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Segment Reporting | 12 Months Ended
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Dec. 31, 2021
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. Prior to 2021, the Ancillary Services segment also included a diagnostic laboratory, which was closed during the third quarter of 2020. The Optical Services segment for the years ended December 31, 2020 and 2019 reflected in the table below consisted of an optical products group purchasing organization, which was sold on December 31, 2020. 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,
|  | 2021 |  | 2020 |  | 2019
Revenues: |  |  |  |  |  |
Surgical Facility Services |  | $ | 2,157.8 |  |  | $ | 1,793.4 |  |  | $ | 1,748.2 |
Ancillary Services |  | 67.3 |  |  | 63.6 |  |  | 79.4 |
Optical Services |  | — |  |  | 3.1 |  |  | 3.8 |
Total |  | $ | 2,225.1 |  |  | $ | 1,860.1 |  |  | $ | 1,831.4 |
Adjusted EBITDA: |  |  |  |  |  |
Surgical Facility Services |  | $ | 422.0 |  |  | $ | 339.3 |  |  | $ | 328.9 |
Ancillary Services |  | 1.7 |  |  | (3.4) |  |  | 2.6 |
Optical Services |  | — |  |  | 1.4 |  |  | 1.4 |
All other |  | (84.1) |  |  | (80.7) |  |  | (74.3) |
Total |  | $ | 339.6 |  |  | $ | 256.6 |  |  | $ | 258.6 |
Reconciliation of Adjusted EBITDA: |  |  |  |  |  |
Income (loss) before income taxes |  | $ | 81.2 |  |  | $ | (18.8) |  |  | $ | 54.6 |
Net income attributable to non-controlling interests |  | (141.6) |  |  | (117.4) |  |  | (119.9) |
Depreciation and amortization |  | 98.8 |  |  | 94.8 |  |  | 76.5 |
Interest expense, net |  | 221.0 |  |  | 201.8 |  |  | 178.9 |
Equity-based compensation expense |  | 17.4 |  |  | 13.2 |  |  | 10.2 |
Transaction and integration related costs (1) |  | 46.1 |  |  | 38.2 |  |  | 36.1 |
Loss (gain) on disposals, net |  | 2.2 |  |  | 5.7 |  |  | (4.4) |
Litigation settlement and other litigation costs (2) |  | 5.6 |  |  | 6.4 |  |  | 4.6 |
Impairment charges |  | — |  |  | 33.5 |  |  | 7.9 |
Gain on escrow release (3) |  | — |  |  | (0.8) |  |  | — |
Loss on debt extinguishment |  | 9.1 |  |  | — |  |  | 11.7 |
Hurricane-related impacts (4) |  | (0.2) |  |  | — |  |  | — |
Tax receivable agreement expense |  | — |  |  | — |  |  | 2.4 |
Adjusted EBITDA |  | $ | 339.6 |  |  | $ | 256.6 |  |  | $ | 258.6 |
(1)For the year ended December 31, 2021, this amount includes transaction and integration costs of $39.8 million and start-up costs related to a de novo surgical hospital of $6.3 million. For the year ended December 31, 2020, this amount includes transaction and integration costs of $23.2 million and start-up costs related to a de novo surgical hospital of $15.0 million. For the year ended December 31, 2019, this amount includes transaction and integration costs of $19.0 million and other acquisition costs and start-up costs related to a de novo surgical hospital of $17.1 million. (2)This amount includes litigation settlement costs of $1.2 million and $0.2 million for the years ended December 31, 2020 and 2019, respectively, with no comparable costs in 2021. This amount also includes other litigation costs of $5.6 million, $5.2 million and $4.4 million for the years ended December 31, 2021, 2020 and 2019, respectively. (3)Included in other income in the consolidated statement of operations for the year ended December 31, 2020, with no comparable gain in 2021 and 2019. (4)Reflects the impact of insurance proceeds received net of operating losses incurred in the six months ended December 31, 2021, at a surgical facility that was closed following Hurricane Ida.
|  | December 31,
|  | 2021 |  | 2020
Assets: |  |  |  |
Surgical Facility Services |  | $ | 5,552.8 |  |  | $ | 4,962.4 |
Ancillary Services |  | 47.5 |  |  | 35.0 |
All other |  | 517.3 |  |  | 415.8 |
Total assets |  | $ | 6,117.6 |  |  | $ | 5,413.2 |
|  | Year Ended December 31,
|  | 2021 |  | 2020 |  | 2019
Cash purchases of property and equipment: |  |  |  |  |  |
Surgical Facility Services |  | $ | 55.0 |  |  | $ | 38.7 |  |  | $ | 65.9 |
Ancillary Services |  | 0.5 |  |  | 0.4 |  |  | 1.1 |
All other |  | 2.1 |  |  | 3.8 |  |  | 6.6 |
Total cash purchases of property and equipment |  | $ | 57.6 |  |  | $ | 42.9 |  |  | $ | 73.6 |

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- Definition The entire disclosure for reporting segments including data and tables. Reportable segments include those that meet any of the following quantitative thresholds a) it's reported revenue, including sales to external customers and intersegment sales or transfers is 10 percent or more of the combined revenue, internal and external, of all operating segments b) the absolute amount of its reported profit or loss is 10 percent or more of the greater, in absolute amount of 1) the combined reported profit of all operating segments that did not report a loss or 2) the combined reported loss of all operating segments that did report a loss c) its assets are 10 percent or more of the combined assets of all operating segments. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 31 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8924-108599 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 34 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8981-108599 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 21 -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8721-108599 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 40 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9031-108599 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (f) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (e) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 26 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8844-108599 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 41 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9038-108599 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (d) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8933-108599 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 22 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8736-108599 Reference 11: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 42 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e9054-108599 Reference 12: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8657-108599 Reference 13: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 21 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=123359005&loc=d3e8721-108599 Reference 14: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -URI http://asc.fasb.org/topic&trid=2134510 + Details
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