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Segment Reporting | 12 Months Ended
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Dec. 31, 2022
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 year ended December 31, 2020 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,
|  | 2022 |  | 2021 |  | 2020
Revenues: |  |  |  |  |  |
Surgical Facility Services |  | $ | 2,470.4 |  |  | $ | 2,157.8 |  |  | $ | 1,793.4 |
Ancillary Services |  | 68.9 |  |  | 67.3 |  |  | 63.6 |
Optical Services |  | — |  |  | — |  |  | 3.1 |
Total |  | $ | 2,539.3 |  |  | $ | 2,225.1 |  |  | $ | 1,860.1 |
Adjusted EBITDA: |  |  |  |  |  |
Surgical Facility Services |  | $ | 473.6 |  |  | $ | 422.0 |  |  | $ | 339.3 |
Ancillary Services |  | (2.3) |  |  | 1.7 |  |  | (3.4) |
Optical Services |  | — |  |  | — |  |  | 1.4 |
All other |  | (91.1) |  |  | (84.1) |  |  | (80.7) |
Total |  | $ | 380.2 |  |  | $ | 339.6 |  |  | $ | 256.6 |
Reconciliation of Adjusted EBITDA: |  |  |  |  |  |
Income (loss) before income taxes |  | $ | 110.3 |  |  | $ | 81.2 |  |  | $ | (18.8) |
Net income attributable to non-controlling interests |  | (141.6) |  |  | (141.6) |  |  | (117.4) |
Interest expense, net |  | 234.9 |  |  | 221.0 |  |  | 201.8 |
Depreciation and amortization |  | 114.8 |  |  | 98.8 |  |  | 94.8 |
Equity-based compensation expense |  | 18.4 |  |  | 17.4 |  |  | 13.2 |
Transaction, integration and acquisition costs (1) |  | 48.6 |  |  | 46.1 |  |  | 38.2 |
Loss on disposals and deconsolidations, net |  | 11.1 |  |  | 2.2 |  |  | 5.7 |
Litigation settlements and other litigation costs (2) |  | (24.7) |  |  | 5.6 |  |  | 6.4 |
Loss on debt extinguishment |  | 14.9 |  |  | 9.1 |  |  | — |
Undesignated derivative activity (3) |  | (8.0) |  |  | — |  |  | — |
Hurricane-related impacts (4) |  | 1.5 |  |  | (0.2) |  |  | — |
Impairment charges |  | — |  |  | — |  |  | 33.5 |
Gain on escrow release (5) |  | — |  |  | — |  |  | (0.8) |
Adjusted EBITDA |  | $ | 380.2 |  |  | $ | 339.6 |  |  | $ | 256.6 |
(1)This amount includes transaction and integration costs of $47.5 million, $39.8 million and $23.2 million for the years ended December 31, 2022, 2021 and 2020, respectively. This amount further includes start-up costs related to de novo surgical facilities of $1.1 million, $6.3 million and $15.0 million for the years ended December 31, 2022, 2021 and 2020, respectively. (2)This amount includes a net litigation settlements gain of $29.3 million and a loss of $1.2 million for the years ended December 31, 2022 and 2020, respectively, with no comparable costs in 2021. This amount also includes other litigation costs of $4.6 million, $5.6 million and $5.2 million for the years ended December 31, 2022, 2021 and 2020, respectively. (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.This amount further includes fair value changes of undesignated derivatives. (4)Reflects losses incurred, net of insurance proceeds received at certain surgical facilities that were closed following Hurricane Ian in September 2022 and Hurricane Ida in September 2021. (5)Included in other income in the consolidated statement of operations for the year ended December 31, 2020, with no comparable gain in 2022 and 2021.
|  | December 31,
|  | 2022 |  | 2021
Assets: |  |  |  |
Surgical Facility Services |  | $ | 6,001.1 |  |  | $ | 5,552.8 |
Ancillary Services |  | 41.7 |  |  | 47.5 |
All other |  | 639.3 |  |  | 517.3 |
Total assets |  | $ | 6,682.1 |  |  | $ | 6,117.6 |
|  | Year Ended December 31,
|  | 2022 |  | 2021 |  | 2020
Cash purchases of property and equipment: |  |  |  |  |  |
Surgical Facility Services |  | $ | 74.3 |  |  | $ | 55.0 |  |  | $ | 38.7 |
Ancillary Services |  | 1.1 |  |  | 0.5 |  |  | 0.4 |
All other |  | 5.2 |  |  | 2.1 |  |  | 3.8 |
Total cash purchases of property and equipment |  | $ | 80.6 |  |  | $ | 57.6 |  |  | $ | 42.9 |

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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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&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 https://asc.fasb.org/extlink&oid=126901519&loc=d3e8721-108599 Reference 14: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -URI https://asc.fasb.org/topic&trid=2134510 + Details
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