| Changes in Carrying Value of Goodwill by Reportable Segments |
Changes in the carrying amount of goodwill by reportable segment were as follows: | | | | | | | | | | | | | | | | | | | | U.S. dialysis | | Other - Ancillary
services | | Consolidated | | Balance at December 31, 2023 | $ | 6,416,825 | | | $ | 695,735 | | | $ | 7,112,560 | | | Acquisitions | 102,082 | | | 246,987 | | | 349,069 | | | Divestitures | (1,687) | | | (1,506) | | | (3,193) | | | | | | | | | Foreign currency and other adjustments | — | | | (83,220) | | | (83,220) | | | Balance at December 31, 2024 | $ | 6,517,220 | | | $ | 857,996 | | | $ | 7,375,216 | | | Acquisitions | 10,396 | | | 61,288 | | | 71,684 | | | | | | | | | | | | | | | Foreign currency and other adjustments | — | | | 98,195 | | | 98,195 | | | Balance at December 31, 2025 | $ | 6,527,616 | | | $ | 1,017,479 | | | $ | 7,545,095 | | | | | | | | | Balance at December 31, 2025: | | | | | | | Goodwill | $ | 6,527,616 | | | $ | 1,174,220 | | | $ | 7,701,836 | | | Accumulated impairment charges | — | | | (156,741) | | | (156,741) | | | $ | 6,527,616 | | | $ | 1,017,479 | | | $ | 7,545,095 | |
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