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v3.20.4

Goodwill - Changes in Carrying Value of Goodwill by Reportable Segments (Details) - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended
--- | --- | ---
Sep. 30, 2019 | Dec. 31, 2020 | Dec. 31, 2019 | Dec. 31, 2018
Goodwill [Roll Forward] |  |  |  |
Beginning balance |  | $ 6,787,635 | $ 6,841,960 |
Acquisitions |  | 130,057 | 90,226 |
Goodwill, Written off Related to Sale of Business Unit |  | (8,293) |  |
Impairment charges |  | 0 | (124,892) | $ (3,106)
Foreign currency and other adjustments |  | 9,710 | (19,659) |
Ending balance |  | 6,919,109 | 6,787,635 | 6,841,960
Goodwill |  | 7,055,660 |  |
Accumulated impairment charges |  | (136,551) |  |
U.S. dialysis |  |  |  |
Goodwill [Roll Forward] |  |  |  |
Beginning balance |  | 6,287,100 | 6,275,004 |
Acquisitions |  | 24,377 | 18,089 |
Goodwill, Written off Related to Sale of Business Unit |  | (1,549) |  |
Impairment charges |  |  | 0 |
Foreign currency and other adjustments |  | 0 | (5,993) |
Ending balance |  | 6,309,928 | 6,287,100 | 6,275,004
Goodwill |  | 6,309,928 |  |
Accumulated impairment charges |  | 0 |  |
Other - Ancillary services |  |  |  |
Goodwill [Roll Forward] |  |  |  |
Beginning balance |  | 500,535 | 566,956 |
Acquisitions |  | 105,680 | 72,137 |
Goodwill, Written off Related to Sale of Business Unit |  | (6,744) |  |
Impairment charges | $ (83,855) |  | (124,892) |
Foreign currency and other adjustments |  | 9,710 | (13,666) |
Ending balance |  | 609,181 | $ 500,535 | $ 566,956
Goodwill |  | 745,732 |  |
Accumulated impairment charges |  | $ (136,551) |  |

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