XML 36 R23.htm IDEA: XBRL DOCUMENT
v3.24.0.1

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 |

X
- References No definition available. + Details
Name: | us-gaap_SegmentReportingAbstract
Namespace Prefix: | us-gaap_
Data Type: | xbrli:stringItemType
Balance Type: | na
Period Type: | duration

X
- 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 -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 22 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-22 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 15 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-15 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 31 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-31 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 32 -Subparagraph (d) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-32 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 42 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-42 Reference 6: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 32 -Subparagraph (f) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-32 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 40 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-40 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -Name Accounting Standards Codification -Publisher FASB -URI https://asc.fasb.org//280/tableOfContent Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 26 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-26 Reference 10: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 34 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-34 Reference 11: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 41 -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-41 Reference 12: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 21 -Subparagraph (a) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-21 Reference 13: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 21 -Subparagraph (b) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-21 Reference 14: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 50 -Paragraph 32 -Subparagraph (e) -Publisher FASB -URI https://asc.fasb.org//1943274/2147482810/280-10-50-32 + Details
Name: | us-gaap_SegmentReportingDisclosureTextBlock
Namespace Prefix: | us-gaap_
Data Type: | dtr-types:textBlockItemType
Balance Type: | na
Period Type: | duration