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Condensed consolidating financial statements | 9 Months Ended
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Sep. 30, 2018
Organization, Consolidation and Presentation of Financial Statements [Abstract] |
Condensed consolidating financial statements | Condensed 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 condensed consolidated financial statements are fully interdependent and integrated. Revenues and operating expenses of the separate legal entities include intercompany charges for management and other administrative services. The Company’s senior notes are guaranteed by a substantial majority of its domestic subsidiaries as measured by revenue, income and assets. The subsidiary guarantors have guaranteed the senior notes on a joint and several basis. However, a subsidiary guarantor will be released from its obligations under its guarantee of the senior notes and the indentures governing the senior notes if, in general, there is a sale or other disposition of all or substantially all of the assets of such subsidiary guarantor, including by merger or consolidation, or a sale or other disposition of all of the equity interests in such subsidiary guarantor held by the Company and its restricted subsidiaries, as defined in the indentures; such subsidiary guarantor is designated by the Company as an unrestricted subsidiary, as defined in the indentures, or otherwise ceases to be a restricted subsidiary of the Company, in each case in accordance with the indentures; or such subsidiary guarantor no longer guarantees any other indebtedness, as defined in the indentures, of the Company or any of its restricted subsidiaries, except for guarantees that are contemporaneously released. The senior notes are not guaranteed by certain of the Company’s domestic subsidiaries, any of the Company’s foreign subsidiaries, or any entities that do not constitute subsidiaries within the meaning of the indentures, such as corporations in which the Company holds capital stock with less than a majority of the voting power, joint ventures and partnerships in which the Company holds less than a majority of the equity or voting interests, non-owned entities and third parties. Condensed Consolidating Statements of Operations
|  | DaVita Inc. |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the three months ended September 30, 2018 |  |  |  |  |
Patient services revenues |  | $ | — |  |  | $ | 1,810,009 |  |  | $ | 914,623 |  |  | $ | (53,931 | ) |  | $ | 2,670,701 |
Provision for uncollectible accounts |  | — |  |  | (8,899 | ) |  | (3,078 | ) |  | — |  |  | (11,977 | )
Net patient service revenues |  | — |  |  | 1,801,110 |  |  | 911,545 |  |  | (53,931 | ) |  | 2,658,724 |
Other revenues |  | 207,968 |  |  | 192,467 |  |  | 36,508 |  |  | (248,337 | ) |  | 188,606 |
Total net revenues |  | 207,968 |  |  | 1,993,577 |  |  | 948,053 |  |  | (302,268 | ) |  | 2,847,330 |
Operating expenses and charges |  | 205,324 |  |  | 1,817,851 |  |  | 837,385 |  |  | (302,268 | ) |  | 2,558,292 |
Operating income |  | 2,644 |  |  | 175,726 |  |  | 110,668 |  |  | — |  |  | 289,038 |
Debt expense |  | (127,353 | ) |  | (52,011 | ) |  | (8,812 | ) |  | 62,249 |  |  | (125,927 | )
Other income, net |  | 106,148 |  |  | 2,339 |  |  | 5,982 |  |  | (110,462 | ) |  | 4,007 |
Income tax (benefit) expense |  | (3,536 | ) |  | 47,977 |  |  | 7,606 |  |  | — |  |  | 52,047 |
Equity earnings in subsidiaries |  | (121,771 | ) |  | 46,972 |  |  | — |  |  | 74,799 |  |  | — |
Net (loss) income from continuing operations |  | (136,796 | ) |  | 125,049 |  |  | 100,232 |  |  | 26,586 |  |  | 115,071 |
Net loss from discontinued operations, net of tax |  | — |  |  | (246,820 | ) |  | (13,132 | ) |  | 48,213 |  |  | (211,739 | )
Net (loss) income |  | (136,796 | ) |  | (121,771 | ) |  | 87,100 |  |  | 74,799 |  |  | (96,668 | )
Less: Net income attributable to noncontrolling interests |  | — |  |  | — |  |  | — |  |  | (40,128 | ) |  | (40,128 | )
Net (loss) income attributable to DaVita Inc. |  | $ | (136,796 | ) |  | $ | (121,771 | ) |  | $ | 87,100 |  |  | $ | 34,671 |  |  | $ | (136,796 | )
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the three months ended September 30, 2017 |  | DaVita Inc. |  |  |  |
Patient service revenues |  | $ | — |  |  | $ | 1,710,708 |  |  | $ | 914,753 |  |  | $ | (63,918 | ) |  | $ | 2,561,543 |
Provision for uncollectible accounts |  | — |  |  | (82,807 | ) |  | (42,649 | ) |  | 6,135 |  |  | (119,321 | )
Net patient service revenues |  | — |  |  | 1,627,901 |  |  | 872,104 |  |  | (57,783 | ) |  | 2,442,222 |
Other revenues |  | 189,275 |  |  | 302,193 |  |  | 11,483 |  |  | (180,102 | ) |  | 322,849 |
Total net revenues |  | 189,275 |  |  | 1,930,094 |  |  | 883,587 |  |  | (237,885 | ) |  | 2,765,071 |
Operating expenses |  | 128,488 |  |  | 1,718,444 |  |  | 760,730 |  |  | (237,885 | ) |  | 2,369,777 |
Operating income |  | 60,787 |  |  | 211,650 |  |  | 122,857 |  |  | — |  |  | 395,294 |
Debt expense |  | (108,453 | ) |  | (48,622 | ) |  | (13,017 | ) |  | 60,786 |  |  | (109,306 | )
Other income |  | 104,250 |  |  | 819 |  |  | 5,941 |  |  | (107,614 | ) |  | 3,396 |
Income tax expense (benefit) |  | 21,199 |  |  | 82,780 |  |  | (13,433 | ) |  | — |  |  | 90,546 |
Equity earnings in subsidiaries |  | (249,861 | ) |  | 89,048 |  |  | — |  |  | 160,813 |  |  | — |
Net (loss) income from continuing operations |  | (214,476 | ) |  | 170,115 |  |  | 129,214 |  |  | 113,985 |  |  | 198,838 |
Net (loss) income from discontinued operations, net of tax |  | — |  |  | (419,976 | ) |  | 2,276 |  |  | 46,828 |  |  | (370,872 | )
Net (loss) income |  | (214,476 | ) |  | (249,861 | ) |  | 131,490 |  |  | 160,813 |  |  | (172,034 | )
Less: Net income attributable to noncontrolling interests |  | — |  |  | — |  |  | — |  |  | (42,442 | ) |  | (42,442 | )
Net (loss) income attributable to DaVita Inc. |  | $ | (214,476 | ) |  | $ | (249,861 | ) |  | $ | 131,490 |  |  | $ | 118,371 |  |  | $ | (214,476 | )
|  | DaVita Inc. |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the nine months ended September 30, 2018 |  |  |  |  |
Patient service revenues |  | $ | — |  |  | $ | 5,431,742 |  |  | $ | 2,699,670 |  |  | $ | (151,234 | ) |  | $ | 7,980,178 |
Provision for uncollectible accounts |  | — |  |  | (26,430 | ) |  | (9,408 | ) |  | — |  |  | (35,838 | )
Net patient service revenues |  | — |  |  | 5,405,312 |  |  | 2,690,262 |  |  | (151,234 | ) |  | 7,944,340 |
Other revenues |  | 608,850 |  |  | 611,693 |  |  | 150,578 |  |  | (731,734 | ) |  | 639,387 |
Total net revenues |  | 608,850 |  |  | 6,017,005 |  |  | 2,840,840 |  |  | (882,968 | ) |  | 8,583,727 |
Operating expenses |  | 484,329 |  |  | 5,459,322 |  |  | 2,385,128 |  |  | (882,968 | ) |  | 7,445,811 |
Operating income |  | 124,521 |  |  | 557,683 |  |  | 455,712 |  |  | — |  |  | 1,137,916 |
Debt expense |  | (362,501 | ) |  | (156,571 | ) |  | (25,461 | ) |  | 185,398 |  |  | (359,135 | )
Other income |  | 315,573 |  |  | 7,718 |  |  | 16,126 |  |  | (328,834 | ) |  | 10,583 |
Income tax expense |  | 24,108 |  |  | 136,939 |  |  | 45,605 |  |  | — |  |  | 206,652 |
Equity earnings in subsidiaries |  | 255,681 |  |  | 305,823 |  |  | — |  |  | (561,504 | ) |  | — |
Net income from continuing operations |  | 309,166 |  |  | 577,714 |  |  | 400,772 |  |  | (704,940 | ) |  | 582,712 |
Net (loss) income from discontinued operations, net of tax |  | — |  |  | (322,033 | ) |  | 30,768 |  |  | 143,436 |  |  | (147,829 | )
Net income |  | 309,166 |  |  | 255,681 |  |  | 431,540 |  |  | (561,504 | ) |  | 434,883 |
Less: Net income attributable to noncontrolling interests |  | — |  |  | — |  |  | — |  |  | (125,717 | ) |  | (125,717 | )
Net income attributable to DaVita Inc. |  | $ | 309,166 |  |  | $ | 255,681 |  |  | $ | 431,540 |  |  | $ | (687,221 | ) |  | $ | 309,166 |
|  | DaVita Inc. |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the nine months ended September 30, 2017 |  |  |  |  |
Patient service revenues |  | $ | — |  |  | $ | 4,895,864 |  |  | $ | 2,723,764 |  |  | $ | (140,690 | ) |  | $ | 7,478,938 |
Provision for uncollectible accounts |  | — |  |  | (216,705 | ) |  | (125,409 | ) |  | 6,135 |  |  | (335,979 | )
Net patient service revenues |  | — |  |  | 4,679,159 |  |  | 2,598,355 |  |  | (134,555 | ) |  | 7,142,959 |
Other revenues |  | 604,246 |  |  | 913,130 |  |  | 43,408 |  |  | (608,022 | ) |  | 952,762 |
Total net revenues |  | 604,246 |  |  | 5,592,289 |  |  | 2,641,763 |  |  | (742,577 | ) |  | 8,095,721 |
Operating expenses |  | 398,502 |  |  | 4,609,747 |  |  | 2,167,631 |  |  | (742,577 | ) |  | 6,433,303 |
Operating income |  | 205,744 |  |  | 982,542 |  |  | 474,132 |  |  | — |  |  | 1,662,418 |
Debt expense |  | (317,276 | ) |  | (144,382 | ) |  | (38,287 | ) |  | 178,308 |  |  | (321,637 | )
Other income |  | 306,886 |  |  | 4,991 |  |  | 15,524 |  |  | (315,221 | ) |  | 12,180 |
Income tax expense |  | 75,680 |  |  | 389,945 |  |  | 8,501 |  |  | — |  |  | 474,126 |
Equity earnings in subsidiaries |  | 240,548 |  |  | 337,213 |  |  | — |  |  | (577,761 | ) |  | — |
Net income from continuing operations |  | 360,222 |  |  | 790,419 |  |  | 442,868 |  |  | (714,674 | ) |  | 878,835 |
Net (loss) income from discontinued operations, net of tax |  | — |  |  | (549,871 | ) |  | 23,999 |  |  | 136,913 |  |  | (388,959 | )
Net income |  | 360,222 |  |  | 240,548 |  |  | 466,867 |  |  | (577,761 | ) |  | 489,876 |
Less: Net income attributable to noncontrolling interests |  | — |  |  | — |  |  | — |  |  | (129,654 | ) |  | (129,654 | )
Net income attributable to DaVita Inc. |  | $ | 360,222 |  |  | $ | 240,548 |  |  | $ | 466,867 |  |  | $ | (707,415 | ) |  | $ | 360,222 |
Condensed Consolidating Statements of Comprehensive Income
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the three months ended September 30, 2018 |  | DaVita Inc. |  |  |  |
Net (loss) income |  | $ | (136,796 | ) |  | $ | (121,771 | ) |  | $ | 87,100 |  |  | $ | 74,799 |  |  | $ | (96,668 | )
Other comprehensive income (loss) |  | 1,643 |  |  | — |  |  | (8,827 | ) |  | — |  |  | (7,184 | )
Total comprehensive (loss) income |  | (135,153 | ) |  | (121,771 | ) |  | 78,273 |  |  | 74,799 |  |  | (103,852 | )
Less: Comprehensive income attributable to noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (40,128 | ) |  | (40,128 | )
Comprehensive (loss) income attributable to DaVita Inc. |  | $ | (135,153 | ) |  | $ | (121,771 | ) |  | $ | 78,273 |  |  | $ | 34,671 |  |  | $ | (143,980 | )
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the three months ended September 30, 2017 |  | DaVita Inc. |  |  |  |
Net (loss) income |  | $ | (214,476 | ) |  | $ | (249,861 | ) |  | $ | 131,490 |  |  | $ | 160,813 |  |  | $ | (172,034 | )
Other comprehensive income |  | 1,641 |  |  | — |  |  | 29,143 |  |  | — |  |  | 30,784 |
Total comprehensive (loss) income |  | (212,835 | ) |  | (249,861 | ) |  | 160,633 |  |  | 160,813 |  |  | (141,250 | )
Less: Comprehensive income attributable to noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (42,442 | ) |  | (42,442 | )
Comprehensive (loss) income attributable to DaVita Inc. |  | $ | (212,835 | ) |  | $ | (249,861 | ) |  | $ | 160,633 |  |  | $ | 118,371 |  |  | $ | (183,692 | )
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the nine months ended September 30, 2018 |  | DaVita Inc. |  |  |  |
Net income |  | $ | 309,166 |  |  | $ | 255,681 |  |  | $ | 431,540 |  |  | $ | (561,504 | ) |  | $ | 434,883 |
Other comprehensive income (loss) |  | 5,499 |  |  | — |  |  | (39,475 | ) |  | — |  |  | (33,976 | )
Total comprehensive income |  | 314,665 |  |  | 255,681 |  |  | 392,065 |  |  | (561,504 | ) |  | 400,907 |
Less: Comprehensive income attributable to noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (125,717 | ) |  | (125,717 | )
Comprehensive income attributable to DaVita Inc. |  | $ | 314,665 |  |  | $ | 255,681 |  |  | $ | 392,065 |  |  | $ | (687,221 | ) |  | $ | 275,190 |
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the nine months ended September 30, 2017 |  | DaVita Inc. |  |  |  |
Net income |  | $ | 360,222 |  |  | $ | 240,548 |  |  | $ | 466,867 |  |  | $ | (577,761 | ) |  | $ | 489,876 |
Other comprehensive income |  | 1,571 |  |  | — |  |  | 91,546 |  |  | — |  |  | 93,117 |
Total comprehensive income |  | 361,793 |  |  | 240,548 |  |  | 558,413 |  |  | (577,761 | ) |  | 582,993 |
Less: Comprehensive income attributable to noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (129,652 | ) |  | (129,652 | )
Comprehensive income attributable to DaVita Inc. |  | $ | 361,793 |  |  | $ | 240,548 |  |  | $ | 558,413 |  |  | $ | (707,413 | ) |  | $ | 453,341 |
Condensed Consolidating Balance Sheets
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
As of September 30, 2018 |  | DaVita Inc. |  |  |  |
Cash and cash equivalents |  | $ | 296,697 |  |  | $ | — |  |  | $ | 151,518 |  |  | $ | — |  |  | $ | 448,215 |
Restricted cash and equivalents |  | 1,004 |  |  | 11,985 |  |  | 78,951 |  |  | — |  |  | 91,940 |
Accounts receivable, net |  | — |  |  | 1,241,147 |  |  | 605,939 |  |  | — |  |  | 1,847,086 |
Other current assets |  | 37,185 |  |  | 467,669 |  |  | 89,620 |  |  | — |  |  | 594,474 |
Current assets held for sale, net |  | — |  |  | 4,999,748 |  |  | 948,038 |  |  | — |  |  | 5,947,786 |
Total current assets |  | 334,886 |  |  | 6,720,549 |  |  | 1,874,066 |  |  | — |  |  | 8,929,501 |
Property and equipment, net |  | 466,162 |  |  | 1,563,552 |  |  | 1,245,922 |  |  | — |  |  | 3,275,636 |
Intangible assets, net |  | 176 |  |  | 43,704 |  |  | 53,729 |  |  | — |  |  | 97,609 |
Investments in subsidiaries |  | 10,071,347 |  |  | 3,164,083 |  |  | — |  |  | (13,235,430 | ) |  | — |
Intercompany receivables |  | 3,496,240 |  |  | — |  |  | 1,478,557 |  |  | (4,974,797 | ) |  | — |
Other long-term assets and investments |  | 54,853 |  |  | 86,821 |  |  | 210,710 |  |  | — |  |  | 352,384 |
Goodwill |  | — |  |  | 4,778,542 |  |  | 1,924,117 |  |  | — |  |  | 6,702,659 |
Total assets |  | $ | 14,423,664 |  |  | $ | 16,357,251 |  |  | $ | 6,787,101 |  |  | $ | (18,210,227 | ) |  | $ | 19,357,789 |
Current liabilities |  | $ | 1,815,234 |  |  | $ | 1,149,518 |  |  | $ | 470,731 |  |  | $ | — |  |  | $ | 3,435,483 |
Current liabilities held for sale |  | — |  |  | 892,548 |  |  | 527,073 |  |  | — |  |  | 1,419,621 |
Intercompany payables |  | — |  |  | 3,485,322 |  |  | 1,489,475 |  |  | (4,974,797 | ) |  | — |
Long-term debt and other long-term liabilities |  | 8,186,683 |  |  | 758,516 |  |  | 463,812 |  |  | — |  |  | 9,409,011 |
Noncontrolling interests subject to put provisions |  | 597,098 |  |  | — |  |  | — |  |  | 467,314 |  |  | 1,064,412 |
Total DaVita Inc. shareholders' equity |  | 3,824,649 |  |  | 10,071,347 |  |  | 3,164,083 |  |  | (13,235,430 | ) |  | 3,824,649 |
Noncontrolling interests not subject to put provisions |  | — |  |  | — |  |  | 671,927 |  |  | (467,314 | ) |  | 204,613 |
Total equity |  | 3,824,649 |  |  | 10,071,347 |  |  | 3,836,010 |  |  | (13,702,744 | ) |  | 4,029,262 |
Total liabilities and equity |  | $ | 14,423,664 |  |  | $ | 16,357,251 |  |  | $ | 6,787,101 |  |  | $ | (18,210,227 | ) |  | $ | 19,357,789 |
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
As of December 31, 2017 |  | DaVita Inc. |  |  |  |
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 |  |  | 595,066 |  |  | 86,955 |  |  | — |  |  | 749,046 |
Current assets held for sale |  | — |  |  | 4,992,067 |  |  | 769,575 |  |  | — |  |  | 5,761,642 |
Total current assets |  | 217,332 |  |  | 6,805,232 |  |  | 1,721,794 |  |  | — |  |  | 8,744,358 |
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 |  |  | $ | 16,302,979 |  |  | $ | 6,371,260 |  |  | $ | (18,086,756 | ) |  | $ | 18,948,193 |
Current liabilities |  | $ | 238,706 |  |  | $ | 1,181,139 |  |  | $ | 436,262 |  |  | $ | — |  |  | $ | 1,856,107 |
Current liabilities held for sale |  | — |  |  | 739,294 |  |  | 445,776 |  |  | — |  |  | 1,185,070 |
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 provisions |  | — |  |  | — |  |  | 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 |  |  | $ | 16,302,979 |  |  | $ | 6,371,260 |  |  | $ | (18,086,756 | ) |  | $ | 18,948,193 |
Condensed Consolidating Statements of Cash Flows
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the nine months ended September 30, 2018 |  | DaVita Inc. |  |  |  |
Cash flows from operating activities: |  |  |  |  |  |  |  |  |  |
Net income |  | $ | 309,166 |  |  | $ | 255,681 |  |  | $ | 431,540 |  |  | $ | (561,504 | ) |  | $ | 434,883 |
Changes in operating assets and liabilities and non-cash items included in net income |  | (235,558 | ) |  | 469,008 |  |  | 152,411 |  |  | 561,504 |  |  | 947,365 |
Net cash provided by operating activities |  | 73,608 |  |  | 724,689 |  |  | 583,951 |  |  | — |  |  | 1,382,248 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Additions of property and equipment |  | (124,585 | ) |  | (385,765 | ) |  | (195,309 | ) |  | — |  |  | (705,659 | )
Acquisitions |  | — |  |  | (18,549 | ) |  | (94,977 | ) |  | — |  |  | (113,526 | )
Proceeds from asset and business sales |  | — |  |  | 47,025 |  |  | 88,243 |  |  | — |  |  | 135,268 |
Proceeds (purchases) from investment sales and other items, net |  | 32,345 |  |  | (9,746 | ) |  | (1 | ) |  | — |  |  | 22,598 |
Net cash used in investing activities |  | (92,240 | ) |  | (367,035 | ) |  | (202,044 | ) |  | — |  |  | (661,319 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Long-term debt and related financing costs, net |  | 866,537 |  |  | (9,135 | ) |  | (11,566 | ) |  | — |  |  | 845,836 |
Intercompany borrowing (payments) |  | 454,410 |  |  | (217,518 | ) |  | (236,892 | ) |  | — |  |  | — |
Other items |  | (1,154,921 | ) |  | (94,281 | ) |  | (19,973 | ) |  | — |  |  | (1,269,175 | )
Net cash provided by (used in) financing activities |  | 166,026 |  |  | (320,934 | ) |  | (268,431 | ) |  | — |  |  | (423,339 | )
Effect of exchange rate changes on cash, cash equivalents and restricted cash |  | — |  |  | — |  |  | (5,790 | ) |  | — |  |  | (5,790 | )
Net increase in cash, cash equivalents and restricted cash |  | 147,394 |  |  | 36,720 |  |  | 107,686 |  |  | — |  |  | 291,800 |
Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations |  | — |  |  | 34,119 |  |  | 236,446 |  |  | — |  |  | 270,565 |
Net increase (decrease) in cash, cash equivalents and restricted cash from continuing operations |  | 147,394 |  |  | 2,601 |  |  | (128,760 | ) |  | — |  |  | 21,235 |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year |  | 150,307 |  |  | 9,384 |  |  | 359,229 |  |  | — |  |  | 518,920 |
Cash, cash equivalents and restricted cash of continuing operations at end of the period |  | $ | 297,701 |  |  | $ | 11,985 |  |  | $ | 230,469 |  |  | $ | — |  |  | $ | 540,155 |
|  |  |  | 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 |  |  | $ | 240,548 |  |  | $ | 466,867 |  |  | $ | (577,761 | ) |  | $ | 489,876 |
Changes in operating assets and liabilities and non-cash items included in net income |  | (282,651 | ) |  | 585,836 |  |  | 197,328 |  |  | 577,761 |  |  | 1,078,274 |
Net cash provided by operating activities |  | 77,571 |  |  | 826,384 |  |  | 664,195 |  |  | — |  |  | 1,568,150 |
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 |  |  | (4,788 | ) |  | 49,183 |  |  | — |  |  | 168,289 |
Net cash provided by (used in) investing activities |  | 29,509 |  |  | (846,840 | ) |  | (288,218 | ) |  | — |  |  | (1,105,549 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Long-term debt and related financing costs, net |  | (92,721 | ) |  | (10,394 | ) |  | (5,348 | ) |  | — |  |  | (108,463 | )
Intercompany borrowing (payments) |  | 188,977 |  |  | (7,968 | ) |  | (181,009 | ) |  | — |  |  | — |
Other items |  | (305,630 | ) |  | (1,432 | ) |  | (114,307 | ) |  | — |  |  | (421,369 | )
Net cash used in financing activities |  | (209,374 | ) |  | (19,794 | ) |  | (300,664 | ) |  | — |  |  | (529,832 | )
Effect of exchange rate changes on cash, cash equivalents and restricted cash |  | — |  |  | — |  |  | 5,449 |  |  | — |  |  | 5,449 |
Net decrease in cash, cash equivalents and restricted cash |  | (102,294 | ) |  | (40,250 | ) |  | 80,762 |  |  | — |  |  | (61,782 | )
Less: Net increase (decrease) in cash, cash equivalents and restricted cash from discontinued operations |  | — |  |  | (41,934 | ) |  | 124,628 |  |  | — |  |  | 82,694 |
Net increase (decrease) in cash, cash equivalents and restricted cash from continuing operations |  | (102,294 | ) |  | 1,684 |  |  | (43,866 | ) |  | — |  |  | (144,476 | )
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year |  | 549,921 |  |  | 8,687 |  |  | 124,855 |  |  | — |  |  | 683,463 |
Cash, cash equivalents and restricted cash of continuing operations at end of the period |  | $ | 447,627 |  |  | $ | 10,371 |  |  | $ | 80,989 |  |  | $ | — |  |  | $ | 538,987 |

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