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v3.19.1

Supplemental Data (Tables) | 3 Months Ended
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Mar. 31, 2019
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 March 31, 2019 |  |  |  |  |
Patient services revenues |  | $ | — |  |  | $ | 1,777,246 |  |  | $ | 918,604 |  |  | $ | (60,698 | ) |  | $ | 2,635,152 |
Provision for uncollectible accounts |  | — |  |  | (3,970 | ) |  | (1,493 | ) |  | — |  |  | (5,463 | )
Net patient service revenues |  | — |  |  | 1,773,276 |  |  | 917,111 |  |  | (60,698 | ) |  | 2,629,689 |
Other revenues |  | 188,836 |  |  | 111,141 |  |  | 35,619 |  |  | (222,173 | ) |  | 113,423 |
Total net revenues |  | 188,836 |  |  | 1,884,417 |  |  | 952,730 |  |  | (282,871 | ) |  | 2,743,112 |
Operating expenses and charges |  | 143,659 |  |  | 1,660,453 |  |  | 881,364 |  |  | (282,871 | ) |  | 2,402,605 |
Operating income |  | 45,177 |  |  | 223,964 |  |  | 71,366 |  |  | — |  |  | 340,507 |
Debt expense |  | (133,595 | ) |  | (52,479 | ) |  | (10,719 | ) |  | 65,274 |  |  | (131,519 | )
Other income, net |  | 110,198 |  |  | 2,596 |  |  | 9,111 |  |  | (114,965 | ) |  | 6,940 |
Income tax expense |  | 7,026 |  |  | 46,544 |  |  | 3,176 |  |  | — |  |  | 56,746 |
Equity earnings in subsidiaries |  | 134,535 |  |  | 46,151 |  |  | — |  |  | (180,686 | ) |  | — |
Net income from continuing operations |  | 149,289 |  |  | 173,688 |  |  | 66,582 |  |  | (230,377 | ) |  | 159,182 |
Net (loss) income from discontinued operations, net of tax |  | — |  |  | (39,153 | ) |  | 19,767 |  |  | 49,691 |  |  | 30,305 |
Net income |  | 149,289 |  |  | 134,535 |  |  | 86,349 |  |  | (180,686 | ) |  | 189,487 |
Less: Net income attributable to noncontrolling interests |  | — |  |  | — |  |  | — |  |  | (40,198 | ) |  | (40,198 | )
Net income attributable to DaVita Inc. |  | $ | 149,289 |  |  | $ | 134,535 |  |  | $ | 86,349 |  |  | $ | (220,884 | ) |  | $ | 149,289 |
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the three months ended March 31, 2018 |  | DaVita Inc. |  |  |  |
Patient service revenues |  | $ | — |  |  | $ | 1,790,188 |  |  | $ | 848,401 |  |  | $ | (47,515 | ) |  | $ | 2,591,074 |
Provision for uncollectible accounts |  | — |  |  | 9,628 |  |  | 15,917 |  |  | — |  |  | 25,545 |
Net patient service revenues |  | — |  |  | 1,799,816 |  |  | 864,318 |  |  | (47,515 | ) |  | 2,616,619 |
Other revenues |  | 195,565 |  |  | 204,960 |  |  | 70,933 |  |  | (238,633 | ) |  | 232,825 |
Total net revenues |  | 195,565 |  |  | 2,004,776 |  |  | 935,251 |  |  | (286,148 | ) |  | 2,849,444 |
Operating expenses |  | 133,356 |  |  | 1,791,094 |  |  | 800,456 |  |  | (286,148 | ) |  | 2,438,758 |
Operating income |  | 62,209 |  |  | 213,682 |  |  | 134,795 |  |  | — |  |  | 410,686 |
Debt expense |  | (114,334 | ) |  | (52,197 | ) |  | (7,375 | ) |  | 60,390 |  |  | (113,516 | )
Other income |  | 104,081 |  |  | 2,523 |  |  | 5,704 |  |  | (107,726 | ) |  | 4,582 |
Income tax expense |  | 14,387 |  |  | 48,944 |  |  | 7,406 |  |  | — |  |  | 70,737 |
Equity earnings in subsidiaries |  | 141,117 |  |  | 66,496 |  |  | — |  |  | (207,613 | ) |  | — |
Net income from continuing operations |  | 178,686 |  |  | 181,560 |  |  | 125,718 |  |  | (254,949 | ) |  | 231,015 |
Net loss from discontinued operations, net of tax |  | — |  |  | (40,443 | ) |  | (12,679 | ) |  | 47,336 |  |  | (5,786 | )
Net income |  | 178,686 |  |  | 141,117 |  |  | 113,039 |  |  | (207,613 | ) |  | 225,229 |
Less: Net income attributable to noncontrolling interests |  | — |  |  | — |  |  | — |  |  | (46,543 | ) |  | (46,543 | )
Net income attributable to DaVita Inc. |  | $ | 178,686 |  |  | $ | 141,117 |  |  | $ | 113,039 |  |  | $ | (254,156 | ) |  | $ | 178,686 |
Condensed Consolidating Statements of Income
|  | Consolidated Total |  | Physician Groups |  | Unrestricted Subsidiaries |  | Company and Restricted Subsidiaries(1)
For the three months ended March 31, 2019 |  |  |  |
Patient service operating revenues |  | $ | 2,635,152 |  |  | $ | — |  |  | $ | — |  |  | $ | 2,635,152 |
Provision for uncollectible accounts |  | (5,463 | ) |  | — |  |  | — |  |  | (5,463 | )
Net patient service operating revenues |  | 2,629,689 |  |  | — |  |  | — |  |  | 2,629,689 |
Other revenues |  | 113,423 |  |  | — |  |  | — |  |  | 113,423 |
Total net operating revenues |  | 2,743,112 |  |  | — |  |  | — |  |  | 2,743,112 |
Operating expenses |  | 2,402,605 |  |  | — |  |  | — |  |  | 2,402,605 |
Operating income |  | 340,507 |  |  | — |  |  | — |  |  | 340,507 |
Debt expense |  | (131,519 | ) |  | — |  |  | — |  |  | (131,519 | )
Other income |  | 6,940 |  |  | — |  |  | — |  |  | 6,940 |
Income tax expense |  | 56,746 |  |  | — |  |  | — |  |  | 56,746 |
Net income from continuing operations |  | 159,182 |  |  | — |  |  | — |  |  | 159,182 |
Net income from discontinued operations, net of tax |  | 30,305 |  |  | 9,237 |  |  | 463 |  |  | 20,605 |
Net income |  | 189,487 |  |  | 9,237 |  |  | 463 |  |  | 179,787 |
Less: Net income attributable to noncontrolling interests |  | (40,198 | ) |  | (1,255 | ) |  | — |  |  | (38,943 | )
Net income attributable to DaVita Inc. |  | $ | 149,289 |  |  | $ | 7,982 |  |  | $ | 463 |  |  | $ | 140,844 |
(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 March 31, 2019 |  | DaVita Inc. |  |  |  |
Net income |  | $ | 149,289 |  |  | $ | 134,535 |  |  | $ | 86,349 |  |  | $ | (180,686 | ) |  | $ | 189,487 |
Other comprehensive income (loss) |  | 1,026 |  |  | — |  |  | (13,653 | ) |  | — |  |  | (12,627 | )
Total comprehensive income |  | 150,315 |  |  | 134,535 |  |  | 72,696 |  |  | (180,686 | ) |  | 176,860 |
Less: Comprehensive income attributable to noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (40,198 | ) |  | (40,198 | )
Comprehensive income attributable to DaVita Inc. |  | $ | 150,315 |  |  | $ | 134,535 |  |  | $ | 72,696 |  |  | $ | (220,884 | ) |  | $ | 136,662 |
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the three months ended March 31, 2018 |  | DaVita Inc. |  |  |  |
Net income |  | $ | 178,686 |  |  | $ | 141,117 |  |  | $ | 113,039 |  |  | $ | (207,613 | ) |  | $ | 225,229 |
Other comprehensive income |  | 2,587 |  |  | — |  |  | 19,881 |  |  | — |  |  | 22,468 |
Total comprehensive income |  | 181,273 |  |  | 141,117 |  |  | 132,920 |  |  | (207,613 | ) |  | 247,697 |
Less: Comprehensive income attributable to noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (46,543 | ) |  | (46,543 | )
Comprehensive income attributable to DaVita Inc. |  | $ | 181,273 |  |  | $ | 141,117 |  |  | $ | 132,920 |  |  | $ | (254,156 | ) |  | $ | 201,154 |
Condensed Consolidating Statements of Comprehensive Income
|  | Consolidated Total |  | Physician Groups |  | Unrestricted Subsidiaries |  | Company and Restricted Subsidiaries(1)
For the three months ended March 31, 2019 |  |  |  |
Net income |  | $ | 189,487 |  |  | $ | 9,237 |  |  | $ | 463 |  |  | $ | 179,787 |
Other comprehensive loss |  | (12,627 | ) |  | — |  |  | — |  |  | (12,627 | )
Total comprehensive income |  | 176,860 |  |  | 9,237 |  |  | 463 |  |  | 167,160 |
Less: Comprehensive income attributable to the noncontrolling interests |  | (40,198 | ) |  | (1,255 | ) |  | — |  |  | (38,943 | )
Comprehensive income attributable to DaVita Inc. |  | $ | 136,662 |  |  | $ | 7,982 |  |  | $ | 463 |  |  | $ | 128,217 |
(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 March 31, 2019 |  | DaVita Inc. |  |  |  |
Cash and cash equivalents |  | $ | 194,347 |  |  | $ | — |  |  | $ | 264,895 |  |  | $ | — |  |  | $ | 459,242 |
Restricted cash and equivalents |  | 1,006 |  |  | 12,114 |  |  | 89,072 |  |  | — |  |  | 102,192 |
Accounts receivable, net |  | — |  |  | 1,349,185 |  |  | 604,237 |  |  | — |  |  | 1,953,422 |
Other current assets |  | 37,185 |  |  | 568,029 |  |  | 100,058 |  |  | — |  |  | 705,272 |
Current assets held for sale, net |  | — |  |  | 4,842,062 |  |  | 1,162,886 |  |  | — |  |  | 6,004,948 |
Total current assets |  | 232,538 |  |  | 6,771,390 |  |  | 2,221,148 |  |  | — |  |  | 9,225,076 |
Property and equipment, net |  | 503,677 |  |  | 1,610,442 |  |  | 1,278,147 |  |  | — |  |  | 3,392,266 |
Operating lease right-of-use assets |  | 107,237 |  |  | 1,594,411 |  |  | 1,034,888 |  |  | — |  |  | 2,736,536 |
Intangible assets, net |  | 130 |  |  | 39,813 |  |  | 78,381 |  |  | — |  |  | 118,324 |
Investments in subsidiaries |  | 10,191,084 |  |  | 3,323,518 |  |  | — |  |  | (13,514,602 | ) |  | — |
Intercompany receivables |  | 3,756,675 |  |  | — |  |  | 1,496,009 |  |  | (5,252,684 | ) |  | — |
Other long-term assets and investments |  | 53,978 |  |  | 84,137 |  |  | 196,259 |  |  | — |  |  | 334,374 |
Goodwill |  | — |  |  | 4,812,366 |  |  | 1,987,002 |  |  | — |  |  | 6,799,368 |
Total assets |  | $ | 14,845,319 |  |  | $ | 18,236,077 |  |  | $ | 8,291,834 |  |  | $ | (18,767,286 | ) |  | $ | 22,605,944 |
Current liabilities |  | $ | 4,702,717 |  |  | $ | 1,182,342 |  |  | $ | 592,508 |  |  | $ | — |  |  | $ | 6,477,567 |
Current liabilities held for sale |  | — |  |  | 1,084,512 |  |  | 668,798 |  |  | — |  |  | 1,753,310 |
Intercompany payables |  | — |  |  | 3,648,453 |  |  | 1,604,231 |  |  | (5,252,684 | ) |  | — |
Long-term operating leases liabilities |  | 133,936 |  |  | 1,502,922 |  |  | 988,918 |  |  | — |  |  | 2,625,776 |
Long-term debt and other long-term liabilities |  | 5,520,830 |  |  | 626,764 |  |  | 371,980 |  |  | — |  |  | 6,519,574 |
Noncontrolling interests subject to put provisions |  | 612,482 |  |  | — |  |  | — |  |  | 530,562 |  |  | 1,143,044 |
Total DaVita Inc. shareholders' equity |  | 3,875,354 |  |  | 10,191,084 |  |  | 3,323,518 |  |  | (13,514,602 | ) |  | 3,875,354 |
Noncontrolling interests not subject to put provisions |  | — |  |  | — |  |  | 741,881 |  |  | (530,562 | ) |  | 211,319 |
Total equity |  | 3,875,354 |  |  | 10,191,084 |  |  | 4,065,399 |  |  | (14,045,164 | ) |  | 4,086,673 |
Total liabilities and equity |  | $ | 14,845,319 |  |  | $ | 18,236,077 |  |  | $ | 8,291,834 |  |  | $ | (18,767,286 | ) |  | $ | 22,605,944 |
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
As of December 31, 2018 |  | DaVita Inc. |  |  |  |
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 |
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 |
Condensed Consolidating Balance Sheets
|  | Consolidated Total |  | Physician Groups |  | Unrestricted Subsidiaries |  | Company and Restricted Subsidiaries(1)
As of March 31, 2019 |  |  |  |
Cash and cash equivalents |  | $ | 459,242 |  |  | $ | — |  |  | $ | — |  |  | $ | 459,242 |
Restricted cash and equivalents |  | 102,192 |  |  | — |  |  | — |  |  | 102,192 |
Accounts receivable, net |  | 1,953,422 |  |  | — |  |  | — |  |  | 1,953,422 |
Other current assets |  | 705,272 |  |  | — |  |  | — |  |  | 705,272 |
Current assets held for sale, net |  | 6,004,948 |  |  | 629,422 |  |  | 3,288 |  |  | 5,372,238 |
Total current assets |  | 9,225,076 |  |  | 629,422 |  |  | 3,288 |  |  | 8,592,366 |
Property and equipment, net |  | 3,392,266 |  |  | — |  |  | — |  |  | 3,392,266 |
Operating lease right-of-use assets |  | 2,736,536 |  |  | — |  |  | — |  |  | 2,736,536 |
Amortizable intangibles, net |  | 118,324 |  |  | — |  |  | — |  |  | 118,324 |
Other long-term assets |  | 334,374 |  |  | — |  |  | — |  |  | 334,374 |
Goodwill |  | 6,799,368 |  |  | — |  |  | — |  |  | 6,799,368 |
Total assets |  | $ | 22,605,944 |  |  | $ | 629,422 |  |  | $ | 3,288 |  |  | $ | 21,973,234 |
Current liabilities |  | $ | 6,477,567 |  |  | $ | — |  |  | $ | — |  |  | $ | 6,477,567 |
Current liabilities held for sale |  | 1,753,310 |  |  | 412,368 |  |  | — |  |  | 1,340,942 |
Payables to parent |  | — |  |  | 72,539 |  |  | 3,288 |  |  | (75,827 | )
Long-term operating leases liabilities |  | 2,625,776 |  |  | — |  |  | — |  |  | 2,625,776 |
Long-term debt and other long-term liabilities |  | 6,519,574 |  |  | — |  |  | — |  |  | 6,519,574 |
Noncontrolling interests subject to put provisions |  | 1,143,044 |  |  | — |  |  | — |  |  | 1,143,044 |
Total DaVita Inc. shareholders’ equity |  | 3,875,354 |  |  | 144,515 |  |  | — |  |  | 3,730,839 |
Noncontrolling interests not subject to put provisions |  | 211,319 |  |  | — |  |  | — |  |  | 211,319 |
Shareholders’ equity |  | 4,086,673 |  |  | 144,515 |  |  | — |  |  | 3,942,158 |
Total liabilities and shareholder’s equity |  | $ | 22,605,944 |  |  | $ | 629,422 |  |  | $ | 3,288 |  |  | $ | 21,973,234 |
(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 three months ended March 31, 2019 |  | DaVita Inc. |  |  |  |
Cash flows from operating activities: |  |  |  |  |  |  |  |  |  |
Net income |  | $ | 149,289 |  |  | $ | 134,535 |  |  | $ | 86,349 |  |  | $ | (180,686 | ) |  | $ | 189,487 |
Changes in operating assets and liabilities and non-cash items included in net income |  | (124,409 | ) |  | (197,096 | ) |  | 92,636 |  |  | 180,686 |  |  | (48,183 | )
Net cash provided by (used in) operating activities |  | 24,880 |  |  | (62,561 | ) |  | 178,985 |  |  | — |  |  | 141,304 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Additions of property and equipment |  | (38,942 | ) |  | (112,376 | ) |  | (47,560 | ) |  | — |  |  | (198,878 | )
Acquisitions |  | — |  |  | — |  |  | (11,274 | ) |  | — |  |  | (11,274 | )
Proceeds from asset and business sales |  | — |  |  | 1,456 |  |  | 12,447 |  |  | — |  |  | 13,903 |
Proceeds (purchases) from investment sales and other items, net |  | 1,804 |  |  | (4,558 | ) |  | (1,355 | ) |  | — |  |  | (4,109 | )
Net cash used in investing activities |  | (37,138 | ) |  | (115,478 | ) |  | (47,742 | ) |  | — |  |  | (200,358 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Long-term debt and related financing costs, net |  | 365,133 |  |  | (2,439 | ) |  | (5,497 | ) |  | — |  |  | 357,197 |
Intercompany borrowing (payments) |  | (220,697 | ) |  | 229,211 |  |  | (8,514 | ) |  | — |  |  | — |
Other items |  | 1,517 |  |  | (8,480 | ) |  | (25,283 | ) |  | — |  |  | (32,246 | )
Net cash provided by (used in) financing activities |  | 145,953 |  |  | 218,292 |  |  | (39,294 | ) |  | — |  |  | 324,951 |
Effect of exchange rate changes on cash, cash equivalents and restricted cash |  | — |  |  | — |  |  | (921 | ) |  | — |  |  | (921 | )
Net increase in cash, cash equivalents and restricted cash |  | 133,695 |  |  | 40,253 |  |  | 91,028 |  |  | — |  |  | 264,976 |
Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations |  | — |  |  | 40,187 |  |  | 78,775 |  |  | — |  |  | 118,962 |
Net increase in cash, cash equivalents and restricted cash from continuing operations |  | 133,695 |  |  | 66 |  |  | 12,253 |  |  | — |  |  | 146,014 |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year |  | 61,658 |  |  | 12,048 |  |  | 341,714 |  |  | — |  |  | 415,420 |
Cash, cash equivalents and restricted cash of continuing operations at end of the period |  | $ | 195,353 |  |  | $ | 12,114 |  |  | $ | 353,967 |  |  | $ | — |  |  | $ | 561,434 |
|  |  |  | Guarantor subsidiaries |  | Non- Guarantor subsidiaries |  | Consolidating adjustments |  | Consolidated total
For the three months ended March 31, 2018 |  | DaVita Inc. |  |  |  |
Cash flows from operating activities: |  |  |  |  |  |  |  |  |  |
Net income |  | $ | 178,686 |  |  | $ | 141,117 |  |  | $ | 113,039 |  |  | $ | (207,613 | ) |  | $ | 225,229 |
Changes in operating assets and liabilities and non-cash items included in net income |  | (82,391 | ) |  | 32,484 |  |  | (20,396 | ) |  | 207,613 |  |  | 137,310 |
Net cash provided by operating activities |  | 96,295 |  |  | 173,601 |  |  | 92,643 |  |  | — |  |  | 362,539 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Additions of property and equipment |  | (27,356 | ) |  | (125,375 | ) |  | (79,712 | ) |  | — |  |  | (232,443 | )
Acquisitions |  | — |  |  | (4,417 | ) |  | (12,165 | ) |  | — |  |  | (16,582 | )
Proceeds from asset and business sales |  | — |  |  | 18,535 |  |  | — |  |  | — |  |  | 18,535 |
Proceeds (purchases) from investment sales and other items, net |  | 31,665 |  |  | (762 | ) |  | (541 | ) |  | — |  |  | 30,362 |
Net cash provided by (used in) investing activities |  | 4,309 |  |  | (112,019 | ) |  | (92,418 | ) |  | — |  |  | (200,128 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Long-term debt and related financing costs, net |  | 116,307 |  |  | (3,377 | ) |  | (8,257 | ) |  | — |  |  | 104,673 |
Intercompany borrowing (payments) |  | 47,394 |  |  | (49,783 | ) |  | 2,389 |  |  | — |  |  | — |
Other items |  | (291,562 | ) |  | (2,200 | ) |  | (33,458 | ) |  | — |  |  | (327,220 | )
Net cash used in financing activities |  | (127,861 | ) |  | (55,360 | ) |  | (39,326 | ) |  | — |  |  | (222,547 | )
Effect of exchange rate changes on cash, cash equivalents and restricted cash |  | — |  |  | — |  |  | 6,668 |  |  | — |  |  | 6,668 |
Net decrease in cash, cash equivalents and restricted cash |  | (27,257 | ) |  | 6,222 |  |  | (32,433 | ) |  | — |  |  | (53,468 | )
Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations |  | — |  |  | 6,185 |  |  | 11,649 |  |  | — |  |  | 17,834 |
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations |  | (27,257 | ) |  | 37 |  |  | (44,082 | ) |  | — |  |  | (71,302 | )
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 |  | $ | 123,050 |  |  | $ | 9,421 |  |  | $ | 315,147 |  |  | $ | — |  |  | $ | 447,618 |
Condensed Consolidating Statements of Cash Flows
|  | Consolidated Total |  | Physician Groups |  | Unrestricted Subsidiaries |  | Company and Restricted Subsidiaries(1)
For the three months ended March 31, 2019 |  |  |  |
Cash flows from operating activities: |  |  |  |  |  |  |  |
Net income |  | $ | 189,487 |  |  | $ | 9,237 |  |  | $ | 463 |  |  | $ | 179,787 |
Changes in operating and intercompany assets and liabilities and non-cash items included in net income |  | (48,183 | ) |  | 9,696 |  |  | (463 | ) |  | (57,416 | )
Net cash provided by operating activities |  | 141,304 |  |  | 18,933 |  |  | — |  |  | 122,371 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |
Additions of property and equipment |  | (198,878 | ) |  | (229 | ) |  | — |  |  | (198,649 | )
Acquisitions |  | (11,274 | ) |  | — |  |  | — |  |  | (11,274 | )
Proceeds from asset and business sales |  | 13,903 |  |  | — |  |  | — |  |  | 13,903 |
Investments and other items |  | (4,109 | ) |  | (1,355 | ) |  | — |  |  | (2,754 | )
Net cash used in investing activities |  | (200,358 | ) |  | (1,584 | ) |  | — |  |  | (198,774 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |
Long-term debt |  | 357,197 |  |  | — |  |  | — |  |  | 357,197 |
Intercompany |  | — |  |  | 28,965 |  |  | — |  |  | (28,965 | )
Other items |  | (32,246 | ) |  | — |  |  | — |  |  | (32,246 | )
Net cash (used in) provided by financing activities |  | 324,951 |  |  | 28,965 |  |  | — |  |  | 295,986 |
Effect of exchange rate changes on cash, cash equivalents and restricted cash |  | (921 | ) |  | — |  |  | — |  |  | (921 | )
Net increase in cash, cash equivalents and restricted cash |  | 264,976 |  |  | 46,314 |  |  | — |  |  | 218,662 |
Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations |  | 118,962 |  |  | 46,314 |  |  | — |  |  | 72,648 |
Net increase in cash, cash equivalents and restricted cash from continuing operations |  | 146,014 |  |  | — |  |  | — |  |  | 146,014 |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year |  | 415,420 |  |  | — |  |  | — |  |  | 415,420 |
Cash, cash equivalents and restricted cash of continuing operations at end of the period |  | $ | 561,434 |  |  | $ | — |  |  | $ | — |  |  | $ | 561,434 |
(1) After elimination of the unrestricted subsidiaries and the physician groups.

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