Goodwill

Changes in goodwill by reportable segments were as follows:

							Other-ancillary
	U.S. dialysis and						services and
	related lab services			HCP			strategic initiatives			Consolidated total
Balance at January 1, 2015	$	5,610,643		$	3,562,534		$	242,118		$	9,415,295
Acquisitions		21,910			29,910			45,273			97,093
Divestitures		(3,370	)		(5,411	)		—			(8,781	)
Goodwill impairment charges		—			(188,769	)		(4,065	)		(192,834	)
Foreign currency and other adjustments		—			—			(16,294	)		(16,294	)
Balance at December 31, 2015	$	5,629,183		$	3,398,264		$	267,032		$	9,294,479
Acquisitions		52,792			248,622			19,598			321,012
Divestitures		(4,222	)		(758	)		—			(4,980	)
Goodwill impairment charges		—			(253,000	)		—			(253,000	)
Foreign currency and other adjustments		—			—			3,446			3,446
Balance at June 30, 2016	$	5,677,753		$	3,393,128		$	290,076		$	9,360,957

Each of the Company’s operating segments described in Note 17 to these condensed consolidated financial statements represents an individual reporting unit for goodwill impairment testing purposes, except that each sovereign jurisdiction within the Company’s international operating segments is considered a separate reporting unit.

Within the U.S. dialysis and related lab services operating segment, the Company considers each of its dialysis centers to constitute an individual business for which discrete financial information is available. However, since these dialysis centers have similar operating and economic characteristics, and the allocation of resources and significant investment decisions concerning these businesses are highly centralized and the benefits broadly distributed, the Company has aggregated these centers and deemed them to constitute a single reporting unit.

The Company has applied a similar aggregation to the HCP operations in each region, to the vascular access service centers in its vascular access services reporting unit, to the physician practices in its physician services reporting unit, and to the dialysis centers within each international reporting unit. For the Company’s other operating segments, no component below the operating segment level is considered a discrete business and therefore these operating segments directly constitute individual reporting units.

Based on continuing developments at the Company’s HCP reporting units during the second quarter of 2016, including the Medicare Advantage final benchmark rates for 2017 announced on April 4, 2016, further changes in expectations concerning future government reimbursement rates and the Company’s expected ability to mitigate them, as well as medical cost and utilization trends, underperformance of certain at-risk units in recent quarters and other market conditions, the Company performed additional impairment assessments for certain at-risk HCP reporting units during the quarter ended June 30, 2016.

As a result of these second quarter assessments, the Company recognized additional goodwill impairment charges of $79,000 for its HCP Nevada reporting unit and $97,000 for its HCP Florida reporting unit during the quarter ended June 30, 2016, and a total of $253,000 in goodwill impairment charges recognized for its HCP reporting units during the six months ended June 30, 2016.

The Company’s HCP Nevada, HCP Florida, HCP Colorado Springs and Kidney Care Malaysia reporting units remain at risk of goodwill impairment. As of June 30, 2016, these reporting units have goodwill amounts of $262,668, $442,835, $16,897 and $13,668, respectively. As of June 30, 2016, the latest estimated fair values of the HCP Nevada, HCP Florida, HCP Colorado Springs and Kidney Care Malaysia reporting units (fell short of) exceeded their total carrying amounts by approximately (25.6)%, (15.0)%, 13.0% and 10.2%, respectively.

For the Company’s at-risk HCP reporting units, further reductions in reimbursement rates, increases in medical cost or utilization trends, or other significant adverse changes in expected future cash flows or valuation assumptions could result in further goodwill impairment charges in the future. For example, a sustained, long-term reduction of 3% in operating income for HCP Nevada or HCP Florida could reduce their estimated fair values by up to 2.2% and 1.6%, respectively. Separately, an increase in their respective discount rates of 100 basis points could reduce the estimated fair values of HCP Nevada and HCP Florida by up to 4.8% and 4.5%, respectively.

Except as described above, none of the Company’s various other reporting units was considered at risk of goodwill impairment as of June 30, 2016. Since the dates of the Company’s last annual goodwill impairment tests, there have been certain developments, events, changes in operating performance and other changes in key circumstances that have affected the Company’s businesses. However, except as further described above, these did not cause management to believe it is more likely than not that the fair value of any of its reporting units would be less than its carrying amount.