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Segment Reporting
 3 Months Ended
Mar. 31, 2024
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):
Three Months Ended March 31,
20242023
Revenues:
Surgical Facility Services$692.7 $649.0 
Ancillary Services24.7 17.2 
Total$717.4 $666.2 
Adjusted EBITDA:
Surgical Facility Services$126.7 $118.8 
Ancillary Services(1.4)(1.4)
All other(27.8)(27.3)
Total$97.5 $90.1 
Reconciliation of Adjusted EBITDA:
Income (loss) before income taxes$28.7 $(0.4)
Net income attributable to non-controlling interests(36.7)(26.1)
Interest expense, net47.3 46.8 
Depreciation and amortization33.7 33.7 
Equity-based compensation expense4.9 4.2 
Transaction, integration and acquisition costs (1)
18.9 12.8 
Net loss on disposals, consolidations and deconsolidations1.5 10.5 
Litigation settlements and regulatory change impact (2)
(1.2)8.0 
Undesignated derivative activity— 0.6 
Other0.4 — 
Adjusted EBITDA$97.5 $90.1 
(1)This amount includes transaction and integration costs of $17.4 million and $12.5 million for the three months ended March 31, 2024 and 2023, respectively. This amount further includes start-up costs related to de novo surgical facilities of $1.5 million and $0.3 million for the three months ended March 31, 2024 and 2023, respectively.
(2)This amount includes a litigation settlements gain of $1.8 million and a loss of $3.0 million for the three months ended March 31, 2024 and 2023, respectively. This amount also includes other litigation costs of $0.6 million and $0.6 million for the three months ended March 31, 2024 and 2023, respectively. Additionally, the three months ended March 31, 2023, includes $4.4 million related to the impact of recent changes in Florida law regarding the use of letters of protection.
March 31, 2024December 31, 2023
Assets:
Surgical Facility Services$6,420.9 $6,347.4 
Ancillary Services60.6 36.3 
All other494.1 493.0 
Total assets$6,975.6 $6,876.7 
Three Months Ended March 31,
20242023
Cash purchases of property and equipment:
Surgical Facility Services$16.3 $23.8 
Ancillary Services— 0.5 
All other4.7 — 
Total cash purchases of property and equipment$21.0 $24.3