DaVita Inc.

Company Overview

Business Model: DaVita Inc. is a leading healthcare provider primarily focused on comprehensive kidney care, aiming to transform care delivery and improve patient quality of life globally. Its core business, U.S. dialysis, provides life-sustaining dialysis and related laboratory services to patients with chronic kidney failure (ESKD) in the United States. The Company also operates a U.S. integrated kidney care (IKC) business, offering integrated care and disease management services, and maintains international operations providing dialysis and administrative services across 14 countries. Revenue is primarily generated from government-based programs, including Medicare, Medicare Advantage, and Medicaid, as well as commercial insurance plans.

Market Position: DaVita Inc. holds a leading position in the U.S. dialysis market, serving approximately 200,500 patients and commanding an estimated 36% market share as of December 31, 2025. The Company has consistently demonstrated leadership in clinical quality and innovation for over 25 years, evidenced by its strong performance in the Centers for Medicare & Medicaid Services’ Quality Incentive Program and Five-Star Quality Rating System. Its strategic focus includes expanding integrated care capabilities across the renal care continuum and leveraging established relationships with nephrologists and payors.

Recent Strategic Developments:

• Integrated Kidney Care Expansion: DaVita Inc. continues to invest significantly in its U.S. IKC business, which manages patients and coordinates care through value-based care arrangements with commercial payors and government programs. This includes active participation in the Center for Medicare and Medicaid Innovation's Comprehensive Kidney Care Contracting (CKCC) model, extended through December 31, 2027.
• Home-Based Dialysis Growth: The Company is investing in infrastructure and processes to expand its home-based dialysis services, including home hemodialysis and peritoneal dialysis, as a key strategic initiative.
• International Growth: In 2025, international operations saw a net increase of 76 dialysis centers, contributing to steady growth and expansion in strategic markets. This included the acquisition of Fresenius Medical Care AG and its affiliates' dialysis operations in Brazil.
• Strategic Investments: The DaVita Venture Group actively identifies and invests in innovative products, solutions, and businesses focused on improving kidney care, spanning digital health, pharmaceuticals, medical devices, and care delivery models.
• Capital Structure Optimization: In 2025, DaVita Inc. refinanced its Term Loan A-1 and Term Loan B-1 facilities with new Term Loan A-2 and Term Loan B-2 facilities, and issued $1.0 billion in 6.75% senior notes due 2033.

Geographic Footprint: DaVita Inc.'s primary operations are in the United States, where it manages a network of 2,657 outpatient dialysis centers across 46 states and the District of Columbia. Internationally, the Company operates 585 outpatient dialysis centers in 14 countries, serving approximately 94,500 patients. Key international markets include Brazil (127 centers), Colombia (74 centers), Malaysia (71 centers), Poland (64 centers), and Chile (63 centers).

Financial Performance

Revenue Analysis

Profitability Metrics:

• Operating Margin: 15.0%
• Net Margin: 7.9%

Investment in Growth:

• Capital Expenditures: $576 million
  • Maintenance Capital Expenditures: $412 million
  • Development Capital Expenditures: $164 million
• Strategic Investments:
  • Acquired the dialysis operations of Fresenius Medical Care AG and its affiliates in Brazil for $94.3 million in 2025.
  • Subsequent to December 31, 2025, signed a definitive agreement to acquire a noncontrolling minority interest in Elara Caring for approximately $200 million.

Business Segment Analysis

U.S. dialysis

Financial Performance:

• Revenue: $11,793 million (+3.5% YoY)
• Operating Income: $2,084 million (-1.7% YoY)
• Adjusted Operating Income: $2,109 million (+1.1% YoY)
• Average Patient Service Revenue per Treatment: $409.56 (+4.7% YoY)
• Patient Care Costs per Treatment: $273.34
• Key Growth Drivers: The increase in average patient service revenue per treatment was primarily driven by the incorporation of phosphate binders into the ESRD PPS bundle and normal annual rate increases, including the Medicare base rate. This was partially offset by a 1.1% decrease in treatment volume due to higher mortality and missed treatments from a more severe flu season, as well as fewer treatment days. Operating income was negatively impacted by cybersecurity incident-related charges in 2025.

Product Portfolio:

• Outpatient hemodialysis services (approximately 76% of U.S. dialysis revenues)
• Home-based dialysis services (HHD and peritoneal dialysis, approximately 18% of U.S. dialysis revenues)
• Hospital inpatient hemodialysis services (approximately 6% of U.S. dialysis revenues)
• ESKD laboratory services (specialized clinical laboratory for ESKD patient testing)
• Management services for 52 outpatient dialysis centers (noncontrolling interest or wholly-owned by third parties)

Market Dynamics:

• Serves approximately 200,500 patients through a network of 2,657 outpatient dialysis centers across 46 states and the District of Columbia.
• Revenue sources: 68% from government-based programs (57% Medicare and Medicare Advantage, 7% Medicaid and managed Medicaid, 3% other government-based programs) and 32% from commercial insurance plans. Commercial payors generate nearly all non-hospital dialysis profits.
• Faces intense competition from large and medium-sized providers, individual nephrologists, and new market entrants.

Other - Ancillary services

Financial Performance:

• Revenue: $1,922 million (+27.3% YoY)
• Operating Income: $92 million (+10.8% YoY)
• Adjusted Operating Income: $117 million (+1,362.5% YoY)
• Key Growth Drivers: Performance was primarily driven by acquired and non-acquired treatment growth in international operations, a net increase in shared savings, and increased revenues related to special needs plans in U.S. IKC. Favorable results in the clinical research business also contributed. Operating income was impacted by a legal accrual in 2025.

Sub-segment Breakdown:

• U.S. Integrated Kidney Care (IKC):
  • Revenue: $542 million (+7.5% YoY)
  • Operating Income: $22 million
  • Patients: 66,000 in risk-based integrated care arrangements, and an additional 9,400 in other integrated care arrangements.
  • Services: Provides advanced integrated care management services to health plans and government programs for ESKD and CKD patients, utilizing health monitoring, clinical coordination, predictive analytics, and information technology.
• U.S. Other Ancillary services:
  • Revenue: $34 million (+17.2% YoY)
  • Operating Loss: $(18) million
  • Includes: DaVita Clinical Research (a provider-based specialty clinical research organization), MedSleuth (a transplant software business), and the DaVita Venture Group (focused on innovative products and solutions).
• International operations:
  • Revenue: $1,346 million (+37.8% YoY)
  • Operating Income: $89 million
  • Patients: Approximately 94,500 patients (+17.6% YoY)
  • Centers: 585 outpatient dialysis centers (+76 net increase YoY)
  • Geographic Presence: Operations in 14 countries, including Brazil (127 centers), Colombia (74 centers), Malaysia (71 centers), Poland (64 centers), Chile (63 centers), Germany (46 centers), United Kingdom (27 centers), Ecuador (26 centers), Saudi Arabia (26 centers), Panama (16 centers), Portugal (14 centers), China (13 centers), Japan (11 centers), and Singapore (7 centers).

Capital Allocation Strategy

Shareholder Returns:

• Share Repurchases: DaVita Inc. repurchased 12.7 million shares of its common stock for an aggregate consideration of $1,788 million in 2025. As of February 6, 2026, $1.9 billion remains available under the current repurchase authorization.
• Dividend Payments: DaVita Inc. has not declared or paid cash dividends to holders of its common stock since going public.

Balance Sheet Position:

• Cash and Equivalents: $676 million (as of December 31, 2025)
• Total Debt: $10,345 million (principal outstanding as of December 31, 2025)
• Net Cash Position: $(9,669) million (net debt position)
• Debt Maturity Profile: Key maturities include $109 million in 2026, $110 million in 2027, $150 million in 2028, $142 million in 2029, $4,486 million in 2030, and $5,348 million thereafter.

Cash Flow Generation:

• Operating Cash Flow: $1,887 million
• Free Cash Flow: $1,024 million

Operational Excellence

Production & Service Model: DaVita Inc. employs a patient-centric care model that integrates various kidney care services, including in-center hemodialysis, home-based dialysis, and hospital inpatient dialysis. The Company's care teams comprise registered nurses, licensed practical/vocational nurses, patient care technicians, social workers, registered dietitians, and biomedical technicians. Clinical outcomes are guided by experienced domestic and international Chief Medical Officers and a Physician Council.

Supply Chain Architecture: Key Suppliers & Partners: DaVita Inc. relies on a limited number of significant third-party suppliers for critical clinical and other supplies. The Company experienced service disruptions and supply chain shortages in 2024 and early 2025 due to a severe weather event impacting a supplier's manufacturing plant, which affected home-based dialysis growth and increased expenses.

• Pharmaceuticals: Purchases pharmaceuticals, such as phosphate binders, which are integrated into the ESRD PPS bundled payment.
• Technology Services: Utilizes third-party vendors for key information technology functions.

Facility Network:

• Manufacturing: Not explicitly stated as owning manufacturing facilities.
• Research & Development: DaVita Clinical Research operates as a provider-based specialty clinical research organization.
• Dialysis Centers: Operates 2,657 outpatient dialysis centers in the U.S. and 585 internationally, with the vast majority being leased.
• Corporate Headquarters: Located in Denver, Colorado (one owned, one leased building).
• International Headquarters: Leased space in the United Kingdom.
• Laboratory: Operates a specialized clinical laboratory in a leased facility in Florida.

Operational Metrics:

• U.S. Dialysis Treatments: 28.7 million in 2025 (-1.1% YoY).
• Average Treatments per Day (U.S.): 91,802 in 2025 (-0.8% YoY).
• Home-based Dialysis Utilization: Approximately 15% of ESKD dialysis patients in the U.S. utilized home-based dialysis in 2023.
• Clinical Labor Wage Rates: Increased approximately 3.8% in 2025.
• Clinical Teammate Turnover: Decreased in 2025 compared to 2024, but remains elevated from historical pre-COVID levels.

Market Access & Customer Relationships

Go-to-Market Strategy: Distribution Channels:

• Direct Sales: Maintains an enterprise sales force for hospital inpatient dialysis services and direct customer relationships.
• Channel Partners: Operates joint ventures with nephrologists, hospitals, management services organizations, and other healthcare providers.
• Digital Platforms: Emphasizes improved technology and data sharing in its integrated care initiatives.

Customer Portfolio: Enterprise Customers:

• Tier 1 Clients: Contracts to provide hospital inpatient dialysis services to approximately 740 hospitals throughout the U.S.
• Strategic Partnerships: Engages over 900 individual physicians and physician groups as medical directors for its outpatient dialysis centers. Collaborates with nephrologists, dieticians, pharmacists, hospitals, and transplant centers in its IKC business.
• Customer Concentration: No single commercial payor accounted for more than 10% of total U.S. dialysis revenues for the year ended December 31, 2025.

Geographic Revenue Distribution:

• U.S. Dialysis: Represents approximately 86% of consolidated revenues in 2025.
  • Medicare and Medicare Advantage plans: 57% of U.S. dialysis patient service revenues.
  • Medicaid and managed Medicaid plans: 7% of U.S. dialysis patient service revenues.
  • Other government-based programs: 3% of U.S. dialysis patient service revenues.
  • Commercial (including hospital dialysis services): 32% of U.S. dialysis patient service revenues.
• International Operations: Represents approximately 10% of consolidated revenues in 2025.

Competitive Intelligence

Market Structure & Dynamics

Industry Characteristics: The U.S. dialysis industry is highly competitive and dynamic, characterized by pricing and cost pressures, evolving regulations, challenging labor markets, and continuous advancements in technologies and treatments. The ESKD dialysis patient population in the U.S. grew at a compound annual rate of 1.8% from 2013 to 2023, and 0.5% from 2022 to 2023. Value-based care arrangements are increasingly fostering collaboration among healthcare providers.

Competitive Positioning Matrix:

Direct Competitors

Primary Competitors:

• Fresenius Medical Care: A major competitor that also manufactures its own supplies and equipment, potentially offering cost advantages.
• Large and medium-sized providers: Directly compete for acquisition targets, individual patients, and qualified medical directors.
• New and emerging providers: Includes new dialysis providers, private equity-backed kidney care providers, and individual nephrologists opening their own facilities.
• Non-traditional providers: Increasingly entering the integrated kidney care market, often with substantial financial resources, and focusing on pre-dialysis care, innovative technologies, or new business models.

Emerging Competitive Threats:

• New entrants and non-traditional kidney care providers with significant capital.
• Disruptive technologies, drugs, or other treatments (e.g., glucagon-like peptide 1 (GLP-1) receptor agonists, SGLT2 inhibitors, xenotransplantation, artificial kidneys) that could slow CKD progression, increase transplant availability, or reduce the overall demand for dialysis treatments.

Competitive Response Strategy: DaVita Inc.'s strategy involves pursuing growth through acquisitions and development of new dialysis centers, focusing on patient retention and referrals, and cultivating strong relationships with physicians and hospitals. The Company is expanding its offerings across the full kidney care continuum and investing in integrated care capabilities and new technologies to maintain its competitive advantage.

Risk Assessment Framework

Strategic & Market Risks

Market Dynamics:

• Patient Census & Treatment Volumes: Vulnerable to global health conditions (e.g., severe flu seasons, infectious diseases leading to elevated mortality), changing population/demographic trends (e.g., U.S. population aging, immigration, transplant rates, incidence of diabetes/hypertension), and potential reductions in demand from new technologies or treatments (e.g., GLP-1 receptor agonists, SGLT2 inhibitors).
• Technology Disruption: Risks from new drugs, treatments, or therapies (e.g., hemodiafiltration, expanded hemodialysis, xenotransplantation, artificial kidneys) that could offer improved clinical outcomes, become preferred by patients, or slow CKD progression, potentially impacting demand for traditional dialysis services.
• Customer Concentration: A material portion of commercial and Medicare Advantage revenue is concentrated with a limited number of private payors, making the Company sensitive to negotiation outcomes and changes in plan designs.

Operational & Execution Risks

Supply Chain Vulnerabilities:

• Supplier Dependency: Significant reliance on a limited number of third-party suppliers for critical clinical and other supplies. Disruptions due to macroeconomic conditions, global events, natural disasters (e.g., a severe weather event in September 2024 impacting a supplier's manufacturing plant), product recalls, or logistical challenges could lead to shortages, delays, or price increases.
• Geographic Concentration: The Company's clinical laboratory is located in Florida, a state susceptible to hurricanes.

Labor & Workforce Risks:

• Labor Costs: The business is labor-intensive, facing increasing hourly wages, elevated compensation levels, and difficulties in hiring skilled clinical personnel (e.g., nurses) due to nationwide shortages.
• Unionization: Increased union organizing activities and potential work stoppages, bargaining costs, and impacts on operational flexibility.
• Leadership & Talent Retention: Competition for key leadership positions and skilled clinical personnel could disrupt business operations and hinder the achievement of strategic goals.

Financial & Regulatory Risks

Market & Financial Risks:

• Demand Volatility: Sensitivity to the number and percentage of patients with higher-paying commercial insurance, which can decline due to adverse economic conditions (e.g., job losses), legislative/executive actions (e.g., expiration of enhanced premium tax credits), or payor plan designs that restrict coverage or charitable premium assistance.
• Foreign Exchange: Exposure to changes in exchange rates between the U.S. dollar and local currencies in international operations, though currently not considered significant to the consolidated enterprise.
• Credit & Liquidity: Substantial indebtedness, potential for additional debt, variable interest rate risk, and restrictive covenants in debt agreements. The ability to generate sufficient cash flow to service debt is critical.
• Reimbursement Rates: Uncertainty regarding future government payment rates (Medicare ESRD PPS, Medicare Advantage, Medicaid) and commercial payor negotiation outcomes, which can lead to downward pressure on rates.
• Tax Strategy: Subject to complex tax laws and regulations in multiple jurisdictions; changes in these laws or interpretations, or adverse audit outcomes, could materially impact the Company's tax liability.

Regulatory & Compliance Risks:

• Industry Regulation: Operates in a complex and evolving regulatory environment, subject to extensive federal, state, local, and international laws (e.g., Anti-Kickback Statute, Stark Law, False Claims Act, Corporate Practice of Medicine, FCPA, HIPAA, state privacy laws, price transparency rules). Non-compliance can result in severe penalties, fines, exclusion from government programs, and reputational harm.
• CMMI Payment Models: Investments in models like the CKCC program are subject to risk if the regulatory environment changes or if the Company cannot adequately adapt.
• Licensure & Certification: Delays in obtaining Medicare certifications or failure to comply with state licensing requirements could impact operations.
• Legal Proceedings: Ongoing lawsuits, governmental investigations, and audits (e.g., False Claims Act, antitrust, insurance practices, charitable premium assistance) could result in substantial financial penalties, required changes to business practices, or reputational damage.

Geopolitical & External Risks

Geopolitical Exposure:

• International Dependencies: International operations expose the Company to risks related to political instability, armed conflicts, public health crises, social changes, trade regulations, tariffs, and foreign currency fluctuations in the 14 countries where it operates.
• Trade Relations: Impact of U.S. administration's tariff and trade policies.

External Conditions:

• General Economic Conditions: Geopolitical and global economic volatility, inflation, interest rate volatility, labor supply shortages, and trade disputes can increase operating costs (labor, supplies) and impact patient insurance coverage.
• Severe Weather Events/Natural Disasters: Events such as hurricanes, earthquakes, fires, or flooding can damage facilities, disrupt operations, impact suppliers, and increase costs.

Innovation & Technology Leadership

Research & Development Focus: Core Technology Areas:

• Integrated Kidney Care: Focused on developing technology and data sharing capabilities to integrate and coordinate care across the renal care continuum.
• Digital Health: The DaVita Venture Group actively invests in innovations in digital health, pharmaceuticals, medical devices, and care delivery models.
• Clinical Research: DaVita Clinical Research (DCR) provides specialty clinical research services for drug and device development, leveraging extensive real-world healthcare expertise.
• Artificial Intelligence: Leveraging AI to enhance personalized development for teammates and for anomaly-based detection in cybersecurity. The Company is also evaluating the use of AI to support clinical practices.

Innovation Pipeline:

• New Dialysis Modalities: Evaluating hemodiafiltration (HDF) and expanded hemodialysis using medium cut-off dialyzers for improved middle molecule clearance in the U.S.
• Transplant Software: MedSleuth, DaVita Inc.'s transplant software business, works with transplant centers to enhance connectivity among transplant candidates, centers, physicians, and care teams.

Intellectual Property Portfolio:

• Patent Strategy: Not explicitly detailed, but the Company emphasizes protecting its proprietary rights to systems.

Technology Partnerships:

• Strategic Alliances: Collaborates with physicians, nurses, dieticians, pharmacists, hospitals, dialysis clinics, transplant centers, and payors as part of its integrated care model.

Leadership & Governance

Executive Leadership Team

Leadership Continuity: The Board of Directors provides oversight on human capital matters, including management development and succession planning, receiving regular updates from the Chief People Officer.

Board Composition: The Board of Directors is composed of 44% women and 22% people of color. All Board Committees, including the Audit Committee, Nominating and Governance Committee, and Compensation Committee, are composed solely of independent directors. Three Board members (Mr. Schechter, Dr. Moore, and Ms. Schoppert) hold a NACD CERT Certificate in Cyber-Risk Oversight.

Human Capital Strategy

Workforce Composition:

• Total Employees: Approximately 78,000 teammates globally as of December 31, 2025.
• Geographic Distribution: Approximately 72% of teammates are located within the U.S.
• Skill Mix: Comprises registered nurses, licensed practical or vocational nurses, patient care technicians, social workers, registered dietitians, biomedical technicians, and administrative/support personnel.

Talent Management: Acquisition & Retention:

• Hiring Strategy: Implements programs and processes to cultivate a talent pipeline and hire ahead of needs.
• Retention Metrics: Clinical teammate turnover decreased in 2025 compared to 2024, but remains elevated from historical pre-COVID levels.
• Employee Value Proposition: Offers a comprehensive total rewards program, including healthcare benefits, free health programs, financial wellness elements (401(k) match, Employee Stock Purchase Plan, deferred compensation, financial planning, DailyPay), family support programs, a Teammate Assistance Program, free access to Headspace, and the DaVita Village Network for financial support during hardship.

Diversity & Development:

• Diversity Metrics (U.S.): Workforce is 78% women and 59% people of color. Among U.S. managers, 74% are women, and 61% of directors are women. 30% of leaders with profit and loss responsibility are people of color.
• Development Programs: The DaVita Ladders program (including Clinical Ladders) provides clear career paths and competitive pay. Approximately 12,000 direct patient care teammates were promoted in 2025. Enhanced leadership development tools were provided to over 2,000 field leaders. The Company plans to leverage artificial intelligence for personalized development.
• Culture & Engagement: Strives to create an environment of trust, respect, and support, with 85% of U.S. teammates reporting a sense of belonging in recent internal engagement surveys.

Environmental & Social Impact

Environmental Commitments: Climate Strategy: Not explicitly detailed in terms of specific emissions targets, carbon neutrality commitments, or renewable energy adoption strategies. Supply Chain Sustainability: Not explicitly detailed regarding ESG requirements for suppliers or responsible sourcing initiatives.

Social Impact Initiatives:

• Community Investment: Teammates volunteered over 70,000 hours in service of their communities during 2025.
• Product Impact: Committed to equitably improving clinical outcomes and quality of life for patients, regardless of location, insurance status, or other factors.
• Diversity, Equity, and Inclusion: Committed to equal pay for equal work and building a diverse team that reflects the communities served.
• Teammate Health and Safety: Implements safety programs to proactively identify, prevent, and mitigate risks in clinical settings, including routine facility assessments, electronic audit systems (OSHA, infection control, biomedical), and mandatory annual compliance trainings.

Business Cyclicality & Seasonality

Demand Patterns:

• Seasonal Trends: U.S. dialysis treatment volumes can be impacted by seasonal factors, such as a more severe flu season, which contributed to decreased treatments in 2025.
• Economic Sensitivity: Patient insurance coverage is sensitive to economic conditions; extended job losses could lead to a shift from higher-paying commercial plans to lower-paying government programs or uninsured status.
• Industry Cycles: ESKD patient population growth rates are influenced by factors such as mortality rates, the growth and aging of the U.S. population, immigration levels, transplant rates, and the incidence rates of diseases like diabetes and hypertension.

Planning & Forecasting: For 2026, DaVita Inc. anticipates approximately flat U.S. dialysis treatment volumes, assuming a slight improvement in flu impact compared to 2025 and admission levels consistent with 2025 (excluding the impact of the recent cyber incident).

Regulatory Environment & Compliance

Regulatory Framework: Industry-Specific Regulations:

• Medicare ESRD Program: Dialysis centers are certified by CMS, with payments made under a single bundled payment rate (ESRD Prospective Payment System - PPS) subject to quality measures (ESRD Quality Incentive Program - QIP) and annual inflation adjustments. Phosphate binders were incorporated into the bundle on January 1, 2025, with reimbursement via a Transitional Drug Add-on Payment Adjustment (TDAPA) until the end of 2026.
• Medicare Advantage (MA): Private health insurers contract with CMS, with MA plans typically offering negotiated reimbursement rates generally higher than Medicare fee-for-service.
• Medicaid and Managed Medicaid: State-administered programs, partially federally funded, with varying eligibility requirements and payment rates.
• Anti-Kickback Statute: Prohibits remuneration to induce referrals for federal healthcare programs. DaVita Inc. structures its arrangements with physicians and referral sources (e.g., medical director agreements, joint ventures, leases) to comply with applicable safe harbors.
• Stark Law: Prohibits physician self-referrals for Designated Health Services (DHS) unless an exception applies. DaVita Inc. believes most services in its dialysis centers are not DHS due to bundled payment, but certain separately billable drugs may be.
• False Claims Act (FCA): Prohibits false claims, bills, or requests for payment to the federal government, with severe penalties.
• Corporate Practice of Medicine and Fee-Splitting: State laws in some operating jurisdictions prohibit business entities not owned by healthcare providers from practicing medicine or employing physicians.
• Civil Monetary Penalties Statute: Authorizes penalties for prohibited conduct, including false claims and offering remuneration to beneficiaries.
• Foreign Corrupt Practices Act (FCPA): Prohibits improper payments to foreign government officials.
• Health Plan Price Transparency Rules: Require public disclosure of pricing and patient responsibility information by health plans.
• No Surprises Act: Requires providers to develop and disclose "Good Faith Estimates" (GFE) for uninsured/self-pay patients.
• Hazardous Waste & OSHA: Subject to state and federal hazardous waste disposal laws and OSHA regulations for worker protection.
• Antitrust and Competition Laws: Enforced by federal and state authorities, impacting acquisitions and market practices.
• Certificate of Need (CON) Programs: Regulate the establishment or expansion of healthcare facilities in certain states.
• State-based Policy Initiatives: Examples include California bill (AB 290) limiting reimbursement for charitable premium assistance, which is currently stayed pending legal challenges.

Legal Proceedings: DaVita Inc. is involved in various lawsuits, demands, claims, qui tam suits, governmental investigations, and audits. Material ongoing matters include:

• 2020 U.S. Attorney New Jersey Investigation: Subpoena and Civil Investigative Demand (CID) concerning joint venture arrangements, medical director agreements, and Corporate Integrity Agreement compliance. A related False Claims Act case (U.S. ex rel. Bayne v. DaVita Inc., et al.) is ongoing, with a motion to dismiss denied.
• 2020 California Department of Insurance Investigation: Investigative Subpoena regarding patient communications about insurance plans, financial assistance from the American Kidney Fund (AKF), and donations to the AKF.
• 2023 District of Columbia Office of Attorney General Investigation: CID in connection with an antitrust investigation into the AKF.
• 2024 Federal Trade Commission Investigation: Two CIDs in connection with an industry antitrust investigation regarding the acquisition of medical director services and restrictive covenants with physicians.
• 2021 Antitrust Indictment and Putative Class Action Suit: Following an acquittal in a federal antitrust indictment, a consolidated putative class action complaint (In re Outpatient Medical Center Employee Antitrust Litigation) alleging Sherman Act violations is ongoing, with a motion to certify the class filed.

Tax Strategy & Considerations

Tax Profile:

• Effective Tax Rate: 21.8% (2025)
• Effective Income Tax Rate from Continuing Operations Attributable to DaVita Inc.: 29.1% (2025)
• Rate Drivers: The increase in 2025 was primarily due to a one-time benefit recognized in 2024 related to non-taxable non-cash gains, a write-down of a 2014 tax refund claim in 2025, and increases in non-deductible executive compensation. The rate is also impacted by the portion of earnings attributable to non-controlling interests.
• Geographic Tax Planning: DaVita Inc. is subject to income taxes in the U.S. and numerous state and foreign jurisdictions. The Company remains indefinitely reinvested in several foreign jurisdictions, with no significant taxes expected if such earnings were remitted following the Tax Cuts and Jobs Act (2017 Tax Act).

Insurance & Risk Transfer

Risk Management Framework:

• Insurance Coverage: DaVita Inc. is primarily self-insured for professional and general liability, workers' compensation, automobile, property, and a portion of its employment liability practice risks through wholly-owned captive insurance companies. It is also predominantly self-insured for employee medical and other health benefits. The Company maintains excess coverage or reinsurance for property, general liability, professional liability, directors' and officers' liability, and cybersecurity.
• Risk Transfer Mechanisms: Utilizes interest rate cap agreements as cash flow hedges to manage its exposure to Secured Overnight Financing Rate (SOFR) interest rate changes on portions of its variable rate debt.