Document and Entity Information
Document and Entity Information - USD ($) shares in Millions, $ in Billions | 12 Months Ended | ||
Dec. 31, 2016 | Jan. 31, 2017 | Jun. 30, 2016 | |
Document And Entity Information [Abstract] | |||
Document Type | 10-K | ||
Amendment Flag | false | ||
Document Period End Date | Dec. 31, 2016 | ||
Document Fiscal Year Focus | 2,016 | ||
Document Fiscal Period Focus | FY | ||
Trading Symbol | DVA | ||
Entity Registrant Name | DAVITA INC. | ||
Entity Central Index Key | 927,066 | ||
Current Fiscal Year End Date | --12-31 | ||
Entity Well-known Seasoned Issuer | Yes | ||
Entity Current Reporting Status | Yes | ||
Entity Voluntary Filers | No | ||
Entity Filer Category | Large Accelerated Filer | ||
Entity Common Stock, Shares Outstanding | 194.6 | 206.9 | |
Entity Public Float | $ 16 |
CONSOLIDATED STATEMENTS OF INCO
CONSOLIDATED STATEMENTS OF INCOME - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Income Statement [Abstract] | |||
Patient service revenues | $ 10,354,161 | $ 9,480,279 | $ 8,868,338 |
Less: Provision for uncollectible accounts | (451,353) | (427,860) | (366,884) |
Net patient service revenues | 9,902,808 | 9,052,419 | 8,501,454 |
Capitated revenues | 3,518,679 | 3,509,095 | 3,261,288 |
Other revenues | 1,323,618 | 1,220,323 | 1,032,364 |
Total net revenues | 14,745,105 | 13,781,837 | 12,795,106 |
Operating expenses and charges: | |||
Patient care costs and other costs | 10,646,736 | 9,824,834 | 9,119,305 |
General and administrative | 1,592,698 | 1,452,135 | 1,261,506 |
Depreciation and amortization | 720,252 | 638,024 | 590,935 |
Provision for uncollectible accounts | 11,677 | 9,240 | 14,453 |
Equity investment income | (13,044) | (18,325) | (23,234) |
Goodwill and other asset impairment charges | 296,408 | 210,234 | |
Gain on changes in ownership interests, net | (404,165) | ||
Settlement charge and loss contingency accrual | 495,000 | 17,000 | |
Total operating expenses and charges | 12,850,562 | 12,611,142 | 10,979,965 |
Operating income | 1,894,543 | 1,170,695 | 1,815,141 |
Debt expense | (414,382) | (408,380) | (410,294) |
Debt redemption and refinancing charges | (48,072) | (97,548) | |
Other income, net | 8,734 | 8,893 | 2,374 |
Income before income taxes | 1,488,895 | 723,136 | 1,309,673 |
Income tax expense | 455,813 | 295,726 | 446,343 |
Net income | 1,033,082 | 427,410 | 863,330 |
Less: Net income attributable to noncontrolling interests | (153,208) | (157,678) | (140,216) |
Net income attributable to DaVita Inc. | $ 879,874 | $ 269,732 | $ 723,114 |
Earnings per share: | |||
Basic net income per share attributable to DaVita Inc. | $ 4.36 | $ 1.27 | $ 3.41 |
Diluted net income per share attributable to DaVita Inc. | $ 4.29 | $ 1.25 | $ 3.33 |
Weighted average shares for earnings per share: | |||
Basic | 201,641,173 | 211,867,714 | 212,301,827 |
Diluted | 204,904,656 | 216,251,807 | 216,927,681 |
CONSOLIDATED STATEMENTS OF COMP
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Statement Of Income And Comprehensive Income [Abstract] | |||
Net income | $ 1,033,082 | $ 427,410 | $ 863,330 |
Unrealized losses on interest rate swap and cap agreements: | |||
Unrealized losses on interest rate swap and cap agreements | (3,670) | (12,241) | (10,059) |
Reclassifications of net swap and cap agreements realized losses into net income | 2,566 | 3,111 | 10,608 |
Unrealized gains (losses) on investments: | |||
Unrealized gains (losses) on investments | 1,427 | (1,413) | 238 |
Reclassification of net investment realized gains into net income | (423) | (377) | (207) |
Foreign currency translation adjustments | |||
Foreign currency translation adjustments | (39,614) | (23,889) | (22,952) |
Reclassification of foreign currency translation into net income | 10,087 | ||
Other comprehensive loss | (29,627) | (34,809) | (22,372) |
Total comprehensive income | 1,003,455 | 392,601 | 840,958 |
Less: Comprehensive income attributable to noncontrolling interests | (153,398) | (157,678) | (140,216) |
Comprehensive income attributable to DaVita Inc. | $ 850,057 | $ 234,923 | $ 700,742 |
CONSOLIDATED BALANCE SHEETS
CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
ASSETS | ||
Cash and cash equivalents | $ 913,187 | $ 1,499,116 |
Short-term investments | 310,198 | 408,084 |
Accounts receivable, less allowance of $252,056 and $264,144 | 1,917,302 | 1,724,228 |
Inventories | 164,858 | 185,575 |
Other receivables | 453,483 | 435,885 |
Other current assets | 210,604 | 190,322 |
Income tax receivable | 10,596 | 60,070 |
Total current assets | 3,980,228 | 4,503,280 |
Property and equipment, net | 3,175,367 | 2,788,740 |
Intangible assets, net | 1,527,767 | 1,687,326 |
Equity investments | 502,389 | 78,368 |
Long-term investments | 103,679 | 89,122 |
Other long-term assets | 44,510 | 73,560 |
Goodwill | 9,407,317 | 9,294,479 |
Total assets | 18,741,257 | 18,514,875 |
LIABILITIES AND EQUITY | ||
Accounts payable | 522,415 | 513,950 |
Other liabilities | 856,847 | 682,123 |
Accrued compensation and benefits | 815,761 | 741,926 |
Medical payables | 336,381 | 332,102 |
Current portion of long-term debt | 165,041 | 129,037 |
Total current liabilities | 2,696,445 | 2,399,138 |
Long-term debt | 8,947,327 | 9,001,308 |
Other long-term liabilities | 465,358 | 439,229 |
Deferred income taxes | 809,128 | 726,962 |
Total liabilities | 12,918,258 | 12,566,637 |
Commitments and contingencies | ||
Noncontrolling interests subject to put provisions | 973,258 | 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; 194,554,491 and 217,120,346 shares issued and 194,554,491 and 209,754,247 shares outstanding, respectively) | 195 | 217 |
Additional paid-in capital | 1,027,182 | 1,118,326 |
Retained earnings | 3,710,313 | 4,356,835 |
Treasury stock (7,366,099 shares at December 31, 2015) | (544,772) | |
Accumulated other comprehensive loss | (89,643) | (59,826) |
Total DaVita Inc. shareholders' equity | 4,648,047 | 4,870,780 |
Noncontrolling interests not subject to put provisions | 201,694 | 213,392 |
Total equity | 4,849,741 | 5,084,172 |
Total liabilities and equity | $ 18,741,257 | $ 18,514,875 |
CONSOLIDATED BALANCE SHEETS (Pa
CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Statement Of Financial Position [Abstract] | ||
Accounts receivable, allowance | $ 252,056 | $ 264,144 |
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 | 194,554,491 | 217,120,346 |
Common stock, shares outstanding | 194,554,491 | 209,754,247 |
Treasury stock, shares | 7,366,099 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Cash flows from operating activities: | |||
Net income | $ 1,033,082 | $ 427,410 | $ 863,330 |
Adjustments to reconcile net income to net cash provided by operating activities: | |||
Settlement charge and loss contingency accrual | 495,000 | 17,000 | |
Depreciation and amortization | 720,252 | 638,024 | 590,935 |
Goodwill and other asset impairment charges | 296,408 | 210,234 | |
Debt redemption and refinancing charges | 48,072 | 97,548 | |
Stock-based compensation expense | 38,338 | 56,664 | 56,743 |
Tax benefits from stock award exercises | 28,397 | 45,749 | 59,119 |
Excess tax benefits from stock award exercises | (13,251) | (28,157) | (45,271) |
Deferred income taxes | 52,010 | 61,744 | 210,955 |
Equity investment income, net | 17,766 | 9,293 | 10,125 |
Gain on sales of business interests, net | (404,165) | ||
Other non-cash charges, net | (7,338) | 44,691 | 39,274 |
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures: | |||
Accounts receivable | (152,240) | (202,867) | (40,676) |
Inventories | 22,920 | (48,313) | (46,398) |
Other receivables and other current assets | (54,038) | 32,761 | (61,674) |
Other long-term assets | 35,893 | 3,723 | 2,916 |
Accounts payable | 11,897 | 30,998 | (2,956) |
Accrued compensation and benefits | 68,272 | 54,950 | 97,261 |
Other current liabilities | 176,494 | 113,470 | 83,590 |
Settlement payments | (493,775) | (410,356) | |
Income taxes | 62,230 | 24,175 | (60,475) |
Other long-term liabilities | 30,517 | 33,354 | (1,583) |
Net cash provided by operating activities | 1,963,444 | 1,557,200 | 1,459,407 |
Cash flows from investing activities: | |||
Additions of property and equipment | (829,095) | (707,998) | (641,330) |
Acquisitions | (563,856) | (96,469) | (272,094) |
Proceeds from asset and business sales | 64,725 | 19,715 | 8,791 |
Purchase of investments available-for-sale | (13,539) | (8,783) | (8,440) |
Purchase of investments held-to-maturity | (1,133,192) | (1,709,883) | (472,628) |
Proceeds from sale of investments available-for-sale | 18,963 | 2,058 | 2,475 |
Proceeds from investments held-to-maturity | 1,240,502 | 1,637,358 | 141,072 |
Purchase of intangible assets | (1,018) | ||
Purchase of equity investments | (27,096) | (17,911) | (35,382) |
Proceeds from sale of equity investments | 40,920 | ||
Distributions received on equity investments | 129 | 825 | |
Net cash used in investing activities | (1,201,668) | (881,784) | (1,277,729) |
Cash flows from financing activities: | |||
Borrowings | 51,991,490 | 54,541,988 | 60,038,508 |
Payments on long-term debt and other financing costs | (52,115,932) | (53,922,290) | (60,046,487) |
Deferred financing and debt redemption and refinancing costs | (188) | (76,672) | (122,988) |
Purchase of treasury stock | (1,097,822) | (549,935) | |
Distributions to noncontrolling interests | (192,401) | (174,635) | (149,339) |
Stock award exercises and other share issuances, net | 23,543 | 26,155 | 19,500 |
Excess tax benefits from stock award exercises | 13,251 | 28,157 | 45,271 |
Contributions from noncontrolling interests | 47,590 | 54,644 | 64,655 |
Proceeds from sales of additional noncontrolling interests | 3,777 | ||
Purchases of noncontrolling interests | (21,512) | (66,382) | (17,876) |
Net cash used in financing activities | (1,351,981) | (138,970) | (164,979) |
Effect of exchange rate changes on cash and cash equivalents | 4,276 | (2,571) | 2,293 |
Net (decrease) increase in cash and cash equivalents | (585,929) | 533,875 | 18,992 |
Cash and cash equivalents at beginning of the year | 1,499,116 | 965,241 | 946,249 |
Cash and cash equivalents at end of the year | $ 913,187 | $ 1,499,116 | $ 965,241 |
CONSOLIDATED STATEMENTS OF EQUI
CONSOLIDATED STATEMENTS OF EQUITY - USD ($) $ in Thousands | Total | Non- controlling Interests subject to put provisions | Common stock | Common stockStock Appreciation Rights | Additional paid-in capital | Additional paid-in capitalStock Appreciation Rights | Retained earnings | Treasury stock | Treasury stockStock Appreciation Rights | Accumulated other comprehensive income (loss) | Total | Non-controlling interests not subject to put provisions |
Beginning Balance at Dec. 31, 2013 | $ 697,300 | $ 213 | $ 1,070,922 | $ 3,363,989 | $ (2,645) | $ 4,432,479 | $ 173,062 | |||||
Beginning Balance (in shares) at Dec. 31, 2013 | 213,163,000 | |||||||||||
Comprehensive income: | ||||||||||||
Net income | 88,425 | 723,114 | 723,114 | 51,791 | ||||||||
Other comprehensive income (loss) | $ (22,372) | (22,372) | (22,372) | |||||||||
Stock purchase shares issued | 19,010 | 19,010 | ||||||||||
Stock purchase shares issued (in shares) | 298,000 | |||||||||||
Stock-settled shares issued | $ 1 | $ 2 | (28) | $ (2) | (27) | |||||||
Stock-settled shares issued (in shares) | 304,000 | 1,876,000 | ||||||||||
Stock-based compensation expense | 54,969 | 54,969 | ||||||||||
Excess tax benefits from stock awards exercised | 45,271 | 45,271 | ||||||||||
Distributions to noncontrolling interests | (93,884) | (55,455) | ||||||||||
Contributions from noncontrolling interests | 41,876 | 22,779 | ||||||||||
Sales and assumptions of additional noncontrolling interests | 25,220 | 355 | 355 | 4,165 | ||||||||
Purchases from noncontrolling interests | (6,111) | (5,357) | (5,357) | (6,544) | ||||||||
Other reclassification | 210 | 210 | ||||||||||
Changes in fair value of noncontrolling interests | 77,139 | (77,139) | (77,139) | |||||||||
Ending Balance at Dec. 31, 2014 | 829,965 | $ 216 | 1,108,211 | 4,087,103 | (25,017) | 5,170,513 | 189,798 | |||||
Ending 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) | (34,809) | |||||||||
Stock purchase shares issued | (6,079) | $ 30,608 | 24,529 | |||||||||
Stock purchase shares issued (in shares) | 414,000 | |||||||||||
Stock-settled shares issued | $ 1 | (1) | ||||||||||
Stock-settled shares issued (in shares) | 348,000 | 1,131,000 | ||||||||||
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 | ||||||||||
Purchases from 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) | (575,380) | |||||||||
Purchase of treasury stock (in shares) | (7,779,958) | (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 | 99,834 | 879,874 | 879,874 | 53,374 | ||||||||
Other comprehensive income (loss) | $ (29,627) | (29,817) | (29,817) | 190 | ||||||||
Stock purchase shares issued | $ 1 | 23,902 | 23,903 | |||||||||
Stock purchase shares issued (in shares) | 438,000 | |||||||||||
Stock-settled shares issued | (19,815) | $ (36,685) | $ 19,815 | $ 36,685 | ||||||||
Stock-settled shares issued (in shares) | 4,000 | 218,000 | 276,000 | 513,000 | ||||||||
Stock-based compensation expense | 37,970 | 37,970 | ||||||||||
Excess tax benefits from stock awards exercised | 13,251 | 13,251 | ||||||||||
Distributions to noncontrolling interests | (111,092) | (81,309) | ||||||||||
Contributions from noncontrolling interests | 33,517 | 14,073 | ||||||||||
Sales and assumptions of additional noncontrolling interests | 28,874 | 3,423 | 3,423 | 2,585 | ||||||||
Purchases from noncontrolling interests | (6,660) | (13,105) | (13,105) | (1,747) | ||||||||
Changes in fair value of noncontrolling interests | 65,855 | (65,855) | (65,855) | |||||||||
Reclassifications and expirations of noncontrolling interests subject to puts | (1,136) | 1,136 | ||||||||||
Purchase of treasury stock | $ (1,072,377) | $ (1,072,377) | (1,072,377) | |||||||||
Purchase of treasury stock (in shares) | (16,649,090) | (16,649,000) | ||||||||||
Retirement of treasury stock | $ (23) | (34,230) | (1,526,396) | $ 1,560,649 | ||||||||
Retirement of treasury stock (in shares) | (23,226,000) | 23,226,000 | ||||||||||
Ending Balance at Dec. 31, 2016 | $ 4,849,741 | $ 973,258 | $ 195 | $ 1,027,182 | $ 3,710,313 | $ (89,643) | $ 4,648,047 | $ 201,694 | ||||
Ending Balance (in shares) at Dec. 31, 2016 | 194,554,491 | 194,554,000 |
Organization and summary of sig
Organization and summary of significant accounting policies | 12 Months Ended |
Dec. 31, 2016 | |
Accounting Policies [Abstract] | |
Organization and summary of significant accounting policies | 1. Organization and summary of significant accounting policies Organization DaVita Inc. operates two major divisions, DaVita Kidney Care (Kidney Care) and DaVita Medical Group (DMG, formerly known as HealthCare Partners or HCP). Kidney Care is comprised of the Company’s U.S. dialysis and related lab services, its ancillary services and strategic initiatives, including its international operations, and its corporate administrative support. The Company’s largest line of business is its U.S. dialysis and related lab services business, which operates kidney dialysis centers in the U.S. for patients suffering from chronic kidney failure also known as end stage renal disease (ESRD). As of December 31, 2016, the Company operated or provided administrative services through a network of 2,350 U.S. outpatient dialysis centers in 46 states and the District of Columbia, serving approximately 187,700 patients. The Company’s DMG division is a patient- and physician-focused integrated healthcare delivery and management company that provides medical services to members primarily through capitation contracts with some of the nation’s leading health plans. In addition, as of December 31, 2016, the Company operated or provided administrative services to 154 outpatient dialysis centers serving approximately 15,100 patients located in 11 countries outside of the U.S. The Company’s U.S. dialysis and related lab services business and DMG qualify as separately reportable segments and the Company’s other ancillary services and strategic initiatives, including its international operations, have been combined and disclosed in the other segments category. Basis of presentation These consolidated financial statements are prepared in accordance with United States generally accepted accounting principles (U.S. GAAP). The financial statements include DaVita Inc. and its subsidiaries, partnerships and other entities in which it maintains a majority voting interest or other controlling financial interest (collectively, the Company). All significant intercompany transactions and balances have been eliminated. Non-marketable equity investments are recorded under the equity or cost method of accounting based upon whether the Company has significant influence over the investee. For the Company’s international subsidiaries, local currencies are considered their functional currencies. Translation adjustments result from translating the Company’s international subsidiaries’ financial statements from their functional currencies into the Company’s reporting currency (USD). 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 consolidated financial statements were issued and has included all necessary adjustments and disclosures. Use of estimates The preparation of financial statements in conformity with U.S. GAAP requires the use of estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. Although actual results in subsequent periods will differ from these estimates, such estimates are developed based on the best information available to management and management’s best judgments at the time. All significant assumptions and estimates underlying the amounts reported in the financial statements and accompanying notes are regularly reviewed and updated when necessary. Changes in estimates are reflected in the financial statements based upon on-going actual experience trends, or subsequent settlements and realizations depending on the nature and predictability of the estimates and contingencies. Interim changes in estimates related to annual operating costs are applied prospectively within annual periods. The most significant assumptions and estimates underlying these financial statements and accompanying notes involve revenue recognition and accounts receivable, contingencies, impairments of long-lived assets and goodwill, valuation adjustments, accounting for income taxes, quarterly, annual and long-term variable compensation accruals, consolidation of variable interest entities, purchase accounting valuation estimates, other fair value estimates, stock-based compensation and medical liability claims. Specific estimating risks and contingencies are further addressed within these notes to the consolidated financial statements. Patient service net revenues and accounts receivable U.S. dialysis and related lab services Patient service net revenues are recognized in the period services are provided. Revenues consist primarily of payments from Medicare, Medicaid and commercial health plans for dialysis and ancillary services provided to patients. A usual and customary fee schedule is maintained for the Company’s dialysis treatments and other patient services; however, actual collectible revenue is normally recognized at a discount from the fee schedule. Revenues associated with Medicare and Medicaid programs are recognized based on: (a) the payment rates that are established by statute or regulation for the portion of payment rates paid by the government payor (e.g., 80% for Medicare patients) and (b) for the portion not paid by the primary government payor, estimates of the amounts ultimately collectible from other government programs paying secondary coverage (e.g., Medicaid secondary coverage), the patient’s commercial health plan secondary coverage, or the patient. The Company’s reimbursements from Medicare are subject to certain variations under Medicare’s single bundled payment rate system, whereby reimbursements can be adjusted for certain patient characteristics and other factors. The Company’s revenue recognition will depend upon its ability to effectively capture, document and bill for Medicare’s base payment rate as well as these other variable factors. Revenues associated with commercial health plans are estimated based on contractual terms for the patients under healthcare plans with which the Company has formal agreements, non-contracted health plan coverage terms if known, estimated secondary collections, historical collection experience, historical trends of refunds and payor payment adjustments (retractions), inefficiencies in the Company’s billing and collection processes that can result in denied claims for payments, and regulatory compliance matters. Commercial revenue recognition also involves significant estimating risks. With many larger, commercial insurers the Company has several different contracts and payment arrangements, and these contracts often include only a subset of the Company’s centers. It is often not possible to determine which contract, if any, should be applied prior to billing. In addition, for services provided by non-contracted centers, final collection may require specific negotiation of a payment amount, typically at a significant discount from the Company’s usual and customary rates. Under Medicare’s bundled payment rate system, services covered by Medicare are subject to estimating risk, whereby reimbursements from Medicare can vary significantly depending upon certain patient characteristics and other variable factors. Even with the bundled payment rate system, Medicare payments for bad debt claims as established by cost reports require evidence of collection efforts. As a result, billing and collection of Medicare bad debt claims can be delayed significantly and final payment is subject to audit. Medicaid payments, when Medicaid coverage is secondary, can also be difficult to estimate. For many states, Medicaid payment terms and methods differ from Medicare, and may prevent accurate estimation of individual payment amounts prior to billing. The Company’s range of revenue estimating risk for the dialysis and related lab services segment is generally expected to be within 1% of its revenue. Changes in revenue estimates for prior periods are not material. Other patient service revenues Patient service revenues earned by DMG are recognized in the period services are provided, net of an estimated contractual allowance and are mainly attributable to primary care physician services and certain other specialty care services provided to patients. Capitated revenue DMG capitated revenue The Company’s associated medical groups are licensed to contract with health maintenance organizations (HMOs), to provide physician services in California under capitation contracts, and to provide both hospital and physician services under global risk capitation contracts in Florida and Nevada. DMG’s revenues consist primarily of fees for medical services provided by these medical group entities’ payments from capitated contracts with various HMOs and revenues under risk-sharing programs. Capitation revenue under HMO contracts is prepaid monthly based on the number of enrollees electing physicians affiliated with one of the medical group entities as their healthcare provider, regardless of the level of actual medical services utilized. Capitation revenue is reported as revenue in the month in which enrollees are entitled to receive healthcare. A portion of the capitation revenue pertaining to Medicare enrollees is subject to possible retroactive premium risk adjustments based on their individual acuity. Due to lack of sufficient data to project the amount of such retroactive adjustments, the Company records any corresponding retroactive revenues in the year of receipt. Depending on the applicable state regulation regarding global risk capitation, revenues may be received by the Company or by an independent hospital with which the Company contracts under various managed care-related administrative services agreements. In the Florida and Nevada Under risk-sharing programs, the medical groups share in the risk for hospitalization services and earn additional incentive revenues or incur penalties based on the utilization of hospital services. Estimated shared-risk receivables from the HMOs are recorded based upon hospital utilization and associated costs incurred by assigned HMO enrollees, including an estimate of IBNR compared to budgeted funding. Differences between actual contract settlements and estimated receivables or payables are recorded in the year of final settlement. The medical groups also receive other incentive payments from health plans based on specified performance and quality criteria. These amounts are accrued when earned and the amounts can be reasonably estimated, and are included in DMG’s capitated revenues. Other capitated revenues One of the Company’s subsidiaries operates Medicare Advantage ESRD Special Needs Plans in partnerships with payors that work with CMS to provide full service healthcare to ESRD patients. The Company is at risk for all medical costs of the program in excess of the capitation payments. Other revenues Other revenues consist of the non-patient service revenues associated with the ancillary services and strategic initiatives, management and administrative support services that are provided to outpatient dialysis centers that the Company does not own or in which the Company owns a noncontrolling interest, retail pharmacies and medical consulting services. The Company also provides administrative and management support services to certain other non-dialysis joint ventures in which the Company owns a noncontrolling interest. Management fees are principally determined as a percentage of the managed operations’ revenues or cash collections and in some cases an additional component based upon a percentage of operating income. Management fees are included in net revenues when earned and represent less than 1% of total consolidated operating revenues. Revenues related to medical consulting services are recognized in the period services are provided. Allowance for uncollectible accounts Net revenue recognition and allowances for uncollectible billings require the use of estimates of the amounts that will ultimately be realized considering, among other items, retroactive adjustments that may be associated with regulatory reviews, audits, billing reviews and other matters. The Company’s policy is to write off any uncollectible accounts receivable balance only after all collection efforts have been exhausted or when write off is mandated by federal or state policies or required by certain payor contracts. It is also the Company’s policy to write off any accounts receivable balance associated with any payors or patients when the Company receives notification of a bankruptcy filing. Other income Other income includes interest income on cash investments, gains (losses) on foreign currency translation adjustments and other non-operating gains from investment transactions, as well as realized foreign currency transaction gains and losses. Cash and cash equivalents Cash equivalents are short-term highly liquid investments with maturities of three months or less at date of purchase. Inventories Inventories are stated at the lower of cost (first-in, first-out) or market and consist principally of pharmaceuticals and dialysis-related supplies. Rebates related to inventory purchases are recorded when earned and are based on certain qualification requirements which are dependent on a variety of factors including future pricing levels by the manufacturer and data submission. Funds on deposit with a third party The Company’s DMG business has established a risk sharing arrangement with a California hospital, wherein the Company shares in any surplus or deficit. One of the terms of this agreement is the establishment of a segregated investment fund to ensure adequate cash to pay IBNR. The Company and the hospital monitor the reserve balance to maintain the adequacy of funds on deposit. The Company has $75,877 in such funds as of December 31, 2016, included in other current assets on the consolidated balance sheet. Property and equipment Property and equipment is stated at cost less accumulated depreciation and amortization and is further reduced by any impairments. Maintenance and repairs are charged to expense as incurred. Depreciation and amortization expenses are computed using the straight-line method over the useful lives of the assets estimated as follows: buildings, 20 to 40 years; leasehold improvements, the shorter of their economic useful life or the expected lease term; and equipment and information systems, principally three to eight years. Disposition gains and losses are included in current operating expenses. Amortizable intangibles Amortizable intangible assets and liabilities include customer relationships, trade names, provider networks, supply agreements, practice management tools, non-competition and similar agreements, lease agreements and hospital acute services contracts, each of which have finite useful lives. Amortization expense is computed using the straight-line method over the useful lives of the assets estimated as follows: customer relationships, principally ten to twenty years; provider networks and practice management tools, two to fifteen years; trade names, principally four years; non-competition and similar agreements, two to ten years; and lease agreements and hospital acute service contracts, over the term of the lease or contract period, respectively. Equity investments Equity investments that do not have readily determinable fair values are carried on the cost or equity method, as applicable. The Company classifies its cost and equity method investments as “Equity investments” on its balance sheet. See Note 8 to these consolidated financial statements for further details. 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 strategies concerning those investments. Equity securities that have readily determinable fair values, and certain other financial instruments that have readily determinable fair values or redemption values, are classified as available for sale and recorded at estimated fair value. Goodwill Goodwill represents the difference between the fair value of businesses acquired and the fair value of the identifiable tangible and intangible net assets acquired. Goodwill is not amortized, but is assessed at the reporting unit for impairment as circumstances warrant and at least annually. An impairment charge is recorded to the extent the carrying amount of goodwill exceeds its implied fair value. The Company operates several reporting units for goodwill impairment assessments. See Note 10 to these consolidated financial statements for further details. Impairment of long-lived assets Long-lived assets, including property and equipment, equity investments in non-consolidated businesses, and amortizable intangible assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred, including changes in the Company’s business strategy and plans, changes in the quality or structure of its relationships with its partners or deteriorating operating performance of individual outpatient dialysis centers or other operations. An impairment is indicated when the sum of the expected future undiscounted net cash flows identifiable to an asset group is less than its carrying amount. Impairment losses are measured based upon the difference between the actual or estimated fair values, which are based on market values, net realizable values or projections of discounted net cash flows, as appropriate, and the carrying amount of the asset group. Impairment charges are included in operating expenses. Indefinite-lived intangible assets are reviewed for possible impairment at least annually or whenever significant events or changes in circumstances indicate that an impairment may have occurred. Self insurance The Company’s Kidney Care division records insurance liabilities for professional and general liability and workers’ compensation in excess of certain individual and or aggregate amounts not covered by third-party carriers. The Company’s Kidney Care division estimates the self-insured retention portion of professional and general liability and workers’ compensation risks using third-party actuarial calculations that are based upon historical claims experience and expectations for future claims. In addition, DMG has purchased external primary professional and general liability insurance from California Medical Group Insurance (CMGI) in which the Company owns an equity interest of 67%. Medical liability costs The medical groups are responsible for integrated care that the associated physicians and contracted hospitals provide to assigned HMO enrollees. The Company provides integrated care to health plan enrollees through a network of contracted providers under sub-capitation and direct patient service arrangements, company-operated clinics and staff physicians. Medical costs for professional and institutional services rendered by contracted providers are recorded as patient care costs in the consolidated statements of income. Costs for operating medical clinics, including the salaries of medical and non-medical personnel and support costs, are also recorded in patient care costs. An estimate of amounts due to contracted physicians, hospitals, and other professional providers for members under global and professional risk arrangements is included in medical payables in the accompanying consolidated balance sheets. Medical payables include claims reported as of the balance sheet date and estimates of IBNR. Such estimates are developed using actuarial methods and are based on many variables, including the utilization of healthcare services, historical payment patterns, cost trends, product mix, seasonality, changes in membership, and other factors. The estimation methods and the resulting reserves are continually reviewed and updated. Many of the medical contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of various services. Such differing interpretations may not come to light until a substantial period of time has passed following the contract implementation. Any adjustments to reserves are reflected in current operations. Income taxes Federal and state income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not currently have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a change in judgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reduce deferred tax assets to amounts expected to be realized. The Company uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to be taken in a tax return in order to be recognized in the financial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the financial statements. Stock-based 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. Stock-based compensation to be settled in shares is recorded to the Company’s shareholders’ equity, while stock-based compensation to be settled in cash is recorded to a liability. Interest rate swap and cap agreements The Company often carries a combination of interest rate caps, forward interest rate caps, or interest rate swaps on portions of its variable rate debt as a means of hedging its exposure to changes in LIBOR interest rates as part of its overall interest rate risk management strategy. These interest rate caps and swaps are not held for trading or speculative purposes and are typically designated as qualifying cash flow hedges. See Note 14 to these consolidated financial statements for further details. Noncontrolling interests Noncontrolling interests represent third-party equity ownership interests in entities which are consolidated by the Company for financial statement reporting purposes. As of December 31, 2016, third parties held noncontrolling equity interests in 490 consolidated legal entities. Fair value estimates The Company currently measures the fair value of certain assets, liabilities (including contingent earn-out consideration) and noncontrolling interests subject to put provisions (temporary equity) based upon valuation techniques that include observable or unobservable market inputs and assumptions that market participants would use in pricing these assets, liabilities and temporary equity. The Company has also classified its assets, liabilities and temporary equity into the appropriate fair value hierarchy levels as defined by the Financial Accounting Standards Board (FASB). See Note 24 to the consolidated financial statements for further details. New accounting standards In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers Revenue from Contracts with Customers (Topic Deferral of Effective Date Revenue from Contracts with Customers (Topic 606) 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 February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) 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 March 2016, the FASB issued ASU No. 2016-09, Compensation – Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting 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 October 2016, the FASB issued ASU No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory In January 2017, the FASB issued ASU No. 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment |
Earnings per share
Earnings per share | 12 Months Ended |
Dec. 31, 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 interest 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 (SSARs), stock options and unvested stock units (under the treasury stock method) as well as shares held in escrow that the Company expects will remain outstanding. The reconciliations of the numerators and denominators used to calculate basic and diluted net income per share are as follows: Year ended December 31, 2016 2015 2014 (shares in thousands) Basic: Net income attributable to DaVita Inc. for basic earnings per share calculation $ 879,874 $ 269,732 $ 723,114 Weighted average shares outstanding during the period 203,835 214,062 214,496 Contingently returnable shares held in escrow for the DaVita HealthCare Partners merger (2,194 ) (2,194 ) (2,194 ) Weighted average shares for basic earnings per share calculation 201,641 211,868 212,302 Basic net income per share attributable to DaVita Inc. $ 4.36 $ 1.27 $ 3.41 Diluted: Net income attributable to DaVita Inc. for diluted earnings per share calculation $ 879,874 $ 269,732 $ 723,114 Weighted average shares outstanding during the period 203,835 214,062 214,496 Assumed incremental shares from stock plans 1,070 2,190 2,432 Weighted average shares for diluted earnings per share calculation 204,905 216,252 216,928 Diluted net income per share attributable to DaVita Inc. $ 4.29 $ 1.25 $ 3.33 Anti-dilutive stock-settled awards excluded from calculation (1) 2,523 1,365 1,715 (1) Shares associated with stock-settled stock appreciation rights excluded from the diluted denominator calculation because they are anti-dilutive under the treasury stock method. |
Accounts receivable
Accounts receivable | 12 Months Ended |
Dec. 31, 2016 | |
Receivables [Abstract] | |
Accounts receivable | 3. Accounts receivable For both years ending December 31, 2016 and 2015, approximately 81% of the Company’s consolidated net accounts receivable is related to patient and other services, and approximately 19% is related to capitated health plans. Approximately 16% and 18% of the Company’s net patient services accounts receivable balances as of December 31, 2016 and 2015, respectively, were more than six months old, and there were no significant balances over one year old. Accounts receivable are principally from Medicare and Medicaid programs and commercial insurance plans. Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the ultimate collectability of its accounts receivable, the Company analyzes its historical cash collection experience and trends for each payor 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 it to determine its current provision for uncollectible accounts and the adequacy of its allowance for doubtful accounts. For receivables associated with dialysis and related lab services covered by government payors, like Medicare, the Company receives 80% of the payment directly from Medicare as established under the government’s bundled payment system and determines an appropriate allowance for doubtful accounts and provision for 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. For receivables associated with the Company’s capitated health plans, the balances remain on the balance sheet for as long as the respective plan years are open, which varies by health plan, but is generally two years in length. The majority of the Company’s capitated health plans accounts receivable is one to three months old with collections occurring on a periodic basis throughout the duration of the corresponding plan year. Approximately 1% of the Company’s U.S. dialysis and related lab services net accounts receivable are associated with patient pay and it is the Company’s policy to reserve 100% of the outstanding accounts receivable balances for dialysis services when those amounts due are outstanding for more than three months and to reserve 100% of the outstanding patient pay accounts receivable balances for DMG’s services when those amounts due have been outstanding for more than twelve months. During the year ended December 31, 2016, the Company’s allowance for doubtful accounts decreased by $12,088. The decrease in 2016 was primarily due to an increase in the write-offs of patient pay billings in the Company’s U.S. dialysis business. The decrease was also due to a reduction in accounts receivable older than six months. During the year ended December 31, 2015, the Company’s allowance for doubtful accounts increased by $21,470. The increase in 2015 was primarily due to an increase in the provision for uncollectible accounts due to an increase in the write-offs of Medicare secondary billings. |
Other receivables
Other receivables | 12 Months Ended |
Dec. 31, 2016 | |
Receivables [Abstract] | |
Other receivables | 4. Other receivables Other receivables were comprised of the following: December 31, 2016 2015 Supplier rebates and non-trade receivables $ 347,123 $ 316,644 Medicare bad debt claims 104,658 105,714 Operating advances under management and administrative services agreements 1,702 13,527 $ 453,483 $ 435,885 Operating advances under management and administrative services agreements are generally unsecured. |
Other current assets
Other current assets | 12 Months Ended |
Dec. 31, 2016 | |
Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract] | |
Other current assets | 5. Other current assets Other current assets were comprised of the following: December 31, 2016 2015 Prepaid expenses $ 131,833 $ 105,216 Funds on deposit with third parties 75,877 82,679 Other 2,894 2,427 $ 210,604 $ 190,322 |
Property and equipment
Property and equipment | 12 Months Ended |
Dec. 31, 2016 | |
Property Plant And Equipment [Abstract] | |
Property and equipment | 6. Property and equipment Property and equipment were comprised of the following: December 31, 2016 2015 Land $ 59,013 $ 42,080 Buildings 491,301 437,283 Leasehold improvements 2,598,471 2,289,425 Equipment and information systems, including internally developed software 2,378,303 2,080,446 New center and capital asset projects in progress 480,439 336,513 6,007,527 5,185,747 Less accumulated depreciation (2,832,160 ) (2,397,007 ) $ 3,175,367 $ 2,788,740 Depreciation expense on property and equipment was $ 545,734 Interest on debt incurred during the development of new centers and other capital asset projects is capitalized as a component of the asset cost based on the respective in-process capital asset balances. Interest capitalized was $12,990, $9,723 and $7,888 for 2016, 2015 and 2014, respectively. |
Intangibles
Intangibles | 12 Months Ended |
Dec. 31, 2016 | |
Goodwill And Intangible Assets Disclosure [Abstract] | |
Intangibles | 7. Intangibles Intangible assets other than goodwill were comprised of the following: December 31, 2016 2015 Customer relationships $ 1,568,161 $ 1,575,865 Trade names 190,761 170,883 Provider network and practice management tools 187,318 183,724 Noncompetition and other agreements 512,505 510,521 Lease agreements 7,624 7,306 Indefinite-lived assets 1,546 9,310 Other 583 408 2,468,498 2,458,017 Less accumulated amortization (940,731 ) (770,691 ) $ 1,527,767 $ 1,687,326 Amortization expense from amortizable intangible assets, other than lease agreements, was $174,518, $166,537 and $167,956 for 2016, 2015 and 2014, respectively. Lease agreement intangible assets and liabilities were amortized to rent expense in the amounts of $(923), $(1,613) and $(1,798) for 2016, 2015 and 2014, respectively. During the year ended December 31, 2016, the Company did not recognize impairment charges on any intangible assets other than goodwill. During the year ended December 31, 2015, the Company recognized a $17,400 impairment charge on an indefinite-lived intangible asset of its DMG Nevada reporting unit. Amortizable intangible liabilities were comprised of the following: December 31, 2016 2015 Lease agreements (net of accumulated amortization of $8,485 and $6,936) 7,420 8,969 $ 7,420 $ 8,969 There was no amortization benefit recognized from the alliance and product supply agreement in 2016 as it expired in September 2015. Amortization benefit related to this agreement was $3,997 for 2015 and $5,330 for 2014 related to this agreement. Lease agreement intangible liabilities are classified in other long-term liabilities and amortized to rent expense. Scheduled amortization charges from amortizable intangible assets and liabilities as of December 31, 2016 were as follows: Customer relationships Trade names Provider network and practice management tools Noncompetition and other agreements Lease agreements Other 2017 82,669 47,046 26,941 30,156 (1,228 ) 102 2018 82,664 47,046 26,881 19,519 (892 ) 102 2019 82,625 11,008 22,492 15,796 (832 ) 87 2020 82,609 3,800 581 10,437 (678 ) 44 2021 82,609 633 97 7,005 (606 ) — Thereafter 821,282 — — 21,990 (3,184 ) — |
Equity investments
Equity investments | 12 Months Ended |
Dec. 31, 2016 | |
Investments Debt And Equity Securities [Abstract] | |
Equity investments | 8. 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 nonconsolidated 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 21, 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. During the year ended December 31, 2016, the Company recorded an impairment of $14,993 related to a minority equity investment in one of its international reporting units. Equity investments in nonconsolidated businesses were $502,389 and $78,368 at December 31, 2016 and 2015, respectively. The increase in equity investments was primarily related to the APAC JV, as discussed above. During 2016, 2015 and 2014, the Company recognized equity investment income of $13,044, $18,325 and $23,234, respectively, relating to equity investments in nonconsolidated businesses under the equity method of accounting. |
Investments in debt and equity
Investments in debt and equity securities | 12 Months Ended |
Dec. 31, 2016 | |
Investments Debt And Equity Securities [Abstract] | |
Investments in debt and equity securities | 9. 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 strategies concerning those investments. Equity securities that have readily determinable fair values, and certain other financial instruments that have readily determinable fair values or redemption values, are classified as available for sale and recorded at estimated fair value. The Company’s investments in securities and certain other financial instruments consist of the following: December 31, 2016 December 31, 2015 Held to maturity Available for sale Total Held to maturity Available for sale Total Certificates of deposit, commercial paper and money market funds due within one year $ 256,827 $ — $ 256,827 $ 406,884 $ — $ 406,884 Investments in mutual funds and common stock 50,000 47,404 97,404 — 33,482 33,482 Cash surrender value of life insurance policies — 59,646 59,646 — 56,840 56,840 $ 306,827 $ 107,050 $ 413,877 $ 406,884 $ 90,322 $ 497,206 Short-term investments $ 306,827 $ 3,371 $ 310,198 $ 406,884 $ 1,200 $ 408,084 Long-term investments — 103,679 103,679 — 89,122 89,122 $ 306,827 $ 107,050 $ 413,877 $ 406,884 $ 90,322 $ 497,206 The cost of certificates of deposit, commercial paper and money market funds at December 31, 2016 and 2015 approximate their fair value. As of December 31, 2016 and 2015, available for sale investments included $3,701 and $2,589, respectively, of gross pre-tax unrealized gains. During 2016 and 2015 the Company recorded gross pre-tax unrealized gains (losses) of $1,802 and $(1,974), respectively, in other comprehensive income associated with changes in the fair value of these investments. During 2016, the Company sold investments in mutual funds and common stock for net proceeds of $14,971, and recognized a pre-tax gain of $690, or $423 after tax, that was previously recorded in other comprehensive income. During 2015, the Company sold investments in mutual funds and common stock for net proceeds of $1,295, and recognized a pre-tax gain of $618, or $377 after tax, that was previously recorded in other comprehensive income. Investments in mutual funds classified as available for sale are held within trusts to fund existing obligations associated with several of the Company’s non-qualified deferred compensation plans. Investments in life insurance policies are carried at their cash surrender value, are held within trusts to fund existing obligations associated with certain of the Company’s non-qualified deferred compensation plans, and are principally classified as long-term to correspond with the long-term classification of the related plan liabilities. See Note 16 for further details. |
Goodwill
Goodwill | 12 Months Ended |
Dec. 31, 2016 | |
Goodwill And Intangible Assets Disclosure [Abstract] | |
Goodwill | 10. Goodwill Changes in the carrying value of goodwill by reportable segments were as follows: U.S. dialysis and related lab services DMG Other ancillary services and 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 75,295 248,901 123,632 $ 447,828 Divestitures (12,891 ) (2,223 ) (29,645 ) $ (44,759 ) Goodwill impairment charges — (253,000 ) (28,415 ) $ (281,415 ) Foreign currency and other adjustments — — (8,816 ) $ (8,816 ) Balance at December 31, 2016 $ 5,691,587 $ 3,391,942 $ 323,788 $ 9,407,317 Balance at December 31, 2016: Goodwill $ 5,691,587 $ 3,833,711 $ 358,112 $ 9,883,410 Accumulated impairment charges — (441,769 ) (34,324 ) $ (476,093 ) $ 5,691,587 $ 3,391,942 $ 323,788 $ 9,407,317 Each of the Company’s operating segments described in Note 25 to these 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 and direct primary care reporting units, and to the dialysis centers within each international reporting unit. For the Company’s other operating segments, discrete business components below the operating segment level constitute individual reporting units. During the fourth quarter of 2015, the Company recognized impairment charges of $188,769 on goodwill of 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 under-performance 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 and other market conditions, the Company performed additional goodwill impairment assessments for certain at-risk DMG reporting units during each of the first three quarters of 2016 and as of their November 1 annual assessment date . In addition, during the quarter ended December 31, 2016, the Company determined that circumstances indicated it had become more likely than not that the goodwill of the Company’s vascular access reporting unit had become impaired. These circumstances included changes in future governmental reimbursement and the Company’s expected ability to mitigate them. Specifically, on November 2, 2016, CMS released the 2017 Physician Fee Schedule Final Rule and the Ambulatory Surgical Center Payment Final Rule which reflected significant changes in reimbursement structure for this business unit. Accordingly, the Company performed the required valuations to estimate the fair value of the net assets and implied goodwill of this reporting unit with the assistance of a third-party valuation firm. As a result of the assessments described above, the Company has recognized the goodwill impairment charges below: Year ended December 31, Reporting unit 2016 2015 2014 DMG Nevada $ 161,800 $ 181,253 $ — DMG Florida 91,200 5,800 — DMG Arizona — 1,716 — Vascular access 28,415 — — International operations — 4,065 1,000 Total $ 281,415 $ 192,834 $ 1,000 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 goodwill impairment charges in the future for the following reporting units, which remain at risk of goodwill impairment: Goodwill balance Carrying Sensitivities Reporting unit as of December 31, 2016 amount coverage (1) Operating income (2) Discount rate (3) DMG Nevada $ 261,204 11.4% -2.2% -3.9% DMG Florida $ 442,835 7.1% -1.7% -3.2% DMG New Mexico $ 70,926 2.6% -1.5% -2.2% DMG Washington $ 244,502 3.7% -1.8% -3.4% Vascular access $ 34,696 4.3% -2.7% -5.3% (1) Excess of estimated fair value of the reporting unit over carrying amount as of the latest assessment date. (2) Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date. (3) Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date. There were no major changes in the business, prospects, or expected future results of these reporting units from their latest assessment date. Except as described above, none of the Company’s various other reporting units were considered at risk of goodwill impairment as of December 31, 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 the Company’s other reporting units would be less than their respective carrying amount. |
Other liabilities
Other liabilities | 12 Months Ended |
Dec. 31, 2016 | |
Other Liabilities Disclosure [Abstract] | |
Other liabilities | 11. Other liabilities Other liabilities were comprised of the following: December 31, 2016 2015 Payor refunds and retractions $ 277,482 $ 153,104 Contingent earn-out consideration 7,217 29,050 Insurance and self-insurance accruals 80,437 80,355 Accrued interest 82,234 81,585 Other medical payables 36,645 53,687 Accrued non-income tax liabilities 27,759 29,291 Other 345,073 255,051 $ 856,847 $ 682,123 |
Medical payables
Medical payables | 12 Months Ended |
Dec. 31, 2016 | |
Health Care Organizations [Abstract] | |
Medical payables | 12. Medical payables The healthcare costs shown in the following table include 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, where state regulation allows for the assumption of global risk. Healthcare costs payable are included in medical payables. The following table shows the components of changes in the healthcare costs payable for the year ended December 31, 2016 and 2015: December 31, 2016 2015 Healthcare costs payable, beginning of the year $ 212,641 $ 214,405 Add: Components of incurred healthcare costs Current year 1,673,742 1,587,036 Prior years (141 ) 1,523 Total incurred healthcare costs 1,673,601 1,588,559 Less: Claims paid Current year 1,473,723 1,397,378 Prior years 198,244 192,945 Total claims paid 1,671,967 1,590,323 Healthcare costs payable, end of the year $ 214,275 $ 212,641 The Company’s prior year estimates of healthcare costs payable resulted in medical claims being settled for different amounts than originally estimated. When significant increases (decreases) in prior-year healthcare 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 healthcare 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 | 12 Months Ended |
Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |
Income taxes | 13. Income taxes The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the financial statements. Under this method, deferred tax assets and liabilities are determined on the basis of the differences between the financial statements and tax basis of assets and liabilities using enacted tax rates in effect for the year in which the differences are expected to reverse. Income before income taxes consisted of the following: Year ended December 31, 2016 2015 2014 Domestic $ 1,144,544 $ 764,998 $ 1,341,208 International 344,351 (41,862 ) (31,535 ) $ 1,488,895 $ 723,136 $ 1,309,673 Income tax expense (benefit) consisted of the following: Year ended December 31, 2016 2015 2014 Current: Federal $ 337,178 $ 183,263 $ 188,302 State 48,771 30,766 30,789 International 1,928 856 1,687 Total current income tax $ 387,877 $ 214,885 $ 220,778 Deferred: Federal 93,214 88,718 192,267 State (27,764 ) (8,307 ) 32,360 International 2,486 430 938 Total deferred income tax $ 67,936 $ 80,841 $ 225,565 $ 455,813 $ 295,726 $ 446,343 The reconciliation between the U.S. federal income tax rate and the Company’s effective tax rate is as follows: Year ended December 31, 2016 2015 2014 Federal income tax rate 35.0 % 35.0 % 35.0 % State income taxes, net of federal benefit 1.2 2.5 3.5 International rate differential 0.2 (1.1 ) (0.2 ) Gain on APAC JV ownership changes (9.8 ) — — Goodwill impairments 6.7 11.7 — Changes in deferred tax valuation allowances 0.6 2.6 0.6 Other 0.2 1.5 (0.8 ) Impact of noncontrolling interests primarily attributable to non-tax paying entities (3.5 ) (11.3 ) (4.0 ) Effective tax rate 30.6 % 40.9 % 34.1 % The Company has indefinitely reinvested $381,523 Deferred tax assets and liabilities arising from temporary differences were as follows: December 31, 2016 2015 Receivables $ 19,283 $ 43,393 Accrued liabilities 318,596 272,080 Net operating loss carryforwards 130,456 130,977 Other 147,487 114,805 Deferred tax assets 615,822 561,255 Valuation allowance (56,016 ) (57,811 ) Net deferred tax assets 559,806 503,444 Intangible assets (1,025,488 ) (927,761 ) Property and equipment (230,870 ) (205,071 ) Investments in partnerships (95,936 ) (83,584 ) Other (16,640 ) (13,990 ) Deferred tax liabilities (1,368,934 ) (1,230,406 ) Net deferred tax liabilities $ (809,128 ) $ (726,962 ) At December 31, 2016, the Company had federal net operating loss carryforwards of approximately $155,790 that expire through 2035, although a substantial amount expire by 2028. The Company also had state net operating loss carryforwards of $836,774 that expire through 2036 and international net operating loss carryforwards of $97,281, some of which have an indefinite life. The utilization of a portion of these losses may be limited in future years based on the profitability of certain entities. The valuation allowance net decrease of $1,795 is primarily due to an increase related to the realizability of losses in certain foreign and state jurisdictions of $8,339 and a decrease relating to the APAC JV ownership changes of $10,134. Unrecognized tax benefits A reconciliation of the beginning and ending liability for unrecognized tax benefits that do not meet the more-likely-than-not threshold were as follows: Year ended December 31, 2016 2015 Beginning balance $ 39,011 $ 31,877 Additions for tax positions related to current year 9,714 6,131 Additions for tax positions related to prior years — 2,999 Reductions related to lapse of applicable statute (1,277 ) (1,996 ) Reductions related to settlements with taxing authorities (23,382 ) — Ending balance $ 24,066 $ 39,011 As of December 31, 2016, the Company’s total liability for unrecognized tax benefits relating to tax positions that do not meet the more-likely-than-not threshold is $24,066, all of which would impact the Company’s effective tax rate if recognized. This balance represents a decrease of $14,945 from the December 31, 2015 balance of $39,011, primarily due to the positive settlement of an IRS and state audit. The Company recognizes accrued interest and penalties related to unrecognized tax benefits in its income tax expense. At December 31, 2016 and 2015, the Company had approximately $2,595 and $9,918, respectively, accrued for interest and penalties related to unrecognized tax benefits, net of federal tax benefit. The Company and its subsidiaries file U.S. federal and state income tax returns and various international income tax returns. The Company is no longer subject to U.S. federal and state examinations by tax authorities for years before 2013 and 2008, respectively. |
Long-term debt
Long-term debt | 12 Months Ended |
Dec. 31, 2016 | |
Debt Disclosure [Abstract] | |
Long-term debt | 14. Long-term debt Long-term debt was comprised of the following: December 31, 2016 2015 Senior Secured Credit Facilities: Term Loan A $ 862,500 $ 925,000 Term Loan B 3,412,500 3,447,500 Senior notes 4,500,000 4,500,000 Acquisition obligations and other notes payable 117,547 70,645 Capital lease obligations 299,682 283,185 Total debt principal outstanding 9,192,229 9,226,330 Discount and deferred financing costs (79,861 ) (95,985 ) 9,112,368 9,130,345 Less current portion (165,041 ) (129,037 ) $ 8,947,327 $ 9,001,308 Scheduled maturities of long-term debt at December 31, 2016 were as follows: 2017 165,041 2018 167,684 2019 747,871 2020 69,508 2021 3,300,437 Thereafter 4,741,688 Term Loans Total outstanding borrowings under Term Loan A and Term Loan B can consist of various individual tranches that can range in maturity from one month to twelve months (currently all tranches are one month in duration). For Term Loan A and Term Loan B, each tranche bears interest at a London Interbank Offered Rate (LIBOR) rate that is determined by the duration of such tranche plus an interest rate margin. The LIBOR variable component of the interest rate for each tranche is reset as such tranche matures and a new tranche is established. At December 31, 2016, the overall weighted average interest rate for Term Loan A was determined based upon the LIBOR interest rates in effect for all of the individual tranches plus the interest rate margin of 1.75%. At December 31, 2016, Term Loan B bears interest at LIBOR (floor of 0.75%) plus a margin of 2.75%. The Company is subject to LIBOR-based interest rate volatility on Term Loan B as the LIBOR-based component of the interest rate exceeded the floor of 0.75% as of December 31, 2016. The overall weighted average interest rate for Term Loan B was determined based upon the LIBOR interest rates in effect for all individual tranches plus the interest rate margin. The Company has several interest rate cap agreements that have the economic effect of capping the LIBOR variable component of the Company’s interest rate at a maximum of 3.50% on $3,500,000 of outstanding principal debt. The remaining $775,000 outstanding principal balance of Term Loan A would still be subject to LIBOR-based interest rate volatility. In addition, the Company maintains several forward interest rate cap agreements with notional amounts totaling $3,500,000, which will be effective June 29, 2018. The cap agreements 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 the Company’s debt. See below for further details. The Company is restricted from paying dividends under the terms of its senior secured credit facilities. During the year ended December 31, 2016, the Company made mandatory principal payments under its then existing senior secured credit facilities totaling $62,500 on Term Loan A and $35,000 on Term Loan B. Revolving lines of credit The Company has an undrawn revolving line under the senior secured credit facilities totaling $1,000,000, of which approximately $95,629 was committed for outstanding letters of credit. In addition, the Company has approximately $1,286 of committed outstanding letters of credit related to DMG, which is backed by a certificate of deposit. Senior Notes The Company’s senior notes as of December 31, 2016 consisted of $1,500,000 of 5.0% Senior Notes due 2025, $1,750,000 5 1 8 3 4 The Senior Notes are unsecured obligations, rank equally in right of payment with the Company’s existing and future unsecured senior indebtedness, and are guaranteed by substantially all of the Company’s direct and indirect wholly-owned domestic subsidiaries and require semi-annual interest payments. The Company may redeem some or all of the Senior Notes at any time on or after certain specific dates and at certain specific redemption prices as outlined in each senior note agreement. The Company is restricted from paying dividends under the indentures governing its Senior Notes. In April 2015, the Company issued $1,500,000 5.0% Senior Notes due 2025 (5.0% Senior Notes). The 5.0% Senior Notes pay interest on May 1 and November 1 of each year beginning November 1, 2015. The 5.0% Senior Notes are unsecured senior obligations, rank equally in right of payment with the Company’s existing and future unsecured senior indebtedness, and are guaranteed by certain of the Company’s domestic subsidiaries. The Company may redeem up to 35% of the 5.0% Senior Notes at any time prior to May 1, 2018 at a certain specified price from the proceeds of one or more equity offerings. In addition, the Company may redeem some or all of the 5.0% Senior Notes at any time prior to May 1, 2020 at make-whole redemption rates and on or after such date at certain specified redemption prices. The net proceeds from the 5.0% Senior Notes offering were used to repurchase all of the $775,000 aggregate outstanding principal balances of the 6 ⅝% Senior Notes due 2020 (6 ⅝% Senior Notes) through a combination of a tender offer and a redemption process and to pay fees and expenses. The remaining net offering proceeds were used for general corporate purposes, acquisitions and share repurchases. As a result of these transactions, the Company incurred $ 48,072 Interest rate swaps and cap agreements During the year ended December 31, 2016 the Company had 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 Term Loan A 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 had settled were reflected as adjustments to debt expense. In addition, the Company has entered into several interest rate cap agreements and several 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. These 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. As of December 31, 2016, the Company maintains 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. These cap agreements expire on June 30, 2018. As of December 31, 2016, the total fair value of these cap agreements was an asset of approximately $116. During the year ended December 31, 2016, the Company recognized debt expense of $2,070 from these caps. During the year ended December 31, 2016, the Company recorded a loss of $1,196 in other comprehensive income due to a decrease in the unrealized fair value of these cap agreements. As of December 31, 2016, the Company 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 December 31, 2016, the total fair value of these cap agreements was an asset Previously, the Company maintained several interest rate cap agreements with notional amounts totaling $2,735,000 The Company also previously maintained several interest rate swap agreements. These agreements 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%. on September 30, 2016. During the year ended December 31, 2016, the Company recognized debt expense of $299 from these swaps, and recorded a loss of $815 in other comprehensive income due to a decrease in the unrealized fair value of these swap agreements. The following table summarizes the Company’s derivative instruments as of December 31, 2016 and 2015: Interest rate swap and cap agreements (liabilities and assets) December 31, 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 assets $ 516 Interest rate cap agreements Other long- term assets $ 9,929 Other long- term assets $ 15,127 The following table summarizes the effects of the Company’s interest rate swap and cap agreements for the years ended December 31, 2016, 2015 and 2014: Amount of losses recognized in OCI on interest rate swap and cap agreements Location of (losses) gains reclassified from Amount of gains reclassified from accumulated OCI into income Years ended December 31, accumulated Years ended December 31, Derivatives designated as cash flow hedges 2016 2015 2014 OCI into income 2016 2015 2014 Interest rate swap agreements $ (815 ) $ (3,971 ) $ (8,390 ) Debt expense $ 299 $ 2,664 $ 12,279 Interest rate cap agreements (5,198 ) (16,114 ) (8,119 ) Debt expense 3,899 2,439 5,130 Tax benefit (expense) 2,343 7,844 6,450 (1,632 ) (1,992 ) (6,801 ) Total $ (3,670 ) $ (12,241 ) $ (10,059 ) $ 2,566 $ 3,111 $ 10,608 As of December 31, 2016, the interest rate on the Company’s Term Loan B debt bears interest at LIBOR plus an interest rate margin of 2.75%. Term Loan B is subject to an interest rate cap if LIBOR should rise above 3.50%. Term Loan A bears interest at LIBOR plus an interest rate margin of 1.75%. The capped portion of Term Loan A is $87.5 million. In addition, the uncapped portion of Term Loan A, which is subject to the variability of LIBOR, is $ million. The Company’s overall weighted average effective interest rate on the senior secured credit facilities was 3.68%, based upon the current margins in effect of 1.75% for Term Loan A and 2.75% for Term Loan B, as of December 31, 2016. The Company’s overall weighted average effective interest rate for the year ended December 31, 2016 was 4.43% and as of December 31, 2016 was 4.52%. Debt expense Debt expense consisted of interest expense of $394,279, $389,755 and $385,750 and the amortization and accretion of debt discounts and premiums, amortization of deferred financing costs and the amortization of interest rate cap agreements of $20,103, $18,625 and $24,544 for 2016, 2015 and 2014, respectively. The interest expense amounts are net of capitalized interest. |
Leases
Leases | 12 Months Ended |
Dec. 31, 2016 | |
Leases [Abstract] | |
Leases | 15. Leases The majority of the Company’s facilities are leased under non-cancelable operating leases ranging in terms from five to fifteen years and which contain renewal options of five to ten years at the fair rental value at the time of renewal. The Company’s leases are generally subject to periodic consumer price index increases or contain fixed escalation clauses. The Company also leases certain facilities and equipment under capital leases. Future minimum lease payments under non-cancelable operating and capital leases are as follows: Operating leases Capital leases 2017 $ 473,302 $ 37,758 2018 442,959 34,442 2019 401,242 35,292 2020 354,559 35,575 2021 310,704 31,133 Thereafter 1,244,309 232,191 $ 3,227,075 406,391 Less portion representing interest (106,709 ) Total capital lease obligations, including current portion $ 299,682 Rent expense under all operating leases for 2016, 2015, and 2014 was $563,204, $514,287 and $460,093, respectively. Rent expense is recorded on a straight-line basis over the term of the lease for leases that contain fixed escalation clauses or include abatement provisions. Leasehold improvement incentives are deferred and amortized to rent expense over the term of the lease. The net book value of property and equipment under capital leases was $263,995 and $261,960 at December 31, 2016 and 2015, respectively. Capital lease obligations are included in long-term debt. See Note 14 to these consolidated financial statements. |
Employee benefit plans
Employee benefit plans | 12 Months Ended |
Dec. 31, 2016 | |
Compensation And Retirement Disclosure [Abstract] | |
Employee benefit plans | 16. Employee benefit plans The Company has a savings plan for substantially all of its non-DMG employees which has been established pursuant to the provisions of Section 401(k) of the Internal Revenue Code (IRC). The plan allows for employees to contribute a percentage of their base annual salaries on a tax-deferred basis not to exceed IRC limitations. The Company does not provide any matching contributions for its non-DMG employees. The Company also has various savings plans covering substantially all of its DMG employees which have been established pursuant to the provisions of Section 401(k) of the IRC. These plans provide for multiple employer matching contributions up to 4% of employee contributions. The Company made matching contributions in 2016, 2015 and 2014 totaling approximately $11,266, $8,324 and $7,400, respectively. The Company also maintains a voluntary compensation deferral plan, the DaVita Voluntary Deferral Plan. This plan is non-qualified and permits certain employees whose annualized base salary equals or exceeds a minimum annual threshold amount as set by the Company to elect to defer all or a portion of their annual bonus payment and up to 50% of their base salary into a deferral account maintained by the Company. Total contributions to this plan in 2016, 2015 and 2014 were $5,344, $4,234 and $3,772, respectively. Deferred amounts are generally paid out in cash at the participant’s election either in the first or second year following retirement or in a specified future period at least three to four years after the deferral election was effective. During 2016, 2015 and 2014 the Company distributed $916, $1,270 and $1,111, respectively, to participants in this plan. Participants are credited with their proportional amount of annual earnings from the plan. The assets of this plan are held in a rabbi trust and as such are subject to the claims of the Company’s general creditors in the event of its bankruptcy. As of December 31, 2016 and 2015, the total fair value of assets held in this plan’s trust were $30,191 and $23,800, respectively. The Company also maintains two separate non-qualified voluntary compensation deferral plans for its DMG business, the HealthCare Partners, LLC Deferred Compensation Plan and the HealthCare Partners Medical Group, Inc. Deferred Compensation Plan 2. As of December 31, 2016 and 2015, the total fair value of the assets held in these plans’ trusts were $14,036 and $8,578, respectively. The Company also maintains an Executive Retirement Plan for certain members of management. This plan is non-qualified and contributions to the plan were made at the discretion of DVA Renal Healthcare based upon a pre-determined percentage of a participant’s base salary. Effective November 2005, all contributions to this plan were discontinued and the balance of the plan assets will be paid out upon termination or retirement of each individual participant. During 2016 and 2015 the Company distributed $149 and $25, respectively, to participants in this plan. During 2014 the Company did not make any distributions to participants under this plan. As of December 31, 2016 and 2015, the total fair value of assets held under this plan’s trust was $1,005 and $1,104, respectively. The Company also maintains a frozen non-qualified trust-owned life insurance deferred compensation plan, the HealthCare Partners Medical Group, Inc. Deferred Compensation Plan, for certain key employees of DMG. The total cash surrender value of all of the life insurance policies totaled approximately $59,646 and $56,840 at December 31, 2016 and 2015, respectively, and is included in long-term investments. In addition, the total deferred compensation liabilities owed to the participants totaled approximately $54,486 and $52,128 at December 31, 2016 and 2015, respectively, and are included in other long-term liabilities. During 2016, 2015 and 2014, the Company did not make any contributions on behalf of its participants. The fair value of all of the assets held in plan trusts as of December 31, 2016, and 2015 totaled $45,233 and $33,482, respectively. The assets of these plans are available for sale and as such are recorded at fair market value with changes in the fair market values being recorded in other comprehensive income. Any fair market value changes to the corresponding liability balance are recorded as compensation expense. See Note 9 to these consolidated financial statements. Most of the Company’s outstanding employee stock plan awards include a provision accelerating the vesting of the award in the event of a change of control. The Company also maintains a change of control protection program for its employees who do not have a significant number of stock awards, which has been in place since 2001, and which provides for cash bonuses to employees in the event of a change of control. Based on the market price of the Company’s common stock and shares outstanding on December 31, 2016, these cash bonuses would total approximately $492,645 if a change of control transaction occurred at that price and the Company’s Board of Directors did not modify the program. This amount has not been accrued at December 31, 2016, and would only be accrued upon a change of control. These change of control provisions may affect the price an acquirer would be willing to pay for the Company. |
Contingencies
Contingencies | 12 Months Ended |
Dec. 31, 2016 | |
Commitments And Contingencies Disclosure [Abstract] | |
Contingencies | 17. 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. The Company operates in a highly regulated industry and is a party to various lawsuits, claims, governmental investigations and audits (including investigations resulting from its obligation to self-report suspected violations of law) and other legal proceedings. The Company records accruals for certain legal proceedings and regulatory matters to the extent that the Company determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. While these accruals reflect the Company’s best estimate of the probable loss for those matters as the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters. Additionally, in some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal proceedings and regulatory matters, which may be exacerbated by various factors, including that they may involve indeterminate claims for monetary damages or may involve fines, penalties or non-monetary remedies; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; are in the early stages of the proceedings; or result in a change of business practices. Further, there may be various levels of judicial review available to the Company in connection with any such proceeding. The following is a description of certain lawsuits, claims, governmental investigations and audits and other legal proceedings to which the Company is subject. Inquiries by the Federal Government and Certain Related Civil Proceedings Vainer Private Civil Suit qui tam 2011 U.S. Attorney Medicaid Investigation Swoben Private Civil Suit qui tam qui tam 2015 U.S. Attorney Transportation Investigation 2015 U.S. Office of Inspector General (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 qui tam 2016 U.S. Attorney Prescription Drug Investigation . Solari Post-Acquisition Matter OIG for the Department of Health and Human Services (HHS) that 16,000 2017 U.S. Attorney American Kidney Fund Investigation Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as described above), 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. Negative findings or terms and conditions that the Company might agree to accept as part of a negotiated resolution of pending or future government inquiries or relator proceedings could result in, among other things, substantial financial penalties or awards against the Company, substantial payments made by the Company, harm to the Company’s reputation, required changes to the Company’s business practices, exclusion from future participation in the Medicare, Medicaid and other federal health care programs and, if criminal proceedings were initiated against the Company, possible criminal penalties, any of which could have a material adverse effect on the Company. Shareholder Claims Peace Officers’ Annuity and Benefit of Georgia Securities Laws Class Action Civil Suit Blackburn Shareholder Derivative Civil Suit Other Proceedings In addition to the foregoing, from time to time the Company is subject to other lawsuits, claims, governmental investigations and audits and legal proceedings that arise due to the nature of its business, including contractual disputes, such as with payors, suppliers and others, employee-related matters and professional and general liability claims. From time to time, the Company initiates litigation or other legal proceedings as a plaintiff arising out of contracts or other matters. In that regard, the Company had a pending lawsuit in the U.S. Court of Federal Claims against the federal government which was originally filed in May 2011. The lawsuit related to the U.S. Department of Veterans Affairs (VA) underpayment of dialysis services the Company provided from 2005 through 2011 to veterans pursuant to VA regulations. In January 2017, the Company reached a resolution of its claims with the government for $538,000, which the Company expects to recognize in its first quarter 2017 financial statements. * * * Other than as described above, the Company cannot predict the ultimate outcomes of the various legal proceedings and regulatory matters to which the Company is or may be subject from time to time, including those described in this Note 17, or the timing of their resolution or the ultimate losses or impact of developments in those matters, which could have a material adverse effect on the Company’s revenues, earnings and cash flows. Further, any legal proceedings or regulatory matters involving the Company, whether meritorious or not, are time consuming, and often require management’s attention and result in significant legal expense, and may result in the diversion of significant operational resources, or otherwise harm the Company’s business or reputation. |
Noncontrolling interests subjec
Noncontrolling interests subject to put provisions and other commitments | 12 Months Ended |
Dec. 31, 2016 | |
Accounting Policies [Abstract] | |
Noncontrolling interests subject to put provisions and other commitments | 18. Noncontrolling interests subject to put provisions and other commitments Noncontrolling interests subject to put provisions The Company has potential obligations to purchase the equity interests held by third parties in several of its majority-owned joint ventures and other nonconsolidated 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’ equity interests at either the appraised fair market value or a predetermined multiple of earnings or cash flow attributable to the equity 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 interests obligations may be settled will 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’ equity interests. The amount of noncontrolling interests subject to put provisions that employ a contractually predetermined multiple of earnings rather than fair value are immaterial. Additionally, the Company has certain other potential commitments to provide operating capital to several dialysis centers that are wholly-owned by third parties or centers in which the Company owns a noncontrolling equity interest as well as to physician-owned vascular access clinics or medical practices that the Company operates under management and administrative service agreements of approximately $1,500. Certain consolidated joint ventures are originally contractually scheduled to dissolve after terms ranging from 10 to 50 years. Accordingly, the noncontrolling interests in these joint ventures 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. Other commitments In January 2017, the Company entered into a six year Sourcing and Supply Agreement with Amgen USA Inc. (Amgen) that expires on December 31, 2022, replacing the Company’s prior agreement that was to expire in 2018. Under terms of the agreement, the Company will purchase EPO in amounts necessary to meet no less than 90% of its requirements for ESAs from Amgen. The actual amount of EPO that the Company will purchase will depend upon the amount of EPO administered during dialysis as prescribed by physicians and the overall number of patients that the Company serves. In 2010, the Company entered into an agreement with Fresenius Medical Care (FMC) which committed the Company to purchase a certain amount of dialysis equipment, parts and supplies from FMC through 2013. This agreement has been subsequently extended through December 31, 2017. During 2016, 2015 and 2014, the Company purchased $164,766, $154,566 and $154,266, respectively, of certain equipment, parts and supplies from FMC. In 2014, the Company entered into an agreement with Baxter Healthcare (Baxter) which committed the Company to purchase a certain amount of its hemodialysis non-equipment product supplies, such as dialyzers, at fixed prices through 2018. During 2016, 2015 and 2014, the Company purchased $162,109, $112,931 and $112,645 of hemodialysis product supplies from Baxter under this agreement. Certain DMG entities are required to maintain minimum cash balances in order to comply with regulatory requirements in conjunction with medical claim reserves. As of December 31, 2016, this minimum cash balance was approximately $60,796. Other than operating leases disclosed in Note 15 to the consolidated financial statements, the letters of credit disclosed in Note 14 to the consolidated financial statements, and the arrangements as described above, the Company has no off balance sheet financing arrangements as of December 31, 2016. |
Long-term incentive compensatio
Long-term incentive compensation and shareholders' equity | 12 Months Ended |
Dec. 31, 2016 | |
Equity [Abstract] | |
Long-term incentive compensation and shareholders' equity | 19. Long-term incentive compensation and shareholders’ equity Long-term incentive compensation Long-term incentive program (LTIP) compensation includes both stock-based awards (principally stock-settled stock appreciation rights, restricted stock units and performance 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. Stock-based compensation to be settled in shares is recorded to the Company’s shareholders’ equity, while stock-based compensation to be settled in cash is recorded to a liability. Shares issued upon exercise of stock awards have generally been issued from treasury shares. Long-term incentive compensation plans The Company’s 2011 Incentive Award Plan (the 2011 Plan) is the Company’s omnibus equity compensation plan and provides for grants of stock-based awards to employees, directors and other individuals providing services to the Company, except that incentive stock options may only be awarded to employees. The 2011 Plan authorizes the Company to award stock options, stock appreciation rights, restricted stock units, restricted stock, and other stock-based or performance-based awards, and is designed to enable the Company to grant equity and cash awards that qualify as performance-based compensation under Section 162(m) of the Internal Revenue Code. The 2011 Plan mandates a maximum award term of five years and stipulates that stock appreciation rights and stock options be granted with prices not less than fair market value on the date of grant. The 2011 Plan also requires that full value share awards such as restricted stock units reduce shares available under the 2011 Plan at a ratio of 3.5:1. The Company’s nonqualified stock appreciation rights and stock units awarded under the 2011 Plan generally vest over 36 to 48 months from the date of grant. At December 31, 2016, there were 7,337,266 stock-settled stock appreciation rights, 785,553 stock-settled stock units, 33,000 cash-settled stock appreciation rights and 1,600 cash-settled stock units outstanding, and 30,543,883 shares available for future grants, under the 2011 Plan. A combined summary of the status of the Company’s stock-settled awards under the 2011 Plan, including base shares for stock-settled stock appreciation rights and stock-settled stock unit awards is as follows: Year ended December 31, 2016 Stock appreciation rights Stock units Weighted Weighted Weighted average average average exercise remaining remaining Awards price contractual Awards contractual life Outstanding at beginning of year 8,533,561 $ 59.05 765,060 Granted 1,280,034 73.40 328,457 Exercised (2,031,593 ) 45.35 (280,197 ) Cancelled (444,736 ) 66.50 (27,767 ) Outstanding at end of period 7,337,266 $ 64.90 2.2 785,553 1.9 Exercisable at end of period 3,026,721 $ 56.83 1.1 — — Weighted-average fair value of grants in 2016 $ 13.74 $ 70.99 Weighted-average fair value of grants in 2015 $ 17.97 $ 80.25 Weighted-average fair value of grants in 2014 $ 16.41 $ 72.24 Awards Weighted average Awards Weighted average Range of SSAR base prices outstanding exercise price exercisable exercise price $30.01–$40.00 16,000 39.89 16,000 39.89 $40.01–$50.00 267,621 44.44 267,621 44.44 $50.01–$60.00 3,489,398 57.53 2,420,035 56.84 $60.01–$70.00 1,306,049 67.46 232,816 65.04 $70.01–$80.00 1,581,487 74.76 50,806 70.44 $80.01–$90.00 676,711 83.60 39,443 81.51 Total 7,337,266 $ 64.90 3,026,721 $ 56.83 The Company granted 9,600 cash-settled stock-based awards during 2016. Liability-classified awards contributed $376, $(236) and $1,774 to stock-based compensation expense for the years ended December 31, 2016, 2015 and 2014, respectively. As of December 31, 2016 the Company had 34,600 liability-classified stock-based awards outstanding, 5,000 of which were vested, and a total stock-based compensation liability balance of $124. For the years ended December 31, 2016, 2015, and 2014, the aggregate intrinsic value of stock-based awards exercised was $73,001, $116,933 and $151,342, respectively. At December 31, 2016, the aggregate intrinsic value of stock awards outstanding was $79,717 and the aggregate intrinsic value of stock awards exercisable was $23,566. Estimated fair value of stock-based compensation awards The Company has estimated the grant-date fair value of stock-settled stock appreciation rights awards using the Black-Scholes-Merton valuation model and stock-settled stock unit awards at intrinsic value on the date of grant, except for portions of the Company’s performance stock unit awards for which a Monte Carlo simulation was used to estimate the grant-date fair value. The following assumptions were used in estimating these values and determining the related stock-based compensation attributable to the current period: Expected term of the awards: The expected term of awards granted represents the period of time that they are expected to remain outstanding from the date of grant. The Company determines the expected term of its stock awards based on its historical experience with similar awards, considering the Company’s historical exercise and post-vesting termination patterns, and the terms expected by peer companies in near industries. Expected volatility: Expected volatility represents the volatility anticipated over the expected term of the award. The Company determines the expected volatility for its awards based on the volatility of the price of its common stock over the most recent retrospective period commensurate with the expected term of the award, considering the volatility expectations implied by the market price of its exchange-traded options and the volatilities expected by peer companies in near industries. Expected dividend yield: The Company has not paid dividends on its common stock and does not currently expect to pay dividends during the term of stock awards granted. Risk-free interest rate: The Company bases the expected risk-free interest rate on the implied yield currently available on stripped interest coupons of U.S. Treasury issues with a remaining term equivalent to the expected term of the award. A summary of the weighted average valuation inputs described above used for estimating the grant-date fair value of stock-settled stock appreciation rights awards granted in the periods indicated is as follows: Year ended December 31, 2016 2015 2014 Expected term 4.2 years 4.1 years 4.2 years Expected volatility 21.0 % 24.6 % 25.8 % Expected dividend yield 0.0 % 0.0 % 0.0 % Risk-free interest rate 1.0 % 1.5 % 1.5 % The Company estimates expected forfeitures based upon historical experience with separate groups of employees that have exhibited similar forfeiture behavior in the past. Stock-based compensation expense is recorded only for awards that are expected to vest. Employee stock purchase plan The Employee Stock Purchase Plan entitles qualifying employees to purchase up to $25 of the Company’s common stock during each calendar year. The amounts used to purchase stock are accumulated through payroll withholdings or through optional lump sum payments made in advance of the first day of the purchase right period. This compensatory plan allows employees to purchase stock for the lesser of 100% of the fair market value on the first day of the purchase right period or 85% of the fair market value on the last day of the purchase right period. Purchase right periods begin on January 1 and July 1, and end on December 31. Contributions used to purchase the Company’s common stock under this plan for the 2016, 2015 and 2014 participation periods were $23,902, $24,523 and $19,010, respectively. Shares purchased pursuant to the plan’s 2016, 2015 and 2014 participation periods were 438,002, 413,859 and 297,954, respectively. At December 31, 2016, there were 7,484,395 shares remaining available for future grants under this plan, which includes an additional 7,500,000 shares approved by stockholders on June 20, 2016. The fair value of employees’ purchase rights was estimated as of the beginning dates of the purchase right periods using the Black-Scholes-Merton valuation model with the following weighted average assumptions for purchase right periods in 2016, 2015 and 2014, respectively: expected volatility of 22%, 26% and 27%; risk-free interest rate of 0.8%, 0.2% and 0.2%, and no dividends. Using these assumptions, the weighted average estimated fair value of these purchase rights was $16.73, $18.76 and $16.40 for 2016, 2015 and 2014, respectively. Long-term incentive compensation expense and proceeds For the years ended December 31, 2016, 2015 and 2014, the Company recognized $73,337, $130,682 and $118,970, respectively, in total long-term incentive program (LTIP) expense, of which $38,338, $56,664 and $56,743, respectively, was stock-based compensation expense for stock appreciation rights, stock units and discounted employee stock plan purchases, which are primarily included in general and administrative expenses. The estimated tax benefits recorded for stock-based compensation in 2016, 2015 and 2014 were $12,731, $19,689 and $20,351, respectively. As of December 31, 2016, there was $92,987 total estimated unrecognized compensation cost for outstanding LTIP awards, including $59,016 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 years ended December 31, 2016, 2015 and 2014, the Company received $28,397, $45,749 and $59,119, respectively, in actual tax benefits upon the exercise of stock awards. Since the Company issues stock-settled stock appreciation rights rather than stock options, it does not Stock repurchases During the years ended December 31, 2016 and 2015, the Company repurchased a total of 16,649,090 shares and 7,779,958 shares of its common stock for $1,072,377 and $575,380, or an average price of $64.41 and $73.96 per share, respectively, pursuant to previously announced authorizations by the Board of Directors. The Company has not repurchased any additional shares of its common stock from January 1, 2017 through February 24, 2017. On July 13, 2016, the Company’s Board of Directors approved a share repurchase authorization in the amount of $1,240,748. This share repurchase authorization 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 of December 31, 2016, there was $677,104 available under the current Board authorizations for additional share repurchases. Although these share repurchase authorizations have no expiration dates, the Company remains subject to share repurchase limitations under the terms of its senior secured credit facilities and the indentures governing its Senior Notes. Charter documents & Delaware law The Company’s charter documents include provisions that may deter hostile takeovers, delay or prevent changes of control or changes in management, or limit the ability of stockholders to approve transactions that they may otherwise determine to be in their best interests. These include provisions prohibiting stockholders from acting by written consent, requiring 90 days advance notice of stockholder proposals or nominations to the Board of Directors and granting the Board of Directors the authority to issue up to five million shares of preferred stock and to determine the rights and preferences of the preferred stock without the need for further stockholder approval. The Company is also subject to Section 203 of the Delaware General Corporation Law which, subject to exceptions, would prohibit the Company from engaging in any business combinations with any interested stockholder, as defined in that section, for a period of three years following the date on which that stockholder became an interested stockholder. These restrictions may discourage, delay or prevent a change in the control of the Company. 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: Year ended December 31, 2016 2015 2014 Net income attributable to DaVita Inc. $ 879,874 $ 269,732 $ 723,114 Increase in paid-in capital for sales of noncontrolling interest — — 355 Decrease in paid-in capital for the purchase of noncontrolling interests (13,105 ) (55,826 ) (5,357 ) Net transfer to noncontrolling interests (13,105 ) (55,826 ) (5,002 ) Change from net income attributable to DaVita Inc. and transfers to noncontrolling interests $ 866,769 $ 213,906 $ 718,112 The Company acquired additional ownership interests in several existing majority-owned joint ventures for $21,512 in 2016 and $66,382 in 2015 in cash, and $17,876 in cash and deferred purchase price of $136 in 2014. |
Other comprehensive (loss) inco
Other comprehensive (loss) income | 12 Months Ended |
Dec. 31, 2016 | |
Statement Of Income And Comprehensive Income [Abstract] | |
Other comprehensive (loss) income | 20. Other comprehensive (loss) income Charges and credits to other comprehensive (loss) income have been as follows: Interest rate swap and cap agreements Investment securities Foreign currency translation adjustments Accumulated other comprehensive income (loss) Balance at December 31, 2013 $ (2,344 ) $ 3,120 $ (3,421 ) $ (2,645 ) Unrealized (losses) gains (16,509 ) 425 (22,952 ) (39,036 ) Related income tax 6,450 (187 ) — 6,263 (10,059 ) 238 (22,952 ) (32,773 ) Reclassification from accumulated other comprehensive losses (income) into net income 17,409 (340 ) — 17,069 Related income tax (6,801 ) 133 — (6,668 ) 10,608 (207 ) — 10,401 Balance at December 31, 2014 $ (1,795 ) $ 3,151 $ (26,373 ) $ (25,017 ) Unrealized losses (20,085 ) (1,974 ) (23,889 ) (45,948 ) Related income tax 7,844 561 — 8,405 (12,241 ) (1,413 ) (23,889 ) (37,543 ) Reclassification from accumulated other comprehensive losses (income) into net income 5,103 (618 ) — 4,485 Related income tax (1,992 ) 241 — (1,751 ) 3,111 (377 ) — 2,734 Balance at December 31, 2015 $ (10,925 ) $ 1,361 $ (50,262 ) $ (59,826 ) Unrealized (losses) gains (6,013 ) 1,802 (39,614 ) (43,825 ) Related income tax 2,343 (565 ) — 1,778 (3,670 ) 1,237 (39,614 ) (42,047 ) Reclassification from accumulated other comprehensive losses (income) into net income 4,198 (690 ) 10,087 13,595 Related income tax (1,632 ) 267 — (1,365 ) 2,566 (423 ) 10,087 12,230 Balance at December 31, 2016 $ (12,029 ) $ 2,175 $ (79,789 ) $ (89,643 ) 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 14 to these 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 9 to these consolidated financial statements for further details. |
Acquisitions and Divestitures
Acquisitions and Divestitures | 12 Months Ended |
Dec. 31, 2016 | |
Business Combinations [Abstract] | |
Acquisitions and divestitures | 21. 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 three 40 50,000 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 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 nineteen 40,280 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. TEC has 500 providers in primary and specialty care locations throughout Snohomish County, Washington who care for more than 315,000 patients. 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 Covenant not-to-compete 3,200 Amortizable intangible and other long-term assets 30,850 Goodwill 244,502 Liabilities assumed (50,940 ) Long-term deferred income taxes (16,880 ) Noncontrolling interests (9,885 ) $ 400,971 Amortizable intangible assets acquired in this acquisition have a weighted average estimated useful life of six None 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 consolidated financial statements from March 1, 2016. Other routine acquisitions During 2016, the Company acquired eight dialysis centers in the U.S., 21 dialysis centers outside the U.S., and other medical businesses for a total of $170,169 in net cash, earn-outs of $1,511, and deferred purchase price and liabilities assumed of $18,373. During 2015, the Company acquired dialysis-related and other ancillary businesses consisting of six dialysis centers in the U.S., 21 dialysis centers outside the U.S., three vascular access centers, and other medical businesses for a total of $96,469 in net cash and deferred purchase price and earn-outs of $8,395. During 2014, the Company acquired dialysis-related and other ancillary businesses consisting of 18 dialysis centers in the U.S., seven dialysis centers outside the U.S. and other medical businesses for a total of $272,094 in net cash and deferred purchase price of $23,781. The assets and liabilities for all acquisitions were recorded at their estimated fair values at the dates of the acquisitions and are included in the Company’s financial statements and operating results from the effective dates of the acquisitions. For several of the 2016 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 several of these acquisitions are pending final quantification. The following table summarizes the assets acquired and liabilities assumed in the above described transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of the noncontrolling interests assumed in these transactions: Year ended December 31, 2016 2015 2014 Current assets $ 3,996 $ 3,843 $ 915 Property and equipment 9,407 12,436 5,999 Customer relationships — — 74,515 Non-compete agreements 5,395 8,959 16,585 Amortizable intangible and other long-term assets 986 4,345 4,193 Goodwill 203,326 97,093 221,514 Long-term deferred income taxes 597 (1,467 ) — Noncontrolling interests assumed (30,337 ) (18,905 ) (25,963 ) Liabilities assumed (3,317 ) (1,440 ) (1,883 ) Aggregate purchase cost $ 190,053 $ 104,864 $ 295,875 Amortizable intangible assets acquired during 2016, 2015 and 2014 had weighted-average estimated useful lives of seven, eight and ten years, respectively. The majority of the intangible assets acquired relate to non-compete agreements and customer relationships. The weighted-average amortization period for customer relationships was ten years for 2014. The weighted-average amortization period for non-compete agreements was seven years for 2016, and eight years for both 2015 and 2014. The total amount of goodwill deductible for tax purposes associated with these acquisitions for 2016, 2015, and 2014 was approximately $173,718, $73,733 and $175,247, respectively. 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 38 one fifty-one one 360,000 Pro forma financial information (unaudited) The following summary, prepared on a pro forma basis, combines the results of operations as if all acquisitions in 2016 and 2015 had been consummated as of the beginning of 2015, including the impact of certain adjustments such as amortization of intangibles, interest expense on acquisition financing and income tax effects. Year ended December 31, 2016 2015 (unaudited) Pro forma net revenues $ 14,875,592 $ 14,342,138 Pro forma net income attributable to DaVita Inc. 884,284 280,124 Pro forma basic net income per share attributable to DaVita Inc. 4.39 1.32 Pro forma diluted net income per share attributable to DaVita Inc. 4.32 1.30 Contingent earn-out obligations The Company has several contingent earn-out obligations associated with acquisitions that could result in the Company paying the former shareholders of acquired companies a total of up to approximately $19,557 if certain EBITDA, operating income performance targets or quality margins are met over the next one to eight 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 remeasurement recorded in earnings. See Note 24 to these consolidated financial statements for further details. As of December 31, 2016, the Company has estimated the fair value of these contingent earn-out obligations to be $9,977, of which a total of $7,217 is included in other liabilities and the remaining $2,760 is included in other long-term liabilities in the Company’s consolidated balance sheet. The following is a reconciliation of changes in the contingent earn-out obligations for the year ended December 31, 2016: Beginning balance January 1, 2016 $ 34,135 Contingent earn-out obligations associated with acquisitions 1,511 Remeasurement of fair value (4,132 ) Payments of contingent earn-out obligations (21,537 ) $ 9,977 |
Variable interest entities
Variable interest entities | 12 Months Ended |
Dec. 31, 2016 | |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Variable interest entities | 22. Variable interest entities The Company relies on the operating activities of certain 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. GAAP, VIEs typically include entities for which (i) the entity’s equity is not sufficient to finance its activities without additional subordinated financial support; (ii) the equity holders as a group lack the power to direct the activities that most significantly influence the entity’s economic performance, the obligation to absorb the entity’s expected losses, or the right to receive the entity’s expected returns; or (iii) the voting rights of some investors are not proportional to their obligations to absorb the entity’s losses. The Company has determined that substantially all of the entities it is associated with that qualify as VIEs must be included in its consolidated financial statements. The Company manages these entities and provides operating and capital funding as necessary for the entities to accomplish their operational and strategic objectives. A number of these entities are subject to nominee share ownership or share 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 its related party 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 December 31, 2016, these consolidated financial statements include total assets of VIEs of $747,574 and total liabilities and noncontrolling interests of VIEs to third parties of $425,034. 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 related liabilities recorded in accrued compensation and benefits and other long-term liabilities. See Note 16 to these consolidated financial statements for disclosures on the assets of these consolidated non-qualified deferred compensation plans. |
Concentrations
Concentrations | 12 Months Ended |
Dec. 31, 2016 | |
Risks And Uncertainties [Abstract] | |
Concentrations | 23. Concentrations Approximately 64%, 66% and 67% of total U.S. dialysis services revenues in 2016, 2015 and 2014, respectively, are from government-based programs, principally Medicare and Medicaid. Related net accounts receivable and other receivables from Medicare, including Medicare-assigned plans, and Medicaid, including Medicaid-assigned plans, were approximately $831,445 and $830,060, as of December 31, 2016 and 2015, respectively. Approximately 72%, 70% and 71% of DMG’s revenues in 2016, 2015 and 2014, respectively, are from government-based programs, principally Medicare and Medicaid. Approximately 63%, 61% and 64% for 2016, 2015 and 2014, respectively, of DMG’s capitated medical revenues are associated with three health plans. In addition, approximately $289,798 and $231,278 at December 31, 2016 and 2015, respectively, of DMG’s capitated accounts receivables are associated with three health plans. One commercial payor, Humana, accounted for approximately 11% of total consolidated net revenues. There is no single commercial payor that accounted for more than 10% of total consolidated accounts receivable at December 31, 2016 and 2015. |
Fair values of financial instru
Fair values of financial instruments | 12 Months Ended |
Dec. 31, 2016 | |
Fair Value Disclosures [Abstract] | |
Fair values of financial instruments | 24. Fair values 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 has also classified certain assets, liabilities and temporary equity that are measured at fair value into the appropriate fair value hierarchy levels as defined by FASB. The following tables summarize the Company’s assets, liabilities and temporary equity measured at fair value on a recurring basis as of December 31, 2016 and 2015: Total Quoted active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) December 31, 2016 Assets Available for sale securities $ 47,404 $ 47,404 $ — $ — Cash surrender value of life insurance policies $ 59,646 $ — $ 59,646 $ — Interest rate cap agreements $ 9,929 $ — $ 9,929 $ — Funds on deposit with third parties $ 75,877 $ 75,877 $ — $ — Liabilities Contingent earn-out obligations $ 9,977 $ — $ — $ 9,977 Temporary equity Noncontrolling interests subject to put provisions $ 973,258 $ — $ — $ 973,258 December 31, 2015 Assets Available for sale securities $ 33,482 $ 33,482 $ — $ — Cash surrender value of life insurance policies $ 56,840 $ — $ 56,840 $ — Interest rate cap agreements $ 15,127 $ — $ 15,127 $ — Interest rate swap agreements $ 516 $ — $ 516 $ — Funds on deposit with third parties $ 82,679 $ 82,679 $ — $ — Liabilities Contingent earn-out obligations $ 34,135 $ — $ — $ 34,135 Temporary equity Noncontrolling interests subject to put provisions $ 864,066 $ — $ — $ 864,066 Available for sale securities represent investments in various open-ended registered investment companies, or mutual funds, and are recorded at fair value estimated based upon quoted prices reported by each mutual fund. See Note 9 to these consolidated financial statements for further discussion. Investments in life insurance policies are carried at their cash surrender value which approximates their fair value. See Note 16 to these consolidated financial statements for further discussion. The interest rate swap and cap agreements are recorded at fair value based upon valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, 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 swap and cap agreements would be materially different from the fair values currently reported. See Note 14 to these 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 probabilities of achieving gross margin 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 values of the quality measures involved. The estimated fair value of these contingent earn-out obligations will be 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 18 to these 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, accounts payable, other accrued liabilities and debt. The balances of the non-debt financial instruments are presented in the consolidated financial statements at December 31, 2016 and 2015 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 $4,217,348 as of December 31, 2016, and the fair value was approximately $4,336,969 based upon quoted market prices. The fair value of the Company’s Senior Notes was approximately $4,530,875 at December 31, 2016 based upon quoted market prices, as compared to the carrying amount of $4,500,000. |
Segment reporting
Segment reporting | 12 Months Ended |
Dec. 31, 2016 | |
Segment Reporting [Abstract] | |
Segment reporting | 25. 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 ancillary services and strategic initiatives, including its international 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 healthcare 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 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 kidney care and other health operations in the European and Middle Eastern, Latin American, and Asian 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 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. These corporate administrative support costs are reduced by internal management fees received from the Company’s ancillary lines of business and were increased by the reduction of a tax asset associated with the DMG acquisition escrow provisions. The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: Year ended December 31, 2016 2015 2014 Segment revenues: U.S. dialysis and related lab services Patient service revenues: External sources $ 9,482,648 $ 8,980,515 $ 8,513,089 Intersegment revenues 68,774 53,476 37,112 Total dialysis and related lab services revenues 9,551,422 9,033,991 8,550,201 Less: Provision for uncollectible accounts (429,882 ) (406,530 ) (353,028 ) Net dialysis and related lab services patient service revenues 9,121,540 8,627,461 8,197,173 Other revenues (1) 16,649 13,971 13,498 Total net dialysis and related lab services revenues 9,138,189 8,641,432 8,210,671 DMG DMG revenues: Capitated revenues $ 3,430,576 $ 3,436,705 $ 3,190,903 Net patient service revenues 621,583 317,950 219,306 Other revenues (2) 61,040 82,470 91,374 Intersegment capitated and other revenues 215 136 716 Total revenues $ 4,113,414 $ 3,837,261 $ 3,502,299 Other - Ancillary services and strategic initiatives Net patient service revenues $ 228,459 $ 160,484 $ 122,087 Capitated revenues 88,103 72,390 70,385 Other external sources 1,245,929 1,123,882 927,492 Intersegment revenues 58,881 25,674 19,535 Total ancillary services and strategic initiatives revenues 1,621,372 1,382,430 1,139,499 Total net segment revenues 14,872,975 13,861,123 12,852,469 Elimination of intersegment revenues (127,870 ) (79,286 ) (57,363 ) Consolidated net revenues $ 14,745,105 $ 13,781,837 $ 12,795,106 Segment operating margin (loss): U.S. dialysis and related lab services $ 1,777,014 $ 1,259,632 $ 1,637,626 DMG (104,233 ) 33,929 214,983 Other—Ancillary services and strategic initiatives 266,323 (103,901 ) (24,456 ) Total segment margin 1,939,104 1,189,660 1,828,153 Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: Corporate administrative support (3) (44,561 ) (18,965 ) (13,012 ) Consolidated operating income 1,894,543 1,170,695 1,815,141 Debt expense (414,382 ) (408,380 ) (410,294 ) Debt refinancing and redemption charges — (48,072 ) (97,548 ) Other income 8,734 8,893 2,374 Consolidated income from continuing operations before income taxes $ 1,488,895 $ 723,136 $ 1,309,673 (1) Includes management fees for providing management and administrative services to dialysis centers in which the Company owns a noncontrolling interest or which are wholly-owned by third parties. (2) 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. (3) Corporate administrative support costs in 2016 also include $30,934 of an adjustment to reduce a tax asset associated with the DMG acquisition escrow provisions. Depreciation and amortization expense by segment is as follows: December 31, 2016 2015 2014 U.S. dialysis and related lab services $ 482,768 $ 438,238 $ 402,767 DMG 210,755 174,118 169,485 Other - Ancillary services and strategic initiatives 26,729 25,668 18,683 $ 720,252 $ 638,024 $ 590,935 Summary of assets by segment is as follows: December 31, 2016 2015 Segment assets U.S. dialysis and related lab services (including equity investments of $66,924 and $29,801, respectively) $ 11,438,100 $ 11,591,507 DMG (including equity investments of $10,350 and $22,714, respectively) 6,213,091 6,150,666 Other - Ancillary services and strategic initiatives (1) 1,090,066 772,702 Consolidated assets $ 18,741,257 $ 18,514,875 (1) Includes approximately $96,396 and $ 69,519 in 2016 and 2015, respectively, of net property and equipment related to the Company’s international operations. Expenditures for property and equipment by segment is as follows: December 31, 2016 2015 2014 U.S. dialysis and related lab services $ 675,994 $ 584,513 $ 560,610 DMG 84,399 66,800 27,885 Other - Ancillary services and strategic initiatives 68,702 56,685 52,835 $ 829,095 $ 707,998 $ 641,330 |
Supplemental cash flow informat
Supplemental cash flow information | 12 Months Ended |
Dec. 31, 2016 | |
Supplemental Cash Flow Elements [Abstract] | |
Supplemental cash flow information | 26. Supplemental cash flow information The table below provides supplemental cash flow information: Year ended December 31, 2016 2015 2014 Cash paid: Income taxes $ 339,411 $ 156,075 $ 238,615 Interest 406,987 405,120 351,967 Non-cash investing and financing activities: Fixed assets under capital lease obligations 28,127 74,035 72,389 |
Selected quarterly financial da
Selected quarterly financial data (unaudited) | 12 Months Ended |
Dec. 31, 2016 | |
Quarterly Financial Information Disclosure [Abstract] | |
Selected quarterly financial data (unaudited) | 27. Selected quarterly financial data (unaudited) 2016 2015 December September 30 June 30 March 31 December September 30 June 30 March 31 Net revenues $ 3,715,742 $ 3,730,576 $ 3,717,651 $ 3,581,136 $ 3,533,589 $ 3,525,665 $ 3,434,618 $ 3,287,965 Operating income (loss) $ 381,428 $ 819,156 $ 329,070 $ 364,889 $ 244,935 $ 509,368 $ 480,548 $ (64,156 ) Income (loss) before income taxes $ 278,072 $ 716,451 $ 229,391 $ 264,981 $ 146,307 $ 408,371 $ 330,539 $ (162,081 ) Net income (loss) attributable to DaVita Inc. $ 157,726 $ 571,332 $ 53,382 $ 97,434 $ (6,000 ) $ 215,872 $ 170,477 $ (110,617 ) Basic net income (loss) per share attributable to DaVita Inc. $ 0.81 $ 2.80 $ 0.26 $ 0.48 $ (0.03 ) $ 1.02 $ 0.80 $ (0.52 ) Diluted net income (loss) per share attributable to DaVita Inc. $ 0.80 $ 2.76 $ 0.26 $ 0.47 $ (0.03 ) $ 1.00 $ 0.78 $ (0.52 ) |
Consolidating financial stateme
Consolidating financial statements | 12 Months Ended |
Dec. 31, 2016 | |
Condensed Financial Information Of Parent Company Only Disclosure [Abstract] | |
Consolidating financial statements | 2 8 . 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 services. The Company’s Senior Notes are guaranteed by substantially all of its domestic subsidiaries. Each of the guarantor subsidiaries has guaranteed the Senior Notes on a joint and several basis. However, the guarantor subsidiaries can be released from their obligations in the event of a sale or other disposition of all or substantially all of the assets of such subsidiary, including by merger or consolidation or the sale of all equity interests in such subsidiary owned by the Company, if such subsidiary guarantor is designated as an unrestricted subsidiary or otherwise ceases to be a restricted subsidiary, and if such subsidiary guarantor no longer guaranties any other indebtedness of the Company. Certain domestic subsidiaries, foreign subsidiaries, joint ventures, partnerships and third parties are not guarantors of the Senior Notes. Consolidating Statements of Income DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the twelve months ended December 31, 2016 Patient services revenues $ — $ 6,766,138 $ 3,761,590 $ (173,567 ) $ 10,354,161 Less: Provision for uncollectible accounts — (278,761 ) (172,592 ) — (451,353 ) Net patient service revenues — 6,487,377 3,588,998 (173,567 ) 9,902,808 Capitated revenues — 1,795,673 1,723,279 (273 ) 3,518,679 Other revenues 767,791 2,089,749 125,203 (1,659,125 ) 1,323,618 Total net revenues 767,791 10,372,799 5,437,480 (1,832,965 ) 14,745,105 Operating expenses and charges 524,108 9,735,334 4,424,085 (1,832,965 ) 12,850,562 Operating income 243,683 637,465 1,013,395 — 1,894,543 Debt expense (407,925 ) (358,535 ) (50,710 ) 402,788 (414,382 ) Other income, net 396,797 6,196 8,529 (402,788 ) 8,734 Income tax expense 79,301 210,338 166,174 — 455,813 Equity earnings in subsidiaries 726,620 651,832 — (1,378,452 ) — Net income 879,874 726,620 805,040 (1,378,452 ) 1,033,082 Less: Net income attributable to noncontrolling interests — — — (153,208 ) (153,208 ) Net income attributable to DaVita Inc. $ 879,874 $ 726,620 $ 805,040 $ (1,531,660 ) $ 879,874 Consolidating Statements of Income DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For twelve months ended December 31, 2015 Patient services revenues $ — $ 6,578,185 $ 3,047,048 $ (144,954 ) $ 9,480,279 Less: Provision for uncollectible accounts — (285,454 ) (142,406 ) — (427,860 ) Net patient service revenues — 6,292,731 2,904,642 (144,954 ) 9,052,419 Capitated revenues — 1,776,311 1,733,027 (243 ) 3,509,095 Other revenues 727,887 1,875,133 32,137 (1,414,834 ) 1,220,323 Total net revenues 727,887 9,944,175 4,669,806 (1,560,031 ) 13,781,837 Operating expenses and charges 488,595 9,565,667 4,116,911 (1,560,031 ) 12,611,142 Operating income 239,292 378,508 552,895 — 1,170,695 Debt (expense) and refinancing charges (449,598 ) (340,176 ) (42,500 ) 375,822 (456,452 ) Other income, net 365,752 11,562 7,401 (375,822 ) 8,893 Income tax expense 81,221 173,063 41,442 — 295,726 Equity earnings in subsidiaries 195,507 318,676 — (514,183 ) — Net income 269,732 195,507 476,354 (514,183 ) 427,410 Less: Net income attributable to noncontrolling interests — — — (157,678 ) (157,678 ) Net income attributable to DaVita Inc. $ 269,732 $ 195,507 $ 476,354 $ (671,861 ) $ 269,732 For the year ended December 31, 2014 Patient services revenues $ — $ 6,246,683 $ 2,739,204 $ (117,549 ) $ 8,868,338 Less: Provision for uncollectible accounts — (238,600 ) (128,284 ) — (366,884 ) Net patient service revenues — 6,008,083 2,610,920 (117,549 ) 8,501,454 Capitated revenues — 1,681,668 1,579,804 (184 ) 3,261,288 Other revenues 684,066 1,639,828 24,155 (1,315,685 ) 1,032,364 Total net revenues 684,066 9,329,579 4,214,879 (1,433,418 ) 12,795,106 Operating expenses and charges 443,951 8,269,025 3,700,407 (1,433,418 ) 10,979,965 Operating income 240,115 1,060,554 514,472 — 1,815,141 Debt (expense) and refinancing charges (502,762 ) (363,623 ) (43,449 ) 401,992 (507,842 ) Other income, net 385,532 11,731 7,103 (401,992 ) 2,374 Income tax expense 46,856 397,268 2,219 — 446,343 Equity earnings in subsidiaries 647,085 335,691 — (982,776 ) — Net income 723,114 647,085 475,907 (982,776 ) 863,330 Less: Net income attributable to noncontrolling interests — — — (140,216 ) (140,216 ) Net income attributable to DaVita Inc. $ 723,114 $ 647,085 $ 475,907 $ (1,122,992 ) $ 723,114 Consolidating Statements of Comprehensive Income DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the year ended December 31, 2016 Net income $ 879,874 $ 726,620 $ 805,040 $ (1,378,452 ) $ 1,033,082 Other comprehensive loss (290 ) — (29,337 ) — (29,627 ) Total comprehensive income 879,584 726,620 775,703 (1,378,452 ) 1,003,455 Less: Comprehensive income attributable to noncontrolling interest — — — (153,398 ) (153,398 ) Comprehensive income attributable to DaVita Inc. $ 879,584 $ 726,620 $ 775,703 $ (1,531,850 ) $ 850,057 For the year ended December 31, 2015 Net income $ 269,732 $ 195,507 $ 476,354 $ (514,183 ) $ 427,410 Other comprehensive loss (10,920 ) — (23,889 ) — (34,809 ) Total comprehensive income 258,812 195,507 452,465 (514,183 ) 392,601 Less: Comprehensive income attributable to noncontrolling interest — — — (157,678 ) (157,678 ) Comprehensive income attributable to DaVita Inc. $ 258,812 $ 195,507 $ 452,465 $ (671,861 ) $ 234,923 For the year ended December 31, 2014 Net income $ 723,114 $ 647,085 $ 475,907 $ (982,776 ) $ 863,330 Other comprehensive income (losses) 580 — (22,952 ) — (22,372 ) Total comprehensive income 723,694 647,085 452,955 (982,776 ) 840,958 Less: Comprehensive income attributable to noncontrolling interest — — — (140,216 ) (140,216 ) Comprehensive income attributable to DaVita Inc. $ 723,694 $ 647,085 $ 452,955 $ (1,122,992 ) $ 700,742 Consolidating Balance Sheets DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total As of December 31, 2016 Cash and cash equivalents $ 549,921 $ 59,192 $ 304,074 $ — $ 913,187 Accounts receivable, net — 1,215,232 702,070 — 1,917,302 Other current assets 277,911 736,727 135,101 — 1,149,739 Total current assets 827,832 2,011,151 1,141,245 — 3,980,228 Property and equipment, net 337,200 1,689,798 1,148,369 — 3,175,367 Intangible assets, net 487 1,491,057 36,223 — 1,527,767 Investments in subsidiaries 9,717,728 2,002,660 — (11,720,388 ) — Intercompany receivables 3,250,692 — 866,955 (4,117,647 ) — Other long-term assets and investments 39,994 86,710 523,874 — 650,578 Goodwill — 7,838,984 1,568,333 — 9,407,317 Total assets $ 14,173,933 $ 15,120,360 $ 5,284,999 $ (15,838,035 ) $ 18,741,257 Current liabilities $ 303,840 $ 1,865,193 $ 527,412 $ — $ 2,696,445 Intercompany payables — 2,322,124 1,795,523 (4,117,647 ) — Long-term debt and other long-term liabilities 8,614,445 1,215,315 392,053 — 10,221,813 Noncontrolling interests subject to put provisions 607,601 — — 365,657 973,258 Total DaVita Inc. shareholders' equity 4,648,047 9,717,728 2,002,660 (11,720,388 ) 4,648,047 Noncontrolling interests not subject to put provisions — — 567,351 (365,657 ) 201,694 Total equity 4,648,047 9,717,728 2,570,011 (12,086,045 ) 4,849,741 Total liabilities and equity $ 14,173,933 $ 15,120,360 $ 5,284,999 $ (15,838,035 ) $ 18,741,257 As of December 31, 2015 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 Consolidating Statements of Cash Flows DaVita Inc. Guarantor Subsidiaries Non-Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the year ended December 31, 2016 Cash flows from operating activities: Net income $ 879,874 $ 726,620 $ 805,040 $ (1,378,452 ) $ 1,033,082 Changes in operating assets and liabilities and non-cash items included in net income (614,642 ) 335,166 (168,614 ) 1,378,452 930,362 Net cash provided by operating activities 265,232 1,061,786 636,426 — 1,963,444 Cash flows from investing activities: Additions of property and equipment, net (139,303 ) (382,305 ) (307,487 ) — (829,095 ) Acquisitions — (472,413 ) (91,443 ) — (563,856 ) Proceeds from asset sales, net of cash divested — 70,342 (5,617 ) — 64,725 Investments and other items 153,031 (29,038 ) 2,565 — 126,558 Net cash provided by (used in) investing activities 13,728 (813,414 ) (401,982 ) — (1,201,668 ) Cash flows from financing activities: Long-term debt and related financing costs, net (92,460 ) (27,830 ) (4,152 ) — (124,442 ) Intercompany borrowing 237,988 (249,182 ) 11,194 — — Other items (1,061,203 ) (21,525 ) (144,811 ) — (1,227,539 ) Net cash used in financing activities (915,675 ) (298,537 ) (137,769 ) — (1,351,981 ) Effect of exchange rate changes on cash — — 4,276 — 4,276 Net (decrease) increase in cash and cash equivalents (636,715 ) (50,165 ) 100,951 — (585,929 ) Cash and cash equivalents at beginning of the year 1,186,636 109,357 203,123 — 1,499,116 Cash and cash equivalents at the end of the year $ 549,921 $ 59,192 $ 304,074 $ — $ 913,187 For the year ended December 31, 2015 Cash flows from operating activities: Net income $ 269,732 $ 195,507 $ 476,354 $ (514,183 ) $ 427,410 Changes in operating assets and liabilities and non-cash items included in net income (146,531 ) 688,106 74,032 514,183 1,129,790 Net cash provided by operating activities 123,201 883,613 550,386 — 1,557,200 Cash flows from investing activities: Additions of property and equipment, net (115,269 ) (319,695 ) (273,034 ) — (707,998 ) Acquisitions — (76,983 ) (19,486 ) — (96,469 ) Proceeds from asset sales — 19,715 — — 19,715 Investments and other items (74,474 ) (2,144 ) (20,414 ) — (97,032 ) Net cash used in investing activities (189,743 ) (379,107 ) (312,934 ) — (881,784 ) Cash flows from financing activities: Long-term debt and related financing costs, net 640,009 (11,953 ) (8,358 ) — 619,698 Intercompany borrowing 486,588 (394,735 ) (91,853 ) — — Other items (572,295 ) (66,382 ) (119,991 ) — (758,668 ) Net cash provided by (used in) financing activities 554,302 (473,070 ) (220,202 ) — (138,970 ) Effect of exchange rate changes on cash — — (2,571 ) — (2,571 ) Net increase in cash and cash equivalents 487,760 31,436 14,679 — 533,875 Cash and cash equivalents at beginning of the year 698,876 77,921 188,444 — 965,241 Cash and cash equivalents at the end of the year $ 1,186,636 $ 109,357 $ 203,123 $ — $ 1,499,116 Consolidating Statements of Cash Flows DaVita Inc. Guarantor Subsidiaries Non-Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the year ended December 31, 2014 Cash flows from operating activities: Net income $ 723,114 $ 647,085 $ 475,907 $ (982,776 ) $ 863,330 Changes in operating assets and liabilities and non-cash items included in net income (597,992 ) 120,772 90,521 982,776 596,077 Net cash provided by operating activities 125,122 767,857 566,428 — 1,459,407 Cash flows from investing activities: Additions of property and equipment, net (51,374 ) (312,191 ) (277,765 ) — (641,330 ) Acquisitions — (228,569 ) (43,525 ) — (272,094 ) Proceeds from asset sales — 8,791 — — 8,791 Investments and other items (333,803 ) (316 ) (38,977 ) — (373,096 ) Net cash used in investing activities (385,177 ) (532,285 ) (360,267 ) — (1,277,729 ) Cash flows from financing activities: Long-term debt and related financing costs, net 4,513 (12,545 ) 43 — (7,989 ) Intercompany borrowing 410,437 (282,461 ) (127,976 ) — — Other items (58,207 ) (14,099 ) (84,684 ) — (156,990 ) Net cash provided by (used in) financing activities 356,743 (309,105 ) (212,617 ) — (164,979 ) Effect of exchange rate changes on cash — — 2,293 — 2,293 Net increase (decrease) in cash and cash equivalents 96,688 (73,533 ) (4,163 ) — 18,992 Cash and cash equivalents at beginning of the year 602,188 151,454 192,607 — 946,249 Cash and cash equivalents at the end of the year $ 698,876 $ 77,921 $ 188,444 $ — $ 965,241 |
Supplemental data
Supplemental data | 12 Months Ended |
Dec. 31, 2016 | |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Supplemental data (unaudited) | 29 . Supplemental data (unaudited) The following information is presented as supplemental data as required by the indentures governing the Company’s Senior Notes. Condensed Consolidating Statements of Income Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the year ended December 31, 2016 Patient services revenues $ 10,354,161 $ 449,473 $ — $ 9,904,688 Less: Provision for uncollectible accounts (451,353 ) (12,696 ) — (438,657 ) Net patient service revenues 9,902,808 436,777 — 9,466,031 Capitated revenues 3,518,679 1,617,794 — 1,900,885 Other revenues 1,323,618 32,938 — 1,290,680 Total net revenues 14,745,105 2,087,509 — 12,657,596 Operating expenses and charges 12,850,562 2,035,001 110 10,815,451 Operating income 1,894,543 52,508 (110 ) 1,842,145 Debt expense (414,382 ) (10,140 ) — (404,242 ) Other income, net 8,734 576 — 8,158 Income tax expense 455,813 10,643 (44 ) 445,214 Net income 1,033,082 32,301 (66 ) 1,000,847 Less: Net income attributable to noncontrolling interests (153,208 ) — — (153,208 ) Net income attributable to DaVita Inc. $ 879,874 $ 32,301 $ (66 ) $ 847,639 Condensed Consolidating Statements of Comprehensive Income Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the year ended December 31, 2016 Net income (losses) $ 1,033,082 $ 32,301 $ (66 ) $ 1,000,847 Other comprehensive losses (29,627 ) — — (29,627 ) Total comprehensive income (losses) 1,003,455 32,301 (66 ) 971,220 Less: Comprehensive income attributable to noncontrolling interest (153,398 ) — — (153,398 ) Comprehensive income (losses) attributable to DaVita Inc. $ 850,057 $ 32,301 $ (66 ) $ 817,822 (1) After the elimination of the unrestricted subsidiaries and the physician groups Condensed Consolidating Balance Sheets Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) As of December 31, 2016 Cash and cash equivalents $ 913,187 $ 104,691 $ — $ 808,496 Accounts receivable, net 1,917,302 207,430 — 1,709,872 Other current assets 1,149,739 15,124 — 1,134,615 Total current assets 3,980,228 327,245 — 3,652,983 Property and equipment, net 3,175,367 1,378 — 3,173,989 Amortizable intangibles, net 1,527,767 4,858 — 1,522,909 Other long-term assets 650,578 78,215 2,714 569,649 Goodwill 9,407,317 16,405 — 9,390,912 Total assets $ 18,741,257 $ 428,101 $ 2,714 $ 18,310,442 Current liabilities $ 2,696,445 $ 223,302 $ — $ 2,473,143 Payables to parent — 56,699 2,714 (59,413 ) Long-term debt and other long-term liabilities 10,221,813 44,094 — 10,177,719 Noncontrolling interests subject to put provisions 973,258 — — 973,258 Total DaVita Inc. shareholders' equity 4,648,047 104,006 — 4,544,041 Noncontrolling interests not subject to put provisions 201,694 — — 201,694 Shareholders' equity 4,849,741 104,006 — 4,745,735 Total liabilities and shareholder's equity $ 18,741,257 $ 428,101 $ 2,714 $ 18,310,442 C ondensed Consolidating Statements of Cash Flows Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the year ended December 31, 2016 Cash flows from operating activities: Net income $ 1,033,082 $ 32,301 $ (66 ) $ 1,000,847 Changes in operating and intercompany assets and liabilities and non-cash items included in net income 930,362 131,863 66 798,433 Net cash provided by operating activities 1,963,444 164,164 — 1,799,280 Cash flows from investing activities: Additions of property and equipment (829,095 ) (863 ) — (828,232 ) Acquisitions and divestitures, net (563,856 ) — — (563,856 ) Proceeds from asset sales 64,725 — — 64,725 Investments and other items 126,558 (3,014 ) — 129,572 Net cash used in investing activities (1,201,668 ) (3,877 ) — (1,197,791 ) Cash flows from financing activities: Long-term debt and related financing costs, net (124,442 ) (4 ) — (124,438 ) Intercompany — (143,837 ) — 143,837 Other items (1,227,539 ) — — (1,227,539 ) Net cash used in financing activities (1,351,981 ) (143,841 ) — (1,208,140 ) Effect of exchange rate changes on cash 4,276 — — 4,276 Net increase (decrease) in cash (585,929 ) 16,446 — (602,375 ) Cash at beginning of the year 1,499,116 88,245 — 1,410,871 Cash at the end of the year $ 913,187 $ 104,691 $ — $ 808,496 (1) After the elimination of the unrestricted subsidiaries and the physician groups |
SCHEDULE II-VALUATION AND QUALI
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS | 12 Months Ended |
Dec. 31, 2016 | |
Valuation And Qualifying Accounts [Abstract] | |
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS | DAVITA INC. SCHEDULE II—VALUATION AND QUALIFYING ACCOUNTS Balance at Amounts Balance beginning charged Amounts at end of Description of year Acquisitions to income written off year (in thousands) Allowance for uncollectible accounts: Year ended December 31, 2014 $ 237,143 $ — $ 381,337 $ 375,806 $ 242,674 Year ended December 31, 2015 $ 242,674 $ — $ 437,100 $ 415,630 $ 264,144 Year ended December 31, 2016 $ 264,144 $ — $ 463,030 $ 475,118 $ 252,056 |
Organization and summary of s38
Organization and summary of significant accounting policies (Policies) | 12 Months Ended |
Dec. 31, 2016 | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | |
Organization | Organization DaVita Inc. operates two major divisions, DaVita Kidney Care (Kidney Care) and DaVita Medical Group (DMG, formerly known as HealthCare Partners or HCP). Kidney Care is comprised of the Company’s U.S. dialysis and related lab services, its ancillary services and strategic initiatives, including its international operations, and its corporate administrative support. The Company’s largest line of business is its U.S. dialysis and related lab services business, which operates kidney dialysis centers in the U.S. for patients suffering from chronic kidney failure also known as end stage renal disease (ESRD). As of December 31, 2016, the Company operated or provided administrative services through a network of 2,350 U.S. outpatient dialysis centers in 46 states and the District of Columbia, serving approximately 187,700 patients. The Company’s DMG division is a patient- and physician-focused integrated healthcare delivery and management company that provides medical services to members primarily through capitation contracts with some of the nation’s leading health plans. In addition, as of December 31, 2016, the Company operated or provided administrative services to 154 outpatient dialysis centers serving approximately 15,100 patients located in 11 countries outside of the U.S. The Company’s U.S. dialysis and related lab services business and DMG qualify as separately reportable segments and the Company’s other ancillary services and strategic initiatives, including its international operations, have been combined and disclosed in the other segments category. |
Basis of presentation | Basis of presentation These consolidated financial statements are prepared in accordance with United States generally accepted accounting principles (U.S. GAAP). The financial statements include DaVita Inc. and its subsidiaries, partnerships and other entities in which it maintains a majority voting interest or other controlling financial interest (collectively, the Company). All significant intercompany transactions and balances have been eliminated. Non-marketable equity investments are recorded under the equity or cost method of accounting based upon whether the Company has significant influence over the investee. For the Company’s international subsidiaries, local currencies are considered their functional currencies. Translation adjustments result from translating the Company’s international subsidiaries’ financial statements from their functional currencies into the Company’s reporting currency (USD). 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 consolidated financial statements were issued and has included all necessary adjustments and disclosures. |
Use of estimates | Use of estimates The preparation of financial statements in conformity with U.S. GAAP requires the use of estimates and assumptions that affect the reported amounts of revenues, expenses, assets, liabilities, contingencies and noncontrolling interests subject to put provisions. Although actual results in subsequent periods will differ from these estimates, such estimates are developed based on the best information available to management and management’s best judgments at the time. All significant assumptions and estimates underlying the amounts reported in the financial statements and accompanying notes are regularly reviewed and updated when necessary. Changes in estimates are reflected in the financial statements based upon on-going actual experience trends, or subsequent settlements and realizations depending on the nature and predictability of the estimates and contingencies. Interim changes in estimates related to annual operating costs are applied prospectively within annual periods. The most significant assumptions and estimates underlying these financial statements and accompanying notes involve revenue recognition and accounts receivable, contingencies, impairments of long-lived assets and goodwill, valuation adjustments, accounting for income taxes, quarterly, annual and long-term variable compensation accruals, consolidation of variable interest entities, purchase accounting valuation estimates, other fair value estimates, stock-based compensation and medical liability claims. Specific estimating risks and contingencies are further addressed within these notes to the consolidated financial statements. |
Patient service net revenues and accounts receivable | Patient service net revenues and accounts receivable U.S. dialysis and related lab services Patient service net revenues are recognized in the period services are provided. Revenues consist primarily of payments from Medicare, Medicaid and commercial health plans for dialysis and ancillary services provided to patients. A usual and customary fee schedule is maintained for the Company’s dialysis treatments and other patient services; however, actual collectible revenue is normally recognized at a discount from the fee schedule. Revenues associated with Medicare and Medicaid programs are recognized based on: (a) the payment rates that are established by statute or regulation for the portion of payment rates paid by the government payor (e.g., 80% for Medicare patients) and (b) for the portion not paid by the primary government payor, estimates of the amounts ultimately collectible from other government programs paying secondary coverage (e.g., Medicaid secondary coverage), the patient’s commercial health plan secondary coverage, or the patient. The Company’s reimbursements from Medicare are subject to certain variations under Medicare’s single bundled payment rate system, whereby reimbursements can be adjusted for certain patient characteristics and other factors. The Company’s revenue recognition will depend upon its ability to effectively capture, document and bill for Medicare’s base payment rate as well as these other variable factors. Revenues associated with commercial health plans are estimated based on contractual terms for the patients under healthcare plans with which the Company has formal agreements, non-contracted health plan coverage terms if known, estimated secondary collections, historical collection experience, historical trends of refunds and payor payment adjustments (retractions), inefficiencies in the Company’s billing and collection processes that can result in denied claims for payments, and regulatory compliance matters. Commercial revenue recognition also involves significant estimating risks. With many larger, commercial insurers the Company has several different contracts and payment arrangements, and these contracts often include only a subset of the Company’s centers. It is often not possible to determine which contract, if any, should be applied prior to billing. In addition, for services provided by non-contracted centers, final collection may require specific negotiation of a payment amount, typically at a significant discount from the Company’s usual and customary rates. Under Medicare’s bundled payment rate system, services covered by Medicare are subject to estimating risk, whereby reimbursements from Medicare can vary significantly depending upon certain patient characteristics and other variable factors. Even with the bundled payment rate system, Medicare payments for bad debt claims as established by cost reports require evidence of collection efforts. As a result, billing and collection of Medicare bad debt claims can be delayed significantly and final payment is subject to audit. Medicaid payments, when Medicaid coverage is secondary, can also be difficult to estimate. For many states, Medicaid payment terms and methods differ from Medicare, and may prevent accurate estimation of individual payment amounts prior to billing. The Company’s range of revenue estimating risk for the dialysis and related lab services segment is generally expected to be within 1% of its revenue. Changes in revenue estimates for prior periods are not material. Other patient service revenues Patient service revenues earned by DMG are recognized in the period services are provided, net of an estimated contractual allowance and are mainly attributable to primary care physician services and certain other specialty care services provided to patients. Capitated revenue DMG capitated revenue The Company’s associated medical groups are licensed to contract with health maintenance organizations (HMOs), to provide physician services in California under capitation contracts, and to provide both hospital and physician services under global risk capitation contracts in Florida and Nevada. DMG’s revenues consist primarily of fees for medical services provided by these medical group entities’ payments from capitated contracts with various HMOs and revenues under risk-sharing programs. Capitation revenue under HMO contracts is prepaid monthly based on the number of enrollees electing physicians affiliated with one of the medical group entities as their healthcare provider, regardless of the level of actual medical services utilized. Capitation revenue is reported as revenue in the month in which enrollees are entitled to receive healthcare. A portion of the capitation revenue pertaining to Medicare enrollees is subject to possible retroactive premium risk adjustments based on their individual acuity. Due to lack of sufficient data to project the amount of such retroactive adjustments, the Company records any corresponding retroactive revenues in the year of receipt. Depending on the applicable state regulation regarding global risk capitation, revenues may be received by the Company or by an independent hospital with which the Company contracts under various managed care-related administrative services agreements. In the Florida and Nevada Under risk-sharing programs, the medical groups share in the risk for hospitalization services and earn additional incentive revenues or incur penalties based on the utilization of hospital services. Estimated shared-risk receivables from the HMOs are recorded based upon hospital utilization and associated costs incurred by assigned HMO enrollees, including an estimate of IBNR compared to budgeted funding. Differences between actual contract settlements and estimated receivables or payables are recorded in the year of final settlement. The medical groups also receive other incentive payments from health plans based on specified performance and quality criteria. These amounts are accrued when earned and the amounts can be reasonably estimated, and are included in DMG’s capitated revenues. Other capitated revenues One of the Company’s subsidiaries operates Medicare Advantage ESRD Special Needs Plans in partnerships with payors that work with CMS to provide full service healthcare to ESRD patients. The Company is at risk for all medical costs of the program in excess of the capitation payments. Other revenues Other revenues consist of the non-patient service revenues associated with the ancillary services and strategic initiatives, management and administrative support services that are provided to outpatient dialysis centers that the Company does not own or in which the Company owns a noncontrolling interest, retail pharmacies and medical consulting services. The Company also provides administrative and management support services to certain other non-dialysis joint ventures in which the Company owns a noncontrolling interest. Management fees are principally determined as a percentage of the managed operations’ revenues or cash collections and in some cases an additional component based upon a percentage of operating income. Management fees are included in net revenues when earned and represent less than 1% of total consolidated operating revenues. Revenues related to medical consulting services are recognized in the period services are provided. |
Allowance for uncollectible accounts | Allowance for uncollectible accounts Net revenue recognition and allowances for uncollectible billings require the use of estimates of the amounts that will ultimately be realized considering, among other items, retroactive adjustments that may be associated with regulatory reviews, audits, billing reviews and other matters. The Company’s policy is to write off any uncollectible accounts receivable balance only after all collection efforts have been exhausted or when write off is mandated by federal or state policies or required by certain payor contracts. It is also the Company’s policy to write off any accounts receivable balance associated with any payors or patients when the Company receives notification of a bankruptcy filing. |
Other income | Other income Other income includes interest income on cash investments, gains (losses) on foreign currency translation adjustments and other non-operating gains from investment transactions, as well as realized foreign currency transaction gains and losses. |
Cash and cash equivalents | Cash and cash equivalents Cash equivalents are short-term highly liquid investments with maturities of three months or less at date of purchase. |
Inventories | Inventories Inventories are stated at the lower of cost (first-in, first-out) or market and consist principally of pharmaceuticals and dialysis-related supplies. Rebates related to inventory purchases are recorded when earned and are based on certain qualification requirements which are dependent on a variety of factors including future pricing levels by the manufacturer and data submission. |
Funds on deposit with a third party | Funds on deposit with a third party The Company’s DMG business has established a risk sharing arrangement with a California hospital, wherein the Company shares in any surplus or deficit. One of the terms of this agreement is the establishment of a segregated investment fund to ensure adequate cash to pay IBNR. The Company and the hospital monitor the reserve balance to maintain the adequacy of funds on deposit. The Company has $75,877 in such funds as of December 31, 2016, included in other current assets on the consolidated balance sheet. |
Property and equipment | Property and equipment Property and equipment is stated at cost less accumulated depreciation and amortization and is further reduced by any impairments. Maintenance and repairs are charged to expense as incurred. Depreciation and amortization expenses are computed using the straight-line method over the useful lives of the assets estimated as follows: buildings, 20 to 40 years; leasehold improvements, the shorter of their economic useful life or the expected lease term; and equipment and information systems, principally three to eight years. Disposition gains and losses are included in current operating expenses. |
Amortizable intangibles | Amortizable intangibles Amortizable intangible assets and liabilities include customer relationships, trade names, provider networks, supply agreements, practice management tools, non-competition and similar agreements, lease agreements and hospital acute services contracts, each of which have finite useful lives. Amortization expense is computed using the straight-line method over the useful lives of the assets estimated as follows: customer relationships, principally ten to twenty years; provider networks and practice management tools, two to fifteen years; trade names, principally four years; non-competition and similar agreements, two to ten years; and lease agreements and hospital acute service contracts, over the term of the lease or contract period, respectively. |
Equity investments | Equity investments Equity investments that do not have readily determinable fair values are carried on the cost or equity method, as applicable. The Company classifies its cost and equity method investments as “Equity investments” on its balance sheet. See Note 8 to these consolidated financial statements for further details. |
Investments in debt and equity securities | 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 strategies concerning those investments. Equity securities that have readily determinable fair values, and certain other financial instruments that have readily determinable fair values or redemption values, are classified as available for sale and recorded at estimated fair value. |
Goodwill | Goodwill Goodwill represents the difference between the fair value of businesses acquired and the fair value of the identifiable tangible and intangible net assets acquired. Goodwill is not amortized, but is assessed at the reporting unit for impairment as circumstances warrant and at least annually. An impairment charge is recorded to the extent the carrying amount of goodwill exceeds its implied fair value. The Company operates several reporting units for goodwill impairment assessments. See Note 10 to these consolidated financial statements for further details. |
Impairment of long-lived assets | Impairment of long-lived assets Long-lived assets, including property and equipment, equity investments in non-consolidated businesses, and amortizable intangible assets are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred, including changes in the Company’s business strategy and plans, changes in the quality or structure of its relationships with its partners or deteriorating operating performance of individual outpatient dialysis centers or other operations. An impairment is indicated when the sum of the expected future undiscounted net cash flows identifiable to an asset group is less than its carrying amount. Impairment losses are measured based upon the difference between the actual or estimated fair values, which are based on market values, net realizable values or projections of discounted net cash flows, as appropriate, and the carrying amount of the asset group. Impairment charges are included in operating expenses. Indefinite-lived intangible assets are reviewed for possible impairment at least annually or whenever significant events or changes in circumstances indicate that an impairment may have occurred. |
Self insurance | Self insurance The Company’s Kidney Care division records insurance liabilities for professional and general liability and workers’ compensation in excess of certain individual and or aggregate amounts not covered by third-party carriers. The Company’s Kidney Care division estimates the self-insured retention portion of professional and general liability and workers’ compensation risks using third-party actuarial calculations that are based upon historical claims experience and expectations for future claims. In addition, DMG has purchased external primary professional and general liability insurance from California Medical Group Insurance (CMGI) in which the Company owns an equity interest of 67%. |
Medical liability costs | Medical liability costs The medical groups are responsible for integrated care that the associated physicians and contracted hospitals provide to assigned HMO enrollees. The Company provides integrated care to health plan enrollees through a network of contracted providers under sub-capitation and direct patient service arrangements, company-operated clinics and staff physicians. Medical costs for professional and institutional services rendered by contracted providers are recorded as patient care costs in the consolidated statements of income. Costs for operating medical clinics, including the salaries of medical and non-medical personnel and support costs, are also recorded in patient care costs. An estimate of amounts due to contracted physicians, hospitals, and other professional providers for members under global and professional risk arrangements is included in medical payables in the accompanying consolidated balance sheets. Medical payables include claims reported as of the balance sheet date and estimates of IBNR. Such estimates are developed using actuarial methods and are based on many variables, including the utilization of healthcare services, historical payment patterns, cost trends, product mix, seasonality, changes in membership, and other factors. The estimation methods and the resulting reserves are continually reviewed and updated. Many of the medical contracts are complex in nature and may be subject to differing interpretations regarding amounts due for the provision of various services. Such differing interpretations may not come to light until a substantial period of time has passed following the contract implementation. Any adjustments to reserves are reflected in current operations. |
Income taxes | Income taxes Federal and state income taxes are computed at currently enacted tax rates less tax credits using the asset and liability method. Deferred taxes are adjusted both for items that do not currently have tax consequences and for the cumulative effect of any changes in tax rates from those previously used to determine deferred tax assets or liabilities. Tax provisions include amounts that are currently payable, changes in deferred tax assets and liabilities that arise because of temporary differences between the timing of when items of income and expense are recognized for financial reporting and income tax purposes, changes in the recognition of tax positions and any changes in the valuation allowance caused by a change in judgment about the realizability of the related deferred tax assets. A valuation allowance is established when necessary to reduce deferred tax assets to amounts expected to be realized. The Company uses a recognition threshold of more-likely-than-not and a measurement attribute on all tax positions taken or expected to be taken in a tax return in order to be recognized in the financial statements. Once the recognition threshold is met, the tax position is then measured to determine the actual amount of benefit to recognize in the financial statements. |
Stock-based compensation | Stock-based 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. Stock-based compensation to be settled in shares is recorded to the Company’s shareholders’ equity, while stock-based compensation to be settled in cash is recorded to a liability. |
Interest rate swap and cap agreements | Interest rate swap and cap agreements The Company often carries a combination of interest rate caps, forward interest rate caps, or interest rate swaps on portions of its variable rate debt as a means of hedging its exposure to changes in LIBOR interest rates as part of its overall interest rate risk management strategy. These interest rate caps and swaps are not held for trading or speculative purposes and are typically designated as qualifying cash flow hedges. See Note 14 to these consolidated financial statements for further details. |
Fair value estimates | Fair value estimates The Company currently measures the fair value of certain assets, liabilities (including contingent earn-out consideration) and noncontrolling interests subject to put provisions (temporary equity) based upon valuation techniques that include observable or unobservable market inputs and assumptions that market participants would use in pricing these assets, liabilities and temporary equity. The Company has also classified its assets, liabilities and temporary equity into the appropriate fair value hierarchy levels as defined by the Financial Accounting Standards Board (FASB). See Note 24 to the consolidated financial statements for further details. |
New accounting standards | New accounting standards In May 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers Revenue from Contracts with Customers (Topic Deferral of Effective Date Revenue from Contracts with Customers (Topic 606) 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 February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) 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 March 2016, the FASB issued ASU No. 2016-09, Compensation – Stock Compensation (Topic 718): Improvements to Employee Share-Based Payment Accounting 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 October 2016, the FASB issued ASU No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory In January 2017, the FASB issued ASU No. 2017-04, Intangibles—Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment |
Earnings per share | Basic net income per share is calculated by dividing net income attributable to the Company, adjusted for any change in noncontrolling interest 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 (SSARs), stock options and unvested stock units (under the treasury stock method) as well as shares held in escrow that the Company expects will remain outstanding. |
Accounts receivable | Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the ultimate collectability of its accounts receivable, the Company analyzes its historical cash collection experience and trends for each payor 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 it to determine its current provision for uncollectible accounts and the adequacy of its allowance for doubtful accounts. For receivables associated with dialysis and related lab services covered by government payors, like Medicare, the Company receives 80% of the payment directly from Medicare as established under the government’s bundled payment system and determines an appropriate allowance for doubtful accounts and provision for 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. |
Other comprehensive (loss) 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 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. 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 related liabilities recorded in accrued compensation and benefits and other long-term liabilities |
Noncontrolling Interest | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | |
Noncontrolling interests | Noncontrolling interests Noncontrolling interests represent third-party equity ownership interests in entities which are consolidated by the Company for financial statement reporting purposes. As of December 31, 2016, third parties held noncontrolling equity interests in 490 consolidated legal entities. |
Put Obligation Fair Value Estimate of Noncontrolling Interest | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | |
Noncontrolling interests | The Company has potential obligations to purchase the equity interests held by third parties in several of its majority-owned joint ventures and other nonconsolidated 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’ equity interests at either the appraised fair market value or a predetermined multiple of earnings or cash flow attributable to the equity 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 interests obligations may be settled will 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’ equity 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) | 12 Months Ended |
Dec. 31, 2016 | |
Earnings Per Share [Abstract] | |
Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Net Income Per Share | The reconciliations of the numerators and denominators used to calculate basic and diluted net income per share are as follows: Year ended December 31, 2016 2015 2014 (shares in thousands) Basic: Net income attributable to DaVita Inc. for basic earnings per share calculation $ 879,874 $ 269,732 $ 723,114 Weighted average shares outstanding during the period 203,835 214,062 214,496 Contingently returnable shares held in escrow for the DaVita HealthCare Partners merger (2,194 ) (2,194 ) (2,194 ) Weighted average shares for basic earnings per share calculation 201,641 211,868 212,302 Basic net income per share attributable to DaVita Inc. $ 4.36 $ 1.27 $ 3.41 Diluted: Net income attributable to DaVita Inc. for diluted earnings per share calculation $ 879,874 $ 269,732 $ 723,114 Weighted average shares outstanding during the period 203,835 214,062 214,496 Assumed incremental shares from stock plans 1,070 2,190 2,432 Weighted average shares for diluted earnings per share calculation 204,905 216,252 216,928 Diluted net income per share attributable to DaVita Inc. $ 4.29 $ 1.25 $ 3.33 Anti-dilutive stock-settled awards excluded from calculation (1) 2,523 1,365 1,715 (1) Shares associated with stock-settled stock appreciation rights excluded from the diluted denominator calculation because they are anti-dilutive under the treasury stock method. |
Other receivables (Tables)
Other receivables (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Receivables [Abstract] | |
Other Receivables | Other receivables were comprised of the following: December 31, 2016 2015 Supplier rebates and non-trade receivables $ 347,123 $ 316,644 Medicare bad debt claims 104,658 105,714 Operating advances under management and administrative services agreements 1,702 13,527 $ 453,483 $ 435,885 |
Other current assets (Tables)
Other current assets (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Deferred Costs Capitalized Prepaid And Other Assets Disclosure [Abstract] | |
Other Current Assets | Other current assets were comprised of the following: December 31, 2016 2015 Prepaid expenses $ 131,833 $ 105,216 Funds on deposit with third parties 75,877 82,679 Other 2,894 2,427 $ 210,604 $ 190,322 |
Property and equipment (Tables)
Property and equipment (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Property Plant And Equipment [Abstract] | |
Property and Equipment | Property and equipment were comprised of the following: December 31, 2016 2015 Land $ 59,013 $ 42,080 Buildings 491,301 437,283 Leasehold improvements 2,598,471 2,289,425 Equipment and information systems, including internally developed software 2,378,303 2,080,446 New center and capital asset projects in progress 480,439 336,513 6,007,527 5,185,747 Less accumulated depreciation (2,832,160 ) (2,397,007 ) $ 3,175,367 $ 2,788,740 |
Intangibles (Tables)
Intangibles (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Intangible Assets Gross Excluding Goodwill [Abstract] | |
Amortizable intangible assets other than goodwill | Intangible assets other than goodwill were comprised of the following: December 31, 2016 2015 Customer relationships $ 1,568,161 $ 1,575,865 Trade names 190,761 170,883 Provider network and practice management tools 187,318 183,724 Noncompetition and other agreements 512,505 510,521 Lease agreements 7,624 7,306 Indefinite-lived assets 1,546 9,310 Other 583 408 2,468,498 2,458,017 Less accumulated amortization (940,731 ) (770,691 ) $ 1,527,767 $ 1,687,326 |
Amortizable Intangible Liabilities | Amortizable intangible liabilities were comprised of the following: December 31, 2016 2015 Lease agreements (net of accumulated amortization of $8,485 and $6,936) 7,420 8,969 $ 7,420 $ 8,969 |
Scheduled Amortization Charges from Intangible Assets and Liabilities | Scheduled amortization charges from amortizable intangible assets and liabilities as of December 31, 2016 were as follows: Customer relationships Trade names Provider network and practice management tools Noncompetition and other agreements Lease agreements Other 2017 82,669 47,046 26,941 30,156 (1,228 ) 102 2018 82,664 47,046 26,881 19,519 (892 ) 102 2019 82,625 11,008 22,492 15,796 (832 ) 87 2020 82,609 3,800 581 10,437 (678 ) 44 2021 82,609 633 97 7,005 (606 ) — Thereafter 821,282 — — 21,990 (3,184 ) — |
Investments in debt and equit44
Investments in debt and equity securities (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Investments Debt And Equity Securities [Abstract] | |
Investments | The Company’s investments in securities and certain other financial instruments consist of the following: December 31, 2016 December 31, 2015 Held to maturity Available for sale Total Held to maturity Available for sale Total Certificates of deposit, commercial paper and money market funds due within one year $ 256,827 $ — $ 256,827 $ 406,884 $ — $ 406,884 Investments in mutual funds and common stock 50,000 47,404 97,404 — 33,482 33,482 Cash surrender value of life insurance policies — 59,646 59,646 — 56,840 56,840 $ 306,827 $ 107,050 $ 413,877 $ 406,884 $ 90,322 $ 497,206 Short-term investments $ 306,827 $ 3,371 $ 310,198 $ 406,884 $ 1,200 $ 408,084 Long-term investments — 103,679 103,679 — 89,122 89,122 $ 306,827 $ 107,050 $ 413,877 $ 406,884 $ 90,322 $ 497,206 |
Goodwill (Tables)
Goodwill (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Goodwill And Intangible Assets Disclosure [Abstract] | |
Changes in Carrying Value of Goodwill by Reportable Segments | Changes in the carrying value of goodwill by reportable segments were as follows: U.S. dialysis and related lab services DMG Other ancillary services and 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 75,295 248,901 123,632 $ 447,828 Divestitures (12,891 ) (2,223 ) (29,645 ) $ (44,759 ) Goodwill impairment charges — (253,000 ) (28,415 ) $ (281,415 ) Foreign currency and other adjustments — — (8,816 ) $ (8,816 ) Balance at December 31, 2016 $ 5,691,587 $ 3,391,942 $ 323,788 $ 9,407,317 Balance at December 31, 2016: Goodwill $ 5,691,587 $ 3,833,711 $ 358,112 $ 9,883,410 Accumulated impairment charges — (441,769 ) (34,324 ) $ (476,093 ) $ 5,691,587 $ 3,391,942 $ 323,788 $ 9,407,317 |
Schedule of Goodwill and Indefinite-Lived Intangible Asset Impairment Charges | As a result of the assessments described above, the Company has recognized the goodwill impairment charges below: Year ended December 31, Reporting unit 2016 2015 2014 DMG Nevada $ 161,800 $ 181,253 $ — DMG Florida 91,200 5,800 — DMG Arizona — 1,716 — Vascular access 28,415 — — International operations — 4,065 1,000 Total $ 281,415 $ 192,834 $ 1,000 |
Schedule of Reporting Units Goodwill Balances | 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 goodwill impairment charges in the future for the following reporting units, which remain at risk of goodwill impairment: Goodwill balance Carrying Sensitivities Reporting unit as of December 31, 2016 amount coverage (1) Operating income (2) Discount rate (3) DMG Nevada $ 261,204 11.4% -2.2% -3.9% DMG Florida $ 442,835 7.1% -1.7% -3.2% DMG New Mexico $ 70,926 2.6% -1.5% -2.2% DMG Washington $ 244,502 3.7% -1.8% -3.4% Vascular access $ 34,696 4.3% -2.7% -5.3% (1) Excess of estimated fair value of the reporting unit over carrying amount as of the latest assessment date. (2) Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date. (3) Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date. |
Other liabilities (Tables)
Other liabilities (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Other Liabilities Disclosure [Abstract] | |
Other Liabilities | Other liabilities were comprised of the following: December 31, 2016 2015 Payor refunds and retractions $ 277,482 $ 153,104 Contingent earn-out consideration 7,217 29,050 Insurance and self-insurance accruals 80,437 80,355 Accrued interest 82,234 81,585 Other medical payables 36,645 53,687 Accrued non-income tax liabilities 27,759 29,291 Other 345,073 255,051 $ 856,847 $ 682,123 |
Medical payables (Tables)
Medical payables (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Health Care Organizations [Abstract] | |
Components of Changes in Healthcare Costs Payable | The following table shows the components of changes in the healthcare costs payable for the year ended December 31, 2016 and 2015: December 31, 2016 2015 Healthcare costs payable, beginning of the year $ 212,641 $ 214,405 Add: Components of incurred healthcare costs Current year 1,673,742 1,587,036 Prior years (141 ) 1,523 Total incurred healthcare costs 1,673,601 1,588,559 Less: Claims paid Current year 1,473,723 1,397,378 Prior years 198,244 192,945 Total claims paid 1,671,967 1,590,323 Healthcare costs payable, end of the year $ 214,275 $ 212,641 |
Income taxes (Tables)
Income taxes (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |
Schedule of Income Before Income Taxes | Income before income taxes consisted of the following: Year ended December 31, 2016 2015 2014 Domestic $ 1,144,544 $ 764,998 $ 1,341,208 International 344,351 (41,862 ) (31,535 ) $ 1,488,895 $ 723,136 $ 1,309,673 |
Components of Income Tax Expense (benefit) | Income tax expense (benefit) consisted of the following: Year ended December 31, 2016 2015 2014 Current: Federal $ 337,178 $ 183,263 $ 188,302 State 48,771 30,766 30,789 International 1,928 856 1,687 Total current income tax $ 387,877 $ 214,885 $ 220,778 Deferred: Federal 93,214 88,718 192,267 State (27,764 ) (8,307 ) 32,360 International 2,486 430 938 Total deferred income tax $ 67,936 $ 80,841 $ 225,565 $ 455,813 $ 295,726 $ 446,343 |
Reconciliation between U.S. Federal Income Tax Rate and Effective Tax Rate | The reconciliation between the U.S. federal income tax rate and the Company’s effective tax rate is as follows: Year ended December 31, 2016 2015 2014 Federal income tax rate 35.0 % 35.0 % 35.0 % State income taxes, net of federal benefit 1.2 2.5 3.5 International rate differential 0.2 (1.1 ) (0.2 ) Gain on APAC JV ownership changes (9.8 ) — — Goodwill impairments 6.7 11.7 — Changes in deferred tax valuation allowances 0.6 2.6 0.6 Other 0.2 1.5 (0.8 ) Impact of noncontrolling interests primarily attributable to non-tax paying entities (3.5 ) (11.3 ) (4.0 ) Effective tax rate 30.6 % 40.9 % 34.1 % |
Deferred Tax Assets and Liabilities Arising from Temporary Differences | Deferred tax assets and liabilities arising from temporary differences were as follows: December 31, 2016 2015 Receivables $ 19,283 $ 43,393 Accrued liabilities 318,596 272,080 Net operating loss carryforwards 130,456 130,977 Other 147,487 114,805 Deferred tax assets 615,822 561,255 Valuation allowance (56,016 ) (57,811 ) Net deferred tax assets 559,806 503,444 Intangible assets (1,025,488 ) (927,761 ) Property and equipment (230,870 ) (205,071 ) Investments in partnerships (95,936 ) (83,584 ) Other (16,640 ) (13,990 ) Deferred tax liabilities (1,368,934 ) (1,230,406 ) Net deferred tax liabilities $ (809,128 ) $ (726,962 ) |
Reconciliation of the Beginning and Ending Liability for Unrecognized Tax Benefits that Do Not Meet the More-Likely-than-not Threshold | A reconciliation of the beginning and ending liability for unrecognized tax benefits that do not meet the more-likely-than-not threshold were as follows: Year ended December 31, 2016 2015 Beginning balance $ 39,011 $ 31,877 Additions for tax positions related to current year 9,714 6,131 Additions for tax positions related to prior years — 2,999 Reductions related to lapse of applicable statute (1,277 ) (1,996 ) Reductions related to settlements with taxing authorities (23,382 ) — Ending balance $ 24,066 $ 39,011 |
Long-term debt (Tables)
Long-term debt (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Debt Disclosure [Abstract] | |
Long-term Debt | Long-term debt was comprised of the following: December 31, 2016 2015 Senior Secured Credit Facilities: Term Loan A $ 862,500 $ 925,000 Term Loan B 3,412,500 3,447,500 Senior notes 4,500,000 4,500,000 Acquisition obligations and other notes payable 117,547 70,645 Capital lease obligations 299,682 283,185 Total debt principal outstanding 9,192,229 9,226,330 Discount and deferred financing costs (79,861 ) (95,985 ) 9,112,368 9,130,345 Less current portion (165,041 ) (129,037 ) $ 8,947,327 $ 9,001,308 |
Scheduled Maturities of Long-term Debt | Scheduled maturities of long-term debt at December 31, 2016 were as follows: 2017 165,041 2018 167,684 2019 747,871 2020 69,508 2021 3,300,437 Thereafter 4,741,688 |
Derivative Instruments | The following table summarizes the Company’s derivative instruments as of December 31, 2016 and 2015: Interest rate swap and cap agreements (liabilities and assets) December 31, 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 assets $ 516 Interest rate cap agreements Other long- term assets $ 9,929 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 years ended December 31, 2016, 2015 and 2014: Amount of losses recognized in OCI on interest rate swap and cap agreements Location of (losses) gains reclassified from Amount of gains reclassified from accumulated OCI into income Years ended December 31, accumulated Years ended December 31, Derivatives designated as cash flow hedges 2016 2015 2014 OCI into income 2016 2015 2014 Interest rate swap agreements $ (815 ) $ (3,971 ) $ (8,390 ) Debt expense $ 299 $ 2,664 $ 12,279 Interest rate cap agreements (5,198 ) (16,114 ) (8,119 ) Debt expense 3,899 2,439 5,130 Tax benefit (expense) 2,343 7,844 6,450 (1,632 ) (1,992 ) (6,801 ) Total $ (3,670 ) $ (12,241 ) $ (10,059 ) $ 2,566 $ 3,111 $ 10,608 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Leases [Abstract] | |
Future Minimum Lease Payments Under Non-cancelable Operating and Capital Leases | Future minimum lease payments under non-cancelable operating and capital leases are as follows: Operating leases Capital leases 2017 $ 473,302 $ 37,758 2018 442,959 34,442 2019 401,242 35,292 2020 354,559 35,575 2021 310,704 31,133 Thereafter 1,244,309 232,191 $ 3,227,075 406,391 Less portion representing interest (106,709 ) Total capital lease obligations, including current portion $ 299,682 |
Long-term incentive compensat51
Long-term incentive compensation and shareholders' equity (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Share Based Compensation [Abstract] | |
Summary of Status of Awards Under Stock-Based Compensation Plans and Agreements | A combined summary of the status of the Company’s stock-settled awards under the 2011 Plan, including base shares for stock-settled stock appreciation rights and stock-settled stock unit awards is as follows: Year ended December 31, 2016 Stock appreciation rights Stock units Weighted Weighted Weighted average average average exercise remaining remaining Awards price contractual Awards contractual life Outstanding at beginning of year 8,533,561 $ 59.05 765,060 Granted 1,280,034 73.40 328,457 Exercised (2,031,593 ) 45.35 (280,197 ) Cancelled (444,736 ) 66.50 (27,767 ) Outstanding at end of period 7,337,266 $ 64.90 2.2 785,553 1.9 Exercisable at end of period 3,026,721 $ 56.83 1.1 — — Weighted-average fair value of grants in 2016 $ 13.74 $ 70.99 Weighted-average fair value of grants in 2015 $ 17.97 $ 80.25 Weighted-average fair value of grants in 2014 $ 16.41 $ 72.24 |
Summary of Range of Exercise Prices | Awards Weighted average Awards Weighted average Range of SSAR base prices outstanding exercise price exercisable exercise price $30.01–$40.00 16,000 39.89 16,000 39.89 $40.01–$50.00 267,621 44.44 267,621 44.44 $50.01–$60.00 3,489,398 57.53 2,420,035 56.84 $60.01–$70.00 1,306,049 67.46 232,816 65.04 $70.01–$80.00 1,581,487 74.76 50,806 70.44 $80.01–$90.00 676,711 83.60 39,443 81.51 Total 7,337,266 $ 64.90 3,026,721 $ 56.83 |
Summary of Weighted Average Valuation Inputs | A summary of the weighted average valuation inputs described above used for estimating the grant-date fair value of stock-settled stock appreciation rights awards granted in the periods indicated is as follows: Year ended December 31, 2016 2015 2014 Expected term 4.2 years 4.1 years 4.2 years Expected volatility 21.0 % 24.6 % 25.8 % Expected dividend yield 0.0 % 0.0 % 0.0 % Risk-free interest rate 1.0 % 1.5 % 1.5 % |
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: Year ended December 31, 2016 2015 2014 Net income attributable to DaVita Inc. $ 879,874 $ 269,732 $ 723,114 Increase in paid-in capital for sales of noncontrolling interest — — 355 Decrease in paid-in capital for the purchase of noncontrolling interests (13,105 ) (55,826 ) (5,357 ) Net transfer to noncontrolling interests (13,105 ) (55,826 ) (5,002 ) Change from net income attributable to DaVita Inc. and transfers to noncontrolling interests $ 866,769 $ 213,906 $ 718,112 |
Other comprehensive (loss) in52
Other comprehensive (loss) income (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Statement Of Income And Comprehensive Income [Abstract] | |
Changes in Accumulated Other Comprehensive (Loss) Income | Charges and credits to other comprehensive (loss) income have been as follows: Interest rate swap and cap agreements Investment securities Foreign currency translation adjustments Accumulated other comprehensive income (loss) Balance at December 31, 2013 $ (2,344 ) $ 3,120 $ (3,421 ) $ (2,645 ) Unrealized (losses) gains (16,509 ) 425 (22,952 ) (39,036 ) Related income tax 6,450 (187 ) — 6,263 (10,059 ) 238 (22,952 ) (32,773 ) Reclassification from accumulated other comprehensive losses (income) into net income 17,409 (340 ) — 17,069 Related income tax (6,801 ) 133 — (6,668 ) 10,608 (207 ) — 10,401 Balance at December 31, 2014 $ (1,795 ) $ 3,151 $ (26,373 ) $ (25,017 ) Unrealized losses (20,085 ) (1,974 ) (23,889 ) (45,948 ) Related income tax 7,844 561 — 8,405 (12,241 ) (1,413 ) (23,889 ) (37,543 ) Reclassification from accumulated other comprehensive losses (income) into net income 5,103 (618 ) — 4,485 Related income tax (1,992 ) 241 — (1,751 ) 3,111 (377 ) — 2,734 Balance at December 31, 2015 $ (10,925 ) $ 1,361 $ (50,262 ) $ (59,826 ) Unrealized (losses) gains (6,013 ) 1,802 (39,614 ) (43,825 ) Related income tax 2,343 (565 ) — 1,778 (3,670 ) 1,237 (39,614 ) (42,047 ) Reclassification from accumulated other comprehensive losses (income) into net income 4,198 (690 ) 10,087 13,595 Related income tax (1,632 ) 267 — (1,365 ) 2,566 (423 ) 10,087 12,230 Balance at December 31, 2016 $ (12,029 ) $ 2,175 $ (79,789 ) $ (89,643 ) |
Acquisitions and Divestitures (
Acquisitions and Divestitures (Tables) | 12 Months Ended |
Dec. 31, 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 Covenant not-to-compete 3,200 Amortizable intangible and other long-term assets 30,850 Goodwill 244,502 Liabilities assumed (50,940 ) Long-term deferred income taxes (16,880 ) Noncontrolling interests (9,885 ) $ 400,971 |
Pro Forma Summary of Results of Operations | The following summary, prepared on a pro forma basis, combines the results of operations as if all acquisitions in 2016 and 2015 had been consummated as of the beginning of 2015, including the impact of certain adjustments such as amortization of intangibles, interest expense on acquisition financing and income tax effects. Year ended December 31, 2016 2015 (unaudited) Pro forma net revenues $ 14,875,592 $ 14,342,138 Pro forma net income attributable to DaVita Inc. 884,284 280,124 Pro forma basic net income per share attributable to DaVita Inc. 4.39 1.32 Pro forma diluted net income per share attributable to DaVita Inc. 4.32 1.30 |
Reconciliation of Changes in Contingent Earn-Out Obligations | The following is a reconciliation of changes in the contingent earn-out obligations for the year ended December 31, 2016: Beginning balance January 1, 2016 $ 34,135 Contingent earn-out obligations associated with acquisitions 1,511 Remeasurement of fair value (4,132 ) Payments of contingent earn-out obligations (21,537 ) $ 9,977 |
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 the above described transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of the noncontrolling interests assumed in these transactions: Year ended December 31, 2016 2015 2014 Current assets $ 3,996 $ 3,843 $ 915 Property and equipment 9,407 12,436 5,999 Customer relationships — — 74,515 Non-compete agreements 5,395 8,959 16,585 Amortizable intangible and other long-term assets 986 4,345 4,193 Goodwill 203,326 97,093 221,514 Long-term deferred income taxes 597 (1,467 ) — Noncontrolling interests assumed (30,337 ) (18,905 ) (25,963 ) Liabilities assumed (3,317 ) (1,440 ) (1,883 ) Aggregate purchase cost $ 190,053 $ 104,864 $ 295,875 |
Fair values of financial inst54
Fair values of financial instruments (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Fair Value Disclosures [Abstract] | |
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis | The following tables summarize the Company’s assets, liabilities and temporary equity measured at fair value on a recurring basis as of December 31, 2016 and 2015: Total Quoted active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) December 31, 2016 Assets Available for sale securities $ 47,404 $ 47,404 $ — $ — Cash surrender value of life insurance policies $ 59,646 $ — $ 59,646 $ — Interest rate cap agreements $ 9,929 $ — $ 9,929 $ — Funds on deposit with third parties $ 75,877 $ 75,877 $ — $ — Liabilities Contingent earn-out obligations $ 9,977 $ — $ — $ 9,977 Temporary equity Noncontrolling interests subject to put provisions $ 973,258 $ — $ — $ 973,258 December 31, 2015 Assets Available for sale securities $ 33,482 $ 33,482 $ — $ — Cash surrender value of life insurance policies $ 56,840 $ — $ 56,840 $ — Interest rate cap agreements $ 15,127 $ — $ 15,127 $ — Interest rate swap agreements $ 516 $ — $ 516 $ — Funds on deposit with third parties $ 82,679 $ 82,679 $ — $ — Liabilities Contingent earn-out obligations $ 34,135 $ — $ — $ 34,135 Temporary equity Noncontrolling interests subject to put provisions $ 864,066 $ — $ — $ 864,066 |
Segment reporting (Tables)
Segment reporting (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Segment Reporting [Abstract] | |
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes | The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: Year ended December 31, 2016 2015 2014 Segment revenues: U.S. dialysis and related lab services Patient service revenues: External sources $ 9,482,648 $ 8,980,515 $ 8,513,089 Intersegment revenues 68,774 53,476 37,112 Total dialysis and related lab services revenues 9,551,422 9,033,991 8,550,201 Less: Provision for uncollectible accounts (429,882 ) (406,530 ) (353,028 ) Net dialysis and related lab services patient service revenues 9,121,540 8,627,461 8,197,173 Other revenues (1) 16,649 13,971 13,498 Total net dialysis and related lab services revenues 9,138,189 8,641,432 8,210,671 DMG DMG revenues: Capitated revenues $ 3,430,576 $ 3,436,705 $ 3,190,903 Net patient service revenues 621,583 317,950 219,306 Other revenues (2) 61,040 82,470 91,374 Intersegment capitated and other revenues 215 136 716 Total revenues $ 4,113,414 $ 3,837,261 $ 3,502,299 Other - Ancillary services and strategic initiatives Net patient service revenues $ 228,459 $ 160,484 $ 122,087 Capitated revenues 88,103 72,390 70,385 Other external sources 1,245,929 1,123,882 927,492 Intersegment revenues 58,881 25,674 19,535 Total ancillary services and strategic initiatives revenues 1,621,372 1,382,430 1,139,499 Total net segment revenues 14,872,975 13,861,123 12,852,469 Elimination of intersegment revenues (127,870 ) (79,286 ) (57,363 ) Consolidated net revenues $ 14,745,105 $ 13,781,837 $ 12,795,106 Segment operating margin (loss): U.S. dialysis and related lab services $ 1,777,014 $ 1,259,632 $ 1,637,626 DMG (104,233 ) 33,929 214,983 Other—Ancillary services and strategic initiatives 266,323 (103,901 ) (24,456 ) Total segment margin 1,939,104 1,189,660 1,828,153 Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: Corporate administrative support (3) (44,561 ) (18,965 ) (13,012 ) Consolidated operating income 1,894,543 1,170,695 1,815,141 Debt expense (414,382 ) (408,380 ) (410,294 ) Debt refinancing and redemption charges — (48,072 ) (97,548 ) Other income 8,734 8,893 2,374 Consolidated income from continuing operations before income taxes $ 1,488,895 $ 723,136 $ 1,309,673 (1) Includes management fees for providing management and administrative services to dialysis centers in which the Company owns a noncontrolling interest or which are wholly-owned by third parties. (2) 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. (3) Corporate administrative support costs in 2016 also include $30,934 of an adjustment to reduce a tax asset associated with the DMG acquisition escrow provisions. |
Summary of Depreciation and Amortization Expense by Segment | Depreciation and amortization expense by segment is as follows: December 31, 2016 2015 2014 U.S. dialysis and related lab services $ 482,768 $ 438,238 $ 402,767 DMG 210,755 174,118 169,485 Other - Ancillary services and strategic initiatives 26,729 25,668 18,683 $ 720,252 $ 638,024 $ 590,935 |
Summary of Assets by Segment | Summary of assets by segment is as follows: December 31, 2016 2015 Segment assets U.S. dialysis and related lab services (including equity investments of $66,924 and $29,801, respectively) $ 11,438,100 $ 11,591,507 DMG (including equity investments of $10,350 and $22,714, respectively) 6,213,091 6,150,666 Other - Ancillary services and strategic initiatives (1) 1,090,066 772,702 Consolidated assets $ 18,741,257 $ 18,514,875 (1) Includes approximately $96,396 and $ 69,519 in 2016 and 2015, respectively, of net property and equipment related to the Company’s international operations. |
Summary of Expenditures for Property and Equipment by Segment | Expenditures for property and equipment by segment is as follows: December 31, 2016 2015 2014 U.S. dialysis and related lab services $ 675,994 $ 584,513 $ 560,610 DMG 84,399 66,800 27,885 Other - Ancillary services and strategic initiatives 68,702 56,685 52,835 $ 829,095 $ 707,998 $ 641,330 |
Supplemental cash flow inform56
Supplemental cash flow information (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Supplemental Cash Flow Elements [Abstract] | |
Supplemental Cash Flow Information | The table below provides supplemental cash flow information: Year ended December 31, 2016 2015 2014 Cash paid: Income taxes $ 339,411 $ 156,075 $ 238,615 Interest 406,987 405,120 351,967 Non-cash investing and financing activities: Fixed assets under capital lease obligations 28,127 74,035 72,389 |
Selected quarterly financial 57
Selected quarterly financial data (unaudited) (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Quarterly Financial Information Disclosure [Abstract] | |
Selected quarterly financial data (unaudited) | 2016 2015 December September 30 June 30 March 31 December September 30 June 30 March 31 Net revenues $ 3,715,742 $ 3,730,576 $ 3,717,651 $ 3,581,136 $ 3,533,589 $ 3,525,665 $ 3,434,618 $ 3,287,965 Operating income (loss) $ 381,428 $ 819,156 $ 329,070 $ 364,889 $ 244,935 $ 509,368 $ 480,548 $ (64,156 ) Income (loss) before income taxes $ 278,072 $ 716,451 $ 229,391 $ 264,981 $ 146,307 $ 408,371 $ 330,539 $ (162,081 ) Net income (loss) attributable to DaVita Inc. $ 157,726 $ 571,332 $ 53,382 $ 97,434 $ (6,000 ) $ 215,872 $ 170,477 $ (110,617 ) Basic net income (loss) per share attributable to DaVita Inc. $ 0.81 $ 2.80 $ 0.26 $ 0.48 $ (0.03 ) $ 1.02 $ 0.80 $ (0.52 ) Diluted net income (loss) per share attributable to DaVita Inc. $ 0.80 $ 2.76 $ 0.26 $ 0.47 $ (0.03 ) $ 1.00 $ 0.78 $ (0.52 ) |
Consolidating financial state58
Consolidating financial statements (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Consolidating Statements of Income | Consolidating Statements of Income DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the twelve months ended December 31, 2016 Patient services revenues $ — $ 6,766,138 $ 3,761,590 $ (173,567 ) $ 10,354,161 Less: Provision for uncollectible accounts — (278,761 ) (172,592 ) — (451,353 ) Net patient service revenues — 6,487,377 3,588,998 (173,567 ) 9,902,808 Capitated revenues — 1,795,673 1,723,279 (273 ) 3,518,679 Other revenues 767,791 2,089,749 125,203 (1,659,125 ) 1,323,618 Total net revenues 767,791 10,372,799 5,437,480 (1,832,965 ) 14,745,105 Operating expenses and charges 524,108 9,735,334 4,424,085 (1,832,965 ) 12,850,562 Operating income 243,683 637,465 1,013,395 — 1,894,543 Debt expense (407,925 ) (358,535 ) (50,710 ) 402,788 (414,382 ) Other income, net 396,797 6,196 8,529 (402,788 ) 8,734 Income tax expense 79,301 210,338 166,174 — 455,813 Equity earnings in subsidiaries 726,620 651,832 — (1,378,452 ) — Net income 879,874 726,620 805,040 (1,378,452 ) 1,033,082 Less: Net income attributable to noncontrolling interests — — — (153,208 ) (153,208 ) Net income attributable to DaVita Inc. $ 879,874 $ 726,620 $ 805,040 $ (1,531,660 ) $ 879,874 Consolidating Statements of Income DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For twelve months ended December 31, 2015 Patient services revenues $ — $ 6,578,185 $ 3,047,048 $ (144,954 ) $ 9,480,279 Less: Provision for uncollectible accounts — (285,454 ) (142,406 ) — (427,860 ) Net patient service revenues — 6,292,731 2,904,642 (144,954 ) 9,052,419 Capitated revenues — 1,776,311 1,733,027 (243 ) 3,509,095 Other revenues 727,887 1,875,133 32,137 (1,414,834 ) 1,220,323 Total net revenues 727,887 9,944,175 4,669,806 (1,560,031 ) 13,781,837 Operating expenses and charges 488,595 9,565,667 4,116,911 (1,560,031 ) 12,611,142 Operating income 239,292 378,508 552,895 — 1,170,695 Debt (expense) and refinancing charges (449,598 ) (340,176 ) (42,500 ) 375,822 (456,452 ) Other income, net 365,752 11,562 7,401 (375,822 ) 8,893 Income tax expense 81,221 173,063 41,442 — 295,726 Equity earnings in subsidiaries 195,507 318,676 — (514,183 ) — Net income 269,732 195,507 476,354 (514,183 ) 427,410 Less: Net income attributable to noncontrolling interests — — — (157,678 ) (157,678 ) Net income attributable to DaVita Inc. $ 269,732 $ 195,507 $ 476,354 $ (671,861 ) $ 269,732 For the year ended December 31, 2014 Patient services revenues $ — $ 6,246,683 $ 2,739,204 $ (117,549 ) $ 8,868,338 Less: Provision for uncollectible accounts — (238,600 ) (128,284 ) — (366,884 ) Net patient service revenues — 6,008,083 2,610,920 (117,549 ) 8,501,454 Capitated revenues — 1,681,668 1,579,804 (184 ) 3,261,288 Other revenues 684,066 1,639,828 24,155 (1,315,685 ) 1,032,364 Total net revenues 684,066 9,329,579 4,214,879 (1,433,418 ) 12,795,106 Operating expenses and charges 443,951 8,269,025 3,700,407 (1,433,418 ) 10,979,965 Operating income 240,115 1,060,554 514,472 — 1,815,141 Debt (expense) and refinancing charges (502,762 ) (363,623 ) (43,449 ) 401,992 (507,842 ) Other income, net 385,532 11,731 7,103 (401,992 ) 2,374 Income tax expense 46,856 397,268 2,219 — 446,343 Equity earnings in subsidiaries 647,085 335,691 — (982,776 ) — Net income 723,114 647,085 475,907 (982,776 ) 863,330 Less: Net income attributable to noncontrolling interests — — — (140,216 ) (140,216 ) Net income attributable to DaVita Inc. $ 723,114 $ 647,085 $ 475,907 $ (1,122,992 ) $ 723,114 |
Consolidating Statements of Comprehensive Income | Consolidating Statements of Comprehensive Income DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the year ended December 31, 2016 Net income $ 879,874 $ 726,620 $ 805,040 $ (1,378,452 ) $ 1,033,082 Other comprehensive loss (290 ) — (29,337 ) — (29,627 ) Total comprehensive income 879,584 726,620 775,703 (1,378,452 ) 1,003,455 Less: Comprehensive income attributable to noncontrolling interest — — — (153,398 ) (153,398 ) Comprehensive income attributable to DaVita Inc. $ 879,584 $ 726,620 $ 775,703 $ (1,531,850 ) $ 850,057 For the year ended December 31, 2015 Net income $ 269,732 $ 195,507 $ 476,354 $ (514,183 ) $ 427,410 Other comprehensive loss (10,920 ) — (23,889 ) — (34,809 ) Total comprehensive income 258,812 195,507 452,465 (514,183 ) 392,601 Less: Comprehensive income attributable to noncontrolling interest — — — (157,678 ) (157,678 ) Comprehensive income attributable to DaVita Inc. $ 258,812 $ 195,507 $ 452,465 $ (671,861 ) $ 234,923 For the year ended December 31, 2014 Net income $ 723,114 $ 647,085 $ 475,907 $ (982,776 ) $ 863,330 Other comprehensive income (losses) 580 — (22,952 ) — (22,372 ) Total comprehensive income 723,694 647,085 452,955 (982,776 ) 840,958 Less: Comprehensive income attributable to noncontrolling interest — — — (140,216 ) (140,216 ) Comprehensive income attributable to DaVita Inc. $ 723,694 $ 647,085 $ 452,955 $ (1,122,992 ) $ 700,742 |
Consolidating Balance Sheets | Consolidating Balance Sheets DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total As of December 31, 2016 Cash and cash equivalents $ 549,921 $ 59,192 $ 304,074 $ — $ 913,187 Accounts receivable, net — 1,215,232 702,070 — 1,917,302 Other current assets 277,911 736,727 135,101 — 1,149,739 Total current assets 827,832 2,011,151 1,141,245 — 3,980,228 Property and equipment, net 337,200 1,689,798 1,148,369 — 3,175,367 Intangible assets, net 487 1,491,057 36,223 — 1,527,767 Investments in subsidiaries 9,717,728 2,002,660 — (11,720,388 ) — Intercompany receivables 3,250,692 — 866,955 (4,117,647 ) — Other long-term assets and investments 39,994 86,710 523,874 — 650,578 Goodwill — 7,838,984 1,568,333 — 9,407,317 Total assets $ 14,173,933 $ 15,120,360 $ 5,284,999 $ (15,838,035 ) $ 18,741,257 Current liabilities $ 303,840 $ 1,865,193 $ 527,412 $ — $ 2,696,445 Intercompany payables — 2,322,124 1,795,523 (4,117,647 ) — Long-term debt and other long-term liabilities 8,614,445 1,215,315 392,053 — 10,221,813 Noncontrolling interests subject to put provisions 607,601 — — 365,657 973,258 Total DaVita Inc. shareholders' equity 4,648,047 9,717,728 2,002,660 (11,720,388 ) 4,648,047 Noncontrolling interests not subject to put provisions — — 567,351 (365,657 ) 201,694 Total equity 4,648,047 9,717,728 2,570,011 (12,086,045 ) 4,849,741 Total liabilities and equity $ 14,173,933 $ 15,120,360 $ 5,284,999 $ (15,838,035 ) $ 18,741,257 As of December 31, 2015 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 |
Consolidating Statements of Cash Flows | Consolidating Statements of Cash Flows DaVita Inc. Guarantor Subsidiaries Non-Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the year ended December 31, 2016 Cash flows from operating activities: Net income $ 879,874 $ 726,620 $ 805,040 $ (1,378,452 ) $ 1,033,082 Changes in operating assets and liabilities and non-cash items included in net income (614,642 ) 335,166 (168,614 ) 1,378,452 930,362 Net cash provided by operating activities 265,232 1,061,786 636,426 — 1,963,444 Cash flows from investing activities: Additions of property and equipment, net (139,303 ) (382,305 ) (307,487 ) — (829,095 ) Acquisitions — (472,413 ) (91,443 ) — (563,856 ) Proceeds from asset sales, net of cash divested — 70,342 (5,617 ) — 64,725 Investments and other items 153,031 (29,038 ) 2,565 — 126,558 Net cash provided by (used in) investing activities 13,728 (813,414 ) (401,982 ) — (1,201,668 ) Cash flows from financing activities: Long-term debt and related financing costs, net (92,460 ) (27,830 ) (4,152 ) — (124,442 ) Intercompany borrowing 237,988 (249,182 ) 11,194 — — Other items (1,061,203 ) (21,525 ) (144,811 ) — (1,227,539 ) Net cash used in financing activities (915,675 ) (298,537 ) (137,769 ) — (1,351,981 ) Effect of exchange rate changes on cash — — 4,276 — 4,276 Net (decrease) increase in cash and cash equivalents (636,715 ) (50,165 ) 100,951 — (585,929 ) Cash and cash equivalents at beginning of the year 1,186,636 109,357 203,123 — 1,499,116 Cash and cash equivalents at the end of the year $ 549,921 $ 59,192 $ 304,074 $ — $ 913,187 For the year ended December 31, 2015 Cash flows from operating activities: Net income $ 269,732 $ 195,507 $ 476,354 $ (514,183 ) $ 427,410 Changes in operating assets and liabilities and non-cash items included in net income (146,531 ) 688,106 74,032 514,183 1,129,790 Net cash provided by operating activities 123,201 883,613 550,386 — 1,557,200 Cash flows from investing activities: Additions of property and equipment, net (115,269 ) (319,695 ) (273,034 ) — (707,998 ) Acquisitions — (76,983 ) (19,486 ) — (96,469 ) Proceeds from asset sales — 19,715 — — 19,715 Investments and other items (74,474 ) (2,144 ) (20,414 ) — (97,032 ) Net cash used in investing activities (189,743 ) (379,107 ) (312,934 ) — (881,784 ) Cash flows from financing activities: Long-term debt and related financing costs, net 640,009 (11,953 ) (8,358 ) — 619,698 Intercompany borrowing 486,588 (394,735 ) (91,853 ) — — Other items (572,295 ) (66,382 ) (119,991 ) — (758,668 ) Net cash provided by (used in) financing activities 554,302 (473,070 ) (220,202 ) — (138,970 ) Effect of exchange rate changes on cash — — (2,571 ) — (2,571 ) Net increase in cash and cash equivalents 487,760 31,436 14,679 — 533,875 Cash and cash equivalents at beginning of the year 698,876 77,921 188,444 — 965,241 Cash and cash equivalents at the end of the year $ 1,186,636 $ 109,357 $ 203,123 $ — $ 1,499,116 Consolidating Statements of Cash Flows DaVita Inc. Guarantor Subsidiaries Non-Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the year ended December 31, 2014 Cash flows from operating activities: Net income $ 723,114 $ 647,085 $ 475,907 $ (982,776 ) $ 863,330 Changes in operating assets and liabilities and non-cash items included in net income (597,992 ) 120,772 90,521 982,776 596,077 Net cash provided by operating activities 125,122 767,857 566,428 — 1,459,407 Cash flows from investing activities: Additions of property and equipment, net (51,374 ) (312,191 ) (277,765 ) — (641,330 ) Acquisitions — (228,569 ) (43,525 ) — (272,094 ) Proceeds from asset sales — 8,791 — — 8,791 Investments and other items (333,803 ) (316 ) (38,977 ) — (373,096 ) Net cash used in investing activities (385,177 ) (532,285 ) (360,267 ) — (1,277,729 ) Cash flows from financing activities: Long-term debt and related financing costs, net 4,513 (12,545 ) 43 — (7,989 ) Intercompany borrowing 410,437 (282,461 ) (127,976 ) — — Other items (58,207 ) (14,099 ) (84,684 ) — (156,990 ) Net cash provided by (used in) financing activities 356,743 (309,105 ) (212,617 ) — (164,979 ) Effect of exchange rate changes on cash — — 2,293 — 2,293 Net increase (decrease) in cash and cash equivalents 96,688 (73,533 ) (4,163 ) — 18,992 Cash and cash equivalents at beginning of the year 602,188 151,454 192,607 — 946,249 Cash and cash equivalents at the end of the year $ 698,876 $ 77,921 $ 188,444 $ — $ 965,241 |
Supplemental data (Tables)
Supplemental data (Tables) | 12 Months Ended |
Dec. 31, 2016 | |
Condensed Financial Statements Captions [Line Items] | |
Consolidating Statements of Income | Consolidating Statements of Income DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the twelve months ended December 31, 2016 Patient services revenues $ — $ 6,766,138 $ 3,761,590 $ (173,567 ) $ 10,354,161 Less: Provision for uncollectible accounts — (278,761 ) (172,592 ) — (451,353 ) Net patient service revenues — 6,487,377 3,588,998 (173,567 ) 9,902,808 Capitated revenues — 1,795,673 1,723,279 (273 ) 3,518,679 Other revenues 767,791 2,089,749 125,203 (1,659,125 ) 1,323,618 Total net revenues 767,791 10,372,799 5,437,480 (1,832,965 ) 14,745,105 Operating expenses and charges 524,108 9,735,334 4,424,085 (1,832,965 ) 12,850,562 Operating income 243,683 637,465 1,013,395 — 1,894,543 Debt expense (407,925 ) (358,535 ) (50,710 ) 402,788 (414,382 ) Other income, net 396,797 6,196 8,529 (402,788 ) 8,734 Income tax expense 79,301 210,338 166,174 — 455,813 Equity earnings in subsidiaries 726,620 651,832 — (1,378,452 ) — Net income 879,874 726,620 805,040 (1,378,452 ) 1,033,082 Less: Net income attributable to noncontrolling interests — — — (153,208 ) (153,208 ) Net income attributable to DaVita Inc. $ 879,874 $ 726,620 $ 805,040 $ (1,531,660 ) $ 879,874 Consolidating Statements of Income DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For twelve months ended December 31, 2015 Patient services revenues $ — $ 6,578,185 $ 3,047,048 $ (144,954 ) $ 9,480,279 Less: Provision for uncollectible accounts — (285,454 ) (142,406 ) — (427,860 ) Net patient service revenues — 6,292,731 2,904,642 (144,954 ) 9,052,419 Capitated revenues — 1,776,311 1,733,027 (243 ) 3,509,095 Other revenues 727,887 1,875,133 32,137 (1,414,834 ) 1,220,323 Total net revenues 727,887 9,944,175 4,669,806 (1,560,031 ) 13,781,837 Operating expenses and charges 488,595 9,565,667 4,116,911 (1,560,031 ) 12,611,142 Operating income 239,292 378,508 552,895 — 1,170,695 Debt (expense) and refinancing charges (449,598 ) (340,176 ) (42,500 ) 375,822 (456,452 ) Other income, net 365,752 11,562 7,401 (375,822 ) 8,893 Income tax expense 81,221 173,063 41,442 — 295,726 Equity earnings in subsidiaries 195,507 318,676 — (514,183 ) — Net income 269,732 195,507 476,354 (514,183 ) 427,410 Less: Net income attributable to noncontrolling interests — — — (157,678 ) (157,678 ) Net income attributable to DaVita Inc. $ 269,732 $ 195,507 $ 476,354 $ (671,861 ) $ 269,732 For the year ended December 31, 2014 Patient services revenues $ — $ 6,246,683 $ 2,739,204 $ (117,549 ) $ 8,868,338 Less: Provision for uncollectible accounts — (238,600 ) (128,284 ) — (366,884 ) Net patient service revenues — 6,008,083 2,610,920 (117,549 ) 8,501,454 Capitated revenues — 1,681,668 1,579,804 (184 ) 3,261,288 Other revenues 684,066 1,639,828 24,155 (1,315,685 ) 1,032,364 Total net revenues 684,066 9,329,579 4,214,879 (1,433,418 ) 12,795,106 Operating expenses and charges 443,951 8,269,025 3,700,407 (1,433,418 ) 10,979,965 Operating income 240,115 1,060,554 514,472 — 1,815,141 Debt (expense) and refinancing charges (502,762 ) (363,623 ) (43,449 ) 401,992 (507,842 ) Other income, net 385,532 11,731 7,103 (401,992 ) 2,374 Income tax expense 46,856 397,268 2,219 — 446,343 Equity earnings in subsidiaries 647,085 335,691 — (982,776 ) — Net income 723,114 647,085 475,907 (982,776 ) 863,330 Less: Net income attributable to noncontrolling interests — — — (140,216 ) (140,216 ) Net income attributable to DaVita Inc. $ 723,114 $ 647,085 $ 475,907 $ (1,122,992 ) $ 723,114 |
Consolidating Statements of Comprehensive Income | Consolidating Statements of Comprehensive Income DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the year ended December 31, 2016 Net income $ 879,874 $ 726,620 $ 805,040 $ (1,378,452 ) $ 1,033,082 Other comprehensive loss (290 ) — (29,337 ) — (29,627 ) Total comprehensive income 879,584 726,620 775,703 (1,378,452 ) 1,003,455 Less: Comprehensive income attributable to noncontrolling interest — — — (153,398 ) (153,398 ) Comprehensive income attributable to DaVita Inc. $ 879,584 $ 726,620 $ 775,703 $ (1,531,850 ) $ 850,057 For the year ended December 31, 2015 Net income $ 269,732 $ 195,507 $ 476,354 $ (514,183 ) $ 427,410 Other comprehensive loss (10,920 ) — (23,889 ) — (34,809 ) Total comprehensive income 258,812 195,507 452,465 (514,183 ) 392,601 Less: Comprehensive income attributable to noncontrolling interest — — — (157,678 ) (157,678 ) Comprehensive income attributable to DaVita Inc. $ 258,812 $ 195,507 $ 452,465 $ (671,861 ) $ 234,923 For the year ended December 31, 2014 Net income $ 723,114 $ 647,085 $ 475,907 $ (982,776 ) $ 863,330 Other comprehensive income (losses) 580 — (22,952 ) — (22,372 ) Total comprehensive income 723,694 647,085 452,955 (982,776 ) 840,958 Less: Comprehensive income attributable to noncontrolling interest — — — (140,216 ) (140,216 ) Comprehensive income attributable to DaVita Inc. $ 723,694 $ 647,085 $ 452,955 $ (1,122,992 ) $ 700,742 |
Consolidating Balance Sheets | Consolidating Balance Sheets DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total As of December 31, 2016 Cash and cash equivalents $ 549,921 $ 59,192 $ 304,074 $ — $ 913,187 Accounts receivable, net — 1,215,232 702,070 — 1,917,302 Other current assets 277,911 736,727 135,101 — 1,149,739 Total current assets 827,832 2,011,151 1,141,245 — 3,980,228 Property and equipment, net 337,200 1,689,798 1,148,369 — 3,175,367 Intangible assets, net 487 1,491,057 36,223 — 1,527,767 Investments in subsidiaries 9,717,728 2,002,660 — (11,720,388 ) — Intercompany receivables 3,250,692 — 866,955 (4,117,647 ) — Other long-term assets and investments 39,994 86,710 523,874 — 650,578 Goodwill — 7,838,984 1,568,333 — 9,407,317 Total assets $ 14,173,933 $ 15,120,360 $ 5,284,999 $ (15,838,035 ) $ 18,741,257 Current liabilities $ 303,840 $ 1,865,193 $ 527,412 $ — $ 2,696,445 Intercompany payables — 2,322,124 1,795,523 (4,117,647 ) — Long-term debt and other long-term liabilities 8,614,445 1,215,315 392,053 — 10,221,813 Noncontrolling interests subject to put provisions 607,601 — — 365,657 973,258 Total DaVita Inc. shareholders' equity 4,648,047 9,717,728 2,002,660 (11,720,388 ) 4,648,047 Noncontrolling interests not subject to put provisions — — 567,351 (365,657 ) 201,694 Total equity 4,648,047 9,717,728 2,570,011 (12,086,045 ) 4,849,741 Total liabilities and equity $ 14,173,933 $ 15,120,360 $ 5,284,999 $ (15,838,035 ) $ 18,741,257 As of December 31, 2015 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 |
Consolidating Statements of Cash Flows | Consolidating Statements of Cash Flows DaVita Inc. Guarantor Subsidiaries Non-Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the year ended December 31, 2016 Cash flows from operating activities: Net income $ 879,874 $ 726,620 $ 805,040 $ (1,378,452 ) $ 1,033,082 Changes in operating assets and liabilities and non-cash items included in net income (614,642 ) 335,166 (168,614 ) 1,378,452 930,362 Net cash provided by operating activities 265,232 1,061,786 636,426 — 1,963,444 Cash flows from investing activities: Additions of property and equipment, net (139,303 ) (382,305 ) (307,487 ) — (829,095 ) Acquisitions — (472,413 ) (91,443 ) — (563,856 ) Proceeds from asset sales, net of cash divested — 70,342 (5,617 ) — 64,725 Investments and other items 153,031 (29,038 ) 2,565 — 126,558 Net cash provided by (used in) investing activities 13,728 (813,414 ) (401,982 ) — (1,201,668 ) Cash flows from financing activities: Long-term debt and related financing costs, net (92,460 ) (27,830 ) (4,152 ) — (124,442 ) Intercompany borrowing 237,988 (249,182 ) 11,194 — — Other items (1,061,203 ) (21,525 ) (144,811 ) — (1,227,539 ) Net cash used in financing activities (915,675 ) (298,537 ) (137,769 ) — (1,351,981 ) Effect of exchange rate changes on cash — — 4,276 — 4,276 Net (decrease) increase in cash and cash equivalents (636,715 ) (50,165 ) 100,951 — (585,929 ) Cash and cash equivalents at beginning of the year 1,186,636 109,357 203,123 — 1,499,116 Cash and cash equivalents at the end of the year $ 549,921 $ 59,192 $ 304,074 $ — $ 913,187 For the year ended December 31, 2015 Cash flows from operating activities: Net income $ 269,732 $ 195,507 $ 476,354 $ (514,183 ) $ 427,410 Changes in operating assets and liabilities and non-cash items included in net income (146,531 ) 688,106 74,032 514,183 1,129,790 Net cash provided by operating activities 123,201 883,613 550,386 — 1,557,200 Cash flows from investing activities: Additions of property and equipment, net (115,269 ) (319,695 ) (273,034 ) — (707,998 ) Acquisitions — (76,983 ) (19,486 ) — (96,469 ) Proceeds from asset sales — 19,715 — — 19,715 Investments and other items (74,474 ) (2,144 ) (20,414 ) — (97,032 ) Net cash used in investing activities (189,743 ) (379,107 ) (312,934 ) — (881,784 ) Cash flows from financing activities: Long-term debt and related financing costs, net 640,009 (11,953 ) (8,358 ) — 619,698 Intercompany borrowing 486,588 (394,735 ) (91,853 ) — — Other items (572,295 ) (66,382 ) (119,991 ) — (758,668 ) Net cash provided by (used in) financing activities 554,302 (473,070 ) (220,202 ) — (138,970 ) Effect of exchange rate changes on cash — — (2,571 ) — (2,571 ) Net increase in cash and cash equivalents 487,760 31,436 14,679 — 533,875 Cash and cash equivalents at beginning of the year 698,876 77,921 188,444 — 965,241 Cash and cash equivalents at the end of the year $ 1,186,636 $ 109,357 $ 203,123 $ — $ 1,499,116 Consolidating Statements of Cash Flows DaVita Inc. Guarantor Subsidiaries Non-Guarantor Subsidiaries Consolidating Adjustments Consolidated Total For the year ended December 31, 2014 Cash flows from operating activities: Net income $ 723,114 $ 647,085 $ 475,907 $ (982,776 ) $ 863,330 Changes in operating assets and liabilities and non-cash items included in net income (597,992 ) 120,772 90,521 982,776 596,077 Net cash provided by operating activities 125,122 767,857 566,428 — 1,459,407 Cash flows from investing activities: Additions of property and equipment, net (51,374 ) (312,191 ) (277,765 ) — (641,330 ) Acquisitions — (228,569 ) (43,525 ) — (272,094 ) Proceeds from asset sales — 8,791 — — 8,791 Investments and other items (333,803 ) (316 ) (38,977 ) — (373,096 ) Net cash used in investing activities (385,177 ) (532,285 ) (360,267 ) — (1,277,729 ) Cash flows from financing activities: Long-term debt and related financing costs, net 4,513 (12,545 ) 43 — (7,989 ) Intercompany borrowing 410,437 (282,461 ) (127,976 ) — — Other items (58,207 ) (14,099 ) (84,684 ) — (156,990 ) Net cash provided by (used in) financing activities 356,743 (309,105 ) (212,617 ) — (164,979 ) Effect of exchange rate changes on cash — — 2,293 — 2,293 Net increase (decrease) in cash and cash equivalents 96,688 (73,533 ) (4,163 ) — 18,992 Cash and cash equivalents at beginning of the year 602,188 151,454 192,607 — 946,249 Cash and cash equivalents at the end of the year $ 698,876 $ 77,921 $ 188,444 $ — $ 965,241 |
Additional Reporting Entities | |
Condensed Financial Statements Captions [Line Items] | |
Consolidating Statements of Income | Condensed Consolidating Statements of Income Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the year ended December 31, 2016 Patient services revenues $ 10,354,161 $ 449,473 $ — $ 9,904,688 Less: Provision for uncollectible accounts (451,353 ) (12,696 ) — (438,657 ) Net patient service revenues 9,902,808 436,777 — 9,466,031 Capitated revenues 3,518,679 1,617,794 — 1,900,885 Other revenues 1,323,618 32,938 — 1,290,680 Total net revenues 14,745,105 2,087,509 — 12,657,596 Operating expenses and charges 12,850,562 2,035,001 110 10,815,451 Operating income 1,894,543 52,508 (110 ) 1,842,145 Debt expense (414,382 ) (10,140 ) — (404,242 ) Other income, net 8,734 576 — 8,158 Income tax expense 455,813 10,643 (44 ) 445,214 Net income 1,033,082 32,301 (66 ) 1,000,847 Less: Net income attributable to noncontrolling interests (153,208 ) — — (153,208 ) Net income attributable to DaVita Inc. $ 879,874 $ 32,301 $ (66 ) $ 847,639 |
Consolidating Statements of Comprehensive Income | Condensed Consolidating Statements of Comprehensive Income Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the year ended December 31, 2016 Net income (losses) $ 1,033,082 $ 32,301 $ (66 ) $ 1,000,847 Other comprehensive losses (29,627 ) — — (29,627 ) Total comprehensive income (losses) 1,003,455 32,301 (66 ) 971,220 Less: Comprehensive income attributable to noncontrolling interest (153,398 ) — — (153,398 ) Comprehensive income (losses) attributable to DaVita Inc. $ 850,057 $ 32,301 $ (66 ) $ 817,822 |
Consolidating Balance Sheets | Condensed Consolidating Balance Sheets Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) As of December 31, 2016 Cash and cash equivalents $ 913,187 $ 104,691 $ — $ 808,496 Accounts receivable, net 1,917,302 207,430 — 1,709,872 Other current assets 1,149,739 15,124 — 1,134,615 Total current assets 3,980,228 327,245 — 3,652,983 Property and equipment, net 3,175,367 1,378 — 3,173,989 Amortizable intangibles, net 1,527,767 4,858 — 1,522,909 Other long-term assets 650,578 78,215 2,714 569,649 Goodwill 9,407,317 16,405 — 9,390,912 Total assets $ 18,741,257 $ 428,101 $ 2,714 $ 18,310,442 Current liabilities $ 2,696,445 $ 223,302 $ — $ 2,473,143 Payables to parent — 56,699 2,714 (59,413 ) Long-term debt and other long-term liabilities 10,221,813 44,094 — 10,177,719 Noncontrolling interests subject to put provisions 973,258 — — 973,258 Total DaVita Inc. shareholders' equity 4,648,047 104,006 — 4,544,041 Noncontrolling interests not subject to put provisions 201,694 — — 201,694 Shareholders' equity 4,849,741 104,006 — 4,745,735 Total liabilities and shareholder's equity $ 18,741,257 $ 428,101 $ 2,714 $ 18,310,442 |
Consolidating Statements of Cash Flows | C ondensed Consolidating Statements of Cash Flows Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) For the year ended December 31, 2016 Cash flows from operating activities: Net income $ 1,033,082 $ 32,301 $ (66 ) $ 1,000,847 Changes in operating and intercompany assets and liabilities and non-cash items included in net income 930,362 131,863 66 798,433 Net cash provided by operating activities 1,963,444 164,164 — 1,799,280 Cash flows from investing activities: Additions of property and equipment (829,095 ) (863 ) — (828,232 ) Acquisitions and divestitures, net (563,856 ) — — (563,856 ) Proceeds from asset sales 64,725 — — 64,725 Investments and other items 126,558 (3,014 ) — 129,572 Net cash used in investing activities (1,201,668 ) (3,877 ) — (1,197,791 ) Cash flows from financing activities: Long-term debt and related financing costs, net (124,442 ) (4 ) — (124,438 ) Intercompany — (143,837 ) — 143,837 Other items (1,227,539 ) — — (1,227,539 ) Net cash used in financing activities (1,351,981 ) (143,841 ) — (1,208,140 ) Effect of exchange rate changes on cash 4,276 — — 4,276 Net increase (decrease) in cash (585,929 ) 16,446 — (602,375 ) Cash at beginning of the year 1,499,116 88,245 — 1,410,871 Cash at the end of the year $ 913,187 $ 104,691 $ — $ 808,496 |
Organization and Summary of S60
Organization and Summary of Significant Accounting Policies - Additional Information (Detail) $ in Thousands | 12 Months Ended | |
Dec. 31, 2016USD ($)EntityLocationPersonSegmentCountry | Dec. 31, 2015USD ($) | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Number of Operating Segments | Segment | 2 | |
Number of countries in which dialysis centers located | Country | 11 | |
Funds on deposit with third parties | $ | $ 75,877 | $ 82,679 |
Number of legal entities that third parties held noncontrolling equity interests | 490 | |
California Medical Group Insurance | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Equity interest owned | 67.00% | |
Trade names | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Amortization period | 4 years | |
Maximum | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Percentage of management fees included in net operating revenues | 1.00% | |
Maximum | Customer relationships | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Amortization period | 20 years | |
Maximum | Provider network and practice management tools | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Amortization period | 15 years | |
Maximum | Noncompetition and other agreements | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Amortization period | 10 years | |
Maximum | Buildings | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Useful lives of the assets | 40 years | |
Maximum | Equipment and Information Systems | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Useful lives of the assets | 8 years | |
Minimum | Customer relationships | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Amortization period | 10 years | |
Minimum | Provider network and practice management tools | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Amortization period | 2 years | |
Minimum | Noncompetition and other agreements | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Amortization period | 2 years | |
Minimum | Buildings | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Useful lives of the assets | 20 years | |
Minimum | Equipment and Information Systems | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Useful lives of the assets | 3 years | |
Dialysis And Related Lab Services | Maximum | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Percentage of risk on revenue | 1.00% | |
UNITED STATES | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Number of dialysis centers that the company operated or provided administrative services | 2,350 | |
Number of states that dialysis centers located | Location | 46 | |
Number of patients served | Person | 187,700 | |
Outside United States | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Number of dialysis centers that the company operated or provided administrative services | 154 | |
Number of patients served | Person | 15,100 |
Reconciliations of Numerators a
Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Net Income Per Share (Detail) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 12 Months Ended | ||||||||||
Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2015 | Sep. 30, 2015 | Jun. 30, 2015 | Mar. 31, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Basic: | ||||||||||||
Net income attributable to DaVita Inc. for basic earnings per share calculation | $ 879,874 | $ 269,732 | $ 723,114 | |||||||||
Weighted average shares outstanding during the period | 203,835,000 | 214,062,000 | 214,496,000 | |||||||||
Contingently returnable shares held in escrow for the DaVita HealthCare Partners merger | (2,194,000) | (2,194,000) | (2,194,000) | |||||||||
Weighted average shares for basic earnings per share calculation | 201,641,173 | 211,867,714 | 212,301,827 | |||||||||
Basic net income per share attributable to DaVita Inc. | $ 0.81 | $ 2.80 | $ 0.26 | $ 0.48 | $ (0.03) | $ 1.02 | $ 0.80 | $ (0.52) | $ 4.36 | $ 1.27 | $ 3.41 | |
Diluted: | ||||||||||||
Net income attributable to DaVita Inc. for diluted earnings per share calculation | $ 879,874 | $ 269,732 | $ 723,114 | |||||||||
Weighted average shares outstanding during the period | 203,835,000 | 214,062,000 | 214,496,000 | |||||||||
Assumed incremental shares from stock plans | 1,070,000 | 2,190,000 | 2,432,000 | |||||||||
Weighted average shares for diluted earnings per share calculation | 204,904,656 | 216,251,807 | 216,927,681 | |||||||||
Diluted net income per share attributable to DaVita Inc. | $ 0.80 | $ 2.76 | $ 0.26 | $ 0.47 | $ (0.03) | $ 1 | $ 0.78 | $ (0.52) | $ 4.29 | $ 1.25 | $ 3.33 | |
Anti-dilutive stock-settled awards excluded from calculation | [1] | 2,523,000 | 1,365,000 | 1,715,000 | ||||||||
[1] | Shares associated with stock-settled stock appreciation rights excluded from the diluted denominator calculation because they are anti-dilutive under the treasury stock method. |
Accounts Receivable - Additiona
Accounts Receivable - Additional Information (Detail) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2016 | Dec. 31, 2015 | |
Accounts Notes And Loans Receivable [Line Items] | ||
Increase (decrease) in allowance for doubtful accounts | $ (12,088) | $ 21,470 |
Minimum | ||
Accounts Notes And Loans Receivable [Line Items] | ||
Accounts receivable collection period | 1 month | |
Maximum | ||
Accounts Notes And Loans Receivable [Line Items] | ||
Accounts receivable collection period | 3 months | |
U.S. Dialysis And Related Lab Services | ||
Accounts Notes And Loans Receivable [Line Items] | ||
Percentage of outstanding patient accounts receivables to be reserved as per Company's policy | 100.00% | |
Accounts Receivable Period Outstanding | 3 months | |
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% | |
Accounts Receivable Period Outstanding | 12 months | |
Health Care Patient and Other Services | Accounts Receivable | ||
Accounts Notes And Loans Receivable [Line Items] | ||
Percentage of net accounts receivable | 81.00% | 81.00% |
Capitated Health Plans | Accounts Receivable | ||
Accounts Notes And Loans Receivable [Line Items] | ||
Percentage of net accounts receivable | 19.00% | 19.00% |
Health Care Patient Services | Accounts Receivable | ||
Accounts Notes And Loans Receivable [Line Items] | ||
Net accounts receivable, percentage of balances more than six months old | 16.00% | 18.00% |
Percentage of accounts receivable due | 1.00% | |
Government-based Programs, Medicare and Medicaid | Accounts Receivable | ||
Accounts Notes And Loans Receivable [Line Items] | ||
Percentage of accounts receivable due | 80.00% |
Other Receivables (Detail)
Other Receivables (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Other Receivables, Net, Current [Abstract] | ||
Other receivables | $ 453,483 | $ 435,885 |
Supplier rebates and other non-trade receivables | ||
Other Receivables, Net, Current [Abstract] | ||
Other receivables | 347,123 | 316,644 |
Medicare bad debt claims | ||
Other Receivables, Net, Current [Abstract] | ||
Other receivables | 104,658 | 105,714 |
Operating advances under management and administrative services agreements | ||
Other Receivables, Net, Current [Abstract] | ||
Other receivables | $ 1,702 | $ 13,527 |
Other Current Assets (Detail)
Other Current Assets (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Prepaid Expense And Other Assets Current [Abstract] | ||
Prepaid expenses | $ 131,833 | $ 105,216 |
Funds on deposit with third parties | 75,877 | 82,679 |
Other | 2,894 | 2,427 |
Other current assets | $ 210,604 | $ 190,322 |
Property and Equipment (Detail)
Property and Equipment (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Property Plant And Equipment [Abstract] | ||
Land | $ 59,013 | $ 42,080 |
Buildings | 491,301 | 437,283 |
Leasehold improvements | 2,598,471 | 2,289,425 |
Equipment and information systems, including internally developed software | 2,378,303 | 2,080,446 |
New center and capital asset projects in progress | 480,439 | 336,513 |
Property, Plant and Equipment, Gross, Total | 6,007,527 | 5,185,747 |
Less accumulated depreciation | (2,832,160) | (2,397,007) |
Property and equipment, net | $ 3,175,367 | $ 2,788,740 |
Property and Equipment - Additi
Property and Equipment - Additional Information (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Property Plant And Equipment [Abstract] | |||
Depreciation and amortization expense on property and equipment | $ 545,734 | $ 475,484 | $ 428,309 |
Interest capitalized | $ 12,990 | $ 9,723 | $ 7,888 |
Amortizable Intangible Assets O
Amortizable Intangible Assets Other Than Goodwill (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Finite Lived Intangible Assets [Line Items] | ||
Customer relationships | $ 1,568,161 | $ 1,575,865 |
Trade names | 190,761 | 170,883 |
Provider network and practice management tools | 187,318 | 183,724 |
Noncompetition and other agreements | 512,505 | 510,521 |
Indefinite-lived assets | 1,546 | 9,310 |
Other | 583 | 408 |
Intangible Assets, Gross (Excluding Goodwill), Total | 2,468,498 | 2,458,017 |
Less accumulated amortization | (940,731) | (770,691) |
Total intangible assets | 1,527,767 | 1,687,326 |
Lease Agreements | ||
Finite Lived Intangible Assets [Line Items] | ||
Lease agreements | $ 7,624 | $ 7,306 |
Intangibles - Additional Inform
Intangibles - Additional Information (Detail) - USD ($) | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Finite Lived Intangible Assets And Liabilities [Line Items] | |||
Amortization expense from amortizable intangible assets | $ 174,518,000 | $ 166,537,000 | $ 167,956,000 |
Amortization of lease agreement intangible assets and liabilities | (923,000) | (1,613,000) | (1,798,000) |
Impairment charges for intangible assets other than goodwill | 0 | ||
Amortization benefit recognized from the alliance and product supply agreement | $ 0 | 3,997,000 | $ 5,330,000 |
DaVita Medical Group (DMG) | Nevada | |||
Finite Lived Intangible Assets And Liabilities [Line Items] | |||
Impairment charge on indefinite-lived intangible asset | $ 17,400,000 |
Amortizable Intangible Liabilit
Amortizable Intangible Liabilities (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Goodwill And Intangible Assets Disclosure [Abstract] | ||
Lease agreements (net of accumulated amortization of $8,485 and $6,936) | $ 7,420 | $ 8,969 |
Finite Lived Intangible Liabilities Net, Total | $ 7,420 | $ 8,969 |
Amortizable Intangible Liabil70
Amortizable Intangible Liabilities (Parenthetical) (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Goodwill And Intangible Assets Disclosure [Abstract] | ||
Lease agreements, accumulated amortization | $ 8,485 | $ 6,936 |
Scheduled Amortization Charges
Scheduled Amortization Charges from Intangible Assets and Liabilities (Detail) $ in Thousands | 12 Months Ended |
Dec. 31, 2016USD ($) | |
Customer relationships | |
Expected Amortization Expense [Line Items] | |
2,017 | $ 82,669 |
2,018 | 82,664 |
2,019 | 82,625 |
2,020 | 82,609 |
2,021 | 82,609 |
Thereafter | 821,282 |
Trade names | |
Expected Amortization Expense [Line Items] | |
2,017 | 47,046 |
2,018 | 47,046 |
2,019 | 11,008 |
2,020 | 3,800 |
2,021 | 633 |
Provider network and practice management tools | |
Expected Amortization Expense [Line Items] | |
2,017 | 26,941 |
2,018 | 26,881 |
2,019 | 22,492 |
2,020 | 581 |
2,021 | 97 |
Noncompetition and other agreements | |
Expected Amortization Expense [Line Items] | |
2,017 | 30,156 |
2,018 | 19,519 |
2,019 | 15,796 |
2,020 | 10,437 |
2,021 | 7,005 |
Thereafter | 21,990 |
Other | |
Expected Amortization Expense [Line Items] | |
2,017 | 102 |
2,018 | 102 |
2,019 | 87 |
2,020 | 44 |
Lease Agreements | |
Expected Amortization Expense [Line Items] | |
2,017 | (1,228) |
2,018 | (892) |
2,019 | (832) |
2,020 | (678) |
2,021 | (606) |
Thereafter | $ (3,184) |
Equity Investments - Additional
Equity Investments - Additional Information (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Equity Method Investments And Joint Ventures [Abstract] | |||
Impairment related to minority equity investment | $ 14,993 | ||
Equity investments in nonconsolidated businesses | 502,389 | $ 78,368 | |
Equity investment income | $ 13,044 | $ 18,325 | $ 23,234 |
Investments (Detail)
Investments (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Investment Holdings [Line Items] | ||
Held to maturity | $ 306,827 | $ 406,884 |
Available for sale | 107,050 | 90,322 |
Total | 413,877 | 497,206 |
Held to maturity, short-term investments | 306,827 | 406,884 |
Available for sale, short-term investments | 3,371 | 1,200 |
Total, short-term investments | 310,198 | 408,084 |
Available for sale, long-term investments | 103,679 | 89,122 |
Total, long-term investments | 103,679 | 89,122 |
Certificates of deposit, commercial paper and money market funds | ||
Investment Holdings [Line Items] | ||
Held to maturity | 256,827 | 406,884 |
Total | 256,827 | 406,884 |
Investments in mutual funds and common stock | ||
Investment Holdings [Line Items] | ||
Held to maturity | 50,000 | |
Available for sale, equity securities | 47,404 | 33,482 |
Total | 97,404 | 33,482 |
Cash surrender value of life insurance policies | ||
Investment Holdings [Line Items] | ||
Available for sale, equity securities | 59,646 | 56,840 |
Total | $ 59,646 | $ 56,840 |
Investments in Debt and Equit74
Investments in Debt and Equity Securities - Additional Information (Detail) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2016 | Dec. 31, 2015 | |
Schedule Of Trading Securities And Other Trading Assets [Line Items] | ||
Available for sale investments gross pre-tax unrealized gain (loss) | $ 3,701 | $ 2,589 |
Proceeds from sale of investments available for sale | 14,971 | 1,295 |
Pre tax reclassification of net investment realized gain (loss) into net income | 690 | 618 |
Reclassification of net investment realized gain (loss) into net income, net of tax | 423 | 377 |
Certificates of deposit, commercial paper and money market funds | ||
Schedule Of Trading Securities And Other Trading Assets [Line Items] | ||
Unrealized (losses) gains on investments, pre tax | $ 1,802 | $ (1,974) |
Changes in Carrying Value of Go
Changes in Carrying Value of Goodwill by Reportable Segments (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | ||
Dec. 31, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Goodwill [Line Items] | ||||
Beginning balance | $ 9,294,479 | $ 9,415,295 | ||
Acquisitions | 447,828 | 97,093 | ||
Divestitures | (44,759) | (8,781) | ||
Goodwill impairment charges | (281,415) | (192,834) | $ (1,000) | |
Foreign currency and other adjustments | (8,816) | (16,294) | ||
Ending balance | $ 9,294,479 | 9,407,317 | 9,294,479 | 9,415,295 |
Goodwill | 9,883,410 | |||
Accumulated impairment charges | (476,093) | |||
U.S. Dialysis And Related Lab Services | ||||
Goodwill [Line Items] | ||||
Beginning balance | 5,629,183 | 5,610,643 | ||
Acquisitions | 75,295 | 21,910 | ||
Divestitures | (12,891) | (3,370) | ||
Ending balance | 5,629,183 | 5,691,587 | 5,629,183 | 5,610,643 |
Goodwill | 5,691,587 | |||
DaVita Medical Group (DMG) | ||||
Goodwill [Line Items] | ||||
Beginning balance | 3,398,264 | 3,562,534 | ||
Acquisitions | 248,901 | 29,910 | ||
Divestitures | (2,223) | (5,411) | ||
Goodwill impairment charges | (188,769) | (253,000) | (188,769) | |
Ending balance | 3,398,264 | 3,391,942 | 3,398,264 | 3,562,534 |
Goodwill | 3,833,711 | |||
Accumulated impairment charges | (441,769) | |||
Other ancillary services and strategic initiatives | ||||
Goodwill [Line Items] | ||||
Beginning balance | 267,032 | 242,118 | ||
Acquisitions | 123,632 | 45,273 | ||
Divestitures | (29,645) | |||
Goodwill impairment charges | (28,415) | (4,065) | ||
Foreign currency and other adjustments | (8,816) | (16,294) | ||
Ending balance | $ 267,032 | 323,788 | $ 267,032 | $ 242,118 |
Goodwill | 358,112 | |||
Accumulated impairment charges | $ (34,324) |
Goodwill - Additional Informati
Goodwill - Additional Information (Detail) - USD ($) | 3 Months Ended | 12 Months Ended | ||
Dec. 31, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Goodwill [Line Items] | ||||
Goodwill impairment charges | $ 281,415,000 | $ 192,834,000 | $ 1,000,000 | |
DaVita Medical Group (DMG) | ||||
Goodwill [Line Items] | ||||
Goodwill impairment charges | $ 188,769,000 | 253,000,000 | $ 188,769,000 | |
Reporting Units Other Than DaVita Medical Group | ||||
Goodwill [Line Items] | ||||
Goodwill impairment charges | $ 0 |
Schedule of Goodwill and Indefi
Schedule of Goodwill and Indefinite-Lived Intangible Asset Impairment Charges (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | ||
Dec. 31, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Goodwill [Line Items] | ||||
Total goodwill impairment charges | $ 281,415 | $ 192,834 | $ 1,000 | |
International operations | ||||
Goodwill [Line Items] | ||||
Total goodwill impairment charges | 4,065 | $ 1,000 | ||
DaVita Medical Group (DMG) | ||||
Goodwill [Line Items] | ||||
Total goodwill impairment charges | $ 188,769 | 253,000 | 188,769 | |
DaVita Medical Group (DMG) | Nevada | ||||
Goodwill [Line Items] | ||||
Total goodwill impairment charges | 161,800 | 181,253 | ||
DaVita Medical Group (DMG) | Arizona | ||||
Goodwill [Line Items] | ||||
Total goodwill impairment charges | 1,716 | |||
DaVita Medical Group (DMG) | Florida | ||||
Goodwill [Line Items] | ||||
Total goodwill impairment charges | 91,200 | $ 5,800 | ||
Vascular access | ||||
Goodwill [Line Items] | ||||
Total goodwill impairment charges | $ 28,415 |
Schedule of Reporting Units Goo
Schedule of Reporting Units Goodwill Balances (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Goodwill [Line Items] | ||||
Goodwill balance as of 12/31/2016 | $ 9,407,317 | $ 9,294,479 | $ 9,415,295 | |
DaVita Medical Group (DMG) | ||||
Goodwill [Line Items] | ||||
Goodwill balance as of 12/31/2016 | 3,391,942 | $ 3,398,264 | $ 3,562,534 | |
DaVita Medical Group (DMG) | Nevada | ||||
Goodwill [Line Items] | ||||
Goodwill balance as of 12/31/2016 | $ 261,204 | |||
Carrying amount coverage | [1] | 11.40% | ||
Sensitivities, Operating Income | [2] | (2.20%) | ||
Sensitivities, Discount rate | [3] | (3.90%) | ||
DaVita Medical Group (DMG) | Florida | ||||
Goodwill [Line Items] | ||||
Goodwill balance as of 12/31/2016 | $ 442,835 | |||
Carrying amount coverage | [1] | 7.10% | ||
Sensitivities, Operating Income | [2] | (1.70%) | ||
Sensitivities, Discount rate | [3] | (3.20%) | ||
DaVita Medical Group (DMG) | New Mexico | ||||
Goodwill [Line Items] | ||||
Goodwill balance as of 12/31/2016 | $ 70,926 | |||
Carrying amount coverage | [1] | 2.60% | ||
Sensitivities, Operating Income | [2] | (1.50%) | ||
Sensitivities, Discount rate | [3] | (2.20%) | ||
DaVita Medical Group (DMG) | Washington | ||||
Goodwill [Line Items] | ||||
Goodwill balance as of 12/31/2016 | $ 244,502 | |||
Carrying amount coverage | [1] | 3.70% | ||
Sensitivities, Operating Income | [2] | (1.80%) | ||
Sensitivities, Discount rate | [3] | (3.40%) | ||
Vascular access | ||||
Goodwill [Line Items] | ||||
Goodwill balance as of 12/31/2016 | $ 34,696 | |||
Carrying amount coverage | [1] | 4.30% | ||
Sensitivities, Operating Income | [2] | (2.70%) | ||
Sensitivities, Discount rate | [3] | (5.30%) | ||
[1] | Excess of estimated fair value of the reporting unit over carrying amount as of the latest assessment date | |||
[2] | Potential impact on estimated fair value of a sustained, long-term reduction of 3% in operating income as of the latest assessment date. | |||
[3] | Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date. |
Schedule of Reporting Units G79
Schedule of Reporting Units Goodwill Balances (Parenthetical) (Detail) | Nov. 01, 2016 |
Goodwill And Intangible Assets Disclosure [Abstract] | |
Decrease in operating income percentage used for assessment of fair values | 3.00% |
Increase in discount rates used for assessment of fair values | 1.00% |
Other Liabilities (Detail)
Other Liabilities (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Other Liabilities Disclosure [Abstract] | ||
Payor refunds and retractions | $ 277,482 | $ 153,104 |
Contingent earn-out consideration | 7,217 | 29,050 |
Insurance and self-insurance accruals | 80,437 | 80,355 |
Accrued interest | 82,234 | 81,585 |
Other medical payables | 36,645 | 53,687 |
Accrued non-income tax liabilities | 27,759 | 29,291 |
Other | 345,073 | 255,051 |
Other liabilities | $ 856,847 | $ 682,123 |
Components of Changes in Health
Components of Changes in Healthcare Costs Payable (Detail) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2016 | Dec. 31, 2015 | |
Medical Expense And Medical Claims Payable [Line Items] | ||
Healthcare costs payable, beginning of the year | $ 332,102 | |
Less: Claims paid | ||
Healthcare costs payable, end of the year | 336,381 | $ 332,102 |
Healthcare Cost | ||
Medical Expense And Medical Claims Payable [Line Items] | ||
Healthcare costs payable, beginning of the year | 212,641 | 214,405 |
Add: Components of incurred healthcare costs | ||
Current year | 1,673,742 | 1,587,036 |
Prior years | (141) | 1,523 |
Total incurred healthcare costs | 1,673,601 | 1,588,559 |
Less: Claims paid | ||
Current year | 1,473,723 | 1,397,378 |
Prior years | 198,244 | 192,945 |
Total claims paid | 1,671,967 | 1,590,323 |
Healthcare costs payable, end of the year | $ 214,275 | $ 212,641 |
Schedule of Income Before Incom
Schedule of Income Before Income Taxes (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Income Tax Disclosure [Abstract] | |||
Domestic | $ 1,144,544 | $ 764,998 | $ 1,341,208 |
International | 344,351 | (41,862) | (31,535) |
Income before income taxes | $ 1,488,895 | $ 723,136 | $ 1,309,673 |
Components of Income Tax Expens
Components of Income Tax Expense (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Current: | |||
Federal | $ 337,178 | $ 183,263 | $ 188,302 |
State | 48,771 | 30,766 | 30,789 |
International | 1,928 | 856 | 1,687 |
Total current income tax | 387,877 | 214,885 | 220,778 |
Deferred: | |||
Federal | 93,214 | 88,718 | 192,267 |
State | (27,764) | (8,307) | 32,360 |
International | 2,486 | 430 | 938 |
Total deferred income tax | 67,936 | 80,841 | 225,565 |
Income Tax Expense (Benefit), Continuing Operations and Discontinued Operations, Total | $ 455,813 | $ 295,726 | $ 446,343 |
Reconciliation between U.S. Fed
Reconciliation between U.S. Federal Income Tax Rate and our Effective Tax Rate from Continuing Operations (Detail) | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Income Tax Disclosure [Abstract] | |||
Federal income tax rate | 35.00% | 35.00% | 35.00% |
State income taxes, net of federal benefit | 1.20% | 2.50% | 3.50% |
International rate differential | 0.20% | (1.10%) | (0.20%) |
Gain on APAC JV ownership changes | (9.80%) | ||
Goodwill impairments | 6.70% | 11.70% | |
Changes in deferred tax valuation allowances | 0.60% | 2.60% | 0.60% |
Other | 0.20% | 1.50% | (0.80%) |
Impact of noncontrolling interests primarily attributable to non-tax paying entities | (3.50%) | (11.30%) | (4.00%) |
Effective tax rate | 30.60% | 40.90% | 34.10% |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Detail) - USD ($) | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Income Taxes [Line Items] | |||
Undistributed earnings of foreign operations | $ 381,523,000 | ||
Non-taxable gain on the APAC JV ownership changes | 404,165,000 | ||
Deferred tax liability recognized for remittance of earnings | 0 | ||
Decrease in valuation allowance related to changes in the estimated tax benefit of federal and state operating losses of separate-return entities | 1,795,000 | ||
Increase in realizability of losses in certain foreign and state jurisdictions | 8,339,000 | ||
Decrease relating to the APAC JV ownership changes | (13,105,000) | $ (55,826,000) | $ (5,002,000) |
Liability for unrecognized tax benefits | 24,066,000 | 39,011,000 | $ 31,877,000 |
Increase in liability for unrecognized tax benefits | (14,945,000) | ||
Accrued interest and penalties related to unrecognized tax benefits, net of federal tax benefits | 2,595,000 | $ 9,918,000 | |
Domestic Tax Authority | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards | $ 155,790,000 | ||
Net operating loss carryforwards, expiration beginning year | 2,028 | ||
Domestic Tax Authority | Maximum | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards, expiration year | 2,035 | ||
State | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards | $ 836,774,000 | ||
State | Maximum | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards, expiration year | 2,036 | ||
Foreign Tax Authority | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards | $ 97,281,000 | ||
APAC JV | |||
Income Taxes [Line Items] | |||
Non-taxable gain on the APAC JV ownership changes | 374,374,000 | ||
Decrease relating to the APAC JV ownership changes | $ (10,134,000) |
Deferred Tax and Liabilities Ar
Deferred Tax and Liabilities Arising from Temporary Differences (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Income Tax Disclosure [Abstract] | ||
Receivables | $ 19,283 | $ 43,393 |
Accrued liabilities | 318,596 | 272,080 |
Net operating loss carryforwards | 130,456 | 130,977 |
Other | 147,487 | 114,805 |
Deferred tax assets | 615,822 | 561,255 |
Valuation allowance | (56,016) | (57,811) |
Net deferred tax assets | 559,806 | 503,444 |
Intangible assets | (1,025,488) | (927,761) |
Property and equipment | (230,870) | (205,071) |
Investments in partnerships | (95,936) | (83,584) |
Other | (16,640) | (13,990) |
Deferred tax liabilities | (1,368,934) | (1,230,406) |
Net deferred tax liabilities | $ (809,128) | $ (726,962) |
Reconciliation of Beginning and
Reconciliation of Beginning and Ending Liability for Unrecognized Tax Benefits that Do Not Meet More-Likely-than-not Threshold (Detail) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2016 | Dec. 31, 2015 | |
Income Tax Disclosure [Abstract] | ||
Beginning balance | $ 39,011 | $ 31,877 |
Additions for tax positions related to current year | 9,714 | 6,131 |
Additions for tax positions related to prior years | 2,999 | |
Reductions related to lapse of applicable statute | (1,277) | (1,996) |
Reductions related to settlements with taxing authorities | (23,382) | |
Ending balance | $ 24,066 | $ 39,011 |
Long-term Debt (Detail)
Long-term Debt (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Debt Instrument [Line Items] | ||
Senior notes | $ 4,500,000 | $ 4,500,000 |
Acquisition obligations and other notes payable | 117,547 | 70,645 |
Capital lease obligations | 299,682 | 283,185 |
Total debt principal outstanding | 9,192,229 | 9,226,330 |
Discount and deferred financing costs | (79,861) | (95,985) |
Carrying Amount of Long-Term Debt, Net of Unamortized Discount or Premium, Current and Noncurrent, Total | 9,112,368 | 9,130,345 |
Less current portion | (165,041) | (129,037) |
Long-term debt | 8,947,327 | 9,001,308 |
Term Loan A | ||
Debt Instrument [Line Items] | ||
Senior Secured Credit Facilities | 862,500 | 925,000 |
Term Loan B | ||
Debt Instrument [Line Items] | ||
Senior Secured Credit Facilities | $ 3,412,500 | $ 3,447,500 |
Scheduled Maturities of Long-te
Scheduled Maturities of Long-term Debt (Detail) $ in Thousands | Dec. 31, 2016USD ($) |
Debt Disclosure [Abstract] | |
2,017 | $ 165,041 |
2,018 | 167,684 |
2,019 | 747,871 |
2,020 | 69,508 |
2,021 | 3,300,437 |
Thereafter | $ 4,741,688 |
Long-term Debt - Additional Inf
Long-term Debt - Additional Information (Detail) - USD ($) | 1 Months Ended | 12 Months Ended | ||
Apr. 30, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Debt Instrument [Line Items] | ||||
Senior notes | $ 4,500,000,000 | $ 4,500,000,000 | ||
Debt expense recognized | 394,279,000 | 389,755,000 | $ 385,750,000 | |
Unrealized losses on interest rate swap and cap agreements | $ (3,670,000) | (12,241,000) | (10,059,000) | |
Weighted average effective interest rate | 4.52% | |||
Weighted average effective interest rate | 4.43% | |||
Amortization of deferred financing costs | $ 20,103,000 | 18,625,000 | $ 24,544,000 | |
DaVita Medical Group (DMG) | ||||
Debt Instrument [Line Items] | ||||
Outstanding letters of credit | 1,286,000 | |||
Letter of Credit | ||||
Debt Instrument [Line Items] | ||||
Outstanding letters of credit | 95,629,000 | |||
Interest rate cap agreements | ||||
Debt Instrument [Line Items] | ||||
Interest rate agreements, notional amount | $ 3,500,000,000 | |||
Derivative, effective date | Jun. 29, 2018 | |||
Interest Rate Cap Agreements Effective September 30, 2016 | ||||
Debt Instrument [Line Items] | ||||
Interest rate agreements, notional amount | $ 3,500,000,000 | |||
Derivative, effective date | Sep. 30, 2016 | |||
Derivative, expiration date | Jun. 30, 2018 | |||
Fair value of assets | $ 116,000 | |||
Debt expense recognized | 2,070,000 | |||
Unrealized losses on interest rate swap and cap agreements | (1,196,000) | |||
Interest Rate Cap Agreements Effective June 29, 2018 | ||||
Debt Instrument [Line Items] | ||||
Interest rate agreements, notional amount | $ 3,500,000,000 | |||
Derivative, effective date | Jun. 29, 2018 | |||
Derivative, expiration date | Jun. 30, 2020 | |||
Fair value of assets | $ 9,813,000 | |||
Unrealized losses on interest rate swap and cap agreements | (4,002,000) | |||
Term Loan A | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, annual principal payment | 62,500,000 | |||
Senior Secured Credit Facilities | $ 862,500,000 | 925,000,000 | ||
Term Loan A | Interest rate swap agreements | ||||
Debt Instrument [Line Items] | ||||
Derivative, expiration date | Sep. 30, 2016 | |||
Debt expense recognized | $ 299,000 | |||
Amount of gains (losses) recognized in OCI on swaps arising during the period net of tax | $ (815,000) | |||
Term Loan B | ||||
Debt Instrument [Line Items] | ||||
Debt instrument Interest rate | 0.75% | |||
Debt instrument, annual principal payment | $ 35,000,000 | |||
Senior Secured Credit Facilities | 3,412,500,000 | $ 3,447,500,000 | ||
Term Loan B | Interest rate cap agreements | ||||
Debt Instrument [Line Items] | ||||
Interest rate agreements, notional amount | $ 2,735,000,000 | |||
Derivative, expiration date | Sep. 30, 2016 | |||
Debt expense recognized | $ 1,829,000 | |||
Term Loan B | Maximum | Interest rate cap agreements 1 | ||||
Debt Instrument [Line Items] | ||||
Debt instrument Interest rate | 3.50% | |||
Interest rate agreements, notional amount | $ 3,500,000,000 | |||
Remaining outstanding debt | $ 775,000,000 | |||
Term Loan B | Maximum | Interest rate cap agreements | ||||
Debt Instrument [Line Items] | ||||
LIBOR interest rate for interest cap | 3.50% | |||
Senior Secured Credit Facilities | ||||
Debt Instrument [Line Items] | ||||
Undrawn revolving credit facilities | $ 1,000,000,000 | |||
Weighted average effective interest rate | 3.68% | |||
Term Loan A subject to interest rate caps | ||||
Debt Instrument [Line Items] | ||||
Senior Secured Credit Facilities | $ 87,500,000 | |||
Term Loan A subject to uncapped portion of variability of LIBOR | ||||
Debt Instrument [Line Items] | ||||
Senior Secured Credit Facilities | $ 775,000,000 | |||
London Interbank Offered Rate (LIBOR) | Interest Rate Cap Agreements Effective September 30, 2016 | ||||
Debt Instrument [Line Items] | ||||
LIBOR cap rate | 3.50% | |||
London Interbank Offered Rate (LIBOR) | Interest Rate Cap Agreements Effective June 29, 2018 | ||||
Debt Instrument [Line Items] | ||||
LIBOR cap rate | 3.50% | |||
London Interbank Offered Rate (LIBOR) | Term Loan A | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, variable interest rate margin | 1.75% | |||
London Interbank Offered Rate (LIBOR) | Term Loan A | Maximum | Interest rate swap agreements | ||||
Debt Instrument [Line Items] | ||||
Fixed interest rate | 0.52% | |||
London Interbank Offered Rate (LIBOR) | Term Loan A | Minimum | Interest rate swap agreements | ||||
Debt Instrument [Line Items] | ||||
Fixed interest rate | 0.49% | |||
London Interbank Offered Rate (LIBOR) | Term Loan B | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, variable interest rate margin | 2.75% | |||
London Interbank Offered Rate (LIBOR) | Term Loan B | Interest rate cap agreements | ||||
Debt Instrument [Line Items] | ||||
LIBOR cap rate | 2.50% | |||
London Interbank Offered Rate (LIBOR) | Term Loan B | Maximum | ||||
Debt Instrument [Line Items] | ||||
Debt instrument, variable interest rate margin | 3.50% | |||
Term Loan A Term Loan B | ||||
Debt Instrument [Line Items] | ||||
Interest rate description | At December 31, 2016, the overall weighted average interest rate for Term Loan A was determined based upon the LIBOR interest rates in effect for all of the individual tranches plus the interest rate margin of 1.75%. | |||
Term Loan A Term Loan B | Maximum | ||||
Debt Instrument [Line Items] | ||||
Term Loan A and Term Loan B maturity date range | 12 months | |||
Term Loan A Term Loan B | Minimum | ||||
Debt Instrument [Line Items] | ||||
Term Loan A and Term Loan B maturity date range | 1 month | |||
Senior Notes 5.0 Percent Due 2025 | ||||
Debt Instrument [Line Items] | ||||
Senior notes | $ 1,500,000,000 | |||
Senior note, interest rate | 5.00% | 5.00% | ||
Senior note, due date | 2,025 | 2,025 | ||
Senior notes, principal balance | $ 1,500,000,000 | |||
Debt Instrument, frequency of periodic payment | The 5.0% Senior Notes pay interest on May 1 and November 1 | |||
Senior notes interest payment, first required payment date | Nov. 1, 2015 | |||
Debt instrument, redemption description | The Company may redeem up to 35% of the 5.0% Senior Notes at any time prior to May 1, 2018 at a certain specified price from the proceeds of one or more equity offerings. In addition, the Company may redeem some or all of the 5.0% Senior Notes at any time prior to May 1, 2020 at make-whole redemption rates and on or after such date at certain specified redemption prices. | |||
Senior Notes 5.0 Percent Due 2025 | Senior Notes Redemption Period One | ||||
Debt Instrument [Line Items] | ||||
End date of debt instrument redemption period | May 1, 2018 | |||
Senior Notes 5.0 Percent Due 2025 | Senior Notes Redemption Period Two | ||||
Debt Instrument [Line Items] | ||||
End date of debt instrument redemption period | May 1, 2020 | |||
Senior Notes 5.0 Percent Due 2025 | Maximum | ||||
Debt Instrument [Line Items] | ||||
Debt Instrument, redemption price percentage | 35.00% | |||
Senior Notes 5.125 Percent Due 2024 | ||||
Debt Instrument [Line Items] | ||||
Senior notes | $ 1,750,000,000 | |||
Senior note, interest rate | 5.125% | |||
Senior note, due date | 2,024 | |||
Senior Notes 5.75 Percent Due 2022 | ||||
Debt Instrument [Line Items] | ||||
Senior notes | $ 1,250,000,000 | |||
Senior note, interest rate | 5.75% | |||
Senior note, due date | 2,022 | |||
Senior Notes 6.625 Percent Due 2020 | ||||
Debt Instrument [Line Items] | ||||
Senior note, interest rate | 6.625% | |||
Senior note, due date | 2,020 | |||
Senior notes, principal balance | $ 775,000,000 | |||
Debt redemption and refinance charges | $ 48,072,000 |
Derivative Instruments (Detail)
Derivative Instruments (Detail) - Designated as Hedging Instrument - USD ($) $ in Thousands | Dec. 31, 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 | $ 9,929 | $ 15,127 |
Effects of Interest Rate Swap a
Effects of Interest Rate Swap and Cap Agreements (Detail) - Cash Flow Hedging - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Derivative Instruments Gain Loss [Line Items] | |||
Amount of losses recognized in OCI on interest rate swap and cap agreements | $ (3,670) | $ (12,241) | $ (10,059) |
Amount of gains reclassified from accumulated OCI into income | 2,566 | 3,111 | 10,608 |
Tax benefit (expense) | |||
Derivative Instruments Gain Loss [Line Items] | |||
Amount of losses recognized in OCI on interest rate swap and cap agreements | 2,343 | 7,844 | 6,450 |
Amount of gains reclassified from accumulated OCI into income | (1,632) | (1,992) | (6,801) |
Interest rate swap agreements | Debt Expense (Including Refinancing Charges) | |||
Derivative Instruments Gain Loss [Line Items] | |||
Amount of losses recognized in OCI on interest rate swap and cap agreements | (815) | (3,971) | (8,390) |
Amount of gains reclassified from accumulated OCI into income | 299 | 2,664 | 12,279 |
Interest rate cap agreements | Debt Expense (Including Refinancing Charges) | |||
Derivative Instruments Gain Loss [Line Items] | |||
Amount of losses recognized in OCI on interest rate swap and cap agreements | (5,198) | (16,114) | (8,119) |
Amount of gains reclassified from accumulated OCI into income | $ 3,899 | $ 2,439 | $ 5,130 |
Leases - Additional Information
Leases - Additional Information (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Leases Disclosure [Line Items] | |||
Rent expense under all operating leases | $ 563,204 | $ 514,287 | $ 460,093 |
Net book value of property and equipment under capital leases | $ 263,995 | $ 261,960 | |
Minimum | |||
Leases Disclosure [Line Items] | |||
Facilities leased under non-cancellable operating leases term range | 5 years | ||
Facilities leased under non-cancellable operating leases renewal option range | 5 years | ||
Maximum | |||
Leases Disclosure [Line Items] | |||
Facilities leased under non-cancellable operating leases term range | 15 years | ||
Facilities leased under non-cancellable operating leases renewal option range | 10 years |
Future Minimum Lease Payments U
Future Minimum Lease Payments Under Non-cancelable Operating and Capital Leases (Detail) $ in Thousands | Dec. 31, 2016USD ($) |
Operating leases | |
2,017 | $ 473,302 |
2,018 | 442,959 |
2,019 | 401,242 |
2,020 | 354,559 |
2,021 | 310,704 |
Thereafter | 1,244,309 |
Operating Leases, Future Minimum Payments Due, Total | 3,227,075 |
Capital leases | |
2,017 | 37,758 |
2,018 | 34,442 |
2,019 | 35,292 |
2,020 | 35,575 |
2,021 | 31,133 |
Thereafter | 232,191 |
Capital Leases, Future Minimum Payments Due, Total | 406,391 |
Less portion representing interest | (106,709) |
Total capital lease obligations, including current portion | $ 299,682 |
Employee Benefit Plans - Additi
Employee Benefit Plans - Additional Information (Detail) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016USD ($)Plan | Dec. 31, 2015USD ($) | Dec. 31, 2014USD ($) | |
DaVita Voluntary Deferral Plan | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Number of non-qualified voluntary compensation deferral plans | Plan | 2 | ||
Nonqualified Deferred Compensation Plan | All Trusts | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Total fair value of assets held in trust | $ 45,233 | $ 33,482 | |
Nonqualified Deferred Compensation Plan | DaVita Voluntary Deferral Plan | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Voluntary compensation deferral plan description | The Company also maintains a voluntary compensation deferral plan, the DaVita Voluntary Deferral Plan. This plan is non-qualified and permits certain employees whose annualized base salary equals or exceeds a minimum annual threshold amount as set by the Company to elect to defer all or a portion of their annual bonus payment and up to 50% of their base salary into a deferral account maintained by the Company | ||
Maximum percentage of employees' base salary to be maintained into deferral account | 50.00% | ||
Non-qualified deferred compensation plan, contributions | $ 5,344 | 4,234 | $ 3,772 |
Deferred compensation arrangement, timing of payments | Deferred amounts are generally paid out in cash at the participant’s election either in the first or second year following retirement or in a specified future period at least three to four years after the deferral election was effective | ||
Non-qualified deferred compensation plan, distributions | $ 916 | 1,270 | 1,111 |
Total fair value of assets held in trust | 14,036 | 8,578 | |
Nonqualified Deferred Compensation Plan | DaVita Voluntary Deferral Plan | Rabbi Trust | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Total fair value of assets held in trust | 30,191 | 23,800 | |
Nonqualified Deferred Compensation Plan | Executive Retirement Plan | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Total fair value of assets held in trust | 1,005 | 1,104 | |
Executive Retirement Plan, distributions | 149 | 25 | 0 |
Change of Control Protection Program | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Cash bonuses to employees in the event of a change of control | 492,645 | ||
DaVita Medical Group (DMG) | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Company matching contributions | 11,266 | 8,324 | 7,400 |
DaVita Medical Group (DMG) | Nonqualified Deferred Compensation Plan | Key Employees | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Non-qualified deferred compensation plan, contributions | 0 | 0 | $ 0 |
Cash surrender value of life insurance policies | 59,646 | 56,840 | |
Deferred compensation liabilities owed to participants | $ 54,486 | $ 52,128 | |
DaVita Medical Group (DMG) | Maximum | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Multiple employer matching contributions rate | 4.00% |
Contingencies - Additional Info
Contingencies - Additional Information (Detail) $ in Thousands | 1 Months Ended | 12 Months Ended | |||
Jan. 31, 2017USD ($) | Mar. 31, 2016USD ($) | Jun. 30, 2015USD ($) | Dec. 31, 2012Entity | Dec. 31, 2016USD ($) | |
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 accruals for potential damages and liabilities | $ 38,330 | ||||
Solari Post-Acquisition Matter | |||||
Other Commitments [Line Items] | |||||
Estimated accruals for potential damages and liabilities | $ 16,000 | ||||
U.S. Department of Veterans Affairs (VA) | Subsequent Event | |||||
Other Commitments [Line Items] | |||||
Litigation settlement amount | $ 538,000 |
Noncontrolling Interests Subj97
Noncontrolling Interests Subject to Put Provisions and Other Commitments - Additional Information (Detail) - USD ($) $ in Thousands | 1 Months Ended | 12 Months Ended | ||
Jan. 31, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Commitments And Contingencies Disclosure [Line Items] | ||||
Schedule of Joint ventures to dissolve | Certain consolidated joint ventures are originally contractually scheduled to dissolve after terms ranging from 10 to 50 years. | |||
DaVita Medical Group (DMG) | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Required minimum cash balance | $ 60,796 | |||
Epogen | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Long term purchase commitment, expiration date | Dec. 31, 2018 | |||
Epogen | Subsequent Event | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Long term purchase commitment, period | 6 years | |||
Long term purchase commitment, expiration date | Dec. 31, 2022 | |||
Dialysis Equipment, Parts and Supplies | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Long-term purchase commitment, time period | In 2010, the Company entered into an agreement with Fresenius Medical Care (FMC) which committed the Company to purchase a certain amount of dialysis equipment, parts and supplies from FMC through 2013. This agreement has been subsequently extended through December 31, 2017. | |||
Long term purchase commitment, expiration year | 2,013 | |||
Purchase commitment, purchase during the period | $ 164,766 | $ 154,566 | $ 154,266 | |
Dialysis Equipment, Parts and Supplies | Extended Expiration | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Long term purchase commitment, expiration month | 2016-02 | |||
Hemodialysis Products, Supplies and Equipment | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Long-term purchase commitment, time period | In 2014, the Company entered into an agreement with Baxter Healthcare (Baxter) which committed the Company to purchase a certain amount of its hemodialysis non-equipment product supplies, such as dialyzers, at fixed prices through 2018 | |||
Long term purchase commitment, expiration year | 2,018 | |||
Purchase commitment, purchase during the period | $ 162,109 | $ 112,931 | $ 112,645 | |
Minimum | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Scheduled dissolution term of joint ventures | 10 years | |||
Minimum | Epogen | Subsequent Event | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Long-term purchase commitment, percentage of quantity required | 90.00% | |||
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 | $ 1,500 |
Long-term incentive compensat98
Long-term incentive compensation and shareholders' equity - Additional Information (Detail) - USD ($) | Jun. 30, 2016 | Dec. 31, 2015 | Feb. 24, 2017 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | Jul. 13, 2016 | Jun. 20, 2016 | Apr. 30, 2015 |
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Shares available for future grants | 7,500,000 | ||||||||
Aggregate intrinsic value of stock awards exercised | $ 73,001,000 | $ 116,933,000 | $ 151,342,000 | ||||||
Aggregate intrinsic value of stock awards outstanding | 79,717,000 | ||||||||
Aggregate intrinsic value exercisable | 23,566,000 | ||||||||
Contributions used to purchase stock accumulated through payroll withholdings or through optional lump sum payments | $ 741,926,000 | 815,761,000 | 741,926,000 | ||||||
Long-term incentive program (LTIP) expense | 73,337,000 | 130,682,000 | 118,970,000 | ||||||
Stock-based compensation expense | 38,338,000 | 56,664,000 | 56,743,000 | ||||||
Estimated tax benefits recorded for stock-based compensation | 12,731,000 | 19,689,000 | 20,351,000 | ||||||
Unrecognized compensation cost related to outstanding LTIP awards | 92,987,000 | ||||||||
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans | $ 59,016,000 | ||||||||
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 | $ 28,397,000 | 45,749,000 | 59,119,000 | ||||||
Proceeds from stock option exercises | $ 0 | $ 0 | 0 | ||||||
Purchase of treasury stock (in shares) | 16,649,090 | 7,779,958 | |||||||
Purchase of treasury stock | $ 1,072,377,000 | $ 575,380,000 | |||||||
Purchase of treasury stock, average price per share | $ 64.41 | $ 73.96 | |||||||
Share repurchase program, authorized amount | $ 1,240,748,000 | $ 259,252,000 | |||||||
Share repurchase program, available under the current board authorizations for additional share repurchase | $ 677,104,000 | ||||||||
Charter documents and Delaware law description | The Company’s charter documents include provisions that may deter hostile takeovers, delay or prevent changes of control or changes in management, or limit the ability of stockholders to approve transactions that they may otherwise determine to be in their best interests. These include provisions prohibiting stockholders from acting by written consent, requiring 90 days advance notice of stockholder proposals or nominations to the Board of Directors and granting the Board of Directors the authority to issue up to five million shares of preferred stock and to determine the rights and preferences of the preferred stock without the need for further stockholder approval. The Company is also subject to Section 203 of the Delaware General Corporation Law which, subject to exceptions, would prohibit the Company from engaging in any business combinations with any interested stockholder, as defined in that section, for a period of three years following the date on which that stockholder became an interested stockholder. These restrictions may discourage, delay or prevent a change in the control of the Company. | ||||||||
Preferred stock authorized to be issued | 5,000,000 | 5,000,000 | 5,000,000 | ||||||
Acquisition of additional ownership interests in several existing majority-owned joint ventures | $ 21,512,000 | $ 66,382,000 | 17,876,000 | ||||||
Deferred purchase price obligations | $ 136,000 | ||||||||
Subsequent Event | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Purchase of treasury stock (in shares) | 0 | ||||||||
Stock Incentive Plan 2011 | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Shares available for future grants | 30,543,883 | ||||||||
Stock Incentive Plan 2011 | Minimum | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Vesting period | 36 months | ||||||||
Stock Incentive Plan 2011 | Maximum | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Terms of award (in years) | 5 years | ||||||||
Vesting period | 48 months | ||||||||
Stock Appreciation Rights | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Outstanding balance | 8,533,561 | 7,337,266 | 8,533,561 | ||||||
Weighted average fair value | $ 13.74 | $ 17.97 | $ 16.41 | ||||||
Stock Appreciation Rights | Stock Incentive Plan 2011 | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Outstanding balance | 7,337,266 | ||||||||
Cash-settled stock appreciation | Stock Incentive Plan 2011 | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Outstanding balance | 33,000 | ||||||||
Stock Settled Stock Units | Stock Incentive Plan 2011 | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Outstanding balance | 785,553 | ||||||||
Cash Settled Stock Units | Stock Incentive Plan 2011 | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Outstanding balance | 1,600 | ||||||||
Cash-settled stock-based awards | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Stock granted | 9,600,000 | ||||||||
Liability-classified share awards | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Outstanding balance | 34,600 | ||||||||
Stock-based compensation expense, fair value adjustment | $ 376,000 | $ (236,000) | $ 1,774,000 | ||||||
Shares vested in period | 5,000 | ||||||||
Stock-based compensation liability | $ 124,000 | ||||||||
Employee stock purchase plan | |||||||||
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||||||||
Shares available for future grants | 7,484,395 | ||||||||
Employee entitlement for purchase of the Company's common stock during each calendar year | $ 25,000 | ||||||||
Stock purchase price as percentage of fair market value | 100.00% | 100.00% | 85.00% | ||||||
Contributions used to purchase stock accumulated through payroll withholdings or through optional lump sum payments | $ 24,523,000 | $ 23,902,000 | $ 24,523,000 | $ 19,010,000 | |||||
Stock issued for employee stock purchase plans | 438,002 | 413,859 | 297,954 | ||||||
Expected volatility Rate | 22.00% | 26.00% | 27.00% | ||||||
Risk-free interest rate | 0.80% | 0.20% | 0.20% | ||||||
Expected Dividend | $ 0 | $ 0 | $ 0 | ||||||
Weighted average fair value | $ 16.73 | $ 18.76 | $ 16.40 |
Summary of Status of Awards Und
Summary of Status of Awards Under Stock-Based Compensation Plans and Agreements (Detail) - $ / shares | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Stock Appreciation Rights | |||
Awards | |||
Outstanding at beginning of year | 8,533,561 | ||
Granted | 1,280,034 | ||
Exercised | (2,031,593) | ||
Cancelled | (444,736) | ||
Outstanding at end of period | 7,337,266 | 8,533,561 | |
Exercisable at end of period | 3,026,721 | ||
Weighted-average fair value of awards granted | $ 13.74 | $ 17.97 | $ 16.41 |
Weighted average exercise price | |||
Outstanding at beginning of year | 59.05 | ||
Granted | 73.40 | ||
Exercised | 45.35 | ||
Cancelled | 66.50 | ||
Outstanding at end of period | 64.90 | $ 59.05 | |
Exercisable at end of period | $ 56.83 | ||
Weighted average remaining contractual life | |||
Outstanding at end of period | 2 years 2 months 12 days | ||
Exercisable at end of period | 1 year 1 month 6 days | ||
Stock Unit | |||
Awards | |||
Outstanding at beginning of year | 765,060 | ||
Granted | 328,457 | ||
Exercised | (280,197) | ||
Cancelled | (27,767) | ||
Outstanding at end of period | 785,553 | 765,060 | |
Weighted-average fair value of awards granted | $ 70.99 | $ 80.25 | $ 72.24 |
Weighted average remaining contractual life | |||
Outstanding at end of period | 1 year 10 months 24 days | ||
Exercisable at end of period | 0 years |
Summary of Range of Exercise Pr
Summary of Range of Exercise Prices (Detail) | 12 Months Ended |
Dec. 31, 2016$ / sharesshares | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Awards outstanding | shares | 7,337,266 |
Weighted average exercise price | $ 64.90 |
Awards exercisable | shares | 3,026,721 |
Weighted average exercise price | $ 56.83 |
Range 1 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Range of exercise prices, lower range | 30.01 |
Range of exercise prices, upper range | $ 40 |
Awards outstanding | shares | 16,000 |
Weighted average exercise price | $ 39.89 |
Awards exercisable | shares | 16,000 |
Weighted average exercise price | $ 39.89 |
Range 2 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Range of exercise prices, lower range | 40.01 |
Range of exercise prices, upper range | $ 50 |
Awards outstanding | shares | 267,621 |
Weighted average exercise price | $ 44.44 |
Awards exercisable | shares | 267,621 |
Weighted average exercise price | $ 44.44 |
Range 3 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Range of exercise prices, lower range | 50.01 |
Range of exercise prices, upper range | $ 60 |
Awards outstanding | shares | 3,489,398 |
Weighted average exercise price | $ 57.53 |
Awards exercisable | shares | 2,420,035 |
Weighted average exercise price | $ 56.84 |
Range 4 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Range of exercise prices, lower range | 60.01 |
Range of exercise prices, upper range | $ 70 |
Awards outstanding | shares | 1,306,049 |
Weighted average exercise price | $ 67.46 |
Awards exercisable | shares | 232,816 |
Weighted average exercise price | $ 65.04 |
Range 5 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Range of exercise prices, lower range | 70.01 |
Range of exercise prices, upper range | $ 80 |
Awards outstanding | shares | 1,581,487 |
Weighted average exercise price | $ 74.76 |
Awards exercisable | shares | 50,806 |
Weighted average exercise price | $ 70.44 |
Range 6 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Range of exercise prices, lower range | 80.01 |
Range of exercise prices, upper range | $ 90 |
Awards outstanding | shares | 676,711 |
Weighted average exercise price | $ 83.60 |
Awards exercisable | shares | 39,443 |
Weighted average exercise price | $ 81.51 |
Summary of Weighted Average Val
Summary of Weighted Average Valuation Inputs (Detail) - Stock Options And Stock Appreciation Rights | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Share Based Compensation Arrangement By Share Based Payment Award [Line Items] | |||
Expected term | 4 years 2 months 12 days | 4 years 1 month 6 days | 4 years 2 months 12 days |
Expected volatility | 21.00% | 24.60% | 25.80% |
Expected dividend yield | 0.00% | 0.00% | 0.00% |
Risk-free interest rate | 1.00% | 1.50% | 1.50% |
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 | 12 Months Ended | |||||||||
Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2015 | Sep. 30, 2015 | Jun. 30, 2015 | Mar. 31, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items] | |||||||||||
Net income attributable to DaVita Inc. | $ 157,726 | $ 571,332 | $ 53,382 | $ 97,434 | $ (6,000) | $ 215,872 | $ 170,477 | $ (110,617) | $ 879,874 | $ 269,732 | $ 723,114 |
Net transfer to noncontrolling interests | (13,105) | (55,826) | (5,002) | ||||||||
Change from net income attributable to DaVita Inc. and transfers to noncontrolling interests | 866,769 | 213,906 | 718,112 | ||||||||
Additional paid-in capital | |||||||||||
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items] | |||||||||||
Increase in paid-in capital for sales of noncontrolling interest | 355 | ||||||||||
Decrease in paid-in capital for the purchase of noncontrolling interests | $ (13,105) | $ (55,826) | $ (5,357) |
Other Comprehensive (loss) I103
Other Comprehensive (loss) Income (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Comprehensive Income (Loss) [Line Items] | |||
Beginning balance | $ (59,826) | ||
Ending balance | (89,643) | $ (59,826) | |
Interest rate swaps and cap agreements | |||
Comprehensive Income (Loss) [Line Items] | |||
Beginning balance | (10,925) | (1,795) | $ (2,344) |
Unrealized (losses) gains | (6,013) | (20,085) | (16,509) |
Related income tax | 2,343 | 7,844 | 6,450 |
Unrealized (losses) gains net | (3,670) | (12,241) | (10,059) |
Reclassification from accumulated other comprehensive losses (income) into net income | 4,198 | 5,103 | 17,409 |
Related income tax | (1,632) | (1,992) | (6,801) |
Reclassification from accumulated other comprehensive income into net income net of tax | 2,566 | 3,111 | 10,608 |
Ending balance | (12,029) | (10,925) | (1,795) |
Investment securities | |||
Comprehensive Income (Loss) [Line Items] | |||
Beginning balance | 1,361 | 3,151 | 3,120 |
Unrealized (losses) gains | 1,802 | (1,974) | 425 |
Related income tax | (565) | 561 | (187) |
Unrealized (losses) gains net | 1,237 | (1,413) | 238 |
Reclassification from accumulated other comprehensive losses (income) into net income | (690) | (618) | (340) |
Related income tax | 267 | 241 | 133 |
Reclassification from accumulated other comprehensive income into net income net of tax | (423) | (377) | (207) |
Ending balance | 2,175 | 1,361 | 3,151 |
Foreign currency translation adjustments | |||
Comprehensive Income (Loss) [Line Items] | |||
Beginning balance | (50,262) | (26,373) | (3,421) |
Unrealized (losses) gains | (39,614) | (23,889) | (22,952) |
Unrealized (losses) gains net | (39,614) | (23,889) | (22,952) |
Reclassification from accumulated other comprehensive losses (income) into net income | 10,087 | ||
Reclassification from accumulated other comprehensive income into net income net of tax | 10,087 | ||
Ending balance | (79,789) | (50,262) | (26,373) |
Accumulated other comprehensive income (loss) | |||
Comprehensive Income (Loss) [Line Items] | |||
Beginning balance | (59,826) | (25,017) | (2,645) |
Unrealized (losses) gains | (43,825) | (45,948) | (39,036) |
Related income tax | 1,778 | 8,405 | 6,263 |
Unrealized (losses) gains net | (42,047) | (37,543) | (32,773) |
Reclassification from accumulated other comprehensive losses (income) into net income | 13,595 | 4,485 | 17,069 |
Related income tax | (1,365) | (1,751) | (6,668) |
Reclassification from accumulated other comprehensive income into net income net of tax | 12,230 | 2,734 | 10,401 |
Ending balance | $ (89,643) | $ (59,826) | $ (25,017) |
Acquisitions and Divestitures -
Acquisitions and Divestitures - Additional Information (Detail) $ in Thousands | Aug. 09, 2016USD ($)Clinic | Aug. 01, 2016USD ($) | Jun. 01, 2016USD ($) | Mar. 01, 2016USD ($)ProviderClinic | Dec. 31, 2012Entity | Jun. 30, 2016USD ($) | Dec. 31, 2016USD ($)Entity | Dec. 31, 2015USD ($)Entity | Dec. 31, 2014USD ($)Entity |
Business Acquisition [Line Items] | |||||||||
Gain (loss) on sales of business interests | $ 404,165 | ||||||||
Cash paid to acquire business | $ 563,856 | $ 96,469 | $ 272,094 | ||||||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 7 years | 8 years | 10 years | ||||||
Goodwill deductible for tax purposes associated with acquisitions | $ 173,718 | $ 73,733 | $ 175,247 | ||||||
Contingent earn-out obligations associated with acquisitions | 1,511 | ||||||||
Deferred purchase price obligations | $ 136 | ||||||||
Additional cash consideration in the form of earn-out payments | 7,217 | 29,050 | |||||||
Fair value of contingent earn-out consideration | 9,977 | $ 34,135 | |||||||
Other Accrued Liabilities | |||||||||
Business Acquisition [Line Items] | |||||||||
Fair value of contingent earn-out consideration | 7,217 | ||||||||
Other long-term liabilities | |||||||||
Business Acquisition [Line Items] | |||||||||
Fair value of contingent earn-out consideration | 2,760 | ||||||||
Other companies | |||||||||
Business Acquisition [Line Items] | |||||||||
Additional cash consideration in the form of earn-out payments | 19,557 | ||||||||
Fair value of contingent earn-out consideration | $ 9,977 | ||||||||
Customer relationships | |||||||||
Business Acquisition [Line Items] | |||||||||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 10 years | ||||||||
Noncompetition agreements | |||||||||
Business Acquisition [Line Items] | |||||||||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 7 years | 8 years | 8 years | ||||||
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 | 8 years | ||||||||
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 | ||||||||
Number of providers in primary and specialty | Provider | 500 | ||||||||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 6 years | ||||||||
Goodwill deductible for tax purposes associated with acquisitions | $ 0 | ||||||||
The Everett Clinic Medical Group (TEC) | Minimum | |||||||||
Business Acquisition [Line Items] | |||||||||
Number of dialysis clinic patients | Clinic | 315,000 | ||||||||
Dialysis-related businesses and other ancillary businesses | |||||||||
Business Acquisition [Line Items] | |||||||||
Cash paid to acquire business | 170,169 | $ 96,469 | $ 272,094 | ||||||
Number of businesses acquired | Entity | 2 | ||||||||
Contingent earn-out obligations associated with acquisitions | 1,511 | ||||||||
Deferred purchase price obligations | $ 18,373 | $ 8,395 | $ 23,781 | ||||||
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 | ||||||||
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 | ||||||||
U.S. Dialysis And Related Lab Services | Dialysis-related businesses and other ancillary businesses | |||||||||
Business Acquisition [Line Items] | |||||||||
Number of businesses acquired | Entity | 8 | 6 | 18 | ||||||
Vascular access | Dialysis-related businesses and other ancillary businesses | |||||||||
Business Acquisition [Line Items] | |||||||||
Number of businesses acquired | Entity | 3 | ||||||||
Vascular access | Renal Ventures Limited, LLC | |||||||||
Business Acquisition [Line Items] | |||||||||
Ownership interest percentage | 51.00% | ||||||||
Number of outpatient dialysis centers acquired | Clinic | 1 | ||||||||
Foreign Dialysis Centers | Dialysis-related businesses and other ancillary businesses | |||||||||
Business Acquisition [Line Items] | |||||||||
Number of businesses acquired | Entity | 21 | 21 | 7 | ||||||
Khazanah Nasional Berhad and Mitsui and Co., LTD | Asia-Pacific dialysis business | |||||||||
Business Acquisition [Line Items] | |||||||||
Subscribed investment amount | $ 300,000 | ||||||||
Investment period | 3 years | ||||||||
Ownership interest percentage | 40.00% | ||||||||
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 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 |
Business Acquisition [Line Items] | |||
Goodwill | $ 9,407,317 | $ 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 | ||
Covenant not-to-compete | 3,200 | ||
Amortizable intangible and other long-term assets | 30,850 | ||
Goodwill | 244,502 | ||
Liabilities assumed | (50,940) | ||
Long-term deferred income taxes | (16,880) | ||
Noncontrolling interests | (9,885) | ||
Aggregate purchase price | $ 400,971 |
Aggregate Purchase Cost Allocat
Aggregate Purchase Cost Allocations for Acquisitions (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 |
Business Acquisition [Line Items] | |||
Goodwill | $ 9,407,317 | $ 9,294,479 | $ 9,415,295 |
Dialysis businesses and other businesses | |||
Business Acquisition [Line Items] | |||
Current assets | 3,996 | 3,843 | 915 |
Property and equipment | 9,407 | 12,436 | 5,999 |
Amortizable intangible and other long-term assets | 986 | 4,345 | 4,193 |
Goodwill | 203,326 | 97,093 | 221,514 |
Long-term deferred income taxes, assets | 597 | ||
Long-term deferred income taxes, liabilities | (1,467) | ||
Noncontrolling interests assumed | (30,337) | (18,905) | (25,963) |
Liabilities assumed | (3,317) | (1,440) | (1,883) |
Aggregate purchase cost | 190,053 | 104,864 | 295,875 |
Dialysis businesses and other businesses | Customer relationships | |||
Business Acquisition [Line Items] | |||
Intangible assets, other than goodwill | 74,515 | ||
Dialysis businesses and other businesses | Noncompetition agreements | |||
Business Acquisition [Line Items] | |||
Intangible assets, other than goodwill | $ 5,395 | $ 8,959 | $ 16,585 |
Pro Forma Summary of Results of
Pro Forma Summary of Results of Operation (Detail) - USD ($) $ / shares in Units, $ in Thousands | 12 Months Ended | |
Dec. 31, 2016 | Dec. 31, 2015 | |
Business Combinations [Abstract] | ||
Pro forma net revenues | $ 14,875,592 | $ 14,342,138 |
Pro forma net income attributable to DaVita Inc. | $ 884,284 | $ 280,124 |
Pro forma basic net income per share attributable to DaVita Inc. | $ 4.39 | $ 1.32 |
Pro forma diluted net income per share attributable to DaVita Inc. | $ 4.32 | $ 1.30 |
Reconciliation of Changes in Co
Reconciliation of Changes in Contingent Earn-Out Obligations (Detail) $ in Thousands | 12 Months Ended |
Dec. 31, 2016USD ($) | |
Business Combinations [Abstract] | |
Beginning balance | $ 34,135 |
Contingent earn-out obligations associated with acquisitions | 1,511 |
Remeasurement of fair value | (4,132) |
Payments of contingent earn-out obligations | (21,537) |
Ending balance | $ 9,977 |
Variable Interest Entities - Ad
Variable Interest Entities - Additional Information (Detail) $ in Thousands | Dec. 31, 2016USD ($) |
Organization Consolidation And Presentation Of Financial Statements [Abstract] | |
Asset | $ 747,574 |
Liabilities | $ 425,034 |
Concentrations - Additional Inf
Concentrations - Additional Information (Detail) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016USD ($)ProjectCustomer | Dec. 31, 2015USD ($)Customer | Dec. 31, 2014 | |
Concentration Risk [Line Items] | |||
Number of customers accounting for approximately 11% of consolidated net revenues | Customer | 1 | ||
Number of customers accounting for more than 10% of consolidated accounts receivable | Customer | 0 | 0 | |
Sales Revenue Services Net | |||
Concentration Risk [Line Items] | |||
Concentration risk, customer | One commercial payor, Humana, accounted for approximately 11% of total consolidated net revenues. | ||
Sales Revenue Services Net | Customer Concentration Risk | Humana | |||
Concentration Risk [Line Items] | |||
Concentration Risk, Percentage | 11.00% | ||
Accounts Receivable | |||
Concentration Risk [Line Items] | |||
Concentration risk, customer | There is no single commercial payor that accounted for more than 10% of total consolidated accounts receivable at December 31, 2016 and 2015. | ||
Accounts Receivable | Government-based Programs, Medicare and Medicaid | |||
Concentration Risk [Line Items] | |||
Concentration Risk, Percentage | 80.00% | ||
U.S. Dialysis And Related Lab Services | Sales Revenue Services Net | Government-based Programs, Medicare and Medicaid | |||
Concentration Risk [Line Items] | |||
Concentration Risk, Percentage | 64.00% | 66.00% | 67.00% |
Accounts receivable, and other receivables, from Medicare and Medicaid-assigned plans | $ | $ 831,445 | $ 830,060 | |
DaVita Medical Group (DMG) | |||
Concentration Risk [Line Items] | |||
Number of health plans | Project | 3 | ||
DaVita Medical Group (DMG) | Sales Revenue Services Net | Government-based Programs, Medicare and Medicaid | |||
Concentration Risk [Line Items] | |||
Concentration Risk, Percentage | 72.00% | 70.00% | 71.00% |
DaVita Medical Group (DMG) | Sales Revenue Services Net | Product Concentration Risk | |||
Concentration Risk [Line Items] | |||
Concentration Risk, Percentage | 63.00% | 61.00% | 64.00% |
DaVita Medical Group (DMG) | Accounts Receivable | Customer Concentration Risk | |||
Concentration Risk [Line Items] | |||
Accounts receivable, and other receivables, from Medicare and Medicaid-assigned plans | $ | $ 289,798 | $ 231,278 |
Assets, Liabilities and Tempora
Assets, Liabilities and Temporary Equity Measured at Fair Value on Recurring Basis (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Assets | ||
Available for sale securities | $ 107,050 | $ 90,322 |
Liabilities | ||
Contingent earn-out obligations | 7,217 | 29,050 |
Fair Value, Measurements, Recurring | ||
Assets | ||
Available for sale securities | 47,404 | 33,482 |
Cash surrender value of life insurance policies | 59,646 | 56,840 |
Funds on deposit with third parties | 75,877 | 82,679 |
Liabilities | ||
Contingent earn-out obligations | 9,977 | 34,135 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 973,258 | 864,066 |
Fair Value, Measurements, Recurring | Interest rate cap agreements | ||
Assets | ||
Interest rate derivative agreements | 9,929 | 15,127 |
Fair Value, Measurements, Recurring | Interest rate swap agreements | ||
Assets | ||
Interest rate derivative agreements | 516 | |
Fair Value, Measurements, Recurring | Level 1 | ||
Assets | ||
Available for sale securities | 47,404 | 33,482 |
Funds on deposit with third parties | 75,877 | 82,679 |
Fair Value, Measurements, Recurring | Level 2 | ||
Assets | ||
Cash surrender value of life insurance policies | 59,646 | 56,840 |
Fair Value, Measurements, Recurring | Level 2 | Interest rate cap agreements | ||
Assets | ||
Interest rate derivative agreements | 9,929 | 15,127 |
Fair Value, Measurements, Recurring | Level 2 | Interest rate swap agreements | ||
Assets | ||
Interest rate derivative agreements | 516 | |
Fair Value, Measurements, Recurring | Level 3 | ||
Liabilities | ||
Contingent earn-out obligations | 9,977 | 34,135 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | $ 973,258 | $ 864,066 |
Fair Value of Financial Instrum
Fair Value of Financial Instruments - Additional Information (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | ||
Debt instrument, carrying amount | $ 9,192,229 | $ 9,226,330 |
Senior Secured Credit Facilities | ||
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | ||
Debt instrument, carrying amount | 4,217,348 | |
Debt instrument, fair value | 4,336,969 | |
Senior Notes | ||
Fair Value Balance Sheet Grouping Financial Statement Captions [Line Items] | ||
Debt instrument, carrying amount | 4,500,000 | |
Debt instrument, fair value | $ 4,530,875 |
Segment Reporting - Additional
Segment Reporting - Additional Information (Detail) | 12 Months Ended |
Dec. 31, 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 from Continuing Operations Before Income Taxes (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | ||||||||||
Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2015 | Sep. 30, 2015 | Jun. 30, 2015 | Mar. 31, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Segment Reporting Information [Line Items] | ||||||||||||
Patient service revenues | $ 3,715,742 | $ 3,730,576 | $ 3,717,651 | $ 3,581,136 | $ 3,533,589 | $ 3,525,665 | $ 3,434,618 | $ 3,287,965 | $ 10,354,161 | $ 9,480,279 | $ 8,868,338 | |
Less: Provision for uncollectible accounts | (451,353) | (427,860) | (366,884) | |||||||||
Net patient service revenues | 9,902,808 | 9,052,419 | 8,501,454 | |||||||||
Other revenues | 1,323,618 | 1,220,323 | 1,032,364 | |||||||||
Total net operating revenues | 14,745,105 | 13,781,837 | 12,795,106 | |||||||||
Capitated revenues | 3,518,679 | 3,509,095 | 3,261,288 | |||||||||
Operating income (loss) | 381,428 | 819,156 | 329,070 | 364,889 | 244,935 | 509,368 | 480,548 | (64,156) | 1,894,543 | 1,170,695 | 1,815,141 | |
Corporate administrative support | [1] | (44,561) | (18,965) | (13,012) | ||||||||
Debt expense | (414,382) | (408,380) | (410,294) | |||||||||
Debt refinancing and redemption charges | (48,072) | (97,548) | ||||||||||
Other income | 8,734 | 8,893 | 2,374 | |||||||||
Income before income taxes | $ 278,072 | $ 716,451 | $ 229,391 | $ 264,981 | $ 146,307 | $ 408,371 | $ 330,539 | $ (162,081) | 1,488,895 | 723,136 | 1,309,673 | |
Operating Segments | ||||||||||||
Segment Reporting Information [Line Items] | ||||||||||||
Total net operating revenues | 14,872,975 | 13,861,123 | 12,852,469 | |||||||||
Operating income (loss) | 1,939,104 | 1,189,660 | 1,828,153 | |||||||||
Operating Segments | U.S. Dialysis And Related Lab Services | ||||||||||||
Segment Reporting Information [Line Items] | ||||||||||||
Patient service revenues | 9,551,422 | 9,033,991 | 8,550,201 | |||||||||
Less: Provision for uncollectible accounts | (429,882) | (406,530) | (353,028) | |||||||||
Net patient service revenues | 9,121,540 | 8,627,461 | 8,197,173 | |||||||||
Other revenues | [2] | 16,649 | 13,971 | 13,498 | ||||||||
Total net operating revenues | 9,138,189 | 8,641,432 | 8,210,671 | |||||||||
Operating income (loss) | 1,777,014 | 1,259,632 | 1,637,626 | |||||||||
Operating Segments | U.S. Dialysis And Related Lab Services | External Sources | ||||||||||||
Segment Reporting Information [Line Items] | ||||||||||||
Patient service revenues | 9,482,648 | 8,980,515 | 8,513,089 | |||||||||
Operating Segments | U.S. Dialysis And Related Lab Services | Intersubsegment Eliminations | ||||||||||||
Segment Reporting Information [Line Items] | ||||||||||||
Patient service revenues | 68,774 | 53,476 | 37,112 | |||||||||
Operating Segments | DaVita Medical Group (DMG) | ||||||||||||
Segment Reporting Information [Line Items] | ||||||||||||
Net patient service revenues | 621,583 | 317,950 | 219,306 | |||||||||
Other revenues | [3] | 61,040 | 82,470 | 91,374 | ||||||||
Total net operating revenues | 4,113,414 | 3,837,261 | 3,502,299 | |||||||||
Capitated revenues | 3,430,576 | 3,436,705 | 3,190,903 | |||||||||
Operating income (loss) | (104,233) | 33,929 | 214,983 | |||||||||
Operating Segments | DaVita Medical Group (DMG) | Intersubsegment Eliminations | ||||||||||||
Segment Reporting Information [Line Items] | ||||||||||||
Other revenues | 215 | 136 | 716 | |||||||||
Operating Segments | Other-Ancillary services and strategic initiatives | ||||||||||||
Segment Reporting Information [Line Items] | ||||||||||||
Net patient service revenues | 228,459 | 160,484 | 122,087 | |||||||||
Other revenues | 1,245,929 | 1,123,882 | 927,492 | |||||||||
Total net operating revenues | 1,621,372 | 1,382,430 | 1,139,499 | |||||||||
Capitated revenues | 88,103 | 72,390 | 70,385 | |||||||||
Operating income (loss) | 266,323 | (103,901) | (24,456) | |||||||||
Operating Segments | Other-Ancillary services and strategic initiatives | Intersubsegment Eliminations | ||||||||||||
Segment Reporting Information [Line Items] | ||||||||||||
Total net operating revenues | 58,881 | 25,674 | 19,535 | |||||||||
Intersegment Elimination | ||||||||||||
Segment Reporting Information [Line Items] | ||||||||||||
Total net operating revenues | $ (127,870) | $ (79,286) | $ (57,363) | |||||||||
[1] | Corporate administrative support costs in 2016 also include $30,934 of an adjustment to reduce a tax asset associated with the DMG acquisition escrow provisions. | |||||||||||
[2] | Includes management fees for providing management and administrative services to dialysis centers in which the Company owns a noncontrolling interest or which are wholly-owned by third parties. | |||||||||||
[3] | Includes medical consulting service fees and management fees for providing management and administrative services to unconsolidated joint ventures, as well as revenue related to the maintenance of existing physician networks |
Summary of Segment Net Reven115
Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Parenthetical) (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Segment Reporting Information [Line Items] | ||||
Corporate administrative support costs, Adjustment to reduce tax asset | [1] | $ 44,561 | $ 18,965 | $ 13,012 |
Tax Adjustments | ||||
Segment Reporting Information [Line Items] | ||||
Corporate administrative support costs, Adjustment to reduce tax asset | $ 30,934 | |||
[1] | Corporate administrative support costs in 2016 also include $30,934 of an adjustment to reduce a tax asset associated with the DMG acquisition escrow provisions. |
Summary of Depreciation and Amo
Summary of Depreciation and Amortization Expense by Segment (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | $ 720,252 | $ 638,024 | $ 590,935 |
U.S. Dialysis And Related Lab Services | |||
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | 482,768 | 438,238 | 402,767 |
DaVita Medical Group (DMG) | |||
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | 210,755 | 174,118 | 169,485 |
Other-Ancillary services and strategic initiatives | |||
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | $ 26,729 | $ 25,668 | $ 18,683 |
Summary of Assets by Segment (D
Summary of Assets by Segment (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 | |
ASSETS | |||
Consolidated assets | $ 18,741,257 | $ 18,514,875 | |
U.S. Dialysis And Related Lab Services | |||
ASSETS | |||
Consolidated assets | 11,438,100 | 11,591,507 | |
DaVita Medical Group (DMG) | |||
ASSETS | |||
Consolidated assets | 6,213,091 | 6,150,666 | |
Other-Ancillary services and strategic initiatives | |||
ASSETS | |||
Consolidated assets | [1] | $ 1,090,066 | $ 772,702 |
[1] | Includes approximately $96,396 and $ 69,519 in 2016 and 2015, respectively, of net property and equipment related to the Company’s international operations. |
Summary of Assets by Segment (P
Summary of Assets by Segment (Parenthetical) (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 |
Segment Reporting Information [Line Items] | ||
Property and equipment, net | $ 3,175,367 | $ 2,788,740 |
Equity investments | 502,389 | 78,368 |
U.S. Dialysis And Related Lab Services | ||
Segment Reporting Information [Line Items] | ||
Equity investments | 66,924 | 29,801 |
DaVita Medical Group (DMG) | ||
Segment Reporting Information [Line Items] | ||
Equity investments | 10,350 | 22,714 |
Other-Ancillary services and strategic initiatives | ||
Segment Reporting Information [Line Items] | ||
Equity investments | 425,115 | 20,853 |
Outside United States | Other-Ancillary services and strategic initiatives | ||
Segment Reporting Information [Line Items] | ||
Property and equipment, net | $ 96,396 | $ 69,519 |
Summary of Expenditures for Pro
Summary of Expenditures for Property and Equipment by Segment (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | $ 829,095 | $ 707,998 | $ 641,330 |
U.S. Dialysis And Related Lab Services | |||
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | 675,994 | 584,513 | 560,610 |
DaVita Medical Group (DMG) | |||
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | 84,399 | 66,800 | 27,885 |
Other-Ancillary services and strategic initiatives | |||
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | $ 68,702 | $ 56,685 | $ 52,835 |
Supplemental Cash Flow Infor120
Supplemental Cash Flow Information (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Cash paid: | |||
Income taxes | $ 339,411 | $ 156,075 | $ 238,615 |
Interest | 406,987 | 405,120 | 351,967 |
Non-cash investing and financing activities: | |||
Fixed assets under capital lease obligations | $ 28,127 | $ 74,035 | $ 72,389 |
Selected quarterly financial121
Selected quarterly financial data (unaudited) (Detail) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2015 | Sep. 30, 2015 | Jun. 30, 2015 | Mar. 31, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Quarterly Financial Information Disclosure [Abstract] | |||||||||||
Net revenues | $ 3,715,742 | $ 3,730,576 | $ 3,717,651 | $ 3,581,136 | $ 3,533,589 | $ 3,525,665 | $ 3,434,618 | $ 3,287,965 | $ 10,354,161 | $ 9,480,279 | $ 8,868,338 |
Operating income (loss) | 381,428 | 819,156 | 329,070 | 364,889 | 244,935 | 509,368 | 480,548 | (64,156) | 1,894,543 | 1,170,695 | 1,815,141 |
Income (loss) before income taxes | 278,072 | 716,451 | 229,391 | 264,981 | 146,307 | 408,371 | 330,539 | (162,081) | 1,488,895 | 723,136 | 1,309,673 |
Net income (loss) attributable to DaVita Inc. | $ 157,726 | $ 571,332 | $ 53,382 | $ 97,434 | $ (6,000) | $ 215,872 | $ 170,477 | $ (110,617) | $ 879,874 | $ 269,732 | $ 723,114 |
Basic net income (loss) per share attributable to DaVita Inc. | $ 0.81 | $ 2.80 | $ 0.26 | $ 0.48 | $ (0.03) | $ 1.02 | $ 0.80 | $ (0.52) | $ 4.36 | $ 1.27 | $ 3.41 |
Diluted net income (loss) per share attributable to DaVita Inc. | $ 0.80 | $ 2.76 | $ 0.26 | $ 0.47 | $ (0.03) | $ 1 | $ 0.78 | $ (0.52) | $ 4.29 | $ 1.25 | $ 3.33 |
Consolidating Statements of Inc
Consolidating Statements of Income (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2015 | Sep. 30, 2015 | Jun. 30, 2015 | Mar. 31, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Condensed Income Statements Captions [Line Items] | |||||||||||
Patient service revenues | $ 3,715,742 | $ 3,730,576 | $ 3,717,651 | $ 3,581,136 | $ 3,533,589 | $ 3,525,665 | $ 3,434,618 | $ 3,287,965 | $ 10,354,161 | $ 9,480,279 | $ 8,868,338 |
Less: Provision for uncollectible accounts | (451,353) | (427,860) | (366,884) | ||||||||
Net patient service revenues | 9,902,808 | 9,052,419 | 8,501,454 | ||||||||
Capitated revenues | 3,518,679 | 3,509,095 | 3,261,288 | ||||||||
Other revenues | 1,323,618 | 1,220,323 | 1,032,364 | ||||||||
Total net revenues | 14,745,105 | 13,781,837 | 12,795,106 | ||||||||
Operating expenses and charges | 12,850,562 | 12,611,142 | 10,979,965 | ||||||||
Operating income | 381,428 | 819,156 | 329,070 | 364,889 | 244,935 | 509,368 | 480,548 | (64,156) | 1,894,543 | 1,170,695 | 1,815,141 |
Debt expense | (414,382) | (408,380) | (410,294) | ||||||||
Debt (expense) and refinancing charges | (456,452) | (507,842) | |||||||||
Other income, net | 8,734 | 8,893 | 2,374 | ||||||||
Income tax expense | 455,813 | 295,726 | 446,343 | ||||||||
Net income | 1,033,082 | 427,410 | 863,330 | ||||||||
Less: Net income attributable to noncontrolling interests | (153,208) | (157,678) | (140,216) | ||||||||
Net income attributable to DaVita Inc. | $ 157,726 | $ 571,332 | $ 53,382 | $ 97,434 | $ (6,000) | $ 215,872 | $ 170,477 | $ (110,617) | 879,874 | 269,732 | 723,114 |
Consolidation, Eliminations | |||||||||||
Condensed Income Statements Captions [Line Items] | |||||||||||
Patient service revenues | (173,567) | (144,954) | (117,549) | ||||||||
Net patient service revenues | (173,567) | (144,954) | (117,549) | ||||||||
Capitated revenues | (273) | (243) | (184) | ||||||||
Other revenues | (1,659,125) | (1,414,834) | (1,315,685) | ||||||||
Total net revenues | (1,832,965) | (1,560,031) | (1,433,418) | ||||||||
Operating expenses and charges | (1,832,965) | (1,560,031) | (1,433,418) | ||||||||
Debt expense | 402,788 | ||||||||||
Debt (expense) and refinancing charges | 375,822 | 401,992 | |||||||||
Other income, net | (402,788) | (375,822) | (401,992) | ||||||||
Equity earnings in subsidiaries | (1,378,452) | (514,183) | (982,776) | ||||||||
Net income | (1,378,452) | (514,183) | (982,776) | ||||||||
Less: Net income attributable to noncontrolling interests | (153,208) | (157,678) | (140,216) | ||||||||
Net income attributable to DaVita Inc. | (1,531,660) | (671,861) | (1,122,992) | ||||||||
DaVita Inc. | Additional Reporting Entities | |||||||||||
Condensed Income Statements Captions [Line Items] | |||||||||||
Other revenues | 767,791 | 727,887 | 684,066 | ||||||||
Total net revenues | 767,791 | 727,887 | 684,066 | ||||||||
Operating expenses and charges | 524,108 | 488,595 | 443,951 | ||||||||
Operating income | 243,683 | 239,292 | 240,115 | ||||||||
Debt expense | (407,925) | ||||||||||
Debt (expense) and refinancing charges | (449,598) | (502,762) | |||||||||
Other income, net | 396,797 | 365,752 | 385,532 | ||||||||
Income tax expense | 79,301 | 81,221 | 46,856 | ||||||||
Equity earnings in subsidiaries | 726,620 | 195,507 | 647,085 | ||||||||
Net income | 879,874 | 269,732 | 723,114 | ||||||||
Net income attributable to DaVita Inc. | 879,874 | 269,732 | 723,114 | ||||||||
Guarantor Subsidiaries | Additional Reporting Entities | |||||||||||
Condensed Income Statements Captions [Line Items] | |||||||||||
Patient service revenues | 6,766,138 | 6,578,185 | 6,246,683 | ||||||||
Less: Provision for uncollectible accounts | (278,761) | (285,454) | (238,600) | ||||||||
Net patient service revenues | 6,487,377 | 6,292,731 | 6,008,083 | ||||||||
Capitated revenues | 1,795,673 | 1,776,311 | 1,681,668 | ||||||||
Other revenues | 2,089,749 | 1,875,133 | 1,639,828 | ||||||||
Total net revenues | 10,372,799 | 9,944,175 | 9,329,579 | ||||||||
Operating expenses and charges | 9,735,334 | 9,565,667 | 8,269,025 | ||||||||
Operating income | 637,465 | 378,508 | 1,060,554 | ||||||||
Debt expense | (358,535) | ||||||||||
Debt (expense) and refinancing charges | (340,176) | (363,623) | |||||||||
Other income, net | 6,196 | 11,562 | 11,731 | ||||||||
Income tax expense | 210,338 | 173,063 | 397,268 | ||||||||
Equity earnings in subsidiaries | 651,832 | 318,676 | 335,691 | ||||||||
Net income | 726,620 | 195,507 | 647,085 | ||||||||
Net income attributable to DaVita Inc. | 726,620 | 195,507 | 647,085 | ||||||||
Non-Guarantor Subsidiaries | Additional Reporting Entities | |||||||||||
Condensed Income Statements Captions [Line Items] | |||||||||||
Patient service revenues | 3,761,590 | 3,047,048 | 2,739,204 | ||||||||
Less: Provision for uncollectible accounts | (172,592) | (142,406) | (128,284) | ||||||||
Net patient service revenues | 3,588,998 | 2,904,642 | 2,610,920 | ||||||||
Capitated revenues | 1,723,279 | 1,733,027 | 1,579,804 | ||||||||
Other revenues | 125,203 | 32,137 | 24,155 | ||||||||
Total net revenues | 5,437,480 | 4,669,806 | 4,214,879 | ||||||||
Operating expenses and charges | 4,424,085 | 4,116,911 | 3,700,407 | ||||||||
Operating income | 1,013,395 | 552,895 | 514,472 | ||||||||
Debt expense | (50,710) | ||||||||||
Debt (expense) and refinancing charges | (42,500) | (43,449) | |||||||||
Other income, net | 8,529 | 7,401 | 7,103 | ||||||||
Income tax expense | 166,174 | 41,442 | 2,219 | ||||||||
Net income | 805,040 | 476,354 | 475,907 | ||||||||
Net income attributable to DaVita Inc. | $ 805,040 | $ 476,354 | $ 475,907 |
Consolidating Statements of Com
Consolidating Statements of Comprehensive Income (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Condensed Financial Statements Captions [Line Items] | |||
Net income | $ 1,033,082 | $ 427,410 | $ 863,330 |
Other comprehensive income (losses) | (29,627) | (34,809) | (22,372) |
Total comprehensive income | 1,003,455 | 392,601 | 840,958 |
Less: Comprehensive income attributable to noncontrolling interests | (153,398) | (157,678) | (140,216) |
Comprehensive income attributable to DaVita Inc. | 850,057 | 234,923 | 700,742 |
Additional Reporting Entities | DaVita Inc. | |||
Condensed Financial Statements Captions [Line Items] | |||
Net income | 879,874 | 269,732 | 723,114 |
Other comprehensive income (losses) | (290) | (10,920) | 580 |
Total comprehensive income | 879,584 | 258,812 | 723,694 |
Comprehensive income attributable to DaVita Inc. | 879,584 | 258,812 | 723,694 |
Additional Reporting Entities | Guarantor Subsidiaries | |||
Condensed Financial Statements Captions [Line Items] | |||
Net income | 726,620 | 195,507 | 647,085 |
Total comprehensive income | 726,620 | 195,507 | 647,085 |
Comprehensive income attributable to DaVita Inc. | 726,620 | 195,507 | 647,085 |
Additional Reporting Entities | Non-Guarantor Subsidiaries | |||
Condensed Financial Statements Captions [Line Items] | |||
Net income | 805,040 | 476,354 | 475,907 |
Other comprehensive income (losses) | (29,337) | (23,889) | (22,952) |
Total comprehensive income | 775,703 | 452,465 | 452,955 |
Comprehensive income attributable to DaVita Inc. | 775,703 | 452,465 | 452,955 |
Consolidation, Eliminations | |||
Condensed Financial Statements Captions [Line Items] | |||
Net income | (1,378,452) | (514,183) | (982,776) |
Total comprehensive income | (1,378,452) | (514,183) | (982,776) |
Less: Comprehensive income attributable to noncontrolling interests | (153,398) | (157,678) | (140,216) |
Comprehensive income attributable to DaVita Inc. | $ (1,531,850) | $ (671,861) | $ (1,122,992) |
Consolidating Balance Sheets (D
Consolidating Balance Sheets (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | Dec. 31, 2013 |
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Cash and cash equivalents | $ 913,187 | $ 1,499,116 | $ 965,241 | $ 946,249 |
Accounts receivable, net | 1,917,302 | 1,724,228 | ||
Other current assets | 1,149,739 | 1,279,936 | ||
Total current assets | 3,980,228 | 4,503,280 | ||
Property and equipment, net | 3,175,367 | 2,788,740 | ||
Intangible assets, net | 1,527,767 | 1,687,326 | ||
Other long-term assets and investments | 650,578 | 241,050 | ||
Goodwill | 9,407,317 | 9,294,479 | 9,415,295 | |
Total assets | 18,741,257 | 18,514,875 | ||
Current liabilities | 2,696,445 | 2,399,138 | ||
Long-term debt and other long-term liabilities | 10,221,813 | 10,167,499 | ||
Noncontrolling interests subject to put provisions | 973,258 | 864,066 | ||
Total DaVita Inc. shareholders' equity | 4,648,047 | 4,870,780 | ||
Noncontrolling interests not subject to put provisions | 201,694 | 213,392 | ||
Total equity | 4,849,741 | 5,084,172 | ||
Total liabilities and equity | 18,741,257 | 18,514,875 | ||
Additional Reporting Entities | DaVita Inc. | ||||
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Cash and cash equivalents | 549,921 | 1,186,636 | 698,876 | 602,188 |
Other current assets | 277,911 | 431,504 | ||
Total current assets | 827,832 | 1,618,140 | ||
Property and equipment, net | 337,200 | 268,066 | ||
Intangible assets, net | 487 | 540 | ||
Investments in subsidiaries | 9,717,728 | 8,893,079 | ||
Intercompany receivables | 3,250,692 | 3,474,133 | ||
Other long-term assets and investments | 39,994 | 74,458 | ||
Total assets | 14,173,933 | 14,328,416 | ||
Current liabilities | 303,840 | 185,217 | ||
Long-term debt and other long-term liabilities | 8,614,445 | 8,730,673 | ||
Noncontrolling interests subject to put provisions | 607,601 | 541,746 | ||
Total DaVita Inc. shareholders' equity | 4,648,047 | 4,870,780 | ||
Total equity | 4,648,047 | 4,870,780 | ||
Total liabilities and equity | 14,173,933 | 14,328,416 | ||
Additional Reporting Entities | Guarantor Subsidiaries | ||||
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Cash and cash equivalents | 59,192 | 109,357 | 77,921 | 151,454 |
Accounts receivable, net | 1,215,232 | 929,390 | ||
Other current assets | 736,727 | 769,947 | ||
Total current assets | 2,011,151 | 1,808,694 | ||
Property and equipment, net | 1,689,798 | 1,575,890 | ||
Intangible assets, net | 1,491,057 | 1,634,920 | ||
Investments in subsidiaries | 2,002,660 | 1,597,185 | ||
Other long-term assets and investments | 86,710 | 53,346 | ||
Goodwill | 7,838,984 | 7,834,257 | ||
Total assets | 15,120,360 | 14,504,292 | ||
Current liabilities | 1,865,193 | 1,730,123 | ||
Intercompany payables | 2,322,124 | 2,750,102 | ||
Long-term debt and other long-term liabilities | 1,215,315 | 1,130,988 | ||
Total DaVita Inc. shareholders' equity | 9,717,728 | 8,893,079 | ||
Total equity | 9,717,728 | 8,893,079 | ||
Total liabilities and equity | 15,120,360 | 14,504,292 | ||
Additional Reporting Entities | Non-Guarantor Subsidiaries | ||||
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Cash and cash equivalents | 304,074 | 203,123 | $ 188,444 | $ 192,607 |
Accounts receivable, net | 702,070 | 794,838 | ||
Other current assets | 135,101 | 78,485 | ||
Total current assets | 1,141,245 | 1,076,446 | ||
Property and equipment, net | 1,148,369 | 944,784 | ||
Intangible assets, net | 36,223 | 51,866 | ||
Intercompany receivables | 866,955 | 701,814 | ||
Other long-term assets and investments | 523,874 | 113,246 | ||
Goodwill | 1,568,333 | 1,460,222 | ||
Total assets | 5,284,999 | 4,348,378 | ||
Current liabilities | 527,412 | 483,798 | ||
Intercompany payables | 1,795,523 | 1,425,845 | ||
Long-term debt and other long-term liabilities | 392,053 | 305,838 | ||
Total DaVita Inc. shareholders' equity | 2,002,660 | 1,597,185 | ||
Noncontrolling interests not subject to put provisions | 567,351 | 535,712 | ||
Total equity | 2,570,011 | 2,132,897 | ||
Total liabilities and equity | 5,284,999 | 4,348,378 | ||
Consolidation, Eliminations | ||||
Condensed Balance Sheet Statements Captions [Line Items] | ||||
Investments in subsidiaries | (11,720,388) | (10,490,264) | ||
Intercompany receivables | (4,117,647) | (4,175,947) | ||
Total assets | (15,838,035) | (14,666,211) | ||
Intercompany payables | (4,117,647) | (4,175,947) | ||
Noncontrolling interests subject to put provisions | 365,657 | 322,320 | ||
Total DaVita Inc. shareholders' equity | (11,720,388) | (10,490,264) | ||
Noncontrolling interests not subject to put provisions | (365,657) | (322,320) | ||
Total equity | (12,086,045) | (10,812,584) | ||
Total liabilities and equity | $ (15,838,035) | $ (14,666,211) |
Consolidating Statements of Cas
Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Cash flows from operating activities: | |||
Net income | $ 1,033,082 | $ 427,410 | $ 863,330 |
Changes in operating assets and liabilities and non-cash items included in net income | 930,362 | 1,129,790 | 596,077 |
Net cash provided by operating activities | 1,963,444 | 1,557,200 | 1,459,407 |
Cash flows from investing activities: | |||
Additions of property and equipment | (829,095) | (707,998) | (641,330) |
Acquisitions | (563,856) | (96,469) | (272,094) |
Proceeds from asset sales, net of cash divested | 64,725 | ||
Proceeds from asset and business sales | 64,725 | 19,715 | 8,791 |
Investments and other items | 126,558 | (97,032) | (373,096) |
Net cash used in investing activities | (1,201,668) | (881,784) | (1,277,729) |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | (124,442) | 619,698 | (7,989) |
Other items | (1,227,539) | (758,668) | (156,990) |
Net cash used in financing activities | (1,351,981) | (138,970) | (164,979) |
Effect of exchange rate changes on cash | 4,276 | (2,571) | 2,293 |
Net (decrease) increase in cash and cash equivalents | (585,929) | 533,875 | 18,992 |
Cash and cash equivalents at beginning of the year | 1,499,116 | 965,241 | 946,249 |
Cash and cash equivalents at end of the year | 913,187 | 1,499,116 | 965,241 |
Additional Reporting Entities | DaVita Inc. | |||
Cash flows from operating activities: | |||
Net income | 879,874 | 269,732 | 723,114 |
Changes in operating assets and liabilities and non-cash items included in net income | (614,642) | (146,531) | (597,992) |
Net cash provided by operating activities | 265,232 | 123,201 | 125,122 |
Cash flows from investing activities: | |||
Additions of property and equipment | (139,303) | (115,269) | (51,374) |
Investments and other items | 153,031 | (74,474) | (333,803) |
Net cash used in investing activities | 13,728 | (189,743) | (385,177) |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | (92,460) | 640,009 | 4,513 |
Intercompany borrowing | 237,988 | 486,588 | 410,437 |
Other items | (1,061,203) | (572,295) | (58,207) |
Net cash used in financing activities | (915,675) | 554,302 | 356,743 |
Net (decrease) increase in cash and cash equivalents | (636,715) | 487,760 | 96,688 |
Cash and cash equivalents at beginning of the year | 1,186,636 | 698,876 | 602,188 |
Cash and cash equivalents at end of the year | 549,921 | 1,186,636 | 698,876 |
Additional Reporting Entities | Guarantor Subsidiaries | |||
Cash flows from operating activities: | |||
Net income | 726,620 | 195,507 | 647,085 |
Changes in operating assets and liabilities and non-cash items included in net income | 335,166 | 688,106 | 120,772 |
Net cash provided by operating activities | 1,061,786 | 883,613 | 767,857 |
Cash flows from investing activities: | |||
Additions of property and equipment | (382,305) | (319,695) | (312,191) |
Acquisitions | (472,413) | (76,983) | (228,569) |
Proceeds from asset sales, net of cash divested | 70,342 | ||
Proceeds from asset and business sales | 19,715 | 8,791 | |
Investments and other items | (29,038) | (2,144) | (316) |
Net cash used in investing activities | (813,414) | (379,107) | (532,285) |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | (27,830) | (11,953) | (12,545) |
Intercompany borrowing | (249,182) | (394,735) | (282,461) |
Other items | (21,525) | (66,382) | (14,099) |
Net cash used in financing activities | (298,537) | (473,070) | (309,105) |
Net (decrease) increase in cash and cash equivalents | (50,165) | 31,436 | (73,533) |
Cash and cash equivalents at beginning of the year | 109,357 | 77,921 | 151,454 |
Cash and cash equivalents at end of the year | 59,192 | 109,357 | 77,921 |
Additional Reporting Entities | Non-Guarantor Subsidiaries | |||
Cash flows from operating activities: | |||
Net income | 805,040 | 476,354 | 475,907 |
Changes in operating assets and liabilities and non-cash items included in net income | (168,614) | 74,032 | 90,521 |
Net cash provided by operating activities | 636,426 | 550,386 | 566,428 |
Cash flows from investing activities: | |||
Additions of property and equipment | (307,487) | (273,034) | (277,765) |
Acquisitions | (91,443) | (19,486) | (43,525) |
Proceeds from asset sales, net of cash divested | (5,617) | ||
Investments and other items | 2,565 | (20,414) | (38,977) |
Net cash used in investing activities | (401,982) | (312,934) | (360,267) |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | (4,152) | (8,358) | 43 |
Intercompany borrowing | 11,194 | (91,853) | (127,976) |
Other items | (144,811) | (119,991) | (84,684) |
Net cash used in financing activities | (137,769) | (220,202) | (212,617) |
Effect of exchange rate changes on cash | 4,276 | (2,571) | 2,293 |
Net (decrease) increase in cash and cash equivalents | 100,951 | 14,679 | (4,163) |
Cash and cash equivalents at beginning of the year | 203,123 | 188,444 | 192,607 |
Cash and cash equivalents at end of the year | 304,074 | 203,123 | 188,444 |
Consolidation, Eliminations | |||
Cash flows from operating activities: | |||
Net income | (1,378,452) | (514,183) | (982,776) |
Changes in operating assets and liabilities and non-cash items included in net income | $ 1,378,452 | $ 514,183 | $ 982,776 |
Supplemental Data - Condensed C
Supplemental Data - Condensed Consolidating Statements of Income (Detail) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | ||||||||||
Dec. 31, 2016 | Sep. 30, 2016 | Jun. 30, 2016 | Mar. 31, 2016 | Dec. 31, 2015 | Sep. 30, 2015 | Jun. 30, 2015 | Mar. 31, 2015 | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Condensed Income Statements Captions [Line Items] | ||||||||||||
Patient service revenues | $ 3,715,742 | $ 3,730,576 | $ 3,717,651 | $ 3,581,136 | $ 3,533,589 | $ 3,525,665 | $ 3,434,618 | $ 3,287,965 | $ 10,354,161 | $ 9,480,279 | $ 8,868,338 | |
Less: Provision for uncollectible accounts | (451,353) | (427,860) | (366,884) | |||||||||
Net patient service revenues | 9,902,808 | 9,052,419 | 8,501,454 | |||||||||
Capitated revenues | 3,518,679 | 3,509,095 | 3,261,288 | |||||||||
Other revenues | 1,323,618 | 1,220,323 | 1,032,364 | |||||||||
Total net revenues | 14,745,105 | 13,781,837 | 12,795,106 | |||||||||
Operating expenses and charges | 12,850,562 | 12,611,142 | 10,979,965 | |||||||||
Operating income | 381,428 | 819,156 | 329,070 | 364,889 | 244,935 | 509,368 | 480,548 | (64,156) | 1,894,543 | 1,170,695 | 1,815,141 | |
Debt expense | (414,382) | (408,380) | (410,294) | |||||||||
Other income, net | 8,734 | 8,893 | 2,374 | |||||||||
Income tax expense | 455,813 | 295,726 | 446,343 | |||||||||
Net income | 1,033,082 | 427,410 | 863,330 | |||||||||
Less: Net income attributable to noncontrolling interests | (153,208) | (157,678) | (140,216) | |||||||||
Net income attributable to DaVita Inc. | $ 157,726 | $ 571,332 | $ 53,382 | $ 97,434 | $ (6,000) | $ 215,872 | $ 170,477 | $ (110,617) | 879,874 | $ 269,732 | $ 723,114 | |
Physician Groups | ||||||||||||
Condensed Income Statements Captions [Line Items] | ||||||||||||
Patient service revenues | 449,473 | |||||||||||
Less: Provision for uncollectible accounts | (12,696) | |||||||||||
Net patient service revenues | 436,777 | |||||||||||
Capitated revenues | 1,617,794 | |||||||||||
Other revenues | 32,938 | |||||||||||
Total net revenues | 2,087,509 | |||||||||||
Operating expenses and charges | 2,035,001 | |||||||||||
Operating income | 52,508 | |||||||||||
Debt expense | (10,140) | |||||||||||
Other income, net | 576 | |||||||||||
Income tax expense | 10,643 | |||||||||||
Net income | 32,301 | |||||||||||
Net income attributable to DaVita Inc. | 32,301 | |||||||||||
Unrestricted Subsidiaries | ||||||||||||
Condensed Income Statements Captions [Line Items] | ||||||||||||
Operating expenses and charges | 110 | |||||||||||
Operating income | (110) | |||||||||||
Income tax expense | (44) | |||||||||||
Net income | (66) | |||||||||||
Net income attributable to DaVita Inc. | (66) | |||||||||||
Company and Restricted Subsidiaries | ||||||||||||
Condensed Income Statements Captions [Line Items] | ||||||||||||
Patient service revenues | 9,904,688 | |||||||||||
Less: Provision for uncollectible accounts | (438,657) | |||||||||||
Net patient service revenues | 9,466,031 | |||||||||||
Capitated revenues | 1,900,885 | |||||||||||
Other revenues | 1,290,680 | |||||||||||
Total net revenues | 12,657,596 | |||||||||||
Operating expenses and charges | 10,815,451 | |||||||||||
Operating income | 1,842,145 | |||||||||||
Debt expense | (404,242) | |||||||||||
Other income, net | 8,158 | |||||||||||
Income tax expense | 445,214 | |||||||||||
Net income | [1] | 1,000,847 | ||||||||||
Less: Net income attributable to noncontrolling interests | (153,208) | |||||||||||
Net income attributable to DaVita Inc. | $ 847,639 | |||||||||||
[1] | After the elimination of the unrestricted subsidiaries and the physician groups |
Supplemental Data - Condense127
Supplemental Data - Condensed Consolidating Statements of Comprehensive Income (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Condensed Financial Statements Captions [Line Items] | ||||
Net income (losses) | $ 1,033,082 | $ 427,410 | $ 863,330 | |
Other comprehensive losses | (29,627) | (34,809) | (22,372) | |
Total comprehensive income | 1,003,455 | 392,601 | 840,958 | |
Less: Comprehensive income attributable to noncontrolling interests | (153,398) | (157,678) | (140,216) | |
Comprehensive income attributable to DaVita Inc. | 850,057 | $ 234,923 | $ 700,742 | |
Physician Groups | ||||
Condensed Financial Statements Captions [Line Items] | ||||
Net income (losses) | 32,301 | |||
Total comprehensive income | 32,301 | |||
Comprehensive income attributable to DaVita Inc. | 32,301 | |||
Unrestricted Subsidiaries | ||||
Condensed Financial Statements Captions [Line Items] | ||||
Net income (losses) | (66) | |||
Total comprehensive income | (66) | |||
Comprehensive income attributable to DaVita Inc. | (66) | |||
Company and Restricted Subsidiaries | ||||
Condensed Financial Statements Captions [Line Items] | ||||
Net income (losses) | [1] | 1,000,847 | ||
Other comprehensive losses | [1] | (29,627) | ||
Total comprehensive income | [1] | 971,220 | ||
Less: Comprehensive income attributable to noncontrolling interests | [1] | (153,398) | ||
Comprehensive income attributable to DaVita Inc. | [1] | $ 817,822 | ||
[1] | After the elimination of the unrestricted subsidiaries and the physician groups |
Supplemental Data - Condense128
Supplemental Data - Condensed Consolidating Balance Sheets (Detail) - USD ($) $ in Thousands | Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | Dec. 31, 2013 | |
Condensed Balance Sheet Statements Captions [Line Items] | |||||
Cash and cash equivalents | $ 913,187 | $ 1,499,116 | $ 965,241 | $ 946,249 | |
Accounts receivable, net | 1,917,302 | 1,724,228 | |||
Other current assets | 1,149,739 | 1,279,936 | |||
Total current assets | 3,980,228 | 4,503,280 | |||
Property and equipment, net | 3,175,367 | 2,788,740 | |||
Amortizable intangibles, net | 1,527,767 | 1,687,326 | |||
Other long-term assets | 650,578 | 241,050 | |||
Goodwill | 9,407,317 | 9,294,479 | $ 9,415,295 | ||
Total assets | 18,741,257 | 18,514,875 | |||
Current liabilities | 2,696,445 | 2,399,138 | |||
Long-term debt and other long-term liabilities | 10,221,813 | 10,167,499 | |||
Noncontrolling interests subject to put provisions | 973,258 | 864,066 | |||
Total DaVita Inc. shareholders' equity | 4,648,047 | 4,870,780 | |||
Noncontrolling interests not subject to put provisions | 201,694 | 213,392 | |||
Total equity | 4,849,741 | 5,084,172 | |||
Total liabilities and equity | 18,741,257 | 18,514,875 | |||
Physician Groups | |||||
Condensed Balance Sheet Statements Captions [Line Items] | |||||
Cash and cash equivalents | 104,691 | 88,245 | |||
Accounts receivable, net | 207,430 | ||||
Other current assets | 15,124 | ||||
Total current assets | 327,245 | ||||
Property and equipment, net | 1,378 | ||||
Amortizable intangibles, net | 4,858 | ||||
Other long-term assets | 78,215 | ||||
Goodwill | 16,405 | ||||
Total assets | 428,101 | ||||
Current liabilities | 223,302 | ||||
Payables to parent | 56,699 | ||||
Long-term debt and other long-term liabilities | 44,094 | ||||
Total DaVita Inc. shareholders' equity | 104,006 | ||||
Total equity | 104,006 | ||||
Total liabilities and equity | 428,101 | ||||
Unrestricted Subsidiaries | |||||
Condensed Balance Sheet Statements Captions [Line Items] | |||||
Other long-term assets | 2,714 | ||||
Total assets | 2,714 | ||||
Payables to parent | 2,714 | ||||
Total liabilities and equity | 2,714 | ||||
Company and Restricted Subsidiaries | |||||
Condensed Balance Sheet Statements Captions [Line Items] | |||||
Cash and cash equivalents | [1] | 808,496 | $ 1,410,871 | ||
Accounts receivable, net | 1,709,872 | ||||
Other current assets | 1,134,615 | ||||
Total current assets | 3,652,983 | ||||
Property and equipment, net | 3,173,989 | ||||
Amortizable intangibles, net | 1,522,909 | ||||
Other long-term assets | 569,649 | ||||
Goodwill | 9,390,912 | ||||
Total assets | 18,310,442 | ||||
Current liabilities | 2,473,143 | ||||
Payables to parent | (59,413) | ||||
Long-term debt and other long-term liabilities | 10,177,719 | ||||
Noncontrolling interests subject to put provisions | 973,258 | ||||
Total DaVita Inc. shareholders' equity | 4,544,041 | ||||
Noncontrolling interests not subject to put provisions | 201,694 | ||||
Total equity | 4,745,735 | ||||
Total liabilities and equity | $ 18,310,442 | ||||
[1] | After the elimination of the unrestricted subsidiaries and the physician groups |
Supplemental Data - Condense129
Supplemental Data - Condensed Consolidating Statements of Cash Flows (Detail) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | ||
Cash flows from operating activities: | ||||
Net income | $ 1,033,082 | $ 427,410 | $ 863,330 | |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 930,362 | 1,129,790 | 596,077 | |
Net cash provided by operating activities | 1,963,444 | 1,557,200 | 1,459,407 | |
Cash flows from investing activities: | ||||
Additions of property and equipment | (829,095) | (707,998) | (641,330) | |
Acquisitions and divestitures, net | (563,856) | |||
Proceeds from asset sales | 64,725 | |||
Investments and other items | 126,558 | (97,032) | (373,096) | |
Net cash used in investing activities | (1,201,668) | (881,784) | (1,277,729) | |
Cash flows from financing activities: | ||||
Long-term debt and related financing costs, net | (124,442) | 619,698 | (7,989) | |
Other items | (1,227,539) | (758,668) | (156,990) | |
Net cash used in financing activities | (1,351,981) | (138,970) | (164,979) | |
Effect of exchange rate changes on cash | 4,276 | (2,571) | 2,293 | |
Net (decrease) increase in cash and cash equivalents | (585,929) | 533,875 | 18,992 | |
Cash and cash equivalents at beginning of the year | 1,499,116 | 965,241 | 946,249 | |
Cash and cash equivalents at end of the year | 913,187 | 1,499,116 | $ 965,241 | |
Physician Groups | ||||
Cash flows from operating activities: | ||||
Net income | 32,301 | |||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 131,863 | |||
Net cash provided by operating activities | 164,164 | |||
Cash flows from investing activities: | ||||
Additions of property and equipment | (863) | |||
Investments and other items | (3,014) | |||
Net cash used in investing activities | (3,877) | |||
Cash flows from financing activities: | ||||
Long-term debt and related financing costs, net | (4) | |||
Intercompany | (143,837) | |||
Net cash used in financing activities | (143,841) | |||
Net (decrease) increase in cash and cash equivalents | 16,446 | |||
Cash and cash equivalents at beginning of the year | 88,245 | |||
Cash and cash equivalents at end of the year | 104,691 | 88,245 | ||
Unrestricted Subsidiaries | ||||
Cash flows from operating activities: | ||||
Net income | (66) | |||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 66 | |||
Company and Restricted Subsidiaries | ||||
Cash flows from operating activities: | ||||
Net income | [1] | 1,000,847 | ||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | [1] | 798,433 | ||
Net cash provided by operating activities | [1] | 1,799,280 | ||
Cash flows from investing activities: | ||||
Additions of property and equipment | [1] | (828,232) | ||
Acquisitions and divestitures, net | [1] | (563,856) | ||
Proceeds from asset sales | [1] | 64,725 | ||
Investments and other items | [1] | 129,572 | ||
Net cash used in investing activities | [1] | (1,197,791) | ||
Cash flows from financing activities: | ||||
Long-term debt and related financing costs, net | [1] | (124,438) | ||
Intercompany | [1] | 143,837 | ||
Other items | [1] | (1,227,539) | ||
Net cash used in financing activities | [1] | (1,208,140) | ||
Effect of exchange rate changes on cash | [1] | 4,276 | ||
Net (decrease) increase in cash and cash equivalents | [1] | (602,375) | ||
Cash and cash equivalents at beginning of the year | [1] | 1,410,871 | ||
Cash and cash equivalents at end of the year | [1] | $ 808,496 | $ 1,410,871 | |
[1] | After the elimination of the unrestricted subsidiaries and the physician groups |
Valuation and Qualifying Accoun
Valuation and Qualifying Accounts (Detail) - Allowance for uncollectible Accounts - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2016 | Dec. 31, 2015 | Dec. 31, 2014 | |
Valuation and Qualifying Accounts Disclosure [Line Items] | |||
Balance at beginning of year | $ 264,144 | $ 242,674 | $ 237,143 |
Amounts charged to income | 463,030 | 437,100 | 381,337 |
Amounts written off | 475,118 | 415,630 | 375,806 |
Balance at end of year | $ 252,056 | $ 264,144 | $ 242,674 |