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Segment Reporting | 12 Months Ended
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Dec. 31, 2020
Segment Reporting [Abstract] |
Segment Reporting | Segment reporting The Company's operations are comprised of its U.S. dialysis and related lab services business (its U.S. dialysis business), its various ancillary services and strategic initiatives, including its international operations (collectively, its ancillary services), and its corporate administrative support. See Note 1 "Organization" for a summary description of the Company's businesses. On June 19, 2019, the Company completed the sale of its DMG business to Optum. As a result of this transaction, DMG's results of operations have been reported as discontinued operations for all periods presented. The Company’s operating segments have been defined based on the separate financial information that is regularly produced and reviewed by the Company’s chief operating decision maker in making decisions about allocating resources to and assessing the financial performance of the Company’s various operating lines of business. The chief operating decision maker for the Company is its Chief Executive Officer. The Company’s separate operating segments include its U.S. dialysis and related lab services business, each of its ancillary services and strategic initiatives, its kidney care operations in each foreign sovereign jurisdiction, its other health operations in each foreign sovereign jurisdiction, and its equity method investment in the APAC joint venture. The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other ancillary services and strategic initiatives operating segments, including the international operating segments, have been combined and disclosed in the other segments category. The Company’s operating segment financial information included in this report is prepared on the internal management reporting basis that the chief operating decision maker uses to allocate resources and assess the financial performance of the Company's operating segments. For internal management reporting, segment operations include direct segment operating expenses but generally exclude corporate administrative support costs, which consist primarily of indirect labor, benefits and long-term incentive compensation expenses of certain departments which provide support to all of the Company’s various operating lines of business, except to the extent that such costs are charged to and borne by certain ancillary services and strategic initiatives via internal management fees. These corporate administrative support costs are reduced by internal management fees received from the Company’s ancillary lines of business. The following is a summary of segment revenues, segment operating margin (loss), and a reconciliation of segment operating margin to consolidated income from continuing operations before income taxes:
| Year ended December 31,
| 2020 |  | 2019 |  | 2018
Segment revenues: |  |  |  |  |
U.S. dialysis |  |  |  |  |
Patient service revenues: |  |  |  |  |
External sources | $ | 10,488,731 |  |  | $ | 10,421,401 |  |  | $ | 10,274,046 |
Intersegment revenues | 144,091 |  |  | 131,199 |  |  | 92,950 |
U.S. dialysis revenues before provision | 10,632,822 |  |  | 10,552,600 |  |  | 10,366,996 |
Provision for uncollectible accounts | (13,458) |  |  | (21,715) |  |  | (50,927) |
U.S. dialysis patient service revenues | 10,619,364 |  |  | 10,530,885 |  |  | 10,316,069 |
Other revenues(1) |  |  |  |  |
External sources | 39,376 |  |  | 30,895 |  |  | 19,880 |
Intersegment revenues | 1,195 |  |  | 1,126 |  |  | — |
Total U.S. dialysis revenues | $ | 10,659,935 |  |  | $ | 10,562,906 |  |  | $ | 10,335,949 |
Other - Ancillary services |  |  |  |  |
Net patient service revenues | 550,978 |  |  | 497,021 |  |  | 437,275 |
Other external sources | 484,977 |  |  | 460,877 |  |  | 724,577 |
Intersegment revenues | 16,743 |  |  | 14,030 |  |  | 34,236 |
Total ancillary services | 1,052,698 |  |  | 971,928 |  |  | 1,196,088 |
Total net segment revenues | 11,712,633 |  |  | 11,534,834 |  |  | 11,532,037 |
Elimination of intersegment revenues | (162,029) |  |  | (146,355) |  |  | (127,186) |
Consolidated revenues | $ | 11,550,604 |  |  | $ | 11,388,479 |  |  | $ | 11,404,851 |
Segment operating margin (loss): |  |  |  |  |
U.S. dialysis | $ | 1,917,604 |  |  | $ | 1,924,826 |  |  | $ | 1,709,721 |
Other - Ancillary services(2) | (76,261) |  |  | (189,174) |  |  | (93,789) |
Total segment margin | 1,841,343 |  |  | 1,735,652 |  |  | 1,615,932 |
Reconciliation of segment operating margin to consolidated income from continuing operations before income taxes: |  |  |  |  |
Corporate administrative support | (146,707) |  |  | (92,335) |  |  | (90,108) |
Consolidated operating income | 1,694,636 |  |  | 1,643,317 |  |  | 1,525,824 |
Debt expense | (304,111) |  |  | (443,824) |  |  | (487,435) |
Debt prepayment, refinancing and redemption charges | (89,022) |  |  | (33,402) |  |  | — |
Other income | 16,759 |  |  | 29,348 |  |  | 10,089 |
Income from continuing operations before income taxes | $ | 1,318,262 |  |  | $ | 1,195,439 |  |  | $ | 1,048,478 |
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(1)Includes management fee revenues from providing management and administrative services to dialysis ventures in which the Company owns a noncontrolling interest or which are wholly-owned by third parties. (2)Includes equity investment income of $5,866, $9,366, and $24,866 in 2020, 2019 and 2018, respectively. Depreciation and amortization expense by reportable segment was as follows:
| Year ended December 31,
| 2020 |  | 2019 |  | 2018
U.S. dialysis | $ | 594,552 |  |  | $ | 583,454 |  |  | $ | 558,810 |
Other - Ancillary services | 35,883 |  |  | 31,698 |  |  | 32,225 |
| $ | 630,435 |  |  | $ | 615,152 |  |  | $ | 591,035 |
Summary of assets by reportable segment was as follows:
| Year ended December 31,
| 2020 |  | 2019
Segment assets |  |  |
U.S. dialysis(1) | $ | 15,344,647 |  |  | $ | 15,778,880 |
Other - Ancillary services(2) | 1,643,869 |  |  | 1,532,514 |
Consolidated assets | $ | 16,988,516 |  |  | $ | 17,311,394 |
(1)Includes equity method and other investments of $122,974 and $124,188 in 2020 and 2019, respectively. (2)Includes equity method and other investments of $134,517 and 117,795 in 2020 and 2019, respectively and includes approximately $181,137 and $154,572 in 2020 and 2019, respectively, of net property and equipment related to the Company’s international operations. Expenditures for property and equipment by reportable segment were as follows:
| Year ended December 31,
| 2020 |  | 2019 |  | 2018
U.S. dialysis | 646,870 |  |  | $ | 681,339 |  |  | $ | 856,108 |
Other - Ancillary services | 27,671 |  |  | 46,741 |  |  | 45,806 |
DMG - Discontinued operations | — |  |  | 38,466 |  |  | 85,224 |
| $ | 674,541 |  |  | $ | 766,546 |  |  | $ | 987,138 |

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- Definition The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 31 -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8924-108599 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 34 -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8981-108599 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 21 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8721-108599 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 40 -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e9031-108599 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (f) -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (e) -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8844-108599 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 41 -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e9038-108599 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (d) -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8933-108599 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 22 -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8736-108599 Reference 11: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 42 -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e9054-108599 Reference 12: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8657-108599 Reference 13: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 21 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=120311839&loc=d3e8721-108599 Reference 14: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -URI http://asc.fasb.org/topic&trid=2134510 + Details
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