Segment Reporting

12 Months Ended

Dec. 31, 2023

Segment Reporting [Abstract]

Segment Reporting

Segment Reporting

The Company currently operates in two major lines of business that are also the Company's reportable operating segments - the operation of surgical facilities and the operation of ancillary services. The Surgical Facility Services segment includes the operation of ASCs, surgical hospitals and anesthesia services. The Ancillary Services segment consists of multi-specialty physician practices. The "All other" line item primarily consists of amounts attributable to the Company's corporate general and administrative functions.

The following tables present financial information for each reportable segment (in millions):

	Year Ended December 31,
	2023		2022		2021
Revenues:
Surgical Facility Services	$	2,675.8	$	2,470.4	$	2,157.8
Ancillary Services	67.5		68.9		67.3
Total	$	2,743.3	$	2,539.3	$	2,225.1
Adjusted EBITDA:
Surgical Facility Services	$	544.0	$	473.6	$	422.0
Ancillary Services	(3.9)		(2.3)		1.7
All other	(102.0)		(91.1)		(84.1)
Total	$	438.1	$	380.2	$	339.6
Reconciliation of Adjusted EBITDA:
Income (loss) before income taxes	$	135.0	$	110.3	$	81.2
Net income attributable to non-controlling interests	(147.2)		(141.6)		(141.6)
Interest expense, net	193.0		234.9		221.0
Depreciation and amortization	118.1		114.8		98.8
Equity-based compensation expense	17.7		18.4		17.4
Transaction, integration and acquisition costs (1)	64.9		48.6		46.1
Net loss on disposals, consolidations and deconsolidations	14.4		11.1		2.2
Litigation settlements and regulatory change impact (2)	17.5		(24.7)		5.6
Loss on debt extinguishment	15.5		14.9		9.1
Undesignated derivative activity (3)	0.6		(8.0)		—
Other (4)	8.6		1.5		(0.2)
Adjusted EBITDA	$	438.1	$	380.2	$	339.6

(1)This amount includes transaction and integration costs of $61.7 million, $47.5 million and $39.8 million for the years ended December 31, 2023, 2022 and 2021, respectively. This amount further includes start-up costs related to de novo surgical facilities of $3.2 million, $1.1 million and $6.3 million for the years ended December 31, 2023, 2022 and 2021, respectively.

(2)This amount includes a litigation settlements loss of $10.6 million and a net gain of $29.3 million for the years ended December 31, 2023 and 2022, respectively, with no comparable costs in 2021. This amount also includes other litigation costs of $2.5 million, $4.6 million and $5.6 million for the years ended December 31, 2023, 2022 and 2021, respectively. Additionally, the year ended December 31, 2023, includes $4.4 million related to the impact of recent changes in Florida law regarding the use of letters of protection.

(3)This amount includes the reclassification of $7.5 million of unrealized gains out of accumulated OCI into income related to the de-designation of a portion of one of the Company's interest rate caps for the year ended December 31, 2022. This amount further includes fair value changes of undesignated derivatives for the years ended December 31, 2023 and 2022, with no comparable activity in 2021.

(4)This amount includes estimates for the net impact of the May 2023 cyber event and losses from a divested business for the year ended December 31, 2023.

Amounts presented for the years ended December 31, 2022 and 2021 reflect losses incurred, net of insurance proceeds received, related to certain surgical facilities that were closed following Hurricane Ian and Hurricane Ida, respectively.

	December 31,
	2023		2022
Assets:
Surgical Facility Services	$	6,347.4	$	6,001.1
Ancillary Services	36.3		41.7
All other	493.0		639.3
Total assets	$	6,876.7	$	6,682.1

	Year Ended December 31,
	2023		2022		2021
Cash purchases of property and equipment:
Surgical Facility Services	$	87.9	$	74.3	$	55.0
Ancillary Services	0.8		1.1		0.5
All other	0.1		5.2		2.1
Total cash purchases of property and equipment	$	88.8	$	80.6	$	57.6