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Segment Reporting | 9 Months Ended
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Sep. 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 September 30, |  |  |  | Nine Months Ended September 30,
|  | 2024 |  | 2023 |  |  |  | 2024 |  | 2023
Revenues: |  |  |  |  |  |  |  |  |  |
Surgical Facility Services |  | $ | 735.4 |  |  | $ | 657.3 |  |  |  |  | $ | 2,158.5 |  |  | $ | 1,956.5 |
Ancillary Services |  | 35.0 |  |  | 16.8 |  |  |  |  | 91.4 |  |  | 51.4 |
Total |  | $ | 770.4 |  |  | $ | 674.1 |  |  |  |  | $ | 2,249.9 |  |  | $ | 2,007.9 |
Adjusted EBITDA: |  |  |  |  |  |  |  |  |  |
Surgical Facility Services |  | $ | 149.6 |  |  | $ | 138.6 |  |  |  |  | $ | 419.3 |  |  | $ | 384.1 |
Ancillary Services |  | 0.7 |  |  | (1.2) |  |  |  |  | (0.6) |  |  | (2.7) |
All other |  | (21.7) |  |  | (31.9) |  |  |  |  | (74.3) |  |  | (85.6) |
Total |  | $ | 128.6 |  |  | $ | 105.5 |  |  |  |  | $ | 344.4 |  |  | $ | 295.8 |
Reconciliation of Adjusted EBITDA: |  |  |  |  |  |  |  |  |  |
Income before income taxes |  | $ | 10.9 |  |  | $ | 32.8 |  |  |  |  | $ | 72.9 |  |  | $ | 82.3 |
Net income attributable to non-controlling interests |  | (38.1) |  |  | (34.6) |  |  |  |  | (118.7) |  |  | (99.5) |
Interest expense, net |  | 50.0 |  |  | 49.8 |  |  |  |  | 148.8 |  |  | 144.3 |
Depreciation and amortization |  | 50.2 |  |  | 28.9 |  |  |  |  | 118.7 |  |  | 87.0 |
Equity-based compensation expense |  | 7.1 |  |  | 4.4 |  |  |  |  | 27.1 |  |  | 13.2 |
Transaction, integration and acquisition costs (1) |  | 31.5 |  |  | 13.0 |  |  |  |  | 71.2 |  |  | 38.8 |
Net loss on disposals, consolidations and deconsolidations |  | 14.7 |  |  | 5.8 |  |  |  |  | 21.5 |  |  | 7.5 |
Litigation settlements and regulatory change impact (2) |  | 1.6 |  |  | 4.2 |  |  |  |  | 1.5 |  |  | 13.9 |
Loss on debt extinguishment |  | — |  |  | — |  |  |  |  | 5.1 |  |  | — |
Undesignated derivative activity |  | — |  |  | — |  |  |  |  | — |  |  | 0.6 |
Other (3) |  | 0.7 |  |  | 1.2 |  |  |  |  | (3.7) |  |  | 7.7 |
Adjusted EBITDA |  | $ | 128.6 |  |  | $ | 105.5 |  |  |  |  | $ | 344.4 |  |  | $ | 295.8 |
(1)This amount includes transaction and integration costs of $29.4 million and $12.8 million for the three months ended September 30, 2024 and 2023, respectively. This amount further includes start-up costs related to de novo surgical facilities of $2.1 million and $0.2 million for the three months ended September 30, 2024 and 2023, respectively. This amount includes transaction and integration costs of $66.1 million and $37.3 million for the nine months ended September 30, 2024 and 2023, respectively. This amount further includes start-up costs related to de novo surgical facilities of $5.1 million and $1.5 million for the nine months ended September 30, 2024 and 2023, respectively. (2)This amount includes a litigation settlement loss of $0.5 million and $3.6 million for the three months ended September 30, 2024 and 2023, respectively. This amount also includes other litigation costs of $1.1 million and $0.6 million for the three months ended September 30, 2024 and 2023, respectively. This amount includes a litigation settlements gain of $0.8 million and a loss of $8.1 million for the nine months ended September 30, 2024 and 2023, respectively. This amount also includes other litigation costs of $2.3 million and $1.4 million for the nine months ended September 30, 2024 and 2023, respectively. Additionally, the nine months ended September 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 months ended September 30, 2024, this amount includes hurricane-related impacts. For the three months ended September 30, 2023, this amount includes estimates for the net impact of a cyber event. For the nine months ended September 30, 2024, this amount includes hurricane-related impacts in the third quarter of 2024, net of insurance proceeds related to cyber event losses predominantly incurred in 2023. For the nine months ended September 30, 2023, this amount includes estimates for the net impact of the same cyber event and losses from a divested business.
|  | September 30, 2024 |  | December 31, 2023
Assets: |  |  |  |
Surgical Facility Services |  | $ | 6,935.7 |  |  | $ | 6,347.4 |
Ancillary Services |  | 85.1 |  |  | 36.3 |
All other |  | 513.6 |  |  | 493.0 |
Total assets |  | $ | 7,534.4 |  |  | $ | 6,876.7 |
|  | Nine Months Ended September 30,
|  | 2024 |  | 2023 |  |
Cash purchases of property and equipment: |  |  |  |  |  |
Surgical Facility Services |  | $ | 62.5 |  |  | $ | 68.4 |  |  |
Ancillary Services |  | 1.9 |  |  | 0.6 |  |  |
All other |  | 3.7 |  |  | — |  |  |
Total cash purchases of property and equipment |  | $ | 68.1 |  |  | $ | 69.0 |  |  |

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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/exampleRef -Topic 280 -SubTopic 10 -Name Accounting Standards Codification -Section 55 -Paragraph 48 -Publisher FASB -URI https://asc.fasb.org/1943274/2147482785/280-10-55-48 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Topic 280 -SubTopic 10 -Name Accounting Standards 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