Document and Entity Information
Document and Entity Information - shares shares in Millions | 9 Months Ended | |
Sep. 30, 2016 | Oct. 31, 2016 | |
Document And Entity Information [Abstract] | ||
Document Type | 10-Q | |
Amendment Flag | false | |
Document Period End Date | Sep. 30, 2016 | |
Document Fiscal Year Focus | 2,016 | |
Document Fiscal Period Focus | Q3 | |
Trading Symbol | DVA | |
Entity Registrant Name | DAVITA INC. | |
Entity Central Index Key | 927,066 | |
Current Fiscal Year End Date | --12-31 | |
Entity Filer Category | Large Accelerated Filer | |
Entity Common Stock, Shares Outstanding | 197.4 |
CONSOLIDATED STATEMENTS OF INCO
CONSOLIDATED STATEMENTS OF INCOME (unaudited) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Income Statement [Abstract] | ||||
Patient service revenues | $ 2,629,661 | $ 2,414,034 | $ 7,678,053 | $ 7,049,428 |
Less: Provision for uncollectible accounts | (115,555) | (109,452) | (336,188) | (314,581) |
Net patient service revenues | 2,514,106 | 2,304,582 | 7,341,865 | 6,734,847 |
Capitated revenues | 869,290 | 926,847 | 2,654,163 | 2,643,552 |
Other revenues | 347,180 | 294,236 | 1,033,335 | 869,849 |
Total net revenues | 3,730,576 | 3,525,665 | 11,029,363 | 10,248,248 |
Operating expenses and charges: | ||||
Patient care costs and other costs | 2,697,629 | 2,501,015 | 7,950,987 | 7,309,703 |
General and administrative | 406,890 | 353,492 | 1,180,214 | 1,043,253 |
Depreciation and amortization | 181,739 | 162,062 | 531,475 | 474,694 |
Provision for uncollectible accounts | 3,773 | 2,511 | 9,856 | 6,497 |
Equity investment income | (4,237) | (2,783) | (5,119) | (10,724) |
Goodwill impairment charges | 253,000 | 4,065 | ||
Gain on changes in ownership interests, net | (374,374) | (404,165) | ||
Settlement charge | 495,000 | |||
Total operating expenses and charges | 2,911,420 | 3,016,297 | 9,516,248 | 9,322,488 |
Operating income | 819,156 | 509,368 | 1,513,115 | 925,760 |
Debt expense | (104,581) | (103,481) | (310,359) | (305,121) |
Debt redemption charges | (48,072) | |||
Other income, net | 1,876 | 2,484 | 8,067 | 4,262 |
Income before income taxes | 716,451 | 408,371 | 1,210,823 | 576,829 |
Income tax expense | 104,301 | 147,064 | 366,011 | 183,893 |
Net income | 612,150 | 261,307 | 844,812 | 392,936 |
Less: Net income attributable to noncontrolling interests | (40,818) | (45,435) | (122,664) | (117,204) |
Net income attributable to DaVita Inc. | $ 571,332 | $ 215,872 | $ 722,148 | $ 275,732 |
Earnings per share: | ||||
Basic net income per share attributable to DaVita Inc. | $ 2.80 | $ 1.02 | $ 3.54 | $ 1.30 |
Diluted net income per share attributable to DaVita Inc. | $ 2.76 | $ 1 | $ 3.48 | $ 1.27 |
Weighted average shares for earnings per share: | ||||
Basic | 203,761,433 | 212,374,897 | 204,206,979 | 212,914,126 |
Diluted | 206,961,450 | 216,691,461 | 207,643,794 | 217,421,213 |
CONSOLIDATED STATEMENTS OF COMP
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (unaudited) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Statement Of Income And Comprehensive Income [Abstract] | ||||
Net income | $ 612,150 | $ 261,307 | $ 844,812 | $ 392,936 |
Unrealized losses on interest rate swap and cap agreements: | ||||
Unrealized losses on interest rate swap and cap agreements | (153) | (1,851) | (8,238) | (10,064) |
Reclassifications of net swap and cap agreements realized losses into net income | 388 | 771 | 1,301 | 2,372 |
Unrealized gains (losses) on investments: | ||||
Unrealized gains (losses) on investments | 1,121 | (1,651) | 1,988 | (1,368) |
Reclassification of net investment realized gains into net income | (50) | (203) | (143) | (376) |
Unrealized gains (losses) on foreign currency translation: | ||||
Foreign currency translation adjustments | (951) | (7,023) | 5,386 | (19,883) |
Reclassification of foreign currency translation adjustment realized loss into net income | 7,513 | 7,513 | ||
Other comprehensive income (loss) | 7,868 | (9,957) | 7,807 | (29,319) |
Total comprehensive income | 620,018 | 251,350 | 852,619 | 363,617 |
Less: Comprehensive income attributable to noncontrolling interests | (40,876) | (45,435) | (122,871) | (117,204) |
Comprehensive income attributable to DaVita Inc. | $ 579,142 | $ 205,915 | $ 729,748 | $ 246,413 |
CONSOLIDATED BALANCE SHEETS (un
CONSOLIDATED BALANCE SHEETS (unaudited) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 |
ASSETS | ||
Cash and cash equivalents | $ 913,496 | $ 1,499,116 |
Short-term investments | 659,478 | 408,084 |
Accounts receivable, less allowance of $251,593 and $264,144 | 1,850,425 | 1,724,228 |
Inventories | 200,563 | 185,575 |
Other receivables | 451,953 | 435,885 |
Other current assets | 177,248 | 190,322 |
Income taxes receivable | 8,196 | 60,070 |
Total current assets | 4,261,359 | 4,503,280 |
Property and equipment, net of accumulated depreciation of $2,728,217 and $2,397,007 | 3,044,988 | 2,788,740 |
Intangible assets, net of accumulated amortization of $895,034 and $770,691 | 1,576,157 | 1,687,326 |
Equity investments | 516,383 | 78,368 |
Long-term investments | 100,786 | 89,122 |
Other long-term assets | 42,984 | 73,560 |
Goodwill | 9,382,996 | 9,294,479 |
Total assets | 18,925,653 | 18,514,875 |
LIABILITIES AND EQUITY | ||
Accounts payable | 498,422 | 513,950 |
Other liabilities | 828,535 | 682,123 |
Accrued compensation and benefits | 845,879 | 741,926 |
Medical payables | 313,869 | 332,102 |
Current portion of long-term debt | 152,764 | 129,037 |
Total current liabilities | 2,639,469 | 2,399,138 |
Long-term debt | 8,972,002 | 9,001,308 |
Other long-term liabilities | 420,938 | 439,229 |
Deferred income taxes | 802,109 | 726,962 |
Total liabilities | 12,834,518 | 12,566,637 |
Commitments and contingencies: | ||
Noncontrolling interests subject to put provisions | 971,744 | 864,066 |
Equity: | ||
Preferred stock ($0.001 par value, 5,000,000 shares authorized; none issued) | ||
Common stock ($0.001 par value, 450,000,000 shares authorized; 217,338,629 and 217,120,346 shares issued and 200,778,434 and 209,754,247 shares outstanding, respectively) | 217 | 217 |
Additional paid-in capital | 1,032,739 | 1,118,326 |
Retained earnings | 5,078,983 | 4,356,835 |
Treasury stock (16,560,195 and 7,366,099 shares, respectively) | (1,147,967) | (544,772) |
Accumulated other comprehensive loss | (52,226) | (59,826) |
Total DaVita Inc. shareholders’ equity | 4,911,746 | 4,870,780 |
Noncontrolling interests not subject to put provisions | 207,645 | 213,392 |
Total equity | 5,119,391 | 5,084,172 |
Total liabilities and equity | $ 18,925,653 | $ 18,514,875 |
CONSOLIDATED BALANCE SHEETS (u5
CONSOLIDATED BALANCE SHEETS (unaudited) (Parenthetical) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 |
Statement Of Financial Position [Abstract] | ||
Accounts receivable, allowance | $ 251,593 | $ 264,144 |
Property and equipment, accumulated depreciation | 2,728,217 | 2,397,007 |
Intangible assets, accumulated amortization | $ 895,034 | $ 770,691 |
Preferred stock, par value | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized | 5,000,000 | 5,000,000 |
Preferred stock, issued | 0 | 0 |
Common stock, par value | $ 0.001 | $ 0.001 |
Common stock, shares authorized | 450,000,000 | 450,000,000 |
Common stock, shares issued | 217,338,629 | 217,120,346 |
Common stock, shares outstanding | 200,778,434 | 209,754,247 |
Treasury stock, shares | 16,560,195 | 7,366,099 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($) $ in Thousands | 9 Months Ended | |
Sep. 30, 2016 | Sep. 30, 2015 | |
Cash flows from operating activities: | ||
Net income | $ 844,812 | $ 392,936 |
Adjustments to reconcile net income to net cash provided by operating activities: | ||
Settlement charge | 495,000 | |
Settlement payments | (493,775) | |
Depreciation and amortization | 531,475 | 474,694 |
Debt redemption charges | 48,072 | |
Goodwill impairment charges | 253,000 | 4,065 |
Stock-based compensation expense | 29,817 | 42,794 |
Tax benefits from stock award exercises | 27,012 | 31,069 |
Excess tax benefits from stock award exercises | (12,584) | (19,555) |
Deferred income taxes | 48,778 | (1,994) |
Equity investment income, net | 16,825 | 10,563 |
Gain on changes in ownership interests, net | (404,165) | |
Other non-cash charges | 9,163 | 22,518 |
Changes in operating assets and liabilities, other than from acquisitions and divestitures: | ||
Accounts receivable | (85,660) | (178,148) |
Inventories | (13,045) | (35,856) |
Other receivables and other current assets | (1,616) | 54,924 |
Other long-term assets | 31,081 | 1,940 |
Accounts payable | (45,507) | 11,473 |
Accrued compensation and benefits | 79,289 | 123,081 |
Other current liabilities | 119,549 | 96,671 |
Income taxes | 65,164 | 35,282 |
Other long-term liabilities | (12,126) | 4,773 |
Net cash provided by operating activities | 1,481,262 | 1,120,527 |
Cash flows from investing activities: | ||
Additions of property and equipment | (575,243) | (462,213) |
Acquisitions | (497,331) | (90,709) |
Proceeds from asset and business sales | 18,991 | 6,865 |
Purchase of investments available for sale | (9,041) | (6,667) |
Purchase of investments held-to-maturity | (976,411) | (1,555,604) |
Proceeds from sale of investments available for sale | 8,636 | 1,961 |
Proceeds from investments held-to-maturity | 743,941 | 969,549 |
Purchase of intangible assets | (75) | |
Purchase of equity investments | (11,629) | (13,623) |
Proceeds from sale of equity investments | 40,920 | |
Distributions received on equity investments | 57 | |
Net cash used in investing activities | (1,257,242) | (1,150,384) |
Cash flows from financing activities: | ||
Borrowings | 39,102,302 | 41,371,392 |
Payments on long-term debt and other financing costs | (39,201,016) | (40,732,075) |
Deferred financing and debt redemption costs | (188) | (59,354) |
Purchase of treasury stock | (620,898) | (384,110) |
Distributions to noncontrolling interests | (145,072) | (125,938) |
Stock award exercises and other share issuances, net | 18,515 | 19,802 |
Excess tax benefits from stock award exercises | 12,584 | 19,555 |
Contributions from noncontrolling interests | 35,524 | 28,212 |
Purchase of noncontrolling interests | (9,727) | (23,605) |
Net cash (used in) provided by financing activities | (807,976) | 113,879 |
Effect of exchange rate changes on cash and cash equivalents | (1,664) | (1,844) |
Net (decrease) increase in cash and cash equivalents | (585,620) | 82,178 |
Cash and cash equivalents at beginning of the year | 1,499,116 | 965,241 |
Cash and cash equivalents at end of the period | $ 913,496 | $ 1,047,419 |
CONSOLIDATED STATEMENTS OF EQUI
CONSOLIDATED STATEMENTS OF EQUITY (unaudited) - USD ($) $ in Thousands | Total | Non- controlling Interests subject to put provisions | Common stock | Common stockRestricted Stock Units | Common stockStock Appreciation Rights | Additional paid-in capital | Additional paid-in capitalRestricted Stock Units | Additional paid-in capitalStock Appreciation Rights | Retained earnings | Treasury stock | Treasury stockRestricted Stock Units | Treasury stockStock Appreciation Rights | Accumulated other comprehensive(loss) | Total | Non-controlling interests not subject to put provisions |
Beginning Balance at Dec. 31, 2014 | $ 829,965 | $ 216 | $ 1,108,211 | $ 4,087,103 | $ (25,017) | $ 5,170,513 | $ 189,798 | ||||||||
Beginning Balance (in shares) at Dec. 31, 2014 | 215,641,000 | ||||||||||||||
Comprehensive income: | |||||||||||||||
Net income | 96,510 | 269,732 | 269,732 | 61,168 | |||||||||||
Other comprehensive income (loss) | (34,809) | (34,809) | |||||||||||||
Stock purchase shares issued | (6,079) | $ 30,608 | 24,529 | ||||||||||||
Stock purchase shares issued (in shares) | 414,000 | ||||||||||||||
Stock unit shares issued | $ 1 | $ (1) | |||||||||||||
Stock unit shares issued (in shares) | 348,000 | 1,131,000 | |||||||||||||
Stock-settled stock-based compensation expense | 56,899 | 56,899 | |||||||||||||
Excess tax benefits from stock awards exercised | 28,157 | 28,157 | |||||||||||||
Distributions to noncontrolling interests | (103,355) | (71,280) | |||||||||||||
Contributions from noncontrolling interests | 25,795 | 28,849 | |||||||||||||
Sales and assumptions of additional noncontrolling interests | 10,654 | 6,875 | |||||||||||||
Purchase of noncontrolling interests | (8,538) | (55,826) | (55,826) | (2,018) | |||||||||||
Changes in fair value of noncontrolling interests | 13,035 | (13,035) | (13,035) | ||||||||||||
Purchase of treasury stock | $ (575,380) | (575,380) | |||||||||||||
Purchase of treasury stock (in shares) | (7,780,000) | ||||||||||||||
Ending Balance at Dec. 31, 2015 | $ 5,084,172 | 864,066 | $ 217 | 1,118,326 | 4,356,835 | $ (544,772) | (59,826) | 4,870,780 | 213,392 | ||||||
Ending Balance (in shares) at Dec. 31, 2015 | 209,754,247 | 217,120,000 | (7,366,000) | ||||||||||||
Comprehensive income: | |||||||||||||||
Net income | 78,770 | 722,148 | 722,148 | 43,894 | |||||||||||
Other comprehensive income (loss) | $ 7,807 | 7,600 | 7,600 | 207 | |||||||||||
Stock unit shares issued | $ (19,815) | $ (33,077) | $ 19,815 | $ 33,077 | |||||||||||
Stock unit shares issued (in shares) | 219,000 | 276,000 | 460,000 | ||||||||||||
Stock-settled stock-based compensation expense | 29,336 | 29,336 | |||||||||||||
Excess tax benefits from stock awards exercised | 12,584 | 12,584 | |||||||||||||
Distributions to noncontrolling interests | (85,337) | (59,735) | |||||||||||||
Contributions from noncontrolling interests | 26,552 | 8,972 | |||||||||||||
Sales and assumptions of additional noncontrolling interests | 17,712 | 3,423 | 3,423 | 2,585 | |||||||||||
Purchase of noncontrolling interests | (2,922) | (5,135) | (5,135) | (1,670) | |||||||||||
Changes in fair value of noncontrolling interests | 72,903 | (72,903) | (72,903) | ||||||||||||
Purchase of treasury stock | $ (656,087) | $ (656,087) | (656,087) | ||||||||||||
Purchase of treasury stock (in shares) | (9,930,000) | (9,930,000) | |||||||||||||
Ending Balance at Sep. 30, 2016 | $ 5,119,391 | $ 971,744 | $ 217 | $ 1,032,739 | $ 5,078,983 | $ (1,147,967) | $ (52,226) | $ 4,911,746 | $ 207,645 | ||||||
Ending Balance (in shares) at Sep. 30, 2016 | 200,778,434 | 217,339,000 | (16,560,000) |
Condensed consolidated interim
Condensed consolidated interim financial statements | 9 Months Ended |
Sep. 30, 2016 | |
Accounting Policies [Abstract] | |
Condensed consolidated interim financial statements | 1. Condensed consolidated interim financial statements The condensed consolidated interim financial statements included in this report are prepared by the Company without audit. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, contingencies, impairments of goodwill and other long-lived assets, fair value estimates, accounting for income taxes, variable compensation accruals, consolidation of variable interest entities, purchase accounting valuation estimates, long-term incentive program compensation and medical liability claims. The results of operations for the nine months ended September 30, 2016 are not necessarily indicative of the operating results for the full year. The condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2015. Prior year balances and amounts have been reclassified to conform to the current year presentation. The Company has evaluated subsequent events through the date these condensed consolidated financial statements were issued and has included all necessary adjustments and disclosures. |
Earnings per share
Earnings per share | 9 Months Ended |
Sep. 30, 2016 | |
Earnings Per Share [Abstract] | |
Earnings per share | 2. Earnings per share Basic net income per share is calculated by dividing net income attributable to the Company, adjusted for any change in noncontrolling interests redemption rights in excess of fair value, by the weighted average number of common shares and vested stock units outstanding, net of shares held in escrow that under certain circumstances may be returned to the Company. Diluted net income per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units (under the treasury stock method) as well as contingently returnable shares held in escrow. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share are as follows: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 Basic: Net income attributable to DaVita Inc. $ 571,332 $ 215,872 $ 722,148 $ 275,732 Weighted average shares outstanding during the period 205,955 214,569 206,401 215,108 Contingently returnable shares held in escrow for the DaVita HealthCare Partners merger (2,194 ) (2,194 ) (2,194 ) (2,194 ) Weighted average shares for basic earnings per share calculation 203,761 212,375 204,207 212,914 Basic net income per share attributable to DaVita Inc. $ 2.80 $ 1.02 $ 3.54 $ 1.30 Diluted: Net income attributable to DaVita Inc. $ 571,332 $ 215,872 $ 722,148 $ 275,732 Weighted average shares outstanding during the period 205,955 214,569 206,401 215,108 Assumed incremental shares from stock plans 1,006 2,122 1,243 2,313 Weighted average shares for diluted earnings per share calculation 206,961 216,691 207,644 217,421 Diluted net income per share attributable to DaVita Inc. $ 2.76 $ 1.00 $ 3.48 $ 1.27 Anti-dilutive potential common shares excluded from calculation (1) 2,375 1,184 2,153 1,092 (1) |
Accounts receivable
Accounts receivable | 9 Months Ended |
Sep. 30, 2016 | |
Receivables [Abstract] | |
Accounts receivable | 3. Accounts receivable Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the ultimate collectability of accounts receivable, the Company analyzes its historical cash collection experience and trends for each of its government payors and commercial payors to estimate the adequacy of the allowance for doubtful accounts and the amount of the provision for uncollectible accounts. Management regularly updates its analysis based upon the most recent information available to determine its current provision for uncollectible accounts and the adequacy of its allowance for doubtful accounts. For receivables associated with dialysis patient services covered by Medicare, the Company receives 80% of the payment directly from Medicare as established under the government’s bundled payment system and determines an appropriate allowance for doubtful accounts and provision for uncollectible accounts on the remaining balance due depending upon the Company’s estimate of the amounts ultimately collectible from other secondary coverage sources or from the patients. For receivables associated with services to patients covered by commercial payors that are either based upon contractual terms or for non-contracted health plan coverage, the Company provides an allowance for doubtful accounts by recording a provision for uncollectible accounts based upon its historical collection experience, potential inefficiencies in its billing processes and for which collectability is determined to be unlikely. Approximately 1% of the Company’s net accounts receivable are associated with patient pay and it’s the Company’s policy to reserve 100% of the outstanding accounts receivable balances for dialysis services when those amounts due have been outstanding for more than three months and to reserve 100% of the outstanding accounts receivable balances for DMG’s services when those amounts due have been outstanding for more than twelve months. During the nine months ended September 30, 2016, the Company’s allowance for doubtful accounts decreased by $12,551. This was primarily due to a decrease in outstanding balances related to the U.S. dialysis and lab business as a result of an increase in write-offs of aged balances. There were no unusual transactions impacting the allowance for doubtful accounts. |
Investments in debt and equity
Investments in debt and equity securities | 9 Months Ended |
Sep. 30, 2016 | |
Investments Debt And Equity Securities [Abstract] | |
Investments in debt and equity securities | 4. Investments in debt and equity securities The Company classifies certain debt securities as held-to-maturity and records them at amortized cost based on the Company’s intentions and strategy concerning those investments. Equity securities that have readily determinable fair values, including those of mutual funds, common stock and other debt securities, are classified as available-for-sale and recorded at fair value. The Company’s investments in these securities consist of the following: September 30, 2016 December 31, 2015 Held to Available Held to Available maturity for sale Total maturity for sale Total Certificates of deposit, commercial paper and money market funds due within one year $ 647,885 $ — $ 647,885 $ 406,884 $ — $ 406,884 Investments in mutual funds, debt securities and common stock — 53,259 53,259 — 33,482 33,482 $ 647,885 $ 53,259 $ 701,144 $ 406,884 $ 33,482 $ 440,366 Short-term investments $ 647,885 $ 11,593 $ 659,478 $ 406,884 $ 1,200 $ 408,084 Long-term investments — 41,666 41,666 — 32,282 32,282 $ 647,885 $ 53,259 $ 701,144 $ 406,884 $ 33,482 $ 440,366 The cost of the certificates of deposit, commercial paper and money market funds at September 30, 2016 and December 31, 2015 approximates their fair value. As of September 30, 2016 and December 31, 2015, the available-for-sale investments included $4,934 and $2,589 of gross pre-tax unrealized gains, respectively. During the nine months ended September 30, 2016, the Company recorded gross pre-tax unrealized gains of $2,578, or $1,781 after tax, in other comprehensive income associated with changes in the fair value of these investments. During the nine months ended September 30, 2016, the Company sold investments in mutual funds and debt securities for net proceeds of $4,645 and recognized a pre-tax gain of $233, or $143 after-tax, which was previously recorded in other comprehensive income. During the nine months ended September 30, 2015, the Company sold investments in mutual funds and common stock for net proceeds of $1,961 and recognized a pre-tax gain of $617, or $376 after-tax, which was previously recorded in other comprehensive income. The investments in mutual funds classified as available-for-sale are held within a trust to fund existing obligations associated with several of the Company’s non-qualified deferred compensation plans. Certain DaVita Medical Group (DMG, formerly known as HealthCare Partners or HCP) legal entities are required to maintain minimum cash balances in order to comply with regulatory requirements in conjunction with medical claim reserves. As of September 30, 2016, this minimum cash balance was approximately $58,127. |
Equity Investments
Equity Investments | 9 Months Ended |
Sep. 30, 2016 | |
Investments Debt And Equity Securities [Abstract] | |
Equity Investments | 5. Equity investments Equity investments that do not have readily determinable fair values are carried on the cost or equity method, as applicable. The Company maintains equity method investments in unconsolidated investees in both its Kidney Care and DMG lines of business, as well as minor cost method investments in private securities of certain other healthcare businesses. The Company classifies its non-marketable cost- or equity-method investments as equity investments on its balance sheet. As described in Note 15, the Company deconsolidated its Asia Pacific dialysis business (APAC JV) effective as of August 1, 2016, adjusted its retained investment in the APAC JV to estimated fair value at that time, and has accounted for this retained investment on the equity method since August 1, 2016. |
Goodwill
Goodwill | 9 Months Ended |
Sep. 30, 2016 | |
Goodwill And Intangible Assets Disclosure [Abstract] | |
Goodwill | 6 . Goodwill Changes in goodwill by reportable segments were as follows: Other-ancillary U.S. dialysis and services and related lab services DMG strategic initiatives Consolidated total Balance at January 1, 2015 $ 5,610,643 $ 3,562,534 $ 242,118 $ 9,415,295 Acquisitions 21,910 29,910 45,273 97,093 Divestitures (3,370 ) (5,411 ) — (8,781 ) Goodwill impairment charges — (188,769 ) (4,065 ) (192,834 ) Foreign currency and other adjustments — — (16,294 ) (16,294 ) Balance at December 31, 2015 $ 5,629,183 $ 3,398,264 $ 267,032 $ 9,294,479 Acquisitions 52,792 248,901 70,116 371,809 Divestitures (4,222 ) (2,223 ) (29,374 ) (35,819 ) Goodwill impairment charges — (253,000 ) — (253,000 ) Foreign currency and other adjustments — — 5,527 5,527 Balance at September 30, 2016 $ 5,677,753 $ 3,391,942 $ 313,301 $ 9,382,996 Each of the Company’s operating segments described in Note 18 to these condensed consolidated financial statements represents an individual reporting unit for goodwill impairment testing purposes, except that each sovereign jurisdiction within the Company’s international operating segments is considered a separate reporting unit. Within the U.S. dialysis and related lab services operating segment, the Company considers each of its dialysis centers to constitute an individual business for which discrete financial information is available. However, since these dialysis centers have similar operating and economic characteristics, and the allocation of resources and significant investment decisions concerning these businesses are highly centralized and the benefits broadly distributed, the Company has aggregated these centers and deemed them to constitute a single reporting unit. The Company has applied a similar aggregation to the DMG operations in each region, to the vascular access service centers in its vascular access services reporting unit, to the physician practices in its physician services reporting unit, and to the dialysis centers within each international reporting unit. For the Company’s other operating segments, no component below the operating segment level is considered a discrete business and therefore these operating segments directly constitute individual reporting units. During the fourth quarter of 2015, the Company recognized $206,169 in goodwill and other intangible asset impairment charges on certain DMG reporting units based on assessments performed after circumstances indicated it had become more likely than not that the goodwill of certain DMG reporting units had become impaired. These circumstances included underperformance of the business in recent quarters, as well as changes in other market conditions, including government reimbursement cuts and the Company’s expected ability to mitigate them. Based on continuing developments at the Company’s DMG reporting units during 2016, including the Medicare Advantage final benchmark rates for 2017 announced on April 4, 2016, further changes in expectations concerning future government reimbursement rates and the Company’s expected ability to mitigate them, as well as medical cost and utilization trends, underperformance of certain at-risk units in recent quarters and other market conditions, the Company performed additional impairment assessments for certain at-risk DMG reporting units during each of the first three quarters of 2016. As a result of these assessments, the Company recognized additional goodwill impairment charges of $77,000 for its DMG Nevada reporting unit during the quarter ended March 31, 2016, and impairment charges of $79,000 for its DMG Nevada reporting unit and $97,000 for its DMG Florida reporting unit during the quarter ended June 30, 2016, for a total of $253,000 in goodwill impairment charges for its DMG reporting units during the nine months ended September 30, 2016. The Company’s DMG Nevada, DMG Florida, DMG Colorado Springs and Lifeline vascular access reporting units are at risk of goodwill impairment. As of September 30, 2016, these reporting units have goodwill amounts of $261,204, $442,835, $16,897 and $63,111, respectively. As of September 30, 2016, the latest estimated fair values of the DMG Nevada, DMG Florida, DMG Colorado Springs and Lifeline vascular access reporting units (fell short of) exceeded their total carrying amounts by approximately (27.8)%, (1.5)%, 15.4% and 14.0%, respectively. For the Company’s at-risk DMG reporting units, further reductions in reimbursement rates, increases in medical cost or utilization trends, or other significant adverse changes in expected future cash flows or valuation assumptions could result in further goodwill impairment charges in the future. For example, a sustained, long-term reduction of 3% in operating income for DMG Nevada or DMG Florida could reduce their estimated fair values by up to 2.5% and 1.9%, respectively. Separately, an increase in their respective discount rates of 100 basis points could reduce the estimated fair values of DMG Nevada and DMG Florida by up to 5.5% and 4.9%, respectively. Similarly, a long-term reduction of 3% in operating income or, separately, an increase in the discount rate of 100 basis points could reduce the estimated fair value of Lifeline vascular access by up to 2.6% and 5.0%. Except as described above, none of the Company’s various other reporting units were considered at risk of goodwill impairment as of September 30, 2016. Since the dates of the Company’s last annual goodwill impairment tests, there have been certain developments, events, changes in operating performance and other changes in key circumstances that have affected the Company’s businesses. However, except as further described above, these did not cause management to believe it is more likely than not that the fair value of any of its reporting units would be less than their carrying amounts. |
Health care costs payable
Health care costs payable | 9 Months Ended |
Sep. 30, 2016 | |
Health Care Organizations [Abstract] | |
Health care costs payable | 7 . Health care costs payable The following table includes estimates for the cost of professional medical services provided by non-employed physicians and other providers, as well as inpatient and other ancillary costs for all markets other than California. The Company does not include inpatient and other ancillary costs for contracts held by its California licensed health plan and for contracts held by its California medical group entities; only professional medical services are included as state regulation does not allow those medical group entities to assume risk for inpatient services. Health care costs payable are included in medical payables in the condensed consolidated balance sheet. The following table shows the components of changes in health care costs payable for the nine months ended September 30, 2016: Nine months ended September 30, 2016 Health care costs payable, beginning of the period $ 212,641 Add: Components of incurred health care costs Current year 1,261,046 Prior years 2,142 Total incurred health care costs 1,263,188 Less: Claims paid Current year 1,061,880 Prior years 199,015 Total claims paid 1,260,895 Health care costs payable, end of the period $ 214,934 The Company’s prior year estimates of health care costs payable increased by $2,142 resulting from certain medical claims being settled for amounts more than originally estimated. When significant increases (decreases) in prior-year health care cost estimates occur that the Company believes significantly impacts its current year operating results, the Company discloses that amount as unfavorable (favorable) development of prior-year’s health care cost estimates. Actual claim payments for prior year services have not been materially different from the Company’s year-end estimates. |
Income taxes
Income taxes | 9 Months Ended |
Sep. 30, 2016 | |
Income Tax Disclosure [Abstract] | |
Income taxes | 8 . Income taxes As of September 30, 2016, the Company’s total liability for unrecognized tax benefits relating to tax positions that do not meet the more-likely-than-not threshold was $24,214, all of which would impact the Company’s effective tax rate if recognized. This balance represents a decrease of $14,797 from the December 31, 2015 balance of $39,011, primarily due to the positive settlement of an IRS audit. The Company recognizes accrued interest and penalties related to unrecognized tax benefits in its income tax expense. At September 30, 2016 and December 31, 2015, the Company had approximately $3,763 and $9,918, respectively, accrued for interest and penalties related to unrecognized tax benefits, net of federal tax benefits. |
Long-term debt
Long-term debt | 9 Months Ended |
Sep. 30, 2016 | |
Debt Disclosure [Abstract] | |
Long-term debt | 9 . Long-term debt Long-term debt was comprised of the following: September 30, December 31, 2016 2015 Senior secured credit facilities: Term Loan A $ 881,250 $ 925,000 Term Loan B 3,421,250 3,447,500 Senior notes 4,500,000 4,500,000 Acquisition obligations and other notes payable 111,407 70,645 Capital lease obligations 294,746 283,185 Total debt principal outstanding 9,208,653 9,226,330 Discount and deferred financing costs (83,887 ) (95,985 ) 9,124,766 9,130,345 Less current portion (152,764 ) (129,037 ) $ 8,972,002 $ 9,001,308 Scheduled maturities of long-term debt at September 30, 2016 were as follows: 2016 (remainder of the year) 40,607 2017 154,000 2018 167,798 2019 743,687 2020 68,156 2021 3,299,551 Thereafter 4,734,854 During the first nine months of 2016, the Company made mandatory principal payments under its senior secured credit facilities totaling $43,750 on the Term Loan A and $26,250 on the Term Loan B. On September 30, 2016, the Company’s interest rate swap agreements expired. The Company had entered into several interest rate swap agreements as a means of hedging its exposure to and volatility from variable-based interest rate changes as part of its overall interest rate risk management strategy. These agreements were not held for trading or speculative purposes and had the economic effect of converting the LIBOR variable component of the Company’s interest rate to a fixed rate. These swap agreements were designated as cash flow hedges, and as a result, hedge-effective gains or losses resulting from changes in the fair values of these swaps were reported in other comprehensive income until such time as the hedged forecasted cash flows occurred, at which time the amounts were reclassified into net income. Net amounts paid or received for each specific swap tranche that have settled have been reflected as adjustments to debt expense. In addition, the Company has entered into several active and forward interest rate cap agreements that have the economic effect of capping the Company’s maximum exposure to LIBOR variable interest rate changes on specific portions of the Company’s floating rate debt, as described below. The cap agreements are also designated as cash flow hedges and, as a result, changes in the fair values of these cap agreements are reported in other comprehensive income. The amortization of the original cap premium is recognized as a component of debt expense on a straight-line basis over the term of the cap agreements. The swap and cap agreements do not contain credit-risk contingent features. The interest rate swap agreements that were in effect during the nine months ended September 30, 2016 had the economic effect of modifying the LIBOR variable component of the Company’s interest rate on an equivalent amount of the Company’s Term Loan A to fixed rates ranging from 0.49% to 0.52%. The Term Loan A debt bears interest at LIBOR plus an interest rate margin of 1.75%. The swap agreements required monthly interest payments. During the nine months ended September 30, 2016, the Company recognized debt expense of $299 from these swaps. During the nine months ended September 30, 2016, the Company recorded a loss of $815 in other comprehensive income due to a decrease in the unrealized fair value of these swap agreements. As of September 30, 2016, the Company maintains several interest rate cap agreements that were entered into in November 2014 with notional amounts totaling $3,500,000. These previously forward cap agreements became effective September 30, 2016 and have the economic effect of capping the LIBOR variable component of the Company’s interest rate at a maximum of 3.50% on an equivalent amount of the Company’s debt. The cap agreements expire on June 30, 2018. As of September 30, 2016, the total fair value of these cap agreements was an asset of approximately $22. During the nine months ended September 30, 2016, the Company recorded a loss of $1,289 As of September 30, 2016, the Company also maintains several forward interest rate cap agreements that were entered into in October 2015 with notional amounts totaling $3,500,000. These forward cap agreements will become effective June 29, 2018 and will have the economic effect of capping the LIBOR variable component of the Company’s interest rate at a maximum of 3.50% on an equivalent amount of its debt. These cap agreements expire on June 30, 2020. As of September 30, 2016, the total fair value of these cap agreements was an asset $ $ decrease On September 30, 2016, the Company’s interest rate cap agreements with notional amounts totaling $2,735,000 on Term Loan B debt expired. During the nine months ended September 30, 2016, these agreements had the economic effect of capping the LIBOR variable component of the Company’s interest rate at a maximum of 2.50% on an equivalent amount of the Company’s Term Loan B. During the nine months ended September 30, 2016, the Company recognized debt expense of $1,829 from these caps. The following table summarizes the Company’s derivative instruments as of September 30, 2016 and December 31, 2015: September 30, 2016 December 31, 2015 Derivatives designated as hedging instruments Balance sheet location Fair value Balance sheet location Fair value Interest rate swap agreements Other short-term liabilities $ — Other short-term assets $ 516 Interest rate cap agreements Other long-term assets $ 2,453 Other long-term assets $ 15,127 The following table summarizes the effects of the Company’s interest rate swap and cap agreements for the three and nine months ended September 30, 2016 and 2015: Amount of gains (losses) Amount of losses recognized in OCI on interest reclassified from rate swap and cap agreements Location of accumulated OCI into income Three months ended Nine months ended losses reclassified Three months ended Nine months ended September 30, September 30, from accumulated September 30, September 30, Derivatives designated as cash flow hedges 2016 2015 2016 2015 OCI into income 2016 2015 2016 2015 Interest rate swap agreements $ 45 $ (1,128 ) $ (815 ) $ (4,798 ) Debt expense $ (25 ) $ (655 ) $ (299 ) $ (2,061 ) Interest rate cap agreements (300 ) (1,909 ) (12,674 ) (11,715 ) Debt expense (609 ) (609 ) (1,829 ) (1,829 ) Tax benefit 102 1,186 5,251 6,449 246 493 827 1,518 Total $ (153 ) $ (1,851 ) $ (8,238 ) $ (10,064 ) $ (388 ) $ (771 ) $ (1,301 ) $ (2,372 ) As of September 30, 2016, the interest rate on the Company’s Term Loan B debt is effectively fixed subject to an embedded LIBOR floor which is higher than actual LIBOR as of such date. The Term Loan B is also subject to interest rate caps if LIBOR should rise above 3.50%. See above for further details. The Term Loan A bears interest at LIBOR plus an interest rate margin of 1.75%. The capped portion of the Term Loan A is $78,750. In addition, the uncapped portion of the Term Loan A, which is subject to the variability of LIBOR, is $802,500. Interest rates on the Company’s senior notes are fixed by their terms. As a result of an embedded LIBOR floor on the Term Loan B debt agreement and the cap agreements, the Company’s overall weighted average effective interest rate on the senior secured credit facilities was 3.61%, based on the current margins in effect of 1.75% for the Term Loan A and 2.75% for the Term Loan B, as of September 30, 2016. The Company’s overall weighted average effective interest rate during the quarter ended September 30, 2016 was 4.42% and as of September 30, 2016 was 4.49%. As of September 30, 2016, the Company’s interest rates are fixed on approximately 52.8% of its total debt. As of September 30, 2016, the Company had undrawn revolving credit facilities totaling $ , |
Contingencies
Contingencies | 9 Months Ended |
Sep. 30, 2016 | |
Commitments And Contingencies Disclosure [Abstract] | |
Contingencies | 10 . Contingencies The majority of the Company’s revenues are from government programs and may be subject to adjustment as a result of (i) examination by government agencies or contractors, for which the resolution of any matters raised may take extended periods of time to finalize; (ii) differing interpretations of government regulations by different Medicare contractors or regulatory authorities; (iii) differing opinions regarding a patient’s medical diagnosis or the medical necessity of services provided; and (iv) retroactive applications or interpretations of governmental requirements. In addition, the Company’s revenues from commercial payors may be subject to adjustment as a result of potential claims for refunds, as a result of government actions, or as a result of other claims by commercial payors. Inquiries by the Federal Government and Certain Related Civil Proceedings Vainer Private Civil Suit 2011 U.S. Attorney Medicaid Investigation Swoben Private Civil Suit qui tam qui tam 2015 U.S. Attorney Transportation Investigation 2015 U.S. OIG Medicare Advantage Civil Investigation In addition to the subpoena described above, in June 2015, the Company received a subpoena from the OIG. This civil subpoena covers the period from January 1, 2008 through the present and seeks production of a wide range of documents relating to the Company’s and its subsidiaries’ (including DMG’s and its subsidiary JSA’s) provision of services to Medicare Advantage plans and related patient diagnosis coding and risk adjustment submissions and payments. The Company believes that the request is part of a broader industry investigation into Medicare Advantage patient diagnosis coding and risk adjustment practices and potential overpayments by the government. The information requested includes information relating to patient diagnosis coding practices for a number of conditions, including potentially improper historical DMG coding for a particular condition. With respect to that condition, the guidance related to that coding issue was discontinued following the Company’s November 1, 2012 acquisition of DMG, and the Company notified CMS in April 2015 of the coding practice and potential overpayments. In that regard, the Company has identified certain additional coding practices which may have been problematic and is in discussions with the DOJ about the scope and nature of a review of claims relating to those practices. The Company is cooperating with the government and is producing the requested information. In addition, the Company is continuing to review other DMG coding practices to determine whether there were any improper coding issues. In connection with the DMG merger, the Company has certain indemnification rights against the sellers and an escrow was established as security for the indemnification. The Company has submitted an indemnification claim against the sellers secured by the escrow for any and all liabilities incurred relating to these matters and intends to pursue recovery from the escrow. However, the Company can make no assurances that the indemnification and escrow will cover the full amount of the Company’s potential losses related to these matters. 2015 U.S. Department of Justice Vascular Access Investigation and Related Qui Tam Litigation vascular access management services for dialysis patients 2016 U.S. Attorney Prescription Drug Investigation Solari Post-Acquisition Matter OIG for HHS that 16,000 Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved, it is not unusual for inquiries such as these to continue for a considerable period of time through the various phases of document and witness requests and on-going discussions with regulators. In addition to the inquiries and proceedings specifically identified above, the Company is frequently subject to other inquiries by state or federal government agencies and/or private civil qui tam complaints filed by relators. Responding to subpoenas or government inquiries and defending the Company in relator proceedings has required and will continue to require management’s attention and significant legal expense. Any negative findings in any government inquiries or relator proceedings could result in substantial financial penalties or awards against the Company, exclusion from future participation in the Medicare and Medicaid programs and if criminal proceedings were initiated against the Company, possible criminal penalties. At this time, the Company cannot predict the ultimate outcome of these inquiries, or the potential outcome of the relators’ claims (except as described above), or the potential range of damages, if any. Shareholder Derivative Claims DaVita HealthCare Partners Inc. Derivative Litigation Other The Company received several notices of claims from commercial payors and other third parties related to historical billing practices and claims against DVA Renal Healthcare (formerly known as Gambro Healthcare), a subsidiary of the Company, related to historical Gambro Healthcare billing practices and other matters covered by its 2004 settlement agreement with the DOJ and certain agencies of the U.S. government. The Company has not received any further indication that any of these claims are active, except for one payor claim relating to a special needs plan, and some of the other claims may be barred by applicable statutes of limitations. The Company is working to resolve the one active claim of which it is aware and, based on the dollar amount of the claim, expects that its eventual resolution will involve an amount that is immaterial. In addition to the foregoing, the Company is subject to claims and suits, including from time to time, contractual disputes and professional and general liability claims, as well as audits and investigations by various government entities, in the ordinary course of business. The Company believes that the ultimate resolution of any such pending proceedings, whether the underlying claims are covered by insurance or not, will not have a material adverse effect on its financial condition, results of operations or cash flows. From time to time, the Company initiates litigation as a plaintiff arising out of contracts or other matters. In that regard, the Company has a pending lawsuit in the U.S. Court of Federal Claims against the federal government which was originally filed in May 2011. The lawsuit relates to the U.S. Department of Veterans Affairs (VA) underpayment of dialysis services the Company provided to veterans pursuant to VA regulations. This lawsuit is scheduled for trial in early 2017. Although the Company seeks damages, there can be no assurances on the outcome of this matter, including whether the Company will recover monetary damages of any amount. |
Noncontrolling interests subjec
Noncontrolling interests subject to put provisions and other commitments | 9 Months Ended |
Sep. 30, 2016 | |
Accounting Policies [Abstract] | |
Noncontrolling interests subject to put provisions and other commitments | 1 1 . Noncontrolling interests subject to put provisions and other commitments The Company has potential obligations to purchase the noncontrolling interests held by third parties in several of its majority-owned partnerships, non-owned legal entities, and minority-owned legal entities. These obligations are in the form of put provisions and are exercisable at the third-party owners’ discretion within specified periods as outlined in each specific put provision. If these put provisions were exercised, the Company would be required to purchase the third-party owners’ noncontrolling interests at either the appraised fair market value or a predetermined multiple of earnings or cash flow attributable to the noncontrolling interests put to the Company, which is intended to approximate fair value. The methodology the Company uses to estimate the fair values of noncontrolling interests subject to put provisions assumes the higher of either a liquidation value of net assets or an average multiple of earnings, based on historical earnings, patient mix and other performance indicators that can affect future results, as well as other factors. The estimated fair values of the noncontrolling interests subject to put provisions is a critical accounting estimate that involves significant judgments and assumptions and may not be indicative of the actual values at which the noncontrolling interests may ultimately be settled, which could vary significantly from the Company’s current estimates. The estimated fair values of noncontrolling interests subject to put provisions can fluctuate and the implicit multiple of earnings at which these noncontrolling interest obligations may be settled could vary significantly depending upon market conditions including potential purchasers’ access to the capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses, the economic performance of these businesses and the restricted marketability of the third-party owners’ noncontrolling interests. The amount of noncontrolling interests subject to put provisions that employ a contractually predetermined multiple of earnings rather than fair value are immaterial. The Company has certain other potential commitments to provide operating capital to several dialysis centers that are wholly-owned by third parties or businesses in which the Company maintains a noncontrolling equity interest as well as to physician-owned vascular access clinics or medical practices that the Company operates under management and administrative services agreements of approximately $14. Certain consolidated partnerships are originally contractually scheduled to dissolve after terms ranging from ten to fifty years. Accordingly, the noncontrolling interests in these partnerships are considered mandatorily redeemable instruments, for which the classification and measurement requirements have been indefinitely deferred. Future distributions upon dissolution of these entities would be valued below the related noncontrolling interest carrying balances in the consolidated balance sheet. |
Long-term incentive compensatio
Long-term incentive compensation | 9 Months Ended |
Sep. 30, 2016 | |
Disclosure Of Compensation Related Costs Sharebased Payments [Abstract] | |
Long-term incentive compensation | 1 2 . Long-term incentive compensation Long-term incentive program (LTIP) compensation includes both stock-based awards (principally stock-settled stock appreciation rights, restricted stock units, performance stock units, and cash-settled stock appreciation rights and restricted stock units) as well as long-term performance-based cash awards. Long-term incentive compensation expense, which was primarily general and administrative in nature, was attributed to the Company’s U.S. dialysis and related lab services business, DMG business, corporate administrative support, and the ancillary services and strategic initiatives. The Company’s stock-based compensation awards are measured at their estimated fair values on the date of grant if settled in shares or at their estimated fair values at the end of each reporting period if settled in cash. The value of stock-based awards so measured is recognized as compensation expense on a cumulative straight-line basis over the vesting terms of the awards, adjusted for expected forfeitures. During the nine months ended September 30, 2016, the Company granted 1,263 stock-settled stock appreciation rights with an aggregate grant-date fair value of $17,373 and a weighted average expected life of approximately 4.2 years, and also granted 227 stock-settled restricted stock units with an aggregate grant-date fair value of $17,008 and a weighted-average expected life of approximately 3.4 years. The Company also granted eight cash-settled stock appreciation rights and two cash-settled restricted stock units during the nine months ended September 30, 2016. For the nine months ended September 30, 2016 and 2015, the Company recognized $61,042 and $100,171, respectively, in total LTIP expense, of which $29,817 and $42,794, respectively, represented stock-based compensation expense for stock appreciation rights, stock units, and discounted employee stock plan purchases, which are primarily included in general and administrative expense. The estimated tax benefits recorded for stock-based compensation for the nine months ended September 30, 2016 and 2015 was $9,769 and $14,870, respectively. As of September 30, 2016, the Company had $108,551 of total estimated unrecognized compensation costs for outstanding LTIP awards, including $62,323 related to stock-based compensation arrangements under the Company’s equity compensation and stock purchase plans. The Company expects to recognize the performance-based cash component of these LTIP costs over a weighted average remaining period of 1.0 year and the stock-based component of these LTIP costs over a weighted average remaining period of 1.4 years. For the nine months ended September 30, 2016 and 2015, the Company received $27,012 and $31,069, respectively, in actual tax benefits upon the exercise of stock awards. |
Share repurchases
Share repurchases | 9 Months Ended |
Sep. 30, 2016 | |
Equity [Abstract] | |
Share Repurchases | 1 3 . Share repurchases During the nine months ended September 30, 2016, the Company repurchased a total of 9,930 shares of its common stock for $656,087, or an average price of $66.07 per share. The Company also repurchased 3,367 On July 13, 2016, the Company’s Board of Directors approved an additional share repurchase authorization in the amount of $1,240,748. This share repurchase approval is in addition to the $259,252 remaining at that time under the Company’s Board of Directors’ prior share repurchase authorization announced in April 2015. As a result of these transactions, the Company has a total of $881,040 available under the current Board repurchase authorization as of October 31, 2016. These share repurchase authorizations have no expiration dates. However, the Company remains subject to share repurchase limitations under the terms of its senior secured credit facilities and the indentures governing its senior notes. |
Comprehensive income
Comprehensive income | 9 Months Ended |
Sep. 30, 2016 | |
Statement Of Income And Comprehensive Income [Abstract] | |
Comprehensive income | 1 4 . Comprehensive income For the three months ended For the nine months ended September 30, 2016 September 30, 2016 Interest Foreign Accumulated Interest Foreign Accumulated rate swap currency other rate swap currency other and cap Investment translation comprehensive and cap Investment translation comprehensive agreements securities adjustments (loss) income agreements securities adjustments (loss) income Beginning balance $ (18,097 ) $ 1,986 $ (43,925 ) $ (60,036 ) $ (10,925 ) $ 1,361 $ (50,262 ) $ (59,826 ) Unrealized (losses) gains (255 ) 1,454 (951 ) 248 (13,489 ) 2,578 5,386 (5,525 ) Related income tax benefit (expense) 102 (391 ) — (289 ) 5,251 (797 ) — 4,454 (153 ) 1,063 (951 ) (41 ) (8,238 ) 1,781 5,386 (1,071 ) Reclassification from accumulated other comprehensive income into net income 634 (81 ) 7,513 8,066 2,128 (233 ) 7,513 9,408 Related income tax (expense) benefit (246 ) 31 — (215 ) (827 ) 90 — (737 ) 388 (50 ) 7,513 7,851 1,301 (143 ) 7,513 8,671 Ending balance $ (17,862 ) $ 2,999 $ (37,363 ) $ (52,226 ) $ (17,862 ) $ 2,999 $ (37,363 ) $ (52,226 ) For the three months ended For the nine months ended September 30, 2015 September 30, 2015 Interest Foreign Accumulated Interest Foreign Accumulated rate swap currency other rate swap currency other and cap Investment translation comprehensive and cap Investment translation comprehensive agreements securities adjustments income (loss) agreements securities adjustments (loss) income Beginning balance $ (8,407 ) $ 3,261 $ (39,233 ) $ (44,379 ) $ (1,795 ) $ 3,151 $ (26,373 ) $ (25,017 ) Unrealized (losses) gains (3,037 ) (2,325 ) (7,023 ) (12,385 ) (16,513 ) (1,864 ) (19,883 ) (38,260 ) Related income tax benefit (expense) 1,186 674 — 1,860 6,449 496 — 6,945 (1,851 ) (1,651 ) (7,023 ) (10,525 ) (10,064 ) (1,368 ) (19,883 ) (31,315 ) Reclassification from accumulated other comprehensive income into net income 1,264 (333 ) — 931 3,890 (617 ) — 3,273 Related income tax (expense) benefit (493 ) 130 — (363 ) (1,518 ) 241 — (1,277 ) 771 (203 ) — 568 2,372 (376 ) — 1,996 Ending balance $ (9,487 ) $ 1,407 $ (46,256 ) $ (54,336 ) $ (9,487 ) $ 1,407 $ (46,256 ) $ (54,336 ) The reclassification of net swap and cap realized losses into income are recorded as debt expense in the corresponding consolidated statements of income. See Note 9 to the condensed consolidated financial statements for further details. The reclassification of net investment realized gains into income are recorded in other income in the corresponding consolidated statements of income. See Note 4 to the condensed consolidated financial statements for further details. |
Acquisitions and Divestitures
Acquisitions and Divestitures | 9 Months Ended |
Sep. 30, 2016 | |
Business Combinations [Abstract] | |
Acquisitions and divestitures | 1 5 . Acquisitions and divestitures Change in ownership interests in Asia Pacific joint venture On August 1, 2016, the Company consummated an agreement with Khazanah Nasional Berhad (Khazanah) and Mitsui and Co., Ltd (Mitsui) whereby Khazanah and Mitsui, subscribed to invest a total of $300,000 over three years in exchange for a 40% total equity interest in the Company’s APAC JV. Khazanah and Mitsui each made related initial investments of $50,000 in this business on August 1, 2016. Based on the governance structure and voting rights put in place upon the formation of the APAC JV, certain key decisions affecting the JV’s operations are no longer at the unilateral discretion of the Company, but rather are shared with the noncontrolling investors. As a result, the Company deconsolidated its Asia Pacific dialysis business in the third quarter and recognized a non-cash non-taxable gain of $374,374 on its retained investment, net of contingent obligations. This retained interest was adjusted to the Company’s proportionate share of the estimated fair value of the business, as implied by the Khazanah and Mitsui investment and adjusted for certain time value of money and uncertainty discounts. Subsequent to the deconsolidation, the Company’s retained interest in the APAC JV is accounted for under the equity method. The calculation of the Company’s non-cash gain on its retained investment in the APAC JV is based upon the best information available to management and will be finalized when certain information arranged to be obtained has been received, including issuance of the final valuation report by an independent third party and certain post-closing adjustments subject to audit of the APAC JV’s financial statements. Sales of Effective June 30, 2016, the Company sold a portion of DMG’s ownership interest in the Tandigm Health (Tandigm) joint venture, reducing its ownership from fifty percent to nineteen percent and resulting in a gain of $40,280. In addition, on June 1, 2016, the Company sold its Acquisition of TEC On March 1, 2016, the Company completed its acquisition of The Everett Clinic (TEC) pursuant to an agreement and plan of merger dated November 23, 2015, whereby TEC became a 100% consolidated subsidiary of DMG. The total consideration paid at closing for all outstanding common units of TEC was approximately $393,687, net of cash acquired, plus the assumption of certain liabilities totaling approximately $7,284. The initial purchase price allocation for the acquisition of TEC is recorded at estimated fair values based upon the best information available to management and will be finalized when certain information arranged to be obtained has been received. The fair values of property and equipment and intangible assets were valued by an independent third party and are pending issuance of the final valuation report. Certain income tax amounts are pending issuance of final tax returns. The following table summarizes the assets acquired and liabilities assumed in this transaction and recognized at the acquisition date at their estimated fair values: Current assets, net of cash acquired $ 91,591 Property and equipment 108,533 Amortizable intangible and other long-term assets 34,050 Goodwill 244,502 Current liabilities assumed (50,940 ) Deferred income taxes (16,880 ) Noncontrolling interests assumed (9,885 ) Aggregate purchase price $ 400,971 Amortizable intangible assets acquired in this acquisition had a weighted average estimated useful life of six years. None of the goodwill recognized in this acquisition The noncontrolling interests assumed as part of the acquisition are stated at estimated fair value based on the estimated fair value of the underlying assets and liabilities of each non-wholly-owned entity. The operating results of TEC are included in the Company’s condensed consolidated financial statements from March 1, 2016. Other routine acquisitions During the nine months ended September 30, 2016, the Company acquired dialysis and other businesses consisting of four dialysis centers located in the U.S., 11 dialysis centers located outside the U.S., and five other medical businesses for a total of $103,644 in net cash and deferred purchase price obligations totaling $15,397. The assets and liabilities for all of these acquisitions were recorded at their estimated fair values at the dates of the acquisitions and are included in the Company’s condensed consolidated financial statements, as are their operating results, from the designated effective dates of the acquisitions. Certain income tax amounts are pending final evaluation and quantification of any pre-acquisition tax contingencies. In addition, valuation of medical claims liabilities and certain other working capital items relating to these acquisitions are pending final quantification. The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values: Current assets $ 1,762 Property and equipment 3,725 Amortizable intangible and other long-term assets 5,777 Goodwill 127,307 Deferred income taxes 597 Noncontrolling interests assumed (19,176 ) Liabilities assumed (951 ) Aggregate purchase price $ 119,041 Amortizable intangible assets acquired during the first nine months of 2016 had weighted-average estimated useful lives of seven years. The majority of the intangible assets acquired during the first months of 2016 relate to non-compete agreements having a weighted-average useful Pro forma financial information The following summary, prepared on a pro forma basis, combines the results of operations as if the acquisitions through September 30, 2016 had been consummated as of the beginning of 2016 and 2015, after including the impact of certain adjustments such as amortization of intangibles and income tax effects. Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 (unaudited) Pro forma net revenues $ 3,731,416 $ 3,660,885 $ 11,146,596 $ 10,678,870 Pro forma net income attributable to DaVita Inc. 571,529 224,808 736,453 306,096 Pro forma basic net income per share attributable to DaVita Inc. 2.80 1.06 3.61 1.44 Pro forma diluted net income per share attributable to DaVita Inc. 2.76 1.04 3.55 1.41 Other pending transactions On August 9, 2016, the Company entered into an amendment to its agreement to acquire Colorado-based Renal Ventures Limited, LLC (Renal Ventures). As a result of the amended agreement, the Company will acquire a 100 percent interest in all 38 outpatient dialysis centers owned by Renal Ventures, including one new center under construction, and a fifty-one percent interest in one vascular access clinic. The purchase price will be approximately $360,000 in cash, subject to, among other things, adjustments for certain items such as working capital. The transaction is subject to approval by the Federal Trade Commission (FTC), including Hart-Scott-Rodino antitrust clearance. The Company anticipates that it will be required by the FTC to divest certain outpatient dialysis centers as a condition of the transaction. The Company expects the transaction to close in early 2017. Contingent earn-out obligations The Company has several contingent earn-out obligations associated with acquisitions that could result in the Company paying the former owners of acquired companies a total of up to $95,804 if certain EBITDA, operating income performance targets or quality margins are met primarily over the next one to two years. Contingent earn-out obligations are remeasured to fair value at each reporting date until the contingencies are resolved with changes in the liability due to the re-measurement recorded in earnings. See Note 17 to these condensed consolidated financial statements for further details. As of September 30, 2016, the Company has estimated the fair value of these contingent earn-out obligations to be $14,198, of which a total of $12,836 is included in other liabilities and the remaining $1,362 is included in other long-term liabilities in the Company’s condensed consolidated balance sheet. The following is a reconciliation of changes in the contingent earn-out obligations for the nine months ended September 30, 2016: Beginning balance, January 1, 2016 $ 34,135 Remeasurement of fair value for contingent earn-out obligations (3,739 ) Payments on contingent earn-out obligations (16,198 ) $ 14,198 |
Variable interest entities
Variable interest entities | 9 Months Ended |
Sep. 30, 2016 | |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Variable interest entities | 16. Variable interest entities The Company relies on the operating activities of certain legal entities that it does not directly own or control, but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to the consolidation guidance applicable to variable interest entities (VIEs). Under U.S. generally accepted accounting principles (GAAP), VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The Company has determined that substantially all of the legal entities it is associated with that qualify as VIEs must be included in its consolidated financial statements. The Company manages these entities and provides operating and capital funding as necessary for these entities to accomplish their operational and strategic objectives. A number of these entities are subject to nominee ownership transfer restriction agreements that effectively transfer the majority of the economic risks and rewards of their ownership to the Company. In other cases, the Company’s management agreements with these entities include both financial terms and protective and participating rights to the entities’ operating, strategic and non-clinical governance decisions which transfer substantial powers over and economic responsibility for the entities to the Company. In some cases, such entities are subject to broad exclusivity or noncompetition restrictions that benefit the Company. Further, in some cases, the Company has contractual arrangements with the nominee owners that effectively indemnify these parties from the economic losses from, or entitle the Company to the economic benefits of, these entities. The analyses upon which these consolidation determinations rest are complex, involve uncertainties, and require significant judgment on various matters, some of which could be subject to different interpretations. At September 30, 2016, these condensed consolidated financial statements include total assets of VIEs of $727,656 and total liabilities and noncontrolling interests of VIEs to third parties of $427,583. The Company also sponsors certain deferred compensation plans whose trusts qualify as VIEs and the Company consolidates each of these plans as their primary beneficiary. The assets of these plans are recorded in short-term or long-term investments with matching offsetting liabilities recorded in accrued compensation and benefits and other long-term liabilities. See Note 4 for disclosures on the assets of these consolidated non-qualified deferred compensation plans. |
Fair value of financial instrum
Fair value of financial instruments | 9 Months Ended |
Sep. 30, 2016 | |
Fair Value Disclosures [Abstract] | |
Fair value of financial instruments | 1 7 . Fair value of financial instruments The Company measures the fair value of certain assets, liabilities and noncontrolling interests subject to put provisions (temporary equity) based upon certain valuation techniques that include observable or unobservable inputs and assumptions that market participants would use in pricing these assets, liabilities, temporary equity and commitments. The Company also has classified certain assets, liabilities and temporary equity that are measured at fair value into the appropriate fair value hierarchy levels as defined by the Financial Accounting Standards Board (FASB). The following table summarizes the Company’s assets, liabilities and temporary equity measured at fair value on a recurring basis as of September 30, 2016: Quoted prices in Significant active Significant other unobservable identical assets observable inputs Total (Level 1) (Level 2) (Level 3) Assets Available-for-sale securities $ 53,259 $ 53,259 $ — $ — Interest rate cap agreements $ 2,453 $ — $ 2,453 $ — Funds on deposit with third parties $ 76,773 $ 76,773 $ — $ — Liabilities Contingent earn-out obligations $ 14,198 $ — $ — $ 14,198 Temporary equity Noncontrolling interests subject to put provisions $ 971,744 $ — $ — $ 971,744 The available-for-sale securities represent investments in various open-ended registered investment companies, or mutual funds, and are recorded at estimated fair value based upon quoted prices reported by each mutual fund. See Note 4 to these condensed consolidated financial statements for further discussion. The interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 9 to the condensed consolidated financial statements for further discussion. The funds on deposit with third parties represent funds held with various third parties as required by regulation or contract and invested by those parties in various investments, which are measured at estimated fair value based primarily on quoted market prices. The estimated fair value measurements of contingent earn-out obligations are primarily based on unobservable inputs including projected EBITDA, estimated probability of achieving gross margins or quality margins of certain medical procedures and the estimated probability of earn-out payments being made using an option pricing technique and a simulation model for expected EBITDA and operating income. In addition, a probability adjusted model was used to estimate the fair value amounts of the quality margins. The estimated fair value of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company credit risk adjusted rate that is used to discount obligations to present value. See Note 11 to these condensed consolidated financial statements for a discussion of the Company’s methodology for estimating the fair value of noncontrolling interests subject to put obligations. Other financial instruments consist primarily of cash, accounts receivable, life insurance contracts, accounts payable, other accrued liabilities and debt. The balances of the non-debt financial instruments are presented in the consolidated financial statements at September 30, 2016 at their approximate fair values due to the short-term nature of their settlements. The carrying balance of the Company’s senior secured credit facilities totaled $4,302,500 as of September 30, 2016, and the fair value was approximately $4,344,000 based upon quoted market prices, a level 2 input. The carrying balance of the Company’s senior notes was $4,500,000 as of September 30, 2016 and their fair value was approximately $4,594,000, based upon quoted market prices, a level 2 input. |
Segment reporting
Segment reporting | 9 Months Ended |
Sep. 30, 2016 | |
Segment Reporting [Abstract] | |
Segment reporting | 1 8 . Segment reporting The Company operates two major divisions, DaVita Kidney Care (Kidney Care) and DaVita Medical Group (DMG). The Kidney Care division is comprised of the Company’s U.S. dialysis and related lab services business, various other ancillary services and strategic initiatives, including its international dialysis operations, and the Company’s corporate administrative support. The Company’s U.S. dialysis and related lab services business is its largest line of business, and is a leading provider of kidney dialysis services in the U.S. for patients suffering from chronic kidney failure, also known as ESRD. The Company’s DMG division is a patient- and physician-focused integrated health care delivery and management company with over two decades of providing coordinated outcomes-based medical care in a cost-effective manner. The Company’s ancillary services and strategic initiatives consist primarily of pharmacy services, disease management services, vascular access services, clinical research programs, physician services, direct primary care and the Company’s international dialysis operations. The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer. The Company’s separate operating segments include its U.S. dialysis and related lab services business, its DMG operations in each region, each of its ancillary services and strategic initiatives, and its consolidated international operations in the European and Middle Eastern, Latin America, and Asia Pacific markets, and under the Saudi Ministry of Health charter. The U.S. dialysis and related lab services business and the DMG business each qualify as separately reportable segments, and all of the other ancillary services and strategic initiatives operating segments, including the international operating segments, have been combined and disclosed in the other segments category. The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to allocate resources and assess the financial performance of the operating segments. For internal management reporting, segment operations include direct segment operating expenses but exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive based compensation of certain departments which provide support to all of the Company’s various operating lines of business. Corporate administrative support costs are reduced by internal management fees received from the Company’s ancillary lines of businesses. The following is a summary of segment net revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 Segment net revenues: U.S. dialysis and related lab services Patient service revenues: External sources $ 2,412,818 $ 2,287,329 $ 7,079,054 $ 6,679,251 Intersegment revenues 16,040 13,630 44,819 39,078 Total dialysis and related lab services revenues 2,428,858 2,300,959 7,123,873 6,718,329 Less: Provision for uncollectible accounts (109,299 ) (103,543 ) (320,565 ) (302,324 ) Net dialysis and related lab services patient service revenues 2,319,559 2,197,416 6,803,308 6,416,005 Other revenues (1) 3,912 3,490 12,134 10,214 Total net dialysis and related lab services revenues 2,323,471 2,200,906 6,815,442 6,426,219 DMG DMG revenues: Capitated revenues 846,245 906,478 2,586,383 2,587,545 Net patient service revenues 153,089 78,938 417,634 241,385 Other revenues (2) 28,728 15,536 72,354 66,124 Intersegment capitated and other revenues 75 84 189 96 Total net DMG revenues 1,028,137 1,001,036 3,076,560 2,895,150 Other—Ancillary services and strategic initiatives Net patient service revenues 57,498 41,858 165,742 116,535 Capitated revenues 23,045 20,369 67,780 56,007 Other external sources 314,540 275,210 948,847 793,511 Intersegment revenues 16,642 7,385 43,189 18,079 Total ancillary services and strategic initiatives revenues 411,725 344,822 1,225,558 984,132 Total net segment revenues 3,763,333 3,546,764 11,117,560 10,305,501 Elimination of intersegment revenues (32,757 ) (21,099 ) (88,197 ) (57,253 ) Consolidated net revenues $ 3,730,576 $ 3,525,665 $ 11,029,363 $ 10,248,248 Segment operating margin (loss): U.S. dialysis and related lab services $ 452,187 $ 461,899 $ 1,341,432 $ 795,255 DMG 33,094 82,562 (126,110 ) 215,192 Other—Ancillary services and strategic initiatives 361,903 (30,118 ) 338,159 (70,153 ) Total segment operating margin 847,184 514,343 1,553,481 940,294 Reconciliation of segment operating margin to consolidated income before income taxes: Corporate administrative support (3) (28,028 ) (4,975 ) (40,366 ) (14,534 ) Consolidated operating income 819,156 509,368 1,513,115 925,760 Debt expense (104,581 ) (103,481 ) (310,359 ) (305,121 ) Debt redemption and refinancing charges — — — (48,072 ) Other income, net 1,876 2,484 8,067 4,262 Consolidated income before income taxes $ 716,451 $ 408,371 $ 1,210,823 $ 576,829 (1) (2) (3) Depreciation and amortization expense by reportable segment is as follows: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 U.S. dialysis and related lab services $ 122,540 $ 111,828 $ 358,427 $ 326,281 DMG 52,595 43,523 153,068 129,890 Ancillary services and strategic initiatives 6,604 6,711 19,980 18,523 $ 181,739 $ 162,062 $ 531,475 $ 474,694 Summary of assets by reportable segment is as follows: September 30, December 31, 2016 2015 Segment assets U.S. dialysis and related lab services (including equity investments of $41,624 and $34,801, respectively) $ 11,460,732 $ 11,591,507 DMG (including equity investments of $11,293 and $22,714, respectively) 6,218,912 6,150,666 Other—Ancillary services and strategic initiatives (including equity investments of $463,466 and $20,853, respectively) 1,246,009 772,702 Consolidated assets $ 18,925,653 $ 18,514,875 Expenditures for property and equipment by reportable segment is as follows: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 U.S. dialysis and related lab services $ 182,741 $ 138,683 $ 467,121 $ 385,734 DMG 17,396 18,885 55,639 36,870 Ancillary services and strategic initiatives 16,479 13,772 52,483 39,609 $ 216,616 $ 171,340 $ 575,243 $ 462,213 |
Changes in DaVita Inc.'s owners
Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries | 9 Months Ended |
Sep. 30, 2016 | |
Noncontrolling Interest [Abstract] | |
Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries | 1 9 . Changes in DaVita Inc.’s ownership interest in consolidated subsidiaries The effects of changes in DaVita Inc.’s ownership interest on the Company’s equity are as follows: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 Net income attributable to DaVita Inc. $ 571,332 $ 215,872 $ 722,148 $ 275,732 Decrease in paid-in capital for the purchase of noncontrolling interests and adjustments to ownership interest (604 ) (12,094 ) (5,135 ) (20,515 ) Net transfers to noncontrolling interests (604 ) (12,094 ) (5,135 ) (20,515 ) Net income attributable to DaVita Inc., net of transfers to noncontrolling interests $ 570,728 $ 203,778 $ 717,013 $ 255,217 |
New accounting standards
New accounting standards | 9 Months Ended |
Sep. 30, 2016 | |
Accounting Changes And Error Corrections [Abstract] | |
New accounting standards | 20 . New accounting standards The Company adopted Accounting Standards Update (ASU) No. 2015-02, Consolidation (Topic 810): Amendments to the Consolidation Analysis The Company adopted ASU No. 2015-05, Customer’s Accounting for Fees Paid in a Cloud Computing Arrangement , Intangibles-Goodwill and Other-Internal-Use Software The Company adopted ASU No. 2015-16, Business Combinations (Topic 805): Simplifying the Accounting for Measurement-Period Adjustments . In October 2016, the FASB issued ASU No. 2016-17, Consolidation (Topic 810): Interests Held through Related Parties That Are under Common Control. In October 2016, the FASB issued ASU No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments In June 2016, the FASB issued ASU No. 2016-13, Financial Instrument – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. In March 2016, the FASB issued ASU No. 2016-09, Compensation – Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting In March 2016, the FASB issued ASU No. 2016-07, Investments – Equity Method and Joint Ventures (Topic 323): Simplifying the Transition to the Equity Method of Accounting. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) In January 2016, the FASB issued ASU No. 2016-01, Financial Statements – Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities. In July 2015, the FASB issued ASU No. 2015-11, Inventory (Topic 330): Simplifying the Measurement of Inventory. In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers Revenue from Contracts with Customers (Topic Revenue from Contracts with Customers (Topic 606) |
Condensed consolidating financi
Condensed consolidating financial statements | 9 Months Ended |
Sep. 30, 2016 | |
Condensed Financial Information Of Parent Company Only Disclosure [Abstract] | |
Condensed consolidating financial statements | 2 1 . Condensed consolidating financial statements The following information is presented in accordance with Rule 3-10 of Regulation S-X. The operating and investing activities of the separate legal entities included in the Company’s consolidated financial statements are fully interdependent and integrated. Revenues and operating expenses of the separate legal entities include intercompany charges for management and other administrative services. The Company’s senior notes are guaranteed by substantially all of its domestic subsidiaries. The subsidiary guarantors have guaranteed the senior notes on a joint and several basis. However, a subsidiary guarantor will be released from its obligations under its guarantee of the senior notes and the indentures governing the senior notes if, in general, there is a sale or other disposition of all or substantially all of the assets of such subsidiary guarantor, including by merger or consolidation, or a sale or other disposition of all of the equity interests in such subsidiary guarantor held by the Company and its restricted subsidiaries, as defined in the indentures; such subsidiary guarantor is designated by the Company as an unrestricted subsidiary, as defined in the indentures, or otherwise ceases to be a restricted subsidiary of the Company, in each case in accordance with the indentures; or such subsidiary guarantor no longer guarantees any other indebtedness, as defined in the indentures, of the Company or any of its restricted subsidiaries, except for guarantees that are contemporaneously released. The senior notes are not guaranteed by certain of the Company’s domestic subsidiaries, any of the Company’s foreign subsidiaries, or any entities that do not constitute subsidiaries within the meaning of the indentures, such as corporations in which the Company holds capital stock with less than a majority of the voting power, joint ventures and partnerships in which the Company holds less than a majority of the equity or voting interests, non-owned entities and third parties. Condensed Consolidating Statements of Income Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Patient services revenues $ — $ 1,726,892 $ 945,659 $ (42,890 ) $ 2,629,661 Less: Provision for uncollectible accounts — (73,833 ) (41,722 ) — (115,555 ) Net patient service revenues — 1,653,059 903,937 (42,890 ) 2,514,106 Capitated revenues — 462,436 406,894 (40 ) 869,290 Other revenues 191,815 509,867 46,185 (400,687 ) 347,180 Total net revenues 191,815 2,625,362 1,357,016 (443,617 ) 3,730,576 Operating expenses and charges 143,784 2,388,114 823,139 (443,617 ) 2,911,420 Operating income 48,031 237,248 533,877 — 819,156 Debt (expense) and refinancing charges (101,895 ) (91,716 ) (14,402 ) 103,432 (104,581 ) Other income, net 99,446 2,659 3,203 (103,432 ) 1,876 Income tax expense (20,898 ) (21,486 ) 146,685 — 104,301 Equity earnings in subsidiaries 504,852 335,175 — (840,027 ) — Net income 571,332 504,852 375,993 (840,027 ) 612,150 Less: Net income attributable to noncontrolling interests — — — (40,818 ) (40,818 ) Net income attributable to DaVita Inc. $ 571,332 $ 504,852 $ 375,993 $ (880,845 ) $ 571,332 Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Patient service revenues $ — $ 1,656,648 $ 795,325 $ (37,939 ) $ 2,414,034 Less: Provision for uncollectible accounts — (78,494 ) (30,958 ) — (109,452 ) Net patient service revenues — 1,578,154 764,367 (37,939 ) 2,304,582 Capitated revenues — 453,766 473,196 (115 ) 926,847 Other revenues 184,561 480,412 7,869 (378,606 ) 294,236 Total net revenues 184,561 2,512,332 1,245,432 (416,660 ) 3,525,665 Operating expenses 110,935 2,244,237 1,077,785 (416,660 ) 3,016,297 Operating income 73,626 268,095 167,647 — 509,368 Debt expense, including debt redemption charges (102,136 ) (83,037 ) (9,766 ) 91,458 (103,481 ) Other income 89,824 2,379 1,739 (91,458 ) 2,484 Income tax expense 25,368 112,310 9,386 — 147,064 Equity earnings in subsidiaries 179,926 104,799 — (284,725 ) — Net income 215,872 179,926 150,234 (284,725 ) 261,307 Less: Net income attributable to noncontrolling interests — — — (45,435 ) (45,435 ) Net income attributable to DaVita Inc. $ 215,872 $ 179,926 $ 150,234 $ (330,160 ) $ 215,872 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Patient services revenues $ — $ 5,044,565 $ 2,756,588 $ (123,100 ) $ 7,678,053 Less: Provision for uncollectible accounts — (207,144 ) (129,044 ) — (336,188 ) Net patient service revenues — 4,837,421 2,627,544 (123,100 ) 7,341,865 Capitated revenues — 1,391,010 1,263,404 (251 ) 2,654,163 Other revenues 575,700 1,518,407 122,509 (1,183,281 ) 1,033,335 Total net revenues 575,700 7,746,838 4,013,457 (1,306,632 ) 11,029,363 Operating expenses and charges 400,129 7,275,863 3,146,888 (1,306,632 ) 9,516,248 Operating income 175,571 470,975 866,569 — 1,513,115 Debt (expense) and refinancing charges (305,097 ) (275,148 ) (38,914 ) 308,800 (310,359 ) Other income, net 296,660 12,416 7,791 (308,800 ) 8,067 Income tax expense 56,190 140,972 168,849 — 366,011 Equity earnings in subsidiaries 611,204 543,933 — (1,155,137 ) — Net income 722,148 611,204 666,597 (1,155,137 ) 844,812 Less: Net income attributable to noncontrolling interests — — — (122,664 ) (122,664 ) Net income attributable to DaVita Inc. $ 722,148 $ 611,204 $ 666,597 $ (1,277,801 ) $ 722,148 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Patient service revenues $ — $ 4,901,959 $ 2,254,624 $ (107,155 ) $ 7,049,428 Less: Provision for uncollectible accounts — (212,816 ) (101,765 ) — (314,581 ) Net patient service revenues — 4,689,143 2,152,859 (107,155 ) 6,734,847 Capitated revenues — 1,340,838 1,302,862 (148 ) 2,643,552 Other revenues 542,412 1,360,261 21,547 (1,054,371 ) 869,849 Total net revenues 542,412 7,390,242 3,477,268 (1,161,674 ) 10,248,248 Operating expenses 363,347 7,042,896 3,077,919 (1,161,674 ) 9,322,488 Operating income 179,065 347,346 399,349 — 925,760 Debt expense, including debt redemption charges (347,719 ) (253,939 ) (30,532 ) 278,997 (353,193 ) Other income 271,847 6,780 4,632 (278,997 ) 4,262 Income tax expense 41,215 116,934 25,744 — 183,893 Equity earnings in subsidiaries 213,754 230,501 — (444,255 ) — Net income 275,732 213,754 347,705 (444,255 ) 392,936 Less: Net income attributable to noncontrolling interests — — — (117,204 ) (117,204 ) Net income attributable to DaVita Inc. $ 275,732 $ 213,754 $ 347,705 $ (561,459 ) $ 275,732 Condensed Consolidating Statements of Comprehensive Income Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 571,332 $ 504,852 $ 375,993 $ (840,027 ) $ 612,150 Other comprehensive income 1,248 — 6,620 — 7,868 Total comprehensive income 572,580 504,852 382,613 (840,027 ) 620,018 Less: Comprehensive income attributable to noncontrolling interest — — — (40,876 ) (40,876 ) Comprehensive income attributable to DaVita Inc. $ 572,580 $ 504,852 $ 382,613 $ (880,903 ) $ 579,142 Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 215,872 $ 179,926 $ 150,234 $ (284,725 ) $ 261,307 Other comprehensive loss (2,934 ) — (7,023 ) — (9,957 ) Total comprehensive income 212,938 179,926 143,211 (284,725 ) 251,350 Less: comprehensive income attributable to the noncontrolling interests — — — (45,435 ) (45,435 ) Comprehensive income attributable to DaVita Inc. $ 212,938 $ 179,926 $ 143,211 $ (330,160 ) $ 205,915 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 722,148 $ 611,204 $ 666,597 $ (1,155,137 ) $ 844,812 Other comprehensive loss (5,299 ) — 13,106 — 7,807 Total comprehensive income 716,849 611,204 679,703 (1,155,137 ) 852,619 Less: Comprehensive income attributable to noncontrolling interest — — — (122,871 ) (122,871 ) Comprehensive income attributable to DaVita Inc. $ 716,849 $ 611,204 $ 679,703 $ (1,278,008 ) $ 729,748 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 275,732 $ 213,754 $ 347,705 $ (444,255 ) $ 392,936 Other comprehensive loss (9,436 ) — (19,883 ) — (29,319 ) Total comprehensive income 266,296 213,754 327,822 (444,255 ) 363,617 Less: comprehensive income attributable to the noncontrolling interests — — — (117,204 ) (117,204 ) Comprehensive income attributable to DaVita Inc. $ 266,296 $ 213,754 $ 327,822 $ (561,459 ) $ 246,413 Condensed Consolidating Balance Sheets Non- Guarantor Guarantor Consolidating Consolidated As of September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Cash and cash equivalents $ 623,901 $ 35,769 $ 253,826 $ — $ 913,496 Accounts receivable, net — 1,174,364 676,061 — 1,850,425 Other current assets 661,642 745,238 90,558 — 1,497,438 Total current assets 1,285,543 1,955,371 1,020,445 — 4,261,359 Property and equipment, net 298,869 1,624,181 1,121,938 — 3,044,988 Intangible assets, net 553 1,537,645 37,959 — 1,576,157 Investments in subsidiaries 9,628,258 1,924,432 — (11,552,690 ) — Intercompany receivables 3,131,796 — 820,536 (3,952,332 ) — Other long-term assets and investments 40,574 55,069 564,510 — 660,153 Goodwill — 7,876,067 1,506,929 — 9,382,996 Total assets $ 14,385,593 $ 14,972,765 $ 5,072,317 $ (15,505,022 ) $ 18,925,653 Current liabilities $ 274,520 $ 1,842,058 $ 522,891 $ — $ 2,639,469 Intercompany payables — 2,264,044 1,688,288 (3,952,332 ) — Long-term debt and other long-term liabilities 8,589,682 1,238,405 366,962 — 10,195,049 Noncontrolling interests subject to put provisions 609,645 — — 362,099 971,744 Total DaVita Inc. shareholder's equity 4,911,746 9,628,258 1,924,432 (11,552,690 ) 4,911,746 Noncontrolling interests not subject to put provisions — — 569,744 (362,099 ) 207,645 Total equity 4,911,746 9,628,258 2,494,176 (11,914,789 ) 5,119,391 Total liabilities and equity $ 14,385,593 $ 14,972,765 $ 5,072,317 $ (15,505,022 ) $ 18,925,653 Non- Guarantor Guarantor Consolidating Consolidated As of December 31, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Cash and cash equivalents $ 1,186,636 $ 109,357 $ 203,123 $ — $ 1,499,116 Accounts receivable, net — 929,390 794,838 — 1,724,228 Other current assets 431,504 769,947 78,485 — 1,279,936 Total current assets 1,618,140 1,808,694 1,076,446 — 4,503,280 Property and equipment, net 268,066 1,575,890 944,784 — 2,788,740 Intangible assets, net 540 1,634,920 51,866 — 1,687,326 Investments in subsidiaries 8,893,079 1,597,185 — (10,490,264 ) — Intercompany receivables 3,474,133 — 701,814 (4,175,947 ) — Other long-term assets and investments 74,458 53,346 113,246 — 241,050 Goodwill — 7,834,257 1,460,222 — 9,294,479 Total assets $ 14,328,416 $ 14,504,292 $ 4,348,378 $ (14,666,211 ) $ 18,514,875 Current liabilities $ 185,217 $ 1,730,123 $ 483,798 $ — $ 2,399,138 Intercompany payables — 2,750,102 1,425,845 (4,175,947 ) — Long-term debt and other long-term liabilities 8,730,673 1,130,988 305,838 — 10,167,499 Noncontrolling interests subject to put provisions 541,746 — — 322,320 864,066 Total DaVita Inc. shareholders’ equity 4,870,780 8,893,079 1,597,185 (10,490,264 ) 4,870,780 Noncontrolling interests not subject to put provisions — — 535,712 (322,320 ) 213,392 Total equity 4,870,780 8,893,079 2,132,897 (10,812,584 ) 5,084,172 Total liabilities and equity $ 14,328,416 $ 14,504,292 $ 4,348,378 $ (14,666,211 ) $ 18,514,875 Condensed Consolidating Statements of Cash Flows Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Cash flows from operating activities: Net income $ 722,148 $ 611,204 $ 666,597 $ (1,155,137 ) $ 844,812 Changes in operating assets and liabilities and non-cash items included in net income (586,804 ) 228,991 (160,874 ) 1,155,137 636,450 Net cash provided by operating activities 135,344 840,195 505,723 — 1,481,262 Cash flows from investing activities: Additions of property and equipment, net (81,785 ) (248,339 ) (245,119 ) — (575,243 ) Acquisitions — (458,556 ) (38,775 ) — (497,331 ) Proceeds from asset and business sales — 24,608 (5,617 ) — 18,991 (Purchases) proceeds from investment sales and other items, net (236,150 ) (12,825 ) 45,316 — (203,659 ) Net cash used in investing activities (317,935 ) (695,112 ) (244,195 ) — (1,257,242 ) Cash flows from financing activities: Long-term debt and related financing costs, net (73,889 ) (20,684 ) (4,151 ) — (98,724 ) Intercompany borrowing (payments) 283,709 (188,247 ) (95,462 ) — — Other items (589,964 ) (9,740 ) (109,548 ) — (709,252 ) Net cash (used in) provided by financing activities (380,144 ) (218,671 ) (209,161 ) — (807,976 ) Effect of exchange rate changes on cash — — (1,664 ) — (1,664 ) Net (decrease) increase in cash and cash equivalents (562,735 ) (73,588 ) 50,703 — (585,620 ) Cash and cash equivalents at beginning of period 1,186,636 109,357 203,123 — 1,499,116 Cash and cash equivalents at end of period $ 623,901 $ 35,769 $ 253,826 $ — $ 913,496 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Cash flows from operating activities: Net income $ 275,732 $ 213,754 $ 347,705 $ (444,255 ) $ 392,936 Changes in operating assets and liabilities and non-cash items included in net income (187,876 ) 441,752 29,460 444,255 727,591 Net cash provided by operating activities 87,856 655,506 377,165 — 1,120,527 Cash flows from investing activities: Additions of property and equipment, net (39,448 ) (222,447 ) (200,318 ) — (462,213 ) Acquisitions — (73,339 ) (17,370 ) — (90,709 ) Proceeds from asset and business sales — 6,865 — — 6,865 (Purchases) proceeds from investment sales and other items, net (587,583 ) 1,513 (18,257 ) — (604,327 ) Net cash used in investing activities (627,031 ) (287,408 ) (235,945 ) — (1,150,384 ) Cash flows from financing activities: Long-term debt and related financing costs, net 661,260 (13,183 ) (8,760 ) — 639,317 Intercompany borrowing (payments) 304,623 (320,262 ) 15,639 — — Other items (404,107 ) (23,605 ) (97,726 ) — (525,438 ) Net cash provided by (used in) financing activities 561,776 (357,050 ) (90,847 ) — 113,879 Effect of exchange rate changes on cash — — (1,844 ) — (1,844 ) Net increase in cash and cash equivalents 22,601 11,048 48,529 — 82,178 Cash and cash equivalents at beginning of period 698,876 77,921 188,444 — 965,241 Cash and cash equivalents at end of period $ 721,477 $ 88,969 $ 236,973 $ — $ 1,047,419 |
Supplemental data
Supplemental data | 9 Months Ended |
Sep. 30, 2016 | |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Supplemental data | 22. Supplemental data The following information is presented as supplemental data as required by the indentures governing the Company’s senior notes. Condensed Consolidating Statements of Income Company and Consolidated Physician Unrestricted Restricted For the nine months ended September 30, 2016 Total Groups Subsidiaries Subsidiaries (1) Patient service operating revenues $ 7,678,053 $ 287,544 $ — $ 7,390,509 Less: Provision for uncollectible accounts (336,188 ) (9,178 ) — (327,010 ) Net patient service operating revenues 7,341,865 278,366 — 7,063,499 Capitated revenues 2,654,163 1,186,001 — 1,468,162 Other revenues 1,033,335 53,124 — 980,211 Total net operating revenues 11,029,363 1,517,491 — 9,511,872 Operating expenses 9,516,248 1,513,569 (129 ) 8,002,808 Operating income 1,513,115 3,922 129 1,509,064 Debt expense, including refinancing charges (310,359 ) (9,347 ) — (301,012 ) Other income 8,067 322 — 7,745 Income tax expense 366,011 10,442 52 355,517 Net income (loss) 844,812 (15,545 ) 77 860,280 Less: Net income attributable to noncontrolling interests (122,664 ) — — (122,664 ) Net income (loss) attributable to DaVita Inc. $ 722,148 $ (15,545 ) $ 77 $ 737,616 (1) Condensed Consolidating Statements of Comprehensive Income Company and Consolidated Physician Unrestricted Restricted For the nine months ended September 30, 2016 Total Groups Subsidiaries Subsidiaries (1) Net income (loss) $ 844,812 $ (15,545 ) $ 77 $ 860,280 Other comprehensive loss 7,807 — — 7,807 Total comprehensive income (loss) 852,619 (15,545 ) 77 868,087 Less: comprehensive income attributable to the noncontrolling interests (122,871 ) — — (122,871 ) Comprehensive income (loss) attributable to DaVita Inc. $ 729,748 $ (15,545 ) $ 77 $ 745,216 (1) Condensed Consolidating Balance Sheets Company and Consolidated Physician Unrestricted Restricted As of September 30, 2016 Total Groups Subsidiaries Subsidiaries (1) Cash and cash equivalents $ 913,496 $ 104,636 $ — $ 808,860 Accounts receivable, net 1,850,425 195,488 — 1,654,937 Other current assets 1,497,438 18,419 — 1,479,019 Total current assets 4,261,359 318,543 — 3,942,816 Property and equipment, net 3,044,988 1,417 — 3,043,571 Amortizable intangibles, net 1,576,157 5,141 — 1,571,016 Other long-term assets 660,153 77,681 2,696 579,776 Goodwill 9,382,996 16,405 — 9,366,591 Total assets $ 18,925,653 $ 419,187 $ 2,696 $ 18,503,770 Current liabilities $ 2,639,469 $ 229,515 $ — $ 2,409,954 Payables to parent — 86,335 2,696 (89,031 ) Long-term debt and other long-term liabilities 10,195,049 50,099 — 10,144,950 Noncontrolling interests subject to put provisions 971,744 — — 971,744 Total DaVita Inc. shareholders’ equity 4,911,746 53,238 — 4,858,508 Noncontrolling interests not subject to put provisions 207,645 — — 207,645 Shareholders’ equity 5,119,391 53,238 — 5,066,153 Total liabilities and shareholder’s equity $ 18,925,653 $ 419,187 $ 2,696 $ 18,503,770 (1) Condensed Consolidating Statements of Cash Flows Company and Consolidated Physician Unrestricted Restricted For the nine months ended September 30, 2016 Total Groups Subsidiaries Subsidiaries (1) Cash flows from operating activities: Net income (loss) $ 844,812 $ (15,545 ) $ 77 $ 860,280 Changes in operating and intercompany assets and liabilities and non-cash items included in net income 636,450 152,461 (77 ) 484,066 Net cash provided by operating activities 1,481,262 136,916 — 1,344,346 Cash flows from investing activities: Additions of property and equipment (575,243 ) (592 ) — (574,651 ) Acquisitions and divestitures, net (497,331 ) — — (497,331 ) Proceeds from discontinued operations 18,991 — — 18,991 Investments and other items (203,659 ) (2,124 ) — (201,535 ) Net cash used in investing activities (1,257,242 ) (2,716 ) — (1,254,526 ) Cash flows from financing activities: Long-term debt (98,724 ) (4 ) — (98,720 ) Intercompany — (117,805 ) — 117,805 Other items (709,252 ) — — (709,252 ) Net cash used in by financing activities (807,976 ) (117,809 ) — (690,167 ) Effect of exchange rate changes on cash (1,664 ) — — (1,664 ) Net decrease in cash (585,620 ) 16,391 — (602,011 ) Cash and cash equivalents at beginning of period 1,499,116 88,245 — 1,410,871 Cash and cash equivalents at end of period $ 913,496 $ 104,636 $ — $ 808,860 (1) |
Condensed consolidated interi30
Condensed consolidated interim financial statements (Policies) | 9 Months Ended |
Sep. 30, 2016 | |
Organization Consolidation And Presentation Of Financial Statements Disclosure [Line Items] | |
Condensed consolidated interim financial statements | The condensed consolidated interim financial statements included in this report are prepared by the Company without audit. In the opinion of management, all adjustments necessary for a fair presentation of the results of operations are reflected in these consolidated interim financial statements. All significant intercompany accounts and transactions have been eliminated. The preparation of these financial statements requires management to make estimates and assumptions that affect the reported amounts of assets, liabilities, revenues and expenses. The most significant estimates and assumptions underlying these financial statements and accompanying notes generally involve revenue recognition and accounts receivable, contingencies, impairments of goodwill and other long-lived assets, fair value estimates, accounting for income taxes, variable compensation accruals, consolidation of variable interest entities, purchase accounting valuation estimates, long-term incentive program compensation and medical liability claims. The results of operations for the nine months ended September 30, 2016 are not necessarily indicative of the operating results for the full year. The condensed consolidated interim financial statements should be read in conjunction with the audited consolidated financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2015. Prior year balances and amounts have been reclassified to conform to the current year presentation. The Company has evaluated subsequent events through the date these condensed consolidated financial statements were issued and has included all necessary adjustments and disclosures. |
Earnings per share | Basic net income per share is calculated by dividing net income attributable to the Company, adjusted for any change in noncontrolling interests redemption rights in excess of fair value, by the weighted average number of common shares and vested stock units outstanding, net of shares held in escrow that under certain circumstances may be returned to the Company. Diluted net income per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units (under the treasury stock method) as well as contingently returnable shares held in escrow. |
Accounts receivable | Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the ultimate collectability of accounts receivable, the Company analyzes its historical cash collection experience and trends for each of its government payors and commercial payors to estimate the adequacy of the allowance for doubtful accounts and the amount of the provision for uncollectible accounts. Management regularly updates its analysis based upon the most recent information available to determine its current provision for uncollectible accounts and the adequacy of its allowance for doubtful accounts. For receivables associated with dialysis patient services covered by Medicare, the Company receives 80% of the payment directly from Medicare as established under the government’s bundled payment system and determines an appropriate allowance for doubtful accounts and provision for uncollectible accounts on the remaining balance due depending upon the Company’s estimate of the amounts ultimately collectible from other secondary coverage sources or from the patients. For receivables associated with services to patients covered by commercial payors that are either based upon contractual terms or for non-contracted health plan coverage, the Company provides an allowance for doubtful accounts by recording a provision for uncollectible accounts based upon its historical collection experience, potential inefficiencies in its billing processes and for which collectability is determined to be unlikely. Approximately 1% of the Company’s net accounts receivable are associated with patient pay and it’s the Company’s policy to reserve 100% of the outstanding accounts receivable balances for dialysis services when those amounts due have been outstanding for more than three months and to reserve 100% of the outstanding accounts receivable balances for DMG’s services when those amounts due have been outstanding for more than twelve months. |
Income taxes | The Company recognizes accrued interest and penalties related to unrecognized tax benefits in its income tax expense. |
Long-term debt | On September 30, 2016, the Company’s interest rate swap agreements expired. The Company had entered into several interest rate swap agreements as a means of hedging its exposure to and volatility from variable-based interest rate changes as part of its overall interest rate risk management strategy. These agreements were not held for trading or speculative purposes and had the economic effect of converting the LIBOR variable component of the Company’s interest rate to a fixed rate. These swap agreements were designated as cash flow hedges, and as a result, hedge-effective gains or losses resulting from changes in the fair values of these swaps were reported in other comprehensive income until such time as the hedged forecasted cash flows occurred, at which time the amounts were reclassified into net income. Net amounts paid or received for each specific swap tranche that have settled have been reflected as adjustments to debt expense. In addition, the Company has entered into several active and forward interest rate cap agreements that have the economic effect of capping the Company’s maximum exposure to LIBOR variable interest rate changes on specific portions of the Company’s floating rate debt, as described below. The cap agreements are also designated as cash flow hedges and, as a result, changes in the fair values of these cap agreements are reported in other comprehensive income. The amortization of the original cap premium is recognized as a component of debt expense on a straight-line basis over the term of the cap agreements. The swap and cap agreements do not contain credit-risk contingent features. |
Long-term incentive compensation | The Company’s stock-based compensation awards are measured at their estimated fair values on the date of grant if settled in shares or at their estimated fair values at the end of each reporting period if settled in cash. The value of stock-based awards so measured is recognized as compensation expense on a cumulative straight-line basis over the vesting terms of the awards, adjusted for expected forfeitures. |
Comprehensive income | The reclassification of net swap and cap realized losses into income are recorded as debt expense in the corresponding consolidated statements of income. The reclassification of net investment realized gains into income are recorded in other income in the corresponding consolidated statements of income. |
Variable interest entities | The Company relies on the operating activities of certain legal entities that it does not directly own or control, but over which it has indirect influence and of which it is considered the primary beneficiary. These entities are subject to the consolidation guidance applicable to variable interest entities (VIEs). Under U.S. generally accepted accounting principles (GAAP), VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The analyses upon which these consolidation determinations rest are complex, involve uncertainties, and require significant judgment on various matters, some of which could be subject to different interpretations. The Company also sponsors certain deferred compensation plans whose trusts qualify as VIEs and the Company consolidates each of these plans as their primary beneficiary. The assets of these plans are recorded in short-term or long-term investments with matching offsetting liabilities recorded in accrued compensation and benefits and other long-term liabilities. |
Fair value of financial instruments | The available-for-sale securities represent investments in various open-ended registered investment companies, or mutual funds, and are recorded at estimated fair value based upon quoted prices reported by each mutual fund. The interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 9 to the condensed consolidated financial statements for further discussion. The funds on deposit with third parties represent funds held with various third parties as required by regulation or contract and invested by those parties in various investments, which are measured at estimated fair value based primarily on quoted market prices. The estimated fair value measurements of contingent earn-out obligations are primarily based on unobservable inputs including projected EBITDA, estimated probability of achieving gross margins or quality margins of certain medical procedures and the estimated probability of earn-out payments being made using an option pricing technique and a simulation model for expected EBITDA and operating income. In addition, a probability adjusted model was used to estimate the fair value amounts of the quality margins. The estimated fair value of these contingent earn-out obligations are remeasured as of each reporting date and could fluctuate based upon any significant changes in key assumptions, such as changes in the Company credit risk adjusted rate that is used to discount obligations to present value. |
New accounting standards | The Company adopted Accounting Standards Update (ASU) No. 2015-02, Consolidation (Topic 810): Amendments to the Consolidation Analysis The Company adopted ASU No. 2015-05, Customer’s Accounting for Fees Paid in a Cloud Computing Arrangement , Intangibles-Goodwill and Other-Internal-Use Software The Company adopted ASU No. 2015-16, Business Combinations (Topic 805): Simplifying the Accounting for Measurement-Period Adjustments . In October 2016, the FASB issued ASU No. 2016-17, Consolidation (Topic 810): Interests Held through Related Parties That Are under Common Control. In October 2016, the FASB issued ASU No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments In June 2016, the FASB issued ASU No. 2016-13, Financial Instrument – Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments. In March 2016, the FASB issued ASU No. 2016-09, Compensation – Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting In March 2016, the FASB issued ASU No. 2016-07, Investments – Equity Method and Joint Ventures (Topic 323): Simplifying the Transition to the Equity Method of Accounting. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) In January 2016, the FASB issued ASU No. 2016-01, Financial Statements – Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities. In July 2015, the FASB issued ASU No. 2015-11, Inventory (Topic 330): Simplifying the Measurement of Inventory. In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers Revenue from Contracts with Customers (Topic Revenue from Contracts with Customers (Topic 606) |
Investments in debt and equity securities | The Company classifies certain debt securities as held-to-maturity and records them at amortized cost based on the Company’s intentions and strategy concerning those investments. Equity securities that have readily determinable fair values, including those of mutual funds, common stock and other debt securities, are classified as available-for-sale and recorded at fair value. The investments in mutual funds classified as available-for-sale are held within a trust to fund existing obligations associated with several of the Company’s non-qualified deferred compensation plans. |
Put Obligation Fair Value Estimate of Noncontrolling Interest | |
Organization Consolidation And Presentation Of Financial Statements Disclosure [Line Items] | |
Noncontrolling interests subject to put provisions and other commitments | The Company has potential obligations to purchase the noncontrolling interests held by third parties in several of its majority-owned partnerships, non-owned legal entities, and minority-owned legal entities. These obligations are in the form of put provisions and are exercisable at the third-party owners’ discretion within specified periods as outlined in each specific put provision. If these put provisions were exercised, the Company would be required to purchase the third-party owners’ noncontrolling interests at either the appraised fair market value or a predetermined multiple of earnings or cash flow attributable to the noncontrolling interests put to the Company, which is intended to approximate fair value. The methodology the Company uses to estimate the fair values of noncontrolling interests subject to put provisions assumes the higher of either a liquidation value of net assets or an average multiple of earnings, based on historical earnings, patient mix and other performance indicators that can affect future results, as well as other factors. The estimated fair values of the noncontrolling interests subject to put provisions is a critical accounting estimate that involves significant judgments and assumptions and may not be indicative of the actual values at which the noncontrolling interests may ultimately be settled, which could vary significantly from the Company’s current estimates. The estimated fair values of noncontrolling interests subject to put provisions can fluctuate and the implicit multiple of earnings at which these noncontrolling interest obligations may be settled could vary significantly depending upon market conditions including potential purchasers’ access to the capital markets, which can impact the level of competition for dialysis and non-dialysis related businesses, the economic performance of these businesses and the restricted marketability of the third-party owners’ noncontrolling interests. The amount of noncontrolling interests subject to put provisions that employ a contractually predetermined multiple of earnings rather than fair value are immaterial. |
Earnings per share (Tables)
Earnings per share (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Earnings Per Share [Abstract] | |
Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Earnings Per Share | The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share are as follows: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 Basic: Net income attributable to DaVita Inc. $ 571,332 $ 215,872 $ 722,148 $ 275,732 Weighted average shares outstanding during the period 205,955 214,569 206,401 215,108 Contingently returnable shares held in escrow for the DaVita HealthCare Partners merger (2,194 ) (2,194 ) (2,194 ) (2,194 ) Weighted average shares for basic earnings per share calculation 203,761 212,375 204,207 212,914 Basic net income per share attributable to DaVita Inc. $ 2.80 $ 1.02 $ 3.54 $ 1.30 Diluted: Net income attributable to DaVita Inc. $ 571,332 $ 215,872 $ 722,148 $ 275,732 Weighted average shares outstanding during the period 205,955 214,569 206,401 215,108 Assumed incremental shares from stock plans 1,006 2,122 1,243 2,313 Weighted average shares for diluted earnings per share calculation 206,961 216,691 207,644 217,421 Diluted net income per share attributable to DaVita Inc. $ 2.76 $ 1.00 $ 3.48 $ 1.27 Anti-dilutive potential common shares excluded from calculation (1) 2,375 1,184 2,153 1,092 (1) |
Investments in debt and equit32
Investments in debt and equity securities (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Investments Debt And Equity Securities [Abstract] | |
Investments | The Company’s investments in these securities consist of the following: September 30, 2016 December 31, 2015 Held to Available Held to Available maturity for sale Total maturity for sale Total Certificates of deposit, commercial paper and money market funds due within one year $ 647,885 $ — $ 647,885 $ 406,884 $ — $ 406,884 Investments in mutual funds, debt securities and common stock — 53,259 53,259 — 33,482 33,482 $ 647,885 $ 53,259 $ 701,144 $ 406,884 $ 33,482 $ 440,366 Short-term investments $ 647,885 $ 11,593 $ 659,478 $ 406,884 $ 1,200 $ 408,084 Long-term investments — 41,666 41,666 — 32,282 32,282 $ 647,885 $ 53,259 $ 701,144 $ 406,884 $ 33,482 $ 440,366 |
Goodwill (Tables)
Goodwill (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Goodwill And Intangible Assets Disclosure [Abstract] | |
Changes in Goodwill by Reportable Segments | Changes in goodwill by reportable segments were as follows: Other-ancillary U.S. dialysis and services and related lab services DMG strategic initiatives Consolidated total Balance at January 1, 2015 $ 5,610,643 $ 3,562,534 $ 242,118 $ 9,415,295 Acquisitions 21,910 29,910 45,273 97,093 Divestitures (3,370 ) (5,411 ) — (8,781 ) Goodwill impairment charges — (188,769 ) (4,065 ) (192,834 ) Foreign currency and other adjustments — — (16,294 ) (16,294 ) Balance at December 31, 2015 $ 5,629,183 $ 3,398,264 $ 267,032 $ 9,294,479 Acquisitions 52,792 248,901 70,116 371,809 Divestitures (4,222 ) (2,223 ) (29,374 ) (35,819 ) Goodwill impairment charges — (253,000 ) — (253,000 ) Foreign currency and other adjustments — — 5,527 5,527 Balance at September 30, 2016 $ 5,677,753 $ 3,391,942 $ 313,301 $ 9,382,996 |
Health care costs payable (Tabl
Health care costs payable (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Health Care Organizations [Abstract] | |
Components of Changes in Health Care Costs Payable | The following table shows the components of changes in health care costs payable for the nine months ended September 30, 2016: Nine months ended September 30, 2016 Health care costs payable, beginning of the period $ 212,641 Add: Components of incurred health care costs Current year 1,261,046 Prior years 2,142 Total incurred health care costs 1,263,188 Less: Claims paid Current year 1,061,880 Prior years 199,015 Total claims paid 1,260,895 Health care costs payable, end of the period $ 214,934 |
Long-term debt (Tables)
Long-term debt (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Debt Disclosure [Abstract] | |
Long-term Debt | Long-term debt was comprised of the following: September 30, December 31, 2016 2015 Senior secured credit facilities: Term Loan A $ 881,250 $ 925,000 Term Loan B 3,421,250 3,447,500 Senior notes 4,500,000 4,500,000 Acquisition obligations and other notes payable 111,407 70,645 Capital lease obligations 294,746 283,185 Total debt principal outstanding 9,208,653 9,226,330 Discount and deferred financing costs (83,887 ) (95,985 ) 9,124,766 9,130,345 Less current portion (152,764 ) (129,037 ) $ 8,972,002 $ 9,001,308 |
Scheduled Maturities of Long-term Debt | Scheduled maturities of long-term debt at September 30, 2016 were as follows: 2016 (remainder of the year) 40,607 2017 154,000 2018 167,798 2019 743,687 2020 68,156 2021 3,299,551 Thereafter 4,734,854 |
Derivative Instruments | The following table summarizes the Company’s derivative instruments as of September 30, 2016 and December 31, 2015: September 30, 2016 December 31, 2015 Derivatives designated as hedging instruments Balance sheet location Fair value Balance sheet location Fair value Interest rate swap agreements Other short-term liabilities $ — Other short-term assets $ 516 Interest rate cap agreements Other long-term assets $ 2,453 Other long-term assets $ 15,127 |
Effects of Interest Rate Swap and Cap Agreements | The following table summarizes the effects of the Company’s interest rate swap and cap agreements for the three and nine months ended September 30, 2016 and 2015: Amount of gains (losses) Amount of losses recognized in OCI on interest reclassified from rate swap and cap agreements Location of accumulated OCI into income Three months ended Nine months ended losses reclassified Three months ended Nine months ended September 30, September 30, from accumulated September 30, September 30, Derivatives designated as cash flow hedges 2016 2015 2016 2015 OCI into income 2016 2015 2016 2015 Interest rate swap agreements $ 45 $ (1,128 ) $ (815 ) $ (4,798 ) Debt expense $ (25 ) $ (655 ) $ (299 ) $ (2,061 ) Interest rate cap agreements (300 ) (1,909 ) (12,674 ) (11,715 ) Debt expense (609 ) (609 ) (1,829 ) (1,829 ) Tax benefit 102 1,186 5,251 6,449 246 493 827 1,518 Total $ (153 ) $ (1,851 ) $ (8,238 ) $ (10,064 ) $ (388 ) $ (771 ) $ (1,301 ) $ (2,372 ) |
Comprehensive income (Tables)
Comprehensive income (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Statement Of Income And Comprehensive Income [Abstract] | |
Comprehensive income | For the three months ended For the nine months ended September 30, 2016 September 30, 2016 Interest Foreign Accumulated Interest Foreign Accumulated rate swap currency other rate swap currency other and cap Investment translation comprehensive and cap Investment translation comprehensive agreements securities adjustments (loss) income agreements securities adjustments (loss) income Beginning balance $ (18,097 ) $ 1,986 $ (43,925 ) $ (60,036 ) $ (10,925 ) $ 1,361 $ (50,262 ) $ (59,826 ) Unrealized (losses) gains (255 ) 1,454 (951 ) 248 (13,489 ) 2,578 5,386 (5,525 ) Related income tax benefit (expense) 102 (391 ) — (289 ) 5,251 (797 ) — 4,454 (153 ) 1,063 (951 ) (41 ) (8,238 ) 1,781 5,386 (1,071 ) Reclassification from accumulated other comprehensive income into net income 634 (81 ) 7,513 8,066 2,128 (233 ) 7,513 9,408 Related income tax (expense) benefit (246 ) 31 — (215 ) (827 ) 90 — (737 ) 388 (50 ) 7,513 7,851 1,301 (143 ) 7,513 8,671 Ending balance $ (17,862 ) $ 2,999 $ (37,363 ) $ (52,226 ) $ (17,862 ) $ 2,999 $ (37,363 ) $ (52,226 ) For the three months ended For the nine months ended September 30, 2015 September 30, 2015 Interest Foreign Accumulated Interest Foreign Accumulated rate swap currency other rate swap currency other and cap Investment translation comprehensive and cap Investment translation comprehensive agreements securities adjustments income (loss) agreements securities adjustments (loss) income Beginning balance $ (8,407 ) $ 3,261 $ (39,233 ) $ (44,379 ) $ (1,795 ) $ 3,151 $ (26,373 ) $ (25,017 ) Unrealized (losses) gains (3,037 ) (2,325 ) (7,023 ) (12,385 ) (16,513 ) (1,864 ) (19,883 ) (38,260 ) Related income tax benefit (expense) 1,186 674 — 1,860 6,449 496 — 6,945 (1,851 ) (1,651 ) (7,023 ) (10,525 ) (10,064 ) (1,368 ) (19,883 ) (31,315 ) Reclassification from accumulated other comprehensive income into net income 1,264 (333 ) — 931 3,890 (617 ) — 3,273 Related income tax (expense) benefit (493 ) 130 — (363 ) (1,518 ) 241 — (1,277 ) 771 (203 ) — 568 2,372 (376 ) — 1,996 Ending balance $ (9,487 ) $ 1,407 $ (46,256 ) $ (54,336 ) $ (9,487 ) $ 1,407 $ (46,256 ) $ (54,336 ) |
Acquisitions and Divestitures (
Acquisitions and Divestitures (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Business Acquisition [Line Items] | |
Aggregate Purchase Cost Allocations for Acquisitions | The following table summarizes the assets acquired and liabilities assumed in this transaction and recognized at the acquisition date at their estimated fair values: Current assets, net of cash acquired $ 91,591 Property and equipment 108,533 Amortizable intangible and other long-term assets 34,050 Goodwill 244,502 Current liabilities assumed (50,940 ) Deferred income taxes (16,880 ) Noncontrolling interests assumed (9,885 ) Aggregate purchase price $ 400,971 |
Pro Forma Financial Information, Results of Operations | The following summary, prepared on a pro forma basis, combines the results of operations as if the acquisitions through September 30, 2016 had been consummated as of the beginning of 2016 and 2015, after including the impact of certain adjustments such as amortization of intangibles and income tax effects. Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 (unaudited) Pro forma net revenues $ 3,731,416 $ 3,660,885 $ 11,146,596 $ 10,678,870 Pro forma net income attributable to DaVita Inc. 571,529 224,808 736,453 306,096 Pro forma basic net income per share attributable to DaVita Inc. 2.80 1.06 3.61 1.44 Pro forma diluted net income per share attributable to DaVita Inc. 2.76 1.04 3.55 1.41 |
Reconciliation of Changes in Contingent Earn-Out Obligations | The following is a reconciliation of changes in the contingent earn-out obligations for the nine months ended September 30, 2016: Beginning balance, January 1, 2016 $ 34,135 Remeasurement of fair value for contingent earn-out obligations (3,739 ) Payments on contingent earn-out obligations (16,198 ) $ 14,198 |
Dialysis businesses and other businesses | |
Business Acquisition [Line Items] | |
Aggregate Purchase Cost Allocations for Acquisitions | The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values: Current assets $ 1,762 Property and equipment 3,725 Amortizable intangible and other long-term assets 5,777 Goodwill 127,307 Deferred income taxes 597 Noncontrolling interests assumed (19,176 ) Liabilities assumed (951 ) Aggregate purchase price $ 119,041 |
Fair value of financial instr38
Fair value of financial instruments (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Fair Value Disclosures [Abstract] | |
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis | The following table summarizes the Company’s assets, liabilities and temporary equity measured at fair value on a recurring basis as of September 30, 2016: Quoted prices in Significant active Significant other unobservable identical assets observable inputs Total (Level 1) (Level 2) (Level 3) Assets Available-for-sale securities $ 53,259 $ 53,259 $ — $ — Interest rate cap agreements $ 2,453 $ — $ 2,453 $ — Funds on deposit with third parties $ 76,773 $ 76,773 $ — $ — Liabilities Contingent earn-out obligations $ 14,198 $ — $ — $ 14,198 Temporary equity Noncontrolling interests subject to put provisions $ 971,744 $ — $ — $ 971,744 |
Segment reporting (Tables)
Segment reporting (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Segment Reporting [Abstract] | |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes | The following is a summary of segment net revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income before income taxes: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 Segment net revenues: U.S. dialysis and related lab services Patient service revenues: External sources $ 2,412,818 $ 2,287,329 $ 7,079,054 $ 6,679,251 Intersegment revenues 16,040 13,630 44,819 39,078 Total dialysis and related lab services revenues 2,428,858 2,300,959 7,123,873 6,718,329 Less: Provision for uncollectible accounts (109,299 ) (103,543 ) (320,565 ) (302,324 ) Net dialysis and related lab services patient service revenues 2,319,559 2,197,416 6,803,308 6,416,005 Other revenues (1) 3,912 3,490 12,134 10,214 Total net dialysis and related lab services revenues 2,323,471 2,200,906 6,815,442 6,426,219 DMG DMG revenues: Capitated revenues 846,245 906,478 2,586,383 2,587,545 Net patient service revenues 153,089 78,938 417,634 241,385 Other revenues (2) 28,728 15,536 72,354 66,124 Intersegment capitated and other revenues 75 84 189 96 Total net DMG revenues 1,028,137 1,001,036 3,076,560 2,895,150 Other—Ancillary services and strategic initiatives Net patient service revenues 57,498 41,858 165,742 116,535 Capitated revenues 23,045 20,369 67,780 56,007 Other external sources 314,540 275,210 948,847 793,511 Intersegment revenues 16,642 7,385 43,189 18,079 Total ancillary services and strategic initiatives revenues 411,725 344,822 1,225,558 984,132 Total net segment revenues 3,763,333 3,546,764 11,117,560 10,305,501 Elimination of intersegment revenues (32,757 ) (21,099 ) (88,197 ) (57,253 ) Consolidated net revenues $ 3,730,576 $ 3,525,665 $ 11,029,363 $ 10,248,248 Segment operating margin (loss): U.S. dialysis and related lab services $ 452,187 $ 461,899 $ 1,341,432 $ 795,255 DMG 33,094 82,562 (126,110 ) 215,192 Other—Ancillary services and strategic initiatives 361,903 (30,118 ) 338,159 (70,153 ) Total segment operating margin 847,184 514,343 1,553,481 940,294 Reconciliation of segment operating margin to consolidated income before income taxes: Corporate administrative support (3) (28,028 ) (4,975 ) (40,366 ) (14,534 ) Consolidated operating income 819,156 509,368 1,513,115 925,760 Debt expense (104,581 ) (103,481 ) (310,359 ) (305,121 ) Debt redemption and refinancing charges — — — (48,072 ) Other income, net 1,876 2,484 8,067 4,262 Consolidated income before income taxes $ 716,451 $ 408,371 $ 1,210,823 $ 576,829 (1) (2) (3) |
Summary of Depreciation and Amortization Expense by Reportable Segment | Depreciation and amortization expense by reportable segment is as follows: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 U.S. dialysis and related lab services $ 122,540 $ 111,828 $ 358,427 $ 326,281 DMG 52,595 43,523 153,068 129,890 Ancillary services and strategic initiatives 6,604 6,711 19,980 18,523 $ 181,739 $ 162,062 $ 531,475 $ 474,694 |
Summary of Assets by Reportable Segment | Summary of assets by reportable segment is as follows: September 30, December 31, 2016 2015 Segment assets U.S. dialysis and related lab services (including equity investments of $41,624 and $34,801, respectively) $ 11,460,732 $ 11,591,507 DMG (including equity investments of $11,293 and $22,714, respectively) 6,218,912 6,150,666 Other—Ancillary services and strategic initiatives (including equity investments of $463,466 and $20,853, respectively) 1,246,009 772,702 Consolidated assets $ 18,925,653 $ 18,514,875 |
Summary of Expenditures for Property and Equipment by Reportable Segment | Expenditures for property and equipment by reportable segment is as follows: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 U.S. dialysis and related lab services $ 182,741 $ 138,683 $ 467,121 $ 385,734 DMG 17,396 18,885 55,639 36,870 Ancillary services and strategic initiatives 16,479 13,772 52,483 39,609 $ 216,616 $ 171,340 $ 575,243 $ 462,213 |
Changes in DaVita Inc.'s owne40
Changes in DaVita Inc.'s ownership interest in consolidated subsidiaries (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Noncontrolling Interest [Abstract] | |
Effects of Changes in DaVita Inc's Ownership Interest on Company's Equity | The effects of changes in DaVita Inc.’s ownership interest on the Company’s equity are as follows: Three months ended Nine months ended September 30, September 30, 2016 2015 2016 2015 Net income attributable to DaVita Inc. $ 571,332 $ 215,872 $ 722,148 $ 275,732 Decrease in paid-in capital for the purchase of noncontrolling interests and adjustments to ownership interest (604 ) (12,094 ) (5,135 ) (20,515 ) Net transfers to noncontrolling interests (604 ) (12,094 ) (5,135 ) (20,515 ) Net income attributable to DaVita Inc., net of transfers to noncontrolling interests $ 570,728 $ 203,778 $ 717,013 $ 255,217 |
Condensed consolidating finan41
Condensed consolidating financial statements (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Condensed Consolidating Statements of Income | Condensed Consolidating Statements of Income Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Patient services revenues $ — $ 1,726,892 $ 945,659 $ (42,890 ) $ 2,629,661 Less: Provision for uncollectible accounts — (73,833 ) (41,722 ) — (115,555 ) Net patient service revenues — 1,653,059 903,937 (42,890 ) 2,514,106 Capitated revenues — 462,436 406,894 (40 ) 869,290 Other revenues 191,815 509,867 46,185 (400,687 ) 347,180 Total net revenues 191,815 2,625,362 1,357,016 (443,617 ) 3,730,576 Operating expenses and charges 143,784 2,388,114 823,139 (443,617 ) 2,911,420 Operating income 48,031 237,248 533,877 — 819,156 Debt (expense) and refinancing charges (101,895 ) (91,716 ) (14,402 ) 103,432 (104,581 ) Other income, net 99,446 2,659 3,203 (103,432 ) 1,876 Income tax expense (20,898 ) (21,486 ) 146,685 — 104,301 Equity earnings in subsidiaries 504,852 335,175 — (840,027 ) — Net income 571,332 504,852 375,993 (840,027 ) 612,150 Less: Net income attributable to noncontrolling interests — — — (40,818 ) (40,818 ) Net income attributable to DaVita Inc. $ 571,332 $ 504,852 $ 375,993 $ (880,845 ) $ 571,332 Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Patient service revenues $ — $ 1,656,648 $ 795,325 $ (37,939 ) $ 2,414,034 Less: Provision for uncollectible accounts — (78,494 ) (30,958 ) — (109,452 ) Net patient service revenues — 1,578,154 764,367 (37,939 ) 2,304,582 Capitated revenues — 453,766 473,196 (115 ) 926,847 Other revenues 184,561 480,412 7,869 (378,606 ) 294,236 Total net revenues 184,561 2,512,332 1,245,432 (416,660 ) 3,525,665 Operating expenses 110,935 2,244,237 1,077,785 (416,660 ) 3,016,297 Operating income 73,626 268,095 167,647 — 509,368 Debt expense, including debt redemption charges (102,136 ) (83,037 ) (9,766 ) 91,458 (103,481 ) Other income 89,824 2,379 1,739 (91,458 ) 2,484 Income tax expense 25,368 112,310 9,386 — 147,064 Equity earnings in subsidiaries 179,926 104,799 — (284,725 ) — Net income 215,872 179,926 150,234 (284,725 ) 261,307 Less: Net income attributable to noncontrolling interests — — — (45,435 ) (45,435 ) Net income attributable to DaVita Inc. $ 215,872 $ 179,926 $ 150,234 $ (330,160 ) $ 215,872 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Patient services revenues $ — $ 5,044,565 $ 2,756,588 $ (123,100 ) $ 7,678,053 Less: Provision for uncollectible accounts — (207,144 ) (129,044 ) — (336,188 ) Net patient service revenues — 4,837,421 2,627,544 (123,100 ) 7,341,865 Capitated revenues — 1,391,010 1,263,404 (251 ) 2,654,163 Other revenues 575,700 1,518,407 122,509 (1,183,281 ) 1,033,335 Total net revenues 575,700 7,746,838 4,013,457 (1,306,632 ) 11,029,363 Operating expenses and charges 400,129 7,275,863 3,146,888 (1,306,632 ) 9,516,248 Operating income 175,571 470,975 866,569 — 1,513,115 Debt (expense) and refinancing charges (305,097 ) (275,148 ) (38,914 ) 308,800 (310,359 ) Other income, net 296,660 12,416 7,791 (308,800 ) 8,067 Income tax expense 56,190 140,972 168,849 — 366,011 Equity earnings in subsidiaries 611,204 543,933 — (1,155,137 ) — Net income 722,148 611,204 666,597 (1,155,137 ) 844,812 Less: Net income attributable to noncontrolling interests — — — (122,664 ) (122,664 ) Net income attributable to DaVita Inc. $ 722,148 $ 611,204 $ 666,597 $ (1,277,801 ) $ 722,148 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Patient service revenues $ — $ 4,901,959 $ 2,254,624 $ (107,155 ) $ 7,049,428 Less: Provision for uncollectible accounts — (212,816 ) (101,765 ) — (314,581 ) Net patient service revenues — 4,689,143 2,152,859 (107,155 ) 6,734,847 Capitated revenues — 1,340,838 1,302,862 (148 ) 2,643,552 Other revenues 542,412 1,360,261 21,547 (1,054,371 ) 869,849 Total net revenues 542,412 7,390,242 3,477,268 (1,161,674 ) 10,248,248 Operating expenses 363,347 7,042,896 3,077,919 (1,161,674 ) 9,322,488 Operating income 179,065 347,346 399,349 — 925,760 Debt expense, including debt redemption charges (347,719 ) (253,939 ) (30,532 ) 278,997 (353,193 ) Other income 271,847 6,780 4,632 (278,997 ) 4,262 Income tax expense 41,215 116,934 25,744 — 183,893 Equity earnings in subsidiaries 213,754 230,501 — (444,255 ) — Net income 275,732 213,754 347,705 (444,255 ) 392,936 Less: Net income attributable to noncontrolling interests — — — (117,204 ) (117,204 ) Net income attributable to DaVita Inc. $ 275,732 $ 213,754 $ 347,705 $ (561,459 ) $ 275,732 |
Condensed Consolidating Statements of Comprehensive Income | Condensed Consolidating Statements of Comprehensive Income Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 571,332 $ 504,852 $ 375,993 $ (840,027 ) $ 612,150 Other comprehensive income 1,248 — 6,620 — 7,868 Total comprehensive income 572,580 504,852 382,613 (840,027 ) 620,018 Less: Comprehensive income attributable to noncontrolling interest — — — (40,876 ) (40,876 ) Comprehensive income attributable to DaVita Inc. $ 572,580 $ 504,852 $ 382,613 $ (880,903 ) $ 579,142 Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 215,872 $ 179,926 $ 150,234 $ (284,725 ) $ 261,307 Other comprehensive loss (2,934 ) — (7,023 ) — (9,957 ) Total comprehensive income 212,938 179,926 143,211 (284,725 ) 251,350 Less: comprehensive income attributable to the noncontrolling interests — — — (45,435 ) (45,435 ) Comprehensive income attributable to DaVita Inc. $ 212,938 $ 179,926 $ 143,211 $ (330,160 ) $ 205,915 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 722,148 $ 611,204 $ 666,597 $ (1,155,137 ) $ 844,812 Other comprehensive loss (5,299 ) — 13,106 — 7,807 Total comprehensive income 716,849 611,204 679,703 (1,155,137 ) 852,619 Less: Comprehensive income attributable to noncontrolling interest — — — (122,871 ) (122,871 ) Comprehensive income attributable to DaVita Inc. $ 716,849 $ 611,204 $ 679,703 $ (1,278,008 ) $ 729,748 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 275,732 $ 213,754 $ 347,705 $ (444,255 ) $ 392,936 Other comprehensive loss (9,436 ) — (19,883 ) — (29,319 ) Total comprehensive income 266,296 213,754 327,822 (444,255 ) 363,617 Less: comprehensive income attributable to the noncontrolling interests — — — (117,204 ) (117,204 ) Comprehensive income attributable to DaVita Inc. $ 266,296 $ 213,754 $ 327,822 $ (561,459 ) $ 246,413 |
Condensed Consolidating Balance Sheets | Condensed Consolidating Balance Sheets Non- Guarantor Guarantor Consolidating Consolidated As of September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Cash and cash equivalents $ 623,901 $ 35,769 $ 253,826 $ — $ 913,496 Accounts receivable, net — 1,174,364 676,061 — 1,850,425 Other current assets 661,642 745,238 90,558 — 1,497,438 Total current assets 1,285,543 1,955,371 1,020,445 — 4,261,359 Property and equipment, net 298,869 1,624,181 1,121,938 — 3,044,988 Intangible assets, net 553 1,537,645 37,959 — 1,576,157 Investments in subsidiaries 9,628,258 1,924,432 — (11,552,690 ) — Intercompany receivables 3,131,796 — 820,536 (3,952,332 ) — Other long-term assets and investments 40,574 55,069 564,510 — 660,153 Goodwill — 7,876,067 1,506,929 — 9,382,996 Total assets $ 14,385,593 $ 14,972,765 $ 5,072,317 $ (15,505,022 ) $ 18,925,653 Current liabilities $ 274,520 $ 1,842,058 $ 522,891 $ — $ 2,639,469 Intercompany payables — 2,264,044 1,688,288 (3,952,332 ) — Long-term debt and other long-term liabilities 8,589,682 1,238,405 366,962 — 10,195,049 Noncontrolling interests subject to put provisions 609,645 — — 362,099 971,744 Total DaVita Inc. shareholder's equity 4,911,746 9,628,258 1,924,432 (11,552,690 ) 4,911,746 Noncontrolling interests not subject to put provisions — — 569,744 (362,099 ) 207,645 Total equity 4,911,746 9,628,258 2,494,176 (11,914,789 ) 5,119,391 Total liabilities and equity $ 14,385,593 $ 14,972,765 $ 5,072,317 $ (15,505,022 ) $ 18,925,653 Non- Guarantor Guarantor Consolidating Consolidated As of December 31, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Cash and cash equivalents $ 1,186,636 $ 109,357 $ 203,123 $ — $ 1,499,116 Accounts receivable, net — 929,390 794,838 — 1,724,228 Other current assets 431,504 769,947 78,485 — 1,279,936 Total current assets 1,618,140 1,808,694 1,076,446 — 4,503,280 Property and equipment, net 268,066 1,575,890 944,784 — 2,788,740 Intangible assets, net 540 1,634,920 51,866 — 1,687,326 Investments in subsidiaries 8,893,079 1,597,185 — (10,490,264 ) — Intercompany receivables 3,474,133 — 701,814 (4,175,947 ) — Other long-term assets and investments 74,458 53,346 113,246 — 241,050 Goodwill — 7,834,257 1,460,222 — 9,294,479 Total assets $ 14,328,416 $ 14,504,292 $ 4,348,378 $ (14,666,211 ) $ 18,514,875 Current liabilities $ 185,217 $ 1,730,123 $ 483,798 $ — $ 2,399,138 Intercompany payables — 2,750,102 1,425,845 (4,175,947 ) — Long-term debt and other long-term liabilities 8,730,673 1,130,988 305,838 — 10,167,499 Noncontrolling interests subject to put provisions 541,746 — — 322,320 864,066 Total DaVita Inc. shareholders’ equity 4,870,780 8,893,079 1,597,185 (10,490,264 ) 4,870,780 Noncontrolling interests not subject to put provisions — — 535,712 (322,320 ) 213,392 Total equity 4,870,780 8,893,079 2,132,897 (10,812,584 ) 5,084,172 Total liabilities and equity $ 14,328,416 $ 14,504,292 $ 4,348,378 $ (14,666,211 ) $ 18,514,875 |
Condensed Consolidating Statements of Cash Flows | Condensed Consolidating Statements of Cash Flows Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Cash flows from operating activities: Net income $ 722,148 $ 611,204 $ 666,597 $ (1,155,137 ) $ 844,812 Changes in operating assets and liabilities and non-cash items included in net income (586,804 ) 228,991 (160,874 ) 1,155,137 636,450 Net cash provided by operating activities 135,344 840,195 505,723 — 1,481,262 Cash flows from investing activities: Additions of property and equipment, net (81,785 ) (248,339 ) (245,119 ) — (575,243 ) Acquisitions — (458,556 ) (38,775 ) — (497,331 ) Proceeds from asset and business sales — 24,608 (5,617 ) — 18,991 (Purchases) proceeds from investment sales and other items, net (236,150 ) (12,825 ) 45,316 — (203,659 ) Net cash used in investing activities (317,935 ) (695,112 ) (244,195 ) — (1,257,242 ) Cash flows from financing activities: Long-term debt and related financing costs, net (73,889 ) (20,684 ) (4,151 ) — (98,724 ) Intercompany borrowing (payments) 283,709 (188,247 ) (95,462 ) — — Other items (589,964 ) (9,740 ) (109,548 ) — (709,252 ) Net cash (used in) provided by financing activities (380,144 ) (218,671 ) (209,161 ) — (807,976 ) Effect of exchange rate changes on cash — — (1,664 ) — (1,664 ) Net (decrease) increase in cash and cash equivalents (562,735 ) (73,588 ) 50,703 — (585,620 ) Cash and cash equivalents at beginning of period 1,186,636 109,357 203,123 — 1,499,116 Cash and cash equivalents at end of period $ 623,901 $ 35,769 $ 253,826 $ — $ 913,496 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Cash flows from operating activities: Net income $ 275,732 $ 213,754 $ 347,705 $ (444,255 ) $ 392,936 Changes in operating assets and liabilities and non-cash items included in net income (187,876 ) 441,752 29,460 444,255 727,591 Net cash provided by operating activities 87,856 655,506 377,165 — 1,120,527 Cash flows from investing activities: Additions of property and equipment, net (39,448 ) (222,447 ) (200,318 ) — (462,213 ) Acquisitions — (73,339 ) (17,370 ) — (90,709 ) Proceeds from asset and business sales — 6,865 — — 6,865 (Purchases) proceeds from investment sales and other items, net (587,583 ) 1,513 (18,257 ) — (604,327 ) Net cash used in investing activities (627,031 ) (287,408 ) (235,945 ) — (1,150,384 ) Cash flows from financing activities: Long-term debt and related financing costs, net 661,260 (13,183 ) (8,760 ) — 639,317 Intercompany borrowing (payments) 304,623 (320,262 ) 15,639 — — Other items (404,107 ) (23,605 ) (97,726 ) — (525,438 ) Net cash provided by (used in) financing activities 561,776 (357,050 ) (90,847 ) — 113,879 Effect of exchange rate changes on cash — — (1,844 ) — (1,844 ) Net increase in cash and cash equivalents 22,601 11,048 48,529 — 82,178 Cash and cash equivalents at beginning of period 698,876 77,921 188,444 — 965,241 Cash and cash equivalents at end of period $ 721,477 $ 88,969 $ 236,973 $ — $ 1,047,419 |
Supplemental data (Tables)
Supplemental data (Tables) | 9 Months Ended |
Sep. 30, 2016 | |
Condensed Financial Statements Captions [Line Items] | |
Condensed Consolidating Statements of Income | Condensed Consolidating Statements of Income Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Patient services revenues $ — $ 1,726,892 $ 945,659 $ (42,890 ) $ 2,629,661 Less: Provision for uncollectible accounts — (73,833 ) (41,722 ) — (115,555 ) Net patient service revenues — 1,653,059 903,937 (42,890 ) 2,514,106 Capitated revenues — 462,436 406,894 (40 ) 869,290 Other revenues 191,815 509,867 46,185 (400,687 ) 347,180 Total net revenues 191,815 2,625,362 1,357,016 (443,617 ) 3,730,576 Operating expenses and charges 143,784 2,388,114 823,139 (443,617 ) 2,911,420 Operating income 48,031 237,248 533,877 — 819,156 Debt (expense) and refinancing charges (101,895 ) (91,716 ) (14,402 ) 103,432 (104,581 ) Other income, net 99,446 2,659 3,203 (103,432 ) 1,876 Income tax expense (20,898 ) (21,486 ) 146,685 — 104,301 Equity earnings in subsidiaries 504,852 335,175 — (840,027 ) — Net income 571,332 504,852 375,993 (840,027 ) 612,150 Less: Net income attributable to noncontrolling interests — — — (40,818 ) (40,818 ) Net income attributable to DaVita Inc. $ 571,332 $ 504,852 $ 375,993 $ (880,845 ) $ 571,332 Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Patient service revenues $ — $ 1,656,648 $ 795,325 $ (37,939 ) $ 2,414,034 Less: Provision for uncollectible accounts — (78,494 ) (30,958 ) — (109,452 ) Net patient service revenues — 1,578,154 764,367 (37,939 ) 2,304,582 Capitated revenues — 453,766 473,196 (115 ) 926,847 Other revenues 184,561 480,412 7,869 (378,606 ) 294,236 Total net revenues 184,561 2,512,332 1,245,432 (416,660 ) 3,525,665 Operating expenses 110,935 2,244,237 1,077,785 (416,660 ) 3,016,297 Operating income 73,626 268,095 167,647 — 509,368 Debt expense, including debt redemption charges (102,136 ) (83,037 ) (9,766 ) 91,458 (103,481 ) Other income 89,824 2,379 1,739 (91,458 ) 2,484 Income tax expense 25,368 112,310 9,386 — 147,064 Equity earnings in subsidiaries 179,926 104,799 — (284,725 ) — Net income 215,872 179,926 150,234 (284,725 ) 261,307 Less: Net income attributable to noncontrolling interests — — — (45,435 ) (45,435 ) Net income attributable to DaVita Inc. $ 215,872 $ 179,926 $ 150,234 $ (330,160 ) $ 215,872 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Patient services revenues $ — $ 5,044,565 $ 2,756,588 $ (123,100 ) $ 7,678,053 Less: Provision for uncollectible accounts — (207,144 ) (129,044 ) — (336,188 ) Net patient service revenues — 4,837,421 2,627,544 (123,100 ) 7,341,865 Capitated revenues — 1,391,010 1,263,404 (251 ) 2,654,163 Other revenues 575,700 1,518,407 122,509 (1,183,281 ) 1,033,335 Total net revenues 575,700 7,746,838 4,013,457 (1,306,632 ) 11,029,363 Operating expenses and charges 400,129 7,275,863 3,146,888 (1,306,632 ) 9,516,248 Operating income 175,571 470,975 866,569 — 1,513,115 Debt (expense) and refinancing charges (305,097 ) (275,148 ) (38,914 ) 308,800 (310,359 ) Other income, net 296,660 12,416 7,791 (308,800 ) 8,067 Income tax expense 56,190 140,972 168,849 — 366,011 Equity earnings in subsidiaries 611,204 543,933 — (1,155,137 ) — Net income 722,148 611,204 666,597 (1,155,137 ) 844,812 Less: Net income attributable to noncontrolling interests — — — (122,664 ) (122,664 ) Net income attributable to DaVita Inc. $ 722,148 $ 611,204 $ 666,597 $ (1,277,801 ) $ 722,148 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Patient service revenues $ — $ 4,901,959 $ 2,254,624 $ (107,155 ) $ 7,049,428 Less: Provision for uncollectible accounts — (212,816 ) (101,765 ) — (314,581 ) Net patient service revenues — 4,689,143 2,152,859 (107,155 ) 6,734,847 Capitated revenues — 1,340,838 1,302,862 (148 ) 2,643,552 Other revenues 542,412 1,360,261 21,547 (1,054,371 ) 869,849 Total net revenues 542,412 7,390,242 3,477,268 (1,161,674 ) 10,248,248 Operating expenses 363,347 7,042,896 3,077,919 (1,161,674 ) 9,322,488 Operating income 179,065 347,346 399,349 — 925,760 Debt expense, including debt redemption charges (347,719 ) (253,939 ) (30,532 ) 278,997 (353,193 ) Other income 271,847 6,780 4,632 (278,997 ) 4,262 Income tax expense 41,215 116,934 25,744 — 183,893 Equity earnings in subsidiaries 213,754 230,501 — (444,255 ) — Net income 275,732 213,754 347,705 (444,255 ) 392,936 Less: Net income attributable to noncontrolling interests — — — (117,204 ) (117,204 ) Net income attributable to DaVita Inc. $ 275,732 $ 213,754 $ 347,705 $ (561,459 ) $ 275,732 |
Condensed Consolidating Statements of Comprehensive Income | Condensed Consolidating Statements of Comprehensive Income Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 571,332 $ 504,852 $ 375,993 $ (840,027 ) $ 612,150 Other comprehensive income 1,248 — 6,620 — 7,868 Total comprehensive income 572,580 504,852 382,613 (840,027 ) 620,018 Less: Comprehensive income attributable to noncontrolling interest — — — (40,876 ) (40,876 ) Comprehensive income attributable to DaVita Inc. $ 572,580 $ 504,852 $ 382,613 $ (880,903 ) $ 579,142 Non- Guarantor Guarantor Consolidating Consolidated For the three months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 215,872 $ 179,926 $ 150,234 $ (284,725 ) $ 261,307 Other comprehensive loss (2,934 ) — (7,023 ) — (9,957 ) Total comprehensive income 212,938 179,926 143,211 (284,725 ) 251,350 Less: comprehensive income attributable to the noncontrolling interests — — — (45,435 ) (45,435 ) Comprehensive income attributable to DaVita Inc. $ 212,938 $ 179,926 $ 143,211 $ (330,160 ) $ 205,915 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 722,148 $ 611,204 $ 666,597 $ (1,155,137 ) $ 844,812 Other comprehensive loss (5,299 ) — 13,106 — 7,807 Total comprehensive income 716,849 611,204 679,703 (1,155,137 ) 852,619 Less: Comprehensive income attributable to noncontrolling interest — — — (122,871 ) (122,871 ) Comprehensive income attributable to DaVita Inc. $ 716,849 $ 611,204 $ 679,703 $ (1,278,008 ) $ 729,748 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Net income $ 275,732 $ 213,754 $ 347,705 $ (444,255 ) $ 392,936 Other comprehensive loss (9,436 ) — (19,883 ) — (29,319 ) Total comprehensive income 266,296 213,754 327,822 (444,255 ) 363,617 Less: comprehensive income attributable to the noncontrolling interests — — — (117,204 ) (117,204 ) Comprehensive income attributable to DaVita Inc. $ 266,296 $ 213,754 $ 327,822 $ (561,459 ) $ 246,413 |
Condensed Consolidating Balance Sheets | Condensed Consolidating Balance Sheets Non- Guarantor Guarantor Consolidating Consolidated As of September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Cash and cash equivalents $ 623,901 $ 35,769 $ 253,826 $ — $ 913,496 Accounts receivable, net — 1,174,364 676,061 — 1,850,425 Other current assets 661,642 745,238 90,558 — 1,497,438 Total current assets 1,285,543 1,955,371 1,020,445 — 4,261,359 Property and equipment, net 298,869 1,624,181 1,121,938 — 3,044,988 Intangible assets, net 553 1,537,645 37,959 — 1,576,157 Investments in subsidiaries 9,628,258 1,924,432 — (11,552,690 ) — Intercompany receivables 3,131,796 — 820,536 (3,952,332 ) — Other long-term assets and investments 40,574 55,069 564,510 — 660,153 Goodwill — 7,876,067 1,506,929 — 9,382,996 Total assets $ 14,385,593 $ 14,972,765 $ 5,072,317 $ (15,505,022 ) $ 18,925,653 Current liabilities $ 274,520 $ 1,842,058 $ 522,891 $ — $ 2,639,469 Intercompany payables — 2,264,044 1,688,288 (3,952,332 ) — Long-term debt and other long-term liabilities 8,589,682 1,238,405 366,962 — 10,195,049 Noncontrolling interests subject to put provisions 609,645 — — 362,099 971,744 Total DaVita Inc. shareholder's equity 4,911,746 9,628,258 1,924,432 (11,552,690 ) 4,911,746 Noncontrolling interests not subject to put provisions — — 569,744 (362,099 ) 207,645 Total equity 4,911,746 9,628,258 2,494,176 (11,914,789 ) 5,119,391 Total liabilities and equity $ 14,385,593 $ 14,972,765 $ 5,072,317 $ (15,505,022 ) $ 18,925,653 Non- Guarantor Guarantor Consolidating Consolidated As of December 31, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Cash and cash equivalents $ 1,186,636 $ 109,357 $ 203,123 $ — $ 1,499,116 Accounts receivable, net — 929,390 794,838 — 1,724,228 Other current assets 431,504 769,947 78,485 — 1,279,936 Total current assets 1,618,140 1,808,694 1,076,446 — 4,503,280 Property and equipment, net 268,066 1,575,890 944,784 — 2,788,740 Intangible assets, net 540 1,634,920 51,866 — 1,687,326 Investments in subsidiaries 8,893,079 1,597,185 — (10,490,264 ) — Intercompany receivables 3,474,133 — 701,814 (4,175,947 ) — Other long-term assets and investments 74,458 53,346 113,246 — 241,050 Goodwill — 7,834,257 1,460,222 — 9,294,479 Total assets $ 14,328,416 $ 14,504,292 $ 4,348,378 $ (14,666,211 ) $ 18,514,875 Current liabilities $ 185,217 $ 1,730,123 $ 483,798 $ — $ 2,399,138 Intercompany payables — 2,750,102 1,425,845 (4,175,947 ) — Long-term debt and other long-term liabilities 8,730,673 1,130,988 305,838 — 10,167,499 Noncontrolling interests subject to put provisions 541,746 — — 322,320 864,066 Total DaVita Inc. shareholders’ equity 4,870,780 8,893,079 1,597,185 (10,490,264 ) 4,870,780 Noncontrolling interests not subject to put provisions — — 535,712 (322,320 ) 213,392 Total equity 4,870,780 8,893,079 2,132,897 (10,812,584 ) 5,084,172 Total liabilities and equity $ 14,328,416 $ 14,504,292 $ 4,348,378 $ (14,666,211 ) $ 18,514,875 |
Condensed Consolidating Statements of Cash Flows | Condensed Consolidating Statements of Cash Flows Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2016 DaVita Inc. subsidiaries subsidiaries adjustments total Cash flows from operating activities: Net income $ 722,148 $ 611,204 $ 666,597 $ (1,155,137 ) $ 844,812 Changes in operating assets and liabilities and non-cash items included in net income (586,804 ) 228,991 (160,874 ) 1,155,137 636,450 Net cash provided by operating activities 135,344 840,195 505,723 — 1,481,262 Cash flows from investing activities: Additions of property and equipment, net (81,785 ) (248,339 ) (245,119 ) — (575,243 ) Acquisitions — (458,556 ) (38,775 ) — (497,331 ) Proceeds from asset and business sales — 24,608 (5,617 ) — 18,991 (Purchases) proceeds from investment sales and other items, net (236,150 ) (12,825 ) 45,316 — (203,659 ) Net cash used in investing activities (317,935 ) (695,112 ) (244,195 ) — (1,257,242 ) Cash flows from financing activities: Long-term debt and related financing costs, net (73,889 ) (20,684 ) (4,151 ) — (98,724 ) Intercompany borrowing (payments) 283,709 (188,247 ) (95,462 ) — — Other items (589,964 ) (9,740 ) (109,548 ) — (709,252 ) Net cash (used in) provided by financing activities (380,144 ) (218,671 ) (209,161 ) — (807,976 ) Effect of exchange rate changes on cash — — (1,664 ) — (1,664 ) Net (decrease) increase in cash and cash equivalents (562,735 ) (73,588 ) 50,703 — (585,620 ) Cash and cash equivalents at beginning of period 1,186,636 109,357 203,123 — 1,499,116 Cash and cash equivalents at end of period $ 623,901 $ 35,769 $ 253,826 $ — $ 913,496 Non- Guarantor Guarantor Consolidating Consolidated For the nine months ended September 30, 2015 DaVita Inc. subsidiaries subsidiaries adjustments total Cash flows from operating activities: Net income $ 275,732 $ 213,754 $ 347,705 $ (444,255 ) $ 392,936 Changes in operating assets and liabilities and non-cash items included in net income (187,876 ) 441,752 29,460 444,255 727,591 Net cash provided by operating activities 87,856 655,506 377,165 — 1,120,527 Cash flows from investing activities: Additions of property and equipment, net (39,448 ) (222,447 ) (200,318 ) — (462,213 ) Acquisitions — (73,339 ) (17,370 ) — (90,709 ) Proceeds from asset and business sales — 6,865 — — 6,865 (Purchases) proceeds from investment sales and other items, net (587,583 ) 1,513 (18,257 ) — (604,327 ) Net cash used in investing activities (627,031 ) (287,408 ) (235,945 ) — (1,150,384 ) Cash flows from financing activities: Long-term debt and related financing costs, net 661,260 (13,183 ) (8,760 ) — 639,317 Intercompany borrowing (payments) 304,623 (320,262 ) 15,639 — — Other items (404,107 ) (23,605 ) (97,726 ) — (525,438 ) Net cash provided by (used in) financing activities 561,776 (357,050 ) (90,847 ) — 113,879 Effect of exchange rate changes on cash — — (1,844 ) — (1,844 ) Net increase in cash and cash equivalents 22,601 11,048 48,529 — 82,178 Cash and cash equivalents at beginning of period 698,876 77,921 188,444 — 965,241 Cash and cash equivalents at end of period $ 721,477 $ 88,969 $ 236,973 $ — $ 1,047,419 |
Additional Reporting Entities | |
Condensed Financial Statements Captions [Line Items] | |
Condensed Consolidating Statements of Income | Condensed Consolidating Statements of Income Company and Consolidated Physician Unrestricted Restricted For the nine months ended September 30, 2016 Total Groups Subsidiaries Subsidiaries (1) Patient service operating revenues $ 7,678,053 $ 287,544 $ — $ 7,390,509 Less: Provision for uncollectible accounts (336,188 ) (9,178 ) — (327,010 ) Net patient service operating revenues 7,341,865 278,366 — 7,063,499 Capitated revenues 2,654,163 1,186,001 — 1,468,162 Other revenues 1,033,335 53,124 — 980,211 Total net operating revenues 11,029,363 1,517,491 — 9,511,872 Operating expenses 9,516,248 1,513,569 (129 ) 8,002,808 Operating income 1,513,115 3,922 129 1,509,064 Debt expense, including refinancing charges (310,359 ) (9,347 ) — (301,012 ) Other income 8,067 322 — 7,745 Income tax expense 366,011 10,442 52 355,517 Net income (loss) 844,812 (15,545 ) 77 860,280 Less: Net income attributable to noncontrolling interests (122,664 ) — — (122,664 ) Net income (loss) attributable to DaVita Inc. $ 722,148 $ (15,545 ) $ 77 $ 737,616 (1) |
Condensed Consolidating Statements of Comprehensive Income | Condensed Consolidating Statements of Comprehensive Income Company and Consolidated Physician Unrestricted Restricted For the nine months ended September 30, 2016 Total Groups Subsidiaries Subsidiaries (1) Net income (loss) $ 844,812 $ (15,545 ) $ 77 $ 860,280 Other comprehensive loss 7,807 — — 7,807 Total comprehensive income (loss) 852,619 (15,545 ) 77 868,087 Less: comprehensive income attributable to the noncontrolling interests (122,871 ) — — (122,871 ) Comprehensive income (loss) attributable to DaVita Inc. $ 729,748 $ (15,545 ) $ 77 $ 745,216 (1) |
Condensed Consolidating Balance Sheets | Condensed Consolidating Balance Sheets Company and Consolidated Physician Unrestricted Restricted As of September 30, 2016 Total Groups Subsidiaries Subsidiaries (1) Cash and cash equivalents $ 913,496 $ 104,636 $ — $ 808,860 Accounts receivable, net 1,850,425 195,488 — 1,654,937 Other current assets 1,497,438 18,419 — 1,479,019 Total current assets 4,261,359 318,543 — 3,942,816 Property and equipment, net 3,044,988 1,417 — 3,043,571 Amortizable intangibles, net 1,576,157 5,141 — 1,571,016 Other long-term assets 660,153 77,681 2,696 579,776 Goodwill 9,382,996 16,405 — 9,366,591 Total assets $ 18,925,653 $ 419,187 $ 2,696 $ 18,503,770 Current liabilities $ 2,639,469 $ 229,515 $ — $ 2,409,954 Payables to parent — 86,335 2,696 (89,031 ) Long-term debt and other long-term liabilities 10,195,049 50,099 — 10,144,950 Noncontrolling interests subject to put provisions 971,744 — — 971,744 Total DaVita Inc. shareholders’ equity 4,911,746 53,238 — 4,858,508 Noncontrolling interests not subject to put provisions 207,645 — — 207,645 Shareholders’ equity 5,119,391 53,238 — 5,066,153 Total liabilities and shareholder’s equity $ 18,925,653 $ 419,187 $ 2,696 $ 18,503,770 (1) |
Condensed Consolidating Statements of Cash Flows | Condensed Consolidating Statements of Cash Flows Company and Consolidated Physician Unrestricted Restricted For the nine months ended September 30, 2016 Total Groups Subsidiaries Subsidiaries (1) Cash flows from operating activities: Net income (loss) $ 844,812 $ (15,545 ) $ 77 $ 860,280 Changes in operating and intercompany assets and liabilities and non-cash items included in net income 636,450 152,461 (77 ) 484,066 Net cash provided by operating activities 1,481,262 136,916 — 1,344,346 Cash flows from investing activities: Additions of property and equipment (575,243 ) (592 ) — (574,651 ) Acquisitions and divestitures, net (497,331 ) — — (497,331 ) Proceeds from discontinued operations 18,991 — — 18,991 Investments and other items (203,659 ) (2,124 ) — (201,535 ) Net cash used in investing activities (1,257,242 ) (2,716 ) — (1,254,526 ) Cash flows from financing activities: Long-term debt (98,724 ) (4 ) — (98,720 ) Intercompany — (117,805 ) — 117,805 Other items (709,252 ) — — (709,252 ) Net cash used in by financing activities (807,976 ) (117,809 ) — (690,167 ) Effect of exchange rate changes on cash (1,664 ) — — (1,664 ) Net decrease in cash (585,620 ) 16,391 — (602,011 ) Cash and cash equivalents at beginning of period 1,499,116 88,245 — 1,410,871 Cash and cash equivalents at end of period $ 913,496 $ 104,636 $ — $ 808,860 (1) |
Reconciliations of Numerators a
Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Earnings Per Share (Detail) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | ||
Basic: | |||||
Net income attributable to DaVita Inc. | $ 571,332 | $ 215,872 | $ 722,148 | $ 275,732 | |
Weighted average shares outstanding during the period | 205,955,000 | 214,569,000 | 206,401,000 | 215,108,000 | |
Contingently returnable shares held in escrow for the DaVita HealthCare Partners merger | (2,194,000) | (2,194,000) | (2,194,000) | (2,194,000) | |
Weighted average shares for basic earnings per share calculation | 203,761,433 | 212,374,897 | 204,206,979 | 212,914,126 | |
Basic net income per share attributable to DaVita Inc. | $ 2.80 | $ 1.02 | $ 3.54 | $ 1.30 | |
Diluted: | |||||
Net income attributable to DaVita Inc. | $ 571,332 | $ 215,872 | $ 722,148 | $ 275,732 | |
Weighted average shares outstanding during the period | 205,955,000 | 214,569,000 | 206,401,000 | 215,108,000 | |
Assumed incremental shares from stock plans | 1,006,000 | 2,122,000 | 1,243,000 | 2,313,000 | |
Weighted average shares for diluted earnings per share calculation | 206,961,450 | 216,691,461 | 207,643,794 | 217,421,213 | |
Diluted net income per share attributable to DaVita Inc. | $ 2.76 | $ 1 | $ 3.48 | $ 1.27 | |
Anti-dilutive potential common shares excluded from calculation | [1] | 2,375,000 | 1,184,000 | 2,153,000 | 1,092,000 |
[1] | Shares associated with stock-settled stock appreciation rights that are excluded from the diluted denominator calculation because they are anti-dilutive under the treasury stock method |
Accounts Receivable - Additiona
Accounts Receivable - Additional Information (Detail) $ in Thousands | 9 Months Ended |
Sep. 30, 2016USD ($) | |
Accounts Notes And Loans Receivable [Line Items] | |
Percentage of outstanding patient accounts receivables to be reserved as per Company's policy | 100.00% |
Account receivable outstanding, number of months | 3 months |
Decrease in allowance for doubtful accounts | $ (12,551) |
Government-based Programs, Medicare and Medicaid | Accounts Receivable | |
Accounts Notes And Loans Receivable [Line Items] | |
Percentage of accounts receivable due | 80.00% |
Health Care Patient | Accounts Receivable | |
Accounts Notes And Loans Receivable [Line Items] | |
Percentage of accounts receivable due | 1.00% |
DaVita Medical Group (DMG) | |
Accounts Notes And Loans Receivable [Line Items] | |
Percentage of outstanding patient accounts receivables to be reserved as per Company's policy | 100.00% |
Account receivable outstanding, number of months | 12 months |
Investments (Detail)
Investments (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 |
Investment Holdings [Line Items] | ||
Held to maturity | $ 647,885 | $ 406,884 |
Available for sale | 53,259 | 33,482 |
Total | 701,144 | 440,366 |
Held to maturity, short-term investments | 647,885 | 406,884 |
Available for sale, short-term investments | 11,593 | 1,200 |
Total, short-term investments | 659,478 | 408,084 |
Available for sale, long-term investments | 41,666 | 32,282 |
Total, long-term investments | 41,666 | 32,282 |
Certificates of deposit, commercial paper and money market funds | ||
Investment Holdings [Line Items] | ||
Held to maturity | 647,885 | 406,884 |
Total | 647,885 | 406,884 |
Investments in mutual funds, debt securities and common stock | ||
Investment Holdings [Line Items] | ||
Available for sale, equity securities | 53,259 | 33,482 |
Total | $ 53,259 | $ 33,482 |
Investments in Debt and Equit46
Investments in Debt and Equity Securities - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | Dec. 31, 2015 | |
Schedule Of Trading Securities And Other Trading Assets [Line Items] | |||||
Available for sale investments gross pre-tax unrealized gain (loss) | $ 4,934 | $ 4,934 | $ 2,589 | ||
Unrealized gain (losses) on investments, net of tax | 1,121 | $ (1,651) | 1,988 | $ (1,368) | |
Proceeds from sale of investments available for sale debt securities | 4,645 | ||||
Proceeds from sale of investments available for sale | 1,961 | ||||
Pre tax reclassification of net investment realized gain (loss) into net income | 233 | 617 | |||
Reclassification of net investment realized gain (loss) into net income, net of tax | 143 | $ 376 | |||
HealthCare Partners (HCP) | |||||
Schedule Of Trading Securities And Other Trading Assets [Line Items] | |||||
Required minimum cash balance | $ 58,127 | 58,127 | |||
Certificates of deposit, commercial paper and money market funds | |||||
Schedule Of Trading Securities And Other Trading Assets [Line Items] | |||||
Unrealized gain (losses) on investments, pre tax | 2,578 | ||||
Unrealized gain (losses) on investments, net of tax | $ 1,781 |
Changes in Goodwill by Reportab
Changes in Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands | 9 Months Ended | 12 Months Ended | |
Sep. 30, 2016 | Sep. 30, 2015 | Dec. 31, 2015 | |
Goodwill [Line Items] | |||
Beginning balance | $ 9,294,479 | $ 9,415,295 | $ 9,415,295 |
Acquisitions | 371,809 | 97,093 | |
Divestitures | (35,819) | (8,781) | |
Goodwill impairment charges | (253,000) | (4,065) | (192,834) |
Foreign currency and other adjustments | 5,527 | (16,294) | |
Ending balance | 9,382,996 | 9,294,479 | |
U.S. Dialysis And Related Lab Services | |||
Goodwill [Line Items] | |||
Beginning balance | 5,629,183 | 5,610,643 | 5,610,643 |
Acquisitions | 52,792 | 21,910 | |
Divestitures | (4,222) | (3,370) | |
Ending balance | 5,677,753 | 5,629,183 | |
DaVita Medical Group (DMG) | |||
Goodwill [Line Items] | |||
Beginning balance | 3,398,264 | 3,562,534 | 3,562,534 |
Acquisitions | 248,901 | 29,910 | |
Divestitures | (2,223) | (5,411) | |
Goodwill impairment charges | (253,000) | (188,769) | |
Ending balance | 3,391,942 | 3,398,264 | |
Other Segments | |||
Goodwill [Line Items] | |||
Beginning balance | 267,032 | $ 242,118 | 242,118 |
Acquisitions | 70,116 | 45,273 | |
Divestitures | (29,374) | ||
Goodwill impairment charges | (4,065) | ||
Foreign currency and other adjustments | 5,527 | (16,294) | |
Ending balance | $ 313,301 | $ 267,032 |
Goodwill - Additional Informati
Goodwill - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | 12 Months Ended | ||||
Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | Dec. 31, 2015 | Dec. 31, 2014 | |
Goodwill [Line Items] | |||||||
Goodwill and other intangible asset impairment charges | $ 206,169 | ||||||
Goodwill impaired facts and circumstances leading to impairment description | Based on continuing developments at the Company’s DMG reporting units during 2016, including the Medicare Advantage final benchmark rates for 2017 announced on April 4, 2016, further changes in expectations concerning future government reimbursement rates and the Company’s expected ability to mitigate them, as well as medical cost and utilization trends, underperformance of certain at-risk units in recent quarters and other market conditions, the Company performed additional impairment assessments for certain at-risk DMG reporting units during each of the first three quarters of 2016. | ||||||
Goodwill impairment charges | $ 253,000 | $ 4,065 | $ 192,834 | ||||
Goodwill | 9,294,479 | $ 9,382,996 | 9,294,479 | $ 9,415,295 | |||
Goodwill impairment charge description | For example, a sustained, long-term reduction of 3% in operating income for DMG Nevada or DMG Florida could reduce their estimated fair values by up to 2.5% and 1.9%, respectively. Separately, an increase in their respective discount rates of 100 basis points could reduce the estimated fair values of DMG Nevada and DMG Florida by up to 5.5% and 4.9%, respectively. Similarly, a long-term reduction of 3% in operating income or, separately, an increase in the discount rate of 100 basis points could reduce the estimated fair value of Lifeline vascular access by up to 2.6% and 5.0%. | ||||||
DaVita Medical Group (DMG) | |||||||
Goodwill [Line Items] | |||||||
Goodwill impairment charges | $ 253,000 | 188,769 | |||||
Goodwill | $ 3,398,264 | $ 3,391,942 | $ 3,398,264 | $ 3,562,534 | |||
DaVita Medical Group (DMG) | Long-term Reduction of 3% Percent Operating Income | |||||||
Goodwill [Line Items] | |||||||
Decrease in operating income percentage used for assessment of fair values | 3.00% | ||||||
DaVita Medical Group (DMG) | Increase In Discount Rates By 100 Basis Points | |||||||
Goodwill [Line Items] | |||||||
Increase in discount rates used for assessment of fair values | 1.00% | ||||||
DaVita Medical Group (DMG) | Nevada | |||||||
Goodwill [Line Items] | |||||||
Goodwill impairment charges | $ 79,000 | $ 77,000 | |||||
Goodwill | $ 261,204 | ||||||
Percentage of fair value in excess of (short of) carrying amount | (27.80%) | ||||||
DaVita Medical Group (DMG) | Nevada | Long-term Reduction of 3% Percent Operating Income | |||||||
Goodwill [Line Items] | |||||||
Percentage of Fair value in excess of carrying amount | 2.50% | ||||||
DaVita Medical Group (DMG) | Nevada | Increase In Discount Rates By 100 Basis Points | |||||||
Goodwill [Line Items] | |||||||
Percentage of Fair value in excess of carrying amount | 5.50% | ||||||
DaVita Medical Group (DMG) | Florida | |||||||
Goodwill [Line Items] | |||||||
Goodwill impairment charges | $ 97,000 | ||||||
Goodwill | $ 442,835 | ||||||
Percentage of fair value in excess of (short of) carrying amount | (1.50%) | ||||||
DaVita Medical Group (DMG) | Florida | Long-term Reduction of 3% Percent Operating Income | |||||||
Goodwill [Line Items] | |||||||
Percentage of Fair value in excess of carrying amount | 1.90% | ||||||
DaVita Medical Group (DMG) | Florida | Increase In Discount Rates By 100 Basis Points | |||||||
Goodwill [Line Items] | |||||||
Percentage of Fair value in excess of carrying amount | 4.90% | ||||||
DaVita Medical Group (DMG) | Colorado | |||||||
Goodwill [Line Items] | |||||||
Goodwill | $ 16,897 | ||||||
Percentage of fair value in excess of (short of) carrying amount | 15.40% | ||||||
Lifeline Vascular Access | |||||||
Goodwill [Line Items] | |||||||
Goodwill | $ 63,111 | ||||||
Percentage of fair value in excess of (short of) carrying amount | 14.00% | ||||||
Lifeline Vascular Access | Long-term Reduction of 3% Percent Operating Income | |||||||
Goodwill [Line Items] | |||||||
Decrease in operating income percentage used for assessment of fair values | 3.00% | ||||||
Percentage of Fair value in excess of carrying amount | 2.60% | ||||||
Lifeline Vascular Access | Increase In Discount Rates By 100 Basis Points | |||||||
Goodwill [Line Items] | |||||||
Percentage of Fair value in excess of carrying amount | 5.00% | ||||||
Increase in discount rates used for assessment of fair values | 1.00% |
Components of Changes in Health
Components of Changes in Health Care Costs Payable (Detail) $ in Thousands | 9 Months Ended |
Sep. 30, 2016USD ($) | |
Medical Expense And Medical Claims Payable [Line Items] | |
Health care costs payable, beginning of the period | $ 332,102 |
Less: Claims paid | |
Health care costs payable, end of the period | 313,869 |
Healthcare Cost | |
Medical Expense And Medical Claims Payable [Line Items] | |
Health care costs payable, beginning of the period | 212,641 |
Add: Components of incurred health care costs | |
Current year | 1,261,046 |
Prior years | 2,142 |
Total incurred health care costs | 1,263,188 |
Less: Claims paid | |
Current year | 1,061,880 |
Prior years | 199,015 |
Total claims paid | 1,260,895 |
Health care costs payable, end of the period | $ 214,934 |
Health Care Costs Payable - Add
Health Care Costs Payable - Additional Information (Detail) $ in Thousands | 9 Months Ended |
Sep. 30, 2016USD ($) | |
Health Care Organizations [Abstract] | |
Increase (decrease) in prior year estimates of health care costs payable | $ 2,142 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) $ in Thousands | 9 Months Ended | |
Sep. 30, 2016 | Dec. 31, 2015 | |
Income Tax Disclosure [Abstract] | ||
Liability for unrecognized tax benefits | $ 24,214 | $ 39,011 |
Decrease in liability for unrecognized tax benefits | 14,797 | |
Accrued interest and penalties related to unrecognized tax benefits, net of federal tax benefits | $ 3,763 | $ 9,918 |
Long-term Debt (Detail)
Long-term Debt (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 |
Debt Instrument [Line Items] | ||
Senior notes | $ 4,500,000 | $ 4,500,000 |
Acquisition obligations and other notes payable | 111,407 | 70,645 |
Capital lease obligations | 294,746 | 283,185 |
Total debt principal outstanding | 9,208,653 | 9,226,330 |
Discount and deferred financing costs | (83,887) | (95,985) |
Carrying Amount of Long-Term Debt, Net of Unamortized Discount or Premium, Current and Noncurrent, Total | 9,124,766 | 9,130,345 |
Less current portion | (152,764) | (129,037) |
Long-term debt | 8,972,002 | 9,001,308 |
Term Loan A | ||
Debt Instrument [Line Items] | ||
Senior Secured Credit Facilities | 881,250 | 925,000 |
Term Loan B | ||
Debt Instrument [Line Items] | ||
Senior Secured Credit Facilities | $ 3,421,250 | $ 3,447,500 |
Scheduled Maturities of Long-te
Scheduled Maturities of Long-term Debt (Detail) $ in Thousands | Sep. 30, 2016USD ($) |
Debt Disclosure [Abstract] | |
2016 (remainder of the year) | $ 40,607 |
2,017 | 154,000 |
2,018 | 167,798 |
2,019 | 743,687 |
2,020 | 68,156 |
2,021 | 3,299,551 |
Thereafter | $ 4,734,854 |
Long-term Debt - Additional Inf
Long-term Debt - Additional Information (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | Dec. 31, 2015 | |
Debt Instrument [Line Items] | |||||
Fixed interest rate | 52.80% | 52.80% | |||
Unrealized losses on interest rate swap and cap agreements | $ (153) | $ (1,851) | $ (8,238) | $ (10,064) | |
Weighted average effective interest rate | 4.49% | 4.49% | |||
Weighted average effective interest rate | 4.42% | ||||
DaVita Medical Group (DMG) | |||||
Debt Instrument [Line Items] | |||||
Letters of credit outstanding | $ 1,286 | $ 1,286 | |||
Revolving Credit Facility | |||||
Debt Instrument [Line Items] | |||||
Undrawn revolving credit facilities | 1,000,000 | 1,000,000 | |||
Letter of Credit | |||||
Debt Instrument [Line Items] | |||||
Letters of credit outstanding | 91,644 | 91,644 | |||
Interest Rate Cap Agreements Effective September 30, 2016 | |||||
Debt Instrument [Line Items] | |||||
Interest rate agreements, notional amount | 3,500,000 | $ 3,500,000 | |||
Derivative, effective date | Sep. 30, 2016 | ||||
Derivative, expiration date | Jun. 30, 2018 | ||||
Fair value of assets | 22 | $ 22 | |||
Unrealized losses on interest rate swap and cap agreements | (1,289) | ||||
Interest Rate Cap Agreements Effective June 29, 2018 | |||||
Debt Instrument [Line Items] | |||||
Interest rate agreements, notional amount | 3,500,000 | $ 3,500,000 | |||
Derivative, effective date | Jun. 29, 2018 | ||||
Derivative, expiration date | Jun. 30, 2020 | ||||
Fair value of assets | $ 2,431 | $ 2,431 | |||
Unrealized losses on interest rate swap and cap agreements | $ (11,385) | ||||
London Interbank Offered Rate (LIBOR) | Interest Rate Cap Agreements Effective September 30, 2016 | |||||
Debt Instrument [Line Items] | |||||
LIBOR cap rate | 3.50% | 3.50% | |||
London Interbank Offered Rate (LIBOR) | Interest Rate Cap Agreements Effective June 29, 2018 | |||||
Debt Instrument [Line Items] | |||||
LIBOR cap rate | 3.50% | 3.50% | |||
Term Loan A | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, annual principal payment | $ 43,750 | $ 43,750 | |||
Senior Secured Credit Facilities | $ 881,250 | $ 881,250 | $ 925,000 | ||
Term Loan A | Interest rate swap agreements | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, variable interest rate margin | 1.75% | ||||
Debt expense recognized | $ 299 | ||||
Amount of gains (losses) recognized in OCI on swaps arising during the period net of tax | $ (815) | ||||
Term Loan A | London Interbank Offered Rate (LIBOR) | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, variable interest rate margin | 1.75% | ||||
Term Loan A | London Interbank Offered Rate (LIBOR) | Minimum | Interest rate swap agreements | |||||
Debt Instrument [Line Items] | |||||
Fixed interest rate | 0.49% | 0.49% | |||
Term Loan A | London Interbank Offered Rate (LIBOR) | Maximum | Interest rate swap agreements | |||||
Debt Instrument [Line Items] | |||||
Fixed interest rate | 0.52% | 0.52% | |||
Term Loan B | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, annual principal payment | $ 26,250 | $ 26,250 | |||
Senior Secured Credit Facilities | 3,421,250 | 3,421,250 | $ 3,447,500 | ||
Term Loan B | Interest rate cap agreements | |||||
Debt Instrument [Line Items] | |||||
Debt expense recognized | 1,829 | ||||
Interest rate agreements, notional amount | $ 2,735,000 | $ 2,735,000 | |||
Term Loan B | London Interbank Offered Rate (LIBOR) | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, variable interest rate margin | 2.75% | ||||
LIBOR cap rate | 2.50% | 2.50% | |||
Term Loan B | London Interbank Offered Rate (LIBOR) | Maximum | |||||
Debt Instrument [Line Items] | |||||
Debt instrument, variable interest rate margin | 3.50% | ||||
Term Loan A subject to interest rate caps | |||||
Debt Instrument [Line Items] | |||||
Senior Secured Credit Facilities | $ 78,750 | $ 78,750 | |||
Term Loan A subject to uncapped portion of variability of LIBOR | |||||
Debt Instrument [Line Items] | |||||
Senior Secured Credit Facilities | $ 802,500 | $ 802,500 | |||
Senior Secured Credit Facilities | |||||
Debt Instrument [Line Items] | |||||
Weighted average effective interest rate | 3.61% | 3.61% |
Derivative Instruments (Detail)
Derivative Instruments (Detail) - Designated as Hedging Instrument - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 |
Interest rate swap agreements | Other short-term assets | ||
Derivative [Line Items] | ||
Derivative assets, Fair value | $ 516 | |
Interest rate cap agreements | Other long-term assets | ||
Derivative [Line Items] | ||
Derivative assets, Fair value | $ 2,453 | $ 15,127 |
Effects of Interest Rate Swap a
Effects of Interest Rate Swap and Cap Agreements (Detail) - Cash Flow Hedging - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Derivative Instruments Gain Loss [Line Items] | ||||
Amount of gains (losses) recognized in OCI on interest rate swap and cap agreements | $ (153) | $ (1,851) | $ (8,238) | $ (10,064) |
Amount of losses reclassified from accumulated OCI into income | (388) | (771) | (1,301) | (2,372) |
Tax benefit | ||||
Derivative Instruments Gain Loss [Line Items] | ||||
Amount of gains (losses) recognized in OCI on interest rate swap and cap agreements | 102 | 1,186 | 5,251 | 6,449 |
Amount of losses reclassified from accumulated OCI into income | 246 | 493 | 827 | 1,518 |
Interest rate swap agreements | Debt Expense (Including Refinancing Charges) | ||||
Derivative Instruments Gain Loss [Line Items] | ||||
Amount of gains (losses) recognized in OCI on interest rate swap and cap agreements | 45 | (1,128) | (815) | (4,798) |
Amount of losses reclassified from accumulated OCI into income | (25) | (655) | (299) | (2,061) |
Interest rate cap agreements | Debt Expense (Including Refinancing Charges) | ||||
Derivative Instruments Gain Loss [Line Items] | ||||
Amount of gains (losses) recognized in OCI on interest rate swap and cap agreements | (300) | (1,909) | (12,674) | (11,715) |
Amount of losses reclassified from accumulated OCI into income | $ (609) | $ (609) | $ (1,829) | $ (1,829) |
Contingencies - Additional Info
Contingencies - Additional Information (Detail) $ in Thousands | 1 Months Ended | 3 Months Ended | ||
Mar. 31, 2016USD ($) | Jun. 30, 2015USD ($) | Dec. 31, 2012Entity | Dec. 31, 2015USD ($) | |
Dialysis businesses and other businesses | ||||
Other Commitments [Line Items] | ||||
Number of businesses acquired | Entity | 2 | |||
Vainer Private Civil Suit | ||||
Other Commitments [Line Items] | ||||
Litigation settlement amount | $ 450,000 | |||
Legal fees | $ 45,000 | |||
2016 U.S. Attorney Prescription Drug Investigation | ||||
Other Commitments [Line Items] | ||||
Estimated accrual for potential damages and liabilities | $ 22,530 | |||
Solari Post-Acquisition Matter | ||||
Other Commitments [Line Items] | ||||
Estimated accrual for potential damages and liabilities | $ 16,000 |
Noncontrolling Interests Subj58
Noncontrolling Interests Subject to Put Provisions and Other Commitments - Additional Information (Detail) $ in Thousands | 9 Months Ended |
Sep. 30, 2016USD ($) | |
Commitments And Contingencies Disclosure [Line Items] | |
Schedule of Joint ventures to dissolve | Certain consolidated partnerships are originally contractually scheduled to dissolve after terms ranging from ten to fifty years. |
Minimum | |
Commitments And Contingencies Disclosure [Line Items] | |
Scheduled dissolution term of joint ventures | 10 years |
Maximum | |
Commitments And Contingencies Disclosure [Line Items] | |
Scheduled dissolution term of joint ventures | 50 years |
Commitments to provide operating capital | |
Commitments And Contingencies Disclosure [Line Items] | |
Other potential commitments to provide operating capital to several dialysis centers | $ 14 |
Long-term Incentive Compensat59
Long-term Incentive Compensation - Additional Information (Detail) - USD ($) shares in Thousands, $ in Thousands | 9 Months Ended | |
Sep. 30, 2016 | Sep. 30, 2015 | |
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | ||
Long-term incentive program (LTIP) expense | $ 61,042 | $ 100,171 |
Stock-based compensation expense | 29,817 | 42,794 |
Estimated tax benefits recorded for stock-based compensation | 9,769 | 14,870 |
Unrecognized compensation cost related to outstanding LTIP awards | 108,551 | |
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans | $ 62,323 | |
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under performance-based cash component of LTIP costs, weighted average remaining period (in years) | 1 year | |
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under stock-based component of LTIP costs, weighted average remaining period (in years) | 1 year 4 months 24 days | |
Tax benefits from stock award exercises | $ 27,012 | $ 31,069 |
Stock Appreciation Rights | ||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | ||
Stock granted | 1,263 | |
Aggregate grant-date fair value | $ 17,373 | |
Weighted-average expected life (in years) | 4 years 2 months 12 days | |
Cash Settled Stock Appreciation Rights | ||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | ||
Stock granted | 8 | |
Cash Settled Restricted Stock Units | ||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | ||
Stock granted | 2 | |
Stock Settled Restricted Stock Units | ||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | ||
Stock granted | 227 | |
Aggregate grant-date fair value | $ 17,008 | |
Weighted-average expected life (in years) | 3 years 4 months 24 days |
Share Repurchases - Additional
Share Repurchases - Additional information (Detail) - USD ($) $ / shares in Units, shares in Thousands | 1 Months Ended | 9 Months Ended | |||
Nov. 02, 2016 | Sep. 30, 2016 | Oct. 31, 2016 | Jul. 13, 2016 | Apr. 30, 2015 | |
Equity Class Of Treasury Stock [Line Items] | |||||
Purchase of treasury stock (in shares) | 9,930 | ||||
Purchase of treasury stock | $ 656,087,000 | ||||
Purchase of treasury stock, average price per share | $ 66.07 | ||||
Share repurchase program, authorized amount | $ 1,240,748,000 | $ 259,252,000 | |||
Subsequent Event | |||||
Equity Class Of Treasury Stock [Line Items] | |||||
Purchase of treasury stock (in shares) | 3,367 | ||||
Purchase of treasury stock | $ 212,353,000 | ||||
Purchase of treasury stock, average price per share | $ 63.07 | ||||
Share repurchase program, outstanding authorizations available for share repurchase | $ 881,040,000 |
Comprehensive Income (Detail)
Comprehensive Income (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | $ (59,826) | |||
Ending balance | $ (52,226) | (52,226) | ||
Interest rate swaps and cap agreements | ||||
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | (18,097) | $ (8,407) | (10,925) | $ (1,795) |
Unrealized (losses) gains | (255) | (3,037) | (13,489) | (16,513) |
Related income tax benefit (expense) | 102 | 1,186 | 5,251 | 6,449 |
Unrealized (losses) gains net | (153) | (1,851) | (8,238) | (10,064) |
Reclassification from accumulated other comprehensive income into net income | 634 | 1,264 | 2,128 | 3,890 |
Related income tax (expense) benefit | (246) | (493) | (827) | (1,518) |
Reclassification from accumulated other comprehensive income into net income net of tax | 388 | 771 | 1,301 | 2,372 |
Ending balance | (17,862) | (9,487) | (17,862) | (9,487) |
Investment securities | ||||
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | 1,986 | 3,261 | 1,361 | 3,151 |
Unrealized (losses) gains | 1,454 | (2,325) | 2,578 | (1,864) |
Related income tax benefit (expense) | (391) | 674 | (797) | 496 |
Unrealized (losses) gains net | 1,063 | (1,651) | 1,781 | (1,368) |
Reclassification from accumulated other comprehensive income into net income | (81) | (333) | (233) | (617) |
Related income tax (expense) benefit | 31 | 130 | 90 | 241 |
Reclassification from accumulated other comprehensive income into net income net of tax | (50) | (203) | (143) | (376) |
Ending balance | 2,999 | 1,407 | 2,999 | 1,407 |
Foreign currency translation adjustments | ||||
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | (43,925) | (39,233) | (50,262) | (26,373) |
Unrealized (losses) gains | (951) | (7,023) | 5,386 | (19,883) |
Unrealized (losses) gains net | (951) | (7,023) | 5,386 | (19,883) |
Reclassification from accumulated other comprehensive income into net income | 7,513 | 7,513 | ||
Reclassification from accumulated other comprehensive income into net income net of tax | 7,513 | 7,513 | ||
Ending balance | (37,363) | (46,256) | (37,363) | (46,256) |
Accumulated other comprehensive (loss) income | ||||
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | (60,036) | (44,379) | (59,826) | (25,017) |
Unrealized (losses) gains | 248 | (12,385) | (5,525) | (38,260) |
Related income tax benefit (expense) | (289) | 1,860 | 4,454 | 6,945 |
Unrealized (losses) gains net | (41) | (10,525) | (1,071) | (31,315) |
Reclassification from accumulated other comprehensive income into net income | 8,066 | 931 | 9,408 | 3,273 |
Related income tax (expense) benefit | (215) | (363) | (737) | (1,277) |
Reclassification from accumulated other comprehensive income into net income net of tax | 7,851 | 568 | 8,671 | 1,996 |
Ending balance | $ (52,226) | $ (54,336) | $ (52,226) | $ (54,336) |
Acquisitions and Divestitures -
Acquisitions and Divestitures - Additional Information (Detail) $ in Thousands | Aug. 09, 2016USD ($)Clinic | Aug. 01, 2016USD ($) | Jun. 01, 2016USD ($) | Mar. 01, 2016USD ($) | Dec. 31, 2012Entity | Sep. 30, 2016USD ($) | Jun. 30, 2016USD ($) | Sep. 30, 2016USD ($)Entity | Sep. 30, 2015USD ($) | Dec. 31, 2015USD ($) |
Business Acquisition [Line Items] | ||||||||||
Gain (loss) on sales of business interests | $ 374,374 | $ 404,165 | ||||||||
Cash paid to acquire business | $ 497,331 | $ 90,709 | ||||||||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 7 years | |||||||||
Goodwill deductible for tax purposes associated with acquisitions | 108,874 | $ 108,874 | ||||||||
Fair value of contingent earn-out consideration | 14,198 | 14,198 | $ 34,135 | |||||||
Other Accrued Liabilities | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Fair value of contingent earn-out consideration | 12,836 | 12,836 | ||||||||
Other long-term liabilities | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Fair value of contingent earn-out consideration | 1,362 | 1,362 | ||||||||
Other companies | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Additional cash consideration in the form of earn-out payments | 95,804 | 95,804 | ||||||||
Fair value of contingent earn-out consideration | 14,198 | $ 14,198 | ||||||||
Minimum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Earn-out consideration payment period | 1 year | |||||||||
Maximum | Other companies | EBITDA or Operating Income Performance Targets or Quality Margins | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Earn-out consideration payment period | 2 years | |||||||||
Noncompetition agreements | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 7 years | |||||||||
DaVita Medical Group (DMG) | Arizona | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Gain (loss) on sales of business interests | $ (10,489) | |||||||||
DaVita Medical Group (DMG) | Tandigm Health | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Ownership interest, before sale | 50.00% | |||||||||
Ownership interest, after sale | 19.00% | |||||||||
Gain (loss) on sales of business interests | $ 40,280 | |||||||||
The Everett Clinic Medical Group (TEC) | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Ownership interest percentage | 100.00% | |||||||||
Date of acquisition agreement | Nov. 23, 2015 | |||||||||
Effective date of acquisition | Mar. 1, 2016 | |||||||||
Cash paid to acquire business | $ 393,687 | |||||||||
Assumptions of certain liabilities | $ 7,284 | |||||||||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 6 years | |||||||||
Goodwill deductible for tax purposes associated with acquisitions | $ 0 | $ 0 | ||||||||
Dialysis businesses and other businesses | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Cash paid to acquire business | 103,644 | |||||||||
Number of businesses acquired | Entity | 2 | |||||||||
Deferred purchase price obligations | $ 15,397 | |||||||||
Dialysis businesses and other businesses | U.S. Dialysis And Related Lab Services | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Number of businesses acquired | Entity | 4 | |||||||||
Renal Ventures Limited, LLC | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Ownership interest percentage | 100.00% | |||||||||
Cash paid to acquire business | $ 360,000 | |||||||||
Number of outpatient dialysis centers acquired | Clinic | 38 | |||||||||
Renal Ventures Limited, LLC | New Center Under Construction | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Number of outpatient dialysis centers acquired | Clinic | 1 | |||||||||
Renal Ventures Limited, LLC | Vascular Access Clinic | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Ownership interest percentage | 51.00% | |||||||||
Number of outpatient dialysis centers acquired | Clinic | 1 | |||||||||
Foreign Dialysis Centers | Dialysis businesses and other businesses | Other Segments | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Number of businesses acquired | Entity | 11 | |||||||||
Other Medical Businesses | Dialysis businesses and other businesses | Other Segments | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Number of businesses acquired | Entity | 5 | |||||||||
Khazanah Nasional Berhad and Mitsui and Co., LTD | Asia-Pacific dialysis business | ||||||||||
Business Acquisition [Line Items] | ||||||||||
Subscribed investment amount | $ 300,000 | |||||||||
Ownership interest percentage | 40.00% | |||||||||
Investment period | 3 years | |||||||||
Initial investment in equity method investment | $ 50,000 | |||||||||
Non-cash non-taxable gain | $ 374,374 |
Assets Acquired and Liabilities
Assets Acquired and Liabilities Assumed and Recognized at Acquisition Dates at Estimated Fair Values (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 | Dec. 31, 2014 |
Business Acquisition [Line Items] | |||
Goodwill | $ 9,382,996 | $ 9,294,479 | $ 9,415,295 |
The Everett Clinic Medical Group (TEC) | |||
Business Acquisition [Line Items] | |||
Current assets, net of cash acquired | 91,591 | ||
Property and equipment | 108,533 | ||
Amortizable intangible and other long-term assets | 34,050 | ||
Goodwill | 244,502 | ||
Current liabilities assumed | (50,940) | ||
Deferred income taxes | (16,880) | ||
Noncontrolling interests assumed | (9,885) | ||
Aggregate purchase price | $ 400,971 |
Aggregate Purchase Cost Allocat
Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 | Dec. 31, 2014 |
Business Acquisition [Line Items] | |||
Goodwill | $ 9,382,996 | $ 9,294,479 | $ 9,415,295 |
Dialysis businesses and other businesses | |||
Business Acquisition [Line Items] | |||
Current assets | 1,762 | ||
Property and equipment | 3,725 | ||
Amortizable intangible and other long-term assets | 5,777 | ||
Goodwill | 127,307 | ||
Deferred income taxes | 597 | ||
Noncontrolling interests assumed | (19,176) | ||
Liabilities assumed | (951) | ||
Aggregate purchase price | $ 119,041 |
Pro Forma Financial Information
Pro Forma Financial Information, Results of Operations (Detail) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Business Combinations [Abstract] | ||||
Pro forma net revenues | $ 3,731,416 | $ 3,660,885 | $ 11,146,596 | $ 10,678,870 |
Pro forma net income attributable to DaVita Inc. | $ 571,529 | $ 224,808 | $ 736,453 | $ 306,096 |
Pro forma basic net income per share attributable to DaVita Inc. | $ 2.80 | $ 1.06 | $ 3.61 | $ 1.44 |
Pro forma diluted net income per share attributable to DaVita Inc. | $ 2.76 | $ 1.04 | $ 3.55 | $ 1.41 |
Reconciliation of Changes in Co
Reconciliation of Changes in Contingent Earn-Out Obligations (Detail) $ in Thousands | 9 Months Ended |
Sep. 30, 2016USD ($) | |
Business Combinations [Abstract] | |
Beginning balance | $ 34,135 |
Remeasurement of fair value for contingent earn-out obligations | (3,739) |
Payments on contingent earn-out obligations | (16,198) |
Ending balance | $ 14,198 |
Variable Interest Entities - Ad
Variable Interest Entities - Additional Information (Detail) $ in Thousands | Sep. 30, 2016USD ($) |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Asset | $ 727,656 |
Liabilities | $ 427,583 |
Assets, Liabilities and Tempora
Assets, Liabilities and Temporary Equity Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 |
Assets | ||
Available-for-sale securities | $ 53,259 | $ 33,482 |
Fair Value, Measurements, Recurring | ||
Assets | ||
Available-for-sale securities | 53,259 | |
Funds on deposit with third parties | 76,773 | |
Liabilities | ||
Contingent earn-out obligations | 14,198 | |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 971,744 | |
Fair Value, Measurements, Recurring | Level 1 | ||
Assets | ||
Available-for-sale securities | 53,259 | |
Funds on deposit with third parties | 76,773 | |
Fair Value, Measurements, Recurring | Level 3 | ||
Liabilities | ||
Contingent earn-out obligations | 14,198 | |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 971,744 | |
Interest rate cap agreements | Fair Value, Measurements, Recurring | ||
Assets | ||
Interest rate derivative agreements | 2,453 | |
Interest rate cap agreements | Fair Value, Measurements, Recurring | Level 2 | ||
Assets | ||
Interest rate derivative agreements | $ 2,453 |
Fair Value of Financial Instr69
Fair Value of Financial Instruments - Additional Information (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 |
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | ||
Debt instrument, carrying amount | $ 9,208,653 | $ 9,226,330 |
Senior Secured Credit Facilities | ||
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | ||
Debt instrument, carrying amount | 4,302,500 | |
Debt instrument, fair value | 4,344,000 | |
Senior Notes | ||
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | ||
Debt instrument, carrying amount | 4,500,000 | |
Debt instrument, fair value | $ 4,594,000 |
Segment Reporting - Additional
Segment Reporting - Additional Information (Detail) | 9 Months Ended |
Sep. 30, 2016Segment | |
Segment Reporting [Abstract] | |
Number of Operating Segments | 2 |
Summary of Segment Net Revenues
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | ||
Segment Reporting Information [Line Items] | |||||
Patient service revenues | $ 2,629,661 | $ 2,414,034 | $ 7,678,053 | $ 7,049,428 | |
Less: Provision for uncollectible accounts | (115,555) | (109,452) | (336,188) | (314,581) | |
Net patient service revenues | 2,514,106 | 2,304,582 | 7,341,865 | 6,734,847 | |
Other revenues | 347,180 | 294,236 | 1,033,335 | 869,849 | |
Total net operating revenues | 3,730,576 | 3,525,665 | 11,029,363 | 10,248,248 | |
Capitated revenues | 869,290 | 926,847 | 2,654,163 | 2,643,552 | |
Operating income (loss) | 819,156 | 509,368 | 1,513,115 | 925,760 | |
Corporate administrative support | [1] | (28,028) | (4,975) | (40,366) | (14,534) |
Debt expense | (104,581) | (103,481) | (310,359) | (305,121) | |
Debt redemption and refinancing charges | (48,072) | ||||
Other income, net | 1,876 | 2,484 | 8,067 | 4,262 | |
Income before income taxes | 716,451 | 408,371 | 1,210,823 | 576,829 | |
Operating Segments | |||||
Segment Reporting Information [Line Items] | |||||
Total net operating revenues | 3,763,333 | 3,546,764 | 11,117,560 | 10,305,501 | |
Operating income (loss) | 847,184 | 514,343 | 1,553,481 | 940,294 | |
Operating Segments | U.S. Dialysis And Related Lab Services | |||||
Segment Reporting Information [Line Items] | |||||
Patient service revenues | 2,428,858 | 2,300,959 | 7,123,873 | 6,718,329 | |
Less: Provision for uncollectible accounts | (109,299) | (103,543) | (320,565) | (302,324) | |
Net patient service revenues | 2,319,559 | 2,197,416 | 6,803,308 | 6,416,005 | |
Other revenues | [2] | 3,912 | 3,490 | 12,134 | 10,214 |
Total net operating revenues | 2,323,471 | 2,200,906 | 6,815,442 | 6,426,219 | |
Operating income (loss) | 452,187 | 461,899 | 1,341,432 | 795,255 | |
Operating Segments | U.S. Dialysis And Related Lab Services | External Sources | |||||
Segment Reporting Information [Line Items] | |||||
Patient service revenues | 2,412,818 | 2,287,329 | 7,079,054 | 6,679,251 | |
Operating Segments | U.S. Dialysis And Related Lab Services | Intersubsegment Eliminations | |||||
Segment Reporting Information [Line Items] | |||||
Patient service revenues | 16,040 | 13,630 | 44,819 | 39,078 | |
Operating Segments | DaVita Medical Group (DMG) | |||||
Segment Reporting Information [Line Items] | |||||
Net patient service revenues | 153,089 | 78,938 | 417,634 | 241,385 | |
Other revenues | [3] | 28,728 | 15,536 | 72,354 | 66,124 |
Total net operating revenues | 1,028,137 | 1,001,036 | 3,076,560 | 2,895,150 | |
Capitated revenues | 846,245 | 906,478 | 2,586,383 | 2,587,545 | |
Operating income (loss) | 33,094 | 82,562 | (126,110) | 215,192 | |
Operating Segments | DaVita Medical Group (DMG) | Intersubsegment Eliminations | |||||
Segment Reporting Information [Line Items] | |||||
Other revenues | 75 | 84 | 189 | 96 | |
Operating Segments | Other Segments | |||||
Segment Reporting Information [Line Items] | |||||
Net patient service revenues | 57,498 | 41,858 | 165,742 | 116,535 | |
Other revenues | 314,540 | 275,210 | 948,847 | 793,511 | |
Total net operating revenues | 411,725 | 344,822 | 1,225,558 | 984,132 | |
Capitated revenues | 23,045 | 20,369 | 67,780 | 56,007 | |
Operating income (loss) | 361,903 | (30,118) | 338,159 | (70,153) | |
Operating Segments | Other Segments | Intersubsegment Eliminations | |||||
Segment Reporting Information [Line Items] | |||||
Total net operating revenues | 16,642 | 7,385 | 43,189 | 18,079 | |
Intersegment Elimination | |||||
Segment Reporting Information [Line Items] | |||||
Total net operating revenues | $ (32,757) | $ (21,099) | $ (88,197) | $ (57,253) | |
[1] | Corporate administrative support costs also include $27,040 of an adjustment to reduce a receivable associated with the DMG acquisition escrow provision relating to an income tax item. | ||||
[2] | Includes management fees for providing management and administrative services to dialysis centers that are wholly-owned by third parties and legal entities in which the Company owns a noncontrolling equity investment. | ||||
[3] | Includes medical consulting service fees and management fees for providing management and administrative services to unconsolidated joint ventures, as well as revenue related to the maintenance of existing physician networks. |
Summary of Segment Net Revenu72
Summary of Segment Net Revenues, Segment Operating income (Loss) and Reconciliation of Segment Income to Consolidated Income Before Income Taxes (Detail) (Parenthetical) (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | ||
Segment Reporting Information [Line Items] | |||||
Corporate administrative support costs, Adjustment to reduce receivable | [1] | $ 28,028 | $ 4,975 | $ 40,366 | $ 14,534 |
Tax Adjustments | |||||
Segment Reporting Information [Line Items] | |||||
Corporate administrative support costs, Adjustment to reduce receivable | $ 27,040 | ||||
[1] | Corporate administrative support costs also include $27,040 of an adjustment to reduce a receivable associated with the DMG acquisition escrow provision relating to an income tax item. |
Summary of Depreciation and Amo
Summary of Depreciation and Amortization Expense by Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Segment Reporting Information [Line Items] | ||||
Depreciation and amortization | $ 181,739 | $ 162,062 | $ 531,475 | $ 474,694 |
U.S. Dialysis And Related Lab Services | ||||
Segment Reporting Information [Line Items] | ||||
Depreciation and amortization | 122,540 | 111,828 | 358,427 | 326,281 |
DaVita Medical Group (DMG) | ||||
Segment Reporting Information [Line Items] | ||||
Depreciation and amortization | 52,595 | 43,523 | 153,068 | 129,890 |
Other Segments | ||||
Segment Reporting Information [Line Items] | ||||
Depreciation and amortization | $ 6,604 | $ 6,711 | $ 19,980 | $ 18,523 |
Summary of Assets by Segment (D
Summary of Assets by Segment (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 |
ASSETS | ||
Total assets | $ 18,925,653 | $ 18,514,875 |
U.S. Dialysis And Related Lab Services | ||
ASSETS | ||
Total assets | 11,460,732 | 11,591,507 |
DaVita Medical Group (DMG) | ||
ASSETS | ||
Total assets | 6,218,912 | 6,150,666 |
Other Segments | ||
ASSETS | ||
Total assets | $ 1,246,009 | $ 772,702 |
Summary of Assets by Segment (P
Summary of Assets by Segment (Parenthetical) (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 |
Segment Reporting Information [Line Items] | ||
Equity investments | $ 516,383 | $ 78,368 |
U.S. Dialysis And Related Lab Services | ||
Segment Reporting Information [Line Items] | ||
Equity investments | 41,624 | 34,801 |
DaVita Medical Group (DMG) | ||
Segment Reporting Information [Line Items] | ||
Equity investments | 11,293 | 22,714 |
Other Segments | ||
Segment Reporting Information [Line Items] | ||
Equity investments | $ 463,466 | $ 20,853 |
Summary of Expenditures for Pro
Summary of Expenditures for Property and Equipment by Segment (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Segment Reporting Information [Line Items] | ||||
Expenditures for property and equipment | $ 216,616 | $ 171,340 | $ 575,243 | $ 462,213 |
U.S. Dialysis And Related Lab Services | ||||
Segment Reporting Information [Line Items] | ||||
Expenditures for property and equipment | 182,741 | 138,683 | 467,121 | 385,734 |
DaVita Medical Group (DMG) | ||||
Segment Reporting Information [Line Items] | ||||
Expenditures for property and equipment | 17,396 | 18,885 | 55,639 | 36,870 |
Other Segments | ||||
Segment Reporting Information [Line Items] | ||||
Expenditures for property and equipment | $ 16,479 | $ 13,772 | $ 52,483 | $ 39,609 |
Effects of Changes in DaVita In
Effects of Changes in DaVita Inc's Ownership Interest on Company's Equity (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items] | ||||
Net income attributable to DaVita Inc. | $ 571,332 | $ 215,872 | $ 722,148 | $ 275,732 |
Net transfers to noncontrolling interests | (604) | (12,094) | (5,135) | (20,515) |
Net income attributable to DaVita Inc., net of transfers to noncontrolling interests | 570,728 | 203,778 | 717,013 | 255,217 |
Additional paid-in capital | ||||
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items] | ||||
Decrease in paid-in capital for the purchase of noncontrolling interests and adjustments to ownership interest | $ (604) | $ (12,094) | $ (5,135) | $ (20,515) |
Condensed Consolidating Stateme
Condensed Consolidating Statements of Income (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Condensed Income Statements Captions [Line Items] | ||||
Patient service revenues | $ 2,629,661 | $ 2,414,034 | $ 7,678,053 | $ 7,049,428 |
Less: Provision for uncollectible accounts | (115,555) | (109,452) | (336,188) | (314,581) |
Net patient service revenues | 2,514,106 | 2,304,582 | 7,341,865 | 6,734,847 |
Capitated revenues | 869,290 | 926,847 | 2,654,163 | 2,643,552 |
Other revenues | 347,180 | 294,236 | 1,033,335 | 869,849 |
Total net revenues | 3,730,576 | 3,525,665 | 11,029,363 | 10,248,248 |
Operating expenses and charges | 2,911,420 | 3,016,297 | 9,516,248 | 9,322,488 |
Operating income | 819,156 | 509,368 | 1,513,115 | 925,760 |
Debt (expense) and refinancing charges | (104,581) | (310,359) | ||
Other income, net | 1,876 | 2,484 | 8,067 | 4,262 |
Income tax (benefit) expense | 104,301 | 147,064 | 366,011 | 183,893 |
Net income | 612,150 | 261,307 | 844,812 | 392,936 |
Less: Net income attributable to noncontrolling interests | (40,818) | (45,435) | (122,664) | (117,204) |
Net income attributable to DaVita Inc. | 571,332 | 215,872 | 722,148 | 275,732 |
Debt expense, including debt redemption charges | (103,481) | (353,193) | ||
Consolidation, Eliminations | ||||
Condensed Income Statements Captions [Line Items] | ||||
Patient service revenues | (42,890) | (37,939) | (123,100) | (107,155) |
Net patient service revenues | (42,890) | (37,939) | (123,100) | (107,155) |
Capitated revenues | (40) | (115) | (251) | (148) |
Other revenues | (400,687) | (378,606) | (1,183,281) | (1,054,371) |
Total net revenues | (443,617) | (416,660) | (1,306,632) | (1,161,674) |
Operating expenses and charges | (443,617) | (416,660) | (1,306,632) | (1,161,674) |
Debt (expense) and refinancing charges | 103,432 | 308,800 | ||
Other income, net | (103,432) | (91,458) | (308,800) | (278,997) |
Equity (loss) earnings in subsidiaries | (840,027) | (284,725) | (1,155,137) | (444,255) |
Net income | (840,027) | (284,725) | (1,155,137) | (444,255) |
Less: Net income attributable to noncontrolling interests | (40,818) | (45,435) | (122,664) | (117,204) |
Net income attributable to DaVita Inc. | (880,845) | (330,160) | (1,277,801) | (561,459) |
Debt expense, including debt redemption charges | 91,458 | 278,997 | ||
DaVita Inc. | Reportable Legal Entities | ||||
Condensed Income Statements Captions [Line Items] | ||||
Other revenues | 191,815 | 184,561 | 575,700 | 542,412 |
Total net revenues | 191,815 | 184,561 | 575,700 | 542,412 |
Operating expenses and charges | 143,784 | 110,935 | 400,129 | 363,347 |
Operating income | 48,031 | 73,626 | 175,571 | 179,065 |
Debt (expense) and refinancing charges | (101,895) | (305,097) | ||
Other income, net | 99,446 | 89,824 | 296,660 | 271,847 |
Income tax (benefit) expense | (20,898) | 25,368 | 56,190 | 41,215 |
Equity (loss) earnings in subsidiaries | 504,852 | 179,926 | 611,204 | 213,754 |
Net income | 571,332 | 215,872 | 722,148 | 275,732 |
Net income attributable to DaVita Inc. | 571,332 | 215,872 | 722,148 | 275,732 |
Debt expense, including debt redemption charges | (102,136) | (347,719) | ||
Guarantor Subsidiaries | Reportable Legal Entities | ||||
Condensed Income Statements Captions [Line Items] | ||||
Patient service revenues | 1,726,892 | 1,656,648 | 5,044,565 | 4,901,959 |
Less: Provision for uncollectible accounts | (73,833) | (78,494) | (207,144) | (212,816) |
Net patient service revenues | 1,653,059 | 1,578,154 | 4,837,421 | 4,689,143 |
Capitated revenues | 462,436 | 453,766 | 1,391,010 | 1,340,838 |
Other revenues | 509,867 | 480,412 | 1,518,407 | 1,360,261 |
Total net revenues | 2,625,362 | 2,512,332 | 7,746,838 | 7,390,242 |
Operating expenses and charges | 2,388,114 | 2,244,237 | 7,275,863 | 7,042,896 |
Operating income | 237,248 | 268,095 | 470,975 | 347,346 |
Debt (expense) and refinancing charges | (91,716) | (275,148) | ||
Other income, net | 2,659 | 2,379 | 12,416 | 6,780 |
Income tax (benefit) expense | (21,486) | 112,310 | 140,972 | 116,934 |
Equity (loss) earnings in subsidiaries | 335,175 | 104,799 | 543,933 | 230,501 |
Net income | 504,852 | 179,926 | 611,204 | 213,754 |
Net income attributable to DaVita Inc. | 504,852 | 179,926 | 611,204 | 213,754 |
Debt expense, including debt redemption charges | (83,037) | (253,939) | ||
Non-Guarantor Subsidiaries | Reportable Legal Entities | ||||
Condensed Income Statements Captions [Line Items] | ||||
Patient service revenues | 945,659 | 795,325 | 2,756,588 | 2,254,624 |
Less: Provision for uncollectible accounts | (41,722) | (30,958) | (129,044) | (101,765) |
Net patient service revenues | 903,937 | 764,367 | 2,627,544 | 2,152,859 |
Capitated revenues | 406,894 | 473,196 | 1,263,404 | 1,302,862 |
Other revenues | 46,185 | 7,869 | 122,509 | 21,547 |
Total net revenues | 1,357,016 | 1,245,432 | 4,013,457 | 3,477,268 |
Operating expenses and charges | 823,139 | 1,077,785 | 3,146,888 | 3,077,919 |
Operating income | 533,877 | 167,647 | 866,569 | 399,349 |
Debt (expense) and refinancing charges | (14,402) | (38,914) | ||
Other income, net | 3,203 | 1,739 | 7,791 | 4,632 |
Income tax (benefit) expense | 146,685 | 9,386 | 168,849 | 25,744 |
Net income | 375,993 | 150,234 | 666,597 | 347,705 |
Net income attributable to DaVita Inc. | $ 375,993 | 150,234 | $ 666,597 | 347,705 |
Debt expense, including debt redemption charges | $ (9,766) | $ (30,532) |
Condensed Consolidating State79
Condensed Consolidating Statements of Comprehensive Income (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Condensed Financial Statements Captions [Line Items] | ||||
Net income | $ 612,150 | $ 261,307 | $ 844,812 | $ 392,936 |
Other comprehensive income (loss) | 7,868 | (9,957) | 7,807 | (29,319) |
Total comprehensive income | 620,018 | 251,350 | 852,619 | 363,617 |
Less: Comprehensive income attributable to noncontrolling interests | (40,876) | (45,435) | (122,871) | (117,204) |
Comprehensive income attributable to DaVita Inc. | 579,142 | 205,915 | 729,748 | 246,413 |
Consolidation, Eliminations | ||||
Condensed Financial Statements Captions [Line Items] | ||||
Net income | (840,027) | (284,725) | (1,155,137) | (444,255) |
Total comprehensive income | (840,027) | (284,725) | (1,155,137) | (444,255) |
Less: Comprehensive income attributable to noncontrolling interests | (40,876) | (45,435) | (122,871) | (117,204) |
Comprehensive income attributable to DaVita Inc. | (880,903) | (330,160) | (1,278,008) | (561,459) |
DaVita Inc. | Reportable Legal Entities | ||||
Condensed Financial Statements Captions [Line Items] | ||||
Net income | 571,332 | 215,872 | 722,148 | 275,732 |
Other comprehensive income (loss) | 1,248 | (2,934) | (5,299) | (9,436) |
Total comprehensive income | 572,580 | 212,938 | 716,849 | 266,296 |
Comprehensive income attributable to DaVita Inc. | 572,580 | 212,938 | 716,849 | 266,296 |
Guarantor Subsidiaries | Reportable Legal Entities | ||||
Condensed Financial Statements Captions [Line Items] | ||||
Net income | 504,852 | 179,926 | 611,204 | 213,754 |
Total comprehensive income | 504,852 | 179,926 | 611,204 | 213,754 |
Comprehensive income attributable to DaVita Inc. | 504,852 | 179,926 | 611,204 | 213,754 |
Non-Guarantor Subsidiaries | Reportable Legal Entities | ||||
Condensed Financial Statements Captions [Line Items] | ||||
Net income | 375,993 | 150,234 | 666,597 | 347,705 |
Other comprehensive income (loss) | 6,620 | (7,023) | 13,106 | (19,883) |
Total comprehensive income | 382,613 | 143,211 | 679,703 | 327,822 |
Comprehensive income attributable to DaVita Inc. | $ 382,613 | $ 143,211 | $ 679,703 | $ 327,822 |
Condensed Consolidating Balance
Condensed Consolidating Balance Sheets (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 | Sep. 30, 2015 | Dec. 31, 2014 |
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Cash and cash equivalents | $ 913,496 | $ 1,499,116 | $ 1,047,419 | $ 965,241 |
Accounts receivable, net | 1,850,425 | 1,724,228 | ||
Other current assets | 1,497,438 | 1,279,936 | ||
Total current assets | 4,261,359 | 4,503,280 | ||
Property and equipment, net | 3,044,988 | 2,788,740 | ||
Intangible assets, net | 1,576,157 | 1,687,326 | ||
Other long-term assets and investments | 660,153 | 241,050 | ||
Goodwill | 9,382,996 | 9,294,479 | 9,415,295 | |
Total assets | 18,925,653 | 18,514,875 | ||
Current liabilities | 2,639,469 | 2,399,138 | ||
Long-term debt and other long-term liabilities | 10,195,049 | 10,167,499 | ||
Noncontrolling interests subject to put provisions | 971,744 | 864,066 | ||
Total DaVita Inc. shareholder's equity | 4,911,746 | 4,870,780 | ||
Noncontrolling interests not subject to put provisions | 207,645 | 213,392 | ||
Total equity | 5,119,391 | 5,084,172 | ||
Total liabilities and equity | 18,925,653 | 18,514,875 | ||
Consolidation, Eliminations | ||||
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Investments in subsidiaries | (11,552,690) | (10,490,264) | ||
Intercompany receivables | (3,952,332) | (4,175,947) | ||
Total assets | (15,505,022) | (14,666,211) | ||
Intercompany payables | (3,952,332) | (4,175,947) | ||
Noncontrolling interests subject to put provisions | 362,099 | 322,320 | ||
Total DaVita Inc. shareholder's equity | (11,552,690) | (10,490,264) | ||
Noncontrolling interests not subject to put provisions | (362,099) | (322,320) | ||
Total equity | (11,914,789) | (10,812,584) | ||
Total liabilities and equity | (15,505,022) | (14,666,211) | ||
DaVita Inc. | Reportable Legal Entities | ||||
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Cash and cash equivalents | 623,901 | 1,186,636 | 721,477 | 698,876 |
Other current assets | 661,642 | 431,504 | ||
Total current assets | 1,285,543 | 1,618,140 | ||
Property and equipment, net | 298,869 | 268,066 | ||
Intangible assets, net | 553 | 540 | ||
Investments in subsidiaries | 9,628,258 | 8,893,079 | ||
Intercompany receivables | 3,131,796 | 3,474,133 | ||
Other long-term assets and investments | 40,574 | 74,458 | ||
Total assets | 14,385,593 | 14,328,416 | ||
Current liabilities | 274,520 | 185,217 | ||
Long-term debt and other long-term liabilities | 8,589,682 | 8,730,673 | ||
Noncontrolling interests subject to put provisions | 609,645 | 541,746 | ||
Total DaVita Inc. shareholder's equity | 4,911,746 | 4,870,780 | ||
Total equity | 4,911,746 | 4,870,780 | ||
Total liabilities and equity | 14,385,593 | 14,328,416 | ||
Guarantor Subsidiaries | Reportable Legal Entities | ||||
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Cash and cash equivalents | 35,769 | 109,357 | 88,969 | 77,921 |
Accounts receivable, net | 1,174,364 | 929,390 | ||
Other current assets | 745,238 | 769,947 | ||
Total current assets | 1,955,371 | 1,808,694 | ||
Property and equipment, net | 1,624,181 | 1,575,890 | ||
Intangible assets, net | 1,537,645 | 1,634,920 | ||
Investments in subsidiaries | 1,924,432 | 1,597,185 | ||
Other long-term assets and investments | 55,069 | 53,346 | ||
Goodwill | 7,876,067 | 7,834,257 | ||
Total assets | 14,972,765 | 14,504,292 | ||
Current liabilities | 1,842,058 | 1,730,123 | ||
Intercompany payables | 2,264,044 | 2,750,102 | ||
Long-term debt and other long-term liabilities | 1,238,405 | 1,130,988 | ||
Total DaVita Inc. shareholder's equity | 9,628,258 | 8,893,079 | ||
Total equity | 9,628,258 | 8,893,079 | ||
Total liabilities and equity | 14,972,765 | 14,504,292 | ||
Non-Guarantor Subsidiaries | Reportable Legal Entities | ||||
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Cash and cash equivalents | 253,826 | 203,123 | $ 236,973 | $ 188,444 |
Accounts receivable, net | 676,061 | 794,838 | ||
Other current assets | 90,558 | 78,485 | ||
Total current assets | 1,020,445 | 1,076,446 | ||
Property and equipment, net | 1,121,938 | 944,784 | ||
Intangible assets, net | 37,959 | 51,866 | ||
Intercompany receivables | 820,536 | 701,814 | ||
Other long-term assets and investments | 564,510 | 113,246 | ||
Goodwill | 1,506,929 | 1,460,222 | ||
Total assets | 5,072,317 | 4,348,378 | ||
Current liabilities | 522,891 | 483,798 | ||
Intercompany payables | 1,688,288 | 1,425,845 | ||
Long-term debt and other long-term liabilities | 366,962 | 305,838 | ||
Total DaVita Inc. shareholder's equity | 1,924,432 | 1,597,185 | ||
Noncontrolling interests not subject to put provisions | 569,744 | 535,712 | ||
Total equity | 2,494,176 | 2,132,897 | ||
Total liabilities and equity | $ 5,072,317 | $ 4,348,378 |
Condensed Consolidating State81
Condensed Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | ||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | |
Cash flows from operating activities: | ||||
Net income | $ 612,150 | $ 261,307 | $ 844,812 | $ 392,936 |
Changes in operating assets and liabilities and non-cash items included in net income | 636,450 | 727,591 | ||
Net cash provided by operating activities | 1,481,262 | 1,120,527 | ||
Cash flows from investing activities: | ||||
Additions of property and equipment | (216,616) | (171,340) | (575,243) | (462,213) |
Acquisitions | (497,331) | (90,709) | ||
Proceeds from asset and business sales | 18,991 | 6,865 | ||
(Purchases) proceeds from investment sales and other items, net | (203,659) | (604,327) | ||
Net cash used in investing activities | (1,257,242) | (1,150,384) | ||
Cash flows from financing activities: | ||||
Long-term debt and related financing costs, net | (98,724) | 639,317 | ||
Other items | (709,252) | (525,438) | ||
Net cash (used in) provided by financing activities | (807,976) | 113,879 | ||
Effect of exchange rate changes on cash | (1,664) | (1,844) | ||
Net (decrease) increase in cash and cash equivalents | (585,620) | 82,178 | ||
Cash and cash equivalents at beginning of the year | 1,499,116 | 965,241 | ||
Cash and cash equivalents at end of the period | 913,496 | 1,047,419 | 913,496 | 1,047,419 |
Consolidation, Eliminations | ||||
Cash flows from operating activities: | ||||
Net income | (840,027) | (284,725) | (1,155,137) | (444,255) |
Changes in operating assets and liabilities and non-cash items included in net income | 1,155,137 | 444,255 | ||
DaVita Inc. | Reportable Legal Entities | ||||
Cash flows from operating activities: | ||||
Net income | 571,332 | 215,872 | 722,148 | 275,732 |
Changes in operating assets and liabilities and non-cash items included in net income | (586,804) | (187,876) | ||
Net cash provided by operating activities | 135,344 | 87,856 | ||
Cash flows from investing activities: | ||||
Additions of property and equipment | (81,785) | (39,448) | ||
(Purchases) proceeds from investment sales and other items, net | (236,150) | (587,583) | ||
Net cash used in investing activities | (317,935) | (627,031) | ||
Cash flows from financing activities: | ||||
Long-term debt and related financing costs, net | (73,889) | 661,260 | ||
Intercompany borrowing (payments) | 283,709 | 304,623 | ||
Other items | (589,964) | (404,107) | ||
Net cash (used in) provided by financing activities | (380,144) | 561,776 | ||
Net (decrease) increase in cash and cash equivalents | (562,735) | 22,601 | ||
Cash and cash equivalents at beginning of the year | 1,186,636 | 698,876 | ||
Cash and cash equivalents at end of the period | 623,901 | 721,477 | 623,901 | 721,477 |
Guarantor Subsidiaries | Reportable Legal Entities | ||||
Cash flows from operating activities: | ||||
Net income | 504,852 | 179,926 | 611,204 | 213,754 |
Changes in operating assets and liabilities and non-cash items included in net income | 228,991 | 441,752 | ||
Net cash provided by operating activities | 840,195 | 655,506 | ||
Cash flows from investing activities: | ||||
Additions of property and equipment | (248,339) | (222,447) | ||
Acquisitions | (458,556) | (73,339) | ||
Proceeds from asset and business sales | 24,608 | 6,865 | ||
(Purchases) proceeds from investment sales and other items, net | (12,825) | 1,513 | ||
Net cash used in investing activities | (695,112) | (287,408) | ||
Cash flows from financing activities: | ||||
Long-term debt and related financing costs, net | (20,684) | (13,183) | ||
Intercompany borrowing (payments) | (188,247) | (320,262) | ||
Other items | (9,740) | (23,605) | ||
Net cash (used in) provided by financing activities | (218,671) | (357,050) | ||
Net (decrease) increase in cash and cash equivalents | (73,588) | 11,048 | ||
Cash and cash equivalents at beginning of the year | 109,357 | 77,921 | ||
Cash and cash equivalents at end of the period | 35,769 | 88,969 | 35,769 | 88,969 |
Non-Guarantor Subsidiaries | Reportable Legal Entities | ||||
Cash flows from operating activities: | ||||
Net income | 375,993 | 150,234 | 666,597 | 347,705 |
Changes in operating assets and liabilities and non-cash items included in net income | (160,874) | 29,460 | ||
Net cash provided by operating activities | 505,723 | 377,165 | ||
Cash flows from investing activities: | ||||
Additions of property and equipment | (245,119) | (200,318) | ||
Acquisitions | (38,775) | (17,370) | ||
Proceeds from asset and business sales | (5,617) | |||
(Purchases) proceeds from investment sales and other items, net | 45,316 | (18,257) | ||
Net cash used in investing activities | (244,195) | (235,945) | ||
Cash flows from financing activities: | ||||
Long-term debt and related financing costs, net | (4,151) | (8,760) | ||
Intercompany borrowing (payments) | (95,462) | 15,639 | ||
Other items | (109,548) | (97,726) | ||
Net cash (used in) provided by financing activities | (209,161) | (90,847) | ||
Effect of exchange rate changes on cash | (1,664) | (1,844) | ||
Net (decrease) increase in cash and cash equivalents | 50,703 | 48,529 | ||
Cash and cash equivalents at beginning of the year | 203,123 | 188,444 | ||
Cash and cash equivalents at end of the period | $ 253,826 | $ 236,973 | $ 253,826 | $ 236,973 |
Supplemental Data - Condensed C
Supplemental Data - Condensed Consolidating Statements of Income (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | ||
Condensed Income Statements Captions [Line Items] | |||||
Patient service operating revenues | $ 2,629,661 | $ 2,414,034 | $ 7,678,053 | $ 7,049,428 | |
Less: Provision for uncollectible accounts | (115,555) | (109,452) | (336,188) | (314,581) | |
Net patient service revenues | 2,514,106 | 2,304,582 | 7,341,865 | 6,734,847 | |
Capitated revenues | 869,290 | 926,847 | 2,654,163 | 2,643,552 | |
Other revenues | 347,180 | 294,236 | 1,033,335 | 869,849 | |
Total net revenues | 3,730,576 | 3,525,665 | 11,029,363 | 10,248,248 | |
Operating expenses | 2,911,420 | 3,016,297 | 9,516,248 | 9,322,488 | |
Operating income | 819,156 | 509,368 | 1,513,115 | 925,760 | |
Debt (expense) and refinancing charges | (104,581) | (310,359) | |||
Other income | 1,876 | 2,484 | 8,067 | 4,262 | |
Income tax expense | 104,301 | 147,064 | 366,011 | 183,893 | |
Net income | 612,150 | 261,307 | 844,812 | 392,936 | |
Less: Net income attributable to noncontrolling interests | (40,818) | (45,435) | (122,664) | (117,204) | |
Net income attributable to DaVita Inc. | $ 571,332 | $ 215,872 | 722,148 | $ 275,732 | |
Physician Groups | |||||
Condensed Income Statements Captions [Line Items] | |||||
Patient service operating revenues | 287,544 | ||||
Less: Provision for uncollectible accounts | (9,178) | ||||
Net patient service revenues | 278,366 | ||||
Capitated revenues | 1,186,001 | ||||
Other revenues | 53,124 | ||||
Total net revenues | 1,517,491 | ||||
Operating expenses | 1,513,569 | ||||
Operating income | 3,922 | ||||
Debt (expense) and refinancing charges | (9,347) | ||||
Other income | 322 | ||||
Income tax expense | 10,442 | ||||
Net income | (15,545) | ||||
Net income attributable to DaVita Inc. | (15,545) | ||||
Unrestricted Subsidiaries | |||||
Condensed Income Statements Captions [Line Items] | |||||
Operating expenses | (129) | ||||
Operating income | 129 | ||||
Income tax expense | 52 | ||||
Net income | 77 | ||||
Net income attributable to DaVita Inc. | 77 | ||||
Company and Restricted Subsidiaries | |||||
Condensed Income Statements Captions [Line Items] | |||||
Patient service operating revenues | [1] | 7,390,509 | |||
Less: Provision for uncollectible accounts | [1] | (327,010) | |||
Net patient service revenues | [1] | 7,063,499 | |||
Capitated revenues | [1] | 1,468,162 | |||
Other revenues | [1] | 980,211 | |||
Total net revenues | [1] | 9,511,872 | |||
Operating expenses | [1] | 8,002,808 | |||
Operating income | [1] | 1,509,064 | |||
Debt (expense) and refinancing charges | [1] | (301,012) | |||
Other income | [1] | 7,745 | |||
Income tax expense | [1] | 355,517 | |||
Net income | [1] | 860,280 | |||
Less: Net income attributable to noncontrolling interests | [1] | (122,664) | |||
Net income attributable to DaVita Inc. | [1] | $ 737,616 | |||
[1] | After elimination of the unrestricted subsidiaries and the physician groups. |
Supplemental Data - Condensed83
Supplemental Data - Condensed Consolidating Statements of Comprehensive Income (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | ||
Condensed Financial Statements Captions [Line Items] | |||||
Net income | $ 612,150 | $ 261,307 | $ 844,812 | $ 392,936 | |
Other comprehensive loss | 7,868 | (9,957) | 7,807 | (29,319) | |
Total comprehensive income | 620,018 | 251,350 | 852,619 | 363,617 | |
Less: Comprehensive income attributable to noncontrolling interests | (40,876) | (45,435) | (122,871) | (117,204) | |
Comprehensive income attributable to DaVita Inc. | $ 579,142 | $ 205,915 | 729,748 | $ 246,413 | |
Physician Groups | |||||
Condensed Financial Statements Captions [Line Items] | |||||
Net income | (15,545) | ||||
Total comprehensive income | (15,545) | ||||
Comprehensive income attributable to DaVita Inc. | (15,545) | ||||
Unrestricted Subsidiaries | |||||
Condensed Financial Statements Captions [Line Items] | |||||
Net income | 77 | ||||
Total comprehensive income | 77 | ||||
Comprehensive income attributable to DaVita Inc. | 77 | ||||
Company and Restricted Subsidiaries | |||||
Condensed Financial Statements Captions [Line Items] | |||||
Net income | [1] | 860,280 | |||
Other comprehensive loss | [1] | 7,807 | |||
Total comprehensive income | [1] | 868,087 | |||
Less: Comprehensive income attributable to noncontrolling interests | [1] | (122,871) | |||
Comprehensive income attributable to DaVita Inc. | [1] | $ 745,216 | |||
[1] | After elimination of the unrestricted subsidiaries and the physician groups. |
Supplemental Data - Condensed84
Supplemental Data - Condensed Consolidating Balance Sheets (Detail) - USD ($) $ in Thousands | Sep. 30, 2016 | Dec. 31, 2015 | Sep. 30, 2015 | Dec. 31, 2014 | |
Condensed Balance Sheet Statements Captions [Line Items] | |||||
Cash and cash equivalents | $ 913,496 | $ 1,499,116 | $ 1,047,419 | $ 965,241 | |
Accounts receivable, net | 1,850,425 | 1,724,228 | |||
Other current assets | 1,497,438 | 1,279,936 | |||
Total current assets | 4,261,359 | 4,503,280 | |||
Property and equipment, net | 3,044,988 | 2,788,740 | |||
Intangible assets, net | 1,576,157 | 1,687,326 | |||
Other long-term assets | 660,153 | 241,050 | |||
Goodwill | 9,382,996 | 9,294,479 | $ 9,415,295 | ||
Total assets | 18,925,653 | 18,514,875 | |||
Current liabilities | 2,639,469 | 2,399,138 | |||
Long-term debt and other long-term liabilities | 10,195,049 | 10,167,499 | |||
Noncontrolling interests subject to put provisions | 971,744 | 864,066 | |||
Total DaVita Inc. shareholders’ equity | 4,911,746 | 4,870,780 | |||
Noncontrolling interests not subject to put provisions | 207,645 | 213,392 | |||
Total equity | 5,119,391 | 5,084,172 | |||
Total liabilities and equity | 18,925,653 | 18,514,875 | |||
Physician Groups | |||||
Condensed Balance Sheet Statements Captions [Line Items] | |||||
Cash and cash equivalents | 104,636 | 88,245 | |||
Accounts receivable, net | 195,488 | ||||
Other current assets | 18,419 | ||||
Total current assets | 318,543 | ||||
Property and equipment, net | 1,417 | ||||
Intangible assets, net | 5,141 | ||||
Other long-term assets | 77,681 | ||||
Goodwill | 16,405 | ||||
Total assets | 419,187 | ||||
Current liabilities | 229,515 | ||||
Payables to parent | 86,335 | ||||
Long-term debt and other long-term liabilities | 50,099 | ||||
Total DaVita Inc. shareholders’ equity | 53,238 | ||||
Total equity | 53,238 | ||||
Total liabilities and equity | 419,187 | ||||
Unrestricted Subsidiaries | |||||
Condensed Balance Sheet Statements Captions [Line Items] | |||||
Other long-term assets | 2,696 | ||||
Total assets | 2,696 | ||||
Payables to parent | 2,696 | ||||
Total liabilities and equity | 2,696 | ||||
Company and Restricted Subsidiaries | |||||
Condensed Balance Sheet Statements Captions [Line Items] | |||||
Cash and cash equivalents | [1] | 808,860 | $ 1,410,871 | ||
Accounts receivable, net | [1] | 1,654,937 | |||
Other current assets | [1] | 1,479,019 | |||
Total current assets | [1] | 3,942,816 | |||
Property and equipment, net | [1] | 3,043,571 | |||
Intangible assets, net | [1] | 1,571,016 | |||
Other long-term assets | [1] | 579,776 | |||
Goodwill | [1] | 9,366,591 | |||
Total assets | [1] | 18,503,770 | |||
Current liabilities | [1] | 2,409,954 | |||
Payables to parent | [1] | (89,031) | |||
Long-term debt and other long-term liabilities | [1] | 10,144,950 | |||
Noncontrolling interests subject to put provisions | [1] | 971,744 | |||
Total DaVita Inc. shareholders’ equity | [1] | 4,858,508 | |||
Noncontrolling interests not subject to put provisions | [1] | 207,645 | |||
Total equity | [1] | 5,066,153 | |||
Total liabilities and equity | [1] | $ 18,503,770 | |||
[1] | After elimination of the unrestricted subsidiaries and the physician groups. |
Supplemental Data - Condensed85
Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands | 3 Months Ended | 9 Months Ended | |||
Sep. 30, 2016 | Sep. 30, 2015 | Sep. 30, 2016 | Sep. 30, 2015 | ||
Cash flows from operating activities: | |||||
Net income | $ 612,150 | $ 261,307 | $ 844,812 | $ 392,936 | |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 636,450 | 727,591 | |||
Net cash provided by operating activities | 1,481,262 | 1,120,527 | |||
Cash flows from investing activities: | |||||
Additions of property and equipment | (216,616) | (171,340) | (575,243) | (462,213) | |
Acquisitions and divestitures, net | (497,331) | ||||
Proceeds from discontinued operations | 18,991 | 6,865 | |||
Investments and other items | (203,659) | (604,327) | |||
Net cash used in investing activities | (1,257,242) | (1,150,384) | |||
Cash flows from financing activities: | |||||
Long-term debt | (98,724) | 639,317 | |||
Other items | (709,252) | (525,438) | |||
Net cash (used in) provided by financing activities | (807,976) | 113,879 | |||
Effect of exchange rate changes on cash | (1,664) | (1,844) | |||
Net (decrease) increase in cash and cash equivalents | (585,620) | 82,178 | |||
Cash and cash equivalents at beginning of the year | 1,499,116 | 965,241 | |||
Cash and cash equivalents at end of the period | 913,496 | $ 1,047,419 | 913,496 | $ 1,047,419 | |
Physician Groups | |||||
Cash flows from operating activities: | |||||
Net income | (15,545) | ||||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 152,461 | ||||
Net cash provided by operating activities | 136,916 | ||||
Cash flows from investing activities: | |||||
Additions of property and equipment | (592) | ||||
Investments and other items | (2,124) | ||||
Net cash used in investing activities | (2,716) | ||||
Cash flows from financing activities: | |||||
Long-term debt | (4) | ||||
Intercompany | (117,805) | ||||
Net cash (used in) provided by financing activities | (117,809) | ||||
Net (decrease) increase in cash and cash equivalents | 16,391 | ||||
Cash and cash equivalents at beginning of the year | 88,245 | ||||
Cash and cash equivalents at end of the period | 104,636 | 104,636 | |||
Unrestricted Subsidiaries | |||||
Cash flows from operating activities: | |||||
Net income | 77 | ||||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | (77) | ||||
Company and Restricted Subsidiaries | |||||
Cash flows from operating activities: | |||||
Net income | [1] | 860,280 | |||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | [1] | 484,066 | |||
Net cash provided by operating activities | [1] | 1,344,346 | |||
Cash flows from investing activities: | |||||
Additions of property and equipment | [1] | (574,651) | |||
Acquisitions and divestitures, net | [1] | (497,331) | |||
Proceeds from discontinued operations | [1] | 18,991 | |||
Investments and other items | [1] | (201,535) | |||
Net cash used in investing activities | [1] | (1,254,526) | |||
Cash flows from financing activities: | |||||
Long-term debt | [1] | (98,720) | |||
Intercompany | [1] | 117,805 | |||
Other items | [1] | (709,252) | |||
Net cash (used in) provided by financing activities | [1] | (690,167) | |||
Effect of exchange rate changes on cash | [1] | (1,664) | |||
Net (decrease) increase in cash and cash equivalents | [1] | (602,011) | |||
Cash and cash equivalents at beginning of the year | [1] | 1,410,871 | |||
Cash and cash equivalents at end of the period | [1] | $ 808,860 | $ 808,860 | ||
[1] | After elimination of the unrestricted subsidiaries and the physician groups. |