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Consolidating Financial Statements | 12 Months Ended
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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 interests |  | — |  |  | — |  |  | — |  |  | (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 interests |  | — |  |  | — |  |  | — |  |  | (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 revenues |  | — |  |  | 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 interests |  | — |  |  | — |  |  | — |  |  | (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 noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (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 noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (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 noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (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 provisions |  | — |  |  | — |  |  | 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 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 |  |  | $ | 16,329,322 |  |  | $ | 6,371,260 |  |  | $ | (18,086,756 | ) |  | $ | 18,974,536 |
Consolidating Statements of Cash Flow
For the year ended December 31, 2018 |  | DaVita Inc. |  | Guarantor Subsidiaries |  | Non-Guarantor Subsidiaries |  | Consolidating Adjustments |  | Consolidated Total
Cash flows from operating activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Net income |  | $ | 159,394 |  |  | $ | 103,196 |  |  | $ | 517,671 |  |  | $ | (447,221 | ) |  | $ | 333,040 |
Changes in operating assets and liabilities and non-cash items included in net income |  | (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 restricted cash from discontinued operations |  | — |  |  | 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 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 year |  | $ | 61,658 |  |  | $ | 12,048 |  |  | $ | 341,714 |  |  | $ | — |  |  | $ | 415,420 |
Consolidating Statements of Cash Flow - (continued)
For the year ended December 31, 2017 |  | DaVita Inc. |  | Guarantor Subsidiaries |  | Non-Guarantor Subsidiaries |  | Consolidating Adjustments |  | Consolidated Total
Cash flows from operating activities: |  |  |  |  |  |  |  |  |  |
Net income |  | $ | 663,618 |  |  | $ | 478,192 |  |  | $ | 241,312 |  |  | $ | (552,567 | ) |  | $ | 830,555 |
Changes in operating assets and liabilities and non-cash items included in net income |  | (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 divested |  | — |  |  | 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 and restricted cash from discontinued operations |  | — |  |  | (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 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 year |  | $ | 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 non-cash items included in net income |  | (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 continuing operations at beginning of the year |  | 1,186,636 |  |  | — |  |  | 58,281 |  |  | — |  |  | 1,244,917 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year |  | $ | 549,921 |  |  | $ | 8,687 |  |  | $ | 124,855 |  |  | $ | — |  |  | $ | 683,463 |

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