Document and Entity Information
Document and Entity Information - USD ($) shares in Millions, $ in Billions | 12 Months Ended | ||
Dec. 31, 2018 | Jan. 31, 2019 | Jun. 29, 2018 | |
Document And Entity Information [Abstract] | |||
Document Type | 10-K | ||
Amendment Flag | false | ||
Document Period End Date | Dec. 31, 2018 | ||
Document Fiscal Year Focus | 2,018 | ||
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 Filer | No | ||
Entity Filer Category | Large Accelerated Filer | ||
Entity Small Business | false | ||
Entity Emerging Growth Company | false | ||
Entity Shell Company | false | ||
Entity Common Stock, Shares Outstanding | 166.4 | ||
Entity Public Float | $ 11.9 |
CONSOLIDATED STATEMENTS OF INCO
CONSOLIDATED STATEMENTS OF INCOME - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Statement [Abstract] | |||
Dialysis and related lab patient service revenues | $ 10,709,981 | $ 10,093,670 | $ 9,727,360 |
Provision for uncollectible accounts | (49,587) | (485,364) | (431,304) |
Net dialysis and related lab patient service revenues | 10,660,394 | 9,608,306 | 9,296,056 |
Other revenues | 744,457 | 1,268,328 | 1,411,411 |
Total revenues | 11,404,851 | 10,876,634 | 10,707,467 |
Operating expenses and charges: | |||
Patient care costs and other costs | 8,195,513 | 7,640,005 | 7,431,582 |
General and administrative | 1,135,454 | 1,064,026 | 1,072,841 |
Depreciation and amortization | 591,035 | 559,911 | 509,497 |
Provision for uncollectible accounts | (7,300) | (7,033) | 11,677 |
Equity investment income | 4,484 | 8,640 | (16,874) |
Investment and other asset impairments | 17,338 | 295,234 | 14,993 |
Goodwill impairment charges | 3,106 | 36,196 | 28,415 |
Gain on changes in ownership interest, net | (60,603) | (6,273) | (374,374) |
Gain on settlement, net | 0 | (526,827) | 0 |
Total operating expenses and charges | 9,879,027 | 9,063,879 | 8,677,757 |
Operating income | 1,525,824 | 1,812,755 | 2,029,710 |
Debt expense | (487,435) | (430,634) | (414,116) |
Other income, net | 10,089 | 17,665 | 7,511 |
Income from continuing operations before income taxes | 1,048,478 | 1,399,786 | 1,623,105 |
Income tax expense | 258,400 | 323,859 | 431,761 |
Net income from continuing operations | 790,078 | 1,075,927 | 1,191,344 |
Net loss from discontinued operations, net of tax | (457,038) | (245,372) | (158,262) |
Net income | 333,040 | 830,555 | 1,033,082 |
Less: Net income attributable to noncontrolling interests | (173,646) | (166,937) | (153,208) |
Net income attributable DaVita Inc. | $ 159,394 | $ 663,618 | $ 879,874 |
Earnings per share attributable to DaVita Inc.: | |||
Basic net income from continuing operations per share attributable to DaVita Inc. (in usd per share) | $ 3.66 | $ 4.78 | $ 5.12 |
Basic net income per share attributable to DaVita Inc. (in usd per share) | 0.93 | 3.52 | 4.36 |
Diluted net income from continuing operations per share attributable to DaVita Inc. (in usd per share) | 3.62 | 4.71 | 5.04 |
Diluted net income per share attributable to DaVita Inc. (in usd per share) | $ 0.92 | $ 3.47 | $ 4.29 |
Weighted average shares for earnings per share: | |||
Basic (in shares) | 170,785,999 | 188,625,559 | 201,641,173 |
Diluted (in shares) | 172,364,581 | 191,348,533 | 204,904,656 |
Amounts attributable to DaVita Inc.: | |||
Net income from continuing operations | $ 624,321 | $ 901,277 | $ 1,032,373 |
Net loss from discontinued operations | (464,927) | (237,659) | (152,499) |
Net (loss) income attributable to DaVita Inc. | $ 159,394 | $ 663,618 | $ 879,874 |
CONSOLIDATED STATEMENTS OF COMP
CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Statement of Comprehensive Income [Abstract] | |||
Net income | $ 333,040 | $ 830,555 | $ 1,033,082 |
Unrealized losses on interest rate cap and swap agreements, net: | |||
Unrealized losses | (133) | (5,437) | (3,670) |
Reclassification into net income | 6,286 | 5,058 | 2,566 |
Unrealized gains (losses) on investments, net: | |||
Unrealized losses | 0 | 3,705 | 1,427 |
Reclassification into net income | 0 | (220) | (423) |
Foreign currency translation adjustments: | |||
Foreign currency translation adjustments | (45,944) | 99,770 | (39,614) |
Reclassification into net income | 0 | 0 | 10,087 |
Other comprehensive (loss) income | (39,791) | 102,876 | (29,627) |
Total comprehensive income | 293,249 | 933,431 | 1,003,455 |
Less: Comprehensive income attributable to noncontrolling interests | (173,646) | (166,935) | (153,398) |
Comprehensive income attributable to DaVita Inc. | $ 119,603 | $ 766,496 | $ 850,057 |
CONSOLIDATED BALANCE SHEETS
CONSOLIDATED BALANCE SHEETS - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
ASSETS | ||
Cash and cash equivalents | $ 323,038 | $ 508,234 |
Restricted cash and equivalents | 92,382 | 10,686 |
Short-term investments | 2,935 | 32,830 |
Accounts receivable, net | 1,858,608 | 1,714,750 |
Inventories | 107,381 | 181,799 |
Other receivables | 469,796 | 399,262 |
Prepaid and other current assets | 111,840 | 112,058 |
Income tax receivable | 68,614 | 49,440 |
Current assets held for sale, net | 5,389,565 | 5,761,642 |
Total current assets | 8,424,159 | 8,770,701 |
Property and equipment, net | 3,393,669 | 3,149,213 |
Intangible assets, net | 118,846 | 113,827 |
Equity method and other investments | 224,611 | 245,534 |
Long-term investments | 35,424 | 37,695 |
Other long-term assets | 71,583 | 47,287 |
Goodwill | 6,841,960 | 6,610,279 |
Total assets | 19,110,252 | 18,974,536 |
LIABILITIES AND EQUITY | ||
Accounts payable | 463,270 | 509,116 |
Other liabilities | 595,850 | 579,005 |
Accrued compensation and benefits | 658,913 | 616,116 |
Current portion of long-term debt | 1,929,369 | 178,213 |
Current liabilities held for sale | 1,243,759 | 1,185,070 |
Total current liabilities | 4,891,161 | 3,067,520 |
Long-term debt | 8,172,847 | 9,158,018 |
Other long-term liabilities | 450,669 | 365,325 |
Deferred income taxes | 562,536 | 486,247 |
Total liabilities | 14,077,213 | 13,077,110 |
Commitments and contingencies: | ||
Noncontrolling interests subject to put provisions | 1,124,641 | 1,011,360 |
Equity: | ||
Preferred stock ($0.001 par value, 5,000,000 shares authorized; none issued) | 0 | 0 |
Common stock ($0.001 par value, 450,000,000 shares authorized; 166,387,307 and 182,462,278 shares issued and outstanding, respectively) | 166 | 182 |
Additional paid-in capital | 995,006 | 1,042,899 |
Retained earnings | 2,743,194 | 3,633,713 |
Accumulated other comprehensive (loss) income | (34,924) | 13,235 |
Total DaVita Inc. shareholders' equity | 3,703,442 | 4,690,029 |
Noncontrolling interests not subject to put provisions | 204,956 | 196,037 |
Total equity | 3,908,398 | 4,886,066 |
Total liabilities and shareholders' equity | $ 19,110,252 | $ 18,974,536 |
CONSOLIDATED BALANCE SHEETS (Pa
CONSOLIDATED BALANCE SHEETS (Parenthetical) - $ / shares | Dec. 31, 2018 | Dec. 31, 2017 |
Statement of Financial Position [Abstract] | ||
Preferred stock, par value (in usd per share) | $ 0.001 | $ 0.001 |
Preferred stock, shares authorized (in shares) | 5,000,000 | 5,000,000 |
Preferred stock, issued (in shares) | 0 | 0 |
Common stock, par value (in usd per share) | $ 0.001 | $ 0.001 |
Common stock, shares authorized (in shares) | 450,000,000 | 450,000,000 |
Common stock, shares issued (in shares) | 166,387,307 | 182,462,278 |
Common stock, shares outstanding (in shares) | 166,387,307 | 182,462,278 |
CONSOLIDATED STATEMENTS OF CASH
CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Cash flows from operating activities: | |||
Net income | $ 333,040 | $ 830,555 | $ 1,033,082 |
Adjustments to reconcile net income to net cash provided by operating activities: | |||
Depreciation and amortization | 591,035 | 777,485 | 720,252 |
Impairment charges | 61,981 | 981,589 | 296,408 |
Valuation adjustment on disposal group | 316,840 | 0 | 0 |
Stock-based compensation expense | 73,061 | 35,092 | 38,338 |
Deferred income taxes | 273,660 | (395,217) | 52,010 |
Equity investment income, net | 26,449 | 28,925 | 17,766 |
Gain on sales of business interests, net | (85,699) | (23,402) | (404,165) |
Other non-cash charges, net | 82,374 | 66,920 | (7,343) |
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures: | |||
Accounts receivable | (81,176) | (156,305) | (152,240) |
Inventories | 73,505 | (18,625) | 22,920 |
Other receivables and other current assets | 236,995 | (111,432) | (45,351) |
Other long-term assets | 3,497 | (11,945) | 35,893 |
Accounts payable | (35,959) | 26,876 | 11,897 |
Accrued compensation and benefits | 84,165 | (78,239) | 68,272 |
Other current liabilities | (157,462) | 1,908 | 176,494 |
Income taxes | (23,635) | (52,176) | 77,376 |
Other long-term liabilities | (1,031) | 11,157 | 30,517 |
Net cash provided by operating activities | 1,771,640 | 1,913,166 | 1,972,126 |
Cash flows from investing activities: | |||
Additions of property and equipment | (987,138) | (905,250) | (829,095) |
Acquisitions | (183,156) | (803,879) | (563,856) |
Proceeds from asset and business sales | 150,205 | 92,336 | 64,725 |
Purchase of investments available for sale | (8,448) | (13,117) | (13,539) |
Purchase of investments held-to-maturity | (5,963) | (228,990) | (1,133,192) |
Proceeds from sale of investments available for sale | 9,526 | 6,408 | 18,963 |
Proceeds from investments held-to-maturity | 34,862 | 492,470 | 1,240,502 |
Purchase of equity investments | (19,177) | (4,816) | (27,096) |
Proceeds from sale of equity investments | 0 | 0 | 40,920 |
Distributions received on equity investments | 3,646 | 106 | 0 |
Net cash used in investing activities | (1,005,643) | (1,364,732) | (1,201,668) |
Cash flows from financing activities: | |||
Borrowings | 59,934,750 | 50,991,960 | 51,991,490 |
Payments on long-term debt and other financing costs | (59,239,973) | (50,837,112) | (52,116,120) |
Purchase of treasury stock | (1,161,511) | (802,949) | (1,097,822) |
Distributions to noncontrolling interests | (196,441) | (211,467) | (192,401) |
Stock award exercises and other share issuances, net | 13,577 | 21,252 | 23,543 |
Excess tax benefits from stock award exercises | 0 | 0 | 13,251 |
Contributions from noncontrolling interests | 52,311 | 74,552 | 47,590 |
Proceeds from sales of additional noncontrolling interests | 15 | 2,864 | 0 |
Purchases of noncontrolling interests | (28,082) | (5,357) | (21,512) |
Net cash used in financing activities | (625,354) | (766,257) | (1,351,981) |
Effect of exchange rate changes on cash, cash equivalents and restricted cash | (3,350) | 254 | 4,276 |
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 137,293 | (217,569) | (577,247) |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 518,920 | 683,463 | 1,244,917 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 415,420 | 518,920 | 683,463 |
Discontinued Operations | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 240,793 | (53,026) | (15,793) |
Continuing Operations | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | $ (103,500) | $ (164,543) | $ (561,454) |
CONSOLIDATED STATEMENTS OF EQUI
CONSOLIDATED STATEMENTS OF EQUITY - USD ($) $ in Thousands | Total | Non-controlling interests subject to put provisions | Common stock | Common stockRestricted Stock Units (RSUs) | Common stockStock appreciation rights | Additional paid-in capital | Additional paid-in capitalRestricted Stock Units (RSUs) | Additional paid-in capitalStock appreciation rights | Retained earnings | Treasury stock | Treasury stockRestricted Stock Units (RSUs) | Treasury stockStock appreciation rights | Accumulated other comprehensive income (loss) | Total | TotalRestricted Stock Units (RSUs) | TotalStock appreciation rights | Non-controlling interests not subject to put provisions |
Temporary equity, beginning balance at Dec. 31, 2015 | $ 864,066 | ||||||||||||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | |||||||||||||||||
Net income | 99,834 | ||||||||||||||||
Distributions | (111,092) | ||||||||||||||||
Contributions | 33,517 | ||||||||||||||||
Acquisitions and divestitures | 28,874 | ||||||||||||||||
Partial purchases | (6,660) | ||||||||||||||||
Fair value remeasurements | 65,855 | ||||||||||||||||
Reclassifications of Temporary to Permanent Equity | (1,136) | $ 1,136 | |||||||||||||||
Temporary equity, ending balance at Dec. 31, 2016 | 973,258 | ||||||||||||||||
Beginning balance (in shares) at Dec. 31, 2015 | (217,120,000) | (7,366,000) | |||||||||||||||
Beginning balance at Dec. 31, 2015 | $ 217 | $ 1,118,326 | $ 4,356,835 | $ (544,772) | $ (59,826) | $ 4,870,780 | 213,392 | ||||||||||
Comprehensive income: | |||||||||||||||||
Net income | $ 879,874 | 879,874 | 879,874 | 53,374 | |||||||||||||
Comprehensive income | (29,627) | (29,817) | (29,817) | 190 | |||||||||||||
Stock purchase shares issued (in shares) | 438,000 | ||||||||||||||||
Stock purchase shares issued | $ 1 | 23,902 | 23,903 | ||||||||||||||
Stock-settled share based payment awards, shares issued (in shares) | 4,000 | 218,000 | 276,000 | 513,000 | |||||||||||||
Stock-settled share based payment awards | $ 0 | $ 0 | $ 19,815 | $ 36,685 | $ 19,815 | $ 36,685 | $ 0 | $ 0 | |||||||||
Stock-settled stock-based compensation expense | 37,970 | 37,970 | |||||||||||||||
Excess tax benefits from stock awards exercised | 13,251 | 13,251 | |||||||||||||||
Distributions | (81,309) | ||||||||||||||||
Contributions | 14,073 | ||||||||||||||||
Acquisitions and divestitures | 3,423 | 3,423 | |||||||||||||||
Acquisitions and divestitures, noncontrolling interest | 2,585 | ||||||||||||||||
Partial purchases | (13,105) | (13,105) | (1,747) | ||||||||||||||
Fair value remeasurements | (65,855) | (65,855) | |||||||||||||||
Reclassifications and expirations of puts | 1,136 | (1,136) | |||||||||||||||
Purchase of treasury stock (in shares) | (16,649,000) | ||||||||||||||||
Purchase of treasury stock | $ (1,072,377) | (1,072,377) | |||||||||||||||
Retirement of treasury stock (in shares) | (23,226,000) | (23,226,000) | |||||||||||||||
Retirement of treasury stock | $ (23) | (34,230) | (1,526,396) | $ 1,560,649 | |||||||||||||
Ending balance at Dec. 31, 2016 | $ 195 | 1,027,182 | 3,710,313 | $ 0 | (89,643) | 4,648,047 | 201,694 | ||||||||||
Ending balance (in shares) at Dec. 31, 2016 | (194,554,000) | 0 | |||||||||||||||
Increase (Decrease) in Temporary Equity [Roll Forward] | |||||||||||||||||
Net income | 103,641 | ||||||||||||||||
Distributions | (128,853) | ||||||||||||||||
Contributions | 52,911 | ||||||||||||||||
Acquisitions and divestitures | 43,799 | ||||||||||||||||
Partial purchases | (397) | ||||||||||||||||
Fair value remeasurements | (32,999) | ||||||||||||||||
Temporary equity, ending balance at Dec. 31, 2017 | 1,011,360 | ||||||||||||||||
Comprehensive income: | |||||||||||||||||
Net income | 663,618 | 663,618 | 663,618 | 63,296 | |||||||||||||
Comprehensive income | $ 102,876 | 102,878 | 102,878 | (2) | |||||||||||||
Stock purchase shares issued (in shares) | 360,000 | ||||||||||||||||
Stock purchase shares issued | 22,131 | 22,131 | |||||||||||||||
Stock-settled share based payment awards, shares issued (in shares) | 117,000 | 398,000 | |||||||||||||||
Stock-settled share based payment awards | 101 | 0 | 101 | 0 | |||||||||||||
Stock-settled stock-based compensation expense | 34,981 | 34,981 | |||||||||||||||
Distributions | (82,614) | ||||||||||||||||
Contributions | 21,641 | ||||||||||||||||
Acquisitions and divestitures | (823) | (823) | |||||||||||||||
Acquisitions and divestitures, noncontrolling interest | (5,770) | ||||||||||||||||
Partial purchases | (2,752) | (2,752) | (2,208) | ||||||||||||||
Fair value remeasurements | 32,999 | 32,999 | |||||||||||||||
Purchase of treasury stock (in shares) | (12,966,672) | (12,967,000) | |||||||||||||||
Purchase of treasury stock | $ (810,949) | $ (810,949) | (810,949) | ||||||||||||||
Retirement of treasury stock (in shares) | (12,967,000) | (12,967,000) | |||||||||||||||
Retirement of treasury stock | $ (13) | (70,718) | (740,218) | $ 810,949 | |||||||||||||
Ending balance at Dec. 31, 2017 | $ 4,886,066 | $ 182 | 1,042,899 | 3,633,713 | $ 0 | 13,235 | 4,690,029 | 196,037 | |||||||||
Ending balance (in shares) at Dec. 31, 2017 | (182,462,278) | (182,462,000) | 0 | ||||||||||||||
Comprehensive income: | |||||||||||||||||
Cumulative Effect of New Accounting Principle in Period of Adoption | 8,368 | (8,368) | 0 | ||||||||||||||
Net income | 105,531 | ||||||||||||||||
Distributions | (119,173) | ||||||||||||||||
Contributions | 32,918 | ||||||||||||||||
Acquisitions and divestitures | 79,078 | ||||||||||||||||
Partial purchases | (8,546) | ||||||||||||||||
Fair value remeasurements | 23,473 | ||||||||||||||||
Temporary equity, ending balance at Dec. 31, 2018 | $ 1,124,641 | ||||||||||||||||
Comprehensive income: | |||||||||||||||||
Net income | $ 159,394 | 159,394 | 159,394 | 68,115 | |||||||||||||
Comprehensive income | $ (39,791) | (39,791) | (39,791) | ||||||||||||||
Stock purchase shares issued (in shares) | 398,000 | ||||||||||||||||
Stock purchase shares issued | 17,398 | 17,398 | |||||||||||||||
Stock-settled share based payment awards, shares issued (in shares) | 158,000 | 213,000 | |||||||||||||||
Stock-settled share based payment awards | $ 1 | $ 448 | $ 4,887 | $ 448 | $ 4,886 | ||||||||||||
Stock-settled stock-based compensation expense | 73,081 | 73,081 | |||||||||||||||
Distributions | (77,268) | ||||||||||||||||
Contributions | 19,393 | ||||||||||||||||
Acquisitions and divestitures | 3,546 | 3,546 | |||||||||||||||
Acquisitions and divestitures, noncontrolling interest | 318 | ||||||||||||||||
Partial purchases | (17,897) | (17,897) | (1,639) | ||||||||||||||
Fair value remeasurements | (23,473) | (23,473) | |||||||||||||||
Purchase of treasury stock (in shares) | (16,844,067) | (16,844,000) | |||||||||||||||
Purchase of treasury stock | $ (1,153,511) | $ (1,153,511) | (1,153,511) | ||||||||||||||
Retirement of treasury stock (in shares) | (16,844,000) | (16,844,000) | |||||||||||||||
Retirement of treasury stock | $ (17) | (95,213) | (1,058,281) | $ 1,153,511 | 0 | ||||||||||||
Ending balance at Dec. 31, 2018 | $ 3,908,398 | $ 166 | $ 995,006 | $ 2,743,194 | $ 0 | $ (34,924) | $ 3,703,442 | $ 204,956 | |||||||||
Ending balance (in shares) at Dec. 31, 2018 | (166,387,307) | (166,387,000) | 0 |
Organization and Summary of Sig
Organization and Summary of Significant Accounting Policies | 12 Months Ended |
Dec. 31, 2018 | |
Accounting Policies [Abstract] | |
Organization and Summary of Significant Accounting Policies | Organization and summary of significant accounting policies Organization DaVita Inc. (the Company) consists of 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, 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, 2018 , the Company operated or provided administrative services through a network of 2,664 U.S. outpatient dialysis centers in 46 states and the District of Columbia, serving a total of approximately 202,700 patients. In addition, as of December 31, 2018 , the Company operated or provided administrative services to a total of 241 outpatient dialysis centers serving approximately 25,000 patients located in nine countries outside of the U.S. 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 December 2017, the Company entered into an agreement to sell its DMG division to Collaborative Care Holdings, LLC (Optum), a subsidiary of UnitedHealth Group Inc., subject to receipt of required regulatory approvals and other customary closing conditions. As a result, the DMG business has been classified as held for sale and its results of operations are reported as discontinued operations for all periods presented in these consolidated financial statements. For financial information about the DMG business, see Note 22 . The Company’s U.S. dialysis and related lab services business qualifies as a separately reportable segment 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. Equity investments in investees over which the Company has significant influence are recorded on the equity method, while investments in other equity securities are recorded at fair value or pursuant to an adjusted cost method measurement alternative, as applicable. 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 (the U.S. dollar, or 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 goodwill and investments, accounting for income taxes, consolidation of variable interest entities, and certain fair value estimates. Specific estimating risks and contingencies are further addressed within these notes to the consolidated financial statements. Revenues On January 1, 2018, the Company adopted Financial Accounting Standards Board (FASB) Accounting Standards Codification Topic 606 Revenue from Contracts with Customers (Topic 606) using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results for reporting periods beginning on and after January 1, 2018 are presented under Topic 606, while prior period amounts continue to be presented in accordance with the Company's historical accounting under Revenue Recognition (Topic 605). The adoption of this new standard primarily changed the Company’s presentation of revenues, provision for uncollectible accounts and allowance for doubtful accounts. Topic 606 requires revenue to be recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Accordingly, for performance obligations satisfied after the adoption of Topic 606, the Company no longer separately presents a provision for uncollectible accounts on the consolidated income statement and no longer presents the related allowance for doubtful accounts on the consolidated balance sheet. However, as a result of the Company’s election to apply Topic 606 only to contracts not substantially completed as of January 1, 2018, the Company continues to maintain an allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of Topic 606. Net collections or write-offs of accounts receivable generated prior to January 1, 2018, beyond amounts previously reserved thereon, are presented in the provision for uncollectible accounts on the consolidated income statement in accordance with Topic 605. Dialysis and related lab patient service revenues Dialysis patient service revenues are recognized in the period services are provided. Revenues consist primarily of payments from government and commercial health plans for dialysis and related lab services provided to patients. A usual and customary fee schedule is maintained for the Company’s dialysis treatments and related lab services; however, actual collectible revenue is normally recognized at a discount from the fee schedule. Revenues associated with Medicare and Medicaid programs are estimated 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. 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. The Company’s revenue recognition is estimated based on its judgment regarding its ability to collect, which depends upon its ability to effectively capture, document and bill for Medicare’s base payment rate as well as these other variable factors. 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. 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. In certain circumstances, it may not be 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. Other revenues Other revenues consist of the revenues associated with the non-dialysis 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, and administrative and management support services to certain other non-dialysis joint ventures in which the Company owns a noncontrolling interest. Revenues associated with pharmacy services are estimated as prescriptions are filled and shipped to patients. Revenues associated with dialysis management services, disease management services, clinical research programs, physician services, ESRD seamless care organizations, and comprehensive care are estimated in the period services are provided. Revenues associated with direct primary care were estimated over the membership period. Other income Other income includes interest income on cash and cash-equivalents and short- and long-term investments, other non-operating gains from investment transactions, and 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. Restricted cash and equivalents Restricted cash and equivalents are restricted cash or cash equivalents held in trust to satisfy insurer and state regulatory requirements related to the Company's self-insurance for professional and general liability and workers' compensation risks administered by wholly-owned captive insurance entities. 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 or redemption values are classified as short-term or long-term investments and recorded at estimated fair value with changes in fair value recognized in current earnings. See Note 5 for further details, including recent changes to the Company's accounting for these investments. Inventories Inventories are stated at the lower of cost (first-in, first-out) or net realizable value 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. 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 years to 40 years ; leasehold improvements, the shorter of ten years or the expected lease term; and equipment and information systems, principally three years to 15 years . Disposition gains and losses are included in current operating expenses. Amortizable intangibles Amortizable intangible assets and liabilities include 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: non-competition and similar agreements, two years to ten years ; and lease agreements and hospital acute service contracts, over the term of the lease or contract period, respectively. Indefinite-lived intangibles Indefinite-lived intangible assets include international licenses and accreditations that allow the Company to be reimbursed for providing dialysis services to patients, each of which has an indefinite useful life. Indefinite-lived intangibles are not amortized, but are assessed for impairment at least annually and whenever significant events or changes in circumstances indicate that an impairment may have occurred. Equity method and other investments Equity investments that do not have readily determinable fair values are carried on the equity method if the Company maintains significant influence over the investee, or on an adjusted cost method measurement alternative representing either the Company's cost or a subsequent observation of fair value, in each case net of any applicable other-than-temporary impairment. The Company classifies its equity and adjusted cost method investments as “Equity method and other investments” on its balance sheet. See Note 10 to these consolidated financial statements for further details, including recent changes to the Company's accounting for these investments. 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 by individual reporting unit for impairment as circumstances warrant and at least annually. An impairment charge is recorded when and to the extent a reporting unit's carrying amount is determined to exceed its fair value. The Company operates multiple reporting units. See Note 11 to these consolidated financial statements for further details. Impairment of equity method and other investments Equity method and other investments are assessed for other-than-temporary impairment when significant events or changes in circumstances indicate that an other-than-temporary impairment may have occurred. An other-than-temporary impairment charge is recorded when the fair value of an investment has fallen below its carrying amount and the shortfall is expected to be indefinitely or permanently unrecoverable. Impairment of other long-lived assets Other long-lived assets, including property and equipment and intangible assets, are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Such changes can include changes in the Company’s business strategy and plans, changes in the quality or structure of its relationships with its partners or deteriorating performance of individual outpatient dialysis centers or other business units. An impairment of an amortizable or depreciable asset is indicated when the sum of the expected future undiscounted net cash flows identifiable to the related asset group is less than its carrying amount. Impairment losses are measured based on the difference between the estimated fair value and the carrying amount of the subject asset group and are included in operating expenses. Self-insurance The Company is predominantly self-insured with respect to professional and general liability and workers' compensation risks through wholly-owned captive insurance companies, with excess or reinsurance coverage for additional risk. The Company is also predominantly self-insured with respect to employee medical and other health benefits. The Company records insurance liabilities for the professional and general liability, workers’ compensation, and employee health benefit risks that it retains and estimates its liability for those risks using third party actuarial calculations that are based upon historical claims experience and expectations for future claims. 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 expense for stock-settled awards is measured at the estimated fair value of awards on the date of grant and recognized on a cumulative straight-line basis over the vesting terms of the awards unless the stock awards are based on non-market based performance metrics, in which case expense is adjusted for expected ultimate payouts as of the end of each reporting period. Stock-based compensation expense for cash-settled awards is based on the estimated fair values as of the end of each reporting period. The expense for all stock-based awards is recognized net of expected forfeitures. Interest rate cap and swap agreements The Company often carries a combination of current or 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, 2018 , third parties held noncontrolling equity interests in 653 consolidated legal entities, including 650 legal entities classified within continuing operations. Fair value estimates The Company relies on fair value measurements and estimates for purposes that require the recording, reassessment, or adjustment of the carrying amounts of certain assets, liabilities and noncontrolling interests subject to put provisions (temporary equity). These purposes can include the accounting for business combination transactions; impairment assessments for goodwill, other intangible assets, or other long-lived assets; recurrent revaluation of investments in debt and equity securities, interest rate cap agreements or other derivative instruments, contingent earn-out obligations, and noncontrolling interests subject to put provisions; and the accounting for equity method and other investments and stock-based compensation, as applicable. The Company has also classified its assets, liabilities and temporary equity into the appropriate fair value hierarchy levels as defined by the FASB. See Note 24 to these consolidated financial statements for further details. New accounting standards On May 28, 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606), which requires an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised goods or services to customers. In 2015, 2016 and 2017, the FASB issued ASU 2015-14, ASU 2016-08, ASU 2016-10, ASU 2016-11, ASU 2016-12, and ASU 2017-10, each of which amended the guidance in ASU 2014-09. These ASUs replaced most existing revenue recognition guidance in GAAP. The Company adopted these ASUs beginning January 1, 2018. See Note 2 for further details. In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments - Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities . In February 2018, the FASB issued ASU 2018-03, which provides various related technical corrections and improvements. The Company adopted these ASUs beginning January 1, 2018. See Note 5 for further details. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) . The amendments in this ASU include revisions to lessee accounting, requiring lessees to recognize a lease liability and a right-of-use asset for substantially all leases with lease terms in excess of twelve months. The Company plans to adopt the amendments in this ASU as of January 1, 2019 using a modified retrospective transition approach for leases existing at, or entered into after, the adoption date with a cumulative effect adjustment. The Company is planning on electing the package of practical expedients to not reassess prior conclusions related to contracts containing leases, lease classification and initial direct costs. The Company estimates the impact of this guidance will result in recognition of additional net lease liabilities of approximately $3,000,000 as of January 1, 2019. The Company is still finalizing its calculations, including the amount of right of use assets to recognize as well as, the cumulative effect adjustment to beginning retained earnings. The Company does not believe this new guidance will have a material effect on its results of operations or liquidity. In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments . The amendments in this ASU clarify how certain cash receipts and cash payments should be classified on the statement of cash flows. In November 2016, the FASB issued ASU No. 2016-18, Statement of Cash Flows (Topic 230): Restricted cash. The amendments in this ASU require that the statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. The adoption of these ASUs did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2018. In October 2016, the FASB issued ASU No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory . The amendments in this ASU allow entities to recognize the income tax consequences of an intra-entity transfer of an asset other than inventory when the transfer occurs. The prior guidance did not allow recognition until the asset had been sold to an outside party. The amendments in this ASU were effective for the Company beginning on January 1, 2018 and have been applied on a modified retrospective basis. The adoption of this ASU did not have a material impact on the Company’s consolidated financial statements. In August 2017, the FASB issued ASU No. 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. The amendments in this ASU better align an entity’s risk management activities and financial reporting for hedging relationships through changes to both the designation and measurement guidance for qualifying hedging relationships and the presentation of hedge results. The amendments in this ASU are effective for the Company on January 1, 2019 and are to be applied prospectively. The adoption of this ASU is not expected to have a material impact on the Company’s consolidated financial statements. In February 2018, the FASB issued ASU No. 2018-02, Income Statement - Reporting Comprehensive Income (Topic 220), Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income , which allows for the reclassification of certain income tax effects related to the Tax Cuts and Jobs Act (2017 Tax Act) between “Accumulated other comprehensive income” and “Retained earnings.” This ASU relates to the requirement that adjustments to deferred tax liabilities and assets related to a change in tax laws or rates be included in “Income from continuing operations”, even in situations where the related items were originally recognized in “Other comprehensive income” (rather than in “Income from continuing operations”). The amendments in this ASU were effective for all entities for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years, with early adoption permitted. The Company elected to early adopt this ASU on January 1, 2018 and applied the change in the period of adoption. The adoption of this ASU resulted in the reclassification of an immaterial amount of deferred tax effects from accumulated other comprehensive income to retained earnings via a cumulative change in accounting principle effective January 1, 2018. See Note 20 for more details. In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework -Changes to the Disclosure Requirements for Fair Value Measurement |
Revenue Recognition
Revenue Recognition | 12 Months Ended |
Dec. 31, 2018 | |
Text Block [Abstract] | |
Revenue Recognition [Text Block] | Revenue recognition and accounts receivable The following table summarizes the Company's segment revenues by primary payor source: Year ended December 31, 2018 U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,063,891 $ — $ 6,063,891 Medicaid and Managed Medicaid 628,766 — 628,766 Other government 446,999 335,594 782,593 Commercial 3,176,413 101,681 3,278,094 Other revenues: Medicare and Medicare Advantage — 492,812 492,812 Medicaid and Managed Medicaid — 44,246 44,246 Commercial — 90,890 90,890 Other (1) 19,880 130,865 150,745 Eliminations of intersegment revenues (92,950 ) (34,236 ) (127,186 ) Total $ 10,242,999 $ 1,161,852 $ 11,404,851 (1) Other consists of management service fees earned in the respective Company line of business as well as revenue from the Company's ancillary services and strategic initiatives. Year ended December 31, 2017 (1) U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated Patient service revenues: Medicare and Medicare Advantage $ 5,253,012 $ — $ 5,253,012 Medicaid and Managed Medicaid 606,827 — 606,827 Other government 362,567 259,651 622,218 Commercial 3,117,920 63,505 3,181,425 Other revenues: Medicare and Medicare Advantage — 902,289 902,289 Medicaid and Managed Medicaid — 71,426 71,426 Commercial — 116,503 116,503 Other (2) 19,739 182,974 202,713 Eliminations of intersegment revenues (55,176 ) (24,603 ) (79,779 ) Total $ 9,304,889 $ 1,571,745 $ 10,876,634 (1) As noted above, prior period amounts have not been adjusted under the cumulative effect method. In this table, the Company's dialysis and related lab services revenues for the year ended December 31, 2017 has been presented net of the provision for uncollectible accounts of $485,364 to conform to the current period presentation. (2) Other consists of management service fees earned in the respective Company line of business as well as revenue from the Company's ancillary services and strategic initiatives. Year ended December 31, 2016 (1) U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated Patient service revenues: Medicare and Medicare Advantage $ 5,303,718 $ — $ 5,303,718 Medicaid and Managed Medicaid 319,553 — 319,553 Other government 143,207 165,193 308,400 Commercial 3,355,066 36,674 3,391,740 Other revenues: Medicare and Medicare Advantage — 974,146 974,146 Medicaid and Managed Medicaid — 82,428 82,428 Commercial — 128,824 128,824 Other (2) 16,645 234,107 250,752 Eliminations of intersegment revenues (27,355 ) (24,739 ) (52,094 ) Total $ 9,110,834 $ 1,596,633 $ 10,707,467 (1) As noted above, prior period amounts have not been adjusted under the cumulative effect method. In this table, the Company's dialysis and related lab services revenues for the year ended December 31, 2016 has been presented net of the provision for uncollectible accounts of $431,304 to conform to the current period presentation. (2) Other consists of management service fees earned in the respective Company line of business as well as revenue from the Company's ancillary services and strategic initiatives. The Company’s allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of Topic 606 was $52,924 and $218,399 as of December 31, 2018 and 2017, respectively. There are significant risks associated with estimating revenue, which generally take several years to resolve. These estimates are subject to ongoing insurance coverage changes, geographic coverage differences, differing interpretations of contract coverage and other payor issues, as well as patient issues including determining applicable primary and secondary coverage, changes in patient coverage and coordination of benefits. As these estimates are refined over time, both positive and negative adjustments to revenue are recognized in the current period. As a result of changes in these estimates, additional revenue was recognized during the year ended December 31, 2018 associated with performance obligations satisfied in years prior to the adoption of Topic 606 of $88,495 , which includes a benefit of $36,000 for the year ended December 31, 2018 from electing to apply Topic 606 only to contracts not substantially completed as of January 1, 2018. There is no single commercial payor that accounted for more than 10% of total consolidated accounts receivable or consolidated net revenues at or for the year ended December 31, 2018 and 2017 . Net dialysis and related lab services accounts receivable and other receivables from Medicare, including Medicare-assigned plans, and Medicaid, including managed Medicaid plans, were approximately $1,080,561 and $874,971 as of December 31, 2018 and 2017 , respectively. Approximately 18% and 21% of the Company’s net patient services accounts receivable balances as of December 31, 2018 and 2017 , respectively, were more than six months old. The decrease was primarily due to improved collections at DaVita Health Solutions and in certain international operations. There were no significant balances over one year |
Earnings Per Share
Earnings Per Share | 12 Months Ended |
Dec. 31, 2018 | |
Earnings Per Share [Abstract] | |
Earnings Per Share | Earnings per share Basic earnings 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, net of the weighted average shares held in escrow that under certain circumstances may have been returned to the Company. Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units (under the treasury stock method) as well as the weighted average shares held in escrow that were outstanding during the period. The reconciliations of the numerators and denominators used to calculate basic and diluted earnings per share were as follows: Year ended December 31, 2018 2017 2016 (shares in thousands) Numerators: Net income from continuing operations attributable to DaVita Inc. $ 624,321 $ 901,277 $ 1,032,373 Net loss from discontinued operations attributable to DaVita Inc. (464,927 ) (237,659 ) (152,499 ) Net income attributable to DaVita Inc. for earnings per share calculation $ 159,394 $ 663,618 $ 879,874 Basic: Weighted average shares outstanding during the period 171,886 190,820 203,835 Weighted average contingently returnable shares previously held in escrow for (1,100 ) (2,194 ) (2,194 ) Weighted average shares for basic earnings per share calculation 170,786 188,626 201,641 Basic net income from continuing operations per share attributable to DaVita Inc. $ 3.66 $ 4.78 $ 5.12 Basic net loss from discontinued operations per share attributable to DaVita Inc. (2.73 ) (1.26 ) (0.76 ) Basic net income per share attributable to DaVita Inc. $ 0.93 $ 3.52 $ 4.36 Diluted: Weighted average shares outstanding during the period 171,886 190,820 203,835 Assumed incremental shares from stock plans 479 529 1,070 Weighted average shares for diluted earnings per share calculation 172,365 191,349 $ 204,905 Diluted net income from continuing operations per share attributable to DaVita Inc. $ 3.62 $ 4.71 $ 5.04 Diluted net loss from discontinued operations per share attributable to DaVita Inc. (2.70 ) (1.24 ) (0.75 ) Diluted net income per share attributable to DaVita Inc. $ 0.92 $ 3.47 $ 4.29 Anti-dilutive stock-settled awards excluded from calculation (1) 5,295 4,350 2,523 (1) |
Restricted Cash Restricted Cash
Restricted Cash Restricted Cash | 12 Months Ended |
Dec. 31, 2018 | |
Restricted Cash [Abstract] | |
Cash and Cash Equivalents Disclosure [Text Block] | Restricted cash and equivalents The Company had restricted cash and cash equivalents of $92,382 and $10,686 at December 31, 2018 and 2017 , respectively. Approximately $79,329 of the balance at December 31, 2018 represents restricted cash equivalents held in trust to satisfy insurer and state regulatory requirements related to the Company's self-insurance for professional and general liability and workers' compensation risks administered by wholly-owned captive insurance entities. Prior to the first quarter of 2018, these requirements were satisfied by a letter of credit rather than restricted cash held in trust. The remaining restricted cash and equivalents held at December 31, 2018 and 2017 primarily represent cash pledged to third parties in connection with two |
Short-term and long-term invest
Short-term and long-term investments | 12 Months Ended |
Dec. 31, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Investments in Debt and Equity Securities | Short-term and long-term investments Effective January 1, 2018, the Company adopted ASU No. 2016-01, Financial Instruments - Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities. The amendments in this ASU revise accounting related to (i) the classification and measurement of investments in equity securities and (ii) the presentation of certain fair value changes for financial liabilities at fair value. The Company also adopted ASU 2018-03 which provides related technical corrections and improvements. The principal effect of these ASUs on the Company's consolidated financial statements is that, prior to adoption of ASU 2016-01, changes in the fair values of available-for-sale equity investments with readily determinable fair values or redemption values were recognized in other comprehensive income until realized, while under ASU 2016-01 all changes in the fair values of such equity securities are recognized in current earnings within "Other income, net". The adoption of these ASUs did not have a material effect on these consolidated financial statements. Effective January 1, 2018, the Company recognized a cumulative effect of change in accounting principle upon adoption of ASUs 2016-01 and 2018-03, in conjunction with ASU 2018-02, the effect of which was to decrease accumulated other comprehensive income, and to increase retained earnings, by $5,662 in after-tax unrealized gains accumulated in other comprehensive income through December 31, 2017 from equity securities classified as available-for-sale investments prior to adoption of ASU 2016-01. From January 1, 2018, equity securities that have readily determinable fair values or redemption values are recorded at estimated fair value with changes in their value recognized in current earnings. The Company classifies its debt securities as held-to-maturity and records them at amortized cost based on its intentions and strategy concerning those investments. The Company classifies these debt and equity investments as "Short-term investments" or "Long-term investments" on its consolidated balance sheet, as applicable, based on the characteristics of the financial instrument or the Company's intentions or expectations for the investment. The Company’s investments in these short-term and long-term debt and equity investments consist of the following: December 31, 2018 December 31, 2017 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 2,235 $ — $ 2,235 $ 31,630 $ — $ 31,630 Investments in mutual funds and common stock — 36,124 36,124 — 38,895 38,895 $ 2,235 $ 36,124 $ 38,359 $ 31,630 $ 38,895 $ 70,525 Short-term investments $ 2,235 $ 700 $ 2,935 $ 31,630 $ 1,200 $ 32,830 Long-term investments — 35,424 35,424 — 37,695 37,695 $ 2,235 $ 36,124 $ 38,359 $ 31,630 $ 38,895 $ 70,525 Debt securities: The Company's short-term debt investments are principally bank certificates of deposit with contractual maturities longer than three months but shorter than one year. These debt securities are accounted for as held-to-maturity and recorded at amortized cost, which approximates their fair values at December 31, 2018 and 2017 . Equity securities: The Company's equity investments in mutual funds and common stock are held within a trust to fund existing obligations associated with several of the Company’s non-qualified deferred compensation plans. During 2018 , the Company recognized pre-tax net losses of $1,208 in the income statement associated with changes in the fair value of these equity securities, comprised of pre-tax realized gains of $4,490 and a net decrease in unrealized gains of $5,698 . During 2017 , the Company recognized pre-tax realized gains on the sale or redemption of equity securities of $360 , or $220 |
Other Receivables Other Receiva
Other Receivables Other Receivables | 12 Months Ended |
Dec. 31, 2018 | |
Receivables [Abstract] | |
Other Receivables | Other receivables Other receivables were comprised of the following: December 31, 2018 2017 Supplier rebates and non-trade receivables $ 334,156 $ 295,292 Medicare bad debt claims 135,640 103,970 $ 469,796 $ 399,262 |
Prepaid and Other Current Asset
Prepaid and Other Current Assets | 12 Months Ended |
Dec. 31, 2018 | |
Prepaid Expense and Other Assets, Current [Abstract] | |
Prepaid and Other Current Assets | Prepaid and other current assets Other current assets were comprised of the following: December 31, 2018 2017 Prepaid expenses $ 108,315 $ 104,727 Other 3,525 7,331 $ 111,840 $ 112,058 |
Property and Equipment
Property and Equipment | 12 Months Ended |
Dec. 31, 2018 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and equipment Property and equipment were comprised of the following: December 31, 2018 2017 Land $ 37,384 $ 33,814 Buildings 467,181 473,489 Leasehold improvements 3,164,943 2,816,675 Equipment and information systems, including internally developed software 2,586,564 2,352,246 New center and capital asset projects in progress 661,695 576,651 6,917,767 6,252,875 Less accumulated depreciation (3,524,098 ) (3,103,662 ) $ 3,393,669 $ 3,149,213 Depreciation expense on property and equipment was $574,799 , $544,129 , and $494,945 for 2018 , 2017 and 2016 , respectively. During 2018 and 2017 , the Company recognized asset impairment charges of $17,338 and $15,168 , respectively, related to the restructuring of its pharmacy business. 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 $25,978 , $19,176 and $12,990 for 2018 , 2017 and 2016 |
Intangibles
Intangibles | 12 Months Ended |
Dec. 31, 2018 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Intangibles | Intangibles Intangible assets other than goodwill were comprised of the following: December 31, 2018 2017 Noncompetition and other agreements $ 131,360 $ 429,140 Lease agreements 7,584 7,623 Indefinite-lived assets 59,885 33,255 Other 583 583 199,412 470,601 Less accumulated amortization (80,566 ) (356,774 ) $ 118,846 $ 113,827 Amortization expense from amortizable intangible assets, other than lease agreements, was $16,236 , $15,782 , and $14,552 for 2018 , 2017 and 2016 , respectively. Lease agreement intangible assets and liabilities were amortized to rent expense in the amounts of $(296) , $(203) and $(232) for 2018 , 2017 and 2016 , respectively. During the years ended December 31, 2018 , 2017 and 2016 , the Company recognized no impairment charges on any intangible assets other than goodwill. Amortizable intangible liabilities as of December 31, 2018 and 2017 were comprised of lease agreements of $5,930 and $5,447 , respectively, which were net of accumulated amortization of $4,362 and $3,508 , respectively. 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, 2018 were as follows: Noncompetition and other agreements Lease liabilities Other 2019 $ 14,442 $ (901 ) $ 91 2020 13,020 (895 ) 45 2021 10,816 (871 ) — 2022 7,001 (864 ) — 2023 4,235 (704 ) — Thereafter 9,311 (1,695 ) — Total $ 58,825 $ (5,930 ) $ 136 |
Equity Method and Other Investm
Equity Method and Other Investments | 12 Months Ended |
Dec. 31, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Equity Method and Other Investments | Equity method and other investments Equity investments in nonconsolidated businesses over which the Company maintains significant influence, but which do not have readily determinable fair values, are carried on the equity method. As described in Note 5 to these consolidated financial statements, effective January 1, 2018, the Company adopted ASU 2016-01 and related ASU 2018-03 concerning recognition and measurement of financial assets and financial liabilities. In adopting this new guidance, the Company has made an accounting policy election to adopt an adjusted cost method measurement alternative for investments in equity securities without readily determinable fair values. Specifically, under this measurement alternative, unless elected otherwise for a particular investment, the Company initially records equity investments that qualify for the measurement alternative at cost but remeasures them to fair value through earnings when there is an observable transaction involving the same or a similar investment with the same issuer or upon an impairment. The Company maintains equity method and minor adjusted cost method investments in the private securities of certain other healthcare and healthcare-related businesses. The Company classifies these investments as "Equity method and other investments" on its consolidated balance sheet. The Company's equity method and other investments were comprised of the following: December 31, 2018 2017 APAC joint venture $ 129,173 $ 160,481 Other equity method partnerships 83,052 79,667 Adjusted cost method investments 12,386 5,386 $ 224,611 $ 245,534 During 2018 , 2017 and 2016 , the Company recognized equity investment (loss) income of $(4,484) , $(8,640) and $16,874 , respectively, from equity method investments in nonconsolidated businesses. The Company's largest equity method investment is its ownership interest in DaVita Care Pte. Ltd. (the APAC joint venture, or APAC JV). As of December 31, 2018 and 2017 , the Company held a 60% voting interest and a 73.3% current economic interest in the APAC JV. Based on the governance structure and voting rights established for the APAC JV at its formation on August 1, 2016, certain key decisions affecting the joint venture’s operations are not subject to the unilateral discretion of the Company, but rather are shared with the other noncontrolling investors. These other noncontrolling investors currently collectively hold a 40% voting interest and a 26.7% economic interest in the APAC JV. During the third quarter of 2018, the investors in the APAC JV jointly agreed to a six-month deferral of the subscribed incremental capital contributions originally scheduled for August 1, 2018 based upon revised assessments of the capital needs of the joint venture. Subsequent to December 31, 2018, the investors have jointly agreed to a further deferral of those capital contributions originally scheduled for August 1, 2018, which will now be due with the final capital contributions originally scheduled for August 1, 2019. The Company continues to expect the economic interests of the noncontrolling investors in the APAC JV to adjust to match their voting interests by August 1, 2019. Upon formation of the APAC JV on August 1, 2016, the Company deconsolidated this Asia Pacific dialysis business based on the governance structure and voting rights put in place at that time and recognized an initial non-cash non-taxable estimated gain of $374,374 on its retained investment, net of contingent obligations. This retained interest in the APAC JV was adjusted to the Company’s proportionate share of the estimated fair value of the business, as implied by the investment commitments from the JV partners and adjusted for certain time value of money and uncertainty discounts. The Company then recognized an additional $6,273 gain in the first quarter of 2017 upon resolution of certain post-closing adjustments related to this transaction. Subsequent to its deconsolidation on August 1, 2016, the Company’s retained interest in the APAC JV has been accounted for under the equity method. During the year ended December 31, 2017, the Company recognized a non-cash other-than-temporary impairment charge of $280,066 on its investment in the APAC JV. This charge resulted from changes in its expectations for the joint venture based on continuing market research and assessments by both the Company and the APAC JV concerning the size of the addressable market available to the joint venture at attractive risk-adjusted returns. The Company estimated the fair value of its retained interest in the APAC JV with the assistance of an independent third party valuation firm based on information available to management as of December 31, 2017. The Company's other equity method investments include 22 legal entities over which the Company has significant influence but in which it does not maintain a controlling financial interest. Almost all of these are U.S. partnerships in the form of limited liability companies. The Company's ownership interests in these partnerships vary, but typically range from 30% to 50% . The total carrying amount of equity investments carried under the adjusted cost method measurement alternative at December 31, 2018 was $12,386 . During 2018 , there have been no |
Goodwill
Goodwill | 12 Months Ended |
Dec. 31, 2018 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Goodwill | Goodwill Changes in the carrying value of goodwill by reportable segments were as follows: U.S. dialysis and related lab services Other ancillary services and strategic initiatives Consolidated total Balance at December 31, 2016 $ 5,691,587 $ 323,788 $ 6,015,375 Acquisitions 485,434 131,598 617,032 Divestitures (32,260 ) (126 ) (32,386 ) Impairment charges — (36,196 ) (36,196 ) Foreign currency and other adjustments — 46,454 46,454 Balance at December 31, 2017 $ 6,144,761 $ 465,518 $ 6,610,279 Acquisitions 130,574 147,774 278,348 Divestitures (331 ) (15,166 ) (15,497 ) Impairment charges — (3,106 ) (3,106 ) Foreign currency and other adjustments — (28,064 ) (28,064 ) Balance at December 31, 2018 $ 6,275,004 $ 566,956 $ 6,841,960 Goodwill $ 6,275,004 $ 594,229 $ 6,869,233 Accumulated impairment charges — (27,273 ) (27,273 ) $ 6,275,004 $ 566,956 $ 6,841,960 The Company elected to early adopt ASU No. 2017-04, Intangibles-Goodwill and Other (Topic 350): Simplifying the Test for Goodwill Impairment effective January 1, 2017. The amendments in this ASU simplify the test for goodwill impairment by eliminating the second step in the assessment. All goodwill impairment tests performed since adoption of this ASU were performed under this new guidance. 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 and 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 vascular access service centers in its vascular access services reporting unit, to the physician practices in its physician services reporting units, and to the dialysis centers and other health operations 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 year ended December 31, 2018 , the Company performed annual and other impairment assessments for various reporting units. As a result of these assessments, the Company recognized a goodwill impairment charge of $3,106 at its German other health operations during the year ended December 31, 2018 . During the years ended December 31, 2017 and December 31, 2016 the Company recognized goodwill impairment charges of $34,696 and $28,415 , respectively, at its vascular access reporting unit. These charges resulted primarily from changes in future governmental reimbursement rates for this business and the Company’s then-evolving plans and expected ability to mitigate them. As of December 31, 2017 , there was no goodwill remaining at the Company's vascular access reporting unit. The Company also recognized a goodwill impairment charge of $1,500 at one of its international reporting units during the year ended December 31, 2017. Based on the most recent assessments, the Company determined that reductions in reimbursement rates, changes in actual or expected growth rates, 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 as of December 31, 2018 : Reporting unit Goodwill Carrying amount (1) Sensitivities Operating (2) Discount (3) Germany Kidney Care $ 403,200 0.5 % (1.5 )% (10.3 )% Brazil Kidney Care $ 39,452 9.8 % (2.5 )% (7.3 )% Germany other health operations $ 12,646 8.1 % (2.2 )% (11.1 )% (1) Excess of estimated fair value of the reporting unit over its 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 through December 31, 2018 . Except as described above, none of the Company’s other reporting units were considered at risk of significant goodwill impairment as of December 31, 2018 . 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 values of any of the Company’s reporting units would be less than their respective carrying amounts as of December 31, 2018 |
Other Liabilities
Other Liabilities | 12 Months Ended |
Dec. 31, 2018 | |
Other Liabilities Disclosure [Abstract] | |
Other Liabilities | Other liabilities Other liabilities were comprised of the following: December 31, 2018 2017 Payor refunds and retractions $ 302,244 $ 292,370 Insurance and self-insurance accruals 58,569 64,924 Accrued interest 82,827 83,362 Accrued non-income tax liabilities 28,663 28,317 Other 123,547 110,032 $ 595,850 $ 579,005 |
Income Taxes
Income Taxes | 12 Months Ended |
Dec. 31, 2018 | |
Income Tax Disclosure [Abstract] | |
Income Taxes | 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 statement 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 from continuing operations consisted of the following: Year ended December 31, 2018 2017 2016 Domestic $ 1,083,578 $ 1,725,822 $ 1,278,754 International (35,100 ) (326,036 ) 344,351 $ 1,048,478 $ 1,399,786 $ 1,623,105 Income tax expense for continuing operations consisted of the following: Year ended December 31, 2018 2017 2016 Current: Federal $ 140,064 $ 330,191 $ 322,940 State 32,990 47,228 44,525 International 7,557 3,422 1,928 Total current income tax 180,611 380,841 369,393 Deferred: Federal 52,034 (98,760 ) 88,412 State 21,096 37,347 (28,530 ) International 4,659 4,431 2,486 Total deferred income tax 77,789 (56,982 ) 62,368 $ 258,400 $ 323,859 $ 431,761 Income taxes are allocated between continuing and discontinued operations as follows: Year ended December 31, 2018 2017 2016 Continuing operations $ 258,400 $ 323,859 $ 431,761 Discontinued operations 99,768 (364,856 ) 24,052 $ 358,168 $ (40,997 ) $ 455,813 The reconciliation between the Company’s effective tax rate from continuing operations and the U.S. federal income tax rate is as follows: Year ended December 31, 2018 2017 2016 Federal income tax rate 21.0 % 35.0 % 35.0 % State income taxes, net of federal benefit 4.1 3.7 2.6 Gain on APAC JV ownership changes — (0.2 ) (9.9 ) Political advocacy costs 2.3 — — APAC investment impairment — 6.4 — Impact of 2017 Tax Act (0.1 ) (20.5 ) — Other 1.9 2.0 1.8 Impact of noncontrolling interests primarily attributable to (4.6 ) (3.3 ) (2.9 ) Effective tax rate 24.6 % 23.1 % 26.6 % On December 22, 2017, the President signed into law tax legislation known as the Tax Cuts and Jobs Act ("2017 Tax Act"). Consistent with Securities and Exchange Commission (SEC) Staff Accounting Bulletin No. 118, the Company completed its analysis of certain aspects of the 2017 Tax Act in the prior year and recorded provisional amounts for those items for which the accounting was not complete as of December 31, 2017. As of December 31, 2018, the Company has completed its analysis of these provisional items and recorded immaterial adjustments to the original estimates. Deferred tax assets and liabilities arising from temporary differences for continuing operations were as follows: December 31, 2018 2017 Receivables $ 19,327 $ 19,705 Accrued liabilities 106,506 96,537 Net operating loss carryforwards 117,511 108,429 Other 36,712 37,794 Deferred tax assets 280,056 262,465 Valuation allowance (70,474 ) (61,282 ) Net deferred tax assets 209,582 201,183 Intangible assets (555,822 ) (501,763 ) Property and equipment (118,008 ) (100,376 ) Investments in partnerships (67,354 ) (61,529 ) Other (30,934 ) (23,762 ) Deferred tax liabilities (772,118 ) (687,430 ) Net deferred tax liabilities $ (562,536 ) $ (486,247 ) At December 31, 2018 , the Company had federal net operating loss carryforwards of approximately $124,935 that expire through 2037 , although a substantial amount expire by 2028 . The Company also had state net operating loss carryforwards of $459,558 that expire through 2038 and international net operating loss carryforwards of $186,757 , 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 net increase of $9,192 in the valuation allowance is primarily due to newly created net operating loss carryforwards in state and foreign jurisdictions that the Company does not anticipate being able to utilize. The Company's foreign earnings continue to be indefinitely reinvested as of December 31, 2018. As a result of the passage of the 2017 Tax Act, the Company does not expect such earnings to be taxable if remitted. 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 is as follows: Year ended December 31, 2018 2017 Beginning balance $ 32,776 $ 24,066 Additions for tax positions related to current year 6,111 7,606 Additions for tax positions related to prior years 4,134 804 Reductions related to lapse of applicable statute (338 ) (1,380 ) Impact of 2017 Tax Act — 3,731 Reductions related to settlements with taxing authorities (2,301 ) (2,051 ) Ending balance $ 40,382 $ 32,776 As of December 31, 2018 , the Company’s total liability for unrecognized tax benefits relating to tax positions that do not meet the more-likely-than-not threshold is $40,382 , of which $37,538 would impact the Company’s effective tax rate if recognized. This balance represents an increase of $7,606 from the December 31, 2017 balance of $32,776 , primarily due to additions for tax positions related to the current year. The Company recognizes accrued interest and penalties related to unrecognized tax benefits in income tax expense. At December 31, 2018 and 2017 , the Company had approximately $9,019 and $4,195 , respectively, accrued for interest and penalties related to unrecognized tax benefits, net of federal tax benefit. |
Long-Term Debt
Long-Term Debt | 12 Months Ended |
Dec. 31, 2018 | |
Debt Disclosure [Abstract] | |
Long-Term Debt | Long-term debt Long-term debt was comprised of the following: December 31, 2018 2017 Interest rate Maturity date Senior Secured Credit Facilities: Term Loan A $ 675,000 $ 775,000 2.00% + LIBOR 6/24/2019 Term Loan A-2 995,000 — 1.00% + LIBOR 6/24/2019 Term Loan B 3,342,500 3,377,500 2.75% + LIBOR (2) 6/24/2021 Revolver 175,000 300,000 2.00% + LIBOR 6/24/2019 Senior Notes: 5 3/4% Senior Notes 1,250,000 1,250,000 5.75% 8/15/2022 5 1/8% Senior Notes 1,750,000 1,750,000 5.125% 7/15/2024 5% Senior Notes 1,500,000 1,500,000 5% 5/1/2025 Acquisition obligations and other notes payable (1) 183,979 150,512 6.24% 2019-2025 Capital lease obligations (1) 282,737 297,170 5.49% 2019-2036 Total debt principal outstanding 10,154,216 9,400,182 Discount and deferred financing costs (52,000 ) (63,951 ) 10,102,216 9,336,231 Less current portion (1,929,369 ) (178,213 ) $ 8,172,847 $ 9,158,018 (1) For acquisition obligations and other notes payable and capital lease obligations, the interest rate is the weighted average interest rate as of December 31, 2018 and the maturity date is the range of maturity dates as of December 31, 2018 . (2) Term Loan B has a floor of 0.75% . Scheduled maturities of long-term debt at December 31, 2018 were as follows: 2019 $ 1,929,369 2020 80,016 2021 3,314,149 2022 1,291,472 2023 37,881 Thereafter $ 3,501,329 During the year ended December 31, 2018 , the Company made mandatory principal payments under its senior secured credit facilities totaling $100,000 on Term Loan A and $35,000 on Term Loan B. Term Loans On March 29, 2018, the Company entered into an Increase Joinder No. 1 (Increase Joinder Agreement) under its existing senior secured credit facilities. Pursuant to this Increase Joinder Agreement, the Company entered into an additional $995,000 Term Loan A-2. Total outstanding borrowings under Term Loan A, Term Loan A-2 and Term Loan B 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, Term Loan A-2 and Term Loan B, each tranche bears interest at a London Interbank Offered Rate (LIBOR) 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, 2018 , the overall weighted average interest rate for Term Loan A, Term Loan A-2 and Term Loan B was determined based upon the LIBOR interest rates in effect for all of the individual tranches plus their respective interest rate margins noted in the table above. The Company maintains 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, including all of Term Loan B and part of Term Loan A. However, the remaining $517,500 outstanding principal balance of Term Loan A and the entire outstanding balance on Term Loan A-2 would still be subject to LIBOR-based interest rate volatility. See below for further details. The Company is restricted from paying dividends under the terms of its senior secured credit facilities. Revolving lines of credit As of December 31, 2018 , the Company has $175,000 drawn on its $1,000,000 revolving line of credit under its senior secured credit facilities, in addition to approximately $14,155 committed for outstanding letters of credit. The Company also has approximately $22,621 of additional outstanding letters of credit under a separate bilateral secured letter of credit facility, and $211 of committed outstanding letters of credit which are backed by a certificate of deposit. Senior Notes The Senior Notes are unsecured obligations, rank equally in right of payment with the Company’s existing and future unsecured senior indebtedness, 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. Interest rates on the Senior Notes are fixed by their terms, and the Company is restricted from paying dividends under the indentures governing its Senior Notes. Interest rate cap and swap agreements As of December 31, 2018 , the Company maintains several interest rate cap 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 are not held for trading or speculative purposes and had 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. These cap agreements do not contain credit-risk contingent features. The Company's current interest rate cap agreements were entered into in October 2015 with notional amounts totaling $3,500,000 . These cap agreements became effective June 29, 2018 , 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, and will expire on June 30, 2020 . As of December 31, 2018 , the total fair value of these cap agreements was an asset of approximately $851 . During the year ended December 31, 2018 , the Company recognized debt expense of $4,327 from these cap agreements and recorded a loss of $181 in other comprehensive income due to a decrease in the unrealized fair value of these cap agreements. Previously, the Company maintained other interest rate cap agreements that were entered into in November 2014 with notional amounts also totaling $3,500,000 . These cap agreements had 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 and expired on June 30, 2018 . During the year ended 2018, the Company recognized debt expense of $4,140 from these cap agreements and recorded an immaterial loss in other comprehensive income due to a decrease in the unrealized fair value of these cap agreements through expiration. The following table summarizes the Company’s derivative instruments as of December 31, 2018 and 2017 : Fair value Derivatives designated as hedging instruments Balance sheet location December 31, 2018 December 31, 2017 Interest rate cap agreements Other long-term assets $ 851 $ 1,032 The following table summarizes the effects of the Company’s interest rate cap and swap agreements for the years ended December 31, 2018 , 2017 and 2016 : Amount of unrealized losses in OCI Location of losses Amount of losses Year ended December 31, Year ended December 31, Derivatives designated as cash flow hedges 2018 2017 2016 2018 2017 2016 Interest rate cap agreements $ (181 ) $ (8,897 ) $ (5,198 ) Debt expense $ 8,466 $ 8,278 $ 3,899 Interest rate swap agreements — — (815 ) Debt expense — — 299 Tax benefit 48 3,460 2,343 Tax expense (2,180 ) (3,220 ) (1,632 ) Total $ (133 ) $ (5,437 ) $ (3,670 ) $ 6,286 $ 5,058 $ 2,566 The Company’s overall weighted average effective interest rate on the senior secured credit facilities at the end of 2018 was 5.11% , based upon the current margins in effect as of December 31, 2018 . The Company’s overall weighted average effective interest rate during the year ended December 31, 2018 was 4.96% and as of December 31, 2018 was 5.19% . Debt expense Debt expense consisted of interest expense of $461,897 , $406,341 and $394,013 and the amortization and accretion of debt discounts and premiums, amortization of deferred financing costs and the amortization of interest rate cap agreements of $25,538 , $24,293 and $20,103 for 2018 , 2017 and 2016 |
Leases
Leases | 12 Months Ended |
Dec. 31, 2018 | |
Leases [Abstract] | |
Leases | Leases The majority of the Company’s facilities are leased under non-cancellable operating leases ranging in terms from five years to 15 years and which contain renewal options of five years 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-cancellable operating and capital leases are as follows: Operating leases Capital leases 2019 $ 483,488 $ 36,754 2020 462,154 41,044 2021 432,950 34,026 2022 395,462 33,690 2023 349,649 33,845 Thereafter 1,589,949 194,611 $ 3,713,652 373,970 Less portion representing interest (91,233 ) Total capital lease obligations, including current portion $ 282,737 Rent expense under all operating leases for 2018 , 2017 , and 2016 was $596,117 , $530,748 and $478,531 , 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 $235,194 and $257,772 at December 31, 2018 and 2017 , respectively. Capital lease obligations are included in long-term debt. See Note 14 |
Employee Benefit Plans
Employee Benefit Plans | 12 Months Ended |
Dec. 31, 2018 | |
Retirement Benefits [Abstract] | |
Employee Benefit Plans | Employee benefit plans The Company has a 401(k) retirement savings plan for substantially all of its Kidney Care employees which has been established pursuant to the applicable provisions 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. Beginning in 2018, the Company implemented a 401(k) matching program under which the Company matches 50% of the employee's contribution up to 6% of the employee's salary, subject to certain limitations. The matching contributions are subject to certain eligibility and vesting conditions. For the year ended December 31, 2018 , the Company accrued matching contributions totaling approximately $67,807 . Prior to 2018, the Company did not provide matching contributions in connection with the 401(k) savings plan for its Kidney Care employees. The Company also maintains a voluntary compensation deferral plan, the Deferred Compensation Plan, as well as other legacy deferral plans. The Deferred Compensation Plan 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 2018 , 2017 and 2016 were $3,090 , $4,497 and $5,344 , 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 2018 , 2017 and 2016 the Company distributed $4,652 , $2,789 and $1,065 , respectively, to participants from its deferred compensation plans. Participants are credited with their proportional amount of annual earnings from the plans. The assets of these plans are held in rabbi trusts and as such are subject to the claims of the Company’s general creditors in the event of its bankruptcy. As of December 31, 2018 and 2017 , the total fair value of assets held in these plans' trusts was $36,124 and $38,895 , respectively. The assets of these plans are recorded at fair value with changes in fair value recorded in other comprehensive income prior to 2018 and recognized in "Other income, net" since January 1, 2018. Any fair value changes to the corresponding liability balance are recorded as compensation expense. See Note 5 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 at December 31, 2018 , these cash bonuses would total approximately $336,530 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, 2018 |
Contingencies
Contingencies | 12 Months Ended |
Dec. 31, 2018 | |
Commitments and Contingencies Disclosure [Abstract] | |
Contingencies | 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, qui tam suits, 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. As of December 31, 2018 , and December 31, 2017 , the Company’s total recorded accruals, including DMG, with respect to legal proceedings and regulatory matters, net of anticipated third party recoveries, were immaterial. While these accruals reflect the Company’s best estimate of the probable loss for those matters as of the dates of those accruals, the recorded amounts may differ materially from the actual amount of the losses for those matters, and any anticipated third party recoveries for any such losses may not ultimately be recoverable. 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 also may be impacted 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 2016 U.S. Attorney Texas Investigation : In early February 2016, the Company announced that its pharmacy services’ wholly-owned subsidiary, DaVita Rx, LLC (DaVita Rx), received a Civil Investigative Demand (CID) from the U.S. Attorney’s Office, Northern District of Texas. The government is conducting a federal False Claims Act (FCA) investigation concerning allegations that DaVita Rx presented or caused to be presented false claims for payment to the government for prescription medications, as well as an investigation into the Company’s relationships with pharmaceutical manufacturers. The CID covers the period from January 1, 2006 through the present. In connection with the Company’s ongoing efforts working with the government, the Company learned that a qui tam complaint had been filed covering some of the issues in the CID and practices that had been identified by the Company in a self-disclosure filed with the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services (HHS) in February 2016. In December 2017, the Company finalized and executed a settlement agreement with the government and relators in the qui tam matter that included total monetary consideration of $63,700 , as previously disclosed, of which $41,500 was an incremental cash payment and $22,200 was for amounts previously refunded, and all of which was previously accrued. The government’s investigation into certain of the Company's relationships with pharmaceutical manufacturers is ongoing, and in July 2018 the OIG served the Company with a subpoena seeking additional documents and information relating to those relationships. The Company is continuing to cooperate with the government in this investigation. 2017 U.S. Attorney Massachusetts Investigation : In January 2017, the Company was served with an administrative subpoena for records by the U.S. Attorney’s Office, District of Massachusetts, relating to an investigation into possible federal health care offenses. The subpoena covers the period from January 1, 2007 through the present, and seeks documents relevant to charitable patient assistance organizations, particularly the American Kidney Fund, including documents related to efforts to provide patients with information concerning the availability of charitable assistance. The Company is continuing to cooperate with the government in this investigation. 2017 U.S. Attorney Colorado Investigation : In November 2017, the U.S. Attorney’s Office, District of Colorado informed the Company of an investigation it was conducting into possible federal health care offenses involving DaVita Kidney Care, as well as several of the Company’s wholly-owned subsidiaries, including DMG, DaVita Rx, DaVita Laboratory Services, Inc. (DaVita Labs), and RMS Lifeline Inc. (Lifeline). In August 2018, the Company received a CID from the U.S. Attorney's Office. The CID was issued pursuant to the FCA and covers the period from January 2005 through the present. In connection with the resolution of the 2015 U.S. OIG Medicare Advantage Civil Investigation referred to below, the Company resolved possible claims relating to DMG in this investigation. The Company is continuing to cooperate with the government in this investigation. 2017 U.S. Attorney Florida Investigation : In November 2017, the U.S. Attorney’s Office, Southern District of Florida informed the Company of an investigation it was conducting into possible federal healthcare offenses involving the Company's wholly-owned subsidiary, Lifeline. The Company is continuing to cooperate with the government in this investigation. 2018 U.S. Attorney Florida Investigation : In March 2018, DaVita Labs received two CIDs from the U.S. Attorney’s Office, Middle District of Florida that were identical in nature but directed to the two different labs. According to the face of the CIDs, the U.S. Attorney’s Office is conducting an investigation as to whether the Company’s subsidiary submitted claims for blood, urine, and fecal testing, where there were insufficient test validation or stability studies to ensure accurate results, in violation of the FCA. In October 2018, DaVita Labs received a subpoena from the OIG in connection with this matter requesting certain patient records linked to clinical laboratory tests. The Company is continuing to cooperate with the government in this investigation. * * * Although the Company cannot predict whether or when proceedings might be initiated or when these matters may be resolved (other than as may be 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 and to develop over the course of time. In addition to the inquiries and proceedings specifically identified above, the Company frequently is 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 and Derivative Claims Peace Officers’ Annuity and Benefit Fund of Georgia Securities Class Action Civil Suit : On February 1, 2017, the Peace Officers’ Annuity and Benefit Fund of Georgia filed a putative federal securities class action complaint in the U.S. District Court for the District of Colorado against the Company and certain executives. The complaint covers the time period of August 2015 to October 2016 and alleges, generally, that the Company and its executives violated federal securities laws concerning the Company’s financial results and revenue derived from patients who received charitable premium assistance from an industry-funded non-profit organization. The complaint further alleges that the process by which patients obtained commercial insurance and received charitable premium assistance was improper and "created a false impression of DaVita’s business and operational status and future growth prospects." In November 2017, the court appointed the lead plaintiff and an amended complaint was filed on January 12, 2018. On March 27, 2018, the Company and various individual defendants filed a motion to dismiss. Briefing on the motion is complete. The plaintiffs filed an opposition to the motion to dismiss on June 6, 2018. The Company filed a reply in support of the motion on July 19, 2018. The Company disputes these allegations and intends to defend this action accordingly. In re DaVita Inc. Stockholder Derivative Litigation : On August 15, 2017, the U.S. District Court for the District of Delaware consolidated three previously disclosed shareholder derivative lawsuits: the Blackburn Shareholder action filed on February 10, 2017, the Gabilondo Shareholder action filed on May 30, 2017, and the City of Warren Police and Fire Retirement System Shareholder action filed on June 9, 2017. The complaint covers the time period from 2015 to present and alleges, generally, breach of fiduciary duty, unjust enrichment, abuse of control, gross mismanagement, corporate waste, and misrepresentations and/or failures to disclose certain information in violation of the federal securities laws in connection with an alleged practice to direct patients with government-subsidized health insurance into private health insurance plans to maximize the Company’s profits. An amended complaint was filed in September 2017, and on December 18, 2017, the Company filed a motion to dismiss and a motion to stay proceedings in the alternative. The plaintiffs filed an opposition to the motion to dismiss on March 9, 2018. On June 25, 2018, the U.S. District Court for the District of Delaware granted the Company’s motion to stay proceedings and stayed the case until January 7, 2019, the date of the next status conference. During the status conference on January 7, 2019 the court further extended the stay until February 8, 2019. The parties submitted a proposed scheduling order on that date. The Company asked the Court to rule on the fully-briefed motion to dismiss before opening discovery. The Company disputes these allegations and intends to defend this action accordingly. Other Proceedings In addition to the foregoing, from time to time the Company is subject to other lawsuits, demands, 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 also initiates litigation or other legal proceedings as a plaintiff arising out of contracts or other matters. Resolved Matters 2011 Suit against the U.S. Department of Veterans Affairs : As previously disclosed, 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 the first quarter of 2017, the Company received a payment of $538,000 related to the settlement with the VA. The Company's consolidated entities recognized a net gain of $527,000 on this settlement. The Company's nonconsolidated and managed entities recognized a gain of $9,000 , of which the Company's equity investment share was $3,000 . The net effect was a net increase of $530,000 to the Company's operating income. 2015 OIG Medicare Advantage Civil Investigation : In March 2015, JSA HealthCare Corporation (JSA), a subsidiary of DMG, received a subpoena from the OIG requesting documents and information for the period from January 1, 2008 through December 31, 2013, for certain MA plans for which JSA provided services. It also requested information regarding JSA’s communications about patient diagnoses as they related to certain MA plans generally, and more specifically as related to two Florida physicians with whom JSA previously contracted. In addition to the subpoena described above, in June 2015, the Company received a civil subpoena from the OIG seeking production of a wide range of documents relating to the Company’s and its subsidiaries’ (including DMG and its subsidiary JSA) provision of services to MA plans and related patient diagnosis coding and risk adjustment submissions and payments. The Company believes that the request was part of a broader industry investigation into MA patient diagnosis coding and risk adjustment practices and potential overpayments by the government. The information requested included information related 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 HealthCare Partners (now known as the Company's DMG business), and the Company notified Centers for Medicare and Medicaid Services (CMS) in April 2015 of the coding practice and potential overpayments. In that regard, the Company identified certain additional coding practices which may have been problematic, some of which were the subject of the previously disclosed and dismissed Swoben Private Civil Suit . The Company entered into a settlement agreement with the DOJ and OIG to resolve these matters on September 28, 2018 . As previously disclosed, an escrow established in connection with the Company's acquisition of HealthCare Partners in 2012 held back a portion of the purchase price to the prior owners of HealthCare Partners as security for the indemnification rights of the Company. The settlement amount of $270,000 was paid with these escrowed funds. White, Kathleen, et al. v. DaVita Healthcare Partners, Inc., Civil Action No. 15-cv-2106, U.S. District Court for the District of Colorado : Three actions (Menchaca v. DaVita Healthcare Partners, Inc., Saldana v. DaVita Healthcare Partners, Inc. and Hardin v. DaVita Healthcare Partners, Inc.) were consolidated in December 2016 into one action in U.S. District Court for the District of Colorado. In all three actions, the plaintiffs brought claims for wrongful death based on allegations related to Granuflo®, a product used as a component of the dialysis process. The Menchaca and Saldana actions arose out of the treatment of patients in California, while the Hardin action arose out of the treatment of a patient in Illinois. On June 27, 2018 , the jury returned a verdict in favor of the plaintiffs, collectively awarding $8,500 in compensatory damages and $375,000 in punitive damages. Judgment on this verdict was not entered. In November 2018, the parties settled all three of the consolidated actions collectively for $25,500 , and all three cases were dismissed with prejudice. One of the Company’s insurance carriers paid $9,200 of the settlement. The Company believes it is probable that it will be able to recover the remainder of the settlement amount from other insurers, indemnitors, and the like; however, the Company can make no assurances that it will recover the full amount. * * * 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 |
Noncontrolling Interests Subjec
Noncontrolling Interests Subject to Put Provisions and Other Commitments | 12 Months Ended |
Dec. 31, 2018 | |
Accounting Policies [Abstract] | |
Noncontrolling Interests Subject to Put Provisions and Other Commitments | 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 that 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 flows 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 noncontrolling interests subject to put provisions are 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 is immaterial. The Company has certain other potential commitments to provide operating capital to a number of dialysis centers that are wholly-owned by third parties or businesses 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 $4,675 . Certain consolidated joint ventures are originally contractually scheduled to dissolve after terms ranging from ten years to 50 years . While noncontrolling interests in these limited life entities qualify as mandatorily redeemable financial instruments, they are subject to a classification and measurement scope exception from the accounting guidance generally applicable to other mandatorily redeemable financial instruments. 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 2017, the Company entered into a Sourcing and Supply Agreement with Amgen USA Inc. (Amgen) that expires on December 31, 2022 . Under the terms of the agreement, the Company will purchase EPO in amounts necessary to meet no less than 90% of its requirements for erythropoiesis-stimulating agents (ESAs) through the expiration of the contract 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. The Company has an agreement with Fresenius Medical Care (FMC) to purchase a certain amount of dialysis equipment, parts and supplies from FMC, which was extended through December 31, 2020 . During 2018 , 2017 and 2016 , the Company purchased $182,446 , $176,212 and $164,766 , respectively, of certain equipment, parts and supplies from FMC. The Company also has an agreement with Baxter Healthcare Corporation (Baxter) that commits the Company to purchase a certain amount of peritoneal dialysis supplies at fixed prices through 2022 . During 2018 , 2017 and 2016 , the Company purchased $162,858 , $166,764 and $162,109 of peritoneal dialysis supplies from Baxter under this agreement. Other than operating leases disclosed in Note 15 to these consolidated financial statements, the letters of credit disclosed in Note 14 to these consolidated financial statements, and the arrangements as described above, the Company has no off balance sheet financing arrangements as of December 31, 2018 |
Long-term Incentive Compensatio
Long-term Incentive Compensation and Shareholders’ Equity | 12 Months Ended |
Dec. 31, 2018 | |
Disclosure of Compensation Related Costs, Share-based Payments [Abstract] | |
Long-term Incentive Compensation and Shareholders’ Equity | 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, corporate administrative support, and the ancillary services and strategic initiatives. The Company’s stock-based compensation expense for stock-settled awards is measured at the estimated fair value of awards on the date of grant and recognized on a cumulative straight-line basis over the vesting terms of the awards unless the stock awards are based on non-market based performance metrics, in which case expense is adjusted for expected ultimate payouts as of the end of each reporting period. Stock-based compensation expense for cash-settled awards is based on the estimated fair values as of the end of each reporting period. The expense for all stock-based awards is recognized net of expected forfeitures. Stock-based compensation to be settled in shares is recorded to the Company’s shareholders’ contributed capital, while stock-based compensation to be settled in cash is recorded to a liability. Shares issued upon exercise of stock awards are issued from authorized but unissued 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 qualified as performance-based compensation under Section 162(m) of the Internal Revenue Code for tax years 2017 and prior. 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 months to 48 months from the date of grant. At December 31, 2018 , there were 6,162,797 stock-settled stock appreciation rights, 1,860,475 stock-settled stock units, 23,000 cash-settled stock appreciation rights and 1,600 cash-settled stock units outstanding, and 23,091,764 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 (SSARs) and stock-settled stock unit awards is as follows: Year ended December 31, 2018 Stock appreciation rights Stock units Awards Weighted Weighted Awards Weighted Outstanding at beginning of year 6,648,199 $ 67.92 1,075,572 Granted 1,902,652 $ 66.54 1,101,388 Exercised (2,059,872 ) $ 60.34 (165,543 ) Canceled (328,182 ) $ 70.44 (150,942 ) Outstanding at end of period 6,162,797 $ 69.90 2.9 1,860,475 2.2 Exercisable at end of period 1,422,529 $ 73.39 0.9 — — Weighted-average fair value of grants 2018 $ 16.24 $ 66.23 2017 $ 14.51 $ 65.73 2016 $ 13.74 $ 70.99 Awards Outstanding Weighted average exercise price Awards exercisable Weighted average exercise price Range of SSARs base prices $50.01–$60.00 131,470 $ 57.90 — $ — $60.01–$70.00 4,083,162 $ 66.66 757,237 $ 68.96 $70.01–$80.00 1,351,997 $ 74.78 346,316 $ 73.81 $80.01–$90.00 596,168 $ 83.60 318,976 $ 83.47 Total 6,162,797 $ 69.90 1,422,529 $ 73.39 The Company did not grant any cash-settled stock-based awards during 2018 . Liability-classified stock-based awards contributed $(20) , $114 and $376 to stock-based compensation expense for the years ended December 31, 2018 , 2017 and 2016 , respectively. As of December 31, 2018 , the Company had 24,600 liability-classified stock-based awards outstanding, none of which were vested, and a total stock-based compensation liability balance of $79 . For the years ended December 31, 2018 , 2017 , and 2016 , the aggregate intrinsic value of stock-based awards exercised was $31,045 , $34,895 and $73,944 , respectively. At December 31, 2018 , the aggregate intrinsic value of stock-based awards outstanding was $95,822 and the aggregate intrinsic value of stock awards exercisable was zero . 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 expense 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, 2018 2017 2016 Expected term 4.2 4.2 4.2 Expected volatility 23.8 % 23.9 % 21.0 % Expected dividend yield — % — % — % Risk-free interest rate 2.9 % 1.7 % 1.0 % 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 its fair market value on the first day of the purchase right period or 85% of its 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 2018 , 2017 and 2016 participation periods were $17,398 , $22,131 and $23,902 , respectively. Shares purchased pursuant to the plan’s 2018 , 2017 and 2016 participation periods were 397,749 , 360,368 and 438,002 , respectively. At December 31, 2018 , there were 6,726,278 shares remaining available for future grants under this plan. The fair value of participants’ 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 2018 , 2017 and 2016 , respectively: expected volatility of 24% , 23% and 22% ; risk-free interest rate of 1.9% , 1.3% and 0.8% , and no dividends. Using these assumptions, the weighted average estimated fair value of these purchase rights was $17.45 , $15.19 and $16.73 for 2018 , 2017 and 2016 , respectively. Long-term incentive compensation expense and proceeds For the years ended December 31, 2018 , 2017 and 2016 , the Company recognized $85,759 , $61,978 and $64,956 , respectively, in total long-term incentive program (LTIP) expense, of which $73,582 , $34,431 and $34,530 , 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 2018 , 2017 and 2016 were $13,591 , $7,717 and $12,731 , respectively. As of December 31, 2018 , there was $99,935 total estimated unrecognized compensation expense for outstanding LTIP awards, including $88,596 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 this LTIP expense over a weighted average remaining period of 0.8 years and the stock-based component of this LTIP expense over a weighted average remaining period of 1.5 years . During the year ended December 31, 2018 , the Company adopted a retirement policy (Rule of 65 policy). The Rule of 65 policy generally provides that Section 16 executive officers that are a minimum age of 55 with five years of continuous service with the Company receive certain benefits with respect to their outstanding equity awards upon a qualifying retirement if the sum of their age plus years of service is greater than or equal to 65. These benefits generally include accelerated vesting of restricted stock unit awards, continued vesting of stock-settled stock appreciation rights and performance stock unit awards and an exercise window from the original vest date through the original expiration date regardless of continued employment, with pro rata vesting for a Rule of 65 retirement within one year of the award grant date. The adoption of the Rule of 65 policy resulted in a $14,704 modification charge and a net acceleration of expense of $9,727 during the year ended December 31, 2018 that is included in the expense amounts reported above. For the years ended December 31, 2018 , 2017 and 2016 , the Company received $7,988 , $13,473 and $28,397 , respectively, in actual tax benefits upon the exercise of stock awards. Since the Company issues stock-settled stock appreciation rights rather than stock options, there have been no cash proceeds from stock option exercises during the years ended December 31, 2018 , 2017 and 2016 . Stock repurchases During the years ended December 31, 2018 and 2017 , the Company repurchased a total of 16,844,067 shares and 12,966,672 shares of its common stock for $1,153,511 and $810,949 , or an average price of $68.48 and $62.54 per share, respectively, pursuant to previously announced authorizations by the Board of Directors. Subsequent to December 31, 2018 , the Company has not repurchased any shares of its common stock through February 22, 2019. On July 11, 2018, the Company's Board of Directors approved an additional share repurchase authorization in the amount of $1,389,999 . This share repurchase authorization was in addition to the $110,001 remaining at that time under the Company’s Board of Directors’ prior share repurchase authorization approved in October 2017. Accordingly, as of February 22, 2019, the Company has a total of $1,355,605 available under the current Board repurchase authorizations for additional share repurchases. Although these share repurchase authorizations do not have 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. The Company retired all shares held in its treasury effective as of December 31, 2018 and December 31, 2017 . 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 5,000,000 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 in consolidated subsidiaries on the Company’s consolidated equity are as follows: Year ended December 31, 2018 2017 2016 Net income attributable to DaVita Inc. $ 159,394 $ 663,618 $ 879,874 Changes in paid-in-capital for: Sales of noncontrolling interest 79 (114 ) — Purchase of noncontrolling interests (17,897 ) (2,752 ) (13,105 ) Net transfer in noncontrolling interests (17,818 ) (2,866 ) (13,105 ) Net income attributable to DaVita Inc. net of transfers in $ 141,576 $ 660,752 $ 866,769 The Company acquired additional ownership interests in several existing majority-owned joint ventures for $28,082 , $5,357 , and $21,512 in 2018 , 2017 , and 2016 |
Other Comprehensive (Loss) Inco
Other Comprehensive (Loss) Income | 12 Months Ended |
Dec. 31, 2018 | |
Statement of Comprehensive Income [Abstract] | |
Other Comprehensive (Loss) Income | Accumulated other comprehensive (loss) income Charges and credits to other comprehensive (loss) income have been as follows: Interest rate cap and swap agreements Investment securities Foreign currency translation adjustments Accumulated other comprehensive (loss) income Balance at January 1, 2016 $ (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 of income (loss) 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 ) Unrealized (losses) gains (8,897 ) 5,075 99,770 95,948 Related income tax 3,460 (1,368 ) — 2,092 (5,437 ) 3,707 99,770 98,040 Reclassification of income (loss) into net income 8,278 (360 ) — 7,918 Related income tax (3,220 ) 140 — (3,080 ) 5,058 (220 ) — 4,838 Balance at December 31, 2017 $ (12,408 ) $ 5,662 $ 19,981 $ 13,235 Cumulative effect of change in accounting principle (1) (2,706 ) (5,662 ) — (8,368 ) Unrealized losses (181 ) — (45,944 ) (46,125 ) Related income tax 48 — — 48 (133 ) — (45,944 ) (46,077 ) Reclassification of income into net income 8,466 — — 8,466 Related income tax (2,180 ) — — (2,180 ) 6,286 — — 6,286 Balance at December 31, 2018 $ (8,961 ) $ — $ (25,963 ) $ (34,924 ) (1) Reflects the cumulative effect of a change in accounting principle for ASUs 2016-01 and 2018-03 on classification and measurement of financial instruments and ASU 2018-02 on remeasurement and reclassification of deferred tax effects in accumulated other comprehensive income associated with the 2017 Tax Act. See Note 5 for further details. The reclassification of net cap and swap 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. |
Acquisitions and Divestitures
Acquisitions and Divestitures | 12 Months Ended |
Dec. 31, 2018 | |
Business Combinations [Abstract] | |
Acquisitions and Divestitures | Acquisitions and divestitures Routine acquisitions During 2018 , the Company acquired 18 dialysis centers in the U.S. and 28 dialysis centers outside the U.S. for a total of $176,161 in net cash paid, earn-outs of $1,246 , and deferred purchase price and liabilities assumed of $34,394 . In one of these transactions we acquired a controlling interest in a previously nonconsolidated U.S. dialysis partnership for which we recognized a non-cash gain of $28,152 on our prior interest upon consolidation. During 2017 , the Company acquired 30 dialysis centers in the U.S. and 68 dialysis centers outside the U.S. for a total of $308,550 in net cash, earn-outs of $2,692 , and deferred purchase price of $23,748 . During 2016 , the Company acquired eight dialysis centers in the U.S. and 21 dialysis centers outside the U.S. for a total of $165,108 in net cash, earn-outs of $1,511 and deferred purchase price of $17,963 . 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 2018 acquisitions, certain income tax amounts are pending final evaluation and quantification of any pre-acquisition tax contingencies. In addition, valuation of intangibles 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 these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of noncontrolling interests assumed in these transactions: Year ended December 31, 2018 2017 2016 Current assets $ 23,686 $ 14,366 $ 3,996 Property and equipment 11,421 18,192 8,840 Amortizable intangible and other long-term assets 3,079 11,663 5,876 Non-amortizable intangibles 23,656 32,296 — Goodwill 278,348 318,832 198,927 Deferred income taxes — (210 ) 597 Noncontrolling interests assumed (80,291 ) (44,303 ) (30,337 ) Liabilities assumed (19,946 ) (15,846 ) (3,317 ) Aggregate purchase cost $ 239,953 $ 334,990 $ 184,582 Amortizable intangible assets acquired, primarily related to non-compete agreements, during 2018 , 2017 and 2016 had weighted-average estimated useful lives of six years , seven years and seven years , respectively. The total amount of goodwill deductible for tax purposes associated with these acquisitions for 2018 , 2017 , and 2016 was approximately $165,013 , $237,363 and $169,379 , respectively. Acquisition of Renal Ventures On May 1, 2017 , the Company completed its acquisition of 100% of the equity of Colorado-based Renal Ventures Management, LLC (Renal Ventures) for approximately $359,913 in net cash. Renal Ventures operated 36 dialysis centers, one uncertified dialysis center and one home program, that provided services to approximately 2,600 patients in six states. As a part of this transaction, the Company was required to divest three Renal Ventures outpatient dialysis centers, and three outpatient dialysis centers and one uncertified dialysis center of the Company, for approximately $21,219 in net cash. The Company also incurred approximately $11,950 in transaction and integration costs during the year ended December 31, 2017 associated with this acquisition that are included in general and administrative expenses. The purchase price allocation for the Renal Ventures acquisition was finalized in 2018 with no material change to the initial allocation. The following table summarizes the assets acquired and liabilities assumed in this transaction and recognized at the acquisition date at estimated fair values: Current assets, net of cash acquired $ 22,739 Property and equipment 36,295 Amortizable intangible and other long-term assets 11,547 Goodwill 298,200 Current liabilities (8,389 ) Long-term liabilities (479 ) $ 359,913 Amortizable intangible assets acquired, primarily related to non-compete agreements, had weighted-average estimated useful lives of five years . The total estimated amount of goodwill deductible for tax purposes associated with this acquisition was approximately $298,200 . Change in ownership interests in Asia Pacific joint venture Upon formation of the APAC JV on August 1, 2016, the Company deconsolidated this Asia Pacific dialysis business based on the governance structure and voting rights put in place at that time and recognized an initial non-cash non-taxable estimated gain of $374,374 on its retained investment, net of contingent obligations. See further discussion of this joint venture in Note 10 . Pro forma financial information (unaudited) The following summary, prepared on a pro forma basis, combines the results of operations as if all acquisitions within continuing operations in 2018 and 2017 had been consummated as of the beginning of 2017, including the impact of certain adjustments such as amortization of intangibles, interest expense on acquisition financing and income tax effects. Year ended December 31, 2018 2017 (unaudited) Pro forma net revenues $ 11,508,555 $ 11,176,736 Pro forma net income from continuing operations attributable to $ 634,326 $ 922,718 Pro forma basic net income per share from continuing operations $ 3.71 $ 4.89 Pro forma diluted net income per share from continuing operations $ 3.68 $ 4.82 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 $11,210 if certain EBITDA, operating income performance targets or quality margins are met over the next one year to five 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 recognized in earnings. See Note 24 to these consolidated financial statements for further details. As of December 31, 2018 , the Company estimated the fair value of these contingent earn-out obligations to be $2,608 , of which a total of $431 is included in other liabilities, and the remaining $2,177 is included in other long-term liabilities in the Company’s consolidated balance sheet. The following is a reconciliation of changes in contingent earn-out obligations for the year ended December 31, 2018 : Beginning balance December 31, 2017 $ 6,388 Contingent earn-out obligations associated with acquisitions 1,246 Remeasurement of fair value (4,729 ) Payments of contingent earn-out obligations (297 ) Ending balance December 31, 2018 $ 2,608 |
Held for Sale and Discontinued
Held for Sale and Discontinued Operations | 12 Months Ended |
Dec. 31, 2018 | |
Discontinued Operations and Disposal Groups [Abstract] | |
Held for Sale and Discontinued Operations | Held for sale and discontinued operations DaVita Medical Group (DMG) In December 2017, the Company entered into an equity purchase agreement to sell its DMG division to Optum, a subsidiary of UnitedHealth Group Inc., subject to receipt of required regulatory approvals and other customary closing conditions. On December 11, 2018, the Company entered into an amendment to the equity purchase agreement, which, among other things, reduced the purchase price for DMG from $4,900,000 to $4,340,000 . The current deadline to close the transaction under the equity purchase agreement is June 30, 2019, and the transaction is expected to close prior to that date. As a result of this pending transaction, the DMG business has been classified as held for sale and its results of operations are reported as discontinued operations for all periods presented in these consolidated financial statements. During 2018 , the Company recorded $468,005 in charges on its DMG business which included a $316,840 valuation adjustment, a $41,537 goodwill impairment charge and $109,628 in related tax expense on this held-for-sale business based on updated assessments of fair value. The following table presents the financial results of discontinued operations related to DMG: Year ended December 31, 2018 2017 2016 Net revenues $ 4,963,792 $ 4,676,213 $ 4,113,414 Expenses 4,962,686 4,634,782 3,994,624 Goodwill and other asset impairment charges 41,537 651,659 253,000 Valuation adjustment on disposal group 316,840 — — Loss from discontinued operations before taxes (357,271 ) (610,228 ) (134,210 ) Income tax expense (benefit) 99,768 (364,856 ) 24,052 Net loss from discontinued operations, net of tax $ (457,038 ) $ (245,372 ) $ (158,262 ) The following table presents the financial position of discontinued operations related to DMG: December 31, 2018 December 31, 2017 Assets Cash and cash equivalents $ 414,683 $ 179,668 Other current assets 557,403 826,608 Property and equipment, net 458,040 379,945 Intangible assets, net 1,316,974 1,316,550 Other long-term assets 112,127 178,894 Goodwill 2,847,178 2,879,977 Valuation allowance on disposal group (316,840 ) — Total current assets held for sale $ 5,389,565 $ 5,761,642 Liabilities Other liabilities $ 479,134 $ 505,734 Medical payables 436,839 457,040 Current portion of long-term debt 3,122 2,845 Long-term debt 33,425 35,003 Other long-term liabilities 291,239 184,448 Total current liabilities held for sale $ 1,243,759 $ 1,185,070 The following table presents cash flows of discontinued operations related to DMG: Year ended December 31, 2018 2017 2016 Net cash provided by operating activities from discontinued operations $ 290,684 $ 357,274 $ 287,044 Net cash used in investing activities from discontinued operations $ (57,382 ) $ (232,329 ) $ (430,917 ) DMG acquisitions During 2018 , the Company's DMG business acquired other medical businesses for a total of $6,995 in net cash and deferred purchase price of $1,142 . During 2017 , the Company's DMG business acquired other medical businesses for a total of $135,416 in net cash, deferred purchase price of $1,038 , and liabilities assumed of $10,145 . During 2016 , the Company's DMG business acquired other medical businesses for a total of $398,748 in net cash and deferred purchase price and liabilities assumed of $7,694 . For several of the 2018 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 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 current held for sale assets and liabilities. Sale of Tandigm Health investment In 2018, DMG sold its 19% ownership interest in the Tandigm Health joint venture and a related supporting business for a gain of $25,096 and associated taxes of $6,460 , resulting in a net of tax gain of $18,636 . Goodwill impairment charges |
Variable Interest Entities
Variable Interest Entities | 12 Months Ended |
Dec. 31, 2018 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Variable Interest Entities | 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 legal entities it is associated with that qualify as VIEs must be included in its consolidated financial statements. A number of these VIEs are within the Company's DMG business, which has been reclassified as held for sale and as a discontinued operation in these 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. At December 31, 2018 , these consolidated financial statements include total assets of VIEs of $917,922 and total liabilities and noncontrolling interests of VIEs to third parties of $507,445 , including assets of $658,684 and liabilities and noncontrolling interests of $355,196 related to the Company's DMG business which is classified as held for sale. The Company also sponsors certain deferred compensation plans whose trusts qualify as VIEs and the Company consolidates 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 |
Fair Values of Financial Instru
Fair Values of Financial Instruments | 12 Months Ended |
Dec. 31, 2018 | |
Fair Value Disclosures [Abstract] | |
Fair Values of Financial Instruments | Fair values of financial instruments Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. Fair value measurements are determined based on the principal or most advantageous market for the item being measured, assume that buyers and sellers are independent, willing and able to transact, and knowledgeable, with access to all information customarily available in such a transaction, and are based on assumptions that market participants would use in pricing the item, not assumptions specific to the reporting entity. 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 the FASB. The following table summarizes the Company’s assets, liabilities and temporary equity measured at fair value on a recurring basis as of December 31, 2018 and 2017 : December 31, 2018 Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 36,124 $ 36,124 $ — $ — Interest rate cap agreements $ 851 $ — $ 851 $ — Liabilities Contingent earn-out obligations $ 2,608 $ — $ — $ 2,608 Temporary equity Noncontrolling interests subject to put provisions $ 1,124,641 $ — $ — $ 1,124,641 December 31, 2017 Assets Investments in equity securities $ 38,895 $ 38,895 $ — $ — Interest rate cap agreements $ 1,032 $ — $ 1,032 $ — Liabilities Contingent earn-out obligations $ 6,388 $ — $ — $ 6,388 Temporary equity Noncontrolling interests subject to put provisions $ 1,011,360 $ — $ — $ 1,011,360 Investments in equity securities represent investments in various open-ended registered investment companies (mutual funds) and common stock and are recorded at fair value estimated based on reported market prices or redemption prices, as applicable. See Note 5 to these consolidated financial statements for further discussion. Interest rate cap agreements are recorded at fair value estimated from valuation models utilizing the income approach and commonly accepted valuation techniques that use inputs from closing prices for similar assets and liabilities in active markets as well as other relevant observable market inputs at quoted intervals such as current interest rates, forward yield curves, implied volatility and credit default swap pricing. The Company does not believe the ultimate amount that could be realized upon settlement of these interest rate cap agreements would be materially different from the fair value estimates currently reported. See Note 14 to these consolidated financial statements for further discussion. The estimated fair value measurements of contingent earn-out obligations are primarily based on unobservable inputs, including projected EBITDA. The estimated fair value of these contingent earn-out obligations is 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 21 to these consolidated financial statements for further discussion. See Note 18 to these consolidated financial statements for a discussion of the Company’s methodology for estimating the fair values 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 non-debt financial instruments are presented in the consolidated financial statements at December 31, 2018 and 2017 at their approximate fair values due to the short-term nature of their settlements. The carrying amount of the Company’s senior secured credit facilities totaled $5,168,815 , including a discount of $6,104 and deferred financing costs of $12,580 , as of December 31, 2018 , and the fair value was approximately $5,194,163 based upon quoted market prices. The carrying amount of the Company’s Senior Notes was approximately $4,466,685 , including deferred financing costs of $33,316 , at December 31, 2018 and the fair value was approximately $4,241,250 at December 31, 2018 |
Segment Reporting
Segment Reporting | 12 Months Ended |
Dec. 31, 2018 | |
Segment Reporting [Abstract] | |
Segment Reporting | Segment reporting The Company consists of 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. See Note 1 "Organization" for a summary description of the Company's businesses. 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, each of its ancillary services and strategic initiatives, its kidney care operations in each foreign sovereign jurisdiction, its other health operations in each foreign sovereign jurisdiction, and its equity method investment in the Asia Pacific joint venture. The U.S. dialysis and related lab services business qualifies as a separately reportable segment, 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 Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive-based compensation expenses of certain departments which provide support to all of the Company’s various operating lines of business, except to the extent that such costs are charged to and borne by certain ancillary services and strategic initiatives via internal management fees. These corporate administrative support costs are reduced by internal management fees received from the Company’s ancillary lines of business. 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, 2018 2017 2016 Segment revenues: (1) U.S. dialysis and related lab services Patient service revenues: External sources $ 10,274,046 $ 9,767,123 $ 9,524,067 Intersegment revenues 92,950 55,176 27,355 Total U.S. dialysis and related lab services revenues 10,366,996 9,822,299 9,551,422 Provision for uncollectible accounts (50,927 ) (481,973 ) (429,878 ) Net U.S. dialysis and related lab services patient service revenues 10,316,069 9,340,326 9,121,544 Other revenues (2) 19,880 19,739 16,645 Total net U.S. dialysis and related lab services revenues 10,335,949 9,360,065 9,138,189 Other - Ancillary services and strategic initiatives Net patient service revenues 437,275 323,156 201,867 Other external sources 724,577 1,248,589 1,394,766 Intersegment revenues 34,236 24,603 24,739 Total ancillary services and strategic initiatives revenues 1,196,088 1,596,348 1,621,372 Total net segment revenues 11,532,037 10,956,413 10,759,561 Elimination of intersegment revenues (127,186 ) (79,779 ) (52,094 ) Consolidated net revenues $ 11,404,851 $ 10,876,634 $ 10,707,467 Segment operating margin (loss): U.S. dialysis and related lab services $ 1,709,721 $ 2,297,198 $ 1,777,014 Other—Ancillary services and strategic initiatives (93,789 ) (439,477 ) 266,324 Total segment margin 1,615,932 1,857,721 2,043,338 Reconciliation of segment operating margin to consolidated income from Corporate administrative support (90,108 ) (44,966 ) (13,628 ) Consolidated operating income 1,525,824 1,812,755 2,029,710 Debt expense (487,435 ) (430,634 ) (414,116 ) Other income 10,089 17,665 7,511 Income from continuing operations before income taxes $ 1,048,478 $ 1,399,786 $ 1,623,105 (1) On January 1, 2018, the Company adopted Revenue from Contracts with Customers (Topic 606) using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results related to performance obligations satisfied beginning on and after January 1, 2018 are presented under Topic 606, while results related to the satisfaction of performance obligations in prior periods continue to be reported in accordance with the Company's historical accounting under Revenue Recognition (Topic 605). See Notes 1 and 2 of these consolidated financial statements for further discussion of the Company's adoption of Topic 606. (2) Includes management fee revenues from providing management and administrative services to dialysis ventures in which the Company owns a noncontrolling interest or which are wholly-owned by third parties. Depreciation and amortization expense by reportable segment is as follows: Year ended December 31, 2018 2017 2016 U.S. dialysis and related lab services $ 558,810 $ 520,965 $ 482,768 Other - Ancillary services and strategic initiatives 32,225 38,946 26,729 $ 591,035 $ 559,911 $ 509,497 Summary of assets by reportable segment is as follows: Year ended December 31, 2018 2017 Segment assets U.S. dialysis and related lab services (including equity investments of $ 12,333,641 $ 11,802,131 Other - Ancillary services and strategic initiatives (1) (including equity 1,387,046 1,410,763 DMG - Held for sale (including equity investments of $4,833 and 5,389,565 5,761,642 Consolidated assets $ 19,110,252 $ 18,974,536 (1) Includes approximately $136,052 and $125,932 in 2018 and 2017 , respectively, of net property and equipment related to the Company’s international operations. Expenditures for property and equipment by reportable segment is as follows: Year ended December 31, 2018 2017 2016 U.S. dialysis and related lab services $ 856,108 $ 769,732 $ 675,994 Other - Ancillary services and strategic initiatives 45,806 40,377 68,702 DMG - Held for sale 85,224 95,141 84,399 $ 987,138 $ 905,250 $ 829,095 |
Supplemental Cash Flow Informat
Supplemental Cash Flow Information | 12 Months Ended |
Dec. 31, 2018 | |
Supplemental Cash Flow Elements [Abstract] | |
Supplemental Cash Flow Information | Supplemental cash flow information The table below provides supplemental cash flow information: Year ended December 31, 2018 2017 2016 Cash paid: Income taxes $ 92,526 $ 387,159 $ 339,411 Interest $ 488,974 $ 424,547 $ 406,987 Non-cash investing and financing activities: Fixed assets under capital lease obligations $ 8,828 $ 48,378 $ 28,127 |
Selected Quarterly Financial Da
Selected Quarterly Financial Data (unaudited) | 12 Months Ended |
Dec. 31, 2018 | |
Quarterly Financial Information Disclosure [Abstract] | |
Selected Quarterly Financial Data (unaudited) | Selected quarterly financial data (unaudited) 2018 December 31 September 30 June 30 March 31 Total revenues $ 2,821,124 $ 2,847,330 $ 2,886,953 $ 2,849,444 Operating income $ 387,908 $ 289,038 $ 438,192 $ 410,686 Attributable to DaVita Inc.: Net income from continuing operations (1) $ 160,332 $ 73,371 $ 199,603 $ 191,015 Net (loss) income from discontinued operations (2) $ (310,104 ) $ (210,167 ) $ 67,673 $ (12,329 ) Net (loss) income $ (149,772 ) $ (136,796 ) $ 267,276 $ 178,686 Per share attributable to DaVita Inc.: Basic net income from continuing operations $ 0.97 $ 0.44 $ 1.16 $ 1.07 Basic net (loss) income from discontinued operations $ (1.87 ) $ (1.26 ) $ 0.40 $ (0.07 ) Basic net (loss) income $ (0.90 ) $ (0.82 ) $ 1.56 $ 1.00 Diluted net income from continuing operations $ 0.96 $ 0.44 $ 1.15 $ 1.05 Diluted net (loss) income from discontinued operations $ (1.86 ) $ (1.26 ) $ 0.38 $ (0.07 ) Diluted net (loss) income $ (0.90 ) $ (0.82 ) $ 1.53 $ 0.98 2017 Total revenues $ 2,780,913 $ 2,765,071 $ 2,699,399 $ 2,631,251 Operating income $ 150,337 $ 395,294 $ 391,196 $ 875,928 Attributable to DaVita Inc.: Net income from continuing operations (1) $ 156,210 $ 152,870 $ 151,292 $ 440,905 Net income (loss) from discontinued operations (2) $ 147,186 $ (367,346 ) $ (24,291 ) $ 6,792 Net income (loss) $ 303,396 $ (214,476 ) $ 127,001 $ 447,697 Per share attributable to DaVita Inc.: Basic net income from continuing operations $ 0.86 $ 0.81 $ 0.79 $ 2.29 Basic net income (loss) from discontinued operations $ 0.80 $ (1.95 ) $ (0.13 ) $ 0.04 Basic net income (loss) $ 1.66 $ (1.14 ) $ 0.66 $ 2.33 Diluted net income from continuing operations $ 0.85 $ 0.80 $ 0.78 $ 2.26 Diluted net income (loss) from discontinued operations $ 0.79 $ (1.92 ) $ (0.13 ) $ 0.03 Diluted net income (loss) $ 1.64 $ (1.12 ) $ 0.65 $ 2.29 (1) Included in the fourth quarter of 2018 is a net gain on changes in ownership interests of $28,152 ; an equity investment loss of $8,715 due to the sale of the APAC JV's India business; and an equity investment loss of $1,530 due to impairments at the APAC JV. The third quarter of 2018 includes restructuring charges of $11,366 and other asset impairment charges of $6,093 related to the Company's pharmacy business; an equity investment loss of $5,995 due to impairments at the APAC JV; an adjustment to the gain on changes in ownership interests on the sale of the Company's direct primary care business of $1,506 ; and $23,470 in additional stock-based compensation expense related to modification charges and net acceleration of expense. The second quarter of 2018 includes asset impairment charges of $11,245 related to the pharmacy business; a net gain on changes in ownership interests of $35,205 on the Company's direct primary care business; a loss of $1,248 related to the unwinding of a business internationally; and a goodwill impairment charge of $3,106 at the Company's German other health operations. Included in the fourth quarter of 2017 was an impairment of $280,066 on the Company's investment in the APAC JV. The third quarter of 2017 included an equity investment loss of $6,293 for goodwill impairments at the APAC JV and restructuring charges in the Company's international business of $2,700 . The second quarter of 2017 included goodwill impairment charges of $10,498 related to the vascular access reporting unit. The first quarter of 2017 included a net gain on settlement of $529,504 ; goodwill impairment charges of $24,198 related to the vascular access reporting unit; an asset impairment of $15,168 related to the restructuring of the pharmacy business; and a gain adjustment on the 2016 ownership change of the APAC JV of $6,273 . (2) Included in discontinued operations in the fourth quarter of 2018 is a $218,639 disposal group valuation adjustment, a $41,537 goodwill impairment charge and $8,318 in related tax benefit. The third quarter of 2018 includes a $216,147 charge on the Company's DMG business which included a $98,201 disposal group valuation adjustment and $117,946 in related tax expense on this held-for-sale business. The second quarter of 2018 includes a gain on the sale of the Company's Tandigm investment of $25,096 . The fourth quarter of 2017 includes a net tax benefit of $163,555 due to a remeasurement of deferred taxes resulting from DMG's reclassification to held for sale. The third quarter of 2017 includes goodwill impairment charges of $601,040 related to certain DMG reporting units; a non-cash gain associated with the Company's Magan acquisition of $17,129 ; restructuring charges of $9,569 ; and a reduction in estimated accruals for legal matters of $11,100 . The second quarter of 2017 includes goodwill impairment charges of $50,619 related to certain DMG reporting units and a reduction in estimated accruals for legal matters of $3,600 |
Supplemental Data (unaudited)
Supplemental Data (unaudited) | 12 Months Ended |
Dec. 31, 2018 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Supplemental Data (unaudited) | 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 For the year ended December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Dialysis and related lab patient service revenues $ 10,709,981 $ — $ — $ 10,709,981 Less: Provision for uncollectible accounts (49,587 ) — — (49,587 ) Net dialysis and related lab patient service revenues 10,660,394 — — 10,660,394 Other revenues 744,457 — — 744,457 Total net revenues 11,404,851 — — 11,404,851 Operating expenses and charges 9,879,027 — — 9,879,027 Operating income 1,525,824 — — 1,525,824 Debt expense (487,435 ) — — (487,435 ) Other income, net 10,089 — — 10,089 Income tax expense 258,400 — — 258,400 Net income from continuing operations 790,078 — — 790,078 Net (loss) income from discontinued operations, net of tax (457,038 ) 37,373 92 (494,503 ) Net income 333,040 37,373 92 295,575 Less: Net income attributable to noncontrolling interests (173,646 ) (7,841 ) — (165,805 ) Net income attributable to DaVita Inc. $ 159,394 $ 29,532 $ 92 $ 129,770 Condensed Consolidating Statements of Comprehensive Income For the year ended December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Net income $ 333,040 $ 37,373 $ 92 $ 295,575 Other comprehensive loss (39,791 ) — — (39,791 ) Total comprehensive income 293,249 37,373 92 255,784 Less: Comprehensive income attributable to noncontrolling (173,646 ) (7,841 ) — (165,805 ) Comprehensive income attributable to DaVita Inc. $ 119,603 $ 29,532 $ 92 $ 89,979 (1) After the elimination of the unrestricted subsidiaries and the physician groups Condensed Consolidating Balance Sheets As of December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Cash and cash equivalents $ 323,038 $ — $ — $ 323,038 Restricted cash and equivalents 92,382 — — 92,382 Accounts receivable, net 1,858,608 — — 1,858,608 Other current assets 760,566 — — 760,566 Other current assets held for sale 5,389,565 532,050 2,825 4,854,690 Total current assets 8,424,159 532,050 2,825 7,889,284 Property and equipment, net 3,393,669 — — 3,393,669 Amortizable intangibles, net 118,846 — — 118,846 Other long-term assets 331,618 — — 331,618 Goodwill 6,841,960 — — 6,841,960 Total assets $ 19,110,252 $ 532,050 $ 2,825 $ 18,575,377 Current liabilities $ 3,647,402 $ — $ — $ 3,647,402 Current liabilities held for sale 1,243,759 351,925 — 891,834 Total current liabilities 4,891,161 351,925 — 4,539,236 Payables to parent — 25,456 2,825 (28,281 ) Long-term debt and other long-term liabilities 9,186,052 — — 9,186,052 Noncontrolling interests subject to put provisions 1,124,641 — — 1,124,641 Total DaVita Inc. shareholders' equity 3,703,442 154,669 — 3,548,773 Noncontrolling interests not subject to put provisions 204,956 — — 204,956 Shareholders' equity 3,908,398 154,669 — 3,753,729 Total liabilities and shareholders' equity $ 19,110,252 $ 532,050 $ 2,825 $ 18,575,377 C ondensed Consolidating Statements of Cash Flow For the year ended December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Cash flows from operating activities: Net income $ 333,040 $ 37,373 $ 92 $ 295,575 Changes in operating and intercompany assets and liabilities 1,438,600 81,722 (92 ) 1,356,970 Net cash provided by operating activities 1,771,640 119,095 — 1,652,545 Cash flows from investing activities: Additions of property and equipment (987,138 ) (2,746 ) — (984,392 ) Acquisitions and divestitures, net (183,156 ) — — (183,156 ) Proceeds from asset sales 150,205 — — 150,205 Investments and other items, net 14,446 (154 ) — 14,600 Net cash used in investing activities (1,005,643 ) (2,900 ) — (1,002,743 ) Cash flows from financing activities: Long-term debt and related financing costs, net 694,777 — — 694,777 Intercompany — 25,296 — (25,296 ) Other items (1,320,131 ) — — (1,320,131 ) Net cash (used in) provided by financing activities (625,354 ) 25,296 — (650,650 ) Effect of exchange rate changes on cash (3,350 ) — — (3,350 ) Net increase (decrease) in cash, cash equivalents and restricted cash 137,293 141,491 — (4,198 ) Less: Net increase in cash, cash equivalents and restricted 240,793 141,491 — 99,302 Net decrease in cash, cash equivalents and restricted cash from continuing operations (103,500 ) — — (103,500 ) Cash, cash equivalents and restricted cash of continuing 518,920 — — 518,920 Cash, cash equivalents and restricted cash of continuing $ 415,420 $ — $ — $ 415,420 (1) |
Consolidating Financial Stateme
Consolidating Financial Statements | 12 Months Ended |
Dec. 31, 2018 | |
Condensed Financial Information Disclosure [Abstract] | |
Consolidating Financial Statements | 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 For twelve months ended December 31, 2018 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Dialysis and related lab patient service revenues $ — $ 7,263,195 $ 3,657,456 $ (210,670 ) $ 10,709,981 Less: Provision for uncollectible accounts — (36,377 ) (13,210 ) — (49,587 ) Net dialysis and related lab patient service revenues — 7,226,818 3,644,246 (210,670 ) 10,660,394 Other revenues 799,230 714,489 189,927 (959,189 ) 744,457 Total net revenues 799,230 7,941,307 3,834,173 (1,169,859 ) 11,404,851 Operating expenses and charges 646,640 7,100,415 3,301,831 (1,169,859 ) 9,879,027 Operating income 152,590 840,892 532,342 — 1,525,824 Debt expense (491,749 ) (208,484 ) (36,427 ) 249,225 (487,435 ) Other income, net 418,839 10,367 22,195 (441,312 ) 10,089 Income tax expense 23,482 187,691 47,227 — 258,400 Equity earnings in subsidiaries 103,196 344,025 — (447,221 ) — Net income from continuing operations 159,394 799,109 470,883 (639,308 ) 790,078 Net (loss) income from discontinued operations, net of tax — (695,913 ) 46,788 192,087 (457,038 ) Net income 159,394 103,196 517,671 (447,221 ) 333,040 Less: Net income attributable to noncontrolling — — — (173,646 ) (173,646 ) Net income attributable to DaVita Inc. $ 159,394 $ 103,196 $ 517,671 $ (620,867 ) $ 159,394 Consolidating Statements of Income - (continued) For twelve months ended December 31, 2017 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Dialysis and related lab patient service revenues $ — $ 6,884,750 $ 3,393,026 $ (184,106 ) $ 10,093,670 Less: Provision for uncollectible accounts — (340,552 ) (151,982 ) 7,170 (485,364 ) Net dialysis and related lab patient service revenues — 6,544,198 3,241,044 (176,936 ) 9,608,306 Other revenues 793,751 1,204,467 68,322 (798,212 ) 1,268,328 Total net revenues 793,751 7,748,665 3,309,366 (975,148 ) 10,876,634 Operating expenses and charges 527,942 6,475,550 3,035,535 (975,148 ) 9,063,879 Operating income 265,809 1,273,115 273,831 — 1,812,755 Debt expense (426,149 ) (209,612 ) (34,831 ) 239,958 (430,634 ) Other income, net 411,731 11,169 18,467 (423,702 ) 17,665 Income tax expense 65,965 237,670 20,224 — 323,859 Equity earnings in subsidiaries 478,192 74,375 — (552,567 ) — Net income from continuing operations 663,618 911,377 237,243 (736,311 ) 1,075,927 Net (loss) income from discontinued operations, net of tax — (433,185 ) 4,069 183,744 (245,372 ) Net income 663,618 478,192 241,312 (552,567 ) 830,555 Less: Net income attributable to noncontrolling — — — (166,937 ) (166,937 ) Net income attributable to DaVita Inc. $ 663,618 $ 478,192 $ 241,312 $ (719,504 ) $ 663,618 For twelve months ended December 31, 2016 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Dialysis and related lab patient service revenues $ — $ 6,665,601 $ 3,215,085 $ (153,326 ) $ 9,727,360 Less: Provision for uncollectible accounts — (272,426 ) (158,878 ) — (431,304 ) Net dialysis and related lab patient service — 6,393,175 3,056,207 (153,326 ) 9,296,056 Other revenues 767,791 1,378,952 30,184 (765,516 ) 1,411,411 Total net revenues 767,791 7,772,127 3,086,391 (918,842 ) 10,707,467 Operating expenses and charges 493,175 6,907,469 2,195,955 (918,842 ) 8,677,757 Operating income 274,616 864,658 890,436 — 2,029,710 Debt expense (407,925 ) (191,083 ) (40,434 ) 225,326 (414,116 ) Other income, net 396,797 3,726 7,694 (400,706 ) 7,511 Income tax expense 77,334 238,446 115,981 — 431,761 Equity earnings in subsidiaries 693,720 667,278 — (1,360,998 ) — Net income from continuing operations 879,874 1,106,133 741,715 (1,536,378 ) 1,191,344 Net (loss) income from discontinued operations, net of tax — (412,413 ) 78,771 175,380 (158,262 ) Net income 879,874 693,720 820,486 (1,360,998 ) 1,033,082 Less: Net income attributable to noncontrolling — — — (153,208 ) (153,208 ) Net income attributable to DaVita Inc. $ 879,874 $ 693,720 $ 820,486 $ (1,514,206 ) $ 879,874 Consolidating Statements of Comprehensive Income For the year ended December 31, 2018 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Net income $ 159,394 $ 103,196 $ 517,671 $ (447,221 ) $ 333,040 Other comprehensive income (loss) 6,153 — (45,944 ) — (39,791 ) Total comprehensive income 165,547 103,196 471,727 (447,221 ) 293,249 Less: Comprehensive income attributable to — — — (173,646 ) (173,646 ) Comprehensive income attributable to DaVita Inc. $ 165,547 $ 103,196 $ 471,727 $ (620,867 ) $ 119,603 For the year ended December 31, 2017 Net income $ 663,618 $ 478,192 $ 241,312 $ (552,567 ) $ 830,555 Other comprehensive income 3,106 — 99,770 — 102,876 Total comprehensive income 666,724 478,192 341,082 (552,567 ) 933,431 Less: Comprehensive income attributable to — — — (166,935 ) (166,935 ) Comprehensive income attributable to DaVita Inc. $ 666,724 $ 478,192 $ 341,082 $ (719,502 ) $ 766,496 For the year ended December 31, 2016 Net income $ 879,874 $ 693,720 $ 820,486 $ (1,360,998 ) $ 1,033,082 Other comprehensive loss (290 ) — (29,337 ) — (29,627 ) Total comprehensive income 879,584 693,720 791,149 (1,360,998 ) 1,003,455 Less: Comprehensive income attributable to — — — (153,398 ) (153,398 ) Comprehensive income attributable to DaVita Inc. $ 879,584 $ 693,720 $ 791,149 $ (1,514,396 ) $ 850,057 Consolidating Balance Sheets As of December 31, 2018 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Cash and cash equivalents $ 60,653 $ — $ 262,385 $ — $ 323,038 Restricted cash and equivalents 1,005 12,048 79,329 — 92,382 Accounts receivable, net — 1,264,290 594,318 — 1,858,608 Other current assets 37,185 601,318 122,063 — 760,566 Current assets held for sale — 4,440,953 948,612 — 5,389,565 Total current assets 98,843 6,318,609 2,006,707 — 8,424,159 Property and equipment, net 491,462 1,624,835 1,277,372 — 3,393,669 Intangible assets, net 153 42,933 75,760 — 118,846 Investments in subsidiaries 10,102,750 3,239,862 — (13,342,612 ) — Intercompany receivables 3,419,448 — 1,471,203 (4,890,651 ) — Other long-term assets and investments 53,385 80,537 197,696 — 331,618 Goodwill — 4,812,365 2,029,595 — 6,841,960 Total assets $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Current liabilities $ 1,945,943 $ 1,251,534 $ 449,925 $ — $ 3,647,402 Current liabilities held for sale — 722,766 520,993 — 1,243,759 Total current liabilities 1,945,943 1,974,300 970,918 — 4,891,161 Intercompany payables — 3,327,026 1,563,625 (4,890,651 ) — Long-term debt and other long-term liabilities 7,918,581 715,065 552,406 — 9,186,052 Noncontrolling interests subject to put provisions 598,075 — — 526,566 1,124,641 Total DaVita Inc. shareholders' equity 3,703,442 10,102,750 3,239,862 (13,342,612 ) 3,703,442 Noncontrolling interests not subject to put — — 731,522 (526,566 ) 204,956 Total equity 3,703,442 10,102,750 3,971,384 (13,869,178 ) 3,908,398 Total liabilities and equity $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Consolidating Balance Sheets - (continued) As of December 31, 2017 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Cash and cash equivalents $ 149,305 $ — $ 358,929 $ — $ 508,234 Restricted cash and equivalents 1,002 9,384 300 — 10,686 Accounts receivable, net — 1,208,715 506,035 — 1,714,750 Other current assets 67,025 621,409 86,955 — 775,389 Current assets held for sale — 4,992,067 769,575 — 5,761,642 Total current assets 217,332 6,831,575 1,721,794 — 8,770,701 Property and equipment, net 408,010 1,560,390 1,180,813 — 3,149,213 Intangible assets, net 250 50,971 62,606 — 113,827 Investments in subsidiaries 10,009,874 3,085,722 — (13,095,596 ) — Intercompany receivables 3,677,947 — 1,313,213 (4,991,160 ) — Other long-term assets and investments 47,297 68,344 214,875 — 330,516 Goodwill — 4,732,320 1,877,959 — 6,610,279 Total assets $ 14,360,710 $ 16,329,322 $ 6,371,260 $ (18,086,756 ) $ 18,974,536 Current liabilities $ 238,706 $ 1,207,482 $ 436,262 $ — $ 1,882,450 Current liabilities held for sale — 739,294 445,776 — 1,185,070 Total current liabilities 238,706 1,946,776 882,038 — 3,067,520 Intercompany payables — 3,690,042 1,301,118 (4,991,160 ) — Long-term debt and other long-term liabilities 8,857,373 682,630 469,587 — 10,009,590 Noncontrolling interests subject to put provisions 574,602 — — 436,758 1,011,360 Total DaVita Inc. shareholders' equity 4,690,029 10,009,874 3,085,722 (13,095,596 ) 4,690,029 Noncontrolling interests not subject to put — — 632,795 (436,758 ) 196,037 Total equity 4,690,029 10,009,874 3,718,517 (13,532,354 ) 4,886,066 Total liabilities and equity $ 14,360,710 $ 16,329,322 $ 6,371,260 $ (18,086,756 ) $ 18,974,536 Consolidating Statements of Cash Flow For the year ended December 31, 2018 DaVita Inc. Guarantor Non-Guarantor Consolidating Consolidated Cash flows from operating activities: Net income $ 159,394 $ 103,196 $ 517,671 $ (447,221 ) $ 333,040 Changes in operating assets and liabilities and (86,070 ) 818,027 259,422 447,221 1,438,600 Net cash provided by operating activities 73,324 921,223 777,093 — 1,771,640 Cash flows from investing activities: Additions of property and equipment, net (175,787 ) (534,278 ) (277,073 ) — (987,138 ) Acquisitions — (73,046 ) (110,110 ) — (183,156 ) Proceeds from asset sales, net of cash divested — 61,962 88,243 — 150,205 Investments and other items 30,962 (16,362 ) (154 ) — 14,446 Net cash used in investing activities (144,825 ) (561,724 ) (299,094 ) — (1,005,643 ) Cash flows from financing activities: Long-term debt and related financing costs, net 725,889 (11,437 ) (19,675 ) — 694,777 Intercompany borrowing 404,897 (311,778 ) (93,119 ) — — Other items (1,147,934 ) (28,067 ) (144,130 ) — (1,320,131 ) Net cash used in financing activities (17,148 ) (351,282 ) (256,924 ) — (625,354 ) Effect of exchange rate changes on cash — — (3,350 ) — (3,350 ) Net (decrease) increase in cash, cash equivalents and restricted cash (88,649 ) 8,217 217,725 — 137,293 Less: Net increase in cash, cash equivalents and — 5,553 235,240 — 240,793 Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (88,649 ) 2,664 (17,515 ) — (103,500 ) Cash, cash equivalents and restricted cash of 150,307 9,384 359,229 — 518,920 Cash, cash equivalents and restricted cash of $ 61,658 $ 12,048 $ 341,714 $ — $ 415,420 Consolidating Statements of Cash Flow - (continued) For the year ended December 31, 2017 DaVita Inc. Guarantor Non-Guarantor Consolidating Consolidated Cash flows from operating activities: Net income $ 663,618 $ 478,192 $ 241,312 $ (552,567 ) $ 830,555 Changes in operating assets and liabilities and (533,300 ) 368,135 695,209 552,567 1,082,611 Net cash provided by operating activities 130,318 846,327 936,521 — 1,913,166 Cash flows from investing activities: Additions of property and equipment, net (155,972 ) (490,800 ) (258,478 ) — (905,250 ) Acquisitions — (693,522 ) (110,357 ) — (803,879 ) Proceeds from asset and business sales, net of cash — 90,340 1,996 — 92,336 Investments and other items 211,619 (7,004 ) 47,446 — 252,061 Net cash provided by (used in) investing activities 55,647 (1,100,986 ) (319,393 ) — (1,364,732 ) Cash flows from financing activities: Long-term debt and related financing costs, net 173,529 (12,662 ) (6,019 ) — 154,848 Intercompany borrowing 22,589 218,980 (241,569 ) — — Other items (781,697 ) (2,493 ) (136,915 ) — (921,105 ) Net cash (used in) provided by financing activities (585,579 ) 203,825 (384,503 ) — (766,257 ) Effect of exchange rate changes on cash — — 254 — 254 Net (decrease) increase in cash, cash equivalents and restricted cash (399,614 ) (50,834 ) 232,879 — (217,569 ) Less: Net decrease in cash, cash equivalents — (51,531 ) (1,495 ) — (53,026 ) Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (399,614 ) 697 234,374 — (164,543 ) Cash, cash equivalents and restricted cash of 549,921 8,687 124,855 — 683,463 Cash, cash equivalents and restricted cash of $ 150,307 $ 9,384 $ 359,229 $ — $ 518,920 Consolidating Statements of Cash Flow - (continued) For the year ended December 31, 2016 DaVita Inc. Guarantor Subsidiaries Non-Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Cash flows from operating activities: Net income $ 879,874 $ 693,720 $ 820,486 $ (1,360,998 ) $ 1,033,082 Changes in operating assets and liabilities and (612,706 ) 359,366 (168,614 ) 1,360,998 939,044 Net cash provided by operating activities 267,168 1,053,086 651,872 — 1,972,126 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 — 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 236,052 (231,800 ) (4,252 ) — — Other items (1,061,203 ) (21,525 ) (144,811 ) — (1,227,539 ) Net cash used in financing activities (917,611 ) (281,155 ) (153,215 ) — (1,351,981 ) Effect of exchange rate changes on cash — — 4,276 — 4,276 Net (decrease) increase in cash, cash equivalents and restricted cash (636,715 ) (41,483 ) 100,951 — (577,247 ) Less: Net (decrease) increase in cash, cash equivalents and restricted cash from discontinued operations — (50,170 ) 34,377 — (15,793 ) Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (636,715 ) 8,687 66,574 — (561,454 ) Cash, cash equivalents and restricted cash of 1,186,636 — 58,281 — 1,244,917 Cash, cash equivalents and restricted cash of $ 549,921 $ 8,687 $ 124,855 $ — $ 683,463 |
SCHEDULE II-VALUATION AND QUALI
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS | 12 Months Ended |
Dec. 31, 2018 | |
SEC Schedule, 12-09, Valuation and Qualifying Accounts [Abstract] | |
SCHEDULE II-VALUATION AND QUALIFYING ACCOUNTS | SCHEDULE II—VALUATION AND QUALIFYING ACCOUNTS Balance at Acquisitions Amounts Amounts written off Balance Description (in thousands) Allowance for uncollectible accounts: Year ended December 31, 2018 $ 218,399 $ — $ 42,287 $ 207,762 $ 52,924 Year ended December 31, 2017 $ 238,897 $ — $ 478,365 $ 498,863 $ 218,399 Year ended December 31, 2016 $ 251,734 $ — $ 442,985 $ 455,822 $ 238,897 |
Organization and Summary of S_2
Organization and Summary of Significant Accounting Policies (Policies) | 12 Months Ended |
Dec. 31, 2018 | |
Accounting Policies [Abstract] | |
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. Equity investments in investees over which the Company has significant influence are recorded on the equity method, while investments in other equity securities are recorded at fair value or pursuant to an adjusted cost method measurement alternative, as applicable. 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 (the U.S. dollar, or USD). Prior year balances and amounts have been reclassified to conform to the current year presentation. |
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. |
Patient service net revenues and accounts receivable | Revenues On January 1, 2018, the Company adopted Financial Accounting Standards Board (FASB) Accounting Standards Codification Topic 606 Revenue from Contracts with Customers (Topic 606) using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results for reporting periods beginning on and after January 1, 2018 are presented under Topic 606, while prior period amounts continue to be presented in accordance with the Company's historical accounting under Revenue Recognition (Topic 605). The adoption of this new standard primarily changed the Company’s presentation of revenues, provision for uncollectible accounts and allowance for doubtful accounts. Topic 606 requires revenue to be recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Accordingly, for performance obligations satisfied after the adoption of Topic 606, the Company no longer separately presents a provision for uncollectible accounts on the consolidated income statement and no longer presents the related allowance for doubtful accounts on the consolidated balance sheet. However, as a result of the Company’s election to apply Topic 606 only to contracts not substantially completed as of January 1, 2018, the Company continues to maintain an allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of Topic 606. Net collections or write-offs of accounts receivable generated prior to January 1, 2018, beyond amounts previously reserved thereon, are presented in the provision for uncollectible accounts on the consolidated income statement in accordance with Topic 605. Dialysis and related lab patient service revenues Dialysis patient service revenues are recognized in the period services are provided. Revenues consist primarily of payments from government and commercial health plans for dialysis and related lab services provided to patients. A usual and customary fee schedule is maintained for the Company’s dialysis treatments and related lab services; however, actual collectible revenue is normally recognized at a discount from the fee schedule. Revenues associated with Medicare and Medicaid programs are estimated 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. 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. The Company’s revenue recognition is estimated based on its judgment regarding its ability to collect, which depends upon its ability to effectively capture, document and bill for Medicare’s base payment rate as well as these other variable factors. 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. 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. In certain circumstances, it may not be 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. Other revenues |
Allowance for uncollectible accounts | The adoption of this new standard primarily changed the Company’s presentation of revenues, provision for uncollectible accounts and allowance for doubtful accounts. Topic 606 requires revenue to be recognized based on the Company’s estimate of the transaction price the Company expects to collect as a result of satisfying its performance obligations. Accordingly, for performance obligations satisfied after the adoption of Topic 606, the Company no longer separately presents a provision for uncollectible accounts on the consolidated income statement and no longer presents the related allowance for doubtful accounts on the consolidated balance sheet. However, as a result of the Company’s election to apply Topic 606 only to contracts not substantially completed as of January 1, 2018, the Company continues to maintain an allowance for doubtful accounts related to performance obligations satisfied prior to the adoption of Topic 606. Net collections or write-offs of accounts receivable generated prior to January 1, 2018, beyond amounts previously reserved thereon, are presented in the provision for uncollectible accounts on the consolidated income statement in accordance with Topic 605. |
Other income | Other incomeOther income includes interest income on cash and cash-equivalents and short- and long-term investments, other non-operating gains from investment transactions, and foreign currency transaction gains and losses. |
Cash and cash equivalents | Cash and cash equivalentsCash equivalents are short-term highly liquid investments with maturities of three months or less at date of purchase. |
Investments in debt and equity securities | Investments in debt and equity securitiesThe 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 or redemption values are classified as short-term or long-term investments and recorded at estimated fair value with changes in fair value recognized in current earnings. |
Inventories | InventoriesInventories are stated at the lower of cost (first-in, first-out) or net realizable value 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. |
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 years to 40 years ; leasehold improvements, the shorter of ten years or the expected lease term; and equipment and information systems, principally three years to 15 years |
Amortizable intangibles | Amortizable intangibles Amortizable intangible assets and liabilities include 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: non-competition and similar agreements, two years to ten years |
Indefinite-lived intangibles | Indefinite-lived intangiblesIndefinite-lived intangible assets include international licenses and accreditations that allow the Company to be reimbursed for providing dialysis services to patients, each of which has an indefinite useful life. Indefinite-lived intangibles are not amortized, but are assessed for impairment at least annually and whenever significant events or changes in circumstances indicate that an impairment may have occurred. |
Equity investments and other investments | Equity method and other investments Equity investments that do not have readily determinable fair values are carried on the equity method if the Company maintains significant influence over the investee, or on an adjusted cost method measurement alternative representing either the Company's cost or a subsequent observation of fair value, in each case net of any applicable other-than-temporary impairment. The Company classifies its equity and adjusted cost method investments as “Equity method and other investments” on its balance sheet. See Note 10 |
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 by individual reporting unit for impairment as circumstances warrant and at least annually. An impairment charge is recorded when and to the extent a reporting unit's carrying amount is determined to exceed its fair value. The Company operates multiple reporting units. See Note 11 |
Impairment of equity method and other investments | Impairment of equity method and other investmentsEquity method and other investments are assessed for other-than-temporary impairment when significant events or changes in circumstances indicate that an other-than-temporary impairment may have occurred. An other-than-temporary impairment charge is recorded when the fair value of an investment has fallen below its carrying amount and the shortfall is expected to be indefinitely or permanently unrecoverable. |
Impairment of other long-lived assets | Impairment of other long-lived assetsOther long-lived assets, including property and equipment and intangible assets, are reviewed for possible impairment whenever significant events or changes in circumstances indicate that an impairment may have occurred. Such changes can include changes in the Company’s business strategy and plans, changes in the quality or structure of its relationships with its partners or deteriorating performance of individual outpatient dialysis centers or other business units. An impairment of an amortizable or depreciable asset is indicated when the sum of the expected future undiscounted net cash flows identifiable to the related asset group is less than its carrying amount. Impairment losses are measured based on the difference between the estimated fair value and the carrying amount of the subject asset group and are included in operating expenses. |
Self insurance | Self-insuranceThe Company is predominantly self-insured with respect to professional and general liability and workers' compensation risks through wholly-owned captive insurance companies, with excess or reinsurance coverage for additional risk. The Company is also predominantly self-insured with respect to employee medical and other health benefits. The Company records insurance liabilities for the professional and general liability, workers’ compensation, and employee health benefit risks that it retains and estimates its liability for those risks using third party actuarial calculations that are based upon historical claims experience and expectations for future claims. |
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. |
Stock-based compensation | Stock-based compensation |
Interest rate swap and cap agreements | Interest rate cap and swap agreements The Company often carries a combination of current or 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 |
Noncontrolling interests | Noncontrolling interestsNoncontrolling interests represent third-party equity ownership interests in entities which are consolidated by the Company for financial statement reporting purposes.Noncontrolling interests subject to put provisionsThe 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 that 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 flows 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 noncontrolling interests subject to put provisions are 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 is immaterial. |
Fair value estimates | Fair value estimatesThe Company relies on fair value measurements and estimates for purposes that require the recording, reassessment, or adjustment of the carrying amounts of certain assets, liabilities and noncontrolling interests subject to put provisions (temporary equity). These purposes can include the accounting for business combination transactions; impairment assessments for goodwill, other intangible assets, or other long-lived assets; recurrent revaluation of investments in debt and equity securities, interest rate cap agreements or other derivative instruments, contingent earn-out obligations, and noncontrolling interests subject to put provisions; and the accounting for equity method and other investments and stock-based compensation, as applicable. The Company has also classified its assets, liabilities and temporary equity into the appropriate fair value hierarchy levels as defined by the FASB. |
New accounting standards | New accounting standards On May 28, 2014, the FASB issued ASU No. 2014-09, Revenue from Contracts with Customers (Topic 606), which requires an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised goods or services to customers. In 2015, 2016 and 2017, the FASB issued ASU 2015-14, ASU 2016-08, ASU 2016-10, ASU 2016-11, ASU 2016-12, and ASU 2017-10, each of which amended the guidance in ASU 2014-09. These ASUs replaced most existing revenue recognition guidance in GAAP. The Company adopted these ASUs beginning January 1, 2018. See Note 2 for further details. In January 2016, the FASB issued ASU No. 2016-01, Financial Instruments - Overall (Subtopic 825-10): Recognition and Measurement of Financial Assets and Financial Liabilities . In February 2018, the FASB issued ASU 2018-03, which provides various related technical corrections and improvements. The Company adopted these ASUs beginning January 1, 2018. See Note 5 for further details. In February 2016, the FASB issued ASU No. 2016-02, Leases (Topic 842) . The amendments in this ASU include revisions to lessee accounting, requiring lessees to recognize a lease liability and a right-of-use asset for substantially all leases with lease terms in excess of twelve months. The Company plans to adopt the amendments in this ASU as of January 1, 2019 using a modified retrospective transition approach for leases existing at, or entered into after, the adoption date with a cumulative effect adjustment. The Company is planning on electing the package of practical expedients to not reassess prior conclusions related to contracts containing leases, lease classification and initial direct costs. The Company estimates the impact of this guidance will result in recognition of additional net lease liabilities of approximately $3,000,000 as of January 1, 2019. The Company is still finalizing its calculations, including the amount of right of use assets to recognize as well as, the cumulative effect adjustment to beginning retained earnings. The Company does not believe this new guidance will have a material effect on its results of operations or liquidity. In August 2016, the FASB issued ASU No. 2016-15, Statement of Cash Flows (Topic 230): Classification of Certain Cash Receipts and Cash Payments . The amendments in this ASU clarify how certain cash receipts and cash payments should be classified on the statement of cash flows. In November 2016, the FASB issued ASU No. 2016-18, Statement of Cash Flows (Topic 230): Restricted cash. The amendments in this ASU require that the statement of cash flows explain the change during the period in the total of cash, cash equivalents, and amounts generally described as restricted cash or restricted cash equivalents. The adoption of these ASUs did not have a material impact on the Company’s consolidated financial statements when adopted on January 1, 2018. In October 2016, the FASB issued ASU No. 2016-16, Income Taxes (Topic 740): Intra-Entity Transfers of Assets Other Than Inventory . The amendments in this ASU allow entities to recognize the income tax consequences of an intra-entity transfer of an asset other than inventory when the transfer occurs. The prior guidance did not allow recognition until the asset had been sold to an outside party. The amendments in this ASU were effective for the Company beginning on January 1, 2018 and have been applied on a modified retrospective basis. The adoption of this ASU did not have a material impact on the Company’s consolidated financial statements. In August 2017, the FASB issued ASU No. 2017-12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities. The amendments in this ASU better align an entity’s risk management activities and financial reporting for hedging relationships through changes to both the designation and measurement guidance for qualifying hedging relationships and the presentation of hedge results. The amendments in this ASU are effective for the Company on January 1, 2019 and are to be applied prospectively. The adoption of this ASU is not expected to have a material impact on the Company’s consolidated financial statements. In February 2018, the FASB issued ASU No. 2018-02, Income Statement - Reporting Comprehensive Income (Topic 220), Reclassification of Certain Tax Effects from Accumulated Other Comprehensive Income , which allows for the reclassification of certain income tax effects related to the Tax Cuts and Jobs Act (2017 Tax Act) between “Accumulated other comprehensive income” and “Retained earnings.” This ASU relates to the requirement that adjustments to deferred tax liabilities and assets related to a change in tax laws or rates be included in “Income from continuing operations”, even in situations where the related items were originally recognized in “Other comprehensive income” (rather than in “Income from continuing operations”). The amendments in this ASU were effective for all entities for fiscal years beginning after December 15, 2018, and interim periods within those fiscal years, with early adoption permitted. The Company elected to early adopt this ASU on January 1, 2018 and applied the change in the period of adoption. The adoption of this ASU resulted in the reclassification of an immaterial amount of deferred tax effects from accumulated other comprehensive income to retained earnings via a cumulative change in accounting principle effective January 1, 2018. See Note 20 for more details. In August 2018, the FASB issued ASU No. 2018-13, Fair Value Measurement (Topic 820): Disclosure Framework -Changes to the Disclosure Requirements for Fair Value Measurement |
Earnings per share | Basic earnings 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, net of the weighted average shares held in escrow that under certain circumstances may have been returned to the Company.Diluted earnings per share includes the dilutive effect of outstanding stock-settled stock appreciation rights and unvested stock units (under the treasury stock method) as well as the weighted average shares held in escrow that were outstanding during the period. |
Other Comprehensive (Loss) Income | The reclassification of net cap and swap 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. |
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. |
Revenue Recognition and Account
Revenue Recognition and Accounts Receivable Segment revenue by major payor (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Revenues by major payor [Abstract] | |
Schedule of Revenue Sources, Health Care Organization [Table Text Block] | The following table summarizes the Company's segment revenues by primary payor source: Year ended December 31, 2018 U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated Patient service revenues: Medicare and Medicare Advantage $ 6,063,891 $ — $ 6,063,891 Medicaid and Managed Medicaid 628,766 — 628,766 Other government 446,999 335,594 782,593 Commercial 3,176,413 101,681 3,278,094 Other revenues: Medicare and Medicare Advantage — 492,812 492,812 Medicaid and Managed Medicaid — 44,246 44,246 Commercial — 90,890 90,890 Other (1) 19,880 130,865 150,745 Eliminations of intersegment revenues (92,950 ) (34,236 ) (127,186 ) Total $ 10,242,999 $ 1,161,852 $ 11,404,851 (1) Other consists of management service fees earned in the respective Company line of business as well as revenue from the Company's ancillary services and strategic initiatives. Year ended December 31, 2017 (1) U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated Patient service revenues: Medicare and Medicare Advantage $ 5,253,012 $ — $ 5,253,012 Medicaid and Managed Medicaid 606,827 — 606,827 Other government 362,567 259,651 622,218 Commercial 3,117,920 63,505 3,181,425 Other revenues: Medicare and Medicare Advantage — 902,289 902,289 Medicaid and Managed Medicaid — 71,426 71,426 Commercial — 116,503 116,503 Other (2) 19,739 182,974 202,713 Eliminations of intersegment revenues (55,176 ) (24,603 ) (79,779 ) Total $ 9,304,889 $ 1,571,745 $ 10,876,634 (1) As noted above, prior period amounts have not been adjusted under the cumulative effect method. In this table, the Company's dialysis and related lab services revenues for the year ended December 31, 2017 has been presented net of the provision for uncollectible accounts of $485,364 to conform to the current period presentation. (2) Other consists of management service fees earned in the respective Company line of business as well as revenue from the Company's ancillary services and strategic initiatives. Year ended December 31, 2016 (1) U.S. dialysis and related lab services Other - Ancillary services and strategic initiatives Consolidated Patient service revenues: Medicare and Medicare Advantage $ 5,303,718 $ — $ 5,303,718 Medicaid and Managed Medicaid 319,553 — 319,553 Other government 143,207 165,193 308,400 Commercial 3,355,066 36,674 3,391,740 Other revenues: Medicare and Medicare Advantage — 974,146 974,146 Medicaid and Managed Medicaid — 82,428 82,428 Commercial — 128,824 128,824 Other (2) 16,645 234,107 250,752 Eliminations of intersegment revenues (27,355 ) (24,739 ) (52,094 ) Total $ 9,110,834 $ 1,596,633 $ 10,707,467 (1) As noted above, prior period amounts have not been adjusted under the cumulative effect method. In this table, the Company's dialysis and related lab services revenues for the year ended December 31, 2016 has been presented net of the provision for uncollectible accounts of $431,304 to conform to the current period presentation. (2) |
Earnings Per Share (Tables)
Earnings Per Share (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
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 earnings per share were as follows: Year ended December 31, 2018 2017 2016 (shares in thousands) Numerators: Net income from continuing operations attributable to DaVita Inc. $ 624,321 $ 901,277 $ 1,032,373 Net loss from discontinued operations attributable to DaVita Inc. (464,927 ) (237,659 ) (152,499 ) Net income attributable to DaVita Inc. for earnings per share calculation $ 159,394 $ 663,618 $ 879,874 Basic: Weighted average shares outstanding during the period 171,886 190,820 203,835 Weighted average contingently returnable shares previously held in escrow for (1,100 ) (2,194 ) (2,194 ) Weighted average shares for basic earnings per share calculation 170,786 188,626 201,641 Basic net income from continuing operations per share attributable to DaVita Inc. $ 3.66 $ 4.78 $ 5.12 Basic net loss from discontinued operations per share attributable to DaVita Inc. (2.73 ) (1.26 ) (0.76 ) Basic net income per share attributable to DaVita Inc. $ 0.93 $ 3.52 $ 4.36 Diluted: Weighted average shares outstanding during the period 171,886 190,820 203,835 Assumed incremental shares from stock plans 479 529 1,070 Weighted average shares for diluted earnings per share calculation 172,365 191,349 $ 204,905 Diluted net income from continuing operations per share attributable to DaVita Inc. $ 3.62 $ 4.71 $ 5.04 Diluted net loss from discontinued operations per share attributable to DaVita Inc. (2.70 ) (1.24 ) (0.75 ) Diluted net income per share attributable to DaVita Inc. $ 0.92 $ 3.47 $ 4.29 Anti-dilutive stock-settled awards excluded from calculation (1) 5,295 4,350 2,523 (1) |
Short-term and long-term invesm
Short-term and long-term invesmtents (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Investments, Debt and Equity Securities [Abstract] | |
Schedule of Investments | The Company’s investments in these short-term and long-term debt and equity investments consist of the following: December 31, 2018 December 31, 2017 Debt Equity Total Debt Equity Total Certificates of deposit and other time deposits $ 2,235 $ — $ 2,235 $ 31,630 $ — $ 31,630 Investments in mutual funds and common stock — 36,124 36,124 — 38,895 38,895 $ 2,235 $ 36,124 $ 38,359 $ 31,630 $ 38,895 $ 70,525 Short-term investments $ 2,235 $ 700 $ 2,935 $ 31,630 $ 1,200 $ 32,830 Long-term investments — 35,424 35,424 — 37,695 37,695 $ 2,235 $ 36,124 $ 38,359 $ 31,630 $ 38,895 $ 70,525 |
Other Receivables (Tables)
Other Receivables (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Receivables [Abstract] | |
Schedule of Other Receivables | Other receivables were comprised of the following: December 31, 2018 2017 Supplier rebates and non-trade receivables $ 334,156 $ 295,292 Medicare bad debt claims 135,640 103,970 $ 469,796 $ 399,262 |
Prepaid and Other Current Ass_2
Prepaid and Other Current Assets (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Prepaid Expense and Other Assets, Current [Abstract] | |
Schedule of Prepaid and Other Current Assets | Other current assets were comprised of the following: December 31, 2018 2017 Prepaid expenses $ 108,315 $ 104,727 Other 3,525 7,331 $ 111,840 $ 112,058 |
Property and Equipment (Tables)
Property and Equipment (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Property, Plant and Equipment [Abstract] | |
Property and Equipment | Property and equipment were comprised of the following: December 31, 2018 2017 Land $ 37,384 $ 33,814 Buildings 467,181 473,489 Leasehold improvements 3,164,943 2,816,675 Equipment and information systems, including internally developed software 2,586,564 2,352,246 New center and capital asset projects in progress 661,695 576,651 6,917,767 6,252,875 Less accumulated depreciation (3,524,098 ) (3,103,662 ) $ 3,393,669 $ 3,149,213 |
Intangibles (Tables)
Intangibles (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |
Schedule of Intangible Assets other than Goodwill | Intangible assets other than goodwill were comprised of the following: December 31, 2018 2017 Noncompetition and other agreements $ 131,360 $ 429,140 Lease agreements 7,584 7,623 Indefinite-lived assets 59,885 33,255 Other 583 583 199,412 470,601 Less accumulated amortization (80,566 ) (356,774 ) $ 118,846 $ 113,827 |
Scheduled Amortization Charges from Intangible Assets and Liabilities | Scheduled amortization charges from amortizable intangible assets and liabilities as of December 31, 2018 were as follows: Noncompetition and other agreements Lease liabilities Other 2019 $ 14,442 $ (901 ) $ 91 2020 13,020 (895 ) 45 2021 10,816 (871 ) — 2022 7,001 (864 ) — 2023 4,235 (704 ) — Thereafter 9,311 (1,695 ) — Total $ 58,825 $ (5,930 ) $ 136 |
Equity Method and Other Inves_2
Equity Method and Other Investmetns Equity Method and Other Investments (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Equity Method Investments and Joint Ventures [Abstract] | |
Equity Method Investments | The Company's equity method and other investments were comprised of the following: December 31, 2018 2017 APAC joint venture $ 129,173 $ 160,481 Other equity method partnerships 83,052 79,667 Adjusted cost method investments 12,386 5,386 $ 224,611 $ 245,534 |
Goodwill (Tables)
Goodwill (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
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 Other ancillary services and strategic initiatives Consolidated total Balance at December 31, 2016 $ 5,691,587 $ 323,788 $ 6,015,375 Acquisitions 485,434 131,598 617,032 Divestitures (32,260 ) (126 ) (32,386 ) Impairment charges — (36,196 ) (36,196 ) Foreign currency and other adjustments — 46,454 46,454 Balance at December 31, 2017 $ 6,144,761 $ 465,518 $ 6,610,279 Acquisitions 130,574 147,774 278,348 Divestitures (331 ) (15,166 ) (15,497 ) Impairment charges — (3,106 ) (3,106 ) Foreign currency and other adjustments — (28,064 ) (28,064 ) Balance at December 31, 2018 $ 6,275,004 $ 566,956 $ 6,841,960 Goodwill $ 6,275,004 $ 594,229 $ 6,869,233 Accumulated impairment charges — (27,273 ) (27,273 ) $ 6,275,004 $ 566,956 $ 6,841,960 |
Schedule of Reporting Units Goodwill Balances | Based on the most recent assessments, the Company determined that reductions in reimbursement rates, changes in actual or expected growth rates, 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 as of December 31, 2018 : Reporting unit Goodwill Carrying amount (1) Sensitivities Operating (2) Discount (3) Germany Kidney Care $ 403,200 0.5 % (1.5 )% (10.3 )% Brazil Kidney Care $ 39,452 9.8 % (2.5 )% (7.3 )% Germany other health operations $ 12,646 8.1 % (2.2 )% (11.1 )% (1) Excess of estimated fair value of the reporting unit over its 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) |
Other Liabilities (Tables)
Other Liabilities (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Other Liabilities Disclosure [Abstract] | |
Schedule of Other Liabilities | Other liabilities were comprised of the following: December 31, 2018 2017 Payor refunds and retractions $ 302,244 $ 292,370 Insurance and self-insurance accruals 58,569 64,924 Accrued interest 82,827 83,362 Accrued non-income tax liabilities 28,663 28,317 Other 123,547 110,032 $ 595,850 $ 579,005 |
Income Taxes (Tables)
Income Taxes (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Income Tax Disclosure [Abstract] | |
Schedule of Income Before Income Taxes | Income before income taxes from continuing operations consisted of the following: Year ended December 31, 2018 2017 2016 Domestic $ 1,083,578 $ 1,725,822 $ 1,278,754 International (35,100 ) (326,036 ) 344,351 $ 1,048,478 $ 1,399,786 $ 1,623,105 |
Components of Income Tax Expense (Benefit) | Income tax expense for continuing operations consisted of the following: Year ended December 31, 2018 2017 2016 Current: Federal $ 140,064 $ 330,191 $ 322,940 State 32,990 47,228 44,525 International 7,557 3,422 1,928 Total current income tax 180,611 380,841 369,393 Deferred: Federal 52,034 (98,760 ) 88,412 State 21,096 37,347 (28,530 ) International 4,659 4,431 2,486 Total deferred income tax 77,789 (56,982 ) 62,368 $ 258,400 $ 323,859 $ 431,761 |
Schedule of Allocation of Income Tax Expense (Benefit) | Income taxes are allocated between continuing and discontinued operations as follows: Year ended December 31, 2018 2017 2016 Continuing operations $ 258,400 $ 323,859 $ 431,761 Discontinued operations 99,768 (364,856 ) 24,052 $ 358,168 $ (40,997 ) $ 455,813 |
Reconciliation between U.S. Federal Income Tax Rate and Effective Tax Rate | The reconciliation between the Company’s effective tax rate from continuing operations and the U.S. federal income tax rate is as follows: Year ended December 31, 2018 2017 2016 Federal income tax rate 21.0 % 35.0 % 35.0 % State income taxes, net of federal benefit 4.1 3.7 2.6 Gain on APAC JV ownership changes — (0.2 ) (9.9 ) Political advocacy costs 2.3 — — APAC investment impairment — 6.4 — Impact of 2017 Tax Act (0.1 ) (20.5 ) — Other 1.9 2.0 1.8 Impact of noncontrolling interests primarily attributable to (4.6 ) (3.3 ) (2.9 ) Effective tax rate 24.6 % 23.1 % 26.6 % |
Deferred Tax Assets and Liabilities Arising from Temporary Differences | Deferred tax assets and liabilities arising from temporary differences for continuing operations were as follows: December 31, 2018 2017 Receivables $ 19,327 $ 19,705 Accrued liabilities 106,506 96,537 Net operating loss carryforwards 117,511 108,429 Other 36,712 37,794 Deferred tax assets 280,056 262,465 Valuation allowance (70,474 ) (61,282 ) Net deferred tax assets 209,582 201,183 Intangible assets (555,822 ) (501,763 ) Property and equipment (118,008 ) (100,376 ) Investments in partnerships (67,354 ) (61,529 ) Other (30,934 ) (23,762 ) Deferred tax liabilities (772,118 ) (687,430 ) Net deferred tax liabilities $ (562,536 ) $ (486,247 ) |
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 is as follows: Year ended December 31, 2018 2017 Beginning balance $ 32,776 $ 24,066 Additions for tax positions related to current year 6,111 7,606 Additions for tax positions related to prior years 4,134 804 Reductions related to lapse of applicable statute (338 ) (1,380 ) Impact of 2017 Tax Act — 3,731 Reductions related to settlements with taxing authorities (2,301 ) (2,051 ) Ending balance $ 40,382 $ 32,776 |
Long-Term Debt (Tables)
Long-Term Debt (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Debt Disclosure [Abstract] | |
Long-term Debt | Long-term debt was comprised of the following: December 31, 2018 2017 Interest rate Maturity date Senior Secured Credit Facilities: Term Loan A $ 675,000 $ 775,000 2.00% + LIBOR 6/24/2019 Term Loan A-2 995,000 — 1.00% + LIBOR 6/24/2019 Term Loan B 3,342,500 3,377,500 2.75% + LIBOR (2) 6/24/2021 Revolver 175,000 300,000 2.00% + LIBOR 6/24/2019 Senior Notes: 5 3/4% Senior Notes 1,250,000 1,250,000 5.75% 8/15/2022 5 1/8% Senior Notes 1,750,000 1,750,000 5.125% 7/15/2024 5% Senior Notes 1,500,000 1,500,000 5% 5/1/2025 Acquisition obligations and other notes payable (1) 183,979 150,512 6.24% 2019-2025 Capital lease obligations (1) 282,737 297,170 5.49% 2019-2036 Total debt principal outstanding 10,154,216 9,400,182 Discount and deferred financing costs (52,000 ) (63,951 ) 10,102,216 9,336,231 Less current portion (1,929,369 ) (178,213 ) $ 8,172,847 $ 9,158,018 |
Scheduled Maturities of Long-term Debt | Scheduled maturities of long-term debt at December 31, 2018 were as follows: 2019 $ 1,929,369 2020 80,016 2021 3,314,149 2022 1,291,472 2023 37,881 Thereafter $ 3,501,329 |
Derivative Instruments | The following table summarizes the Company’s derivative instruments as of December 31, 2018 and 2017 : Fair value Derivatives designated as hedging instruments Balance sheet location December 31, 2018 December 31, 2017 Interest rate cap agreements Other long-term assets $ 851 $ 1,032 |
Effects of Interest Rate Swap and Cap Agreements | The following table summarizes the effects of the Company’s interest rate cap and swap agreements for the years ended December 31, 2018 , 2017 and 2016 : Amount of unrealized losses in OCI Location of losses Amount of losses Year ended December 31, Year ended December 31, Derivatives designated as cash flow hedges 2018 2017 2016 2018 2017 2016 Interest rate cap agreements $ (181 ) $ (8,897 ) $ (5,198 ) Debt expense $ 8,466 $ 8,278 $ 3,899 Interest rate swap agreements — — (815 ) Debt expense — — 299 Tax benefit 48 3,460 2,343 Tax expense (2,180 ) (3,220 ) (1,632 ) Total $ (133 ) $ (5,437 ) $ (3,670 ) $ 6,286 $ 5,058 $ 2,566 |
Leases (Tables)
Leases (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Leases [Abstract] | |
Future Minimum Lease Payments Under Non-cancelable Operating and Capital Leases | Future minimum lease payments under non-cancellable operating and capital leases are as follows: Operating leases Capital leases 2019 $ 483,488 $ 36,754 2020 462,154 41,044 2021 432,950 34,026 2022 395,462 33,690 2023 349,649 33,845 Thereafter 1,589,949 194,611 $ 3,713,652 373,970 Less portion representing interest (91,233 ) Total capital lease obligations, including current portion $ 282,737 |
Long-term Incentive Compensat_2
Long-term Incentive Compensation and Shareholders’ Equity (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Disclosure of Compensation Related Costs, Share-based Payments [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 (SSARs) and stock-settled stock unit awards is as follows: Year ended December 31, 2018 Stock appreciation rights Stock units Awards Weighted Weighted Awards Weighted Outstanding at beginning of year 6,648,199 $ 67.92 1,075,572 Granted 1,902,652 $ 66.54 1,101,388 Exercised (2,059,872 ) $ 60.34 (165,543 ) Canceled (328,182 ) $ 70.44 (150,942 ) Outstanding at end of period 6,162,797 $ 69.90 2.9 1,860,475 2.2 Exercisable at end of period 1,422,529 $ 73.39 0.9 — — Weighted-average fair value of grants 2018 $ 16.24 $ 66.23 2017 $ 14.51 $ 65.73 2016 $ 13.74 $ 70.99 |
Summary of Range of Exercise Prices | Awards Outstanding Weighted average exercise price Awards exercisable Weighted average exercise price Range of SSARs base prices $50.01–$60.00 131,470 $ 57.90 — $ — $60.01–$70.00 4,083,162 $ 66.66 757,237 $ 68.96 $70.01–$80.00 1,351,997 $ 74.78 346,316 $ 73.81 $80.01–$90.00 596,168 $ 83.60 318,976 $ 83.47 Total 6,162,797 $ 69.90 1,422,529 $ 73.39 |
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, 2018 2017 2016 Expected term 4.2 4.2 4.2 Expected volatility 23.8 % 23.9 % 21.0 % Expected dividend yield — % — % — % Risk-free interest rate 2.9 % 1.7 % 1.0 % |
Effects of Changes in DaVita Inc's Ownership Interest on Company's Equity | The effects of changes in DaVita Inc.’s ownership interest in consolidated subsidiaries on the Company’s consolidated equity are as follows: Year ended December 31, 2018 2017 2016 Net income attributable to DaVita Inc. $ 159,394 $ 663,618 $ 879,874 Changes in paid-in-capital for: Sales of noncontrolling interest 79 (114 ) — Purchase of noncontrolling interests (17,897 ) (2,752 ) (13,105 ) Net transfer in noncontrolling interests (17,818 ) (2,866 ) (13,105 ) Net income attributable to DaVita Inc. net of transfers in $ 141,576 $ 660,752 $ 866,769 |
Other Comprehensive (Loss) In_2
Other Comprehensive (Loss) Income (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Statement of Comprehensive Income [Abstract] | |
Changes in Other Comprehensive (Loss) Income | Charges and credits to other comprehensive (loss) income have been as follows: Interest rate cap and swap agreements Investment securities Foreign currency translation adjustments Accumulated other comprehensive (loss) income Balance at January 1, 2016 $ (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 of income (loss) 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 ) Unrealized (losses) gains (8,897 ) 5,075 99,770 95,948 Related income tax 3,460 (1,368 ) — 2,092 (5,437 ) 3,707 99,770 98,040 Reclassification of income (loss) into net income 8,278 (360 ) — 7,918 Related income tax (3,220 ) 140 — (3,080 ) 5,058 (220 ) — 4,838 Balance at December 31, 2017 $ (12,408 ) $ 5,662 $ 19,981 $ 13,235 Cumulative effect of change in accounting principle (1) (2,706 ) (5,662 ) — (8,368 ) Unrealized losses (181 ) — (45,944 ) (46,125 ) Related income tax 48 — — 48 (133 ) — (45,944 ) (46,077 ) Reclassification of income into net income 8,466 — — 8,466 Related income tax (2,180 ) — — (2,180 ) 6,286 — — 6,286 Balance at December 31, 2018 $ (8,961 ) $ — $ (25,963 ) $ (34,924 ) (1) Reflects the cumulative effect of a change in accounting principle for ASUs 2016-01 and 2018-03 on classification and measurement of financial instruments and ASU 2018-02 on remeasurement and reclassification of deferred tax effects in accumulated other comprehensive income associated with the 2017 Tax Act. See Note 5 |
Acquisitions and Divestitures (
Acquisitions and Divestitures (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Business Acquisition [Line Items] | |
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 within continuing operations in 2018 and 2017 had been consummated as of the beginning of 2017, including the impact of certain adjustments such as amortization of intangibles, interest expense on acquisition financing and income tax effects. Year ended December 31, 2018 2017 (unaudited) Pro forma net revenues $ 11,508,555 $ 11,176,736 Pro forma net income from continuing operations attributable to $ 634,326 $ 922,718 Pro forma basic net income per share from continuing operations $ 3.71 $ 4.89 Pro forma diluted net income per share from continuing operations $ 3.68 $ 4.82 |
Reconciliation of Changes in Contingent Earn-Out Obligations | The following is a reconciliation of changes in contingent earn-out obligations for the year ended December 31, 2018 : Beginning balance December 31, 2017 $ 6,388 Contingent earn-out obligations associated with acquisitions 1,246 Remeasurement of fair value (4,729 ) Payments of contingent earn-out obligations (297 ) Ending balance December 31, 2018 $ 2,608 |
Series of individually immaterial business acquisitions | |
Business Acquisition [Line Items] | |
Aggregate Purchase Cost Allocations for Acquisitions | The following table summarizes the assets acquired and liabilities assumed in these transactions and recognized at their acquisition dates at estimated fair values, as well as the estimated fair value of noncontrolling interests assumed in these transactions: Year ended December 31, 2018 2017 2016 Current assets $ 23,686 $ 14,366 $ 3,996 Property and equipment 11,421 18,192 8,840 Amortizable intangible and other long-term assets 3,079 11,663 5,876 Non-amortizable intangibles 23,656 32,296 — Goodwill 278,348 318,832 198,927 Deferred income taxes — (210 ) 597 Noncontrolling interests assumed (80,291 ) (44,303 ) (30,337 ) Liabilities assumed (19,946 ) (15,846 ) (3,317 ) Aggregate purchase cost $ 239,953 $ 334,990 $ 184,582 |
Renal Ventures Limited, LLC | |
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 estimated fair values: Current assets, net of cash acquired $ 22,739 Property and equipment 36,295 Amortizable intangible and other long-term assets 11,547 Goodwill 298,200 Current liabilities (8,389 ) Long-term liabilities (479 ) $ 359,913 |
Held for Sale and Discontinue_2
Held for Sale and Discontinued Operations (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Reconciliation of Cash Flows | The following table presents cash flows of discontinued operations related to DMG: Year ended December 31, 2018 2017 2016 Net cash provided by operating activities from discontinued operations $ 290,684 $ 357,274 $ 287,044 Net cash used in investing activities from discontinued operations $ (57,382 ) $ (232,329 ) $ (430,917 ) |
Summary of Information Related to Assets Held For Sale and Discontinued Operations | The following table presents the financial results of discontinued operations related to DMG: Year ended December 31, 2018 2017 2016 Net revenues $ 4,963,792 $ 4,676,213 $ 4,113,414 Expenses 4,962,686 4,634,782 3,994,624 Goodwill and other asset impairment charges 41,537 651,659 253,000 Valuation adjustment on disposal group 316,840 — — Loss from discontinued operations before taxes (357,271 ) (610,228 ) (134,210 ) Income tax expense (benefit) 99,768 (364,856 ) 24,052 Net loss from discontinued operations, net of tax $ (457,038 ) $ (245,372 ) $ (158,262 ) December 31, 2018 December 31, 2017 Assets Cash and cash equivalents $ 414,683 $ 179,668 Other current assets 557,403 826,608 Property and equipment, net 458,040 379,945 Intangible assets, net 1,316,974 1,316,550 Other long-term assets 112,127 178,894 Goodwill 2,847,178 2,879,977 Valuation allowance on disposal group (316,840 ) — Total current assets held for sale $ 5,389,565 $ 5,761,642 Liabilities Other liabilities $ 479,134 $ 505,734 Medical payables 436,839 457,040 Current portion of long-term debt 3,122 2,845 Long-term debt 33,425 35,003 Other long-term liabilities 291,239 184,448 Total current liabilities held for sale $ 1,243,759 $ 1,185,070 |
Fair Values of Financial Inst_2
Fair Values of Financial Instruments (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Fair Value Disclosures [Abstract] | |
Assets, Liabilities and Temporary Equity Measured at Fair Value on a Recurring Basis | The following table summarizes the Company’s assets, liabilities and temporary equity measured at fair value on a recurring basis as of December 31, 2018 and 2017 : December 31, 2018 Total Quoted prices in Significant other Significant Assets Investments in equity securities $ 36,124 $ 36,124 $ — $ — Interest rate cap agreements $ 851 $ — $ 851 $ — Liabilities Contingent earn-out obligations $ 2,608 $ — $ — $ 2,608 Temporary equity Noncontrolling interests subject to put provisions $ 1,124,641 $ — $ — $ 1,124,641 December 31, 2017 Assets Investments in equity securities $ 38,895 $ 38,895 $ — $ — Interest rate cap agreements $ 1,032 $ — $ 1,032 $ — Liabilities Contingent earn-out obligations $ 6,388 $ — $ — $ 6,388 Temporary equity Noncontrolling interests subject to put provisions $ 1,011,360 $ — $ — $ 1,011,360 |
Segment Reporting (Tables)
Segment Reporting (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
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, 2018 2017 2016 Segment revenues: (1) U.S. dialysis and related lab services Patient service revenues: External sources $ 10,274,046 $ 9,767,123 $ 9,524,067 Intersegment revenues 92,950 55,176 27,355 Total U.S. dialysis and related lab services revenues 10,366,996 9,822,299 9,551,422 Provision for uncollectible accounts (50,927 ) (481,973 ) (429,878 ) Net U.S. dialysis and related lab services patient service revenues 10,316,069 9,340,326 9,121,544 Other revenues (2) 19,880 19,739 16,645 Total net U.S. dialysis and related lab services revenues 10,335,949 9,360,065 9,138,189 Other - Ancillary services and strategic initiatives Net patient service revenues 437,275 323,156 201,867 Other external sources 724,577 1,248,589 1,394,766 Intersegment revenues 34,236 24,603 24,739 Total ancillary services and strategic initiatives revenues 1,196,088 1,596,348 1,621,372 Total net segment revenues 11,532,037 10,956,413 10,759,561 Elimination of intersegment revenues (127,186 ) (79,779 ) (52,094 ) Consolidated net revenues $ 11,404,851 $ 10,876,634 $ 10,707,467 Segment operating margin (loss): U.S. dialysis and related lab services $ 1,709,721 $ 2,297,198 $ 1,777,014 Other—Ancillary services and strategic initiatives (93,789 ) (439,477 ) 266,324 Total segment margin 1,615,932 1,857,721 2,043,338 Reconciliation of segment operating margin to consolidated income from Corporate administrative support (90,108 ) (44,966 ) (13,628 ) Consolidated operating income 1,525,824 1,812,755 2,029,710 Debt expense (487,435 ) (430,634 ) (414,116 ) Other income 10,089 17,665 7,511 Income from continuing operations before income taxes $ 1,048,478 $ 1,399,786 $ 1,623,105 (1) On January 1, 2018, the Company adopted Revenue from Contracts with Customers (Topic 606) using the cumulative effect method for those contracts that were not substantially completed as of January 1, 2018. Results related to performance obligations satisfied beginning on and after January 1, 2018 are presented under Topic 606, while results related to the satisfaction of performance obligations in prior periods continue to be reported in accordance with the Company's historical accounting under Revenue Recognition (Topic 605). See Notes 1 and 2 of these consolidated financial statements for further discussion of the Company's adoption of Topic 606. (2) |
Summary of Depreciation and Amortization Expense by Segment | Depreciation and amortization expense by reportable segment is as follows: Year ended December 31, 2018 2017 2016 U.S. dialysis and related lab services $ 558,810 $ 520,965 $ 482,768 Other - Ancillary services and strategic initiatives 32,225 38,946 26,729 $ 591,035 $ 559,911 $ 509,497 |
Summary of Assets by Segment | Year ended December 31, 2018 2017 2016 U.S. dialysis and related lab services $ 558,810 $ 520,965 $ 482,768 Other - Ancillary services and strategic initiatives 32,225 38,946 26,729 $ 591,035 $ 559,911 $ 509,497 Summary of assets by reportable segment is as follows: Year ended December 31, 2018 2017 Segment assets U.S. dialysis and related lab services (including equity investments of $ 12,333,641 $ 11,802,131 Other - Ancillary services and strategic initiatives (1) (including equity 1,387,046 1,410,763 DMG - Held for sale (including equity investments of $4,833 and 5,389,565 5,761,642 Consolidated assets $ 19,110,252 $ 18,974,536 (1) Includes approximately $136,052 and $125,932 in 2018 and 2017 |
Summary of Expenditures for Property and Equipment by Segment | Expenditures for property and equipment by reportable segment is as follows: Year ended December 31, 2018 2017 2016 U.S. dialysis and related lab services $ 856,108 $ 769,732 $ 675,994 Other - Ancillary services and strategic initiatives 45,806 40,377 68,702 DMG - Held for sale 85,224 95,141 84,399 $ 987,138 $ 905,250 $ 829,095 |
Supplemental Cash Flow Inform_2
Supplemental Cash Flow Information (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Supplemental Cash Flow Elements [Abstract] | |
Supplemental Cash Flow Information | The table below provides supplemental cash flow information: Year ended December 31, 2018 2017 2016 Cash paid: Income taxes $ 92,526 $ 387,159 $ 339,411 Interest $ 488,974 $ 424,547 $ 406,987 Non-cash investing and financing activities: Fixed assets under capital lease obligations $ 8,828 $ 48,378 $ 28,127 |
Selected Quarterly Financial _2
Selected Quarterly Financial Data (unaudited) (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Quarterly Financial Information Disclosure [Abstract] | |
Selected Quarterly Financial Data (unaudited) | 2018 December 31 September 30 June 30 March 31 Total revenues $ 2,821,124 $ 2,847,330 $ 2,886,953 $ 2,849,444 Operating income $ 387,908 $ 289,038 $ 438,192 $ 410,686 Attributable to DaVita Inc.: Net income from continuing operations (1) $ 160,332 $ 73,371 $ 199,603 $ 191,015 Net (loss) income from discontinued operations (2) $ (310,104 ) $ (210,167 ) $ 67,673 $ (12,329 ) Net (loss) income $ (149,772 ) $ (136,796 ) $ 267,276 $ 178,686 Per share attributable to DaVita Inc.: Basic net income from continuing operations $ 0.97 $ 0.44 $ 1.16 $ 1.07 Basic net (loss) income from discontinued operations $ (1.87 ) $ (1.26 ) $ 0.40 $ (0.07 ) Basic net (loss) income $ (0.90 ) $ (0.82 ) $ 1.56 $ 1.00 Diluted net income from continuing operations $ 0.96 $ 0.44 $ 1.15 $ 1.05 Diluted net (loss) income from discontinued operations $ (1.86 ) $ (1.26 ) $ 0.38 $ (0.07 ) Diluted net (loss) income $ (0.90 ) $ (0.82 ) $ 1.53 $ 0.98 2017 Total revenues $ 2,780,913 $ 2,765,071 $ 2,699,399 $ 2,631,251 Operating income $ 150,337 $ 395,294 $ 391,196 $ 875,928 Attributable to DaVita Inc.: Net income from continuing operations (1) $ 156,210 $ 152,870 $ 151,292 $ 440,905 Net income (loss) from discontinued operations (2) $ 147,186 $ (367,346 ) $ (24,291 ) $ 6,792 Net income (loss) $ 303,396 $ (214,476 ) $ 127,001 $ 447,697 Per share attributable to DaVita Inc.: Basic net income from continuing operations $ 0.86 $ 0.81 $ 0.79 $ 2.29 Basic net income (loss) from discontinued operations $ 0.80 $ (1.95 ) $ (0.13 ) $ 0.04 Basic net income (loss) $ 1.66 $ (1.14 ) $ 0.66 $ 2.33 Diluted net income from continuing operations $ 0.85 $ 0.80 $ 0.78 $ 2.26 Diluted net income (loss) from discontinued operations $ 0.79 $ (1.92 ) $ (0.13 ) $ 0.03 Diluted net income (loss) $ 1.64 $ (1.12 ) $ 0.65 $ 2.29 (1) Included in the fourth quarter of 2018 is a net gain on changes in ownership interests of $28,152 ; an equity investment loss of $8,715 due to the sale of the APAC JV's India business; and an equity investment loss of $1,530 due to impairments at the APAC JV. The third quarter of 2018 includes restructuring charges of $11,366 and other asset impairment charges of $6,093 related to the Company's pharmacy business; an equity investment loss of $5,995 due to impairments at the APAC JV; an adjustment to the gain on changes in ownership interests on the sale of the Company's direct primary care business of $1,506 ; and $23,470 in additional stock-based compensation expense related to modification charges and net acceleration of expense. The second quarter of 2018 includes asset impairment charges of $11,245 related to the pharmacy business; a net gain on changes in ownership interests of $35,205 on the Company's direct primary care business; a loss of $1,248 related to the unwinding of a business internationally; and a goodwill impairment charge of $3,106 at the Company's German other health operations. Included in the fourth quarter of 2017 was an impairment of $280,066 on the Company's investment in the APAC JV. The third quarter of 2017 included an equity investment loss of $6,293 for goodwill impairments at the APAC JV and restructuring charges in the Company's international business of $2,700 . The second quarter of 2017 included goodwill impairment charges of $10,498 related to the vascular access reporting unit. The first quarter of 2017 included a net gain on settlement of $529,504 ; goodwill impairment charges of $24,198 related to the vascular access reporting unit; an asset impairment of $15,168 related to the restructuring of the pharmacy business; and a gain adjustment on the 2016 ownership change of the APAC JV of $6,273 . (2) Included in discontinued operations in the fourth quarter of 2018 is a $218,639 disposal group valuation adjustment, a $41,537 goodwill impairment charge and $8,318 in related tax benefit. The third quarter of 2018 includes a $216,147 charge on the Company's DMG business which included a $98,201 disposal group valuation adjustment and $117,946 in related tax expense on this held-for-sale business. The second quarter of 2018 includes a gain on the sale of the Company's Tandigm investment of $25,096 . The fourth quarter of 2017 includes a net tax benefit of $163,555 due to a remeasurement of deferred taxes resulting from DMG's reclassification to held for sale. The third quarter of 2017 includes goodwill impairment charges of $601,040 related to certain DMG reporting units; a non-cash gain associated with the Company's Magan acquisition of $17,129 ; restructuring charges of $9,569 ; and a reduction in estimated accruals for legal matters of $11,100 . The second quarter of 2017 includes goodwill impairment charges of $50,619 related to certain DMG reporting units and a reduction in estimated accruals for legal matters of $3,600 |
Supplemental Data (unaudited) (
Supplemental Data (unaudited) (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Organization, Consolidation and Presentation of Financial Statements [Abstract] | |
Consolidating Statements of Income | Consolidating Statements of Income For twelve months ended December 31, 2018 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Dialysis and related lab patient service revenues $ — $ 7,263,195 $ 3,657,456 $ (210,670 ) $ 10,709,981 Less: Provision for uncollectible accounts — (36,377 ) (13,210 ) — (49,587 ) Net dialysis and related lab patient service revenues — 7,226,818 3,644,246 (210,670 ) 10,660,394 Other revenues 799,230 714,489 189,927 (959,189 ) 744,457 Total net revenues 799,230 7,941,307 3,834,173 (1,169,859 ) 11,404,851 Operating expenses and charges 646,640 7,100,415 3,301,831 (1,169,859 ) 9,879,027 Operating income 152,590 840,892 532,342 — 1,525,824 Debt expense (491,749 ) (208,484 ) (36,427 ) 249,225 (487,435 ) Other income, net 418,839 10,367 22,195 (441,312 ) 10,089 Income tax expense 23,482 187,691 47,227 — 258,400 Equity earnings in subsidiaries 103,196 344,025 — (447,221 ) — Net income from continuing operations 159,394 799,109 470,883 (639,308 ) 790,078 Net (loss) income from discontinued operations, net of tax — (695,913 ) 46,788 192,087 (457,038 ) Net income 159,394 103,196 517,671 (447,221 ) 333,040 Less: Net income attributable to noncontrolling — — — (173,646 ) (173,646 ) Net income attributable to DaVita Inc. $ 159,394 $ 103,196 $ 517,671 $ (620,867 ) $ 159,394 Consolidating Statements of Income - (continued) For twelve months ended December 31, 2017 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Dialysis and related lab patient service revenues $ — $ 6,884,750 $ 3,393,026 $ (184,106 ) $ 10,093,670 Less: Provision for uncollectible accounts — (340,552 ) (151,982 ) 7,170 (485,364 ) Net dialysis and related lab patient service revenues — 6,544,198 3,241,044 (176,936 ) 9,608,306 Other revenues 793,751 1,204,467 68,322 (798,212 ) 1,268,328 Total net revenues 793,751 7,748,665 3,309,366 (975,148 ) 10,876,634 Operating expenses and charges 527,942 6,475,550 3,035,535 (975,148 ) 9,063,879 Operating income 265,809 1,273,115 273,831 — 1,812,755 Debt expense (426,149 ) (209,612 ) (34,831 ) 239,958 (430,634 ) Other income, net 411,731 11,169 18,467 (423,702 ) 17,665 Income tax expense 65,965 237,670 20,224 — 323,859 Equity earnings in subsidiaries 478,192 74,375 — (552,567 ) — Net income from continuing operations 663,618 911,377 237,243 (736,311 ) 1,075,927 Net (loss) income from discontinued operations, net of tax — (433,185 ) 4,069 183,744 (245,372 ) Net income 663,618 478,192 241,312 (552,567 ) 830,555 Less: Net income attributable to noncontrolling — — — (166,937 ) (166,937 ) Net income attributable to DaVita Inc. $ 663,618 $ 478,192 $ 241,312 $ (719,504 ) $ 663,618 For twelve months ended December 31, 2016 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Dialysis and related lab patient service revenues $ — $ 6,665,601 $ 3,215,085 $ (153,326 ) $ 9,727,360 Less: Provision for uncollectible accounts — (272,426 ) (158,878 ) — (431,304 ) Net dialysis and related lab patient service — 6,393,175 3,056,207 (153,326 ) 9,296,056 Other revenues 767,791 1,378,952 30,184 (765,516 ) 1,411,411 Total net revenues 767,791 7,772,127 3,086,391 (918,842 ) 10,707,467 Operating expenses and charges 493,175 6,907,469 2,195,955 (918,842 ) 8,677,757 Operating income 274,616 864,658 890,436 — 2,029,710 Debt expense (407,925 ) (191,083 ) (40,434 ) 225,326 (414,116 ) Other income, net 396,797 3,726 7,694 (400,706 ) 7,511 Income tax expense 77,334 238,446 115,981 — 431,761 Equity earnings in subsidiaries 693,720 667,278 — (1,360,998 ) — Net income from continuing operations 879,874 1,106,133 741,715 (1,536,378 ) 1,191,344 Net (loss) income from discontinued operations, net of tax — (412,413 ) 78,771 175,380 (158,262 ) Net income 879,874 693,720 820,486 (1,360,998 ) 1,033,082 Less: Net income attributable to noncontrolling — — — (153,208 ) (153,208 ) Net income attributable to DaVita Inc. $ 879,874 $ 693,720 $ 820,486 $ (1,514,206 ) $ 879,874 For the year ended December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Dialysis and related lab patient service revenues $ 10,709,981 $ — $ — $ 10,709,981 Less: Provision for uncollectible accounts (49,587 ) — — (49,587 ) Net dialysis and related lab patient service revenues 10,660,394 — — 10,660,394 Other revenues 744,457 — — 744,457 Total net revenues 11,404,851 — — 11,404,851 Operating expenses and charges 9,879,027 — — 9,879,027 Operating income 1,525,824 — — 1,525,824 Debt expense (487,435 ) — — (487,435 ) Other income, net 10,089 — — 10,089 Income tax expense 258,400 — — 258,400 Net income from continuing operations 790,078 — — 790,078 Net (loss) income from discontinued operations, net of tax (457,038 ) 37,373 92 (494,503 ) Net income 333,040 37,373 92 295,575 Less: Net income attributable to noncontrolling interests (173,646 ) (7,841 ) — (165,805 ) Net income attributable to DaVita Inc. $ 159,394 $ 29,532 $ 92 $ 129,770 |
Consolidating Statements of Comprehensive Income | Consolidating Statements of Comprehensive Income For the year ended December 31, 2018 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Net income $ 159,394 $ 103,196 $ 517,671 $ (447,221 ) $ 333,040 Other comprehensive income (loss) 6,153 — (45,944 ) — (39,791 ) Total comprehensive income 165,547 103,196 471,727 (447,221 ) 293,249 Less: Comprehensive income attributable to — — — (173,646 ) (173,646 ) Comprehensive income attributable to DaVita Inc. $ 165,547 $ 103,196 $ 471,727 $ (620,867 ) $ 119,603 For the year ended December 31, 2017 Net income $ 663,618 $ 478,192 $ 241,312 $ (552,567 ) $ 830,555 Other comprehensive income 3,106 — 99,770 — 102,876 Total comprehensive income 666,724 478,192 341,082 (552,567 ) 933,431 Less: Comprehensive income attributable to — — — (166,935 ) (166,935 ) Comprehensive income attributable to DaVita Inc. $ 666,724 $ 478,192 $ 341,082 $ (719,502 ) $ 766,496 For the year ended December 31, 2016 Net income $ 879,874 $ 693,720 $ 820,486 $ (1,360,998 ) $ 1,033,082 Other comprehensive loss (290 ) — (29,337 ) — (29,627 ) Total comprehensive income 879,584 693,720 791,149 (1,360,998 ) 1,003,455 Less: Comprehensive income attributable to — — — (153,398 ) (153,398 ) Comprehensive income attributable to DaVita Inc. $ 879,584 $ 693,720 $ 791,149 $ (1,514,396 ) $ 850,057 For the year ended December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Net income $ 333,040 $ 37,373 $ 92 $ 295,575 Other comprehensive loss (39,791 ) — — (39,791 ) Total comprehensive income 293,249 37,373 92 255,784 Less: Comprehensive income attributable to noncontrolling (173,646 ) (7,841 ) — (165,805 ) Comprehensive income attributable to DaVita Inc. $ 119,603 $ 29,532 $ 92 $ 89,979 (1) |
Consolidating Balance Sheets | Consolidating Balance Sheets As of December 31, 2018 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Cash and cash equivalents $ 60,653 $ — $ 262,385 $ — $ 323,038 Restricted cash and equivalents 1,005 12,048 79,329 — 92,382 Accounts receivable, net — 1,264,290 594,318 — 1,858,608 Other current assets 37,185 601,318 122,063 — 760,566 Current assets held for sale — 4,440,953 948,612 — 5,389,565 Total current assets 98,843 6,318,609 2,006,707 — 8,424,159 Property and equipment, net 491,462 1,624,835 1,277,372 — 3,393,669 Intangible assets, net 153 42,933 75,760 — 118,846 Investments in subsidiaries 10,102,750 3,239,862 — (13,342,612 ) — Intercompany receivables 3,419,448 — 1,471,203 (4,890,651 ) — Other long-term assets and investments 53,385 80,537 197,696 — 331,618 Goodwill — 4,812,365 2,029,595 — 6,841,960 Total assets $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Current liabilities $ 1,945,943 $ 1,251,534 $ 449,925 $ — $ 3,647,402 Current liabilities held for sale — 722,766 520,993 — 1,243,759 Total current liabilities 1,945,943 1,974,300 970,918 — 4,891,161 Intercompany payables — 3,327,026 1,563,625 (4,890,651 ) — Long-term debt and other long-term liabilities 7,918,581 715,065 552,406 — 9,186,052 Noncontrolling interests subject to put provisions 598,075 — — 526,566 1,124,641 Total DaVita Inc. shareholders' equity 3,703,442 10,102,750 3,239,862 (13,342,612 ) 3,703,442 Noncontrolling interests not subject to put — — 731,522 (526,566 ) 204,956 Total equity 3,703,442 10,102,750 3,971,384 (13,869,178 ) 3,908,398 Total liabilities and equity $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Consolidating Balance Sheets - (continued) As of December 31, 2017 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Cash and cash equivalents $ 149,305 $ — $ 358,929 $ — $ 508,234 Restricted cash and equivalents 1,002 9,384 300 — 10,686 Accounts receivable, net — 1,208,715 506,035 — 1,714,750 Other current assets 67,025 621,409 86,955 — 775,389 Current assets held for sale — 4,992,067 769,575 — 5,761,642 Total current assets 217,332 6,831,575 1,721,794 — 8,770,701 Property and equipment, net 408,010 1,560,390 1,180,813 — 3,149,213 Intangible assets, net 250 50,971 62,606 — 113,827 Investments in subsidiaries 10,009,874 3,085,722 — (13,095,596 ) — Intercompany receivables 3,677,947 — 1,313,213 (4,991,160 ) — Other long-term assets and investments 47,297 68,344 214,875 — 330,516 Goodwill — 4,732,320 1,877,959 — 6,610,279 Total assets $ 14,360,710 $ 16,329,322 $ 6,371,260 $ (18,086,756 ) $ 18,974,536 Current liabilities $ 238,706 $ 1,207,482 $ 436,262 $ — $ 1,882,450 Current liabilities held for sale — 739,294 445,776 — 1,185,070 Total current liabilities 238,706 1,946,776 882,038 — 3,067,520 Intercompany payables — 3,690,042 1,301,118 (4,991,160 ) — Long-term debt and other long-term liabilities 8,857,373 682,630 469,587 — 10,009,590 Noncontrolling interests subject to put provisions 574,602 — — 436,758 1,011,360 Total DaVita Inc. shareholders' equity 4,690,029 10,009,874 3,085,722 (13,095,596 ) 4,690,029 Noncontrolling interests not subject to put — — 632,795 (436,758 ) 196,037 Total equity 4,690,029 10,009,874 3,718,517 (13,532,354 ) 4,886,066 Total liabilities and equity $ 14,360,710 $ 16,329,322 $ 6,371,260 $ (18,086,756 ) $ 18,974,536 As of December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Cash and cash equivalents $ 323,038 $ — $ — $ 323,038 Restricted cash and equivalents 92,382 — — 92,382 Accounts receivable, net 1,858,608 — — 1,858,608 Other current assets 760,566 — — 760,566 Other current assets held for sale 5,389,565 532,050 2,825 4,854,690 Total current assets 8,424,159 532,050 2,825 7,889,284 Property and equipment, net 3,393,669 — — 3,393,669 Amortizable intangibles, net 118,846 — — 118,846 Other long-term assets 331,618 — — 331,618 Goodwill 6,841,960 — — 6,841,960 Total assets $ 19,110,252 $ 532,050 $ 2,825 $ 18,575,377 Current liabilities $ 3,647,402 $ — $ — $ 3,647,402 Current liabilities held for sale 1,243,759 351,925 — 891,834 Total current liabilities 4,891,161 351,925 — 4,539,236 Payables to parent — 25,456 2,825 (28,281 ) Long-term debt and other long-term liabilities 9,186,052 — — 9,186,052 Noncontrolling interests subject to put provisions 1,124,641 — — 1,124,641 Total DaVita Inc. shareholders' equity 3,703,442 154,669 — 3,548,773 Noncontrolling interests not subject to put provisions 204,956 — — 204,956 Shareholders' equity 3,908,398 154,669 — 3,753,729 Total liabilities and shareholders' equity $ 19,110,252 $ 532,050 $ 2,825 $ 18,575,377 |
Consolidating Statements of Cash Flows | Consolidating Statements of Cash Flow For the year ended December 31, 2018 DaVita Inc. Guarantor Non-Guarantor Consolidating Consolidated Cash flows from operating activities: Net income $ 159,394 $ 103,196 $ 517,671 $ (447,221 ) $ 333,040 Changes in operating assets and liabilities and (86,070 ) 818,027 259,422 447,221 1,438,600 Net cash provided by operating activities 73,324 921,223 777,093 — 1,771,640 Cash flows from investing activities: Additions of property and equipment, net (175,787 ) (534,278 ) (277,073 ) — (987,138 ) Acquisitions — (73,046 ) (110,110 ) — (183,156 ) Proceeds from asset sales, net of cash divested — 61,962 88,243 — 150,205 Investments and other items 30,962 (16,362 ) (154 ) — 14,446 Net cash used in investing activities (144,825 ) (561,724 ) (299,094 ) — (1,005,643 ) Cash flows from financing activities: Long-term debt and related financing costs, net 725,889 (11,437 ) (19,675 ) — 694,777 Intercompany borrowing 404,897 (311,778 ) (93,119 ) — — Other items (1,147,934 ) (28,067 ) (144,130 ) — (1,320,131 ) Net cash used in financing activities (17,148 ) (351,282 ) (256,924 ) — (625,354 ) Effect of exchange rate changes on cash — — (3,350 ) — (3,350 ) Net (decrease) increase in cash, cash equivalents and restricted cash (88,649 ) 8,217 217,725 — 137,293 Less: Net increase in cash, cash equivalents and — 5,553 235,240 — 240,793 Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (88,649 ) 2,664 (17,515 ) — (103,500 ) Cash, cash equivalents and restricted cash of 150,307 9,384 359,229 — 518,920 Cash, cash equivalents and restricted cash of $ 61,658 $ 12,048 $ 341,714 $ — $ 415,420 Consolidating Statements of Cash Flow - (continued) For the year ended December 31, 2017 DaVita Inc. Guarantor Non-Guarantor Consolidating Consolidated Cash flows from operating activities: Net income $ 663,618 $ 478,192 $ 241,312 $ (552,567 ) $ 830,555 Changes in operating assets and liabilities and (533,300 ) 368,135 695,209 552,567 1,082,611 Net cash provided by operating activities 130,318 846,327 936,521 — 1,913,166 Cash flows from investing activities: Additions of property and equipment, net (155,972 ) (490,800 ) (258,478 ) — (905,250 ) Acquisitions — (693,522 ) (110,357 ) — (803,879 ) Proceeds from asset and business sales, net of cash — 90,340 1,996 — 92,336 Investments and other items 211,619 (7,004 ) 47,446 — 252,061 Net cash provided by (used in) investing activities 55,647 (1,100,986 ) (319,393 ) — (1,364,732 ) Cash flows from financing activities: Long-term debt and related financing costs, net 173,529 (12,662 ) (6,019 ) — 154,848 Intercompany borrowing 22,589 218,980 (241,569 ) — — Other items (781,697 ) (2,493 ) (136,915 ) — (921,105 ) Net cash (used in) provided by financing activities (585,579 ) 203,825 (384,503 ) — (766,257 ) Effect of exchange rate changes on cash — — 254 — 254 Net (decrease) increase in cash, cash equivalents and restricted cash (399,614 ) (50,834 ) 232,879 — (217,569 ) Less: Net decrease in cash, cash equivalents — (51,531 ) (1,495 ) — (53,026 ) Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (399,614 ) 697 234,374 — (164,543 ) Cash, cash equivalents and restricted cash of 549,921 8,687 124,855 — 683,463 Cash, cash equivalents and restricted cash of $ 150,307 $ 9,384 $ 359,229 $ — $ 518,920 Consolidating Statements of Cash Flow - (continued) For the year ended December 31, 2016 DaVita Inc. Guarantor Subsidiaries Non-Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Cash flows from operating activities: Net income $ 879,874 $ 693,720 $ 820,486 $ (1,360,998 ) $ 1,033,082 Changes in operating assets and liabilities and (612,706 ) 359,366 (168,614 ) 1,360,998 939,044 Net cash provided by operating activities 267,168 1,053,086 651,872 — 1,972,126 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 — 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 236,052 (231,800 ) (4,252 ) — — Other items (1,061,203 ) (21,525 ) (144,811 ) — (1,227,539 ) Net cash used in financing activities (917,611 ) (281,155 ) (153,215 ) — (1,351,981 ) Effect of exchange rate changes on cash — — 4,276 — 4,276 Net (decrease) increase in cash, cash equivalents and restricted cash (636,715 ) (41,483 ) 100,951 — (577,247 ) Less: Net (decrease) increase in cash, cash equivalents and restricted cash from discontinued operations — (50,170 ) 34,377 — (15,793 ) Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (636,715 ) 8,687 66,574 — (561,454 ) Cash, cash equivalents and restricted cash of 1,186,636 — 58,281 — 1,244,917 Cash, cash equivalents and restricted cash of $ 549,921 $ 8,687 $ 124,855 $ — $ 683,463 ondensed Consolidating Statements of Cash Flow For the year ended December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Cash flows from operating activities: Net income $ 333,040 $ 37,373 $ 92 $ 295,575 Changes in operating and intercompany assets and liabilities 1,438,600 81,722 (92 ) 1,356,970 Net cash provided by operating activities 1,771,640 119,095 — 1,652,545 Cash flows from investing activities: Additions of property and equipment (987,138 ) (2,746 ) — (984,392 ) Acquisitions and divestitures, net (183,156 ) — — (183,156 ) Proceeds from asset sales 150,205 — — 150,205 Investments and other items, net 14,446 (154 ) — 14,600 Net cash used in investing activities (1,005,643 ) (2,900 ) — (1,002,743 ) Cash flows from financing activities: Long-term debt and related financing costs, net 694,777 — — 694,777 Intercompany — 25,296 — (25,296 ) Other items (1,320,131 ) — — (1,320,131 ) Net cash (used in) provided by financing activities (625,354 ) 25,296 — (650,650 ) Effect of exchange rate changes on cash (3,350 ) — — (3,350 ) Net increase (decrease) in cash, cash equivalents and restricted cash 137,293 141,491 — (4,198 ) Less: Net increase in cash, cash equivalents and restricted 240,793 141,491 — 99,302 Net decrease in cash, cash equivalents and restricted cash from continuing operations (103,500 ) — — (103,500 ) Cash, cash equivalents and restricted cash of continuing 518,920 — — 518,920 Cash, cash equivalents and restricted cash of continuing $ 415,420 $ — $ — $ 415,420 (1) |
Consolidating Financial State_2
Consolidating Financial Statements (Tables) | 12 Months Ended |
Dec. 31, 2018 | |
Condensed Financial Information Disclosure [Abstract] | |
Consolidating Statements of Income | Consolidating Statements of Income For twelve months ended December 31, 2018 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Dialysis and related lab patient service revenues $ — $ 7,263,195 $ 3,657,456 $ (210,670 ) $ 10,709,981 Less: Provision for uncollectible accounts — (36,377 ) (13,210 ) — (49,587 ) Net dialysis and related lab patient service revenues — 7,226,818 3,644,246 (210,670 ) 10,660,394 Other revenues 799,230 714,489 189,927 (959,189 ) 744,457 Total net revenues 799,230 7,941,307 3,834,173 (1,169,859 ) 11,404,851 Operating expenses and charges 646,640 7,100,415 3,301,831 (1,169,859 ) 9,879,027 Operating income 152,590 840,892 532,342 — 1,525,824 Debt expense (491,749 ) (208,484 ) (36,427 ) 249,225 (487,435 ) Other income, net 418,839 10,367 22,195 (441,312 ) 10,089 Income tax expense 23,482 187,691 47,227 — 258,400 Equity earnings in subsidiaries 103,196 344,025 — (447,221 ) — Net income from continuing operations 159,394 799,109 470,883 (639,308 ) 790,078 Net (loss) income from discontinued operations, net of tax — (695,913 ) 46,788 192,087 (457,038 ) Net income 159,394 103,196 517,671 (447,221 ) 333,040 Less: Net income attributable to noncontrolling — — — (173,646 ) (173,646 ) Net income attributable to DaVita Inc. $ 159,394 $ 103,196 $ 517,671 $ (620,867 ) $ 159,394 Consolidating Statements of Income - (continued) For twelve months ended December 31, 2017 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Dialysis and related lab patient service revenues $ — $ 6,884,750 $ 3,393,026 $ (184,106 ) $ 10,093,670 Less: Provision for uncollectible accounts — (340,552 ) (151,982 ) 7,170 (485,364 ) Net dialysis and related lab patient service revenues — 6,544,198 3,241,044 (176,936 ) 9,608,306 Other revenues 793,751 1,204,467 68,322 (798,212 ) 1,268,328 Total net revenues 793,751 7,748,665 3,309,366 (975,148 ) 10,876,634 Operating expenses and charges 527,942 6,475,550 3,035,535 (975,148 ) 9,063,879 Operating income 265,809 1,273,115 273,831 — 1,812,755 Debt expense (426,149 ) (209,612 ) (34,831 ) 239,958 (430,634 ) Other income, net 411,731 11,169 18,467 (423,702 ) 17,665 Income tax expense 65,965 237,670 20,224 — 323,859 Equity earnings in subsidiaries 478,192 74,375 — (552,567 ) — Net income from continuing operations 663,618 911,377 237,243 (736,311 ) 1,075,927 Net (loss) income from discontinued operations, net of tax — (433,185 ) 4,069 183,744 (245,372 ) Net income 663,618 478,192 241,312 (552,567 ) 830,555 Less: Net income attributable to noncontrolling — — — (166,937 ) (166,937 ) Net income attributable to DaVita Inc. $ 663,618 $ 478,192 $ 241,312 $ (719,504 ) $ 663,618 For twelve months ended December 31, 2016 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Dialysis and related lab patient service revenues $ — $ 6,665,601 $ 3,215,085 $ (153,326 ) $ 9,727,360 Less: Provision for uncollectible accounts — (272,426 ) (158,878 ) — (431,304 ) Net dialysis and related lab patient service — 6,393,175 3,056,207 (153,326 ) 9,296,056 Other revenues 767,791 1,378,952 30,184 (765,516 ) 1,411,411 Total net revenues 767,791 7,772,127 3,086,391 (918,842 ) 10,707,467 Operating expenses and charges 493,175 6,907,469 2,195,955 (918,842 ) 8,677,757 Operating income 274,616 864,658 890,436 — 2,029,710 Debt expense (407,925 ) (191,083 ) (40,434 ) 225,326 (414,116 ) Other income, net 396,797 3,726 7,694 (400,706 ) 7,511 Income tax expense 77,334 238,446 115,981 — 431,761 Equity earnings in subsidiaries 693,720 667,278 — (1,360,998 ) — Net income from continuing operations 879,874 1,106,133 741,715 (1,536,378 ) 1,191,344 Net (loss) income from discontinued operations, net of tax — (412,413 ) 78,771 175,380 (158,262 ) Net income 879,874 693,720 820,486 (1,360,998 ) 1,033,082 Less: Net income attributable to noncontrolling — — — (153,208 ) (153,208 ) Net income attributable to DaVita Inc. $ 879,874 $ 693,720 $ 820,486 $ (1,514,206 ) $ 879,874 For the year ended December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Dialysis and related lab patient service revenues $ 10,709,981 $ — $ — $ 10,709,981 Less: Provision for uncollectible accounts (49,587 ) — — (49,587 ) Net dialysis and related lab patient service revenues 10,660,394 — — 10,660,394 Other revenues 744,457 — — 744,457 Total net revenues 11,404,851 — — 11,404,851 Operating expenses and charges 9,879,027 — — 9,879,027 Operating income 1,525,824 — — 1,525,824 Debt expense (487,435 ) — — (487,435 ) Other income, net 10,089 — — 10,089 Income tax expense 258,400 — — 258,400 Net income from continuing operations 790,078 — — 790,078 Net (loss) income from discontinued operations, net of tax (457,038 ) 37,373 92 (494,503 ) Net income 333,040 37,373 92 295,575 Less: Net income attributable to noncontrolling interests (173,646 ) (7,841 ) — (165,805 ) Net income attributable to DaVita Inc. $ 159,394 $ 29,532 $ 92 $ 129,770 |
Consolidating Statements of Comprehensive Income | Consolidating Statements of Comprehensive Income For the year ended December 31, 2018 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Net income $ 159,394 $ 103,196 $ 517,671 $ (447,221 ) $ 333,040 Other comprehensive income (loss) 6,153 — (45,944 ) — (39,791 ) Total comprehensive income 165,547 103,196 471,727 (447,221 ) 293,249 Less: Comprehensive income attributable to — — — (173,646 ) (173,646 ) Comprehensive income attributable to DaVita Inc. $ 165,547 $ 103,196 $ 471,727 $ (620,867 ) $ 119,603 For the year ended December 31, 2017 Net income $ 663,618 $ 478,192 $ 241,312 $ (552,567 ) $ 830,555 Other comprehensive income 3,106 — 99,770 — 102,876 Total comprehensive income 666,724 478,192 341,082 (552,567 ) 933,431 Less: Comprehensive income attributable to — — — (166,935 ) (166,935 ) Comprehensive income attributable to DaVita Inc. $ 666,724 $ 478,192 $ 341,082 $ (719,502 ) $ 766,496 For the year ended December 31, 2016 Net income $ 879,874 $ 693,720 $ 820,486 $ (1,360,998 ) $ 1,033,082 Other comprehensive loss (290 ) — (29,337 ) — (29,627 ) Total comprehensive income 879,584 693,720 791,149 (1,360,998 ) 1,003,455 Less: Comprehensive income attributable to — — — (153,398 ) (153,398 ) Comprehensive income attributable to DaVita Inc. $ 879,584 $ 693,720 $ 791,149 $ (1,514,396 ) $ 850,057 For the year ended December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Net income $ 333,040 $ 37,373 $ 92 $ 295,575 Other comprehensive loss (39,791 ) — — (39,791 ) Total comprehensive income 293,249 37,373 92 255,784 Less: Comprehensive income attributable to noncontrolling (173,646 ) (7,841 ) — (165,805 ) Comprehensive income attributable to DaVita Inc. $ 119,603 $ 29,532 $ 92 $ 89,979 (1) |
Consolidating Balance Sheets | Consolidating Balance Sheets As of December 31, 2018 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Cash and cash equivalents $ 60,653 $ — $ 262,385 $ — $ 323,038 Restricted cash and equivalents 1,005 12,048 79,329 — 92,382 Accounts receivable, net — 1,264,290 594,318 — 1,858,608 Other current assets 37,185 601,318 122,063 — 760,566 Current assets held for sale — 4,440,953 948,612 — 5,389,565 Total current assets 98,843 6,318,609 2,006,707 — 8,424,159 Property and equipment, net 491,462 1,624,835 1,277,372 — 3,393,669 Intangible assets, net 153 42,933 75,760 — 118,846 Investments in subsidiaries 10,102,750 3,239,862 — (13,342,612 ) — Intercompany receivables 3,419,448 — 1,471,203 (4,890,651 ) — Other long-term assets and investments 53,385 80,537 197,696 — 331,618 Goodwill — 4,812,365 2,029,595 — 6,841,960 Total assets $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Current liabilities $ 1,945,943 $ 1,251,534 $ 449,925 $ — $ 3,647,402 Current liabilities held for sale — 722,766 520,993 — 1,243,759 Total current liabilities 1,945,943 1,974,300 970,918 — 4,891,161 Intercompany payables — 3,327,026 1,563,625 (4,890,651 ) — Long-term debt and other long-term liabilities 7,918,581 715,065 552,406 — 9,186,052 Noncontrolling interests subject to put provisions 598,075 — — 526,566 1,124,641 Total DaVita Inc. shareholders' equity 3,703,442 10,102,750 3,239,862 (13,342,612 ) 3,703,442 Noncontrolling interests not subject to put — — 731,522 (526,566 ) 204,956 Total equity 3,703,442 10,102,750 3,971,384 (13,869,178 ) 3,908,398 Total liabilities and equity $ 14,166,041 $ 16,119,141 $ 7,058,333 $ (18,233,263 ) $ 19,110,252 Consolidating Balance Sheets - (continued) As of December 31, 2017 DaVita Inc. Guarantor Subsidiaries Non- Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Cash and cash equivalents $ 149,305 $ — $ 358,929 $ — $ 508,234 Restricted cash and equivalents 1,002 9,384 300 — 10,686 Accounts receivable, net — 1,208,715 506,035 — 1,714,750 Other current assets 67,025 621,409 86,955 — 775,389 Current assets held for sale — 4,992,067 769,575 — 5,761,642 Total current assets 217,332 6,831,575 1,721,794 — 8,770,701 Property and equipment, net 408,010 1,560,390 1,180,813 — 3,149,213 Intangible assets, net 250 50,971 62,606 — 113,827 Investments in subsidiaries 10,009,874 3,085,722 — (13,095,596 ) — Intercompany receivables 3,677,947 — 1,313,213 (4,991,160 ) — Other long-term assets and investments 47,297 68,344 214,875 — 330,516 Goodwill — 4,732,320 1,877,959 — 6,610,279 Total assets $ 14,360,710 $ 16,329,322 $ 6,371,260 $ (18,086,756 ) $ 18,974,536 Current liabilities $ 238,706 $ 1,207,482 $ 436,262 $ — $ 1,882,450 Current liabilities held for sale — 739,294 445,776 — 1,185,070 Total current liabilities 238,706 1,946,776 882,038 — 3,067,520 Intercompany payables — 3,690,042 1,301,118 (4,991,160 ) — Long-term debt and other long-term liabilities 8,857,373 682,630 469,587 — 10,009,590 Noncontrolling interests subject to put provisions 574,602 — — 436,758 1,011,360 Total DaVita Inc. shareholders' equity 4,690,029 10,009,874 3,085,722 (13,095,596 ) 4,690,029 Noncontrolling interests not subject to put — — 632,795 (436,758 ) 196,037 Total equity 4,690,029 10,009,874 3,718,517 (13,532,354 ) 4,886,066 Total liabilities and equity $ 14,360,710 $ 16,329,322 $ 6,371,260 $ (18,086,756 ) $ 18,974,536 As of December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Cash and cash equivalents $ 323,038 $ — $ — $ 323,038 Restricted cash and equivalents 92,382 — — 92,382 Accounts receivable, net 1,858,608 — — 1,858,608 Other current assets 760,566 — — 760,566 Other current assets held for sale 5,389,565 532,050 2,825 4,854,690 Total current assets 8,424,159 532,050 2,825 7,889,284 Property and equipment, net 3,393,669 — — 3,393,669 Amortizable intangibles, net 118,846 — — 118,846 Other long-term assets 331,618 — — 331,618 Goodwill 6,841,960 — — 6,841,960 Total assets $ 19,110,252 $ 532,050 $ 2,825 $ 18,575,377 Current liabilities $ 3,647,402 $ — $ — $ 3,647,402 Current liabilities held for sale 1,243,759 351,925 — 891,834 Total current liabilities 4,891,161 351,925 — 4,539,236 Payables to parent — 25,456 2,825 (28,281 ) Long-term debt and other long-term liabilities 9,186,052 — — 9,186,052 Noncontrolling interests subject to put provisions 1,124,641 — — 1,124,641 Total DaVita Inc. shareholders' equity 3,703,442 154,669 — 3,548,773 Noncontrolling interests not subject to put provisions 204,956 — — 204,956 Shareholders' equity 3,908,398 154,669 — 3,753,729 Total liabilities and shareholders' equity $ 19,110,252 $ 532,050 $ 2,825 $ 18,575,377 |
Consolidating Statements of Cash Flows | Consolidating Statements of Cash Flow For the year ended December 31, 2018 DaVita Inc. Guarantor Non-Guarantor Consolidating Consolidated Cash flows from operating activities: Net income $ 159,394 $ 103,196 $ 517,671 $ (447,221 ) $ 333,040 Changes in operating assets and liabilities and (86,070 ) 818,027 259,422 447,221 1,438,600 Net cash provided by operating activities 73,324 921,223 777,093 — 1,771,640 Cash flows from investing activities: Additions of property and equipment, net (175,787 ) (534,278 ) (277,073 ) — (987,138 ) Acquisitions — (73,046 ) (110,110 ) — (183,156 ) Proceeds from asset sales, net of cash divested — 61,962 88,243 — 150,205 Investments and other items 30,962 (16,362 ) (154 ) — 14,446 Net cash used in investing activities (144,825 ) (561,724 ) (299,094 ) — (1,005,643 ) Cash flows from financing activities: Long-term debt and related financing costs, net 725,889 (11,437 ) (19,675 ) — 694,777 Intercompany borrowing 404,897 (311,778 ) (93,119 ) — — Other items (1,147,934 ) (28,067 ) (144,130 ) — (1,320,131 ) Net cash used in financing activities (17,148 ) (351,282 ) (256,924 ) — (625,354 ) Effect of exchange rate changes on cash — — (3,350 ) — (3,350 ) Net (decrease) increase in cash, cash equivalents and restricted cash (88,649 ) 8,217 217,725 — 137,293 Less: Net increase in cash, cash equivalents and — 5,553 235,240 — 240,793 Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (88,649 ) 2,664 (17,515 ) — (103,500 ) Cash, cash equivalents and restricted cash of 150,307 9,384 359,229 — 518,920 Cash, cash equivalents and restricted cash of $ 61,658 $ 12,048 $ 341,714 $ — $ 415,420 Consolidating Statements of Cash Flow - (continued) For the year ended December 31, 2017 DaVita Inc. Guarantor Non-Guarantor Consolidating Consolidated Cash flows from operating activities: Net income $ 663,618 $ 478,192 $ 241,312 $ (552,567 ) $ 830,555 Changes in operating assets and liabilities and (533,300 ) 368,135 695,209 552,567 1,082,611 Net cash provided by operating activities 130,318 846,327 936,521 — 1,913,166 Cash flows from investing activities: Additions of property and equipment, net (155,972 ) (490,800 ) (258,478 ) — (905,250 ) Acquisitions — (693,522 ) (110,357 ) — (803,879 ) Proceeds from asset and business sales, net of cash — 90,340 1,996 — 92,336 Investments and other items 211,619 (7,004 ) 47,446 — 252,061 Net cash provided by (used in) investing activities 55,647 (1,100,986 ) (319,393 ) — (1,364,732 ) Cash flows from financing activities: Long-term debt and related financing costs, net 173,529 (12,662 ) (6,019 ) — 154,848 Intercompany borrowing 22,589 218,980 (241,569 ) — — Other items (781,697 ) (2,493 ) (136,915 ) — (921,105 ) Net cash (used in) provided by financing activities (585,579 ) 203,825 (384,503 ) — (766,257 ) Effect of exchange rate changes on cash — — 254 — 254 Net (decrease) increase in cash, cash equivalents and restricted cash (399,614 ) (50,834 ) 232,879 — (217,569 ) Less: Net decrease in cash, cash equivalents — (51,531 ) (1,495 ) — (53,026 ) Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (399,614 ) 697 234,374 — (164,543 ) Cash, cash equivalents and restricted cash of 549,921 8,687 124,855 — 683,463 Cash, cash equivalents and restricted cash of $ 150,307 $ 9,384 $ 359,229 $ — $ 518,920 Consolidating Statements of Cash Flow - (continued) For the year ended December 31, 2016 DaVita Inc. Guarantor Subsidiaries Non-Guarantor Subsidiaries Consolidating Adjustments Consolidated Total Cash flows from operating activities: Net income $ 879,874 $ 693,720 $ 820,486 $ (1,360,998 ) $ 1,033,082 Changes in operating assets and liabilities and (612,706 ) 359,366 (168,614 ) 1,360,998 939,044 Net cash provided by operating activities 267,168 1,053,086 651,872 — 1,972,126 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 — 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 236,052 (231,800 ) (4,252 ) — — Other items (1,061,203 ) (21,525 ) (144,811 ) — (1,227,539 ) Net cash used in financing activities (917,611 ) (281,155 ) (153,215 ) — (1,351,981 ) Effect of exchange rate changes on cash — — 4,276 — 4,276 Net (decrease) increase in cash, cash equivalents and restricted cash (636,715 ) (41,483 ) 100,951 — (577,247 ) Less: Net (decrease) increase in cash, cash equivalents and restricted cash from discontinued operations — (50,170 ) 34,377 — (15,793 ) Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations (636,715 ) 8,687 66,574 — (561,454 ) Cash, cash equivalents and restricted cash of 1,186,636 — 58,281 — 1,244,917 Cash, cash equivalents and restricted cash of $ 549,921 $ 8,687 $ 124,855 $ — $ 683,463 ondensed Consolidating Statements of Cash Flow For the year ended December 31, 2018 Consolidated Total Physician Groups Unrestricted Subsidiaries Company and Restricted Subsidiaries (1) Cash flows from operating activities: Net income $ 333,040 $ 37,373 $ 92 $ 295,575 Changes in operating and intercompany assets and liabilities 1,438,600 81,722 (92 ) 1,356,970 Net cash provided by operating activities 1,771,640 119,095 — 1,652,545 Cash flows from investing activities: Additions of property and equipment (987,138 ) (2,746 ) — (984,392 ) Acquisitions and divestitures, net (183,156 ) — — (183,156 ) Proceeds from asset sales 150,205 — — 150,205 Investments and other items, net 14,446 (154 ) — 14,600 Net cash used in investing activities (1,005,643 ) (2,900 ) — (1,002,743 ) Cash flows from financing activities: Long-term debt and related financing costs, net 694,777 — — 694,777 Intercompany — 25,296 — (25,296 ) Other items (1,320,131 ) — — (1,320,131 ) Net cash (used in) provided by financing activities (625,354 ) 25,296 — (650,650 ) Effect of exchange rate changes on cash (3,350 ) — — (3,350 ) Net increase (decrease) in cash, cash equivalents and restricted cash 137,293 141,491 — (4,198 ) Less: Net increase in cash, cash equivalents and restricted 240,793 141,491 — 99,302 Net decrease in cash, cash equivalents and restricted cash from continuing operations (103,500 ) — — (103,500 ) Cash, cash equivalents and restricted cash of continuing 518,920 — — 518,920 Cash, cash equivalents and restricted cash of continuing $ 415,420 $ — $ — $ 415,420 (1) |
Organization and Summary of S_3
Organization and Summary of Significant Accounting Policies - Additional Information (Details) $ in Thousands | 12 Months Ended | |
Dec. 31, 2018segmentpatientstatecountryclinicentity | Jan. 01, 2019USD ($) | |
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Operating divisions | segment | 2 | |
Number of legal entities that third parties held noncontrolling equity interests | entity | 653 | |
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] | ||
Property, and equipment useful lives | 20 years | |
Minimum | Leasehold Improvements | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Property, and equipment useful lives | 10 years | |
Minimum | Equipment and Information Systems | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Property, and equipment useful lives | 3 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] | ||
Property, and equipment useful lives | 40 years | |
Maximum | Equipment and Information Systems | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Property, and equipment useful lives | 15 years | |
United States | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Number of dialysis centers that the company operated or provided administrative services | clinic | 2,664 | |
Number of states where dialysis centers are located | state | 46 | |
Number of patients served | patient | 202,700 | |
International Operations | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Number of dialysis centers that the company operated or provided administrative services | clinic | 241 | |
Number of patients served | patient | 25,000 | |
Number of countries in which dialysis centers located | country | 9 | |
Continuing Operations | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Number of legal entities that third parties held noncontrolling equity interests | entity | 650 | |
Adjustments for New Accounting Pronouncement [Member] | Scenario, Forecast | ||
Organization, Consolidation and Presentation of Financial Statements Disclosure [Line Items] | ||
Net lease liabilities | $ | $ 3,000,000 |
Revenue Recognition and Accou_2
Revenue Recognition and Accounts Receivable - Additional Information (Detail) | 12 Months Ended | ||
Dec. 31, 2018USD ($) | Dec. 31, 2017USD ($) | Dec. 31, 2016USD ($) | |
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] | |||
Provision for uncollectible accounts | $ 49,587,000 | $ 485,364,000 | $ 431,304,000 |
Accounts receivable, net | 1,858,608,000 | 1,714,750,000 | |
Medicare bad debt claims | |||
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] | |||
Accounts receivable, net | $ 1,080,561,000 | $ 874,971,000 | |
Accounts Receivable | |||
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] | |||
Accounts Receivable Period Outstanding | 1 year | ||
Patient Services Customer Concentration Risk | Accounts Receivable | |||
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] | |||
Number Of Concentration Risk Customers | 0 | 0 | |
Percentage of U.S. dialysis service revenues related to government-based programs | 10.00% | 10.00% | |
Accounts receivable, net | $ 0 | ||
Percentage Of Accounts Receivable Six Months Or More Past Due | 18.00% | 21.00% | |
Accounts Receivable Period Outstanding | 6 months | ||
Difference between Revenue Guidance in Effect before and after Topic 606 | |||
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] | |||
Contract with Customer, Performance Obligation Satisfied in Previous Period | $ 88,495,000 | ||
New Accounting Pronouncement or Change in Accounting Principle, Effect of Adoption, Quantification | 36,000,000 | ||
Accounts Receivable | |||
Revenue, Initial Application Period Cumulative Effect Transition [Line Items] | |||
Accounts receivable, allowance | $ 52,924,000 | $ 218,399,000 |
Revenue Recognition and Accou_3
Revenue Recognition and Accounts Receivable Revenue Recognition Segment Revenue by Payor (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | $ 10,709,981 | $ 10,093,670 | $ 9,727,360 | ||||||||
Other revenues | 744,457 | 1,268,328 | 1,411,411 | ||||||||
Total revenues | $ 2,821,124 | $ 2,847,330 | $ 2,886,953 | $ 2,849,444 | $ 2,780,913 | $ 2,765,071 | $ 2,699,399 | $ 2,631,251 | 11,404,851 | 10,876,634 | 10,707,467 |
Intersegment Elimination | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Total revenues | (127,186) | (79,779) | (52,094) | ||||||||
Medicare and Medicare Advantage | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 6,063,891 | 5,253,012 | 5,303,718 | ||||||||
Other revenues | 492,812 | 902,289 | 974,146 | ||||||||
Medicaid and Managed Medicaid | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 628,766 | 606,827 | 319,553 | ||||||||
Other revenues | 44,246 | 71,426 | 82,428 | ||||||||
Other Government Payors | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 782,593 | 622,218 | 308,400 | ||||||||
Commercial Payors | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 3,278,094 | 3,181,425 | 3,391,740 | ||||||||
Other revenues | 90,890 | 116,503 | 128,824 | ||||||||
Other | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Other revenues | 150,745 | 202,713 | 250,752 | ||||||||
U.S. dialysis and related lab services | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Total revenues | 10,242,999 | 9,304,889 | 9,110,834 | ||||||||
U.S. dialysis and related lab services | Intersegment Elimination | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Total revenues | (92,950) | (55,176) | (27,355) | ||||||||
U.S. dialysis and related lab services | Medicare and Medicare Advantage | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 6,063,891 | 5,253,012 | 5,303,718 | ||||||||
Other revenues | 0 | 0 | 0 | ||||||||
U.S. dialysis and related lab services | Medicaid and Managed Medicaid | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 628,766 | 606,827 | 319,553 | ||||||||
Other revenues | 0 | 0 | 0 | ||||||||
U.S. dialysis and related lab services | Other Government Payors | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 446,999 | 362,567 | 143,207 | ||||||||
U.S. dialysis and related lab services | Commercial Payors | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 3,176,413 | 3,117,920 | 3,355,066 | ||||||||
Other revenues | 0 | 0 | 0 | ||||||||
U.S. dialysis and related lab services | Other | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Other revenues | 19,880 | 19,739 | 16,645 | ||||||||
Other ancillary services and strategic initiatives | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Total revenues | 1,161,852 | 1,571,745 | 1,596,633 | ||||||||
Other ancillary services and strategic initiatives | Intersegment Elimination | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Total revenues | (34,236) | (24,603) | (24,739) | ||||||||
Other ancillary services and strategic initiatives | Medicare and Medicare Advantage | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 0 | 0 | 0 | ||||||||
Other revenues | 492,812 | 902,289 | 974,146 | ||||||||
Other ancillary services and strategic initiatives | Medicaid and Managed Medicaid | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 0 | 0 | 0 | ||||||||
Other revenues | 44,246 | 71,426 | 82,428 | ||||||||
Other ancillary services and strategic initiatives | Other Government Payors | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 335,594 | 259,651 | 165,193 | ||||||||
Other ancillary services and strategic initiatives | Commercial Payors | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Patient service revenues | 101,681 | 63,505 | 36,674 | ||||||||
Other revenues | 90,890 | 116,503 | 128,824 | ||||||||
Other ancillary services and strategic initiatives | Other | |||||||||||
Disaggregation of Revenue [Line Items] | |||||||||||
Other revenues | $ 130,865 | $ 182,974 | $ 234,107 |
Earnings Per Share - Reconcilia
Earnings Per Share - Reconciliations of Numerators and Denominators Used to Calculate Basic and Diluted Net Income Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Numerators: | |||||||||||
Net income from continuing operations | $ 160,332 | $ 73,371 | $ 199,603 | $ 191,015 | $ 156,210 | $ 152,870 | $ 151,292 | $ 440,905 | $ 624,321 | $ 901,277 | $ 1,032,373 |
Net loss from discontinued operations attributable to DaVita Inc. | (310,104) | (210,167) | 67,673 | (12,329) | 147,186 | (367,346) | (24,291) | 6,792 | (464,927) | (237,659) | (152,499) |
Net (loss) income attributable to DaVita Inc. | $ (149,772) | $ (136,796) | $ 267,276 | $ 178,686 | $ 303,396 | $ (214,476) | $ 127,001 | $ 447,697 | $ 159,394 | $ 663,618 | $ 879,874 |
Weighted average shares outstanding during the period (in shares) | 171,886,000 | 190,820,000 | 203,835,000 | ||||||||
Contingently returnable shares held in escrow for the DaVita HealthCare Partners merger (in shares) | (1,100,000) | (2,194,000) | (2,194,000) | ||||||||
Weighted average shares for basic earnings per share calculation (in shares) | 170,785,999 | 188,625,559 | 201,641,173 | ||||||||
Basic net income from continuing operations per share attributable to DaVita Inc. (in usd per share) | $ 0.97 | $ 0.44 | $ 1.16 | $ 1.07 | $ 0.86 | $ 0.81 | $ 0.79 | $ 2.29 | $ 3.66 | $ 4.78 | $ 5.12 |
Basic net loss from discontinued operations per share attributable to DaVita Inc. (in usd per share) | (1.87) | (1.26) | 0.40 | (0.07) | 0.80 | (1.95) | (0.13) | 0.04 | (2.73) | (1.26) | (0.76) |
Basic net income per share attributable to DaVita Inc. (in usd per share) | (0.90) | (0.82) | 1.56 | 1 | 1.66 | (1.14) | 0.66 | 2.33 | $ 0.93 | $ 3.52 | $ 4.36 |
Diluted: | |||||||||||
Weighted average shares outstanding during the period (in shares) | 171,886,000 | 190,820,000 | 203,835,000 | ||||||||
Assumed incremental shares from stock plans (in shares) | 479,000 | 529,000 | 1,070,000 | ||||||||
Weighted average shares for diluted earnings per share calculation (in shares) | 172,364,581 | 191,348,533 | 204,904,656 | ||||||||
Diluted net income from continuing operations per share attributable to DaVita Inc. (in usd per share) | 0.96 | 0.44 | 1.15 | 1.05 | 0.85 | 0.80 | 0.78 | 2.26 | $ 3.62 | $ 4.71 | $ 5.04 |
Diluted net loss from discontinued operations per share attributable to DaVita Inc. (in usd per share) | (1.86) | (1.26) | 0.38 | (0.07) | 0.79 | (1.92) | (0.13) | 0.03 | (2.70) | (1.24) | (0.75) |
Diluted net income per share attributable to DaVita Inc. (in usd per share) | $ (0.90) | $ (0.82) | $ 1.53 | $ 0.98 | $ 1.64 | $ (1.12) | $ 0.65 | $ 2.29 | $ 0.92 | $ 3.47 | $ 4.29 |
Anti-dilutive stock-settled awards excluded from calculation (in shares) | 5,295,000 | 4,350,000 | 2,523,000 |
Restricted Cash and Equivalents
Restricted Cash and Equivalents - Additional Information (Details) $ in Thousands | Dec. 31, 2018USD ($) | Dec. 31, 2017USD ($) |
Restricted Cash and Cash Equivalents Items [Line Items] | ||
Restricted cash and equivalents | $ 92,382 | $ 10,686 |
Number Of Businesses | 22 | |
Assets Held-in-trust, Current | $ 79,329 | |
Other ancillary services and strategic initiatives | ||
Restricted Cash and Cash Equivalents Items [Line Items] | ||
Number Of Businesses | 2 |
Short-term and long-term inve_2
Short-term and long-term investments (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Investment Holdings [Line Items] | ||
Debt securities | $ 2,235 | $ 31,630 |
Equity Securities, FV-NI | 36,124 | |
Available for sale | 38,895 | |
Total | 38,359 | 70,525 |
Held to maturity, short-term investments | 2,235 | 31,630 |
Available for sale, short-term investments | 1,200 | |
Total, short-term investments | 2,935 | 32,830 |
Held to maturity, long-term investments | 0 | 0 |
Available for sale, long-term investments | 37,695 | |
Total, long-term investments | 35,424 | 37,695 |
Certificates of deposit and other time deposits | ||
Investment Holdings [Line Items] | ||
Debt securities | 2,235 | 31,630 |
Equity Securities, FV-NI | 0 | |
Available for sale, equity securities | 0 | |
Total | 2,235 | 31,630 |
Investments in mutual funds and common stock | ||
Investment Holdings [Line Items] | ||
Debt securities | 0 | 0 |
Equity Securities, FV-NI | 36,124 | |
Available for sale, equity securities | 38,895 | |
Total | 36,124 | $ 38,895 |
Short-term Investments | ||
Investment Holdings [Line Items] | ||
Equity Securities, FV-NI | 700 | |
Other Long-term Investments | ||
Investment Holdings [Line Items] | ||
Equity Securities, FV-NI | $ 35,424 |
Short-term and long-term inve_3
Short-term and long-term investments - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Jan. 01, 2018 | |
Debt and Equity Securities, FV-NI [Line Items] | |||
Pre tax reclassification of net investment realized gain into net income | $ 360 | ||
Reclassification of net investment realized gain into net income, net of tax | $ 220 | ||
Investments in mutual funds and common stock | |||
Debt and Equity Securities, FV-NI [Line Items] | |||
Equity Securities, FV-NI, Gain (Loss) | $ 1,208 | ||
Equity Securities, FV-NI, Realized Gain | 4,490 | ||
Equity Securities, FV-NI, Unrealized Gain | $ 5,698 | ||
Investment securities | |||
Debt and Equity Securities, FV-NI [Line Items] | |||
Cumulative Effect of New Accounting Principle in Period of Adoption | $ (5,662) |
Other Receivables (Details)
Other Receivables (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Other receivables | $ 469,796 | $ 399,262 |
Supplier rebates and non-trade receivables | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Other receivables | 334,156 | 295,292 |
Medicare bad debt claims | ||
Accounts, Notes, Loans and Financing Receivable [Line Items] | ||
Other receivables | $ 135,640 | $ 103,970 |
Prepaid and Other Current Ass_3
Prepaid and Other Current Assets (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Prepaid Expense and Other Assets, Current [Abstract] | ||
Prepaid expenses | $ 108,315 | $ 104,727 |
Other | 3,525 | 7,331 |
Prepaid and other current assets | $ 111,840 | $ 112,058 |
Property and Equipment (Details
Property and Equipment (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Property, Plant and Equipment [Abstract] | ||
Land | $ 37,384 | $ 33,814 |
Buildings | 467,181 | 473,489 |
Leasehold improvements | 3,164,943 | 2,816,675 |
Equipment and information systems, including internally developed software | 2,586,564 | 2,352,246 |
New center and capital asset projects in progress | 661,695 | 576,651 |
Property, plant and equipment, gross, total | 6,917,767 | 6,252,875 |
Less accumulated depreciation | (3,524,098) | (3,103,662) |
Property and equipment, net | $ 3,393,669 | $ 3,149,213 |
Property and Equipment - Additi
Property and Equipment - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Property, Plant and Equipment [Line Items] | |||
Depreciation expense on property and equipment | $ 574,799 | $ 544,129 | $ 494,945 |
Investment and other asset impairments | 17,338 | 295,234 | 14,993 |
Capitalized interest | 25,978 | 19,176 | $ 12,990 |
Pharmacy Business | |||
Property, Plant and Equipment [Line Items] | |||
Investment and other asset impairments | $ 17,338 | $ 15,168 |
Intangibles - Amortizable Intan
Intangibles - Amortizable Intangible Assets Other Than Goodwill (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Goodwill and Intangible Assets Disclosure [Abstract] | ||
Noncompetition and other agreements | $ 131,360 | $ 429,140 |
Lease agreements | 7,584 | 7,623 |
Indefinite-lived assets | 59,885 | 33,255 |
Other | 583 | 583 |
Intangible assets, gross (excluding goodwill) | 199,412 | 470,601 |
Less accumulated amortization | (80,566) | (356,774) |
Total intangible assets | $ 118,846 | $ 113,827 |
Intangibles - Additional Inform
Intangibles - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Goodwill and Intangible Assets Disclosure [Abstract] | |||
Amortization expense from amortizable intangible assets, other than lease agreements | $ 16,236 | $ 15,782 | $ 14,552 |
Amortization of lease agreement intangible assets and liabilities | (296) | (203) | (232) |
Impairment of Intangible Assets (Excluding Goodwill) | 0 | 0 | $ 0 |
Amortizable intangible lease liabilities | 5,930 | 5,447 | |
Lease agreements, accumulated amortization | $ 4,362 | $ 3,508 |
Intangibles - Scheduled Amortiz
Intangibles - Scheduled Amortization Charges from Intangible Assets and Liabilities (Details) $ in Thousands | Dec. 31, 2018USD ($) |
Noncompetition and other agreements | |
Expected Amortization Expense [Line Items] | |
2,019 | $ (14,442) |
2,020 | (13,020) |
2,021 | (10,816) |
2,022 | (7,001) |
2,023 | (4,235) |
Thereafter | (9,311) |
Total | 58,825 |
Lease liabilities | |
Expected Amortization Expense [Line Items] | |
2,019 | (901) |
2,020 | (895) |
2,021 | (871) |
2,022 | (864) |
2,023 | (704) |
Thereafter | (1,695) |
Total | 5,930 |
Other | |
Expected Amortization Expense [Line Items] | |
2,019 | (91) |
2,020 | (45) |
2,021 | 0 |
2,022 | 0 |
2,023 | 0 |
Thereafter | 0 |
Total | $ 136 |
Equity Method and Other Inves_3
Equity Method and Other Investmetns Equity Method and Other Investments (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Schedule of Equity Method Investments [Line Items] | ||
Equity method and other investments | $ 224,611 | $ 245,534 |
Adjusted cost method investments | ||
Schedule of Equity Method Investments [Line Items] | ||
Equity method and other investments | 12,386 | 5,386 |
Other partnerships | ||
Schedule of Equity Method Investments [Line Items] | ||
Equity method and other investments | 83,052 | 79,667 |
APAC JV - Deconsolidated Noncontrolling Entity | ||
Schedule of Equity Method Investments [Line Items] | ||
Equity method and other investments | $ 129,173 | $ 160,481 |
Equity Method and Other Inves_4
Equity Method and Other Investments - Additional Information (Details) - USD ($) $ in Thousands | Aug. 01, 2016 | Mar. 31, 2019 | Dec. 31, 2018 | Sep. 30, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 |
Noncontrolling Interest [Line Items] | ||||||||||
Equity investment (loss) income | $ (4,484) | $ (8,640) | $ 16,874 | |||||||
Equity Method Investment, Additional Information | During the third quarter of 2018, the investors in the APAC JV jointly agreed to a six-month deferral of the subscribed incremental capital contributions originally scheduled for August 1, 2018 based upon revised assessments of the capital needs of the joint venture. | |||||||||
Number Of Partnerships | 22 | 22 | ||||||||
Cost-method total aggregate carrying amount of equity investments | $ 12,386 | $ 12,386 | ||||||||
Valuation Adjustment | 0 | |||||||||
APAC JV - Deconsolidated Noncontrolling Entity | ||||||||||
Noncontrolling Interest [Line Items] | ||||||||||
Equity investment (loss) income | $ 1,530 | $ 5,995 | $ 6,293 | $ (4,484) | $ (8,640) | $ 16,874 | ||||
Non-cash other than temporary impairment losses | $ 280,066 | |||||||||
Voting Interest, in percents | 40.00% | 40.00% | ||||||||
Current economic interest in the APAC JV, Owned by Noncontrolling Investors | 26.70% | 26.70% | ||||||||
Company and Restricted Subsidiaries(1) | ||||||||||
Noncontrolling Interest [Line Items] | ||||||||||
Voting Interest, in percents | 60.00% | 60.00% | ||||||||
Current economic interest in the APAC JV, Owned by the Parent Company | 73.30% | 73.30% | ||||||||
Ownership percentage by Parent | 73.30% | 73.30% | ||||||||
Minimum | ||||||||||
Noncontrolling Interest [Line Items] | ||||||||||
Current economic interest in the APAC JV, Owned by the Parent Company | 30.00% | 30.00% | ||||||||
Ownership percentage by Parent | 30.00% | 30.00% | ||||||||
Maximum | ||||||||||
Noncontrolling Interest [Line Items] | ||||||||||
Current economic interest in the APAC JV, Owned by the Parent Company | 50.00% | 50.00% | ||||||||
Ownership percentage by Parent | 50.00% | 50.00% | ||||||||
Subsequent Event | ||||||||||
Noncontrolling Interest [Line Items] | ||||||||||
Equity Method Investment, Additional Information | Subsequent to December 31, 2018, the investors have jointly agreed to a further deferral of those capital contributions originally scheduled for August 1, 2018, which will now be due with the final capital contributions | |||||||||
Asia-Pacific dialysis business | Khazanah And Mitsui | ||||||||||
Noncontrolling Interest [Line Items] | ||||||||||
Non-cash non-taxable gain | $ (374,374) | $ (6,273) |
Goodwill - Changes in Carrying
Goodwill - Changes in Carrying Value of Goodwill by Reportable Segments (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Goodwill [Roll Forward] | |||
Beginning balance | $ 6,610,279 | $ 6,015,375 | |
Acquisitions | 278,348 | 617,032 | |
Divestitures | (15,497) | (32,386) | |
Impairment charges | (3,106) | (36,196) | $ (28,415) |
Foreign currency and other adjustments | (28,064) | 46,454 | |
Ending balance | 6,841,960 | 6,610,279 | 6,015,375 |
Goodwill | 6,869,233 | ||
Accumulated impairment charges | (27,273) | ||
U.S. dialysis and related lab services | |||
Goodwill [Roll Forward] | |||
Beginning balance | 6,144,761 | 5,691,587 | |
Acquisitions | 130,574 | 485,434 | |
Divestitures | (331) | (32,260) | |
Impairment charges | 0 | 0 | |
Foreign currency and other adjustments | 0 | 0 | |
Ending balance | 6,275,004 | 6,144,761 | 5,691,587 |
Goodwill | 6,275,004 | ||
Accumulated impairment charges | 0 | ||
Other ancillary services and strategic initiatives | |||
Goodwill [Roll Forward] | |||
Beginning balance | 465,518 | 323,788 | |
Acquisitions | 147,774 | 131,598 | |
Divestitures | (15,166) | (126) | |
Impairment charges | (3,106) | (36,196) | |
Foreign currency and other adjustments | (28,064) | 46,454 | |
Ending balance | 566,956 | $ 465,518 | $ 323,788 |
Goodwill | 594,229 | ||
Accumulated impairment charges | $ (27,273) |
Goodwill - Additional Informati
Goodwill - Additional Information (Details) - USD ($) | 3 Months Ended | 6 Months Ended | 12 Months Ended | |||
Jun. 30, 2018 | Mar. 31, 2017 | Jun. 30, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Goodwill [Line Items] | ||||||
Goodwill impairment charges | $ 3,106,000 | $ 36,196,000 | $ 28,415,000 | |||
Goodwill | 6,841,960,000 | 6,610,279,000 | 6,015,375,000 | |||
Vascular access | ||||||
Goodwill [Line Items] | ||||||
Goodwill impairment charges | $ 24,198,000 | $ 10,498,000 | 34,696,000 | $ 28,415,000 | ||
Goodwill | 0 | |||||
International Operations | ||||||
Goodwill [Line Items] | ||||||
Goodwill impairment charges | $ 1,500,000 | |||||
Reporting Units Other Than DaVita Medical Group | ||||||
Goodwill [Line Items] | ||||||
Goodwill impairment charges | 0 | |||||
GERMANY | ||||||
Goodwill [Line Items] | ||||||
Goodwill impairment charges | $ 3,106,000 | 3,106,000 | ||||
GERMANY | International Operations | ||||||
Goodwill [Line Items] | ||||||
Goodwill | $ 12,646,000 |
Goodwill - Schedule of Reportin
Goodwill - Schedule of Reporting Units Goodwill Balances (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Goodwill [Line Items] | |||
Goodwill | $ 6,841,960 | $ 6,610,279 | $ 6,015,375 |
Percentage change in operating income used to evaluate fair value of reporting unit for goodwill assessment | 3.00% | ||
Percentage change in discount rate used to evaluate fair value of reporting unit for goodwill assessment | 1.00% | ||
Kidney Care | GERMANY | |||
Goodwill [Line Items] | |||
Goodwill | $ 403,200 | ||
Carrying amount coverage | 0.50% | ||
Sensitivities, Operating Income | (1.50%) | ||
Sensitivities, Discount rate | (10.30%) | ||
Kidney Care | BRAZIL | |||
Goodwill [Line Items] | |||
Goodwill | $ 39,452 | ||
Carrying amount coverage | 9.80% | ||
Sensitivities, Operating Income | (2.50%) | ||
Sensitivities, Discount rate | (7.30%) | ||
International Operations | GERMANY | |||
Goodwill [Line Items] | |||
Goodwill | $ 12,646 | ||
Carrying amount coverage | 8.10% | ||
Sensitivities, Operating Income | (2.20%) | ||
Sensitivities, Discount rate | (11.10%) |
Other Liabilities (Details)
Other Liabilities (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Other Liabilities Disclosure [Abstract] | ||
Payor refunds and retractions | $ 302,244 | $ 292,370 |
Insurance and self-insurance accruals | 58,569 | 64,924 |
Accrued interest | 82,827 | 83,362 |
Accrued non-income tax liabilities | 28,663 | 28,317 |
Other | 123,547 | 110,032 |
Other liabilities | $ 595,850 | $ 579,005 |
Income Taxes - Schedule of Inco
Income Taxes - Schedule of Income Before Income Taxes (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |||
Domestic | $ 1,083,578 | $ 1,725,822 | $ 1,278,754 |
International | (35,100) | (326,036) | 344,351 |
Income from continuing operations before income taxes | $ 1,048,478 | $ 1,399,786 | $ 1,623,105 |
Income Taxes - Components of In
Income Taxes - Components of Income Tax Expense (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Current: | |||
Federal | $ 140,064 | $ 330,191 | $ 322,940 |
State | 32,990 | 47,228 | 44,525 |
International | 7,557 | 3,422 | 1,928 |
Total current income tax | 180,611 | 380,841 | 369,393 |
Deferred: | |||
Federal | 52,034 | (98,760) | 88,412 |
State | 21,096 | 37,347 | (28,530) |
International | 4,659 | 4,431 | 2,486 |
Total deferred income tax | 77,789 | (56,982) | 62,368 |
Continuing operations | $ 258,400 | $ 323,859 | $ 431,761 |
Income Taxes Income Taxes - All
Income Taxes Income Taxes - Allocation of Income Tax Expense (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |||
Continuing operations | $ 258,400 | $ 323,859 | $ 431,761 |
Discontinued operations | 99,768 | (364,856) | 24,052 |
Income tax (benefit) expense from continuing and discontinued operations | $ 358,168 | $ (40,997) | $ 455,813 |
Income Taxes - Reconciliation B
Income Taxes - Reconciliation Between U.S. Federal Income Tax Rate and Our Effective Tax Rate From Continuing Operations (Details) | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Tax Disclosure [Abstract] | |||
Federal income tax rate | 21.00% | 35.00% | 35.00% |
State income taxes, net of federal benefit | 4.10% | 3.70% | 2.60% |
Gain on APAC JV ownership changes | 0.00% | (0.20%) | (9.90%) |
Political advocacy costs | 2.30% | 0.00% | 0.00% |
APAC investment impairment | 0.00% | 6.40% | 0.00% |
Impact of 2017 Tax Act | (0.10%) | (20.50%) | 0.00% |
Other | 1.90% | 2.00% | 1.80% |
Impact of noncontrolling interests primarily attributable to non-tax paying entities | (4.60%) | (3.30%) | (2.90%) |
Effective tax rate | 24.60% | 23.10% | 26.60% |
Income Taxes - Deferred Tax and
Income Taxes - Deferred Tax and Liabilities Arising from Temporary Differences (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Income Tax Disclosure [Abstract] | ||
Receivables | $ 19,327 | $ 19,705 |
Accrued liabilities | 106,506 | 96,537 |
Net operating loss carryforwards | 117,511 | 108,429 |
Other | 36,712 | 37,794 |
Deferred tax assets | 280,056 | 262,465 |
Valuation allowance | (70,474) | (61,282) |
Net deferred tax assets | 209,582 | 201,183 |
Intangible assets | (555,822) | (501,763) |
Property and equipment | (118,008) | (100,376) |
Investments in partnerships | (67,354) | (61,529) |
Other | (30,934) | (23,762) |
Deferred tax liabilities | (772,118) | (687,430) |
Net deferred tax liabilities | $ (562,536) | $ (486,247) |
Income Taxes - Reconciliation o
Income Taxes - Reconciliation of Beginning and Ending Liability for Unrecognized Tax Benefits that Do Not Meet More-Likely-Than-Not Threshold (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2018 | Dec. 31, 2017 | |
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward] | ||
Beginning balance | $ 32,776 | $ 24,066 |
Additions for tax positions related to current year | 6,111 | 7,606 |
Additions for tax positions related to prior years | 4,134 | 804 |
Reductions related to lapse of applicable statute | (338) | (1,380) |
Impact of 2017 Tax Act | 0 | 3,731 |
Reductions related to settlements with taxing authorities | (2,301) | (2,051) |
Ending balance | $ 40,382 | $ 32,776 |
Income Taxes - Additional Infor
Income Taxes - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Taxes [Line Items] | |||
Increase in valuation allowance related to changes in the estimated tax benefit of federal and state operating losses of separate-return entities | $ 9,192 | ||
Liability for unrecognized tax benefits | 40,382 | $ 32,776 | $ 24,066 |
Unrecognized Tax Benefits that Would Impact Effective Tax Rate | 37,538 | ||
Increase in liability for unrecognized tax benefits | 7,606 | ||
Accrued interest and penalties related to unrecognized tax benefits, net of federal tax benefits | 9,019 | $ 4,195 | |
Domestic Tax Authority | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards | 124,935 | ||
State | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards | 459,558 | ||
Foreign Tax Authority | |||
Income Taxes [Line Items] | |||
Net operating loss carryforwards | $ 186,757 |
Long-Term Debt - Schedule of Lo
Long-Term Debt - Schedule of Long-Term Debt (Details) - USD ($) $ in Thousands | 12 Months Ended | |
Dec. 31, 2018 | Dec. 31, 2017 | |
Senior Notes: | ||
Total debt principal outstanding | $ 10,154,216 | $ 9,400,182 |
Discount and deferred financing costs | (52,000) | (63,951) |
Carrying amount of long-term debt, net of unamortized discounts | 10,102,216 | 9,336,231 |
Less current portion | (1,929,369) | (178,213) |
Total long-term debt | $ 8,172,847 | 9,158,018 |
Debt interest rate | 4.96% | |
Senior Notes 5.75% due 2022 | ||
Senior Notes: | ||
Senior Notes | $ 1,250,000 | 1,250,000 |
Debt interest rate | 5.75% | |
Debt Instrument, Maturity Date | Aug. 15, 2022 | |
Senior Notes 5.125 Percent Due 2024 | ||
Senior Notes: | ||
Senior Notes | $ 1,750,000 | 1,750,000 |
Debt interest rate | 5.125% | |
Debt Instrument, Maturity Date | Jul. 15, 2024 | |
Senior Notes 5.0 Percent Due 2025 | ||
Senior Notes: | ||
Senior Notes | $ 1,500,000 | 1,500,000 |
Debt interest rate | 5.00% | |
Debt Instrument, Maturity Date | May 1, 2025 | |
Acquisition Obligations and Other Notes Payable | ||
Senior Notes: | ||
Acquisition obligations and other notes payable | $ 183,979 | 150,512 |
Debt interest rate | 6.24% | |
Debt Instrument, Maturity Date, Description | 2019-2025 | |
Capital Lease Obligations | ||
Senior Notes: | ||
Capital lease obligations | $ 282,737 | 297,170 |
Debt interest rate | 5.49% | |
Debt Instrument, Maturity Date, Description | 2019-2036 | |
Term Loan A | ||
Debt Instrument [Line Items] | ||
Senior secured credit facilities | $ 675,000 | 775,000 |
Senior Notes: | ||
Debt Instrument, Description of Variable Rate Basis | 2.00% + LIBOR | |
Debt Instrument, Maturity Date | Jun. 24, 2019 | |
Term Loan A-2 | ||
Debt Instrument [Line Items] | ||
Senior secured credit facilities | 0 | |
Senior Notes: | ||
Debt Instrument, Description of Variable Rate Basis | 1.00% + LIBOR | |
Debt Instrument, Maturity Date | Jun. 24, 2019 | |
Term Loan B | ||
Debt Instrument [Line Items] | ||
Senior secured credit facilities | $ 3,342,500 | 3,377,500 |
Senior Notes: | ||
Debt Instrument, Description of Variable Rate Basis | 2.75% + LIBOR | |
Debt Instrument, Maturity Date | Jun. 24, 2021 | |
Revolver | ||
Debt Instrument [Line Items] | ||
Senior secured credit facilities | $ 175,000 | $ 300,000 |
Senior Notes: | ||
Debt Instrument, Description of Variable Rate Basis | 2.00% + LIBOR | |
Debt Instrument, Maturity Date | Jun. 24, 2019 |
Long-Term Debt - Scheduled Matu
Long-Term Debt - Scheduled Maturities of Long-term Debt (Details) $ in Thousands | Dec. 31, 2018USD ($) |
Debt Disclosure [Abstract] | |
2,019 | $ 1,929,369 |
2,020 | 80,016 |
2,021 | 3,314,149 |
2,022 | 1,291,472 |
2,023 | 37,881 |
Thereafter | $ 3,501,329 |
Long-Term Debt - Term Loans (De
Long-Term Debt - Term Loans (Details) - USD ($) | 6 Months Ended | 12 Months Ended | |
Dec. 31, 2018 | Jun. 30, 2018 | Dec. 31, 2018 | |
Term Loan A | |||
Debt Instrument [Line Items] | |||
Debt instrument, annual principal payment | $ 100,000,000 | $ 100,000,000 | |
Term Loan B | |||
Debt Instrument [Line Items] | |||
Debt instrument, annual principal payment | 35,000,000 | $ 35,000,000 | |
Term Loan B | London Interbank Offered Rate (LIBOR) | Minimum | |||
Debt Instrument [Line Items] | |||
Debt instrument, variable interest rate margin | 0.75% | ||
Term Loan A-2 | |||
Debt Instrument [Line Items] | |||
Derivative Asset, Notional Amount | 995,000,000 | $ 995,000,000 | |
Term Loan Facility | Minimum | |||
Debt Instrument [Line Items] | |||
Maturity date ranges | 1 month | ||
Term Loan Facility | Maximum | |||
Debt Instrument [Line Items] | |||
Maturity date ranges | 12 months | ||
Interest rate cap agreements 1 | Term Loan A | Maximum | |||
Debt Instrument [Line Items] | |||
Remaining outstanding debt | $ 517,500,000 | $ 517,500,000 | |
Interest rate cap agreements 1 | Term Loan B | Maximum | |||
Debt Instrument [Line Items] | |||
Derivative Asset, Notional Amount | $ 3,500,000,000 | ||
Interest rate cap agreements 1 | Term Loan Facility | Maximum | |||
Debt Instrument [Line Items] | |||
Debt instrument, variable interest rate margin | 3.50% | 3.50% | |
Derivative Asset, Notional Amount | $ 3,500,000,000 | $ 3,500,000,000 |
Long-Term Debt - Revolving Line
Long-Term Debt - Revolving Lines Of Credit (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Letter of Credit | ||
Line of Credit Facility [Line Items] | ||
Outstanding letters of credit | $ 14,155 | |
Revolver | ||
Line of Credit Facility [Line Items] | ||
Line of credit outstanding amount | 175,000 | $ 300,000 |
Revolving credit facilities | 1,000,000 | |
Kidney Care | ||
Line of Credit Facility [Line Items] | ||
Outstanding letters of credit | 22,621 | |
DMG | ||
Line of Credit Facility [Line Items] | ||
Outstanding letters of credit | $ 211 |
Long-Term Debt - Interest Rate
Long-Term Debt - Interest Rate Cap and Swap Agreement (Details) - USD ($) | 6 Months Ended | 12 Months Ended | |||
Dec. 31, 2018 | Jun. 30, 2018 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Derivative [Line Items] | |||||
Debt expense recognized | $ 461,897,000 | $ 406,341,000 | $ 394,013,000 | ||
Weighted average effective interest rate at period end | 5.19% | 5.19% | |||
Weighted average effective interest rate during the period | 4.96% | ||||
Interest Rate Cap Agreements Effective September 30, 2016 | |||||
Derivative [Line Items] | |||||
Derivative, expiration date | Jun. 30, 2018 | ||||
Debt expense recognized | $ 4,140,000 | ||||
Interest Rate Cap Agreements Effective June 29, 2018 | |||||
Derivative [Line Items] | |||||
Derivative, effective date | Jun. 29, 2018 | ||||
Derivative, expiration date | Jun. 30, 2020 | ||||
Fair value of assets | $ 851,000 | $ 851,000 | |||
Debt expense recognized | 4,327,000 | ||||
Amount of unrealized losses in OCI on interest rate cap and swap agreements | (181,000) | ||||
Term Loan B | Maximum | Interest rate cap agreements 1 | |||||
Derivative [Line Items] | |||||
Derivative Asset, Notional Amount | $ 3,500,000,000 | ||||
Term Loan Facility | Maximum | Interest rate cap agreements 1 | |||||
Derivative [Line Items] | |||||
Derivative Asset, Notional Amount | $ 3,500,000,000 | $ 3,500,000,000 | |||
Debt instrument, variable interest rate margin | 3.50% | 3.50% | |||
Senior Secured Credit Facilities | |||||
Derivative [Line Items] | |||||
Weighted average effective interest rate at period end | 5.11% | 5.11% |
Long-Term Debt - Debt Expense (
Long-Term Debt - Debt Expense (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Debt Disclosure [Abstract] | |||
Debt expense recognized | $ 461,897 | $ 406,341 | $ 394,013 |
Amortization of deferred financing costs | $ 25,538 | $ 24,293 | $ 20,103 |
Long-Term Debt - Derivative Ins
Long-Term Debt - Derivative Instruments (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Derivatives designated as hedging instruments | Interest rate cap agreements | Other long-term assets | ||
Derivative [Line Items] | ||
Derivative assets, Fair value | $ 851 | $ 1,032 |
Long-Term Debt - Effects of Int
Long-Term Debt - Effects of Interest Rate Swap and Cap Agreements (Details) - Cash Flow Hedging - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of unrealized losses in OCI on interest rate cap and swap agreements | $ (133) | $ (5,437) | $ (3,670) |
Amount of losses reclassified from accumulated OCI into income | 6,286 | 5,058 | 2,566 |
Tax benefit (expense) | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of unrealized losses in OCI on interest rate cap and swap agreements | 48 | 3,460 | 2,343 |
Amount of losses reclassified from accumulated OCI into income | (2,180) | (3,220) | (1,632) |
Interest rate cap agreements | Debt Expense (Including Refinancing Charges) | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of unrealized losses in OCI on interest rate cap and swap agreements | (181) | (8,897) | (5,198) |
Amount of losses reclassified from accumulated OCI into income | 8,466 | 8,278 | 3,899 |
Interest rate swap agreements | Debt Expense (Including Refinancing Charges) | |||
Derivative Instruments, Gain (Loss) [Line Items] | |||
Amount of unrealized losses in OCI on interest rate cap and swap agreements | 0 | 0 | (815) |
Amount of losses reclassified from accumulated OCI into income | $ 0 | $ 0 | $ 299 |
Leases - Additional Information
Leases - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Leases Disclosure [Line Items] | |||
Rent expense under all operating leases | $ 596,117 | $ 530,748 | $ 478,531 |
Net book value of property and equipment under capital leases | $ 235,194 | $ 257,772 | |
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 |
Leases - Future Minimum Lease P
Leases - Future Minimum Lease Payments Under Non-Cancelable Operating and Capital Leases (Details) $ in Thousands | Dec. 31, 2018USD ($) |
Operating leases | |
2,019 | $ 483,488 |
2,020 | 462,154 |
2,021 | 432,950 |
2,022 | 395,462 |
2,023 | 349,649 |
Thereafter | 1,589,949 |
Total future minimum lease payments due under operating leases | 3,713,652 |
Capital leases | |
2,019 | 36,754 |
2,020 | 41,044 |
2,021 | 34,026 |
2,022 | 33,690 |
2,023 | 33,845 |
Thereafter | 194,611 |
Total future minimum capital lease payments | 373,970 |
Less portion representing interest | (91,233) |
Total capital lease obligations, including current portion | $ 282,737 |
Employee Benefit Plans - Additi
Employee Benefit Plans - Additional Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Defined Benefit Plan Disclosure [Line Items] | |||
Employer matching contribution, percent of match | 50.00% | ||
Employer matching contribution, percent of employees' gross wages | 6.00% | ||
Defined Benefit Plan, Benefit Obligation, Benefits Paid | $ 67,807 | ||
Change of Control Protection Program | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Cash bonuses to employees in the event of a change of control | 336,530 | ||
Nonqualified Deferred Compensation Plan | All Trusts | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Total fair value of assets held in trust | $ 36,124 | $ 38,895 | |
Nonqualified Deferred Compensation Plan | DaVita Voluntary Deferral Plan | |||
Defined Benefit Plan Disclosure [Line Items] | |||
Maximum percentage of employees' base salary to be maintained into deferral account | 50.00% | ||
Non-qualified deferred compensation plan, contributions | $ 3,090 | 4,497 | $ 5,344 |
Non-qualified deferred compensation plan, distributions | $ 4,652 | $ 2,789 | $ 1,065 |
Contingencies - Additional Info
Contingencies - Additional Information (Details) $ in Thousands | Nov. 01, 2018USD ($) | Sep. 28, 2018USD ($) | Jun. 27, 2018USD ($) | Dec. 31, 2017USD ($) | Dec. 31, 2018USD ($) | Mar. 31, 2017USD ($) | Dec. 31, 2018USD ($) | Dec. 31, 2017USD ($) | Dec. 31, 2016USD ($) |
Other Commitments [Line Items] | |||||||||
Gain (loss) related to litigation settlement | $ 0 | $ 526,827 | $ 0 | ||||||
US Attorney Prescription Drug Investigation | |||||||||
Other Commitments [Line Items] | |||||||||
Litigation settlement amount awarded to other party | $ 63,700 | ||||||||
U.S. Department of Veterans Affairs (VA) | |||||||||
Other Commitments [Line Items] | |||||||||
Litigation settlement amount awarded from other party | $ 538,000 | ||||||||
Gain (loss) related to litigation settlement | $ (529,504) | 527,000 | |||||||
OIG Medicare Advantage Civil Investigation | |||||||||
Other Commitments [Line Items] | |||||||||
Litigation settlement amount awarded to other party | $ 270,000 | ||||||||
Settlement agreement date | September 28, 2018 | ||||||||
White, Kathleen, Et Al | |||||||||
Other Commitments [Line Items] | |||||||||
Litigation settlement amount awarded to other party | $ 25,500 | ||||||||
Settlement agreement date | Jun. 27, 2018 | ||||||||
Number of claims dismissed | 3 | ||||||||
Insurance recoveries | $ 9,200 | ||||||||
Operating Income (Loss) | U.S. Department of Veterans Affairs (VA) | |||||||||
Other Commitments [Line Items] | |||||||||
Gain (loss) related to litigation settlement | 530,000 | ||||||||
Noncontrolling Interest | U.S. Department of Veterans Affairs (VA) | |||||||||
Other Commitments [Line Items] | |||||||||
Gain (loss) related to litigation settlement | 9,000 | ||||||||
Equity Method Investments | Noncontrolling Interest | U.S. Department of Veterans Affairs (VA) | |||||||||
Other Commitments [Line Items] | |||||||||
Gain (loss) related to litigation settlement | $ 3,000 | ||||||||
Incremental Cash Portion | US Attorney Prescription Drug Investigation | |||||||||
Other Commitments [Line Items] | |||||||||
Litigation settlement amount awarded to other party | 41,500 | ||||||||
Cash Paid For Portion Previously Refunded | US Attorney Prescription Drug Investigation | |||||||||
Other Commitments [Line Items] | |||||||||
Litigation settlement amount awarded to other party | $ 22,200 | ||||||||
Compensatory Damages | White, Kathleen, Et Al | |||||||||
Other Commitments [Line Items] | |||||||||
Value of damages awarded | $ 8,500 | ||||||||
Punitive Damages | White, Kathleen, Et Al | |||||||||
Other Commitments [Line Items] | |||||||||
Value of damages awarded | $ 375,000 |
Noncontrolling Interests Subj_2
Noncontrolling Interests Subject to Put Provisions and Other Commitments - Additional Information (Details) - USD ($) $ in Thousands | 1 Months Ended | 12 Months Ended | ||
Jan. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Epogen | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Long term purchase commitment, expiration date | Dec. 31, 2022 | |||
Dialysis Equipment, Parts and Supplies | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Long term purchase commitment, expiration date | Dec. 31, 2020 | |||
Purchase commitment, purchase during the period | $ 182,446 | $ 176,212 | $ 164,766 | |
Hemodialysis Products, Supplies and Equipment | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Purchase commitment, purchase during the period | $ 162,858 | $ 166,764 | $ 162,109 | |
Minimum | ||||
Commitments And Contingencies Disclosure [Line Items] | ||||
Scheduled dissolution term of joint ventures | 10 years | |||
Minimum | Epogen | ||||
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 | $ 4,675 |
Long-term Incentive Compensat_3
Long-term Incentive Compensation and Shareholders’ Equity - Additional Information (Details) | Jul. 01, 2018 | Jan. 01, 2018 | Feb. 22, 2019USD ($)shares | Sep. 30, 2018USD ($) | Dec. 31, 2018USD ($)$ / sharesshares | Dec. 31, 2017USD ($)$ / sharesshares | Dec. 31, 2016USD ($)$ / sharesshares | Jul. 11, 2018USD ($) | Oct. 10, 2017shares |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Aggregate intrinsic value of stock awards exercised | $ 31,045,000 | $ 34,895,000 | $ 73,944,000 | ||||||
Aggregate intrinsic value of stock awards outstanding | 95,822,000 | ||||||||
Aggregate intrinsic value of stock awards exercisable | 0 | ||||||||
Contributions used to purchase stock accumulated through payroll withholdings or through optional lump sum payments | 658,913,000 | 616,116,000 | |||||||
Share-based awards, fair value assumptions, expected dividend | 0 | 0 | 0 | ||||||
Long-term incentive program (LTIP) expense | 85,759,000 | 61,978,000 | 64,956,000 | ||||||
Stock-based compensation expense | 73,061,000 | 35,092,000 | 38,338,000 | ||||||
Estimated tax benefits recorded for stock-based compensation | 13,591,000 | 7,717,000 | 12,731,000 | ||||||
Unrecognized compensation cost related to outstanding LTIP awards | 99,935,000 | ||||||||
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under equity compensation and stock purchase plans | $ 88,596,000 | ||||||||
Unrecognized compensation cost related to nonvested stock-based compensation arrangements under performance-based cash component of LTIP costs, weighted average remaining period (in years) | 9 months 18 days | ||||||||
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 6 months | ||||||||
Employee Service Share-based Compensation, Tax Benefit from Compensation Expense | $ 7,988,000 | 13,473,000 | 28,397,000 | ||||||
Stock award exercises and other share issuances, net | $ 0 | $ 0 | 0 | ||||||
Purchase of treasury stock (in shares) | shares | 16,844,067 | 12,966,672 | |||||||
Purchase of treasury stock | $ 1,153,511,000 | $ 810,949,000 | |||||||
Purchase of treasury stock, average price per share | $ / shares | $ 68.48 | $ 62.54 | |||||||
Stock repurchase program, additional authorized amount | $ 1,389,999,000 | ||||||||
Stock repurchase program, number of shares authorized to be repurchased | shares | 110,001,000 | ||||||||
Preferred stock, shares authorized (in shares) | shares | 5,000,000 | 5,000,000 | |||||||
Acquisition of additional ownership interests in several existing majority-owned joint ventures | $ 28,082,000 | $ 5,357,000 | $ 21,512,000 | ||||||
Share-based Compensation Arrangement by Share-based Payment Award, Plan Modification, Incremental Compensation Cost | $ 23,470,000 | 14,704,000 | |||||||
Share-based Compensation Arrangement by Share-based Payment Award Accelerated Compensation Cost | $ 9,727,000 | ||||||||
Subsequent Event | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Purchase of treasury stock (in shares) | shares | 0 | ||||||||
Share repurchase program, available under the current board authorizations for additional share repurchase | $ 1,355,605,000 | ||||||||
Stock Incentive Plan 2011 | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Terms of award (in years) | 5 years | ||||||||
Full share awards to shares available, conversion ratio | 3.5 | ||||||||
Shares available for future grants | shares | 23,091,764 | ||||||||
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] | |||||||||
Vesting period | 48 months | ||||||||
Stock appreciation rights | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Outstanding balance of stock-settled stock appreciation rights (in shares) | shares | 6,162,797 | 6,648,199 | |||||||
Weighted average fair value | $ / shares | $ 16.24 | $ 14.51 | $ 13.74 | ||||||
Stock appreciation rights | Stock Incentive Plan 2011 | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Outstanding balance of stock-settled stock appreciation rights (in shares) | shares | 6,162,797 | ||||||||
Stock Settled Stock Units | Stock Incentive Plan 2011 | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Outstanding balance of stock-settled stock units and cash-settled stock appreciation rights (in shares) | shares | 1,860,475 | ||||||||
Cash-settled stock appreciation rights | Stock Incentive Plan 2011 | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Outstanding balance of stock-settled stock units and cash-settled stock appreciation rights (in shares) | shares | 23,000 | ||||||||
Cash Settled Stock Units | Stock Incentive Plan 2011 | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Outstanding balance of cash-settled stock units | shares | 1,600 | ||||||||
Cash-settled stock-based awards | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Stock granted | shares | 0 | ||||||||
Liability-classified share awards | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Outstanding balance of cash-settled stock units | shares | 24,600 | ||||||||
Stock-based compensation expense, fair value adjustment | $ (20,000) | $ 114,000 | $ 376,000 | ||||||
Shares vested in period (in shares) | shares | 0 | ||||||||
Stock-based compensation liability | $ 79,000 | ||||||||
Employee stock purchase plan | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Shares available for future grants | shares | 6,726,278 | ||||||||
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 | $ 17,398,000 | $ 22,131,000 | $ 23,902,000 | ||||||
Stock issued for employee stock purchase plans | shares | 397,749 | 360,368 | 438,002 | ||||||
Expected volatility Rate | 24.00% | 23.00% | 22.00% | ||||||
Risk-free interest rate | 1.90% | 1.30% | 0.80% | ||||||
Weighted average fair value | $ / shares | $ 17.45 | $ 15.19 | $ 16.73 | ||||||
General and Administrative Expense | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Stock-based compensation expense | $ 73,582,000 | $ 34,431,000 | $ 34,530,000 | ||||||
Treasury stock | |||||||||
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||||||||
Purchase of treasury stock (in shares) | shares | 16,844,000 | 12,967,000 | 16,649,000 | ||||||
Purchase of treasury stock | $ 1,153,511,000 | $ 810,949,000 | $ 1,072,377,000 | ||||||
Treasury Stock, Shares, Retired | shares | 16,844,000 | 12,967,000 | 23,226,000 |
Long-term Incentive Compensat_4
Long-term Incentive Compensation and Shareholders’ Equity - Summary of Status of Awards Under Stock-Based Compensation Plans and Agreements (Details) - $ / shares | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Stock appreciation rights | |||
Awards | |||
Outstanding at beginning of year (in shares) | 6,648,199 | ||
Granted (in shares) | 1,902,652 | ||
Exercised (in shares) | (2,059,872) | ||
Canceled (in shares) | (328,182) | ||
Outstanding at end of period (in shares) | 6,162,797 | 6,648,199 | |
Exercisable at end of period (in shares) | 1,422,529 | ||
Weighted-average fair value of grants | $ 16.24 | $ 14.51 | $ 13.74 |
Weighted average exercise price | |||
Outstanding at beginning of year (USD per share) | 67.92 | ||
Granted (USD per share) | 66.54 | ||
Exercised (USD per share) | 60.34 | ||
Canceled (USD per share) | 70.44 | ||
Outstanding at end of period (USD per share) | 69.90 | $ 67.92 | |
Exercisable at end of period (USD per share) | $ 73.39 | ||
Weighted average remaining contractual life | |||
Outstanding at end of period | 2 years 10 months 24 days | ||
Exercisable at end of period | 10 months 24 days | ||
Stock units | |||
Awards | |||
Outstanding at beginning of year (in shares) | 1,075,572 | ||
Granted (in shares) | 1,101,388 | ||
Exercised (in shares) | (165,543) | ||
Canceled (in shares) | (150,942) | ||
Outstanding at end of period (in shares) | 1,860,475 | 1,075,572 | |
Exercisable at end of period (in shares) | 0 | ||
Weighted-average fair value of grants (USD per share) | $ 66.23 | $ 65.73 | $ 70.99 |
Weighted average remaining contractual life | |||
Outstanding at end of period | 2 years 2 months 12 days | ||
Exercisable at end of period | 0 years |
Long-term Incentive Compensat_5
Long-term Incentive Compensation and Shareholders’ Equity - Summary of Range of Exercise Prices (Details) | 12 Months Ended |
Dec. 31, 2018$ / sharesshares | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 6,162,797 |
Weighted average exercise price (USD per share) | $ 69.90 |
Awards exercisable (in shares) | shares | 1,422,529 |
Weighted average exercise price (USD per share) | $ 73.39 |
$50.01–$60.00 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 131,470 |
Weighted average exercise price (USD per share) | $ 57.90 |
Awards exercisable (in shares) | shares | 0 |
Weighted average exercise price (USD per share) | $ 0 |
Range of exercise prices, lower range (USD per share) | 50.01 |
Range of exercise prices, upper range (USD per share) | $ 60 |
$60.01–$70.00 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 4,083,162 |
Weighted average exercise price (USD per share) | $ 66.66 |
Awards exercisable (in shares) | shares | 757,237 |
Weighted average exercise price (USD per share) | $ 68.96 |
Range of exercise prices, lower range (USD per share) | 60.01 |
Range of exercise prices, upper range (USD per share) | $ 70 |
$70.01–$80.00 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 1,351,997 |
Weighted average exercise price (USD per share) | $ 74.78 |
Awards exercisable (in shares) | shares | 346,316 |
Weighted average exercise price (USD per share) | $ 73.81 |
Range of exercise prices, lower range (USD per share) | 70.01 |
Range of exercise prices, upper range (USD per share) | $ 80 |
$80.01–$90.00 | |
Share-based Compensation, Shares Authorized under Stock Option Plans, Exercise Price Range [Line Items] | |
Awards outstanding (in shares) | shares | 596,168 |
Weighted average exercise price (USD per share) | $ 83.60 |
Awards exercisable (in shares) | shares | 318,976 |
Weighted average exercise price (USD per share) | $ 83.47 |
Range of exercise prices, lower range (USD per share) | 80.01 |
Range of exercise prices, upper range (USD per share) | $ 90 |
Long-term Incentive Compensat_6
Long-term Incentive Compensation and Shareholders Equity - Summary of Weighted Average Valuation Inputs (Details) - Stock Options and Stock Appreciation Rights | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Share-based Compensation Arrangement by Share-based Payment Award [Line Items] | |||
Expected term | 4 years 2 months 12 days | 4 years 2 months 12 days | 4 years 2 months 12 days |
Expected volatility | 23.80% | 23.90% | 21.00% |
Expected dividend yield | 0.00% | 0.00% | 0.00% |
Risk-free interest rate | 2.90% | 1.70% | 1.00% |
Long-term Incentive Compensat_7
Long-term Incentive Compensation and Shareholders’ Equity - Effects of Changes in DaVita Inc's Ownership Interest on Company's Equity (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items] | |||||||||||
Net income attributable to DaVita Inc. | $ (149,772) | $ (136,796) | $ 267,276 | $ 178,686 | $ 303,396 | $ (214,476) | $ 127,001 | $ 447,697 | $ 159,394 | $ 663,618 | $ 879,874 |
Changes in paid-in-capital for: | |||||||||||
Net income attributable to DaVita Inc. net of transfers in noncontrolling interests | 141,576 | 660,752 | 866,769 | ||||||||
Additional paid-in capital | |||||||||||
Changes in paid-in-capital for: | |||||||||||
Sales of noncontrolling interest | 79 | (114) | 0 | ||||||||
Purchase of noncontrolling interests | (17,897) | (2,752) | (13,105) | ||||||||
Net transfer in noncontrolling interests | $ (17,818) | $ (2,866) | $ (13,105) |
Other Comprehensive (Loss) In_3
Other Comprehensive (Loss) Income (Details) - USD ($) $ in Thousands | 12 Months Ended | |||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | Jan. 01, 2018 | |
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | $ 4,690,029 | |||
Ending balance | 3,703,442 | $ 4,690,029 | ||
Interest rate cap and swap agreements | ||||
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | (12,408) | (12,029) | $ (10,925) | |
Cumulative Effect of New Accounting Principle in Period of Adoption | $ (2,706) | |||
Unrealized (losses) gains | (181) | (8,897) | (6,013) | |
Related income tax | 48 | 3,460 | 2,343 | |
Unrealized (losses) gains net | (133) | (5,437) | (3,670) | |
Reclassification from accumulated other comprehensive losses (income) into net income | 8,466 | 8,278 | 4,198 | |
Related income tax | (2,180) | (3,220) | (1,632) | |
Reclassification from accumulated other comprehensive income into net income net of tax | 6,286 | 5,058 | 2,566 | |
Ending balance | (8,961) | (12,408) | (12,029) | |
Investment securities | ||||
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | 5,662 | 2,175 | 1,361 | |
Cumulative Effect of New Accounting Principle in Period of Adoption | (5,662) | |||
Unrealized (losses) gains | 0 | 5,075 | 1,802 | |
Related income tax | 0 | (1,368) | (565) | |
Unrealized (losses) gains net | 0 | 3,707 | 1,237 | |
Reclassification from accumulated other comprehensive losses (income) into net income | 0 | (360) | (690) | |
Related income tax | 0 | 140 | 267 | |
Reclassification from accumulated other comprehensive income into net income net of tax | 0 | (220) | (423) | |
Ending balance | 0 | 5,662 | 2,175 | |
Foreign currency translation adjustments | ||||
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | 19,981 | (79,789) | (50,262) | |
Cumulative Effect of New Accounting Principle in Period of Adoption | 0 | |||
Unrealized (losses) gains | (45,944) | 99,770 | (39,614) | |
Related income tax | 0 | 0 | 0 | |
Unrealized (losses) gains net | (45,944) | 99,770 | (39,614) | |
Reclassification from accumulated other comprehensive losses (income) into net income | 0 | 0 | 10,087 | |
Related income tax | 0 | 0 | 0 | |
Reclassification from accumulated other comprehensive income into net income net of tax | 0 | 0 | 10,087 | |
Ending balance | (25,963) | 19,981 | (79,789) | |
Accumulated other comprehensive (loss) income | ||||
Comprehensive Income (Loss) [Line Items] | ||||
Beginning balance | 13,235 | (89,643) | (59,826) | |
Cumulative Effect of New Accounting Principle in Period of Adoption | $ (8,368) | |||
Unrealized (losses) gains | (46,125) | 95,948 | (43,825) | |
Related income tax | 48 | 2,092 | 1,778 | |
Unrealized (losses) gains net | (46,077) | 98,040 | (42,047) | |
Reclassification from accumulated other comprehensive losses (income) into net income | 8,466 | 7,918 | 13,595 | |
Related income tax | (2,180) | (3,080) | (1,365) | |
Reclassification from accumulated other comprehensive income into net income net of tax | 6,286 | 4,838 | 12,230 | |
Ending balance | $ (34,924) | $ 13,235 | $ (89,643) |
Acquisitions and Divestitures -
Acquisitions and Divestitures - Additional Information (Details) $ in Thousands | May 01, 2017USD ($)patientstateclinicoutpatient_dialysis_center | Aug. 01, 2016USD ($) | Dec. 31, 2018USD ($) | Mar. 31, 2017USD ($) | Dec. 31, 2018USD ($)clinic | Dec. 31, 2017USD ($)clinic | Dec. 31, 2016USD ($)clinic |
Business Acquisition [Line Items] | |||||||
Cash paid to acquire business | $ 183,156 | $ 803,879 | $ 563,856 | ||||
Contingent earn-out obligations associated with acquisitions | 1,246 | ||||||
Non-cash gain on acquiring additional ownership in business acquisition | $ 28,152 | 28,152 | |||||
Contingent earn-out obligations | 11,210 | 11,210 | |||||
Fair value of contingent earn-out consideration | 2,608 | 2,608 | 6,388 | ||||
Other Accrued Liabilities | |||||||
Business Acquisition [Line Items] | |||||||
Fair value of contingent earn-out consideration | 431 | 431 | |||||
Other long-term liabilities | |||||||
Business Acquisition [Line Items] | |||||||
Fair value of contingent earn-out consideration | 2,177 | 2,177 | |||||
Other companies | |||||||
Business Acquisition [Line Items] | |||||||
Fair value of contingent earn-out consideration | 2,608 | $ 2,608 | |||||
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 | 5 years | ||||||
Renal Ventures Limited, LLC | |||||||
Business Acquisition [Line Items] | |||||||
Cash paid to acquire business | $ 359,913 | ||||||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 5 years | ||||||
Goodwill deductible for tax purposes associated with acquisitions | 298,200 | $ 298,200 | |||||
Ownership interest percentage | 100.00% | ||||||
Number of dialysis clinic patients | patient | 2,600 | ||||||
Number of states where dialysis centers are located | state | 6 | ||||||
Proceeds from divestiture of business | $ 21,219 | ||||||
Business acquisition, transaction costs | 11,950 | ||||||
Series of individually immaterial business acquisitions | |||||||
Business Acquisition [Line Items] | |||||||
Cash paid to acquire business | 176,161 | 308,550 | 165,108 | ||||
Contingent earn-out obligations associated with acquisitions | 1,246 | 2,692 | 1,511 | ||||
Liabilities assumed | $ 34,394 | $ 23,748 | $ 17,963 | ||||
Amortizable intangible assets acquired, weighted-average estimated useful lives | 6 years | 7 years | 7 years | ||||
Goodwill deductible for tax purposes associated with acquisitions | $ 165,013 | $ 165,013 | $ 237,363 | $ 169,379 | |||
U S Dialysis And Related Lab Services | Series of individually immaterial business acquisitions | |||||||
Business Acquisition [Line Items] | |||||||
Number of businesses acquired | clinic | 18 | 30 | 8 | ||||
Foreign Dialysis Centers | Series of individually immaterial business acquisitions | |||||||
Business Acquisition [Line Items] | |||||||
Number of businesses acquired | clinic | 28 | 68 | 21 | ||||
Operating Dialysis Center | |||||||
Business Acquisition [Line Items] | |||||||
Number of businesses divested | outpatient_dialysis_center | 3 | ||||||
Operating Dialysis Center | Renal Ventures Limited, LLC | |||||||
Business Acquisition [Line Items] | |||||||
Number of businesses acquired | clinic | 36 | ||||||
Number of businesses divested | outpatient_dialysis_center | 3 | ||||||
New Center Under Construction | Renal Ventures Limited, LLC | |||||||
Business Acquisition [Line Items] | |||||||
Number of businesses acquired | clinic | 1 | ||||||
Number of businesses divested | outpatient_dialysis_center | 1 | ||||||
Home Dialysis Clinic | Renal Ventures Limited, LLC | |||||||
Business Acquisition [Line Items] | |||||||
Number of businesses acquired | clinic | 1 | ||||||
Khazanah And Mitsui | Asia-Pacific dialysis business | |||||||
Business Acquisition [Line Items] | |||||||
Non-cash non-taxable gain | $ (374,374) | $ (6,273) |
Acquisitions and Divestitures_2
Acquisitions and Divestitures - Aggregate Purchase Cost Allocations for Acquisitions (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 |
Business Acquisition [Line Items] | |||
Goodwill | $ 6,841,960 | $ 6,610,279 | $ 6,015,375 |
Series of individually immaterial business acquisitions | |||
Business Acquisition [Line Items] | |||
Current assets, net of cash acquired | 23,686 | 14,366 | 3,996 |
Property and equipment | 11,421 | 18,192 | 8,840 |
Amortizable intangible and other long-term assets | 3,079 | 11,663 | 5,876 |
Non-amortizable intangibles | 23,656 | 32,296 | 0 |
Goodwill | 278,348 | 318,832 | 198,927 |
Deferred income taxes, liabilities | 0 | (210) | |
Deferred income taxes, assets | 597 | ||
Noncontrolling interests assumed | (80,291) | (44,303) | (30,337) |
Liabilities assumed | (19,946) | (15,846) | (3,317) |
Aggregate purchase price | $ 239,953 | $ 334,990 | $ 184,582 |
Acquisitions and Divestitures_3
Acquisitions and Divestitures - Assets Acquired and Liabilities Assumed and Recognized at Acquisition Dates at Estimated Fair Values (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 |
Business Acquisition [Line Items] | |||
Goodwill | $ 6,841,960 | $ 6,610,279 | $ 6,015,375 |
Renal Ventures Limited, LLC | |||
Business Acquisition [Line Items] | |||
Current assets, net of cash acquired | 22,739 | ||
Property and equipment | 36,295 | ||
Amortizable intangible and other long-term assets | 11,547 | ||
Goodwill | 298,200 | ||
Current liabilities | (8,389) | ||
Long-term liabilities | (479) | ||
Aggregate purchase price | $ 359,913 |
Acquisitions and Divestitures_4
Acquisitions and Divestitures - Pro Forma Summary of Results of Operation (Details) - USD ($) $ / shares in Units, $ in Thousands | 12 Months Ended | |
Dec. 31, 2018 | Dec. 31, 2017 | |
Business Combinations [Abstract] | ||
Pro forma net revenues | $ 11,508,555 | $ 11,176,736 |
Pro forma net income attributable to DaVita Inc. | $ 634,326 | $ 922,718 |
Pro forma basic net income per share attributable to DaVita Inc. (USD per share) | $ 3.71 | $ 4.89 |
Pro forma diluted net income per share attributable to DaVita Inc. (USD per share) | $ 3.68 | $ 4.82 |
Acquisitions and Divestitures_5
Acquisitions and Divestitures - Reconciliation of Changes in Contingent Earn-Out Obligations (Details) $ in Thousands | 12 Months Ended |
Dec. 31, 2018USD ($) | |
Business Combinations [Abstract] | |
Beginning balance December 31, 2017 | $ 6,388 |
Contingent earn-out obligations associated with acquisitions | 1,246 |
Remeasurement of fair value | (4,729) |
Payments of contingent earn-out obligations | (297) |
Ending balance December 31, 2018 | $ 2,608 |
Held for Sale and Discontinue_3
Held for Sale and Discontinued Operations - Additional Information (Details) - USD ($) $ in Thousands | Jun. 01, 2018 | Dec. 31, 2018 | Dec. 31, 2018 | Sep. 30, 2018 | Sep. 30, 2017 | Jun. 30, 2017 | Dec. 10, 2018 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||||||||
Valuation adjustment on disposal group | $ 316,840 | $ 0 | $ 0 | |||||||
Goodwill impairment charges | 3,106 | 36,196 | 28,415 | |||||||
Payments to Acquire Businesses, Gross | 183,156 | 803,879 | 563,856 | |||||||
DMG | ||||||||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||||||||
Proceeds from sale of DMG division | $ 4,340,000 | $ 4,900,000 | ||||||||
Goodwill impairment charges | $ 601,040 | $ 50,619 | ||||||||
Series of individually immaterial business acquisitions | ||||||||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||||||||
Payments to Acquire Businesses, Gross | 176,161 | 308,550 | 165,108 | |||||||
Business combination, liabilities assumed | 34,394 | 23,748 | 17,963 | |||||||
DMG Acquisitions | Series of individually immaterial business acquisitions | ||||||||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||||||||
Payments to Acquire Businesses, Gross | 6,995 | 135,416 | 398,748 | |||||||
Business combination, deferred purchase price | 1,142 | 1,038 | ||||||||
Business combination, liabilities assumed | 10,145 | |||||||||
Business combination, deferred purchase price and liabilities assumed | 7,694 | |||||||||
Discontinued Operations, Held-for-sale | DMG | ||||||||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||||||||
Valuation charge to record valuation allowance and related tax expense, disposal group, including discontinued operations | $ (216,147) | (468,005) | ||||||||
Valuation adjustment on disposal group | $ 218,639 | 98,201 | 316,840 | |||||||
Goodwill impairment charges | 41,537 | 41,537 | $ 651,659 | $ 253,000 | ||||||
Tax expense related to valuation adjustment, disposal group, including discontinued operation | $ 8,318 | $ 117,946 | 109,628 | |||||||
Tandigm Health | ||||||||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | ||||||||||
Percentage of ownership sold | 19.00% | |||||||||
Equity Method Investment, Realized Gain (Loss) on Disposal | 25,096 | |||||||||
Tax related to gain on sale of equity investment | $ 6,460 | |||||||||
Gain (loss) on disposition of business, net of tax | $ 18,636 |
Held for Sale and Discontinue_4
Held for Sale and Discontinued Operations - Schedule of Financial Results for DMG's Discontinued Operations (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||
Dec. 31, 2018 | Sep. 30, 2018 | Sep. 30, 2017 | Jun. 30, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||||||
Valuation adjustment on disposal group | $ 316,840 | $ 0 | $ 0 | ||||
Goodwill and other asset impairment charges | 3,106 | 36,196 | 28,415 | ||||
Income (Loss) from Discontinued Operations, Net of Tax, Including Portion Attributable to Noncontrolling Interest | (457,038) | (245,372) | (158,262) | ||||
DMG | |||||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||||||
Goodwill and other asset impairment charges | $ 601,040 | $ 50,619 | |||||
DMG | Discontinued Operations, Held-for-sale | |||||||
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items] | |||||||
Net revenues | 4,963,792 | 4,676,213 | 4,113,414 | ||||
Expenses | 4,962,686 | 4,634,782 | 3,994,624 | ||||
Valuation adjustment on disposal group | $ 218,639 | $ 98,201 | 316,840 | ||||
Goodwill and other asset impairment charges | $ 41,537 | 41,537 | 651,659 | 253,000 | |||
Loss from discontinued operations before taxes | (357,271) | (610,228) | (134,210) | ||||
Income tax expense (benefit) | $ 99,768 | $ (364,856) | $ 24,052 |
Held for Sale and Discontinue_5
Held for Sale and Discontinued Operations - Schedule of Financial Position for DMG's Discontinued Operations (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Assets | ||
Total current assets held for sale | $ 5,389,565 | $ 5,761,642 |
Liabilities | ||
Total current liabilities held for sale | 1,243,759 | 1,185,070 |
DMG | Discontinued Operations, Held-for-sale | ||
Assets | ||
Cash and cash equivalents | 414,683 | 179,668 |
Other current assets | 557,403 | 826,608 |
Property and equipment, net | 458,040 | 379,945 |
Intangible assets, net | 1,316,974 | 1,316,550 |
Other long-term assets | 112,127 | 178,894 |
Goodwill | 2,847,178 | 2,879,977 |
Valuation Allowance On Disposal Group | (316,840) | 0 |
Total current assets held for sale | 5,389,565 | 5,761,642 |
Liabilities | ||
Other liabilities | 479,134 | 505,734 |
Medical payables | 436,839 | 457,040 |
Current portion of long-term debt | 3,122 | 2,845 |
Long-term debt | 33,425 | 35,003 |
Other long-term liabilities | 157,167 | 184,448 |
Total current liabilities held for sale | $ 1,243,759 | $ 1,185,070 |
Held for Sale and Discontinue_6
Held for Sale and Discontinued Operations - Reconciliation of Cash Flows (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Discontinued Operations and Disposal Groups [Abstract] | |||
Net cash provided by operating activities from discontinued operations | $ 290,684 | $ 357,274 | $ 287,044 |
Net cash used in investing activities from discontinued operations | $ (57,382) | $ (232,329) | $ (430,917) |
Variable Interest Entities - Ad
Variable Interest Entities - Additional Information (Details) $ in Thousands | Dec. 31, 2018USD ($) |
Variable Interest Entities [Line Items] | |
Total assets of VIEs | $ 917,922 |
Total liabilities of VIEs | 507,445 |
DMG | Discontinued Operations, Held-for-sale | |
Variable Interest Entities [Line Items] | |
Total assets of VIEs | 658,684 |
Total liabilities of VIEs | $ 355,196 |
Fair Values of Financial Inst_3
Fair Values of Financial Instruments - Assets, Liabilities and Temporary Equity Measured at Fair Value on Recurring Basis (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Assets | ||
Equity Securities, FV-NI | $ 36,124 | |
Liabilities | ||
Contingent earn-out obligations | 11,210 | |
Fair Value, Measurements, Recurring | ||
Assets | ||
Equity Securities, FV-NI | 36,124 | $ 38,895 |
Interest rate cap agreements | 851 | 1,032 |
Liabilities | ||
Contingent earn-out obligations | 2,608 | 6,388 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 1,124,641 | 1,011,360 |
Fair Value, Measurements, Recurring | Quoted prices in active markets for identical assets (Level 1) | ||
Assets | ||
Equity Securities, FV-NI | 36,124 | 38,895 |
Interest rate cap agreements | 0 | 0 |
Liabilities | ||
Contingent earn-out obligations | 0 | 0 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 0 | 0 |
Fair Value, Measurements, Recurring | Significant other observable inputs (Level 2) | ||
Assets | ||
Equity Securities, FV-NI | 0 | 0 |
Interest rate cap agreements | 851 | 1,032 |
Liabilities | ||
Contingent earn-out obligations | 0 | 0 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | 0 | 0 |
Fair Value, Measurements, Recurring | Significant unobservable inputs (Level 3) | ||
Assets | ||
Equity Securities, FV-NI | 0 | 0 |
Interest rate cap agreements | 0 | 0 |
Liabilities | ||
Contingent earn-out obligations | 2,608 | 6,388 |
Temporary equity | ||
Noncontrolling interests subject to put provisions | $ 1,124,641 | $ 1,011,360 |
Fair Values of Financial Inst_4
Fair Values of Financial Instruments - Additional Information (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Carrying balance of debt | $ 10,154,216 | $ 9,400,182 |
Discount on borrowing amount | 52,000 | $ 63,951 |
Senior Secured Credit Facilities | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Carrying balance of debt | 5,168,815 | |
Discount on borrowing amount | 6,104 | |
Deferred financing costs, net | 12,580 | |
Fair value of debt | 5,194,163 | |
Senior Notes | ||
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items] | ||
Carrying balance of debt | 4,466,685 | |
Deferred financing costs, net | 33,316 | |
Fair value of debt | $ 4,241,250 |
Segment Reporting - Additional
Segment Reporting - Additional Information (Details) | 12 Months Ended |
Dec. 31, 2018segment | |
Segment Reporting Information [Line Items] | |
Operating divisions | 2 |
Segment Reporting - Summary of
Segment Reporting - Summary of Segment Net Revenues, Segment Operating Income (Loss) and Reconciliation of Segment Income to Consolidated Income from Continuing Operations Before Income Taxes (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Segment Reporting Information [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | $ 10,709,981 | $ 10,093,670 | $ 9,727,360 | ||||||||
Provision for uncollectible accounts | (49,587) | (485,364) | (431,304) | ||||||||
Net dialysis and related lab patient service revenues | 10,660,394 | 9,608,306 | 9,296,056 | ||||||||
Other revenues | 744,457 | 1,268,328 | 1,411,411 | ||||||||
Total revenues | $ 2,821,124 | $ 2,847,330 | $ 2,886,953 | $ 2,849,444 | $ 2,780,913 | $ 2,765,071 | $ 2,699,399 | $ 2,631,251 | 11,404,851 | 10,876,634 | 10,707,467 |
Operating income | $ 387,908 | $ 289,038 | $ 438,192 | $ 410,686 | $ 150,337 | $ 395,294 | $ 391,196 | $ 875,928 | 1,525,824 | 1,812,755 | 2,029,710 |
Corporate administrative support | (90,108) | (44,966) | (13,628) | ||||||||
Debt expense | (487,435) | (430,634) | (414,116) | ||||||||
Other income | 10,089 | 17,665 | 7,511 | ||||||||
Income from continuing operations before income taxes | 1,048,478 | 1,399,786 | 1,623,105 | ||||||||
U.S. dialysis and related lab services | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Total revenues | 10,242,999 | 9,304,889 | 9,110,834 | ||||||||
Other ancillary services and strategic initiatives | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Total revenues | 1,161,852 | 1,571,745 | 1,596,633 | ||||||||
Operating Segments | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Total revenues | 11,532,037 | 10,956,413 | 10,759,561 | ||||||||
Operating income | 1,615,932 | 1,857,721 | 2,043,338 | ||||||||
Operating Segments | U.S. dialysis and related lab services | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 10,366,996 | 9,822,299 | 9,551,422 | ||||||||
Provision for uncollectible accounts | (50,927) | 481,973 | (429,878) | ||||||||
Net dialysis and related lab patient service revenues | 10,316,069 | 9,340,326 | 9,121,544 | ||||||||
Other revenues | 19,880 | 19,739 | 16,645 | ||||||||
Total revenues | 10,335,949 | 9,360,065 | 9,138,189 | ||||||||
Operating income | 1,709,721 | 2,297,198 | 1,777,014 | ||||||||
Operating Segments | U.S. dialysis and related lab services | External Sources | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 10,274,046 | 9,767,123 | 9,524,067 | ||||||||
Operating Segments | U.S. dialysis and related lab services | Intersubsegment Eliminations | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 92,950 | 55,176 | 27,355 | ||||||||
Operating Segments | Other ancillary services and strategic initiatives | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 437,275 | 323,156 | 201,867 | ||||||||
Other revenues | 724,577 | 1,248,589 | 1,394,766 | ||||||||
Total revenues | 1,196,088 | 1,596,348 | 1,621,372 | ||||||||
Operating income | (93,789) | (439,477) | 266,324 | ||||||||
Operating Segments | Other ancillary services and strategic initiatives | Intersubsegment Eliminations | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 34,236 | 24,603 | 24,739 | ||||||||
Intersegment Elimination | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Total revenues | (127,186) | (79,779) | (52,094) | ||||||||
Intersegment Elimination | U.S. dialysis and related lab services | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Total revenues | (92,950) | (55,176) | (27,355) | ||||||||
Intersegment Elimination | Other ancillary services and strategic initiatives | |||||||||||
Segment Reporting Information [Line Items] | |||||||||||
Total revenues | $ (34,236) | $ (24,603) | $ (24,739) |
Segment Reporting - Summary o_2
Segment Reporting - Summary of Depreciation and Amortization Expense by Segment (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | $ 591,035 | $ 559,911 | $ 509,497 |
U.S. dialysis and related lab services | |||
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | 558,810 | 520,965 | 482,768 |
Other ancillary services and strategic initiatives | |||
Segment Reporting Information [Line Items] | |||
Depreciation and amortization | $ 32,225 | $ 38,946 | $ 26,729 |
Segment Reporting - Summary o_3
Segment Reporting - Summary of Assets by Segment (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 |
ASSETS | ||
Consolidated assets | $ 19,110,252 | $ 18,974,536 |
Equity method and other investments | 224,611 | 245,534 |
Property and equipment, net | 3,393,669 | 3,149,213 |
U.S. dialysis and related lab services | ||
ASSETS | ||
Consolidated assets | 12,333,641 | 11,802,131 |
Equity method and other investments | 95,290 | 84,866 |
Other ancillary services and strategic initiatives | ||
ASSETS | ||
Consolidated assets | 1,387,046 | 1,410,763 |
Equity method and other investments | 129,321 | 160,668 |
DMG - Held for sale | ||
ASSETS | ||
Consolidated assets | 5,389,565 | 5,761,642 |
Equity method and other investments | 4,833 | 10,321 |
Non-US | Other ancillary services and strategic initiatives | ||
ASSETS | ||
Property and equipment, net | $ 136,052 | $ 125,932 |
Segment Reporting - Summary o_4
Segment Reporting - Summary of Expenditures for Property and Equipment by Segment (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | $ 987,138 | $ 905,250 | $ 829,095 |
U.S. dialysis and related lab services | |||
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | 856,108 | 769,732 | 675,994 |
Other ancillary services and strategic initiatives | |||
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | 45,806 | 40,377 | 68,702 |
DMG - Held for sale | |||
Segment Reporting Information [Line Items] | |||
Expenditures for property and equipment | $ 85,224 | $ 95,141 | $ 84,399 |
Supplemental Cash Flow Inform_3
Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Cash paid: | |||
Income taxes | $ 92,526 | $ 387,159 | $ 339,411 |
Interest | 488,974 | 424,547 | 406,987 |
Non-cash investing and financing activities: | |||
Fixed assets under capital lease obligations | $ 8,828 | $ 48,378 | $ 28,127 |
Selected Quarterly Financial _3
Selected Quarterly Financial Data (unaudited) (Details) - USD ($) $ / shares in Units, $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Quarterly Financial Information Disclosure [Abstract] | |||||||||||
Net revenues | $ 2,821,124 | $ 2,847,330 | $ 2,886,953 | $ 2,849,444 | $ 2,780,913 | $ 2,765,071 | $ 2,699,399 | $ 2,631,251 | $ 11,404,851 | $ 10,876,634 | $ 10,707,467 |
Operating income | 387,908 | 289,038 | 438,192 | 410,686 | 150,337 | 395,294 | 391,196 | 875,928 | 1,525,824 | 1,812,755 | 2,029,710 |
Amounts attributable to DaVita Inc.: | |||||||||||
Net income from continuing operations | 160,332 | 73,371 | 199,603 | 191,015 | 156,210 | 152,870 | 151,292 | 440,905 | 624,321 | 901,277 | 1,032,373 |
Net loss from discontinued operations | (310,104) | (210,167) | 67,673 | (12,329) | 147,186 | (367,346) | (24,291) | 6,792 | (464,927) | (237,659) | (152,499) |
Net (loss) income attributable to DaVita Inc. | $ (149,772) | $ (136,796) | $ 267,276 | $ 178,686 | $ 303,396 | $ (214,476) | $ 127,001 | $ 447,697 | $ 159,394 | $ 663,618 | $ 879,874 |
Earnings per share attributable to DaVita Inc.: | |||||||||||
Basic net income from continuing operations per share attributable to DaVita Inc. (in usd per share) | $ 0.97 | $ 0.44 | $ 1.16 | $ 1.07 | $ 0.86 | $ 0.81 | $ 0.79 | $ 2.29 | $ 3.66 | $ 4.78 | $ 5.12 |
Basic net loss from discontinued operations per share attributable to DaVita Inc. (in usd per share) | (1.87) | (1.26) | 0.40 | (0.07) | 0.80 | (1.95) | (0.13) | 0.04 | (2.73) | (1.26) | (0.76) |
Basic net income per share attributable to DaVita Inc. (in usd per share) | (0.90) | (0.82) | 1.56 | 1 | 1.66 | (1.14) | 0.66 | 2.33 | 0.93 | 3.52 | 4.36 |
Diluted net income from continuing operations per share attributable to DaVita Inc. (in usd per share) | 0.96 | 0.44 | 1.15 | 1.05 | 0.85 | 0.80 | 0.78 | 2.26 | 3.62 | 4.71 | 5.04 |
Diluted net loss from discontinued operations per share attributable to DaVita Inc. (in usd per share) | (1.86) | (1.26) | 0.38 | (0.07) | 0.79 | (1.92) | (0.13) | 0.03 | (2.70) | (1.24) | (0.75) |
Diluted net income per share attributable to DaVita Inc. (in usd per share) | $ (0.90) | $ (0.82) | $ 1.53 | $ 0.98 | $ 1.64 | $ (1.12) | $ 0.65 | $ 2.29 | $ 0.92 | $ 3.47 | $ 4.29 |
Selected Quarterly Financial _4
Selected Quarterly Financial Data (unaudited) Selected Quarterly Financial Data - Additional Information (Details) - USD ($) $ in Thousands | 3 Months Ended | 6 Months Ended | 12 Months Ended | ||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Jun. 30, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Schedule of Equity Method Investments [Line Items] | |||||||||||
Business Combination, Step Acquisition, Equity Interest in Acquiree, Remeasurement Gain | $ (28,152) | $ (28,152) | |||||||||
Income tax expense | 258,400 | $ 323,859 | $ 431,761 | ||||||||
Valuation adjustment on disposal group | 316,840 | 0 | 0 | ||||||||
Equity investment (loss) income | (4,484) | (8,640) | 16,874 | ||||||||
Restructuring Charges | $ 9,569 | ||||||||||
Loss Contingency Accrual, Period Increase (Decrease) | 11,100 | $ 3,600 | |||||||||
Investment and other asset impairments | 17,338 | 295,234 | 14,993 | ||||||||
Share-based Compensation Arrangement by Share-based Payment Award, Plan Modification, Incremental Compensation Cost | $ 23,470 | 14,704 | |||||||||
Goodwill impairment charges | 3,106 | 36,196 | 28,415 | ||||||||
Gain (loss) related to litigation settlement | 0 | 526,827 | 0 | ||||||||
APAC JV - Deconsolidated Noncontrolling Entity | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Equity Method Investment, Realized Gain (Loss) on Disposal | $ (6,273) | ||||||||||
Equity investment (loss) income | 1,530 | 5,995 | 6,293 | (4,484) | (8,640) | 16,874 | |||||
Equity Method Investment, Other than Temporary Impairment | $ 280,066 | ||||||||||
Paladina - Direct Primary Care | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Equity Method Investment, Realized Gain (Loss) on Disposal | 1,506 | $ 35,205 | |||||||||
Tandigm Health | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Equity Method Investment, Realized Gain (Loss) on Disposal | 25,096 | ||||||||||
Business Combination, Bargain Purchase, Gain Recognized, Amount | (17,129) | ||||||||||
INDIA | APAC JV - Deconsolidated Noncontrolling Entity | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Equity investment (loss) income | 8,715 | ||||||||||
GERMANY | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Goodwill impairment charges | 3,106 | 3,106 | |||||||||
DaVita Rx - Pharmacy | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Restructuring Charges | 11,366 | ||||||||||
Investment and other asset impairments | 6,093 | ||||||||||
Asset Impairment Charges | 11,245 | 15,168 | |||||||||
International Operations | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Equity Method Investment, Realized Gain (Loss) on Disposal | $ 1,248 | ||||||||||
Restructuring Charges | 2,700 | ||||||||||
Goodwill impairment charges | 1,500 | ||||||||||
Vascular access | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Goodwill impairment charges | 24,198 | $ 10,498 | 34,696 | 28,415 | |||||||
U.S. Department of Veterans Affairs (VA) | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Gain (loss) related to litigation settlement | $ (529,504) | 527,000 | |||||||||
DMG - Held for sale | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Goodwill impairment charges | $ 601,040 | $ 50,619 | |||||||||
DMG - Held for sale | Discontinued Operations, Held-for-sale | |||||||||||
Schedule of Equity Method Investments [Line Items] | |||||||||||
Income tax expense | $ 163,555 | ||||||||||
Valuation adjustment on disposal group | 218,639 | 98,201 | 316,840 | ||||||||
Goodwill impairment charges | 41,537 | 41,537 | $ 651,659 | $ 253,000 | |||||||
Tax expense related to valuation adjustment, disposal group, including discontinued operation | $ 8,318 | 117,946 | 109,628 | ||||||||
Valuation Charge To Record Valuation Allowance And Related Tax Expense, Disposal Group, Including Discontinued Operations | $ 216,147 | $ 468,005 |
Supplemental Data (unaudited) -
Supplemental Data (unaudited) - Condensed Consolidating Statements of Income (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Condensed Income Statements, Captions [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | $ 10,709,981 | $ 10,093,670 | $ 9,727,360 | ||||||||
Provision for uncollectible accounts | (49,587) | (485,364) | (431,304) | ||||||||
Net dialysis and related lab patient service revenues | 10,660,394 | 9,608,306 | 9,296,056 | ||||||||
Other revenues | 744,457 | 1,268,328 | 1,411,411 | ||||||||
Total revenues | $ 2,821,124 | $ 2,847,330 | $ 2,886,953 | $ 2,849,444 | $ 2,780,913 | $ 2,765,071 | $ 2,699,399 | $ 2,631,251 | 11,404,851 | 10,876,634 | 10,707,467 |
Operating expenses and charges | 9,879,027 | 9,063,879 | 8,677,757 | ||||||||
Operating income | 387,908 | 289,038 | 438,192 | 410,686 | 150,337 | 395,294 | 391,196 | 875,928 | 1,525,824 | 1,812,755 | 2,029,710 |
Debt expense | (487,435) | (430,634) | (414,116) | ||||||||
Other income, net | 10,089 | 17,665 | 7,511 | ||||||||
Income tax expense | 258,400 | 323,859 | 431,761 | ||||||||
Net income from continuing operations | 790,078 | 1,075,927 | 1,191,344 | ||||||||
Net loss from discontinued operations, net of tax | (457,038) | (245,372) | (158,262) | ||||||||
Net income | 333,040 | 830,555 | 1,033,082 | ||||||||
Less: Net income attributable to noncontrolling interests | (173,646) | (166,937) | (153,208) | ||||||||
Net (loss) income attributable to DaVita Inc. | $ (149,772) | $ (136,796) | $ 267,276 | $ 178,686 | $ 303,396 | $ (214,476) | $ 127,001 | $ 447,697 | 159,394 | $ 663,618 | $ 879,874 |
Physician Groups | |||||||||||
Condensed Income Statements, Captions [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 0 | ||||||||||
Provision for uncollectible accounts | 0 | ||||||||||
Net dialysis and related lab patient service revenues | 0 | ||||||||||
Other revenues | 0 | ||||||||||
Total revenues | 0 | ||||||||||
Operating expenses and charges | 0 | ||||||||||
Operating income | 0 | ||||||||||
Debt expense | 0 | ||||||||||
Other income, net | 0 | ||||||||||
Income tax expense | 0 | ||||||||||
Net income from continuing operations | 0 | ||||||||||
Net loss from discontinued operations, net of tax | 37,373 | ||||||||||
Net income | 37,373 | ||||||||||
Less: Net income attributable to noncontrolling interests | (7,841) | ||||||||||
Net (loss) income attributable to DaVita Inc. | 29,532 | ||||||||||
Unrestricted Subsidiaries | |||||||||||
Condensed Income Statements, Captions [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 0 | ||||||||||
Provision for uncollectible accounts | 0 | ||||||||||
Net dialysis and related lab patient service revenues | 0 | ||||||||||
Other revenues | 0 | ||||||||||
Total revenues | 0 | ||||||||||
Operating expenses and charges | 0 | ||||||||||
Operating income | 0 | ||||||||||
Debt expense | 0 | ||||||||||
Other income, net | 0 | ||||||||||
Income tax expense | 0 | ||||||||||
Net income from continuing operations | 0 | ||||||||||
Net loss from discontinued operations, net of tax | 92 | ||||||||||
Net income | 92 | ||||||||||
Less: Net income attributable to noncontrolling interests | 0 | ||||||||||
Net (loss) income attributable to DaVita Inc. | 92 | ||||||||||
Company and Restricted Subsidiaries(1) | |||||||||||
Condensed Income Statements, Captions [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 10,709,981 | ||||||||||
Provision for uncollectible accounts | (49,587) | ||||||||||
Net dialysis and related lab patient service revenues | 10,660,394 | ||||||||||
Other revenues | 744,457 | ||||||||||
Total revenues | 11,404,851 | ||||||||||
Operating expenses and charges | 9,879,027 | ||||||||||
Operating income | 1,525,824 | ||||||||||
Debt expense | (487,435) | ||||||||||
Other income, net | 10,089 | ||||||||||
Income tax expense | 258,400 | ||||||||||
Net income from continuing operations | 790,078 | ||||||||||
Net loss from discontinued operations, net of tax | (494,503) | ||||||||||
Net income | 295,575 | ||||||||||
Less: Net income attributable to noncontrolling interests | (165,805) | ||||||||||
Net (loss) income attributable to DaVita Inc. | $ 129,770 |
Supplemental Data (unaudited)_2
Supplemental Data (unaudited) - Condensed Consolidating Statements of Comprehensive Income (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Condensed Financial Statements, Captions [Line Items] | |||
Net income | $ 333,040 | $ 830,555 | $ 1,033,082 |
Other comprehensive loss | (39,791) | 102,876 | (29,627) |
Total comprehensive income | 293,249 | 933,431 | 1,003,455 |
Less: Comprehensive income attributable to noncontrolling interests | (173,646) | (166,935) | (153,398) |
Comprehensive income attributable to DaVita Inc. | 119,603 | $ 766,496 | $ 850,057 |
Physician Groups | |||
Condensed Financial Statements, Captions [Line Items] | |||
Net income | 37,373 | ||
Other comprehensive loss | 0 | ||
Total comprehensive income | 37,373 | ||
Less: Comprehensive income attributable to noncontrolling interests | (7,841) | ||
Comprehensive income attributable to DaVita Inc. | 29,532 | ||
Unrestricted Subsidiaries | |||
Condensed Financial Statements, Captions [Line Items] | |||
Net income | 92 | ||
Other comprehensive loss | 0 | ||
Total comprehensive income | 92 | ||
Less: Comprehensive income attributable to noncontrolling interests | 0 | ||
Comprehensive income attributable to DaVita Inc. | 92 | ||
Company and Restricted Subsidiaries(1) | |||
Condensed Financial Statements, Captions [Line Items] | |||
Net income | 295,575 | ||
Other comprehensive loss | (39,791) | ||
Total comprehensive income | 255,784 | ||
Less: Comprehensive income attributable to noncontrolling interests | (165,805) | ||
Comprehensive income attributable to DaVita Inc. | $ 89,979 |
Supplemental Data (unaudited)_3
Supplemental Data (unaudited) - Condensed Consolidating Balance Sheets (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 |
Condensed Balance Sheet Statements, Captions [Line Items] | |||
Cash and cash equivalents | $ 323,038 | $ 508,234 | |
Restricted cash and equivalents | 92,382 | 10,686 | |
Accounts receivable, net | 1,858,608 | 1,714,750 | |
Other current assets | 760,566 | 775,389 | |
Current assets held for sale, net | 5,389,565 | 5,761,642 | |
Total current assets | 8,424,159 | 8,770,701 | |
Property and equipment, net | 3,393,669 | 3,149,213 | |
Amortizable intangibles, net | 118,846 | 113,827 | |
Other long-term assets | 331,618 | 330,516 | |
Goodwill | 6,841,960 | 6,610,279 | $ 6,015,375 |
Total assets | 19,110,252 | 18,974,536 | |
Current liabilities | 3,647,402 | 1,882,450 | |
Current liabilities held for sale | 1,243,759 | 1,185,070 | |
Total current liabilities | 4,891,161 | 3,067,520 | |
Payables to parent | 0 | ||
Long-term debt and other long-term liabilities | 9,186,052 | 10,009,590 | |
Noncontrolling interests subject to put provisions | 1,124,641 | 1,011,360 | |
Total DaVita Inc. shareholders' equity | 3,703,442 | 4,690,029 | |
Noncontrolling interests not subject to put provisions | 204,956 | 196,037 | |
Total equity | 3,908,398 | 4,886,066 | |
Total liabilities and shareholders' equity | 19,110,252 | $ 18,974,536 | |
Physician Groups | |||
Condensed Balance Sheet Statements, Captions [Line Items] | |||
Cash and cash equivalents | 0 | ||
Restricted cash and equivalents | 0 | ||
Accounts receivable, net | 0 | ||
Other current assets | 0 | ||
Current assets held for sale, net | 532,050 | ||
Total current assets | 532,050 | ||
Property and equipment, net | 0 | ||
Amortizable intangibles, net | 0 | ||
Other long-term assets | 0 | ||
Goodwill | 0 | ||
Total assets | 532,050 | ||
Current liabilities | 0 | ||
Current liabilities held for sale | 351,925 | ||
Total current liabilities | 351,925 | ||
Payables to parent | 25,456 | ||
Long-term debt and other long-term liabilities | 0 | ||
Noncontrolling interests subject to put provisions | 0 | ||
Total DaVita Inc. shareholders' equity | 154,669 | ||
Noncontrolling interests not subject to put provisions | 0 | ||
Total equity | 154,669 | ||
Total liabilities and shareholders' equity | 532,050 | ||
Unrestricted Subsidiaries | |||
Condensed Balance Sheet Statements, Captions [Line Items] | |||
Cash and cash equivalents | 0 | ||
Restricted cash and equivalents | 0 | ||
Accounts receivable, net | 0 | ||
Other current assets | 0 | ||
Current assets held for sale, net | 2,825 | ||
Total current assets | 2,825 | ||
Property and equipment, net | 0 | ||
Amortizable intangibles, net | 0 | ||
Other long-term assets | 0 | ||
Goodwill | 0 | ||
Total assets | 2,825 | ||
Current liabilities | 0 | ||
Current liabilities held for sale | 0 | ||
Total current liabilities | 0 | ||
Payables to parent | 2,825 | ||
Long-term debt and other long-term liabilities | 0 | ||
Noncontrolling interests subject to put provisions | 0 | ||
Total DaVita Inc. shareholders' equity | 0 | ||
Noncontrolling interests not subject to put provisions | 0 | ||
Total equity | 0 | ||
Total liabilities and shareholders' equity | 2,825 | ||
Company and Restricted Subsidiaries(1) | |||
Condensed Balance Sheet Statements, Captions [Line Items] | |||
Cash and cash equivalents | 323,038 | ||
Restricted cash and equivalents | 92,382 | ||
Accounts receivable, net | 1,858,608 | ||
Other current assets | 760,566 | ||
Current assets held for sale, net | 4,854,690 | ||
Total current assets | 7,889,284 | ||
Property and equipment, net | 3,393,669 | ||
Amortizable intangibles, net | 118,846 | ||
Other long-term assets | 331,618 | ||
Goodwill | 6,841,960 | ||
Total assets | 18,575,377 | ||
Current liabilities | 3,647,402 | ||
Current liabilities held for sale | 891,834 | ||
Total current liabilities | 4,539,236 | ||
Payables to parent | (28,281) | ||
Long-term debt and other long-term liabilities | 9,186,052 | ||
Noncontrolling interests subject to put provisions | 1,124,641 | ||
Total DaVita Inc. shareholders' equity | 3,548,773 | ||
Noncontrolling interests not subject to put provisions | 204,956 | ||
Total equity | 3,753,729 | ||
Total liabilities and shareholders' equity | $ 18,575,377 |
Supplemental Data (unaudited)_4
Supplemental Data (unaudited) - Condensed Consolidating Statements of Cash Flows (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Cash flows from operating activities: | |||
Net income | $ 333,040 | $ 830,555 | $ 1,033,082 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 1,438,600 | 1,082,611 | 939,044 |
Net cash provided by operating activities | 1,771,640 | 1,913,166 | 1,972,126 |
Cash flows from investing activities: | |||
Additions of property and equipment | (987,138) | (905,250) | (829,095) |
Acquisitions and divestitures, net | (183,156) | ||
Proceeds from asset sales | 150,205 | ||
Investments and other items, net | 14,446 | 252,061 | 126,558 |
Net cash used in investing activities | (1,005,643) | (1,364,732) | (1,201,668) |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | 694,777 | 154,848 | (124,442) |
Intercompany | 0 | 0 | 0 |
Other items | (1,320,131) | (921,105) | (1,227,539) |
Net cash used in financing activities | (625,354) | (766,257) | (1,351,981) |
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations | (3,350) | 254 | 4,276 |
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 137,293 | (217,569) | (577,247) |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 518,920 | 683,463 | 1,244,917 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 415,420 | 518,920 | 683,463 |
Physician Groups | |||
Cash flows from operating activities: | |||
Net income | 37,373 | ||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 81,722 | ||
Net cash provided by operating activities | 119,095 | ||
Cash flows from investing activities: | |||
Additions of property and equipment | (2,746) | ||
Acquisitions and divestitures, net | 0 | ||
Proceeds from asset sales | 0 | ||
Investments and other items, net | (154) | ||
Net cash used in investing activities | (2,900) | ||
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | 0 | ||
Intercompany | 25,296 | ||
Other items | 0 | ||
Net cash used in financing activities | 25,296 | ||
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations | 0 | ||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 141,491 | ||
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 0 | ||
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 0 | 0 | |
Unrestricted Subsidiaries | |||
Cash flows from operating activities: | |||
Net income | 92 | ||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | (92) | ||
Net cash provided by operating activities | 0 | ||
Cash flows from investing activities: | |||
Additions of property and equipment | 0 | ||
Acquisitions and divestitures, net | 0 | ||
Proceeds from asset sales | 0 | ||
Investments and other items, net | 0 | ||
Net cash used in investing activities | 0 | ||
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | 0 | ||
Intercompany | 0 | ||
Other items | 0 | ||
Net cash used in financing activities | 0 | ||
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations | 0 | ||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 0 | ||
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 0 | ||
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 0 | 0 | |
Company and Restricted Subsidiaries(1) | |||
Cash flows from operating activities: | |||
Net income | 295,575 | ||
Changes in operating and intercompany assets and liabilities and non-cash items included in net income | 1,356,970 | ||
Net cash provided by operating activities | 1,652,545 | ||
Cash flows from investing activities: | |||
Additions of property and equipment | (984,392) | ||
Acquisitions and divestitures, net | (183,156) | ||
Proceeds from asset sales | 150,205 | ||
Investments and other items, net | 14,600 | ||
Net cash used in investing activities | (1,002,743) | ||
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | 694,777 | ||
Intercompany | (25,296) | ||
Other items | (1,320,131) | ||
Net cash used in financing activities | (650,650) | ||
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations | (3,350) | ||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | (4,198) | ||
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 518,920 | ||
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 415,420 | 518,920 | |
Discontinued Operations | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 240,793 | (53,026) | (15,793) |
Discontinued Operations | Physician Groups | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 141,491 | ||
Discontinued Operations | Unrestricted Subsidiaries | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 0 | ||
Discontinued Operations | Company and Restricted Subsidiaries(1) | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 99,302 | ||
Continuing Operations | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | (103,500) | $ (164,543) | $ (561,454) |
Continuing Operations | Physician Groups | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 0 | ||
Continuing Operations | Unrestricted Subsidiaries | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 0 | ||
Continuing Operations | Company and Restricted Subsidiaries(1) | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | $ (103,500) |
Consolidating Financial State_3
Consolidating Financial Statements - Consolidating Statements of Income (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | |||||||||
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Condensed Income Statements, Captions [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | $ 10,709,981 | $ 10,093,670 | $ 9,727,360 | ||||||||
Provision for uncollectible accounts | (49,587) | (485,364) | (431,304) | ||||||||
Net dialysis and related lab patient service revenues | 10,660,394 | 9,608,306 | 9,296,056 | ||||||||
Other revenues | 744,457 | 1,268,328 | 1,411,411 | ||||||||
Total revenues | $ 2,821,124 | $ 2,847,330 | $ 2,886,953 | $ 2,849,444 | $ 2,780,913 | $ 2,765,071 | $ 2,699,399 | $ 2,631,251 | 11,404,851 | 10,876,634 | 10,707,467 |
Operating expenses and charges | 9,879,027 | 9,063,879 | 8,677,757 | ||||||||
Operating income | 387,908 | 289,038 | 438,192 | 410,686 | 150,337 | 395,294 | 391,196 | 875,928 | 1,525,824 | 1,812,755 | 2,029,710 |
Debt expense | (487,435) | (430,634) | (414,116) | ||||||||
Other income, net | 10,089 | 17,665 | 7,511 | ||||||||
Income tax expense | 258,400 | 323,859 | 431,761 | ||||||||
Equity earnings in subsidiaries | 0 | 0 | 0 | ||||||||
Net income from continuing operations | 790,078 | 1,075,927 | 1,191,344 | ||||||||
Net loss from discontinued operations, net of tax | (457,038) | (245,372) | (158,262) | ||||||||
Net income | 333,040 | 830,555 | 1,033,082 | ||||||||
Less: Net income attributable to noncontrolling interests | (173,646) | (166,937) | (153,208) | ||||||||
Net (loss) income attributable to DaVita Inc. | $ (149,772) | $ (136,796) | $ 267,276 | $ 178,686 | $ 303,396 | $ (214,476) | $ 127,001 | $ 447,697 | 159,394 | 663,618 | 879,874 |
Consolidating Adjustments | |||||||||||
Condensed Income Statements, Captions [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | (210,670) | (184,106) | (153,326) | ||||||||
Provision for uncollectible accounts | 0 | 7,170 | 0 | ||||||||
Net dialysis and related lab patient service revenues | (210,670) | (176,936) | (153,326) | ||||||||
Other revenues | (959,189) | (798,212) | (765,516) | ||||||||
Total revenues | (1,169,859) | (975,148) | (918,842) | ||||||||
Operating expenses and charges | (1,169,859) | (975,148) | (918,842) | ||||||||
Operating income | 0 | 0 | 0 | ||||||||
Debt expense | 249,225 | 239,958 | 225,326 | ||||||||
Other income, net | (441,312) | (423,702) | (400,706) | ||||||||
Income tax expense | 0 | 0 | 0 | ||||||||
Equity earnings in subsidiaries | (447,221) | (552,567) | (1,360,998) | ||||||||
Net income from continuing operations | (639,308) | (736,311) | (1,536,378) | ||||||||
Net loss from discontinued operations, net of tax | 192,087 | 183,744 | 175,380 | ||||||||
Net income | (447,221) | (552,567) | (1,360,998) | ||||||||
Less: Net income attributable to noncontrolling interests | (173,646) | (166,937) | (153,208) | ||||||||
Net (loss) income attributable to DaVita Inc. | (620,867) | (719,504) | (1,514,206) | ||||||||
DaVita Inc. | Reportable Legal Entites | |||||||||||
Condensed Income Statements, Captions [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 0 | 0 | 0 | ||||||||
Provision for uncollectible accounts | 0 | 0 | 0 | ||||||||
Net dialysis and related lab patient service revenues | 0 | 0 | 0 | ||||||||
Other revenues | 799,230 | 793,751 | 767,791 | ||||||||
Total revenues | 799,230 | 793,751 | 767,791 | ||||||||
Operating expenses and charges | 646,640 | 527,942 | 493,175 | ||||||||
Operating income | 152,590 | 265,809 | 274,616 | ||||||||
Debt expense | (491,749) | (426,149) | (407,925) | ||||||||
Other income, net | 418,839 | 411,731 | 396,797 | ||||||||
Income tax expense | 23,482 | 65,965 | 77,334 | ||||||||
Equity earnings in subsidiaries | 103,196 | 478,192 | 693,720 | ||||||||
Net income from continuing operations | 159,394 | 663,618 | 879,874 | ||||||||
Net loss from discontinued operations, net of tax | 0 | 0 | 0 | ||||||||
Net income | 159,394 | 663,618 | 879,874 | ||||||||
Less: Net income attributable to noncontrolling interests | 0 | 0 | 0 | ||||||||
Net (loss) income attributable to DaVita Inc. | 159,394 | 663,618 | 879,874 | ||||||||
Guarantor Subsidiaries | Reportable Legal Entites | |||||||||||
Condensed Income Statements, Captions [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 7,263,195 | 6,884,750 | 6,665,601 | ||||||||
Provision for uncollectible accounts | (36,377) | (340,552) | (272,426) | ||||||||
Net dialysis and related lab patient service revenues | 7,226,818 | 6,544,198 | 6,393,175 | ||||||||
Other revenues | 714,489 | 1,204,467 | 1,378,952 | ||||||||
Total revenues | 7,941,307 | 7,748,665 | 7,772,127 | ||||||||
Operating expenses and charges | 7,100,415 | 6,475,550 | 6,907,469 | ||||||||
Operating income | 840,892 | 1,273,115 | 864,658 | ||||||||
Debt expense | (208,484) | (209,612) | (191,083) | ||||||||
Other income, net | 10,367 | 11,169 | 3,726 | ||||||||
Income tax expense | 187,691 | 237,670 | 238,446 | ||||||||
Equity earnings in subsidiaries | 344,025 | 74,375 | 667,278 | ||||||||
Net income from continuing operations | 799,109 | 911,377 | 1,106,133 | ||||||||
Net loss from discontinued operations, net of tax | (695,913) | (433,185) | (412,413) | ||||||||
Net income | 103,196 | 478,192 | 693,720 | ||||||||
Less: Net income attributable to noncontrolling interests | 0 | 0 | 0 | ||||||||
Net (loss) income attributable to DaVita Inc. | 103,196 | 478,192 | 693,720 | ||||||||
Non- Guarantor Subsidiaries | Reportable Legal Entites | |||||||||||
Condensed Income Statements, Captions [Line Items] | |||||||||||
Dialysis and related lab patient service revenues | 3,657,456 | 3,393,026 | 3,215,085 | ||||||||
Provision for uncollectible accounts | (13,210) | (151,982) | (158,878) | ||||||||
Net dialysis and related lab patient service revenues | 3,644,246 | 3,241,044 | 3,056,207 | ||||||||
Other revenues | 189,927 | 68,322 | 30,184 | ||||||||
Total revenues | 3,834,173 | 3,309,366 | 3,086,391 | ||||||||
Operating expenses and charges | 3,301,831 | 3,035,535 | 2,195,955 | ||||||||
Operating income | 532,342 | 273,831 | 890,436 | ||||||||
Debt expense | (36,427) | (34,831) | (40,434) | ||||||||
Other income, net | 22,195 | 18,467 | 7,694 | ||||||||
Income tax expense | 47,227 | 20,224 | 115,981 | ||||||||
Equity earnings in subsidiaries | 0 | 0 | 0 | ||||||||
Net income from continuing operations | 470,883 | 237,243 | 741,715 | ||||||||
Net loss from discontinued operations, net of tax | 46,788 | 4,069 | 78,771 | ||||||||
Net income | 517,671 | 241,312 | 820,486 | ||||||||
Less: Net income attributable to noncontrolling interests | 0 | 0 | 0 | ||||||||
Net (loss) income attributable to DaVita Inc. | $ 517,671 | $ 241,312 | $ 820,486 |
Consolidating Financial State_4
Consolidating Financial Statements - Consolidating Statements of Comprehensive Income (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Condensed Financial Statements, Captions [Line Items] | |||
Net income | $ 333,040 | $ 830,555 | $ 1,033,082 |
Other comprehensive income (loss) | (39,791) | 102,876 | (29,627) |
Total comprehensive income | 293,249 | 933,431 | 1,003,455 |
Less: Comprehensive income attributable to noncontrolling interests | (173,646) | (166,935) | (153,398) |
Comprehensive income attributable to DaVita Inc. | 119,603 | 766,496 | 850,057 |
Reportable Legal Entites | DaVita Inc. | |||
Condensed Financial Statements, Captions [Line Items] | |||
Net income | 159,394 | 663,618 | 879,874 |
Other comprehensive income (loss) | 6,153 | 3,106 | (290) |
Total comprehensive income | 165,547 | 666,724 | 879,584 |
Less: Comprehensive income attributable to noncontrolling interests | 0 | 0 | 0 |
Comprehensive income attributable to DaVita Inc. | 165,547 | 666,724 | 879,584 |
Reportable Legal Entites | Guarantor Subsidiaries | |||
Condensed Financial Statements, Captions [Line Items] | |||
Net income | 103,196 | 478,192 | 693,720 |
Other comprehensive income (loss) | 0 | 0 | 0 |
Total comprehensive income | 103,196 | 478,192 | 693,720 |
Less: Comprehensive income attributable to noncontrolling interests | 0 | 0 | 0 |
Comprehensive income attributable to DaVita Inc. | 103,196 | 478,192 | 693,720 |
Reportable Legal Entites | Non- Guarantor Subsidiaries | |||
Condensed Financial Statements, Captions [Line Items] | |||
Net income | 517,671 | 241,312 | 820,486 |
Other comprehensive income (loss) | (45,944) | 99,770 | (29,337) |
Total comprehensive income | 471,727 | 341,082 | 791,149 |
Less: Comprehensive income attributable to noncontrolling interests | 0 | 0 | 0 |
Comprehensive income attributable to DaVita Inc. | 471,727 | 341,082 | 791,149 |
Consolidating Adjustments | |||
Condensed Financial Statements, Captions [Line Items] | |||
Net income | (447,221) | (552,567) | (1,360,998) |
Other comprehensive income (loss) | 0 | 0 | 0 |
Total comprehensive income | (447,221) | (552,567) | (1,360,998) |
Less: Comprehensive income attributable to noncontrolling interests | (173,646) | (166,935) | (153,398) |
Comprehensive income attributable to DaVita Inc. | $ (620,867) | $ (719,502) | $ (1,514,396) |
Consolidating Financial State_5
Consolidating Financial Statements - Consolidating Balance Sheets (Details) - USD ($) $ in Thousands | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 |
Condensed Balance Sheet Statements, Captions [Line Items] | |||
Cash and cash equivalents | $ 323,038 | $ 508,234 | |
Restricted cash and equivalents | 92,382 | 10,686 | |
Accounts receivable, net | 1,858,608 | 1,714,750 | |
Other current assets | 760,566 | 775,389 | |
Current assets held for sale, net | 5,389,565 | 5,761,642 | |
Total current assets | 8,424,159 | 8,770,701 | |
Property and equipment, net | 3,393,669 | 3,149,213 | |
Intangible assets, net | 118,846 | 113,827 | |
Investments in subsidiaries | 0 | 0 | |
Intercompany receivables | 0 | 0 | |
Other long-term assets and investments | 331,618 | 330,516 | |
Goodwill | 6,841,960 | 6,610,279 | $ 6,015,375 |
Total assets | 19,110,252 | 18,974,536 | |
Current liabilities | 3,647,402 | 1,882,450 | |
Current liabilities held for sale | 1,243,759 | 1,185,070 | |
Total current liabilities | 4,891,161 | 3,067,520 | |
Intercompany payables | 0 | 0 | |
Long-term debt and other long-term liabilities | 9,186,052 | 10,009,590 | |
Noncontrolling interests subject to put provisions | 1,124,641 | 1,011,360 | |
Total DaVita Inc. shareholders' equity | 3,703,442 | 4,690,029 | |
Noncontrolling interests not subject to put provisions | 204,956 | 196,037 | |
Total equity | 3,908,398 | 4,886,066 | |
Total liabilities and shareholders' equity | 19,110,252 | 18,974,536 | |
Reportable Legal Entites | DaVita Inc. | |||
Condensed Balance Sheet Statements, Captions [Line Items] | |||
Cash and cash equivalents | 60,653 | 149,305 | |
Restricted cash and equivalents | 1,005 | 1,002 | |
Accounts receivable, net | 0 | 0 | |
Other current assets | 37,185 | 67,025 | |
Current assets held for sale, net | 0 | 0 | |
Total current assets | 98,843 | 217,332 | |
Property and equipment, net | 491,462 | 408,010 | |
Intangible assets, net | 153 | 250 | |
Investments in subsidiaries | 10,102,750 | 10,009,874 | |
Intercompany receivables | 3,419,448 | 3,677,947 | |
Other long-term assets and investments | 53,385 | 47,297 | |
Goodwill | 0 | 0 | |
Total assets | 14,166,041 | 14,360,710 | |
Current liabilities | 1,945,943 | 238,706 | |
Current liabilities held for sale | 0 | 0 | |
Total current liabilities | 1,945,943 | 238,706 | |
Intercompany payables | 0 | 0 | |
Long-term debt and other long-term liabilities | 7,918,581 | 8,857,373 | |
Noncontrolling interests subject to put provisions | 598,075 | 574,602 | |
Total DaVita Inc. shareholders' equity | 3,703,442 | 4,690,029 | |
Noncontrolling interests not subject to put provisions | 0 | 0 | |
Total equity | 3,703,442 | 4,690,029 | |
Total liabilities and shareholders' equity | 14,166,041 | 14,360,710 | |
Reportable Legal Entites | Guarantor Subsidiaries | |||
Condensed Balance Sheet Statements, Captions [Line Items] | |||
Cash and cash equivalents | 0 | 0 | |
Restricted cash and equivalents | 12,048 | 9,384 | |
Accounts receivable, net | 1,264,290 | 1,208,715 | |
Other current assets | 601,318 | 621,409 | |
Current assets held for sale, net | 4,440,953 | 4,992,067 | |
Total current assets | 6,318,609 | 6,831,575 | |
Property and equipment, net | 1,624,835 | 1,560,390 | |
Intangible assets, net | 42,933 | 50,971 | |
Investments in subsidiaries | 3,239,862 | 3,085,722 | |
Intercompany receivables | 0 | 0 | |
Other long-term assets and investments | 80,537 | 68,344 | |
Goodwill | 4,812,365 | 4,732,320 | |
Total assets | 16,119,141 | 16,329,322 | |
Current liabilities | 1,251,534 | 1,207,482 | |
Current liabilities held for sale | 722,766 | 739,294 | |
Total current liabilities | 1,974,300 | 1,946,776 | |
Intercompany payables | 3,327,026 | 3,690,042 | |
Long-term debt and other long-term liabilities | 715,065 | 682,630 | |
Noncontrolling interests subject to put provisions | 0 | 0 | |
Total DaVita Inc. shareholders' equity | 10,102,750 | 10,009,874 | |
Noncontrolling interests not subject to put provisions | 0 | 0 | |
Total equity | 10,102,750 | 10,009,874 | |
Total liabilities and shareholders' equity | 16,119,141 | 16,329,322 | |
Reportable Legal Entites | Non- Guarantor Subsidiaries | |||
Condensed Balance Sheet Statements, Captions [Line Items] | |||
Cash and cash equivalents | 262,385 | 358,929 | |
Restricted cash and equivalents | 79,329 | 300 | |
Accounts receivable, net | 594,318 | 506,035 | |
Other current assets | 122,063 | 86,955 | |
Current assets held for sale, net | 948,612 | 769,575 | |
Total current assets | 2,006,707 | 1,721,794 | |
Property and equipment, net | 1,277,372 | 1,180,813 | |
Intangible assets, net | 75,760 | 62,606 | |
Investments in subsidiaries | 0 | 0 | |
Intercompany receivables | 1,471,203 | 1,313,213 | |
Other long-term assets and investments | 197,696 | 214,875 | |
Goodwill | 2,029,595 | 1,877,959 | |
Total assets | 7,058,333 | 6,371,260 | |
Current liabilities | 449,925 | 436,262 | |
Current liabilities held for sale | 520,993 | 445,776 | |
Total current liabilities | 970,918 | 882,038 | |
Intercompany payables | 1,563,625 | 1,301,118 | |
Long-term debt and other long-term liabilities | 552,406 | 469,587 | |
Noncontrolling interests subject to put provisions | 0 | 0 | |
Total DaVita Inc. shareholders' equity | 3,239,862 | 3,085,722 | |
Noncontrolling interests not subject to put provisions | 731,522 | 632,795 | |
Total equity | 3,971,384 | 3,718,517 | |
Total liabilities and shareholders' equity | 7,058,333 | 6,371,260 | |
Consolidating Adjustments | |||
Condensed Balance Sheet Statements, Captions [Line Items] | |||
Cash and cash equivalents | 0 | 0 | |
Restricted cash and equivalents | 0 | 0 | |
Accounts receivable, net | 0 | 0 | |
Other current assets | 0 | 0 | |
Current assets held for sale, net | 0 | 0 | |
Total current assets | 0 | 0 | |
Property and equipment, net | 0 | 0 | |
Intangible assets, net | 0 | 0 | |
Investments in subsidiaries | (13,342,612) | (13,095,596) | |
Intercompany receivables | (4,890,651) | (4,991,160) | |
Other long-term assets and investments | 0 | 0 | |
Goodwill | 0 | 0 | |
Total assets | (18,233,263) | (18,086,756) | |
Current liabilities | 0 | 0 | |
Current liabilities held for sale | 0 | 0 | |
Total current liabilities | 0 | 0 | |
Intercompany payables | (4,890,651) | (4,991,160) | |
Long-term debt and other long-term liabilities | 0 | 0 | |
Noncontrolling interests subject to put provisions | 526,566 | 436,758 | |
Total DaVita Inc. shareholders' equity | (13,342,612) | (13,095,596) | |
Noncontrolling interests not subject to put provisions | (526,566) | (436,758) | |
Total equity | (13,869,178) | (13,532,354) | |
Total liabilities and shareholders' equity | $ (18,233,263) | $ (18,086,756) |
Consolidating Financial State_6
Consolidating Financial Statements - Consolidating Statements of Cash Flows (Details) - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
Cash flows from operating activities: | |||
Net income | $ 333,040 | $ 830,555 | $ 1,033,082 |
Changes in operating assets and liabilities and non-cash items included in net income | 1,438,600 | 1,082,611 | 939,044 |
Net cash provided by operating activities | 1,771,640 | 1,913,166 | 1,972,126 |
Cash flows from investing activities: | |||
Additions of property and equipment | (987,138) | (905,250) | (829,095) |
Acquisitions | (183,156) | (803,879) | (563,856) |
Proceeds from asset and business sales | 150,205 | 92,336 | 64,725 |
Investments and other items | 14,446 | 252,061 | 126,558 |
Net cash used in investing activities | (1,005,643) | (1,364,732) | (1,201,668) |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | 694,777 | 154,848 | (124,442) |
Intercompany borrowing | 0 | 0 | 0 |
Other items | (1,320,131) | (921,105) | (1,227,539) |
Net cash used in financing activities | (625,354) | (766,257) | (1,351,981) |
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations | (3,350) | 254 | 4,276 |
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 137,293 | (217,569) | (577,247) |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 518,920 | 683,463 | 1,244,917 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 415,420 | 518,920 | 683,463 |
Reportable Legal Entites | DaVita Inc. | |||
Cash flows from operating activities: | |||
Net income | 159,394 | 663,618 | 879,874 |
Changes in operating assets and liabilities and non-cash items included in net income | (86,070) | (533,300) | (612,706) |
Net cash provided by operating activities | 73,324 | 130,318 | 267,168 |
Cash flows from investing activities: | |||
Additions of property and equipment | (175,787) | (155,972) | (139,303) |
Acquisitions | 0 | 0 | 0 |
Proceeds from asset and business sales | 0 | 0 | 0 |
Investments and other items | 30,962 | 211,619 | 153,031 |
Net cash used in investing activities | (144,825) | 55,647 | 13,728 |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | 725,889 | 173,529 | (92,460) |
Intercompany borrowing | 404,897 | 22,589 | 236,052 |
Other items | (1,147,934) | (781,697) | (1,061,203) |
Net cash used in financing activities | (17,148) | (585,579) | (917,611) |
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations | 0 | 0 | 0 |
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | (88,649) | (399,614) | (636,715) |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 150,307 | 549,921 | 1,186,636 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 61,658 | 150,307 | 549,921 |
Reportable Legal Entites | Guarantor Subsidiaries | |||
Cash flows from operating activities: | |||
Net income | 103,196 | 478,192 | 693,720 |
Changes in operating assets and liabilities and non-cash items included in net income | 818,027 | 368,135 | 359,366 |
Net cash provided by operating activities | 921,223 | 846,327 | 1,053,086 |
Cash flows from investing activities: | |||
Additions of property and equipment | (534,278) | (490,800) | (382,305) |
Acquisitions | (73,046) | (693,522) | (472,413) |
Proceeds from asset and business sales | 61,962 | 90,340 | 70,342 |
Investments and other items | (16,362) | (7,004) | (29,038) |
Net cash used in investing activities | (561,724) | (1,100,986) | (813,414) |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | (11,437) | (12,662) | (27,830) |
Intercompany borrowing | (311,778) | 218,980 | (231,800) |
Other items | (28,067) | (2,493) | (21,525) |
Net cash used in financing activities | (351,282) | 203,825 | (281,155) |
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations | 0 | 0 | 0 |
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 8,217 | (50,834) | (41,483) |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 9,384 | 8,687 | 0 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 12,048 | 9,384 | 8,687 |
Reportable Legal Entites | Non- Guarantor Subsidiaries | |||
Cash flows from operating activities: | |||
Net income | 517,671 | 241,312 | 820,486 |
Changes in operating assets and liabilities and non-cash items included in net income | 259,422 | 695,209 | (168,614) |
Net cash provided by operating activities | 777,093 | 936,521 | 651,872 |
Cash flows from investing activities: | |||
Additions of property and equipment | (277,073) | (258,478) | (307,487) |
Acquisitions | (110,110) | (110,357) | (91,443) |
Proceeds from asset and business sales | 88,243 | 1,996 | (5,617) |
Investments and other items | (154) | 47,446 | 2,565 |
Net cash used in investing activities | (299,094) | (319,393) | (401,982) |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | (19,675) | (6,019) | (4,152) |
Intercompany borrowing | (93,119) | (241,569) | (4,252) |
Other items | (144,130) | (136,915) | (144,811) |
Net cash used in financing activities | (256,924) | (384,503) | (153,215) |
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations | (3,350) | 254 | 4,276 |
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 217,725 | 232,879 | 100,951 |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 359,229 | 124,855 | 58,281 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 341,714 | 359,229 | 124,855 |
Consolidating Adjustments | |||
Cash flows from operating activities: | |||
Net income | (447,221) | (552,567) | (1,360,998) |
Changes in operating assets and liabilities and non-cash items included in net income | 447,221 | 552,567 | 1,360,998 |
Net cash provided by operating activities | 0 | 0 | 0 |
Cash flows from investing activities: | |||
Additions of property and equipment | 0 | 0 | 0 |
Acquisitions | 0 | 0 | 0 |
Proceeds from asset and business sales | 0 | 0 | 0 |
Investments and other items | 0 | 0 | 0 |
Net cash used in investing activities | 0 | 0 | 0 |
Cash flows from financing activities: | |||
Long-term debt and related financing costs, net | 0 | 0 | 0 |
Intercompany borrowing | 0 | 0 | 0 |
Other items | 0 | 0 | 0 |
Net cash used in financing activities | 0 | 0 | 0 |
Effect of Exchange Rate on Cash, Cash Equivalents, Restricted Cash and Restricted Cash Equivalents, Including Disposal Group and Discontinued Operations | 0 | 0 | 0 |
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 0 | 0 | 0 |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year | 0 | 0 | 0 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year | 0 | 0 | 0 |
Discontinued Operations | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 240,793 | (53,026) | (15,793) |
Discontinued Operations | Reportable Legal Entites | DaVita Inc. | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 0 | 0 | 0 |
Discontinued Operations | Reportable Legal Entites | Guarantor Subsidiaries | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 5,553 | (51,531) | (50,170) |
Discontinued Operations | Reportable Legal Entites | Non- Guarantor Subsidiaries | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 235,240 | (1,495) | 34,377 |
Discontinued Operations | Consolidating Adjustments | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 0 | 0 | 0 |
Continuing Operations | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | (103,500) | (164,543) | (561,454) |
Continuing Operations | Reportable Legal Entites | DaVita Inc. | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | (88,649) | (399,614) | (636,715) |
Continuing Operations | Reportable Legal Entites | Guarantor Subsidiaries | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | 2,664 | 697 | 8,687 |
Continuing Operations | Reportable Legal Entites | Non- Guarantor Subsidiaries | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | (17,515) | 234,374 | 66,574 |
Continuing Operations | Consolidating Adjustments | |||
Cash flows from financing activities: | |||
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations | $ 0 | $ 0 | $ 0 |
SCHEDULE II - VALUATION AND QUA
SCHEDULE II - VALUATION AND QUALIFYING ACCOUNTS (Details) - Allowance for uncollectible Accounts - USD ($) $ in Thousands | 12 Months Ended | ||
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016 | |
SEC Schedule, 12-09, Valuation and Qualifying Accounts Disclosure [Line Items] | |||
Balance at beginning of year | $ 218,399 | $ 238,897 | $ 251,734 |
Acquisitions | 0 | 0 | 0 |
Amounts charged to income | 42,287 | 478,365 | 442,985 |
Amounts written off | 207,762 | 498,863 | 455,822 |
Balance at end of year | $ 52,924 | $ 218,399 | $ 238,897 |