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Segment Reporting
 6 Months Ended
Jun. 30, 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 June 30,Six Months Ended June 30,
2024202320242023
Revenues:
Surgical Facility Services$730.4 $650.2 $1,423.1 $1,299.2 
Ancillary Services31.7 17.4 56.4 34.6 
Total$762.1 $667.6 $1,479.5 $1,333.8 
Adjusted EBITDA:
Surgical Facility Services$143.0 $126.7 $269.7 $245.5 
Ancillary Services0.1 (0.1)(1.3)(1.5)
All other(24.8)(26.4)(52.6)(53.7)
Total$118.3 $100.2 $215.8 $190.3 
Reconciliation of Adjusted EBITDA:
Income before income taxes$33.3 $49.9 $62.0 $49.5 
Net income attributable to non-controlling interests(43.9)(38.8)(80.6)(64.9)
Interest expense, net51.5 47.7 98.8 94.5 
Depreciation and amortization34.8 24.4 68.5 58.1 
Equity-based compensation expense15.1 4.6 20.0 8.8 
Transaction, integration and acquisition costs (1)
20.8 13.0 39.7 25.8 
Net loss (gain) on disposals, consolidations and deconsolidations5.3 (8.8)6.8 1.7 
Litigation settlements and regulatory change impact (2)
1.1 1.7 (0.1)9.7 
Loss on debt extinguishment5.1 — 5.1 — 
Undesignated derivative activity— — — 0.6 
Other (3)
(4.8)6.5 (4.4)6.5 
Adjusted EBITDA$118.3 $100.2 $215.8 $190.3 
(1)This amount includes transaction and integration costs of $19.3 million and $12.0 million for the three months ended June 30, 2024 and 2023, respectively. This amount further includes start-up costs related to de novo surgical facilities of $1.5 million and $1.0 million for the three months ended June 30, 2024 and 2023, respectively.
This amount includes transaction and integration costs of $36.7 million and $24.5 million for the six months ended June 30, 2024 and 2023, respectively. This amount further includes start-up costs related to de novo surgical facilities of $3.0 million and $1.3 million for the six months ended June 30, 2024 and 2023, respectively.
(2)This amount includes a litigation settlement loss of $0.5 million and $1.5 million for the three months ended June 30, 2024 and 2023, respectively. This amount also includes other litigation costs of $0.6 million and $0.2 million for the three months ended June 30, 2024 and 2023, respectively.
This amount includes a litigation settlements gain of $1.3 million and a loss of $4.5 million for the six months ended June 30, 2024 and 2023, respectively. This amount also includes other litigation costs of $1.2 million and $0.8 million for the six months ended June 30, 2024 and 2023, respectively. Additionally, the six months ended June 30, 2023 includes $4.4 million related to the impact of recent changes in Florida law regarding the use of letters of protection.
(3)For the three and six months ended June 30, 2024, this amount includes insurance proceeds related to cyber event losses predominantly incurred in 2023. For the three and six months ended June 30, 2023, this amount includes estimates for the net impact of the same cyber event and losses from a divested business.
June 30,
2024		December 31, 2023
Assets:
Surgical Facility Services$6,874.7 $6,347.4 
Ancillary Services68.1 36.3 
All other545.8 493.0 
Total assets$7,488.6 $6,876.7 
Six Months Ended June 30,
20242023
Cash purchases of property and equipment:
Surgical Facility Services$39.1 $49.5 
Ancillary Services1.3 0.6 
All other7.5 — 
Total cash purchases of property and equipment$47.9 $50.1