
	U.S. dialysis		Other — Ancillary services		Consolidated
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
Acquisitions	25,903		24,106		50,009

Impairment charges	—		(57,104)		(57,104)
Foreign currency and other adjustments	—		10,042		10,042
Balance at September 30, 2026	$	6,553,519	$	994,523	$	7,548,042

Balance at September 30, 2026:
Goodwill	$	6,553,519	$	1,204,478	$	7,757,997
Accumulated impairment charges	—		(209,955)		(209,955)
	$	6,553,519	$	994,523	$	7,548,042

Substantially all of the Company's operating segments described in Note 13 to the condensed consolidated financial statements represents an individual reporting unit for goodwill impairment assessment purposes.

The Company performs its annual goodwill impairment assessments at various points throughout the year for its reporting units, including in the third quarter.

During the three months ended September 30, 2026, the Company recognized goodwill impairment charges of $57,104 in its China reporting unit, of which $31,597 was allocated to noncontrolling interests. The impairment charge resulted primarily from adverse reimbursement rate changes and corresponding operating developments across non-renal hospital services. The estimated fair value of the China reporting unit was determined using an income approach based on discounted cash flow projections.

Further changes in patient census, operating margins, reimbursement rates, or other adverse changes in expected future cash flows or valuation assumptions could result in additional goodwill impairment charges in the future for the China reporting unit, which remains at risk of goodwill impairment as of September 30, 2026:


Reporting unit	Goodwill balance as of September 30, 2026		Carrying amount coverage(1)		Sensitivities
					Discount rate(2)		Operating income(3)
China	$	42,930	—	%	(9.6)	%	(2.2)	%

(2)Potential impact on estimated fair value of an increase in discount rates of 100 basis points as of the latest assessment date.

(3)Potential impact on estimated fair value of a sustained, long-term reduction of 300 basis points in operating income as of the latest assessment date.

The Company performed various other annual impairment assessments during the nine months ended September 30, 2026, with no other impairments indicated. Except as described above, none of the Company's various other reporting units were considered at risk of significant goodwill impairment as of September 30, 2026.