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Condensed Consolidating financial statements (Tables)
 9 Months Ended
Sep. 30, 2017
Organization, Consolidation and Presentation of Financial Statements [Abstract]  
Condensed Consolidating Statements of Operations
Condensed Consolidating Statements of Operations
 
 
 
DaVita Inc.
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Three Months Ended September 30, 2017
 
 
 
 
 
Patient services revenues
 
$
—

 
$
1,732,287

 
$
1,076,035

 
$
(62,065
)
 
$
2,746,257

Less: Provision for uncollectible accounts
 
—

 
(82,860
)
 
(46,989
)
 
6,089

 
(123,760
)
Net patient service revenues
 
—

 
1,649,427

 
1,029,046

 
(55,976
)
 
2,622,497

Capitated revenues
 
—

 
461,866

 
555,481

 
(982
)
 
1,016,365

Other revenues
 
189,275

 
468,948

 
52,283

 
(426,537
)
 
283,969

Total net revenues
 
189,275

 
2,580,241

 
1,636,810

 
(483,495
)
 
3,922,831

Operating expenses and charges
 
128,488

 
2,964,867

 
1,505,494

 
(483,495
)
 
4,115,354

Operating income (loss)
 
60,787

 
(384,626
)
 
131,316

 
—

 
(192,523
)
Debt expense
 
(108,453
)
 
(93,243
)
 
(16,168
)
 
108,241

 
(109,623
)
Other income, net
 
104,250

 
1,774

 
6,587

 
(108,241
)
 
4,370

Income tax expense (benefit)
 
27,624

 
(150,192
)
 
(3,174
)
 
—

 
(125,742
)
Equity (losses) earnings in subsidiaries
 
(243,436
)
 
82,467

 
—

 
160,969

 
—

Net (loss) income
 
(214,476
)
 
(243,436
)
 
124,909

 
160,969

 
(172,034
)
Less: Net income attributable to noncontrolling interests
 
—

 
—

 
—

 
(42,442
)
 
(42,442
)
Net (loss) income attributable to DaVita Inc.
 
$
(214,476
)
 
$
(243,436
)
 
$
124,909

 
$
118,527

 
$
(214,476
)

 
 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Three Months Ended September 30, 2016
 
DaVita Inc.
 
 
 
 
Patient service revenues
 
$
—

 
$
1,726,892

 
$
959,193

 
$
(42,891
)
 
$
2,643,194

Less: Provision for uncollectible accounts
 
—

 
(73,833
)
 
(41,722
)
 
—

 
(115,555
)
Net patient service revenues
 
—

 
1,653,059

 
917,471

 
(42,891
)
 
2,527,639

Capitated revenues
 
—

 
465,684

 
406,893

 
(39
)
 
872,538

Other revenues
 
191,815

 
506,619

 
32,652

 
(400,687
)
 
330,399

Total net revenues
 
191,815

 
2,625,362

 
1,357,016

 
(443,617
)
 
3,730,576

Operating expenses
 
143,784

 
2,388,114

 
823,139

 
(443,617
)
 
2,911,420

Operating income
 
48,031

 
237,248

 
533,877

 
—

 
819,156

Debt expense
 
(101,895
)
 
(91,716
)
 
(14,402
)
 
103,432

 
(104,581
)
Other income
 
99,446

 
2,659

 
3,203

 
(103,432
)
 
1,876

Income tax (benefit) expense
 
(20,898
)
 
(21,486
)
 
146,685

 
—

 
104,301

Equity earnings in subsidiaries
 
504,852

 
335,175

 
—

 
(840,027
)
 
—

Net income
 
571,332

 
504,852

 
375,993

 
(840,027
)
 
612,150

Less: Net income attributable to noncontrolling interests
 
—

 
—

 
—

 
(40,818
)
 
(40,818
)
Net income attributable to DaVita Inc.
 
$
571,332

 
$
504,852

 
$
375,993

 
$
(880,845
)
 
$
571,332


 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Nine Months Ended September 30, 2017
 
DaVita Inc.
 
 
 
 
Patient services revenues
 
$
—

 
$
4,966,892

 
$
3,230,584

 
$
(167,374
)
 
$
8,030,102

Less: Provision for uncollectible accounts
 
—

 
(219,554
)
 
(138,763
)
 
6,089

 
(352,228
)
Net patient service revenues
 
—

 
4,747,338

 
3,091,821

 
(161,285
)
 
7,677,874

Capitated revenues
 
—

 
1,393,345

 
1,566,382

 
(3,248
)
 
2,956,479

Other revenues
 
604,246

 
1,448,484

 
122,177

 
(1,311,669
)
 
863,238

Total net revenues
 
604,246

 
7,589,167

 
4,780,380

 
(1,476,202
)
 
11,497,591

Operating expenses and charges
 
398,502

 
7,241,745

 
4,259,517

 
(1,476,202
)
 
10,423,562

Operating income
 
205,744

 
347,422

 
520,863

 
—

 
1,074,029

Debt expense
 
(317,276
)
 
(276,990
)
 
(44,827
)
 
317,079

 
(322,014
)
Other income, net
 
306,886

 
7,502

 
16,557

 
(317,079
)
 
13,866

Income tax expense
 
84,686

 
142,156

 
49,163

 
—

 
276,005

Equity earnings in subsidiaries
 
249,554

 
313,776

 
—

 
(563,330
)
 
—

Net income
 
360,222

 
249,554

 
443,430

 
(563,330
)
 
489,876

Less: Net income attributable to noncontrolling interests
 
—

 
—

 
—

 
(129,654
)
 
(129,654
)
Net income attributable to DaVita Inc.
 
$
360,222

 
$
249,554

 
$
443,430

 
$
(692,984
)
 
$
360,222


 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Nine Months Ended September 30, 2016
 
DaVita Inc.
 
 
 
 
Patient services revenues
 
$
—

 
$
5,044,565

 
$
2,787,176

 
$
(123,100
)
 
$
7,708,641

Less: Provision for uncollectible accounts
 
—

 
(207,144
)
 
(129,044
)
 
—

 
(336,188
)
Net patient service revenues
 
—

 
4,837,421

 
2,658,132

 
(123,100
)
 
7,372,453

Capitated revenues
 
—

 
1,397,378

 
1,263,404

 
(250
)
 
2,660,532

Other revenues
 
575,700

 
1,512,039

 
91,921

 
(1,183,282
)
 
996,378

Total net revenues
 
575,700

 
7,746,838

 
4,013,457

 
(1,306,632
)
 
11,029,363

Operating expenses and charges
 
400,129

 
7,275,863

 
3,146,888

 
(1,306,632
)
 
9,516,248

Operating income
 
175,571

 
470,975

 
866,569

 
—

 
1,513,115

Debt expense
 
(305,097
)
 
(275,148
)
 
(38,914
)
 
308,800

 
(310,359
)
Other income, net
 
296,660

 
12,416

 
7,791

 
(308,800
)
 
8,067

Income tax expense
 
56,190

 
140,972

 
168,849

 
—

 
366,011

Equity earnings in subsidiaries
 
611,204

 
543,933

 
—

 
(1,155,137
)
 
—

Net income
 
722,148

 
611,204

 
666,597

 
(1,155,137
)
 
844,812

Less: Net income attributable to noncontrolling interests
 
—

 
—

 
—

 
(122,664
)
 
(122,664
)
Net income attributable to DaVita Inc.
 
$
722,148

 
$
611,204

 
$
666,597

 
$
(1,277,801
)
 
$
722,148



Condensed Consolidating Statements of Income
 
 
 
Consolidated
Total
 
Physician
Groups
 
Unrestricted
Subsidiaries
 
Company and
Restricted Subsidiaries(1)
For The Nine Months Ended September 30, 2017
 
 
 
 
Patient service operating revenues
 
$
8,030,102

 
$
414,784

 
$
—

 
$
7,615,318

Less: Provision for uncollectible accounts
 
(352,228
)
 
(11,010
)
 
—

 
(341,218
)
Net patient service operating revenues
 
7,677,874

 
403,774

 
—

 
7,274,100

Capitated revenues
 
2,956,479

 
1,186,185

 
—

 
1,770,294

Other revenues
 
863,238

 
33,688

 
—

 
829,550

Total net operating revenues
 
11,497,591

 
1,623,647

 
—

 
9,873,944

Operating expenses
 
10,423,562

 
1,572,064

 
(147
)
 
8,851,645

Operating income
 
1,074,029

 
51,583

 
147

 
1,022,299

Debt expense, including refinancing charges
 
(322,014
)
 
(6,458
)
 
—

 
(315,556
)
Other income
 
13,866

 
478

 
—

 
13,388

Income tax expense
 
276,005

 
38,059

 
59

 
237,887

Net income
 
489,876

 
7,544

 
88

 
482,244

Less: Net income attributable to noncontrolling interests
 
(129,654
)
 
—

 
—

 
(129,654
)
Net income attributable to DaVita Inc.
 
$
360,222

 
$
7,544

 
$
88

 
$
352,590


(1)
After elimination of the unrestricted subsidiaries and the physician groups.
Condensed Consolidating Statements of Comprehensive Income
Condensed Consolidating Statements of Comprehensive Income

 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Three Months Ended September 30, 2017
 
DaVita Inc.
 
 
 
 
Net (loss) income
 
$
(214,476
)
 
$
(243,436
)
 
$
124,909

 
$
160,969

 
$
(172,034
)
Other comprehensive income
 
1,641

 
—

 
29,143

 
—

 
30,784

Total comprehensive (loss) income
 
(212,835
)
 
(243,436
)
 
154,052

 
160,969

 
(141,250
)
Less: Comprehensive income attributable to
   noncontrolling interest
 
—

 
—

 
—

 
(42,442
)
 
(42,442
)
Comprehensive (loss) income attributable to DaVita Inc.
 
$
(212,835
)
 
$
(243,436
)
 
$
154,052

 
$
118,527

 
$
(183,692
)
 
 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Three Months Ended September 30, 2016
 
DaVita Inc.
 
 
 
 
Net income
 
$
571,332

 
$
504,852

 
$
375,993

 
$
(840,027
)
 
$
612,150

Other comprehensive income
 
1,248

 
—

 
6,620

 
—

 
7,868

Total comprehensive income
 
572,580

 
504,852

 
382,613

 
(840,027
)
 
620,018

Less: Comprehensive income attributable to the
   noncontrolling interests
 
—

 
—

 
—

 
(40,876
)
 
(40,876
)
Comprehensive income attributable to DaVita Inc.
 
$
572,580

 
$
504,852

 
$
382,613

 
$
(880,903
)
 
$
579,142

 
 
 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Nine Months Ended September 30, 2017
 
DaVita Inc.
 
 
 
 
Net income
 
$
360,222

 
$
249,554

 
$
443,430

 
$
(563,330
)
 
$
489,876

Other comprehensive income
 
1,571

 
—

 
91,546

 
—

 
93,117

Total comprehensive income
 
361,793

 
249,554

 
534,976

 
(563,330
)
 
582,993

Less: Comprehensive income attributable to
   noncontrolling interest
 
—

 
—

 
—

 
(129,652
)
 
(129,652
)
Comprehensive income attributable to DaVita Inc.
 
$
361,793

 
$
249,554

 
$
534,976

 
$
(692,982
)
 
$
453,341


 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Nine Months Ended September 30, 2016
 
DaVita Inc.
 
 
 
 
Net income
 
$
722,148

 
$
611,204

 
$
666,597

 
$
(1,155,137
)
 
$
844,812

Other comprehensive (loss) income
 
(5,299
)
 
—

 
13,106

 
—

 
7,807

Total comprehensive income
 
716,849

 
611,204

 
679,703

 
(1,155,137
)
 
852,619

Less: Comprehensive income attributable to the
   noncontrolling interests
 
—

 
—

 
—

 
(122,871
)
 
(122,871
)
Comprehensive income attributable to DaVita Inc.
 
$
716,849

 
$
611,204

 
$
679,703

 
$
(1,278,008
)
 
$
729,748


Condensed Consolidating Statements of Comprehensive Income
 
 
 
Consolidated
Total
 
Physician
Groups
 
Unrestricted
Subsidiaries
 
Company and
Restricted Subsidiaries(1)
For The Nine Months Ended September 30, 2017
 
 
 
 
Net income
 
$
489,876

 
$
7,544

 
$
88

 
$
482,244

Other comprehensive income
 
93,117

 
—

 
—

 
93,117

Total comprehensive income
 
582,993

 
7,544

 
88

 
575,361

Less: Comprehensive income attributable to the noncontrolling
   interests
 
(129,652
)
 
—

 
—

 
(129,652
)
Comprehensive income attributable to DaVita Inc.
 
$
453,341

 
$
7,544

 
$
88

 
$
445,709

 
 
(1)
After elimination of the unrestricted subsidiaries and the physician groups.
Condensed Consolidating Balance Sheets
Condensed Consolidating Balance Sheets
 
 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
As of September 30, 2017
 
DaVita Inc.
 
 
 
 
Cash and cash equivalents
 
$
447,627

 
$
14,768

 
$
383,715

 
$
—

 
$
846,110

Accounts receivable, net
 
—

 
1,325,029

 
766,045

 
—

 
2,091,074

Other current assets
 
178,901

 
804,580

 
112,884

 
—

 
1,096,365

Total current assets
 
626,528

 
2,144,377

 
1,262,644

 
—

 
4,033,549

Property and equipment, net
 
368,233

 
1,752,690

 
1,265,133

 
—

 
3,386,056

Intangible assets, net
 
289

 
1,370,085

 
80,659

 
—

 
1,451,033

Investments in subsidiaries
 
10,116,956

 
2,738,851

 
—

 
(12,855,807
)
 
—

Intercompany receivables
 
3,079,514

 
—

 
1,172,721

 
(4,252,235
)
 
—

Other long-term assets and investments
 
46,028

 
99,584

 
581,212

 
—

 
726,824

Goodwill
 
—

 
7,248,275

 
2,167,602

 
—

 
9,415,877

Total assets
 
$
14,237,548

 
$
15,353,862

 
$
6,529,971

 
$
(17,108,042
)
 
$
19,013,339

Current liabilities
 
$
283,770

 
$
1,907,482

 
$
683,541

 
$
—

 
$
2,874,793

Intercompany payables
 
—

 
2,231,303

 
2,020,932

 
(4,252,235
)
 
—

Long-term debt and other long-term liabilities
 
8,565,734

 
1,098,121

 
478,672

 
—

 
10,142,527

Noncontrolling interests subject to put provisions
 
603,463

 
—

 
—

 
423,427

 
1,026,890

Total DaVita Inc. shareholder's equity
 
4,784,581

 
10,116,956

 
2,738,851

 
(12,855,807
)
 
4,784,581

Noncontrolling interests not subject to put
provisions
 
—

 
—

 
607,975

 
(423,427
)
 
184,548

Total equity
 
4,784,581

 
10,116,956

 
3,346,826

 
(13,279,234
)
 
4,969,129

Total liabilities and equity
 
$
14,237,548

 
$
15,353,862

 
$
6,529,971

 
$
(17,108,042
)
 
$
19,013,339


 
 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
As of December 31, 2016
 
DaVita Inc.
 
 
 
 
Cash and cash equivalents
 
$
549,921

 
$
59,192

 
$
304,074

 
$
—

 
$
913,187

Accounts receivable, net
 
—

 
1,215,232

 
702,070

 
—

 
1,917,302

Other current assets
 
277,911

 
736,727

 
135,101

 
—

 
1,149,739

Total current assets
 
827,832

 
2,011,151

 
1,141,245

 
—

 
3,980,228

Property and equipment, net
 
337,200

 
1,689,798

 
1,148,369

 
—

 
3,175,367

Intangible assets, net
 
487

 
1,491,057

 
36,223

 
—

 
1,527,767

Investments in subsidiaries
 
9,717,728

 
2,002,660

 
—

 
(11,720,388
)
 
—

Intercompany receivables
 
3,250,692

 
—

 
866,955

 
(4,117,647
)
 
—

Other long-term assets and investments
 
39,994

 
86,710

 
523,874

 
—

 
650,578

Goodwill
 
—

 
7,838,984

 
1,568,333

 
—

 
9,407,317

Total assets
 
$
14,173,933

 
$
15,120,360

 
$
5,284,999

 
$
(15,838,035
)
 
$
18,741,257

Current liabilities
 
$
303,840

 
$
1,865,193

 
$
527,412

 
$
—

 
$
2,696,445

Intercompany payables
 
—

 
2,322,124

 
1,795,523

 
(4,117,647
)
 
—

Long-term debt and other long-term liabilities
 
8,614,445

 
1,215,315

 
392,053

 
—

 
10,221,813

Noncontrolling interests subject to put provisions
 
607,601

 
—

 
—

 
365,657

 
973,258

Total DaVita Inc. shareholder's equity
 
4,648,047

 
9,717,728

 
2,002,660

 
(11,720,388
)
 
4,648,047

Noncontrolling interests not subject to put
provisions
 
—

 
—

 
567,351

 
(365,657
)
 
201,694

Total equity
 
4,648,047

 
9,717,728

 
2,570,011

 
(12,086,045
)
 
4,849,741

Total liabilities and equity
 
$
14,173,933

 
$
15,120,360

 
$
5,284,999

 
$
(15,838,035
)
 
$
18,741,257

Condensed Consolidating Balance Sheets
 
 
Consolidated
Total
 
Physician
Groups
 
Unrestricted
Subsidiaries
 
Company and
Restricted Subsidiaries(1)
As of September 30, 2017
 
 
 
 
Cash and cash equivalents
 
$
846,110

 
$
162,536

 
$
—

 
$
683,574

Accounts receivable, net
 
2,091,074

 
174,944

 
—

 
1,916,130

Other current assets
 
1,096,365

 
17,722

 
—

 
1,078,643

Total current assets
 
4,033,549

 
355,202

 
—

 
3,678,347

Property and equipment, net
 
3,386,056

 
3,334

 
—

 
3,382,722

Amortizable intangibles, net
 
1,451,033

 
4,313

 
—

 
1,446,720

Other long-term assets
 
726,824

 
81,877

 
2,861

 
642,086

Goodwill
 
9,415,877

 
30,993

 
—

 
9,384,884

Total assets
 
$
19,013,339

 
$
475,719

 
$
2,861

 
$
18,534,759

Current liabilities
 
$
2,874,793

 
$
202,386

 
$
—

 
$
2,672,407

Payables to parent
 
—

 
97,434

 
2,861

 
(100,295
)
Long-term debt and other long-term liabilities
 
10,142,527

 
63,272

 
—

 
10,079,255

Noncontrolling interests subject to put provisions
 
1,026,890

 
—

 
—

 
1,026,890

Total DaVita Inc. shareholders’ equity
 
4,784,581

 
112,627

 
—

 
4,671,954

Noncontrolling interests not subject to put provisions
 
184,548

 
—

 
—

 
184,548

Shareholders’ equity
 
4,969,129

 
112,627

 
—

 
4,856,502

Total liabilities and shareholder’s equity
 
$
19,013,339

 
$
475,719

 
$
2,861

 
$
18,534,759

 
 
(1)
After elimination of the unrestricted subsidiaries and the physician groups.
Condensed Consolidating Statements of Cash Flows
Condensed Consolidating Statements of Cash Flows
 
 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Nine Months Ended September 30, 2017
 
DaVita Inc.
 
 
 
 
Cash flows from operating activities:
 
 
 
 
 
 
 
 
 
 
Net income
 
$
360,222

 
$
249,554

 
$
443,430

 
$
(563,330
)
 
$
489,876

Changes in operating assets and liabilities and non-cash items included in net income
 
(291,657
)
 
606,783

 
196,207

 
563,330

 
1,074,663

Net cash provided by operating activities
 
68,565

 
856,337

 
639,637

 
—

 
1,564,539

Cash flows from investing activities:
 
 

 
 

 
 

 
 

 
 

Additions of property and equipment
 
(94,385
)
 
(305,261
)
 
(240,183
)
 
—

 
(639,829
)
Acquisitions
 
—

 
(627,324
)
 
(99,214
)
 
—

 
(726,538
)
Proceeds from asset and business sales
 
—

 
90,533

 
1,996

 
—

 
92,529

Proceeds (purchases) from investment sales and other items, net
 
123,894

 
(6,472
)
 
49,183

 
—

 
166,605

Net cash provided by (used in) investing activities
 
29,509

 
(848,524
)
 
(288,218
)
 
—

 
(1,107,233
)
Cash flows from financing activities:
 
 

 
 

 
 

 
 

 
 

Long-term debt and related financing costs, net
 
(92,721
)
 
(10,394
)
 
(5,348
)
 
—

 
(108,463
)
Intercompany borrowing (payments)
 
197,983

 
(40,411
)
 
(157,572
)
 
—

 
—

Other items
 
(305,630
)
 
(1,432
)
 
(114,307
)
 
—

 
(421,369
)
Net cash used in financing activities
 
(200,368
)
 
(52,237
)
 
(277,227
)
 
—

 
(529,832
)
Effect of exchange rate changes on cash
 
—

 
—

 
5,449

 
—

 
5,449

Net (decrease) increase in cash and cash equivalents
 
(102,294
)
 
(44,424
)
 
79,641

 
—

 
(67,077
)
Cash and cash equivalents at beginning of period
 
549,921

 
59,192

 
304,074

 
—

 
913,187

Cash and cash equivalents at end of period
 
$
447,627

 
$
14,768

 
$
383,715

 
$
—

 
$
846,110


 
 
 
 
 
Guarantor
subsidiaries
 
Non-
Guarantor
subsidiaries
 
Consolidating
adjustments
 
Consolidated
total
For The Nine Months Ended September 30, 2016
 
DaVita Inc.
 
 
 
 
Cash flows from operating activities:
 
 
 
 
 
 
 
 
 
 
Net income
 
$
722,148

 
$
611,204

 
$
666,597

 
$
(1,155,137
)
 
$
844,812

Changes in operating assets and liabilities and non-cash
   items included in net income
 
(586,804
)
 
228,991

 
(160,874
)
 
1,155,137

 
636,450

Net cash provided by operating activities
 
135,344

 
840,195

 
505,723

 
—

 
1,481,262

Cash flows from investing activities:
 
 

 
 

 
 

 
 

 
 

Additions of property and equipment
 
(81,785
)
 
(248,339
)
 
(245,119
)
 
—

 
(575,243
)
Acquisitions
 
—

 
(458,556
)
 
(38,775
)
 
—

 
(497,331
)
Proceeds from asset and business sales, net of cash
divested
 
—

 
24,608

 
(5,617
)
 
—

 
18,991

(Purchases) proceeds from investment sales and other
items, net
 
(236,150
)
 
(12,825
)
 
45,316

 
—

 
(203,659
)
Net cash used in investing activities
 
(317,935
)
 
(695,112
)
 
(244,195
)
 
—

 
(1,257,242
)
Cash flows from financing activities:
 
 

 
 

 
 

 
 

 
 

Long-term debt and related financing costs, net
 
(73,889
)
 
(20,684
)
 
(4,151
)
 
—

 
(98,724
)
Intercompany borrowing (payments)
 
283,709

 
(188,247
)
 
(95,462
)
 
—

 
—

Other items
 
(589,964
)
 
(9,740
)
 
(109,548
)
 
—

 
(709,252
)
Net cash used in financing activities
 
(380,144
)
 
(218,671
)
 
(209,161
)
 
—

 
(807,976
)
Effect of exchange rate changes on cash
 
—

 
—

 
(1,664
)
 
—

 
(1,664
)
Net (decrease) increase in cash and cash equivalents
 
(562,735
)
 
(73,588
)
 
50,703

 
—

 
(585,620
)
Cash and cash equivalents at beginning of period
 
1,186,636

 
109,357

 
203,123

 
—

 
1,499,116

Cash and cash equivalents at end of period
 
$
623,901

 
$
35,769

 
$
253,826

 
$
—

 
$
913,496


Condensed Consolidating Statements of Cash Flows
 
 
Consolidated
Total
 
Physician
Groups
 
Unrestricted
Subsidiaries
 
Company and
Restricted Subsidiaries(1)
For The Nine Months Ended September 30, 2017
 
 
 
 
Cash flows from operating activities:
 
 
 
 
 
 
 
 
Net income
 
$
489,876

 
$
7,544

 
$
88

 
$
482,244

Changes in operating and intercompany assets and liabilities
   and non-cash items included in net income
 
1,074,663

 
29,753

 
(88
)
 
1,044,998

Net cash provided by operating activities
 
1,564,539

 
37,297

 
—

 
1,527,242

Cash flows from investing activities:
 
 

 
 

 
 

 
 

Additions of property and equipment
 
(639,829
)
 
(5,903
)
 
—

 
(633,926
)
Acquisitions
 
(726,538
)
 
—

 
—

 
(726,538
)
Proceeds from asset and business sales
 
92,529

 
—

 
—

 
92,529

Investments and other items
 
166,605

 
(2,378
)
 
—

 
168,983

Net cash used in investing activities
 
(1,107,233
)
 
(8,281
)
 
—

 
(1,098,952
)
Cash flows from financing activities:
 
 

 
 

 
 

 
 

Long-term debt
 
(108,463
)
 
—

 
—

 
(108,463
)
Intercompany
 
—

 
28,829

 
—

 
(28,829
)
Other items
 
(421,369
)
 
—

 
—

 
(421,369
)
Net cash (used in) provided by financing activities
 
(529,832
)
 
28,829

 
—

 
(558,661
)
Effect of exchange rate changes on cash
 
5,449

 
—

 
—

 
5,449

Net (decrease) increase in cash
 
(67,077
)
 
57,845

 
—

 
(124,922
)
Cash and cash equivalents at beginning of period
 
913,187

 
104,691

 
—

 
808,496

Cash and cash equivalents at end of period
 
$
846,110

 
$
162,536

 
$
—

 
$
683,574

 
(1)
After elimination of the unrestricted subsidiaries and the physician groups.