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Segment reporting | 9 Months Ended
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Sep. 30, 2021
Segment Reporting [Abstract] |
Segment Reporting Disclosure | 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 including its international operations (collectively, its ancillary services), and its corporate administrative support. The Company’s separate operating segments include its U.S. dialysis and related lab services business, each of its ancillary services, 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 Asia Pacific joint venture (APAC JV). The U.S. dialysis and related lab services business qualifies as a separately reportable segment, and all other ancillary services operating segments, including the international operating segments, have been combined and disclosed in the other segments category. See Note 25 to the Company's consolidated financial statements included in the 2020 10-K for further description of how the Company determines and measures results for its operating segments. The following is a summary of segment net revenues, segment operating income (loss), and a reconciliation of segment operating income (loss) to consolidated income before income taxes:
| Three months ended September 30, |  | Nine months ended September 30,
| 2021 |  | 2020 |  | 2021 |  | 2020
Segment revenues: |  |  |  |  |  |  |
U.S. dialysis |  |  |  |  |  |  |
Dialysis patient service revenues: |  |  |  |  |  |  |
External sources | $ | 2,669,823 |  |  | $ | 2,639,761 |  |  | $ | 7,874,759 |  |  | $ | 7,850,828 |
Intersegment revenues | 22,007 |  |  | 37,049 |  |  | 70,196 |  |  | 104,111 |
U.S. dialysis patient service revenues | 2,691,830 |  |  | 2,676,810 |  |  | 7,944,955 |  |  | 7,954,939 |
Other revenues: |  |  |  |  |  |  |
External sources | 6,119 |  |  | 17,141 |  |  | 19,080 |  |  | 29,970 |
Intersegment revenues | 97 |  |  | 268 |  |  | 228 |  |  | 876 |
Total U.S. dialysis revenues | 2,698,046 |  |  | 2,694,219 |  |  | 7,964,263 |  |  | 7,985,785 |
Other—Ancillary services |  |  |  |  |  |  |
Dialysis patient service revenues | 168,117 |  |  | 141,889 |  |  | 495,725 |  |  | 402,300 |
Other external sources | 94,260 |  |  | 125,275 |  |  | 285,266 |  |  | 362,184 |
Intersegment revenues | — |  |  | 4,079 |  |  | 4,294 |  |  | 12,402 |
Total ancillary services revenues | 262,377 |  |  | 271,243 |  |  | 785,285 |  |  | 776,886 |
Total net segment revenues | 2,960,423 |  |  | 2,965,462 |  |  | 8,749,548 |  |  | 8,762,671 |
Elimination of intersegment revenues | (22,104) |  |  | (41,396) |  |  | (74,718) |  |  | (117,389) |
Consolidated revenues | $ | 2,938,319 |  |  | $ | 2,924,066 |  |  | $ | 8,674,830 |  |  | $ | 8,645,282 |
Segment operating income (loss): |  |  |  |  |  |  |
U.S. dialysis | $ | 509,939 |  |  | $ | 470,596 |  |  | $ | 1,523,625 |  |  | $ | 1,484,833 |
Other—Ancillary services | (6,909) |  |  | (7,086) |  |  | (36,577) |  |  | (49,354) |
Total segment operating income | 503,030 |  |  | 463,510 |  |  | 1,487,048 |  |  | 1,435,479 |
Reconciliation of segment operating income to consolidated income from continuing operations before income taxes: |  |  |  |  |  |  |
Corporate administrative support | (28,153) |  |  | (25,841) |  |  | (79,093) |  |  | (122,514) |
Consolidated operating income | 474,877 |  |  | 437,669 |  |  | 1,407,955 |  |  | 1,312,965 |
Debt expense | (72,829) |  |  | (73,658) |  |  | (213,167) |  |  | (243,642) |
Debt prepayment, refinancing and redemption charges | — |  |  | (86,074) |  |  | — |  |  | (89,022) |
Other (loss) income, net | (7,590) |  |  | 5,395 |  |  | 8,766 |  |  | 10,590 |
Consolidated income from continuing operations before income taxes | $ | 394,458 |  |  | $ | 283,332 |  |  | $ | 1,203,554 |  |  | $ | 990,891 |
Depreciation and amortization expense by reportable segment was as follows:
| Three months ended September 30, |  | Nine months ended September 30,
| 2021 |  | 2020 |  | 2021 |  | 2020
U.S. dialysis | $ | 161,252 |  |  | $ | 148,221 |  |  | $ | 477,054 |  |  | $ | 442,833 |
Other—Ancillary services | 9,210 |  |  | 8,673 |  |  | 28,798 |  |  | 26,116 |
| $ | 170,462 |  |  | $ | 156,894 |  |  | $ | 505,852 |  |  | $ | 468,949 |
Expenditures for property and equipment by reportable segment were as follows:
| Nine months ended September 30,
| 2021 |  | 2020
U.S. dialysis | $ | 415,994 |  |  | $ | 430,646 |
Other—Ancillary services | 35,915 |  |  | 19,250 |
| $ | 451,909 |  |  | $ | 449,896 |
A summary of assets by reportable segment was as follows:
| September 30, 2021 |  | December 31, 2020
U.S. dialysis | $ | 15,939,286 |  |  | $ | 15,344,647 |
Other—Ancillary services | 1,694,654 |  |  | 1,643,869 |
Consolidated assets | $ | 17,633,940 |  |  | $ | 16,988,516 |

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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=123359005&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=123359005&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=123359005&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=123359005&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=123359005&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=123359005&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=123359005&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=123359005&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=123359005&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=123359005&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=123359005&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=123359005&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=123359005&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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