performance during the applicable periods, but that the remaining performance conditions are achieved but not vested as of June 30, 2020. In December 2019, the Company granted approximately 51,500 performance-based restricted stock awards to certain executives, with a weighted average grant date fair value per share of $10.19. These awards will vest over 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 certain of the performance conditions for these awards will not be achieved as a result of the Company’s operating performance during the applicable periods, but that the remaining performance conditions are probable of achievement as of June 30, 2020. In March 2020, the Company granted approximately 280,953 performance-based restricted stock awards to certain executives, with a weighted average grant date fair value per share of $7.58. These awards will vest over the two-year service period, and the quantity of awards that vest is dependent upon the Company’s achievement of a defined performance metric with multiple performance levels. The Company has determined that an amount between the threshold and target performance levels is probable of achievement and has expensed the awards to this extent as of June 30, 2020. The Company issued 562,062 of restricted stock awards in March 2020 in addition to the performance-based restricted stock awards noted above. As of June 30, 2020, a total of 1,022,599 shares of restricted stock were unvested and outstanding, which results in unamortized stock-based compensation of $5,180 to be recognized as stock-based compensation expense over the remaining weighted-average vesting period of 1.48 years. A summary of restricted stock award activity is as follows: Six Months Ended June 30, 2020 Number of shares Weighted-average grant date fair value per award Unvested as of January 1, 2020 579,283 $ 15.01 Granted 843,015 7.58 Vested (223,196) 14.52 Forfeited/Canceled (176,503) 9.75 Unvested as of June 30, 2020 1,022,599 $ 9.41 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 was paid on vested options and becomes due upon vesting for unvested options. Additionally, in connection with the cash dividend, through June 30, 2020, the Company has made payments equal to $1.30 per share, or $5,396 in the aggregate, to option holders, and, in the case of some performance and market options, a future payment totaling $1,235 will be due upon vesting. In March 2020, the Company entered into a Transition Services Agreement with an executive, which included terms to modify the vesting conditions of outstanding awards. 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, the Company recognized $(48) and $327 of additional stock compensation expense during the three and six months ended June 30, 2020, respectively.

EARNINGS (LOSS) PER SHARE

EARNINGS (LOSS) PER SHARE	6 Months Ended
	Jun. 30, 2020
Earnings Per Share [Abstract]
EARNINGS (LOSS) PER SHARE	EARNINGS (LOSS) PER SHARE Basic earnings (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 earnings (loss) per share is computed using the weighted-average number of common shares outstanding during the applicable period, plus the dilutive effect of outstanding options, using the treasury stock method and the average market price of the Company’s common stock during the applicable period. Certain shares related to some of the Company’s outstanding stock options were excluded from the computation of diluted earnings (loss) 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, 2020 2019 2020 2019 Basic Net income (loss) attributable to American Renal Associates Holdings, Inc. $ 795 $ (8,178) $ (6,439) $ (18,657) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests (444) 1,025 (703) 284 Net income (loss) attributable to common shareholders $ 351 $ (7,153) $ (7,142) $ (18,373) Weighted-average common shares outstanding 32,862,637 32,275,807 32,661,238 32,232,004 Earnings (loss) per share, basic $ 0.01 $ (0.22) $ (0.22) $ (0.57) Diluted Net income (loss) attributable to American Renal Associates Holdings, Inc. $ 795 $ (8,178) $ (6,439) $ (18,657) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests (444) 1,025 (703) 284 Net income (loss) attributable to common shareholders for diluted earnings per share calculation $ 351 $ (7,153) $ (7,142) $ (18,373) Weighted-average common shares outstanding, basic 32,862,637 32,275,807 32,661,238 32,232,004 Weighted-average common shares outstanding, assuming dilution 34,612,591 32,275,807 32,661,238 32,232,004 Earnings (loss) per share, diluted $ 0.01 $ (0.22) $ (0.22) $ (0.57) Outstanding options and restricted stock excluded as impact would be anti-dilutive 2,427,031 3,235,582 2,948,016 3,404,444

RELATED PARTY TRANSACTIONS

RELATED PARTY TRANSACTIONS	6 Months Ended
	Jun. 30, 2020
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	RELATED PARTY TRANSACTIONS Term Loan Holdings The Company partly finances clinic development costs of some of its JV 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 JV subsidiaries by ARA OpCo to a newly formed entity, Term Loan Holdings LLC ( “ Term Loan Holdings ”) , which ownership interest was distributed to pre-IPO stockholders (affiliates of Centerbridge and certain of the Company’s current and former directors and executive officers) pro rata in accordance with their ownership in the Company. As of June 30, 2020, one such assigned clinic loan remained, of $26, with an interest rate of 4.52%, which matured in July 2020. 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 certain of its executive officers. The TRA provides for the Company to pay 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 are actually realized 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, 2020 , the Company’s total liability under the TRA is estimated to be $2,108, including the fair value of the financial instrument of $520 as well as accrued but unpaid obligations of $1,588 . The current portion of $1,755 is included as a component of other accrued expenses on the Condensed Consolidated Balance Sheet. The Company paid no amount under the TRA for the three and six months ended June 30, 2020 or 2019 . Due from Related Party The Company entered into agreements with certain clinics, the members of which are also noncontrolling interest shareholders, to provide for various facility buildouts. In connection with these agreements, the Company provided financing in the initial total amount of $3,142. As of June 30, 2020, the loans had maturities ranging from March 2026 to September 2033 and interest rates ranging from 6.0% to 8.1%, with a weighted average interest rate of 6.1%. Fixed principal and interest payments with respect to such loans are payable monthly. As of June 30, 2020, the remaining balance to be paid to the Company was $2,940, of which $223 is included in Prepaid expenses and other current assets and $2,717 is included in Other long-term assets on the Condensed Consolidated Balance Sheet. Transactions with Executive Officer The Company licenses software relating to electronic medical record solutions from Kinetic Decision Solutions LLC (“Kinetic”) which 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 to Kinetic $85 and $140 during each of the six months ended June 30, 2020 and 2019, respectively. The 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 JVs. 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, 2020, 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 $1,840. As of June 30, 2020, such loans had maturities ranging from August 2022 to August 2024, with a weighted average maturity of approximately 3.17 years (August 2023), and interest rates ranging from 4.08% to 4.62%, with a weighted average interest rate of 4.35%. 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 $421 of such outstanding loans as of June 30, 2020.

COMMITMENTS AND CONTINGENCIES

COMMITMENTS AND CONTINGENCIES	6 Months Ended
	Jun. 30, 2020
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 the Company generates 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 its common stock at the time of such exercise. 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 AND OTHER MATTERS

CERTAIN LEGAL AND OTHER MATTERS	6 Months Ended
	Jun. 30, 2020
Commitments and Contingencies Disclosure [Abstract]
CERTAIN LEGAL AND OTHER MATTERS	CERTAIN LEGAL AND OTHER MATTERS The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject. Government Inquiries and Investigations On January 3, 2017, the Company received a subpoena from the United States Attorney’s Office, District of Massachusetts, requesting certain information relating to the Company’s payments and other interactions with the American Kidney Fund 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. As the Company has done with the other regulators who have expressed interest in such matters, the Company cooperated fully with the government. The Company believes that this investigation related to a complaint, unsealed on August 1, 2019 in the U.S. District Court for the District of Massachusetts, that named certain of its competitors, the AKF and certain unidentified parties as defendants. The complaint alleges violations of the federal False Claims Act and various state false claims acts. The Department of Justice elected not to intervene in the matter. While the Company was not identified as a defendant in the matter, the Company can make no assurance that it will not be named as one of the unidentified defendant parties. In October 2018, the Staff of the SEC requested that the Company voluntarily provide documents and information relating to certain revenue recognition, collections and related matters. Following receipt of the SEC request, the Company responded by producing documents and information to the Staff. On March 27, 2019, the Company filed a Current Report on Form 8-K (the “March 27 Form 8-K”) that described, among other things, certain preliminary findings arising from the review being conducted by the Audit Committee of the Board, which commenced following receipt of the SEC request. On March 28, 2019, the Company received a subpoena from the Staff of the SEC, which reiterated the SEC’s prior request and required the production of additional documents and information relating to the matters disclosed in the March 27 Form 8-K and related matters. The Company has since received additional subpoenas and other requests from the Staff related to this investigation and may receive more in the future. The Company has cooperated fully with this investigation and will continue to do so. Shareholder and Derivative Claims On March 28, 2019 and April 19, 2019, putative shareholder class action complaints were filed in the United States District Court for the District of New Jersey against the Company and certain of its current and former executive officers. Both complaints alleged violations of Sections 10(b) and 20(a) of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), and Rule 10b-5 thereunder related to the matters disclosed in the March 27 Form 8-K and certain prior filings. The complaints sought unspecified damages on behalf of the individuals or entities that purchased or otherwise acquired ARA’s securities from August 10, 2016 to March 27, 2019. On July 3, 2019, the complaints were consolidated and a lead plaintiff was appointed for the putative shareholder class action complaint, captioned Ali Vandevar, et al. v. American Renal Associates Holdings Inc., et al ., No. 19-09074-ES-MAH (the “Vandevar Action”). On November 11, 2019, the lead plaintiff filed a consolidated amended complaint against the Company and certain of its current and former executive officers. The amended complaint asserts federal securities laws claims under Sections 10(b) and 20(a) of the Exchange Act and Rule 10b-5 thereunder related to the matters disclosed in the March 27 Form 8-K and certain prior filings. On January 17, 2020, the Company filed a motion to dismiss the amended complaint. On February 24, 2020, the lead plaintiff filed an opposition to the motion to dismiss. On February 26, 2020, the parties participated in a mediation. On March 11, 2020, the parties reached an agreement in principle to resolve the claims asserted in this lawsuit. On June 25, 2020, the parties filed with the Court a Stipulation and Agreement of Settlement, which sets forth the terms and conditions for a proposed settlement of the action and which remains subject to court approval. The principal terms agreed upon by the parties contemplate a settlement payment of $5,775, which will be made by the Company’s insurer, in exchange for a release of claims. The settlement will resolve the claims asserted against all defendants in the action without any liability or wrongdoing attributed to them, and defendants continue to deny all of the allegations and claims asserted in this action. On July 25, 2019, a derivative lawsuit, Luke Johnson v. Joseph A. Carlucci, et al. , 2:19-CV-15812-JMV-JBC, was filed, purportedly on behalf of the Company, in the United States District Court for the District of New Jersey against the then current members of the Company’s board of directors and certain of its current and former executive officers. The lawsuit asserts claims for violations of Section 14(a) of the Exchange Act, breach of fiduciary duties, unjust enrichment and waste of corporate assets based on, among other things, the Restatement and the related material weaknesses in the Company’s internal control over financial reporting, alleged misstatements and omissions in the Company’s 2017 and 2018 proxy statements, compensation paid to the individual defendants and the costs incurred in connection with the Restatement process. The lawsuit seeks, among other things, recovery of damages sustained by the Company as a result of the individual defendants’ alleged misconduct, a direction to the Company to hold an annual meeting of stockholders and reforms to the Company’s corporate governance and internal procedures. The complaint also seeks restitution and costs and attorney’s fees. On October 4, 2019, the court stayed the lawsuit until final resolution of the Vandevar Action. On February 26, 2020, the parties participated in a mediation, following which, on March 27, 2020, the parties reached an agreement in principle to resolve all asserted claims. On July 2, 2020, the parties filed with the Court a Stipulation and Agreement of Settlement, which sets forth the terms and conditions for a proposed settlement of the action and which remains subject to court approval. The principal settlement terms contemplate certain corporate governance actions taken by the Company and the payment by the Company’s insurer of up to $413 for plaintiff’s attorney’s fees, in exchange for a release of claims. The settlement will resolve the claims currently asserted against all defendants in the action without any liability or wrongdoing attributed to them, and defendants will continue to deny all of the allegations and claims asserted in this action. The Company, the Board, and its current and former executive officers could become subject to additional litigation relating to these matters. Other From time to time, the Company is subject to various legal actions and proceedings involving claims incidental to the conduct of its business, including contractual and related disputes and professional and general liability claims, as well as audits and investigations by various government entities. Contractual and related disputes include those with commercial payors, noncontrolling interest holders and others. Based on information currently available, established reserves, available insurance coverage and other resources, the Company does not believe that the outcomes of any such pending actions, proceedings or investigations are likely to be, individually or in the aggregate, material to its 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 the Company’s business, financial condition, results of operations or cash flows. No assurance can be given as to the timing or outcome of the legal matters discussed above, nor can any assurance be given as to whether the filing of these lawsuits and any inquiries will affect the Company’s business relationships, or the Company’s business generally. The Company cannot predict the outcome of any of these matters, and an adverse result in one or more of them could have a material adverse effect on the Company’s business, results of operations and financial condition. Although the Company is not currently subject to any formal regulatory investigations or proceedings other than those described herein, there is no assurance that any such investigations or proceedings will not be commenced by any U.S. federal or state healthcare or other regulatory agencies. In addition, the Company may in the future be subject to additional inquiries, investigations, 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 the Company’s business, financial condition and results of operations. The Company also records in Certain legal and other matters, legal fees and other expenses relating to matters that it believes do not reflect its core business operations. Resolved Matters The wholly owned operating subsidiary of ARA, American Renal Associates LLC (“ARA OpCo”), and its subsidiary, American Renal Management LLC (“ARM”), were 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), filed July 1, 2016, and the United States District Court for the District of Massachusetts (Case Number 1:18-cv-10622-ADB), filed March 30, 2018. 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 included 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 an initial present value of $29,614, which is included in Certain legal and other matters in the Consolidated Statem ent of Operations during the year ended December 31, 2018. As of June 30, 2020, of the remaining present value of $12,715, $6,939 is cla ssified as Accrued expenses and other current liabilities and $5,776 is classified in Other long-term liabilities. The Company paid the first installment of $10,000 on August 1, 2018, the second installment of $8,000 August 1, 2019 and the third installment of $7,000 on August 1, 2020. The Company expects to pay the fourth installment of $3,500 on August 1, 2021 and the final installment of $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 included 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 in-network agreement went into effect on September 1, 2018.

CHANGES IN OWNERSHIP INTEREST I

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES	6 Months Ended
	Jun. 30, 2020
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 in consolidated subsidiaries on the Company’s equity are as follows: Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Net income (loss) attributable to American Renal Holdings Associates, Inc. $ 795 $ (8,178) $ (6,439) $ (18,657) Increase in paid-in capital for the sales of noncontrolling interest — — 3,448 — Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (886) (7,590) (886) (7,540) Net transfers to/from noncontrolling interests $ (886) $ (7,590) $ 2,562 $ (7,540) Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests $ (91) $ (15,768) $ (3,877) $ (26,197)

SUBSEQUENT EVENTS

SUBSEQUENT EVENTS	6 Months Ended
	Jun. 30, 2020
Subsequent Events [Abstract]
SUBSEQUENT EVENTS	SUBSEQUENT EVENTS Divestitures From time to time, the Company divests the operating assets and liabilities of dialysis centers. The results of operations for these divestitures are derecognized from the Company's condensed consolidated statements of operations as of their respective sale consummation dates. On August 3, 2020, the Company completed the sale of certain clinics in Pen nsylvania and received a combined cash consideration for the sales of $16,800. The transactions resulted in a reduction of goodwill of $10,550 and the impact on the Condensed Consolidated Income Statement was not material.

BASIS OF PRESENTATION, ORGANI_2

BASIS OF PRESENTATION, ORGANIZATION AND RECENT EVENTS (Policies)	6 Months Ended
	Jun. 30, 2020
Accounting Policies [Abstract]
Basis of Presentation and Consolidation	Basis of Presentation and Consolidation The accompanying unaudited condensed 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. GAAP”) for complete financial statements. The Company’s condensed consolidated financial statements include the accounts of the Company, its wholly owned subsidiaries and variable interest entities (“VIEs”) that operate its clinics (“joint ventures”). For its joint ventures, the Company has determined that a majority voting interest and/or contractual rights granted to it provide the Company with the ability to direct the activities of these entities, and therefore the Company has determined that it is the primary beneficiary of these entities. Accordingly, the financial results of these joint ventures are fully consolidated into the Company’s operating results. The equity interests of the outside investors in the equity and results of operations of these consolidated entities are accounted for and presented as noncontrolling interests. 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 6 — Variable Interest Entities.” In the opinion of management, the Company has prepared the accompanying unaudited condensed 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 condensed 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, 2019 (“Form 10-K”). Operating results for the interim periods are not necessarily indicative of the results that may be expected for the full year.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with U.S GAAP requires the use of estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities and contingencies. Although actual results in subsequent periods will differ from these estimates, such estimates are developed based on the best information available to management and management’s best judgments at the time made. All significant assumptions and estimates underlying the reported amounts in the consolidated financial statements and accompanying notes are regularly reviewed and updated. Changes in estimates are reflected in the financial statements based upon ongoing actual experience, trends or subsequent settlements and realizations, depending on the nature and predictability of the estimates and contingencies. The most significant assumptions and estimates underlying these financial statements and accompanying notes involve revenue recognition and provisions for uncollectible accounts, impairments and valuation adjustments, the useful lives of property and equipment, fair value measurements, accounting for income taxes, acquisition accounting valuation estimates,
Segment Information	Segment Information Accounting pronouncements establish standards for the manner in which public companies report information about operating segments in annual and interim financial statements. Operating segments are identified as components of an enterprise for which separate discrete financial information is evaluated regularly by the chief operating decision-maker in making decisions about how to allocate resources and assess performance. Based on its operating management and financial reporting structure, the Company has determined that it is operating as one reportable business segment, the ownership and operation of dialysis clinics, all of which are located in the United States.
Accounting Pronouncements to be Adopted	Accounting Pronouncements to be Adopted In December 2019, the FASB issued ASU No. 2019-12, Income Taxes (Topic 740): Simplifying the Accounting for Income Taxes , to reduce complexity in accounting for income taxes by removing certain exceptions to the general principles in Topic 740. The amendments also improve consistent application of and simplify U.S. GAAP for other areas of Topic 740 by clarifying and amending existing guidance. The ASU is effective for public business entities for fiscal years, and interim periods within those fiscal years, beginning after December 15, 2020, and early application is permitted. The Company is still evaluating certain aspects of this ASU as well as the impact it may have on its condensed consolidated financial statements and related disclosures. In June 2016, the FASB issued ASU No. 2016-13, Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments , and related clarifying standards, which replaces the incurred loss impairment methodology in current U.S. GAAP with a methodology that reflects expected credit losses and requires consideration of a broader range of reasonable and supportable information to inform credit loss estimates. The FASB issued ASU 2019-10, which updated the effective date for smaller reporting companies to fiscal years beginning after December 15, 2022, with early adoption permitted. The Company is still evaluating certain aspects of this ASU as well as the impacts it may have on its condensed consolidated financial statements and related disclosures.
Fair Value Measurements	FAIR VALUE MEASUREMENTS The Company’s derivatives (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 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.

REVENUE (Tables)

REVENUE (Tables)	6 Months Ended
	Jun. 30, 2020
Revenue from Contract with Customer [Abstract]
Sources of Revenue	The composition of patient care service revenue by payment source is as follows: Three Months Ended June 30, Six Months Ended June 30, Percentage of Revenues by Payor: 2020 2019 2020 2019 Medicare and Medicare Advantage 69 % 70 % 69 % 70 % Commercial and other(1) 26 % 26 % 27 % 25 % Medicaid and Managed Medicaid 4 % 4 % 4 % 4 % Other(2) 1 % — % — % 1 % 100 % 100 % 100 % 100 % ___________________ (1) Principally commercial insurance companies and also includes the VA. (2) Other payments of revenues by payor include hospitals and patient self-pay. “Patient self-pay” revenues consist of payments received directly from patients who are either uninsured or self-pay a portion of the bill.

ASSETS HELD FOR SALE (Tables)

ASSETS HELD FOR SALE (Tables)	6 Months Ended
	Jun. 30, 2020
Discontinued Operations and Disposal Groups [Abstract]
Schedule of assets and liabilities held for sale	The following is a summary of the major categories of assets and liabilities that have been reclassified to held for sale on the Condensed Consolidated Balance Sheets: As of June 30, 2020 As of December 31, 2019 Inventories $ 333 $ 265 Prepaid expenses and other current assets 18 20 Property and equipment, net 11,054 11,245 Operating lease right-of-use assets 3,897 5,408 Goodwill 34,184 34,184 Valuation allowance on disposal group(1) (289) (1,023) Total assets held for sale $ 49,197 $ 50,099 Operating lease liabilities $ 4,210 $ 5,767 Total liabilities held for sale $ 4,210 $ 5,767 (1) The Company adjusted the carrying value to fair value less costs to sell for certain held for sale assets.

FAIR VALUE MEASUREMENTS (Tables

FAIR VALUE MEASUREMENTS (Tables)	6 Months Ended
	Jun. 30, 2020
Fair Value Disclosures [Abstract]
Schedule of the fair value of financial instruments	June 30, 2020 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 9 $ — $ 9 $ — Total Assets $ 9 $ — $ 9 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable with a portion included in Accrued expenses and other current liabilities) $ 520 $ — $ — $ 520 Interest rate swap agreement (included in Accrued expense and other current liabilities) 2,036 — 2,036 — Interest rate swap agreement (included in Other long-term liabilities) 632 — 632 — Total Liabilities $ 3,188 $ — $ 2,668 $ 520 Temporary Equity Noncontrolling interests subject to put provisions $ 110,405 $ — $ — $ 110,405 December 31, 2019 Total Level 1 Level 2 Level 3 Assets Interest rate derivative agreements (included in Prepaid expenses and other current assets) $ 143 $ — $ 143 $ — Total Assets $ 143 $ — $ 143 $ — Liabilities Tax Receivable Agreement Liability (included in Income tax receivable agreement payable) $ 3,000 $ — $ — $ 3,000 Interest rate swap agreement (included in Accrued expenses and other current liabilities) 783 — 783 — Interest rate swap agreement (included in Other long-term liabilities) 725 — 725 — Total Liabilities $ 4,508 $ — $ 1,508 $ 3,000 Temporary Equity Noncontrolling interests subject to put provisions $ 126,483 $ — $ — $ 126,483
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, 2020 for the TRA liability, which is classified as a Level 3 financial instrument: Balance at December 31, 2019 $ 3,000 Options exercised and dividend equivalent payment vesting (1,137) Total realized/unrealized losses: Included in earnings and reported as Change in fair value of income tax receivable agreement (1,343) Balance at June 30, 2020 $ 520

ACCRUED EXPENSES AND OTHER CU_2

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Tables)	6 Months Ended
	Jun. 30, 2020
Payables and Accruals [Abstract]
Summary of accrued compensation and benefits	Accrued compensation and benefits consist of the following: June 30, 2020 December 31, 2019 Accrued compensation $ 20,299 $ 24,526 Accrued vacation pay 17,438 12,670 $ 37,737 $ 37,196
Summary of accrued expenses and other current liabilities	Accrued expenses and other current liabilities consist of the following: June 30, 2020 December 31, 2019 Refunds due to payors $ 28,166 $ 20,085 Deferred revenue - advanced payments from CMS 83,193 — Grant funds escrow 16,758 — Accrued settlements (Note 15) 12,714 6,573 IPO put liability (Note 7) 16,685 — Other 16,098 10,935 $ 173,614 $ 37,593

NONCONTROLLING INTERESTS SUBJ_2

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS (Tables)	6 Months Ended
	Jun. 30, 2020
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, 2020 and December 31, 2019 is set forth below: June 30, 2020 December 31, 2019 Redemption value $ — $ 17,303 Estimated fair values for accounting purposes — 1,647 Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests $ — $ 15,656 In addition, the tables below set forth a reconciliation of noncontrolling interests subject to put provisions: June 30, 2020 December 31, 2019 Noncontrolling interests subject to put provisions stated at estimated fair value for accounting purposes $ 110,405 $ 110,827 Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests — 15,656 Noncontrolling interests subject to put provisions stated at maximum redemption value $ 110,405 $ 126,483 In addition, the tables below set forth a reconciliation of noncontrolling interests subject to put provisions. Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Change in estimated fair value for accounting purposes $ (4,019) $ (4,611) $ (434) $ (4,199) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests 444 (1,025) 703 (284) Total change in fair value of noncontrolling interests subject to put provisions stated at maximum redemption $ (3,575) $ (5,636) $ 269 $ (4,483)

DEBT (Tables)

DEBT (Tables)	6 Months Ended
	Jun. 30, 2020
Debt Disclosure [Abstract]
Schedule of long-term debt	Long-term debt consists of the following: June 30, 2020 December 31, 2019 2017 Credit Agreement - Term B Loan Facility $ 424,600 $ 429,000 2017 Credit Agreement - Revolving Credit Facility 73,000 64,500 Assigned Clinic Loans due to Term Loan Holdings 26 866 Other Term Loans 86,929 92,958 Other Lines of Credit 3,917 5,006 Finance Lease Obligations 7,594 7,780 596,066 600,110 Less: discounts and fees, net of accumulated amortization (10,919) (12,496) Less: current maturities (36,047) (38,779) $ 549,100 $ 548,835
Schedule of maturities of long-term debt	Scheduled maturities of long-term debt as of June 30, 2020 are as follows: 2020 (remainder) $ 22,187 2021 28,135 2022 94,949 2023 19,181 2024 419,030 Thereafter 12,584 $ 596,066

LEASES (Tables)

LEASES (Tables)	6 Months Ended
	Jun. 30, 2020
Leases [Abstract]
Schedule of lease expenses and supplemental cash flow information	The components of lease expense were as follows: Three Months Ended Six Months Ended Lease Cost June 30, 2020 June 30, 2019 June 30, 2020 June 30, 2019 Operating lease cost $ 8,204 $ 7,881 $ 16,465 $ 15,715 Finance lease cost: Amortization of right-of-use assets 165 144 330 289 Interest on lease liabilities 177 140 355 280 Short-term lease cost (1) 85 76 171 148 Variable lease cost 2,671 2,645 5,702 5,207 Less: Sublease income (473) (465) (936) (903) Total lease cost $ 10,829 $ 10,421 $ 22,087 $ 20,736 _____ (1) Short-term leases are leases having a term of twelve months or less. The Company elected to recognize short-term leases on a straight-line basis and does not record a related lease asset or liability for such leases. Supplemental cash flow information related to leases was as follows: Six Months Ended Other Information June 30, 2020 June 30, 2019 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flows from operating leases $ 16,585 $ 15,858 Operating cash flows from finance leases 355 280 Financing cash flows from finance leases 175 101 Right-of-use assets obtained in exchange for new or modified lease obligations: Operating leases 10,914 8,889 Finance leases — —
Supplemental balance sheet information related to leases	Supplemental balance sheet information related to leases was as follows: As of June 30, 2020 As of December 31, 2019 Operating Leases Operating lease right-of-use assets $ 135,078 $ 133,899 Current portion of operating lease liabilities $ 23,201 $ 22,061 Long-term operating lease liabilities, less current portion 124,058 123,792 Total operating lease liabilities $ 147,259 $ 145,853 Finance Leases Property and equipment, at cost $ 7,488 $ 7,499 Accumulated depreciation (918) (588) Property and equipment, net $ 6,570 $ 6,911 Current portion of long-term debt $ 413 $ 390 Long-term debt, less current portion 7,181 7,390 Total finance lease liabilities $ 7,594 $ 7,780 Weighted Average Remaining Lease Term Operating leases 7.0 years 7.1 years Finance leases 10.5 years 10.9 years Weighted Average Discount Rate Operating leases 7.0 % 7.0 % Finance leases 9.8 % 9.7 %
Future minimum lease payments under noncancelable operating leases	Future minimum lease payments under noncancelable operating leases, net of sublease receipts and finance leases as of June 30, 2020, are as follows: Year Ended December 31, Operating Less: Net Operating Finance Leases 2020 (excluding the six months ended June 30, 2020) $ 16,943 $ 740 $ 16,203 $ 547 2021 32,892 1,555 31,337 1,107 2022 30,562 1,575 28,987 1,123 2023 26,056 1,116 24,940 1,140 2024 21,614 603 21,011 1,188 Thereafter 66,120 2,454 63,666 7,532 Total minimum lease payments $ 194,187 $ 8,043 $ 186,144 $ 12,637 Less: amount representing interest 42,718 5,043 Present value of lease liabilities held for sale 4,210 — Present value of lease liabilities $ 147,259 $ 7,594 Future minimum lease payments under noncancelable operating leases, net of sublease receipts and finance leases as of December 31, 2019, are as follows: Year Ended December 31, Operating Less: Net Operating Finance Leases 2020 $ 32,691 $ 1,607 $ 31,084 $ 1,093 2021 31,105 1,641 29,464 1,108 2022 28,637 1,662 26,975 1,123 2023 24,242 1,142 23,100 1,141 2024 19,844 607 19,237 1,188 Thereafter 57,893 2,575 55,318 7,495 Total minimum lease payments $ 194,412 $ 9,234 $ 185,178 $ 13,148 Less: amount representing interest 42,792 5,368 Present value of lease liabilities held for sale 5,767 — Present value of lease liabilities $ 145,853 $ 7,780
Future minimum lease payments under noncancelable finance leases	Future minimum lease payments under noncancelable operating leases, net of sublease receipts and finance leases as of June 30, 2020, are as follows: Year Ended December 31, Operating Less: Net Operating Finance Leases 2020 (excluding the six months ended June 30, 2020) $ 16,943 $ 740 $ 16,203 $ 547 2021 32,892 1,555 31,337 1,107 2022 30,562 1,575 28,987 1,123 2023 26,056 1,116 24,940 1,140 2024 21,614 603 21,011 1,188 Thereafter 66,120 2,454 63,666 7,532 Total minimum lease payments $ 194,187 $ 8,043 $ 186,144 $ 12,637 Less: amount representing interest 42,718 5,043 Present value of lease liabilities held for sale 4,210 — Present value of lease liabilities $ 147,259 $ 7,594 Future minimum lease payments under noncancelable operating leases, net of sublease receipts and finance leases as of December 31, 2019, are as follows: Year Ended December 31, Operating Less: Net Operating Finance Leases 2020 $ 32,691 $ 1,607 $ 31,084 $ 1,093 2021 31,105 1,641 29,464 1,108 2022 28,637 1,662 26,975 1,123 2023 24,242 1,142 23,100 1,141 2024 19,844 607 19,237 1,188 Thereafter 57,893 2,575 55,318 7,495 Total minimum lease payments $ 194,412 $ 9,234 $ 185,178 $ 13,148 Less: amount representing interest 42,792 5,368 Present value of lease liabilities held for sale 5,767 — Present value of lease liabilities $ 145,853 $ 7,780

STOCK-BASED COMPENSATION (Table

STOCK-BASED COMPENSATION (Tables)	6 Months Ended
	Jun. 30, 2020
Share-based Payment Arrangement [Abstract]
Schedule of stock-based compensation expense	For the three and six months ended June 30, 2020 and 2019, stock-based compensation expense was reflected in the accompanying Condensed Consolidated Statements of Operations as follows: Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Patient care costs $ 171 $ 164 $ 383 $ 348 General and administrative 1,346 687 3,857 1,904 Total stock-based compensation before tax $ 1,517 $ 851 $ 4,240 $ 2,252
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 2020 and the fair value at the date of grant under the 2016 Plan are noted in the following table: Six Months Ended June 30, 2020 Expected Volatility 60% Weighted average expected terms in years 6.0 Weighted average risk-free interest rate 0.94% Expected annual dividend yield —% Weighted average grant-date fair value $4.17
Schedule of information concerning options activity for options to acquire common stock	Information concerning options activity for options under all option plans to acquire common stock is summarized as follows: Six Months Ended June 30, 2020 Number Weighted-average Options outstanding as of January 1, 2020 4,803,146 $ 12.29 Granted 96,765 7.58 Exercised (900,180) 1.41 Forfeited/Canceled (163,935) 9.76 Options outstanding as of June 30, 2020 3,835,796 $ 14.83 Vested and expected to vest as of June 30, 2020 3,835,796 $ 14.83 Exercisable as of June 30, 2020 2,393,293 $ 13.11
Schedule of restricted stock award activity	A summary of restricted stock award activity is as follows: Six Months Ended June 30, 2020 Number of shares Weighted-average grant date fair value per award Unvested as of January 1, 2020 579,283 $ 15.01 Granted 843,015 7.58 Vested (223,196) 14.52 Forfeited/Canceled (176,503) 9.75 Unvested as of June 30, 2020 1,022,599 $ 9.41

EARNINGS (LOSS) PER SHARE (Tabl

EARNINGS (LOSS) PER SHARE (Tables)	6 Months Ended
	Jun. 30, 2020
Earnings Per Share [Abstract]
Schedule of basic and diluted earnings (loss) per share	Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Basic Net income (loss) attributable to American Renal Associates Holdings, Inc. $ 795 $ (8,178) $ (6,439) $ (18,657) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests (444) 1,025 (703) 284 Net income (loss) attributable to common shareholders $ 351 $ (7,153) $ (7,142) $ (18,373) Weighted-average common shares outstanding 32,862,637 32,275,807 32,661,238 32,232,004 Earnings (loss) per share, basic $ 0.01 $ (0.22) $ (0.22) $ (0.57) Diluted Net income (loss) attributable to American Renal Associates Holdings, Inc. $ 795 $ (8,178) $ (6,439) $ (18,657) Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests (444) 1,025 (703) 284 Net income (loss) attributable to common shareholders for diluted earnings per share calculation $ 351 $ (7,153) $ (7,142) $ (18,373) Weighted-average common shares outstanding, basic 32,862,637 32,275,807 32,661,238 32,232,004 Weighted-average common shares outstanding, assuming dilution 34,612,591 32,275,807 32,661,238 32,232,004 Earnings (loss) per share, diluted $ 0.01 $ (0.22) $ (0.22) $ (0.57) Outstanding options and restricted stock excluded as impact would be anti-dilutive 2,427,031 3,235,582 2,948,016 3,404,444

CHANGES IN OWNERSHIP INTEREST_2

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES (Tables)	6 Months Ended
	Jun. 30, 2020
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 in consolidated subsidiaries on the Company’s equity are as follows: Three Months Ended June 30, Six Months Ended June 30, 2020 2019 2020 2019 Net income (loss) attributable to American Renal Holdings Associates, Inc. $ 795 $ (8,178) $ (6,439) $ (18,657) Increase in paid-in capital for the sales of noncontrolling interest — — 3,448 — Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest (886) (7,590) (886) (7,540) Net transfers to/from noncontrolling interests $ (886) $ (7,590) $ 2,562 $ (7,540) Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests $ (91) $ (15,768) $ (3,877) $ (26,197)

BASIS OF PRESENTATION, ORGANI_3

BASIS OF PRESENTATION, ORGANIZATION AND RECENT EVENTS (Details)	1 Months Ended	3 Months Ended			6 Months Ended
	Mar. 31, 2020	Jun. 30, 2020USD ($)state	Mar. 31, 2020USD ($)	Jun. 30, 2019USD ($)	Jun. 30, 2020USD ($)statedialysisClinicsegmentpatient	Jun. 30, 2019USD ($)	Dec. 31, 2019USD ($)
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Number of dialysis clinics owned and operated | dialysisClinic					251
Number of patients company treats | patient					17,356
Number of states in which company operates in | state		27			27
Number of reportable segments | segment					1
Asset impairment charges		$ 0	$ 0
Proceeds from grant fund, CARES Act					$ 26,595,000
Amounts utilized under the grant funds, CARES Act					9,800,000
Other income, CARES Act		1,474,000		$ 0	1,474,000	$ 0
Revenue received from temporary suspension of automatic 2% reduction of medicare program payments, CARES Act		1,123,000
Medicare accelerated and advance payment program, payment request	100.00%
Medicare accelerated and advance payment program, payment request period	3 months
Medicare accelerated and advance payment program, payment commencement, period post payment issuance	120 days
Deferred revenue, advanced payments from Centers for Medicare and Medicaid Services		83,193,000			83,193,000		$ 0
COVID-19
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Additional operating expenses incurred related to COVID-19		7,310,000			8,612,000
Other income, CARES Act		1,474,000			1,474,000
Operating expenses offset by grant funds, CARES Act		$ 8,368,000			$ 8,368,000
American Renal Holdings Intermediate Company, LLC
New Accounting Pronouncements or Change in Accounting Principle [Line Items]
Percentage ownership of subsidiary		100.00%			100.00%
Percentage ownership of parent		100.00%			100.00%

REVENUE (Details)

REVENUE (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020USD ($)	Jun. 30, 2019	Jun. 30, 2020USD ($)performance_obligation	Jun. 30, 2019	Dec. 31, 2019USD ($)
Disaggregation of Revenue [Line Items]
Number of performance obligations | performance_obligation			1
Percentage of receivable under government’s bundled payment system	80.00%		80.00%
Amounts pending approval from third-party payors associated with Medicare recovery claims	$ 20,541		$ 20,541		$ 17,509
Patient care service revenue	100.00%	100.00%	100.00%	100.00%
Medicare and Medicare Advantage
Disaggregation of Revenue [Line Items]
Patient care service revenue	69.00%	70.00%	69.00%	70.00%
Commercial and other
Disaggregation of Revenue [Line Items]
Patient care service revenue	26.00%	26.00%	27.00%	25.00%
Medicaid and Managed Medicaid
Disaggregation of Revenue [Line Items]
Patient care service revenue	4.00%	4.00%	4.00%	4.00%
Other
Disaggregation of Revenue [Line Items]
Patient care service revenue	1.00%	0.00%	0.00%	1.00%
Prepaid expenses and other current assets
Disaggregation of Revenue [Line Items]
Amounts pending approval from third-party payors associated with Medicare recovery claims	$ 4,956		$ 4,956		9,284
Other long-term assets
Disaggregation of Revenue [Line Items]
Amounts pending approval from third-party payors associated with Medicare recovery claims	$ 15,585		$ 15,585		$ 8,225

ASSETS HELD FOR SALE - Narrativ

ASSETS HELD FOR SALE - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2020	Dec. 31, 2019
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Current liabilities held for sale	$ 4,210	$ 4,210	$ 5,767
Certain Clinics In Pennsylvania, Ohio, and New Jersey and Other Property and Equipment | Disposal Group, Held-for-sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Increase (decrease) in valuation allowance	7	(498)
Current assets held for sale	49,197	49,197	50,099
Current liabilities held for sale	4,210	4,210	$ 5,767
Revenue	$ 6,846	$ 13,619

ASSETS HELD FOR SALE - Schedule

ASSETS HELD FOR SALE - Schedule of assets and liabilities held for sale (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Operating lease right-of-use assets	$ 135,078	$ 133,899
Operating lease liabilities	4,210	5,767
Current liabilities held for sale	4,210	5,767
Certain Clinics In Pennsylvania, Ohio, and New Jersey and Other Property and Equipment | Disposal Group, Held-for-sale, Not Discontinued Operations
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Inventories	333	265
Prepaid expenses and other current assets	18	20
Property and equipment, net	11,054	11,245
Operating lease right-of-use assets	3,897	5,408
Goodwill	34,184	34,184
Valuation allowance on disposal group	(289)	(1,023)
Total assets held for sale	49,197	50,099
Operating lease liabilities	4,210	5,767
Current liabilities held for sale	$ 4,210	$ 5,767

FAIR VALUE MEASUREMENTS - Sched

FAIR VALUE MEASUREMENTS - Schedule of fair values (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Temporary Equity
Noncontrolling interests subject to put provisions	$ 110,405	$ 126,483
Recurring basis
Assets
Interest rate derivative agreements asset	9	143
Liabilities
Total Liabilities	3,188	4,508
Temporary Equity
Noncontrolling interests subject to put provisions	110,405	126,483
Recurring basis | Level 1
Assets
Interest rate derivative agreements asset	0	0
Liabilities
Total Liabilities	0	0
Temporary Equity
Noncontrolling interests subject to put provisions	0	0
Recurring basis | Level 2
Assets
Interest rate derivative agreements asset	9	143
Liabilities
Total Liabilities	2,668	1,508
Temporary Equity
Noncontrolling interests subject to put provisions	0	0
Recurring basis | Level 3
Assets
Interest rate derivative agreements asset	0	0
Liabilities
Total Liabilities	520	3,000
Temporary Equity
Noncontrolling interests subject to put provisions	110,405	126,483
Prepaid expenses and other current assets | Recurring basis
Assets
Interest rate derivative agreements asset	9	143
Prepaid expenses and other current assets | Recurring basis | Level 1
Assets
Interest rate derivative agreements asset	0	0
Prepaid expenses and other current assets | Recurring basis | Level 2
Assets
Interest rate derivative agreements asset	9	143
Prepaid expenses and other current assets | Recurring basis | Level 3
Assets
Interest rate derivative agreements asset	0	0
Income tax receivable agreement payable
Liabilities
Tax receivable agreement liability	520
Income tax receivable agreement payable | Recurring basis
Liabilities
Tax receivable agreement liability	520	3,000
Income tax receivable agreement payable | Recurring basis | Level 1
Liabilities
Tax receivable agreement liability	0	0
Income tax receivable agreement payable | Recurring basis | Level 2
Liabilities
Tax receivable agreement liability	0	0
Income tax receivable agreement payable | Recurring basis | Level 3
Liabilities
Tax receivable agreement liability	520	3,000
Accrued expense and other current liabilities | Recurring basis
Liabilities
Interest rate swap agreement	2,036	783
Accrued expense and other current liabilities | Recurring basis | Level 1
Liabilities
Interest rate swap agreement	0	0
Accrued expense and other current liabilities | Recurring basis | Level 2
Liabilities
Interest rate swap agreement	2,036	783
Accrued expense and other current liabilities | Recurring basis | Level 3
Liabilities
Interest rate swap agreement	0	0
Other noncurrent liabilities | Recurring basis
Liabilities
Interest rate swap agreement	632	725
Other noncurrent liabilities | Recurring basis | Level 1
Liabilities
Interest rate swap agreement	0	0
Other noncurrent liabilities | Recurring basis | Level 2
Liabilities
Interest rate swap agreement	632	725
Other noncurrent liabilities | Recurring basis | Level 3
Liabilities
Interest rate swap agreement	$ 0	$ 0

FAIR VALUE MEASUREMENTS - Fair

FAIR VALUE MEASUREMENTS - Fair value rollforward for tax receivable agreement liability (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2020USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Balance at December 31, 2019	$ 3,000
Options exercised and dividend equivalent payment vesting	(1,137)
Total realized/unrealized losses:
Included in earnings and reported as Change in fair value of income tax receivable agreement	(1,343)
Balance at June 30, 2020	$ 520

FAIR VALUE MEASUREMENTS - Narra

FAIR VALUE MEASUREMENTS - Narrative (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Carrying amount of long-term debt	$ 596,066
First lien term loans
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Fair value of debt	397,001	$ 407,550
Carrying amount of long-term debt	$ 424,600	$ 429,000

ACCRUED EXPENSES AND OTHER CU_3

ACCRUED EXPENSES AND OTHER CURRENT LIABILITIES (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Accrued compensation and benefits:
Accrued compensation	$ 20,299	$ 24,526
Accrued vacation pay	17,438	12,670
Accrued compensation and benefits	37,737	37,196
Accrued expenses and other current liabilities:
Refunds due to payors	28,166	20,085
Deferred revenue - advanced payments from CMS	83,193	0
Grant funds escrow	16,758	0
Accrued settlement	12,714	6,573
IPO put liability	16,685	0
Other	16,098	10,935
Accrued expenses and other current liabilities	$ 173,614	$ 37,593

VARIABLE INTEREST ENTITIES (Det

VARIABLE INTEREST ENTITIES (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Variable Interest Entity [Line Items]
Total assets of VIEs	$ 1,199,699	$ 1,086,791
Total liabilities of VIEs	1,010,219	$ 875,769
Variable Interest Entity, Primary Beneficiary
Variable Interest Entity [Line Items]
Total assets of VIEs	20,759
Total liabilities of VIEs	$ 19,760

NONCONTROLLING INTERESTS SUBJ_3

NONCONTROLLING INTERESTS SUBJECT TO PUT PROVISIONS (Details) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020USD ($)	Jun. 30, 2019USD ($)	Jun. 30, 2020USD ($)	Jun. 30, 2019USD ($)	Dec. 31, 2019USD ($)
Temporary Equity [Line Items]
Estimated redemption value					$ 16,240
Additional redemption value on related noncontrolling interest	$ 444	$ (1,025)	$ 703	$ (284)
Redemption value	0		0		17,303
Estimated fair values for accounting purposes	0		0		1,647
Difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests	0		0		15,656
Noncontrolling interests subject to put provisions stated at estimated fair value for accounting purposes	110,405		110,405		110,827
Noncontrolling interests subject to put provisions stated at maximum redemption value	110,405		110,405		$ 126,483
Total change in fair value of noncontrolling interests subject to put provisions stated at maximum redemption	3,575	5,636	(269)	4,483
Noncontrolling Interests Subject to Put Provisions
Temporary Equity [Line Items]
Change in estimated fair value for accounting purposes	(4,019)	(4,611)	(434)	(4,199)
Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests	444	(1,025)	703	(284)
Total change in fair value of noncontrolling interests subject to put provisions stated at maximum redemption	$ (3,575)	$ (5,636)	$ 269	$ (4,483)
Weighted Average Cost of Capital | Minimum
Temporary Equity [Line Items]
Weighted average cost of capital			0.1450
Weighted Average Cost of Capital | Maximum
Temporary Equity [Line Items]
Weighted average cost of capital			0.2000

DEBT - Schedule of long-term de

DEBT - Schedule of long-term debt (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Debt Instrument [Line Items]
Finance Lease Obligations	$ 7,594	$ 7,780
Long-term debt, gross	596,066	600,110
Less: discounts and fees, net of accumulated amortization	(10,919)	(12,496)
Less: current maturities	(36,047)	(38,779)
Long-term debt, less current portion	549,100	548,835
Assigned Clinic Loans due to Term Loan Holdings
Debt Instrument [Line Items]
Long-term debt, gross	26	866
Other Term Loans
Debt Instrument [Line Items]
Long-term debt, gross	86,929	92,958
Other Lines of Credit
Debt Instrument [Line Items]
Long-term debt, gross	3,917	5,006
2017 Credit Agreement | 2017 Credit Agreement - Term B Loan Facility
Debt Instrument [Line Items]
Long-term debt, gross	424,600	429,000
Revolving Credit Facility | 2017 Credit Agreement | 2017 Credit Agreement - Revolving Credit Facility
Debt Instrument [Line Items]
Long-term debt, gross	$ 73,000	$ 64,500

DEBT - Scheduled maturities of

DEBT - Scheduled maturities of long-term debt (Details) $ in Thousands	Jun. 30, 2020USD ($)
Debt Disclosure [Abstract]
2020 (remainder)	$ 22,187
2021	28,135
2022	94,949
2023	19,181
2024	419,030
Thereafter	12,584
Carrying amount of long-term debt	$ 596,066

DEBT - Narrative (Details)

DEBT - Narrative (Details)	Jan. 01, 2020USD ($)	Sep. 04, 2019	Apr. 26, 2019	Jun. 22, 2017USD ($)	Jun. 30, 2020USD ($)	Jun. 30, 2019USD ($)	Sep. 04, 2019	Jun. 30, 2020USD ($)	Jun. 30, 2019USD ($)	May 06, 2020USD ($)	Mar. 31, 2017USD ($)interest_rate_cap_agreement
Debt Instrument [Line Items]
Repayment of debt during 2020					$ 22,187,000			$ 22,187,000
Repayment of debt during second quarter of 2021					$ 94,949,000			$ 94,949,000
Maximum
Debt Instrument [Line Items]
Interest rate					4.52%			4.52%
Interest rate swap agreements
Debt Instrument [Line Items]
Amounts reclassified from accumulated other comprehensive income (loss) into income					$ 0
Unrealized pre-tax (gain) loss on derivatives					(198,000)	$ 1,241,000		$ 1,950,000	$ 1,102,000
Interest rate swap agreements | Designated as hedge | Cash flow hedge
Debt Instrument [Line Items]
Interest rate swap and cap agreements notional amount											$ 133,000,000
Interest rate cap agreements
Debt Instrument [Line Items]
Amounts reclassified from accumulated other comprehensive income (loss) into income					0
Unrealized pre-tax (gain) loss on derivatives					$ 1,000	136,000		$ 1,058,000	1,025,000
Interest rate cap agreements | Designated as hedge | Cash flow hedge
Debt Instrument [Line Items]
Interest rate swap and cap agreements notional amount											$ 147,000,000
Number of interest rate swap agreements | interest_rate_cap_agreement											2
Credit Agreement 2017, First Amendment
Debt Instrument [Line Items]
Financial covenant, net leverage ratio, maximum					7			7
Credit Agreement 2017, First Amendment | Revolving Credit Facility
Debt Instrument [Line Items]
Fees related to debt amendment						$ 6,021,000			$ 6,021,000
Third-Party Clinic Loan Agreements
Debt Instrument [Line Items]
Repayment of debt during 2020										$ 4,274,000
Repayment of debt during second quarter of 2021										5,318,000
Other long-term debt					$ 90,846,000			$ 90,846,000
Third-Party Clinic Loan Agreements | Minimum
Debt Instrument [Line Items]
Interest rate					3.10%			3.10%
Third-Party Clinic Loan Agreements | Maximum
Debt Instrument [Line Items]
Interest rate					7.68%			7.68%
First Lien Credit Agreement
Debt Instrument [Line Items]
Principal payments								$ 4,400,000
Line of Credit | 2017 Credit Agreement | Revolving Credit Facility
Debt Instrument [Line Items]
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%
Pay down of line of credit					$ 27,000,000
Revolving credit facility borrowings outstanding					$ 73,000,000			$ 73,000,000
Interest rate at period end					4.94%			4.94%
Financial covenant, net leverage ratio, maximum					6			6
Line of Credit | Credit Agreement 2017, First Amendment | Revolving Credit Facility
Debt Instrument [Line Items]
Interest rate margin							0.50%
Line of Credit | Credit Agreement 2017, First Amendment | Revolving Credit Facility | Eurodollar one-month rate
Debt Instrument [Line Items]
Interest rate margin							5.25%
Line of Credit | Credit Agreement 2017, First Amendment | Revolving Credit Facility | Base Rate
Debt Instrument [Line Items]
Interest rate margin							4.25%
Line of Credit | Credit Agreement 2017, First Amendment | Revolving Credit Facility | Alternate Base Rate Or London Interbank Offered Rate (LIBOR)
Debt Instrument [Line Items]
Interest rate margin		1.75%
Term loans | 2017 Credit Agreement
Debt Instrument [Line Items]
Principal payments	$ 2,200,000
Debt face amount				$ 440,000,000
Required prepayment								$ 0
Interest rate								5.18%
Term loans | Credit Agreement 2017, First Amendment | Federal funds effective rate
Debt Instrument [Line Items]
Interest rate margin							0.50%
Term loans | Credit Agreement 2017, First Amendment | Eurodollar one-month rate
Debt Instrument [Line Items]
Interest rate margin							1.00%
Applicable margin, increase		5.00%
Term loans | Credit Agreement 2017, First Amendment | ABR rate
Debt Instrument [Line Items]
Applicable margin, increase							4.50%
Term loans | Credit Agreement 2017, First Amendment | LIBOR rate, adjusted for changes in Eurodollar reserves
Debt Instrument [Line Items]
Applicable margin, increase							5.50%
Term loans | Credit Agreement 2017, First Amendment | Base Rate
Debt Instrument [Line Items]
Applicable margin, increase		4.00%
Term loans | Credit Agreement 2017, First Amendment | Debt Instrument, Redemption, Period One
Debt Instrument [Line Items]
Debt redemption price, percentage			1.00%
Term loans | Credit Agreement 2017, First Amendment | Debt Instrument, Redemption, Period Two
Debt Instrument [Line Items]
Debt redemption price, percentage			2.00%
Term loans | First Lien Credit Agreement, Second Amendment | ABR rate
Debt Instrument [Line Items]
Applicable margin, increase				2.25%
Term loans | First Lien Credit Agreement, Second Amendment | LIBOR rate, adjusted for changes in Eurodollar reserves
Debt Instrument [Line Items]
Applicable margin, increase				3.25%
Term loans | Term B loans
Debt Instrument [Line Items]
Debt face amount											$ 440,000,000
Third Parties to Clinic Loan Agreements | Third-Party Clinic Loan Agreements
Debt Instrument [Line Items]
Repayment of debt during 2020										7,589,000
Repayment of debt during second quarter of 2021										$ 10,506,000

LEASES - Narrative (Details)

LEASES - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Lessee, Lease, Description [Line Items]
Rent expense	$ 2,944	$ 2,818	$ 5,772	$ 5,653
Rental income under subleases	473	465	936	903
Future rental receipts due from related party	3,905		3,905
Operating lease not yet commenced, liability	1,028		1,028
Finance lease not yet commenced, liability	$ 992		$ 992
Finance lease not yet commenced lease term	10 years		10 years
Operating lease not yet commenced lease term	10 years		10 years
Facility Space to Noncontrolling Interest Members
Lessee, Lease, Description [Line Items]
Rental income under subleases	$ 233	257	$ 465	514
Facility Space to Nephrologist Partners
Lessee, Lease, Description [Line Items]
Rental income under subleases	$ 473	$ 465	$ 936	$ 903
Minimum
Lessee, Lease, Description [Line Items]
Lease agreements cover periods			5 years
Lease agreements renewal option period			5 years
Maximum
Lessee, Lease, Description [Line Items]
Lease agreements cover periods			15 years
Lease agreements renewal option period			10 years

LEASES - Lease cost (Details)

LEASES - Lease cost (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Leases [Abstract]
Operating lease cost	$ 8,204	$ 7,881	$ 16,465	$ 15,715
Finance lease cost:
Amortization of right-of-use assets	165	144	330	289
Interest on lease liabilities	177	140	355	280
Short-term lease cost	85	76	171	148
Variable lease cost	2,671	2,645	5,702	5,207
Less: Sublease income	(473)	(465)	(936)	(903)
Total lease cost	$ 10,829	$ 10,421	$ 22,087	$ 20,736

LEASES - Supplemental cash flow

LEASES - Supplemental cash flow related to leases (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases	$ 16,585	$ 15,858
Operating cash flows from finance leases	355	280
Financing cash flows from finance leases	175	101
Right-of-use assets obtained in exchange for new or modified lease obligations:
Operating leases	10,914	8,889
Finance leases	$ 0	$ 0

LEASES - Supplemental balance s

LEASES - Supplemental balance sheet related to leases (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Operating Leases
Operating lease right-of-use assets	$ 135,078	$ 133,899
Current portion of operating lease liabilities	23,201	22,061
Long-term operating lease liabilities, less current portion	124,058	123,792
Total operating lease liabilities	147,259	145,853
Finance Leases
Property and equipment, at cost	7,488	7,499
Accumulated depreciation	(918)	(588)
Property and equipment, net	6,570	6,911
Current portion of long-term debt	413	390
Long-term debt, less current portion	7,181	7,390
Total finance lease liabilities	$ 7,594	$ 7,780
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	us-gaap:PropertyPlantAndEquipmentAndFinanceLeaseRightOfUseAssetAfterAccumulatedDepreciationAndAmortization	us-gaap:PropertyPlantAndEquipmentAndFinanceLeaseRightOfUseAssetAfterAccumulatedDepreciationAndAmortization
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List]	us-gaap:LongTermDebtAndCapitalLeaseObligationsCurrent	us-gaap:LongTermDebtAndCapitalLeaseObligationsCurrent
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	us-gaap:LongTermDebtAndCapitalLeaseObligations	us-gaap:LongTermDebtAndCapitalLeaseObligations
Weighted Average Remaining Lease Term
Operating leases	7 years	7 years 1 month 6 days
Finance leases	10 years 6 months	10 years 10 months 24 days
Weighted Average Discount Rate
Operating leases	7.00%	7.00%
Finance leases	9.80%	9.70%

LEASES - Future Minimum Lease P

LEASES - Future Minimum Lease Payments Under Noncancelable Leases - For Period Ending June 30, 2020 (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Operating Leases
2020 (excluding the six months ended June 30, 2020)	$ 16,943
2021	32,892	$ 32,691
2022	30,562	31,105
2023	26,056	28,637
2024	21,614	24,242
Thereafter	66,120
Total minimum lease payments	194,187	194,412
Less: amount representing interest	42,718	42,792
Present value of lease liabilities held for sale	4,210	5,767
Present value of lease liabilities	147,259	145,853
Less: Sublease Income
2020 (excluding the six months ended June 30, 2020)	740
2021	1,555	1,607
2022	1,575	1,641
2023	1,116	1,662
2024	603	1,142
Thereafter	2,454
Total minimum lease payments	8,043	9,234
Net Operating Lease
2020 (excluding the six months ended June 30, 2020)	16,203
2021	31,337	31,084
2022	28,987	29,464
2023	24,940	26,975
2024	21,011	23,100
Thereafter	63,666
Total minimum lease payments	186,144	185,178
Finance Leases
2020 (excluding the six months ended June 30, 2020)	547
2021	1,107	1,093
2022	1,123	1,108
2023	1,140	1,123
2024	1,188	1,141
Thereafter	7,532
Total minimum lease payments	12,637	13,148
Less: amount representing interest	5,043	5,368
Present value of lease liabilities held for sale	0	0
Present value of lease liabilities	$ 7,594	$ 7,780

LEASES - Future Minimum Lease_2

LEASES - Future Minimum Lease Payments Under Noncancelable Leases - For Period Ending December 31, 2019 (Details) - USD ($) $ in Thousands	Jun. 30, 2020	Dec. 31, 2019
Operating Leases
2020	$ 32,892	$ 32,691
2021	30,562	31,105
2022	26,056	28,637
2023	21,614	24,242
2024		19,844
Thereafter		57,893
Total minimum lease payments	194,187	194,412
Less: amount representing interest	42,718	42,792
Present value of lease liabilities held for sale	4,210	5,767
Present value of lease liabilities	147,259	145,853
Less: Sublease Income
2020	1,555	1,607
2021	1,575	1,641
2022	1,116	1,662
2023	603	1,142
2024		607
Thereafter		2,575
Total minimum lease payments	8,043	9,234
Net Operating Lease
2020	31,337	31,084
2021	28,987	29,464
2022	24,940	26,975
2023	21,011	23,100
2024		19,237
Thereafter		55,318
Total minimum lease payments	186,144	185,178
Finance Leases
2020	1,107	1,093
2021	1,123	1,108
2022	1,140	1,123
2023	1,188	1,141
2024		1,188
Thereafter		7,495
Total minimum lease payments	12,637	13,148
Less: amount representing interest	5,043	5,368
Present value of lease liabilities held for sale	0	0
Present value of lease liabilities	$ 7,594	$ 7,780

INCOME TAXES (Details)

INCOME TAXES (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Income Tax Disclosure [Abstract]
Effective income tax rate	13.70%	11.10%	(12.70%)	100.40%
Operating loss carryforward	$ 16,289		$ 16,289
Income tax benefit, CARES Act			2,281
Valuation allowance released			$ 3,210

STOCK-BASED COMPENSATION - Sche

STOCK-BASED COMPENSATION - Schedule of expense (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation before tax	$ 1,517	$ 851	$ 4,240	$ 2,252
Patient care costs
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation before tax	171	164	383	348
General and administrative
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Total stock-based compensation before tax	$ 1,346	$ 687	$ 3,857	$ 1,904

STOCK-BASED COMPENSATION - Narr

STOCK-BASED COMPENSATION - Narrative (Details) - USD ($) $ / shares in Units, $ in Thousands	Apr. 26, 2016	Apr. 07, 2016	Mar. 31, 2020	Dec. 31, 2019	Mar. 31, 2018	Jun. 30, 2020	Jun. 30, 2020
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Cash dividend (in USD per share)	$ 1.30
Cash dividend	$ 28,886
Vested option stockholders
Share-based Payment Arrangement, Expensed and Capitalized, Amount [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							$ 5,396
Unvested option stockholders
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Equitable adjustments in the form of cash dividend equivalent payments							$ 1,235
Restricted stock awards
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Granted (in shares)							843,015
Granted (in USD per share)							$ 7.58
Unvested and outstanding (in shares)				579,283		1,022,599	1,022,599
Unrecognized compensation costs						$ 5,180	$ 5,180
Unrecognized compensation costs recognition period							1 year 5 months 23 days
Certain executives | Restricted stock awards
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Granted (in shares)			280,953	51,500	95,000
Granted (in USD per share)			$ 7.58	$ 10.19	$ 22.33
Vesting period			2 years	3 years	3 years
Issued in period (in shares)			562,062
2016 Omnibus Incentive Plan
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Authorized additional stock options (in shares)		4,000,000
Stock options to purchase outstanding (in shares)						1,295,818	1,295,818
Transition Services Agreement | Share-based Payment Arrangement, Option
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Additional stock compensation expense (credit) related to plan modification						$ (48)	$ 327

STOCK-BASED COMPENSATION STOCK-

STOCK-BASED COMPENSATION STOCK-BASED COMPENSATION - Assumptions used for options granted (Details) - Employee Stock Option	6 Months Ended
	Jun. 30, 2020$ / shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected Volatility	60.00%
Weighted average expected terms in years	6 years
Weighted average risk-free interest rate	0.94%
Expected annual dividend yield	0.00%
Weighted average grant-date fair value (in USD per share)	$ 4.17

STOCK-BASED COMPENSATION - Opti

STOCK-BASED COMPENSATION - Option activity (Details) - 2016 Omnibus Incentive Plan - $ / shares	6 Months Ended
	Jun. 30, 2020
Number of options
Options outstanding, beginning of period (in shares)	4,803,146
Granted (in shares)	96,765
Exercised (in shares)	(900,180)
Forfeited/Canceled (in shares)	(163,935)
Options outstanding, end of period (in shares)	3,835,796
Vested and expected to vest, end of period (in shares)	3,835,796
Exercisable, end of period (in shares)	2,393,293
Weighted-average exercise price
Options outstanding, beginning period (in USD per share)	$ 12.29
Granted (in USD per share)	7.58
Exercised (in USD per share)	1.41
Forfeited (in USD per share)	9.76
Options outstanding, end of period (in USD per share)	14.83
Vested and expected to vest, end of period (in USD per share)	14.83
Exercisable, end of period (in USD per share)	$ 13.11

STOCK-BASED COMPENSATION - Rest

STOCK-BASED COMPENSATION - Restricted stock awards (Details) - Restricted stock awards	6 Months Ended
	Jun. 30, 2020$ / sharesshares
Number of shares
Unvested, beginning of period (in shares) | shares	579,283
Granted (in shares) | shares	843,015
Vested (in shares) | shares	(223,196)
Forfeited/Canceled (in shares) | shares	(176,503)
Unvested, end of period (in shares) | shares	1,022,599
Weighted-average grant date fair value per award
Unvested, beginning of period (in USD per share) | $ / shares	$ 15.01
Granted (in USD per share) | $ / shares	7.58
Vested (in USD per share) | $ / shares	14.52
Forfeited/Canceled (in shares) | $ / shares	9.75
Unvested, end of period (in USD per share) | $ / shares	$ 9.41

EARNINGS (LOSS) PER SHARE (Deta

EARNINGS (LOSS) PER SHARE (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Earnings Per Share [Abstract]
Net income (loss) attributable to American Renal Associates Holdings, Inc.	$ 795	$ (8,178)	$ (6,439)	$ (18,657)
Change in the difference between the redemption value and estimated fair value for accounting purposes of the related noncontrolling interests	(444)	1,025	(703)	284
Net income (loss) attributable to common shareholders	$ 351	$ (7,153)	$ (7,142)	$ (18,373)
Weighted-average common shares outstanding, basic (in shares)	32,862,637	32,275,807	32,661,238	32,232,004
Earnings (loss) per share, basic (in USD per share)	$ 0.01	$ (0.22)	$ (0.22)	$ (0.57)
Net income (loss) attributable to common shareholders for diluted earnings per share calculation	$ 351	$ (7,153)	$ (7,142)	$ (18,373)
Weighted-average common shares outstanding, assuming dilution (in shares)	34,612,591	32,275,807	32,661,238	32,232,004
Earnings (loss) per share, diluted (in USD per share)	$ 0.01	$ (0.22)	$ (0.22)	$ (0.57)
Outstanding options and restricted stock excluded as impact would be anti-dilutive (in shares)	2,427,031	3,235,582	2,948,016	3,404,444

RELATED PARTY TRANSACTIONS (Det

RELATED PARTY TRANSACTIONS (Details) - USD ($)	Apr. 20, 2016	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019	Apr. 26, 2016
Related Party Transaction [Line Items]
Assigned clinic loans		$ 26,000,000		$ 26,000,000
Percentage tax savings payable to pre-IPO stockholders						85.00%
Income tax receivable agreement liability total	$ 23,400,000			2,108,000
Accrued income tax receivable agreement liability				1,588,000
Tax receivable agreement liability, current				1,755,000
Payments made for the income tax receivable agreement		0	$ 0	0	$ 0
Future rental receipts due from related party		$ 3,905,000		$ 3,905,000
Agreements With Certain Clinics To Provide For Various Facility Build Outs
Related Party Transaction [Line Items]
Weighted average interest rate		6.10%		6.10%
Total amount of initial financing		$ 3,142,000		$ 3,142,000
Future rental receipts due from related party		2,940,000		2,940,000
Amount outstanding, current		223,000		223,000
Amount outstanding, noncurrent		$ 2,717,000		$ 2,717,000
Executive | Software services agreement | Kinetic
Related Party Transaction [Line Items]
Ownership percentage		51.00%		51.00%
Executive | Financing transactions
Related Party Transaction [Line Items]
Period of weighted average maturity, clinic loans				3 years 2 months 1 day
Weighted average interest rate		4.35%		4.35%
Ownership interest in joint venture		$ 1,840,000		$ 1,840,000
Loan guarantee outstanding		$ 421,000		$ 421,000
Spouse of executive | Software services agreement | Kinetic
Related Party Transaction [Line Items]
Ownership percentage		2.50%		2.50%
Expense related to agreement				$ 85,000	$ 140,000
Minimum | Agreements With Certain Clinics To Provide For Various Facility Build Outs
Related Party Transaction [Line Items]
Interest rate		6.00%		6.00%
Minimum | Executive | Financing transactions
Related Party Transaction [Line Items]
Interest rate		4.08%		4.08%
Maximum
Related Party Transaction [Line Items]
Interest rate		4.52%		4.52%
Maximum | Agreements With Certain Clinics To Provide For Various Facility Build Outs
Related Party Transaction [Line Items]
Interest rate		8.10%		8.10%
Maximum | Executive | Financing transactions
Related Party Transaction [Line Items]
Interest rate		4.62%		4.62%
Income tax receivable agreement payable
Related Party Transaction [Line Items]
Fair value of tax receivable agreement liability		$ 520,000		$ 520,000

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 AND OTHER MATTE_2

CERTAIN LEGAL AND OTHER MATTERS (Details) $ in Thousands	Jul. 02, 2020USD ($)	Mar. 11, 2020USD ($)	Aug. 01, 2019USD ($)	Aug. 01, 2018USD ($)	Dec. 31, 2018USD ($)paymentInstallment	Jun. 30, 2020USD ($)	Dec. 31, 2019USD ($)
Loss Contingencies [Line Items]
Accrued expenses and other current liabilities						$ 173,614	$ 37,593
Other long-term liabilities						10,876	$ 6,501
ARA, ARA OpCo And ARM vs UnitedHealth Group Inc.
Loss Contingencies [Line Items]
Litigation settlement, amount awarded to other party				$ 32,000
Number of installments | paymentInstallment					5
Estimated litigation liability					$ 29,614	12,715
Accrued expenses and other current liabilities						6,939
Other long-term liabilities						5,776
Settlement payment			$ 8,000	$ 10,000
Installment payment to be paid August 1, 2020						7,000
Installment payment to be paid August 1, 2021						3,500
Installment payment to be paid August 1, 2022						$ 3,500
Agreement term				3 years
Pending Litigation | Ali Vandevar, et al. v. American Renal Associates Holdings Inc., et al.
Loss Contingencies [Line Items]
Litigation settlement, amount awarded to other party		$ 5,775
Settled Litigation | Luke Johnson v. Joseph A. Carlucci, et al. | Subsequent Event
Loss Contingencies [Line Items]
Litigation settlement, amount awarded from other party	$ 413

CHANGES IN OWNERSHIP INTEREST_3

CHANGES IN OWNERSHIP INTEREST IN CONSOLIDATED SUBSIDIARIES (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2020	Jun. 30, 2019	Jun. 30, 2020	Jun. 30, 2019
Noncontrolling Interest [Abstract]
Net income (loss) attributable to American Renal Associates Holdings, Inc.	$ 795	$ (8,178)	$ (6,439)	$ (18,657)
Increase in paid-in capital for the sales of noncontrolling interest	0	0	3,448	0
Decrease in paid-in capital for the purchase of noncontrolling interest and adjustments to ownership interest	(886)	(7,590)	(886)	(7,540)
Net transfers to/from noncontrolling interests	(886)	(7,590)	2,562	(7,540)
Net loss attributable to American Renal Holdings Associates, Inc., net of transfers to/from noncontrolling interests	$ (91)	$ (15,768)	$ (3,877)	$ (26,197)

SUBSEQUENT EVENTS (Details)

SUBSEQUENT EVENTS (Details) - Disposal Group, Disposed of by Sale, Not Discontinued Operations - Certain Clinics In Pennsylvania - Subsequent Event $ in Thousands	Aug. 03, 2020USD ($)
Subsequent Event [Line Items]
Proceeds from divestiture of clinics	$ 16,800
Goodwill	$ 10,550