American Renal Associates Holdings, Inc. announced unaudited consolidated earnings results for the fourth quarter and full year ended December 31, 2016. For the quarter, the company reported net patient service operating revenues of $199,114,000 compared to $174,211,000 a year ago. Operating income was $25,200,000 compared to $42,033,000 a year ago. Income before income taxes was $14,394,000 compared to $31,272,000 a year ago. Net income was $16,560,000 compared to $27,720,000 a year ago. Net loss attributable to the company was $7,119,000 or $0.02 per basic and diluted share compared to income of $6,842,000 or $0.30 per diluted share a year ago. Cash provided by operating activities was $30,308,000 compared to $29,076,000 a year ago. Purchases of property and equipment were $14,773,000 compared to $8,376,000 a year ago. Adjusted EBITDA (including noncontrolling interests) was $55,880,000 compared to $52,012,000 a year ago. Adjusted EBITDA-NCI was $32,201,000 compared to $31,134,000 a year ago. Adjusted net income attributable to the company was $8,740,000 or $0.26 per share. Adjusted cash provided by operating activities was $30,308,000 compared to $29,057,000 a year ago. Total capital expenditures were $14,773,000 compared to $8,376,000 a year ago. As at December 31, 2016, the company's net debt was $438,144,000. Capital expenditures for the fourth quarter of 2016 included $4.5 million for maintenance and $10.3 million for expansions and new clinic development.

For the year, the company reported net patient service operating revenues of $756,329,000 compared to $657,505,000 a year ago. Operating income was $126,807,000 compared to $150,850,000 a year ago. Income before income taxes was $87,452,000 compared to $105,450,000 a year ago. Net income was $88,205,000 compared to $93,077,000 a year ago. Net loss attributable to the company was $385,000 or $0.28 per basic and diluted share compared to income of $18,845,000 or $0.83 per diluted share a year ago. Cash provided by operating activities was $172,211,000 compared to $133,595,000 a year ago. Purchases of property and equipment were $61,432,000 compared to $46,273,000 a year ago. Adjusted EBITDA (including noncontrolling interests) was $212,172,000 compared to $188,055,000 a year ago. Adjusted EBITDA-NCI was $123,582,000 compared to $113,823,000 a year ago. Adjusted cash provided by operating activities was $174,450,000 compared to $135,681,000 a year ago. Total capital expenditures were $61,432,000 compared to $46,273,000 a year ago.

The company provided earnings guidance for the full year of 2017. The company expects 2017 adjusted EBITDA less NCI to be lower than in 2016, due primarily to the impact from an estimated decline of approximately $25 million related to reductions from Affordable Care Act-compliant individual marketplace plans (both on-exchange and off-exchange), as compared to 2016, for patients who also received charitable premium assistance. The estimated $25 million decline from 2016 Adjusted EBITDA less NCI takes ARA's weighted average dialysis facility ownership into account, and represents an increase of approximately $1 million to the company's prior estimate.