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Leases | 12 Months Ended
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Dec. 31, 2022
Leases [Abstract] |
Leases Disclosure | Leases The Company leases substantially all of its U.S. dialysis facilities. The majority of the Company’s facilities are leased under non-cancellable operating leases which range in terms from five years to 15 years and which contain renewal options of five years to ten years at the fair rental value at the time of renewal. The Company's leases are generally subject to fixed escalation clauses or contain consumer price index increases. See Note 1 for further information on how the Company accounts for leases. As of December 31, 2022 and December 31, 2021, assets recorded under finance leases were $319,546 and $322,060, respectively, and accumulated amortization associated with finance leases was $101,361 and $75,252, respectively, included in property and equipment, net, on the Company's consolidated balance sheet. In certain markets, the Company acquires and develops dialysis centers. Upon completion, the Company sells the center to a third party and leases the space back with the intent of operating the center on a long term basis. Both the sale and leaseback terms are generally market terms. The lease terms are consistent with the Company's other operating leases with the majority of the leases under non-cancellable operating leases ranging in terms from five years to 15 years and which contain renewal options of five years to ten years at the fair rental value at the time of renewal. The components of lease expense were as follows:
|  | Year ended December 31,
Lease cost |  | 2022 |  | 2021 |  | 2020
Operating lease cost(1): |  |  |  |  |  |
Fixed lease expense |  | $ | 552,194 |  |  | $ | 547,923 |  |  | $ | 541,090 |
Variable lease expense |  | 127,621 |  |  | 125,981 |  |  | 122,729 |
Financing lease cost: |  |  |  |  |  |
Amortization of leased assets |  | 27,079 |  |  | 26,846 |  |  | 24,720 |
Interest on lease liabilities |  | 12,776 |  |  | 13,988 |  |  | 14,421 |
Net lease cost |  | $ | 719,670 |  |  | $ | 714,738 |  |  | $ | 702,960 |
(1) Includes short-term lease expense and sublease income, which are immaterial. Other information related to leases was as follows:
|  | Year ended December 31,
Lease term and discount rate |  | 2022 |  | 2021 |  | 2020
Weighted average remaining lease term (years): |  |  |  |  |  |
Operating leases |  | 8.2 |  | 8.3 |  | 8.7
Finance leases |  | 9.4 |  | 10.5 |  | 10.5
Weighted average discount rate: |  |  |  |  |  |
Operating leases |  | 3.6 | % |  | 3.5 | % |  | 3.8 | %
Finance leases |  | 4.5 | % |  | 4.5 | % |  | 5.1 | %
|  | Year ended December 31,
Other information |  | 2022 |  | 2021 |  | 2020
Gains on sale leasebacks, net |  | $ | 28,005 |  |  | $ | 17,137 |  |  | $ | 34,301 |
Cash paid for amounts included in the measurement of lease liabilities: |  |  |  |  |  |
Operating cash flows for operating leases |  | $ | 696,291 |  |  | $ | 684,186 |  |  | $ | 661,318 |
Operating cash flows for finance leases |  | $ | 20,103 |  |  | $ | 21,343 |  |  | $ | 20,981 |
Financing cash flows for finance leases |  | $ | 24,329 |  |  | $ | 22,445 |  |  | $ | 24,780 |
Net operating lease assets obtained in exchange for new or modified operating lease liabilities |  | $ | 278,108 |  |  | $ | 361,101 |  |  | $ | 401,559 |
Future minimum lease payments under non-cancellable leases as of December 31, 2022 are as follows:
|  | Operating leases |  | Finance leases
2023 |  | $ | 492,566 |  |  | $ | 37,442 |
2024 |  | 500,422 |  |  | 37,951 |
2025 |  | 452,080 |  |  | 38,125 |
2026 |  | 400,879 |  |  | 36,908 |
2027 |  | 333,580 |  |  | 35,569 |
Thereafter |  | 1,175,340 |  |  | 145,987 |
Total future minimum lease payments |  | 3,354,867 |  |  | 331,982 |
Less portion representing interest |  | (456,398) |  |  | (58,294) |
Present value of lease liabilities |  | $ | 2,898,469 |  |  | $ | 273,688 |
Rent expense under all operating leases for 2022, 2021 and 2020 was $679,815, $673,904 and $663,819, respectively. Rent expense is recorded on a straight-line basis over the term of the lease, including leases that contain fixed escalation clauses or include abatement provisions. Leasehold improvement incentives reduce the carrying value of right-of-use assets and are amortized to rent expense over the term of the lease. Finance lease obligations are included in long-term debt. See Note 13 for further details on long-term debt.

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