EXHIBIT 12.1 TOTAL RENAL CARE HOLDINGS, INC. RATIO OF EARNINGS TO FIXED CHARGES The ratio of earnings to fixed charges is computed by dividing fixed charges into earnings. Earnings is defined as pretax income from continuing operations adjusted by adding fixed charges and excluding interest capitalized during the period. Fixed charges means the total of interest expense and amortization of financing costs, and the estimated interest component of rental expense on operating leases. Year ended December 31, ---------------------------------------------- 1999 1998 1997 1996 1995 --------- -------- -------- ------- ------- (in thousands, except for ratio data) Income before income taxes, extraordinary items and cumulative effect of a change in accounting principle........ $(181,826) $ 48,641 $ 81,178 $54,563 $37,141 --------- -------- -------- ------- ------- Fixed charges: Interest expense and amortization of debt issuance costs and discounts on all indebtedness................. 110,797 84,003 29,082 13,670 12,921 Interest portion of rental expense...................... 17,501 12,992 8,196 5,301 3,346 --------- -------- -------- ------- ------- Total fixed charges......... 128,298 96,995 37,278 18,971 16,267 --------- -------- -------- ------- ------- Earnings before income taxes, extraordinary items, cumulative effect of a change in accounting principle and fixed charges........................ $ (53,528) $145,636 $118,456 $73,534 $53,408 ========= ======== ======== ======= ======= Ratio of earnings to fixed charges........................ (a) 1.50 3.18 3.88 3.28 ========= ======== ======== ======= ======= - -------- (a) Due to the Company's loss in 1999, the ratio coverage was less than 1:1. The Company would have had to generate additional earnings of $182 million to achieve a coverage of 1:1.