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Consolidating Financial Statements (Tables) | 12 Months Ended
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Dec. 31, 2019
Condensed Financial Information Disclosure [Abstract] |
Consolidating Statements of Income | Consolidating Statements of Income
For year ended December 31, 2019 |  | DaVita Inc. |  | Guarantor Subsidiaries |  | Non- Guarantor Subsidiaries |  | Consolidating Adjustments |  | Consolidated Total
Dialysis patient service revenues |  | $ | — |  |  | $ | 6,961,825 |  |  | $ | 4,226,402 |  |  | $ | (269,806 | ) |  | $ | 10,918,421 |
Less: Provision for uncollectible accounts |  | — |  |  | (15,296 | ) |  | (6,419 | ) |  | — |  |  | (21,715 | )
Net dialysis patient service revenues |  | — |  |  | 6,946,529 |  |  | 4,219,983 |  |  | (269,806 | ) |  | 10,896,706 |
Other revenues |  | 804,684 |  |  | 601,394 |  |  | 171,856 |  |  | (1,086,161 | ) |  | 491,773 |
Total revenues |  | 804,684 |  |  | 7,547,923 |  |  | 4,391,839 |  |  | (1,355,967 | ) |  | 11,388,479 |
Operating expenses and charges |  | 642,717 |  |  | 6,631,471 |  |  | 3,826,941 |  |  | (1,355,967 | ) |  | 9,745,162 |
Operating income |  | 161,967 |  |  | 916,452 |  |  | 564,898 |  |  | — |  |  | 1,643,317 |
Debt expense |  | (482,074 | ) |  | (183,272 | ) |  | (53,043 | ) |  | 241,163 |  |  | (477,226 | )
Other income, net |  | 309,623 |  |  | 7,314 |  |  | 46,306 |  |  | (333,895 | ) |  | 29,348 |
Income tax (benefit) expense |  | (2,616 | ) |  | 263,563 |  |  | 18,681 |  |  | — |  |  | 279,628 |
Equity earnings in subsidiaries |  | 818,849 |  |  | 429,628 |  |  | — |  |  | (1,248,477 | ) |  | — |
Net income from continuing operations |  | 810,981 |  |  | 906,559 |  |  | 539,480 |  |  | (1,341,209 | ) |  | 915,811 |
Net income from discontinued operations, net of tax |  | — |  |  | — |  |  | 12,751 |  |  | 92,732 |  |  | 105,483 |
Net income |  | 810,981 |  |  | 906,559 |  |  | 552,231 |  |  | (1,248,477 | ) |  | 1,021,294 |
Less: Net income attributable to noncontrolling interests |  | — |  |  | — |  |  | — |  |  | (210,313 | ) |  | (210,313 | )
Net income attributable to DaVita Inc. |  | $ | 810,981 |  |  | $ | 906,559 |  |  | $ | 552,231 |  |  | $ | (1,458,790 | ) |  | $ | 810,981 |
Consolidating Statements of Income - (continued)
For year ended December 31, 2018 |  | DaVita Inc. |  | Guarantor Subsidiaries |  | Non- Guarantor Subsidiaries |  | Consolidating Adjustments |  | Consolidated Total
Dialysis patient service revenues |  | $ | — |  |  | $ | 6,834,865 |  |  | $ | 4,096,666 |  |  | $ | (221,550 | ) |  | $ | 10,709,981 |
Less: Provision for uncollectible accounts |  | — |  |  | (34,977 | ) |  | (14,610 | ) |  | — |  |  | (49,587 | )
Net dialysis patient service revenues |  | — |  |  | 6,799,888 |  |  | 4,082,056 |  |  | (221,550 | ) |  | 10,660,394 |
Other revenues |  | 799,230 |  |  | 488,086 |  |  | 558,079 |  |  | (1,100,938 | ) |  | 744,457 |
Total revenues |  | 799,230 |  |  | 7,287,974 |  |  | 4,640,135 |  |  | (1,322,488 | ) |  | 11,404,851 |
Operating expenses and charges |  | 646,640 |  |  | 6,551,328 |  |  | 4,003,547 |  |  | (1,322,488 | ) |  | 9,879,027 |
Operating income |  | 152,590 |  |  | 736,646 |  |  | 636,588 |  |  | — |  |  | 1,525,824 |
Debt expense |  | (491,749 | ) |  | (201,496 | ) |  | (43,414 | ) |  | 249,224 |  |  | (487,435 | )
Other income, net |  | 418,839 |  |  | 3,430 |  |  | 29,132 |  |  | (441,312 | ) |  | 10,089 |
Income tax expense |  | 23,482 |  |  | 155,372 |  |  | 79,546 |  |  | — |  |  | 258,400 |
Equity earnings in subsidiaries |  | 103,196 |  |  | 388,737 |  |  | — |  |  | (491,933 | ) |  | — |
Net income from continuing operations |  | 159,394 |  |  | 771,945 |  |  | 542,760 |  |  | (684,021 | ) |  | 790,078 |
Net loss from discontinued operations, net of tax |  | — |  |  | — |  |  | (649,126 | ) |  | 192,088 |  |  | (457,038 | )
Net income (loss) |  | 159,394 |  |  | 771,945 |  |  | (106,366 | ) |  | (491,933 | ) |  | 333,040 |
Less: Net income attributable to noncontrolling interests |  | — |  |  | — |  |  | — |  |  | (173,646 | ) |  | (173,646 | )
Net income (loss) attributable to DaVita Inc. |  | $ | 159,394 |  |  | $ | 771,945 |  |  | $ | (106,366 | ) |  | $ | (665,579 | ) |  | $ | 159,394 |
For year ended December 31, 2017 |  | DaVita Inc. |  | Guarantor Subsidiaries |  | Non- Guarantor Subsidiaries |  | Consolidating Adjustments |  | Consolidated Total
Dialysis patient service revenues |  | $ | — |  |  | $ | 6,417,574 |  |  | $ | 3,848,172 |  |  | $ | (172,076 | ) |  | $ | 10,093,670 |
Less: Provision for uncollectible accounts |  | — |  |  | (322,085 | ) |  | (170,447 | ) |  | 7,168 |  |  | (485,364 | )
Net dialysis patient service revenues |  | — |  |  | 6,095,489 |  |  | 3,677,725 |  |  | (164,908 | ) |  | 9,608,306 |
Other revenues |  | 793,751 |  |  | 408,460 |  |  | 1,080,832 |  |  | (1,014,715 | ) |  | 1,268,328 |
Total net revenues |  | 793,751 |  |  | 6,503,949 |  |  | 4,758,557 |  |  | (1,179,623 | ) |  | 10,876,634 |
Operating expenses and charges |  | 527,942 |  |  | 5,331,545 |  |  | 4,384,015 |  |  | (1,179,623 | ) |  | 9,063,879 |
Operating income |  | 265,809 |  |  | 1,172,404 |  |  | 374,542 |  |  | — |  |  | 1,812,755 |
Debt expense |  | (426,149 | ) |  | (200,953 | ) |  | (43,490 | ) |  | 239,958 |  |  | (430,634 | )
Other income, net |  | 411,731 |  |  | 5,979 |  |  | 23,657 |  |  | (423,702 | ) |  | 17,665 |
Income tax expense |  | 65,965 |  |  | 210,068 |  |  | 47,826 |  |  | — |  |  | 323,859 |
Equity earnings in subsidiaries |  | 478,192 |  |  | 460,261 |  |  | — |  |  | (938,453 | ) |  | — |
Net income from continuing operations |  | 663,618 |  |  | 1,227,623 |  |  | 306,883 |  |  | (1,122,197 | ) |  | 1,075,927 |
Net loss from discontinued operations, net of tax |  | — |  |  | — |  |  | (429,116 | ) |  | 183,744 |  |  | (245,372 | )
Net income (loss) |  | 663,618 |  |  | 1,227,623 |  |  | (122,233 | ) |  | (938,453 | ) |  | 830,555 |
Less: Net income attributable to noncontrolling interests |  | — |  |  | — |  |  | — |  |  | (166,937 | ) |  | (166,937 | )
Net income (loss) attributable to DaVita Inc. |  | $ | 663,618 |  |  | $ | 1,227,623 |  |  | $ | (122,233 | ) |  | $ | (1,105,390 | ) |  | $ | 663,618 |
Consolidating Statements of Comprehensive Income | Consolidating Statements of Comprehensive Income
For the year ended December 31, 2019 |  | DaVita Inc. |  | Guarantor Subsidiaries |  | Non- Guarantor Subsidiaries |  | Consolidating Adjustments |  | Consolidated Total
Net income |  | $ | 810,981 |  |  | $ | 906,559 |  |  | $ | 552,231 |  |  | $ | (1,248,477 | ) |  | $ | 1,021,294 |
Other comprehensive income (loss) |  | 7,528 |  |  | — |  |  | (20,102 | ) |  | — |  |  | (12,574 | )
Total comprehensive income |  | 818,509 |  |  | 906,559 |  |  | 532,129 |  |  | (1,248,477 | ) |  | 1,008,720 |
Less: Comprehensive income attributable to noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (210,313 | ) |  | (210,313 | )
Comprehensive income attributable to DaVita Inc. |  | $ | 818,509 |  |  | $ | 906,559 |  |  | $ | 532,129 |  |  | $ | (1,458,790 | ) |  | $ | 798,407 |
For the year ended December 31, 2018 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Net income (loss) |  | $ | 159,394 |  |  | $ | 771,945 |  |  | $ | (106,366 | ) |  | $ | (491,933 | ) |  | $ | 333,040 |
Other comprehensive income (loss) |  | 6,153 |  |  | — |  |  | (45,944 | ) |  | — |  |  | (39,791 | )
Total comprehensive income (loss) |  | 165,547 |  |  | 771,945 |  |  | (152,310 | ) |  | (491,933 | ) |  | 293,249 |
Less: Comprehensive income attributable to noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (173,646 | ) |  | (173,646 | )
Comprehensive income (loss) attributable to DaVita Inc. |  | $ | 165,547 |  |  | $ | 771,945 |  |  | $ | (152,310 | ) |  | $ | (665,579 | ) |  | $ | 119,603 |
For the year ended December 31, 2017 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Net income (loss) |  | $ | 663,618 |  |  | $ | 1,227,623 |  |  | $ | (122,233 | ) |  | $ | (938,453 | ) |  | $ | 830,555 |
Other comprehensive income (loss) |  | 3,106 |  |  | — |  |  | 99,770 |  |  | — |  |  | 102,876 |
Total comprehensive income (loss) |  | 666,724 |  |  | 1,227,623 |  |  | (22,463 | ) |  | (938,453 | ) |  | 933,431 |
Less: Comprehensive income attributable to noncontrolling interest |  | — |  |  | — |  |  | — |  |  | (166,935 | ) |  | (166,935 | )
Comprehensive income (loss) attributable to DaVita Inc. |  | $ | 666,724 |  |  | $ | 1,227,623 |  |  | $ | (22,463 | ) |  | $ | (1,105,388 | ) |  | $ | 766,496 |
Consolidating Balance Sheets | Consolidating Balance Sheets
As of December 31, 2019 |  | DaVita Inc. |  | Guarantor Subsidiaries |  | Non- Guarantor Subsidiaries |  | Consolidating Adjustments |  | Consolidated Total
Cash and cash equivalents |  | $ | 758,241 |  |  | $ | 532 |  |  | $ | 343,599 |  |  | $ | — |  |  | $ | 1,102,372 |
Restricted cash and equivalents |  | 14,499 |  |  | — |  |  | 91,847 |  |  | — |  |  | 106,346 |
Accounts receivable, net |  | — |  |  | 1,189,301 |  |  | 606,297 |  |  | — |  |  | 1,795,598 |
Other current assets |  | 76,787 |  |  | 548,553 |  |  | 102,410 |  |  | (41,896 | ) |  | 685,854 |
Total current assets |  | 849,527 |  |  | 1,738,386 |  |  | 1,144,153 |  |  | (41,896 | ) |  | 3,690,170 |
Property and equipment, net |  | 543,932 |  |  | 1,589,417 |  |  | 1,344,543 |  |  | (4,508 | ) |  | 3,473,384 |
Operating lease right-of-use assets |  | 109,415 |  |  | 1,656,145 |  |  | 1,084,552 |  |  | (20,065 | ) |  | 2,830,047 |
Intangible assets, net |  | 362 |  |  | 31,569 |  |  | 103,753 |  |  | — |  |  | 135,684 |
Investments in and advances to affiliates, net |  | 10,813,991 |  |  | 7,611,402 |  |  | 3,051,208 |  |  | (21,476,601 | ) |  | — |
Other long-term assets and investments |  | 102,779 |  |  | 133,698 |  |  | 176,315 |  |  | (18,318 | ) |  | 394,474 |
Goodwill |  | — |  |  | 4,812,972 |  |  | 1,974,663 |  |  | — |  |  | 6,787,635 |
Total assets |  | $ | 12,420,006 |  |  | $ | 17,573,589 |  |  | $ | 8,879,187 |  |  | $ | (21,561,388 | ) |  | $ | 17,311,394 |
Current liabilities |  | $ | 379,286 |  |  | $ | 1,327,378 |  |  | $ | 666,470 |  |  | $ | (1,036 | ) |  | $ | 2,372,098 |
Intercompany payables |  | 1,381,863 |  |  | 3,051,208 |  |  | 2,615,151 |  |  | (7,048,222 | ) |  | — |
Long-term operating lease liabilities |  | 136,123 |  |  | 1,567,776 |  |  | 1,039,145 |  |  | (19,244 | ) |  | 2,723,800 |
Long-term debt and other long-term liabilities |  | 7,741,725 |  |  | 674,558 |  |  | 364,102 |  |  | (64,507 | ) |  | 8,715,878 |
Noncontrolling interests subject to put provisions |  | 647,600 |  |  | — |  |  | — |  |  | 532,776 |  |  | 1,180,376 |
Total DaVita Inc. shareholders' equity |  | 2,133,409 |  |  | 10,952,669 |  |  | 3,475,710 |  |  | (14,428,379 | ) |  | 2,133,409 |
Noncontrolling interests not subject to put provisions |  | — |  |  | — |  |  | 718,609 |  |  | (532,776 | ) |  | 185,833 |
Total equity |  | 2,133,409 |  |  | 10,952,669 |  |  | 4,194,319 |  |  | (14,961,155 | ) |  | 2,319,242 |
Total liabilities and equity |  | $ | 12,420,006 |  |  | $ | 17,573,589 |  |  | $ | 8,879,187 |  |  | $ | (21,561,388 | ) |  | $ | 17,311,394 |
Consolidating Balance Sheets - (continued)
As of December 31, 2018 |  | DaVita Inc. |  | Guarantor Subsidiaries |  | Non- Guarantor Subsidiaries |  | Consolidating Adjustments |  | Consolidated Total
Cash and cash equivalents |  | $ | 60,653 |  |  | $ | 1,232 |  |  | $ | 261,153 |  |  | $ | — |  |  | $ | 323,038 |
Restricted cash and equivalents |  | 1,005 |  |  | 12,048 |  |  | 79,329 |  |  | — |  |  | 92,382 |
Accounts receivable, net |  | — |  |  | 1,204,122 |  |  | 654,486 |  |  | — |  |  | 1,858,608 |
Other current assets |  | 37,185 |  |  | 565,974 |  |  | 157,407 |  |  | — |  |  | 760,566 |
Current assets held for sale |  | — |  |  | — |  |  | 5,389,565 |  |  | — |  |  | 5,389,565 |
Total current assets |  | 98,843 |  |  | 1,783,376 |  |  | 6,541,940 |  |  | — |  |  | 8,424,159 |
Property and equipment, net |  | 491,462 |  |  | 1,584,321 |  |  | 1,317,886 |  |  | — |  |  | 3,393,669 |
Intangible assets, net |  | 153 |  |  | 42,896 |  |  | 75,797 |  |  | — |  |  | 118,846 |
Investments in and advances to affiliates, net |  | 13,522,198 |  |  | 6,196,801 |  |  | 2,498,545 |  |  | (22,217,544 | ) |  | — |
Other long-term assets and investments |  | 53,385 |  |  | 90,037 |  |  | 188,196 |  |  | — |  |  | 331,618 |
Goodwill |  | — |  |  | 4,806,939 |  |  | 2,035,021 |  |  | — |  |  | 6,841,960 |
Total assets |  | $ | 14,166,041 |  |  | $ | 14,504,370 |  |  | $ | 12,657,385 |  |  | $ | (22,217,544 | ) |  | $ | 19,110,252 |
Current liabilities |  | $ | 1,945,943 |  |  | $ | 1,217,526 |  |  | $ | 483,933 |  |  | $ | — |  |  | $ | 3,647,402 |
Current liabilities held for sale |  | — |  |  | — |  |  | 1,243,759 |  |  | — |  |  | 1,243,759 |
Total current liabilities |  | 1,945,943 |  |  | 1,217,526 |  |  | 1,727,692 |  |  | — |  |  | 4,891,161 |
Intercompany payables |  | — |  |  | 2,498,545 |  |  | 6,161,292 |  |  | (8,659,837 | ) |  | — |
Long-term debt and other long-term liabilities |  | 7,918,581 |  |  | 687,443 |  |  | 580,028 |  |  | — |  |  | 9,186,052 |
Noncontrolling interests subject to put provisions |  | 598,075 |  |  | — |  |  | — |  |  | 526,566 |  |  | 1,124,641 |
Total DaVita Inc. shareholders' equity |  | 3,703,442 |  |  | 10,100,856 |  |  | 3,456,851 |  |  | (13,557,707 | ) |  | 3,703,442 |
Noncontrolling interests not subject to put provisions |  | — |  |  | — |  |  | 731,522 |  |  | (526,566 | ) |  | 204,956 |
Total equity |  | 3,703,442 |  |  | 10,100,856 |  |  | 4,188,373 |  |  | (14,084,273 | ) |  | 3,908,398 |
Total liabilities and equity |  | $ | 14,166,041 |  |  | $ | 14,504,370 |  |  | $ | 12,657,385 |  |  | $ | (22,217,544 | ) |  | $ | 19,110,252 |
Consolidating Statements of Cash Flows | Consolidating Statements of Cash Flow
For the year ended December 31, 2019 |  | DaVita Inc. |  | Guarantor Subsidiaries |  | Non-Guarantor Subsidiaries |  | Consolidating Adjustments |  | Consolidated Total
Cash flows from operating activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Net income |  | $ | 810,981 |  |  | $ | 906,559 |  |  | $ | 552,231 |  |  | $ | (1,248,477 | ) |  | $ | 1,021,294 |
Changes in operating assets and liabilities and non-cash items included in net income |  | (602,288 | ) |  | (73,356 | ) |  | 478,228 |  |  | 1,248,477 |  |  | 1,051,061 |
Net cash provided by operating activities |  | 208,693 |  |  | 833,203 |  |  | 1,030,459 |  |  | — |  |  | 2,072,355 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Additions of property and equipment, net |  | (145,378 | ) |  | (310,032 | ) |  | (311,136 | ) |  | — |  |  | (766,546 | )
Acquisitions |  | — |  |  | (11,851 | ) |  | (89,010 | ) |  | — |  |  | (100,861 | )
Proceeds from asset sales, net of cash divested |  | 3,824,516 |  |  | 1,777 |  |  | 51,099 |  |  | — |  |  | 3,877,392 |
Investments and other items |  | (4,606 | ) |  | (6,676 | ) |  | (3,363 | ) |  | — |  |  | (14,645 | )
Net cash provided by (used in) investing activities |  | 3,674,532 |  |  | (326,782 | ) |  | (352,410 | ) |  | — |  |  | 2,995,340 |
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Long-term debt and related financing costs, net |  | (2,052,197 | ) |  | (10,481 | ) |  | (17,513 | ) |  | — |  |  | (2,080,191 | )
Intercompany borrowing |  | 1,267,138 |  |  | (455,405 | ) |  | (811,733 | ) |  | — |  |  | — |
Other items |  | (2,387,084 | ) |  | (53,283 | ) |  | (175,892 | ) |  | — |  |  | (2,616,259 | )
Net cash used in financing activities |  | (3,172,143 | ) |  | (519,169 | ) |  | (1,005,138 | ) |  | — |  |  | (4,696,450 | )
Effect of exchange rate changes on cash |  | — |  |  | — |  |  | (1,760 | ) |  | — |  |  | (1,760 | )
Net increase (decrease) in cash, cash equivalents and restricted cash |  | 711,082 |  |  | (12,748 | ) |  | (328,849 | ) |  | — |  |  | 369,485 |
Less: Net increase in cash, cash equivalents and restricted cash from discontinued operations |  | — |  |  | — |  |  | (423,813 | ) |  | — |  |  | (423,813 | )
Net increase (decrease) in cash, cash equivalents and restricted cash from continuing operations |  | 711,082 |  |  | (12,748 | ) |  | 94,964 |  |  | — |  |  | 793,298 |
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year |  | 61,658 |  |  | 13,280 |  |  | 340,482 |  |  | — |  |  | 415,420 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year |  | $ | 772,740 |  |  | $ | 532 |  |  | $ | 435,446 |  |  | $ | — |  |  | $ | 1,208,718 |
Consolidating Statements of Cash Flow - (continued)
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 |  |  | $ | 771,945 |  |  | $ | (106,366 | ) |  | $ | (491,933 | ) |  | $ | 333,040 |
Changes in operating assets and liabilities and non-cash items included in net income |  | (86,070 | ) |  | (150,976 | ) |  | 1,183,713 |  |  | 491,933 |  |  | 1,438,600 |
Net cash provided by operating activities |  | 73,324 |  |  | 620,969 |  |  | 1,077,347 |  |  | — |  |  | 1,771,640 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Additions of property and equipment, net |  | (175,787 | ) |  | (425,008 | ) |  | (386,343 | ) |  | — |  |  | (987,138 | )
Acquisitions |  | — |  |  | (42,987 | ) |  | (140,169 | ) |  | — |  |  | (183,156 | )
Proceeds from asset and business sales, net of cash divested |  | — |  |  | 55,184 |  |  | 95,021 |  |  | — |  |  | 150,205 |
Investments and other items |  | 30,962 |  |  | (8,286 | ) |  | (8,230 | ) |  | — |  |  | 14,446 |
Net cash used in investing activities |  | (144,825 | ) |  | (421,097 | ) |  | (439,721 | ) |  | — |  |  | (1,005,643 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Long-term debt and related financing costs, net |  | 725,889 |  |  | (8,874 | ) |  | (22,238 | ) |  | — |  |  | 694,777 |
Intercompany borrowing |  | 404,897 |  |  | (168,224 | ) |  | (236,673 | ) |  | — |  |  | — |
Other items |  | (1,147,934 | ) |  | (29,457 | ) |  | (142,740 | ) |  | — |  |  | (1,320,131 | )
Net cash used in financing activities |  | (17,148 | ) |  | (206,555 | ) |  | (401,651 | ) |  | — |  |  | (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 | ) |  | (6,683 | ) |  | 232,625 |  |  | — |  |  | 137,293 |
Less: Net decrease in cash, cash equivalents and restricted cash from discontinued operations |  | — |  |  | — |  |  | 240,793 |  |  | — |  |  | 240,793 |
Net decrease in cash, cash equivalents and restricted cash from continuing operations |  | (88,649 | ) |  | (6,683 | ) |  | (8,168 | ) |  | — |  |  | (103,500 | )
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year |  | 150,307 |  |  | 19,963 |  |  | 348,650 |  |  | — |  |  | 518,920 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year |  | $ | 61,658 |  |  | $ | 13,280 |  |  | $ | 340,482 |  |  | $ | — |  |  | $ | 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 |  |  | $ | 1,227,623 |  |  | $ | (122,233 | ) |  | $ | (938,453 | ) |  | $ | 830,555 |
Changes in operating assets and liabilities and non-cash items included in net income |  | (533,300 | ) |  | (739,023 | ) |  | 1,416,481 |  |  | 938,453 |  |  | 1,082,611 |
Net cash provided by operating activities |  | 130,318 |  |  | 488,600 |  |  | 1,294,248 |  |  | — |  |  | 1,913,166 |
Cash flows from investing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Additions of property and equipment, net |  | (155,972 | ) |  | (348,292 | ) |  | (400,986 | ) |  | — |  |  | (905,250 | )
Acquisitions |  | — |  |  | (528,588 | ) |  | (275,291 | ) |  | — |  |  | (803,879 | )
Proceeds from asset sales |  | — |  |  | 25,989 |  |  | 66,347 |  |  | — |  |  | 92,336 |
Investments and other items |  | 211,619 |  |  | (3,526 | ) |  | 43,968 |  |  | — |  |  | 252,061 |
Net cash provided by (used in) investing activities |  | 55,647 |  |  | (854,417 | ) |  | (565,962 | ) |  | — |  |  | (1,364,732 | )
Cash flows from financing activities: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
Long-term debt and related financing costs, net |  | 173,529 |  |  | (8,186 | ) |  | (10,495 | ) |  | — |  |  | 154,848 |
Intercompany borrowing |  | 22,589 |  |  | 382,452 |  |  | (405,041 | ) |  | — |  |  | — |
Other items |  | (781,697 | ) |  | (2,205 | ) |  | (137,203 | ) |  | — |  |  | (921,105 | )
Net cash (used in) provided by financing activities |  | (585,579 | ) |  | 372,061 |  |  | (552,739 | ) |  | — |  |  | (766,257 | )
Effect of exchange rate changes on cash |  | — |  |  | — |  |  | 254 |  |  | — |  |  | 254 |
Net (decrease) increase in cash, cash equivalents and restricted cash |  | (399,614 | ) |  | 6,244 |  |  | 175,801 |  |  | — |  |  | (217,569 | )
Less: Net decrease in cash, cash equivalents and restricted cash from discontinued operations |  | — |  |  | — |  |  | (53,026 | ) |  | — |  |  | (53,026 | )
Net (decrease) increase in cash, cash equivalents and restricted cash from continuing operations |  | (399,614 | ) |  | 6,244 |  |  | 228,827 |  |  | — |  |  | (164,543 | )
Cash, cash equivalents and restricted cash of continuing operations at beginning of the year |  | 549,921 |  |  | 13,719 |  |  | 119,823 |  |  | — |  |  | 683,463 |
Cash, cash equivalents and restricted cash of continuing operations at end of the year |  | $ | 150,307 |  |  | $ | 19,963 |  |  | $ | 348,650 |  |  | $ | — |  |  | $ | 518,920 |

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