0001638833-24-000135 | 10-Q | XBRL Viewer

Organization and Summary of Accounting Policies

6 Months Ended

Jun. 30, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Organization and Summary of Accounting Policies

Organization

Surgery Partners, Inc., a Delaware corporation, acting through its subsidiaries, owns and operates a national network of surgical facilities and ancillary services. The surgical facilities, which include ambulatory surgery centers ("ASCs") and surgical hospitals, primarily provide non-emergency surgical procedures across many specialties, including orthopedics and pain management, gastroenterology, ophthalmology, and general surgery. The Company's surgical hospitals also provide services such as diagnostic imaging, laboratory, oncology, pharmacy, physical therapy and wound care. Ancillary services are comprised of multi-specialty physician practices, urgent care facilities and anesthesia services. Unless the context otherwise indicates, Surgery Partners, Inc. and its subsidiaries are referred to herein as "Surgery Partners," "we," "us," "our" or the "Company."

As of June 30, 2024, the Company owned or operated a portfolio of 167 surgical facilities, comprised of 148 ASCs and 19 surgical hospitals in 33 states. The Company owns these facilities in partnership with physicians and, in some cases, health care systems in the markets and communities it serves. The Company owned a majority interest in 92 of these surgical facilities and consolidated 127 surgical facilities for financial reporting purposes.

Basis of Presentation

The accompanying condensed consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles ("GAAP") for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and notes required by GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring adjustments) considered necessary for fair presentation of the Company's financial position and results of operations have been included. The Company’s fiscal year ends on December 31 and interim results are not necessarily indicative of results for a full year or any other interim period. The information contained in these condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements and notes thereto included in the Company's Annual Report on Form 10-K for the year ended December 31, 2023 (the "2023 Annual Report on Form 10-K"). Certain prior year amounts have been reclassified to conform with the current year presentation.

The condensed consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries, as well as interests in partnerships and limited liability companies controlled by the Company through its ownership of a majority voting interest or other rights granted to the Company by contract to manage and control the affiliate's business. All significant intercompany balances and transactions are eliminated in consolidation.

Use of Estimates

The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and footnotes. Examples include, but are not limited to, estimates of accounts receivable allowances, professional and general liabilities and the estimate of deferred tax assets or liabilities. Actual results could differ from those estimates.

Revenues

The Company's revenues generally relate to contracts with patients in which the performance obligations are to provide health care services. The Company recognizes revenues in the period in which its obligations to provide health care services are satisfied and reports the amount that reflects the consideration the Company expects to be entitled to receive. The contractual relationships with patients, in most cases, also involve a third-party payor (e.g., Medicare, Medicaid and private insurance organizations, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by or negotiated with the third-party payors. The payment arrangements with third-party payors for the services provided to the related patients typically specify payments at amounts less than the Company's standard charges. The Company continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals.

The following table presents a summary of revenues by service type as a percentage of total revenues:


	Three Months Ended June 30,				Six Months Ended June 30,
	2024		2023		2024		2023
Patient service revenues:
Surgical Facility Services	94.0	%	96.0	%	94.5	%	96.0	%
Ancillary Services	4.1	%	2.6	%	3.8	%	2.5	%
Total patient service revenues	98.1	%	98.6	%	98.3	%	98.5	%
Other service revenues	1.9	%	1.4	%	1.7	%	1.5	%
Total revenues	100.0	%	100.0	%	100.0	%	100.0	%

Patient service revenues. This revenue is related to charging facility fees in exchange for providing patient care. The fee charged for health care procedures performed in surgical facilities varies depending on the type of service provided, but usually includes all charges for usage of an operating room, a recovery room, special equipment, medical supplies, nursing staff and medications. The fee does not normally include professional fees charged by the patient’s surgeon, anesthesiologist or other attending physician, which are billed directly by such physicians to the patient or third-party payor. However, in several surgical facilities, the Company charges for anesthesia services. Ancillary service revenues include fees for patient visits to the Company's physician practices, pharmacy services and diagnostic tests ordered by physicians.

Patient service revenues are recognized as performance obligations are satisfied. Performance obligations are based on the nature of services provided. Typically, the Company recognizes revenue at a point in time in which services are rendered and the Company has no obligation to provide further patient services. Because the Company primarily performs outpatient procedures, performance obligations are generally satisfied same day and revenue is recognized on the date of service.

The Company determines the transaction price based on gross charges for services provided, net of estimated contractual adjustments and discounts from third-party payors. The Company estimates its contractual adjustments and discounts based on contractual agreements, its discount policies and historical experience. Changes in estimated contractual adjustments and discounts are recorded in the period of change.

Several states utilize supplemental Medicaid reimbursement programs for the purpose of providing reimbursement to providers to increase base rates to the levels that Medicare would have paid for the same service or for payments that offset a portion of the cost of providing care to Medicaid and indigent patients. These programs are designed with input from the Centers for Medicare & Medicaid Services (“CMS”) and are funded with a combination of state and federal resources, including, in certain instances, fees or taxes levied on the providers. We account for payments under these supplemental programs as variable consideration and estimate the amount using the most likely amount method. Reimbursement under these programs, including the recognition of variable consideration, is reflected in patient service revenues. Taxes or other program-related costs are reflected in other operating expenses.

Other service revenues. Other service revenues include management and administrative service fees derived from the non-consolidated facilities that the Company accounts for under the equity method, management of surgical facilities in which it does not own an interest, and management services provided to physician practices for which the Company is not required to provide capital or additional assets and other non-patient services. The management agreements typically require the Company to provide recurring management services over a multi-year period, which are billed and collected on a monthly basis. The fees derived from these management arrangements are based on a predetermined percentage of the revenues of each facility or practice and are recognized in the period in which management services are rendered and billed.

The following table sets forth patient service revenues by type of payor and as a percentage of total patient service revenues for the Company's consolidated surgical facilities (dollars in millions):


	Three Months Ended June 30,
	2024				2023
	Amount		%		Amount		%
Patient service revenues:
Private insurance	$	398.0	53.2	%	$	341.6	51.9	%
Government	310.1		41.5	%	278.2		42.3	%
Self-pay	20.7		2.8	%	17.1		2.6	%
Other (1)	19.3		2.5	%	21.1		3.2	%
Total patient service revenues	748.1		100.0	%	658.0		100.0	%
Other service revenues	14.0				9.6
Total revenues	$	762.1			$	667.6


	Six Months Ended June 30,
	2024				2023
	Amount		%		Amount		%
Patient service revenues:
Private insurance	$	759.0	52.2	%	$	677.2	51.5	%
Government	613.7		42.2	%	566.0		43.1	%
Self-pay	40.5		2.8	%	32.7		2.5	%
Other (1)	40.2		2.8	%	38.5		2.9	%
Total patient service revenues	1,453.4		100.0	%	1,314.4		100.0	%
Other service revenues	26.1				19.4
Total revenues	$	1,479.5			$	1,333.8

(1)Other is comprised of automobile liability, letters of protection and other payor types.

Accounts Receivable

Accounts receivable from third-party payors are recorded net of estimated implicit price concessions, which are estimated based on the historical trend of the Company's surgical hospitals’ cash collections and contractual write-offs, and for the Company's surgical facilities in general, established fee schedules, relationships with payors and procedure statistics. While changes in estimated reimbursement from third-party payors remain a possibility, the Company expects that any such changes would be minimal and, therefore, would not have a material effect on its financial condition or results of operations.

Accounts receivable consists of receivables from federal and state agencies (under the Medicare and Medicaid programs), private insurance organizations, employers and patients. Management recognizes that revenues and receivables from government agencies are significant to the Company's operations, but it does not believe that there is significant credit risk associated with these government agencies. Concentration of credit risk with respect to other payors is limited because of the large number of such payors.

The Company recognizes that final reimbursement of accounts receivable is subject to final approval by each third-party payor. However, because the Company has contracts with its third-party payors and also verifies insurance coverage of the patient before medical services are rendered, the amounts that are pending approval from third-party payors are not considered significant. Amounts are classified outside of self-pay if the Company has an agreement with the third-party payor or has verified a patient’s coverage prior to services rendered. The Company's policy is to collect co-payments and deductibles prior to providing medical services. Patient services of the Company are primarily non-emergency, which allows the surgical facilities to control the procedures for which third-party reimbursement is sought and obtained. The Company does not require collateral from self-pay patients.

The Company's collection policies and procedures are based on the type of payor, size of claim and estimated collection percentage for each patient account. The Company analyzes accounts receivable at each of its surgical facilities to ensure the proper collection and aged category. Collection efforts include direct contact with third-party payors or patients, written correspondence and the use of legal or collection agency assistance, as required.

Income Taxes

The Company uses the asset and liability method to account for income taxes. Under this method, deferred income tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected

to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. If a carryforward exists, the Company makes a determination as to whether the carryforward will be utilized in the future. A valuation allowance is established for certain carryforwards when their recoverability is deemed to be uncertain. The carrying value of the net deferred tax assets assumes that the Company will be able to generate sufficient future taxable income in certain tax jurisdictions, based on estimates and assumptions. If our expectations for future operating results on a consolidated basis or at the state jurisdiction level vary from actual results due to changes in health care regulations, general economic conditions, or other factors, we may need to adjust the valuation allowance, for all or a portion of our deferred tax assets. Our income tax expense in future periods will be reduced or increased to the extent of offsetting decreases or increases, respectively, in our valuation allowance in the period when the change in circumstances occurs. These changes could have a significant impact on our future earnings.

The Company and certain of its subsidiaries file a consolidated federal income tax return. The partnerships, limited liability companies, and certain non-consolidated physician practice corporations also file separate income tax returns. The Company's allocable portion of each partnership's and limited liability company's income or loss is included in taxable income of the Company. The remaining income or loss of each partnership and limited liability company is allocated to the other owners.

The Company's effective tax rate was 15.0% for the six months ended June 30, 2024 compared to (19.0)% for the six months ended June 30, 2023. For the six months ended June 30, 2024, the effective tax rate differed from the U.S. federal statutory rate of 21% primarily due to earnings attributable to non-controlling interests, an increase in the Company’s valuation allowance attributable to interest expense limitations, state tax expense, and a discrete tax expense of $0.6 million related to the vesting of restricted stock awards. For the six months ended June 30, 2023, the effective tax rate differed from the U.S. federal statutory rate of 21% primarily due to earnings attributable to non-controlling interests, an increase in the Company’s valuation allowance attributable to interest expense limitations, and discrete tax benefits of (i) $1.8 million related to the vesting of restricted stock awards and (ii) $15.9 million related to entity divestitures. Based upon the application of interim accounting guidance, the tax rate as a percentage of net income after income attributable to non-controlling interests will vary based upon the relative net income from period to period.

Goodwill

Goodwill represents the excess of the fair value of the consideration provided in an acquisition plus the fair value of any non-controlling interests over the fair value of net assets acquired and is not amortized. Additions to goodwill include amounts resulting from new business combinations and incremental ownership purchases in the Company's subsidiaries. A summary of the Company's acquisitions and disposals for the six months ended June 30, 2024 is included in Note 2. "Acquisitions and Disposals."

A summary of activity related to goodwill for the six months ended June 30, 2024 is as follows (in millions):


Balance at December 31, 2023	$	4,326.0
Acquisitions, including post acquisition adjustments	486.3
Disposals	(6.0)
Balance at June 30, 2024	$	4,806.3

A detailed evaluation of potential impairment indicators was performed as of June 30, 2024, which specifically considered recent increases in interest rates, inflation risk and market volatility. On the basis of available evidence as of June 30, 2024, no indicators of impairment were identified. Future estimates of fair value could be adversely affected if the actual outcome of one or more of the Company's assumptions changes materially in the future, including a material decline in the Company’s stock price and the fair value of its long-term debt, lower than expected surgical case volumes, higher market interest rates or increased operating costs. Such changes impacting the calculation of fair value could result in a material impairment charge in the future.

Derivative Instruments and Hedging Activities

The Company records all derivatives on the balance sheet at fair value and any financing elements treated as debt instruments are recorded at amortized cost. The accounting for changes in the fair value of derivatives depends on the intended use of the derivative, whether the Company has elected to designate a derivative in a hedging relationship and apply hedge accounting and whether the hedging relationship has satisfied the criteria necessary to apply hedge accounting. Hedge accounting generally provides for the matching of the timing of gain or loss recognition on the hedging instrument with the recognition of the changes in the fair value of the hedged asset or liability that are attributable to the hedged risk in a fair value hedge or the earnings effect of the hedged forecasted transactions in a cash flow hedge. The Company may enter into derivative contracts that are intended to economically hedge certain risks, even though hedge accounting does not apply or the Company elects not to apply hedge accounting.

The Company made an accounting policy election to measure the credit risk of its derivative financial instruments that are subject to master netting agreements on a net basis by counterparty portfolio.

Non-Controlling Interests—Redeemable

Each partnership and limited liability company through which the Company owns and operates its surgical facilities is governed by a partnership or operating agreement, respectively. In certain circumstances, the applicable partnership or operating agreements for the Company's surgical facilities provide that the facilities will purchase all of the physician limited partners’ or physician minority members’, as applicable, ownership if certain adverse regulatory events occur, such as it becoming illegal for the physician(s) to own an interest in a surgical facility, refer patients to a surgical facility or receive cash distributions from a surgical facility. Management believes the likelihood of an event occurring that would trigger such purchases was remote as of June 30, 2024. The non-controlling interests—redeemable are reported outside of stockholders' equity in the condensed consolidated balance sheets.

A summary of activity related to redeemable non-controlling interests is as follows (in millions):


	Six Months Ended June 30,
	2024		2023

Balance at beginning of period	$	327.4	$	342.0
Net income attributable to non-controlling interests—redeemable	15.8		19.0
Acquisition and disposal of shares of non-controlling interests, net—redeemable	120.3		(10.0)
Distributions to non-controlling interest —redeemable holders	(21.4)		(22.9)
Balance at end of period	$	442.1	$	328.1

Fair Value of Financial Instruments

The fair value of a financial instrument is the amount at which the instrument could be exchanged in an orderly transaction between market participants to sell the asset or transfer the liability. The Company uses fair value measurements based on inputs classified into the following hierarchy:

•Level 1: Unadjusted quoted prices in active markets for identical assets or liabilities.

•Level 2: Inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly. These may include quoted prices for similar assets or liabilities in active markets and quoted prices for identical or similar assets or liabilities in markets that are not active.

•Level 3: Unobservable inputs in which little or no market data exists, therefore requiring an entity to develop its own assumptions, depending on the nature of the item being valued.

The carrying amounts reported in the condensed consolidated balance sheets for cash and cash equivalents, accounts receivable and accounts payable approximate their fair values under Level 3 calculations.

A summary of the carrying amounts and estimated fair values of the Company's long-term debt follows (in millions):


	Carrying Amount				Fair Value
	June 30, 2024		December 31, 2023		June 30, 2024		December 31, 2023

Senior secured term loan	$	1,398.5	$	1,398.4	$	1,402.0	$	1,401.9
6.750% senior unsecured notes due 2025	$	—	$	185.0	$	—	$	183.2
10.000% senior unsecured notes due 2027	$	—	$	320.0	$	—	$	321.2
7.250% senior unsecured notes due 2032	$	800.0	$	—	$	808.0	$	—

The fair values in the table above were based on Level 2 inputs using quoted prices for identical liabilities in inactive markets. The carrying amounts related to the Company's other long-term debt obligations, including finance lease obligations, approximate their fair values based on Level 3 inputs.

Variable Interest Entities

The condensed consolidated financial statements include the accounts of variable interest entities ("VIE") in which the Company is the primary beneficiary under the provisions of the Financial Accounting Standards Board's ("FASB") Accounting Standards Codification 810, "Consolidation". The Company has the power to direct the activities that most significantly impact a VIE's economic performance. Additionally, the Company would absorb the majority of the expected losses from any of these entities should such expected losses occur. As of June 30, 2024, the Company's consolidated VIEs consisted of nine surgical facilities, eighteen physician practices, and one anesthesia practice.

The total assets (excluding goodwill and intangible assets, net) of the consolidated VIEs included in the accompanying condensed consolidated balance sheets as of June 30, 2024 and December 31, 2023, were $71.9 million and $65.3 million, respectively, and the total liabilities of the consolidated VIEs were $43.0 million and $41.2 million, respectively.

Recent Accounting Pronouncements

In November 2023, the FASB issued Accounting Standards Update ("ASU") 2023-07, Segment Reporting (Topic 280), Improvements to Reportable Segment Disclosures, which requires enhanced disclosures of significant segment expenses. The ASU is effective for annual periods beginning after December 15, 2023 and interim periods beginning after December 15, 2024. The amendments in this ASU must be applied retrospectively to all periods presented and early adoption is permitted. The Company is evaluating the impact of this ASU on its condensed consolidated financial statements.

In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740), Improvements to Income Tax Disclosures, which establishes new requirements for the categorization and disaggregation of information in the rate reconciliation as well as for disaggregation of income taxes paid. The ASU is effective for annual periods beginning after December 15, 2024 and interim periods beginning after December 15, 2025. The amendments in this ASU may be applied prospectively or retrospectively to all periods presented and early adoption is permitted. The Company is evaluating the impact of this ASU on its condensed consolidated financial statements.

Pay vs Performance Disclosure - USD ($) $ in Millions	3 Months Ended		6 Months Ended
Pay vs Performance Disclosure - USD ($) $ in Millions	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Pay vs Performance Disclosure
Net Income (Loss) Attributable to Parent	$ (15.5)	$ 18.9	$ (27.9)	$ (6.0)

- Definition

The portion of profit or loss for the period, net of income taxes, which is attributable to the parent.

+ References

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-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iii)(B))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 30: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(4)(iv))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 31: http://www.xbrl.org/2003/role/disclosureRef
-Topic 470
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1B
-Subparagraph (SX 210.13-02(a)(5))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480097/470-10-S99-1B

Reference 32: http://www.xbrl.org/2003/role/disclosureRef
-Topic 260
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 60B
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482689/260-10-45-60B

Reference 33: http://www.xbrl.org/2003/role/disclosureRef
-Topic 205
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 7
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483499/205-20-50-7

Reference 34: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 230
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 28
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482740/230-10-45-28

Reference 35: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 1A
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482790/220-10-45-1A

Reference 36: http://www.xbrl.org/2003/role/disclosureRef
-Topic 220
-SubTopic 10
-Name Accounting Standards Codification
-Section 45
-Paragraph 1B
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482790/220-10-45-1B

Reference 37: http://fasb.org/us-gaap/role/ref/legacyRef
-Topic 942
-SubTopic 220
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-04(22))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478524/942-220-S99-1

+ Details

Leases - Schedule of Lease Expense and Cash Flow Information (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Leases [Abstract]
Operating lease costs	$ 32.3	$ 33.2
Finance lease costs:
Amortization of leased assets	23.6	18.3
Interest on lease liabilities	26.7	23.8
Total finance lease costs	50.3	42.1
Variable and short-term lease costs	11.8	10.4
Total lease costs	94.4	85.7
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases	31.3	32.2
Operating cash outflows from finance leases	25.4	22.6
Financing cash outflows from finance leases	15.4	12.6
Right-of-use assets obtained in exchange for lease obligations:
Operating leases	38.0	15.1
Finance leases	$ 21.2	$ 23.6

CONDENSED CONSOLIDATED BALANCE SHEETS - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 213.5	$ 195.9
Accounts receivable	523.4	496.4
Inventories	80.9	75.2
Prepaid expenses	44.7	31.0
Other current assets	150.0	96.5
Total current assets	1,012.5	895.0
Property and equipment, net of accumulated depreciation of $519.1 and $454.4, respectively	1,005.8	968.7
Goodwill and other intangible assets, net	4,858.5	4,380.8
Investments in and advances to affiliates	227.1	184.1
Right-of-use operating lease assets	266.9	255.3
Long-term deferred tax assets	81.8	89.5
Other long-term assets	36.0	103.3
Total assets	7,488.6	6,876.7
Current liabilities:
Accounts payable	174.0	171.8
Accrued payroll and benefits	63.1	73.8
Other current liabilities	222.3	204.1
Current maturities of long-term debt	92.4	73.3
Total current liabilities	551.8	523.0
Long-term debt, less current maturities	3,039.7	2,701.8
Right-of-use operating lease liabilities	257.6	248.9
Other long-term liabilities	21.1	41.1
Non-controlling interests—redeemable	442.1	327.4
Stockholders' equity:
Preferred stock, $0.01 par value; shares authorized - 20,310,000; shares issued or outstanding - none	0.0	0.0
Common stock, $0.01 par value; shares authorized - 300,000,000; shares issued and outstanding - 127,123,940 and 126,593,727, respectively	1.3	1.3
Additional paid-in capital	2,511.1	2,497.6
Accumulated other comprehensive income	37.1	57.5
Retained deficit	(597.1)	(569.2)
Total Surgery Partners, Inc. stockholders' equity	1,952.4	1,987.2
Non-controlling interests—non-redeemable	1,223.9	1,047.3
Total stockholders' equity	3,176.3	3,034.5
Total liabilities and stockholders' equity	$ 7,488.6	$ 6,876.7

Organization and Summary of Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Basis of Presentation	Basis of Presentation The accompanying condensed consolidated financial statements have been prepared in accordance with U.S. generally accepted accounting principles ("GAAP") for interim financial information and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all of the information and notes required by GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of normal recurring adjustments) considered necessary for fair presentation of the Company's financial position and results of operations have been included. The Company’s fiscal year ends on December 31 and interim results are not necessarily indicative of results for a full year or any other interim period. The information contained in these condensed consolidated financial statements should be read in conjunction with the Company’s consolidated financial statements and notes thereto included in the Company's Annual Report on Form 10-K for the year ended December 31, 2023 (the "2023 Annual Report on Form 10-K").
Reclassification	Certain prior year amounts have been reclassified to conform with the current year presentation.
Principles of Consolidation	The condensed consolidated financial statements include the accounts of the Company and its wholly-owned subsidiaries, as well as interests in partnerships and limited liability companies controlled by the Company through its ownership of a majority voting interest or other rights granted to the Company by contract to manage and control the affiliate's business. All significant intercompany balances and transactions are eliminated in consolidation.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and footnotes. Examples include, but are not limited to, estimates of accounts receivable allowances, professional and general liabilities and the estimate of deferred tax assets or liabilities. Actual results could differ from those estimates.
Revenues	Revenues The Company's revenues generally relate to contracts with patients in which the performance obligations are to provide health care services. The Company recognizes revenues in the period in which its obligations to provide health care services are satisfied and reports the amount that reflects the consideration the Company expects to be entitled to receive. The contractual relationships with patients, in most cases, also involve a third-party payor (e.g., Medicare, Medicaid and private insurance organizations, including plans offered through the health insurance exchanges) and the transaction prices for the services provided are dependent upon the terms provided by or negotiated with the third-party payors. The payment arrangements with third-party payors for the services provided to the related patients typically specify payments at amounts less than the Company's standard charges. The Company continually reviews the contractual estimation process to consider and incorporate updates to laws and regulations and the frequent changes in managed care contractual terms resulting from contract renegotiations and renewals. Patient service revenues. This revenue is related to charging facility fees in exchange for providing patient care. The fee charged for health care procedures performed in surgical facilities varies depending on the type of service provided, but usually includes all charges for usage of an operating room, a recovery room, special equipment, medical supplies, nursing staff and medications. The fee does not normally include professional fees charged by the patient’s surgeon, anesthesiologist or other attending physician, which are billed directly by such physicians to the patient or third-party payor. However, in several surgical facilities, the Company charges for anesthesia services. Ancillary service revenues include fees for patient visits to the Company's physician practices, pharmacy services and diagnostic tests ordered by physicians. Patient service revenues are recognized as performance obligations are satisfied. Performance obligations are based on the nature of services provided. Typically, the Company recognizes revenue at a point in time in which services are rendered and the Company has no obligation to provide further patient services. Because the Company primarily performs outpatient procedures, performance obligations are generally satisfied same day and revenue is recognized on the date of service. The Company determines the transaction price based on gross charges for services provided, net of estimated contractual adjustments and discounts from third-party payors. The Company estimates its contractual adjustments and discounts based on contractual agreements, its discount policies and historical experience. Changes in estimated contractual adjustments and discounts are recorded in the period of change. Several states utilize supplemental Medicaid reimbursement programs for the purpose of providing reimbursement to providers to increase base rates to the levels that Medicare would have paid for the same service or for payments that offset a portion of the cost of providing care to Medicaid and indigent patients. These programs are designed with input from the Centers for Medicare & Medicaid Services (“CMS”) and are funded with a combination of state and federal resources, including, in certain instances, fees or taxes levied on the providers. We account for payments under these supplemental programs as variable consideration and estimate the amount using the most likely amount method. Reimbursement under these programs, including the recognition of variable consideration, is reflected in patient service revenues. Taxes or other program-related costs are reflected in other operating expenses. Other service revenues. Other service revenues include management and administrative service fees derived from the non-consolidated facilities that the Company accounts for under the equity method, management of surgical facilities in which it does not own an interest, and management services provided to physician practices for which the Company is not required to provide capital or additional assets and other non-patient services. The management agreements typically require the Company to provide recurring management services over a multi-year period, which are billed and collected on a monthly basis. The fees derived from these management arrangements are based on a predetermined percentage of the revenues of each facility or practice and are recognized in the period in which management services are rendered and billed.
Accounts Receivable	Accounts Receivable Accounts receivable from third-party payors are recorded net of estimated implicit price concessions, which are estimated based on the historical trend of the Company's surgical hospitals’ cash collections and contractual write-offs, and for the Company's surgical facilities in general, established fee schedules, relationships with payors and procedure statistics. While changes in estimated reimbursement from third-party payors remain a possibility, the Company expects that any such changes would be minimal and, therefore, would not have a material effect on its financial condition or results of operations. Accounts receivable consists of receivables from federal and state agencies (under the Medicare and Medicaid programs), private insurance organizations, employers and patients. Management recognizes that revenues and receivables from government agencies are significant to the Company's operations, but it does not believe that there is significant credit risk associated with these government agencies. Concentration of credit risk with respect to other payors is limited because of the large number of such payors. The Company recognizes that final reimbursement of accounts receivable is subject to final approval by each third-party payor. However, because the Company has contracts with its third-party payors and also verifies insurance coverage of the patient before medical services are rendered, the amounts that are pending approval from third-party payors are not considered significant. Amounts are classified outside of self-pay if the Company has an agreement with the third-party payor or has verified a patient’s coverage prior to services rendered. The Company's policy is to collect co-payments and deductibles prior to providing medical services. Patient services of the Company are primarily non-emergency, which allows the surgical facilities to control the procedures for which third-party reimbursement is sought and obtained. The Company does not require collateral from self-pay patients. The Company's collection policies and procedures are based on the type of payor, size of claim and estimated collection percentage for each patient account. The Company analyzes accounts receivable at each of its surgical facilities to ensure the proper collection and aged category. Collection efforts include direct contact with third-party payors or patients, written correspondence and the use of legal or collection agency assistance, as required.
Income Taxes	Income Taxes The Company uses the asset and liability method to account for income taxes. Under this method, deferred income tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and their respective tax bases. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in income in the period that includes the enactment date. If a carryforward exists, the Company makes a determination as to whether the carryforward will be utilized in the future. A valuation allowance is established for certain carryforwards when their recoverability is deemed to be uncertain. The carrying value of the net deferred tax assets assumes that the Company will be able to generate sufficient future taxable income in certain tax jurisdictions, based on estimates and assumptions. If our expectations for future operating results on a consolidated basis or at the state jurisdiction level vary from actual results due to changes in health care regulations, general economic conditions, or other factors, we may need to adjust the valuation allowance, for all or a portion of our deferred tax assets. Our income tax expense in future periods will be reduced or increased to the extent of offsetting decreases or increases, respectively, in our valuation allowance in the period when the change in circumstances occurs. These changes could have a significant impact on our future earnings. The Company and certain of its subsidiaries file a consolidated federal income tax return. The partnerships, limited liability companies, and certain non-consolidated physician practice corporations also file separate income tax returns. The Company's allocable portion of each partnership's and limited liability company's income or loss is included in taxable income of the Company. The remaining income or loss of each partnership and limited liability company is allocated to the other owners.
Goodwill	Goodwill Goodwill represents the excess of the fair value of the consideration provided in an acquisition plus the fair value of any non-controlling interests over the fair value of net assets acquired and is not amortized. Additions to goodwill include amounts resulting from new business combinations and incremental ownership purchases in the Company's subsidiaries.
Derivative Instruments and Hedging Activities	Derivative Instruments and Hedging Activities The Company records all derivatives on the balance sheet at fair value and any financing elements treated as debt instruments are recorded at amortized cost. The accounting for changes in the fair value of derivatives depends on the intended use of the derivative, whether the Company has elected to designate a derivative in a hedging relationship and apply hedge accounting and whether the hedging relationship has satisfied the criteria necessary to apply hedge accounting. Hedge accounting generally provides for the matching of the timing of gain or loss recognition on the hedging instrument with the recognition of the changes in the fair value of the hedged asset or liability that are attributable to the hedged risk in a fair value hedge or the earnings effect of the hedged forecasted transactions in a cash flow hedge. The Company may enter into derivative contracts that are intended to economically hedge certain risks, even though hedge accounting does not apply or the Company elects not to apply hedge accounting. The Company made an accounting policy election to measure the credit risk of its derivative financial instruments that are subject to master netting agreements on a net basis by counterparty portfolio.
Non-Controlling Interests—Redeemable	Non-Controlling Interests—Redeemable Each partnership and limited liability company through which the Company owns and operates its surgical facilities is governed by a partnership or operating agreement, respectively. In certain circumstances, the applicable partnership or operating agreements for the Company's surgical facilities provide that the facilities will purchase all of the physician limited partners’ or physician minority members’, as applicable, ownership if certain adverse regulatory events occur, such as it becoming illegal for the physician(s) to own an interest in a surgical facility, refer patients to a surgical facility or receive cash distributions from a surgical facility. Management believes the likelihood of an event occurring that would trigger such purchases was remote as of June 30, 2024. The non-controlling interests—redeemable are reported outside of stockholders' equity in the condensed consolidated balance sheets.
Fair Value of Financial Instruments	Fair Value of Financial Instruments The fair value of a financial instrument is the amount at which the instrument could be exchanged in an orderly transaction between market participants to sell the asset or transfer the liability. The Company uses fair value measurements based on inputs classified into the following hierarchy: •Level 1: Unadjusted quoted prices in active markets for identical assets or liabilities. •Level 2: Inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly. These may include quoted prices for similar assets or liabilities in active markets and quoted prices for identical or similar assets or liabilities in markets that are not active. •Level 3: Unobservable inputs in which little or no market data exists, therefore requiring an entity to develop its own assumptions, depending on the nature of the item being valued. The carrying amounts reported in the condensed consolidated balance sheets for cash and cash equivalents, accounts receivable and accounts payable approximate their fair values under Level 3 calculations. The fair values in the table above were based on Level 2 inputs using quoted prices for identical liabilities in inactive markets. The carrying amounts related to the Company's other long-term debt obligations, including finance lease obligations, approximate their fair values based on Level 3 inputs.
Variable Interest Entities	Variable Interest Entities The condensed consolidated financial statements include the accounts of variable interest entities ("VIE") in which the Company is the primary beneficiary under the provisions of the Financial Accounting Standards Board's ("FASB") Accounting Standards Codification 810, "Consolidation". The Company has the power to direct the activities that most significantly impact a VIE's economic performance. Additionally, the Company would absorb the majority of the expected losses from any of these entities should such expected losses occur.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In November 2023, the FASB issued Accounting Standards Update ("ASU") 2023-07, Segment Reporting (Topic 280), Improvements to Reportable Segment Disclosures, which requires enhanced disclosures of significant segment expenses. The ASU is effective for annual periods beginning after December 15, 2023 and interim periods beginning after December 15, 2024. The amendments in this ASU must be applied retrospectively to all periods presented and early adoption is permitted. The Company is evaluating the impact of this ASU on its condensed consolidated financial statements. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740), Improvements to Income Tax Disclosures, which establishes new requirements for the categorization and disaggregation of information in the rate reconciliation as well as for disaggregation of income taxes paid. The ASU is effective for annual periods beginning after December 15, 2024 and interim periods beginning after December 15, 2025. The amendments in this ASU may be applied prospectively or retrospectively to all periods presented and early adoption is permitted. The Company is evaluating the impact of this ASU on its condensed consolidated financial statements.
Leases	LeasesThe Company's operating leases are primarily for real estate, including medical office buildings, and corporate and other administrative offices. The Company's finance leases are primarily for medical equipment and information technology and telecommunications assets.
Earnings Per Share	Earnings Per ShareBasic and diluted earnings (loss) per share are calculated based on the weighted-average number of shares outstanding in each period and dilutive stock options, unvested shares and warrants, to the extent such securities exist and have a dilutive effect on earnings per share.

Acquisitions, Disposals and Deconsolidations	6 Months Ended
Acquisitions, Disposals and Deconsolidations	Jun. 30, 2024
Business Combination, Asset Acquisition, and Joint Venture Formation [Abstract]
Acquisitions, Disposals and Deconsolidations	Acquisitions, Disposals and Deconsolidations Acquisitions During the six months ended June 30, 2024: •The Company acquired a controlling interest in six surgical facilities and several physician practices for aggregate cash consideration of $264.6 million, net of cash acquired, and non-cash consideration of $1.1 million, which consisted of a non-controlling interest in one of the Company's existing surgical facilities. In connection with these acquisitions, the Company preliminarily recognized non-controlling interests of $290.7 million, goodwill of $483.0 million and investments and advances to affiliates of $44.6 million related to an acquired surgical facility accounted for as an equity method investment. During the six months ended June 30, 2023: •The Company acquired a controlling interest in one surgical facility and one physician practice for aggregate cash consideration of $17.9 million, net of cash acquired and non-cash consideration of $1.3 million, which consisted of non-controlling interest in one of the Company's existing surgical facilities. In connection with these acquisitions, the Company preliminarily recognized non-controlling interests of $12.0 million and goodwill of $27.4 million. •The Company acquired a controlling interest in two surgical facilities, which were previously accounted for as equity method investments, for aggregate cash consideration of $26.9 million, net of cash acquired. The Company also amended the operating agreement of a previously non-controlled surgical facility resulting in the Company obtaining a controlling interest in the facility. These transactions resulted in the consolidation of the previously non-consolidated entities. The previously held non-controlling interests were remeasured and recorded at fair value as of the dates of the transactions. The fair value measurement utilizes Level 3 inputs, which includes unobservable data. The acquisition date fair value of the previously held non-controlling interests was $27.3 million. As a result of increasing its ownership interest, the Company recognized a net loss of $7.1 million included in net loss on disposals, consolidations and deconsolidations in the condensed consolidated statements of operations for the six months ended June 30, 2023. The net loss was determined based on the difference between the fair value of the Company's previously held non-controlling interests in the entities and the carrying values immediately prior to the transactions. In connection with the consolidation of these facilities, the Company preliminarily recognized non-controlling interests of $55.2 million and goodwill of $106.3 million. •The Company acquired non-controlling interests in four surgical facilities and two in-development de novo surgical facilities for aggregate cash consideration of $48.4 million. The non-controlling interests were accounted for as equity method investments and recorded as a component of investments in and advances to affiliates in the condensed consolidated balance sheets. The Company also paid cash consideration of $20.0 million to acquire management rights from the prior management service provider related to three of the aforementioned surgical facilities. Management rights agreements are accounted for and recorded as a component of intangibles assets, net in the accompanying condensed consolidated balance sheets. The cash paid to acquire the management rights is presented as a component of other investing activities on the condensed consolidated statements of cash flows. Disposals and Deconsolidations During the six months ended June 30, 2024: •The Company disposed of its non-controlling interests in one surgical facility, which was previously accounted for as an equity method investment, for cash proceeds of $2.0 million. In connection with this transaction, the Company recognized a pre-tax loss of $3.7 million, which is included in net loss on disposals, consolidations and deconsolidations in the accompanying condensed consolidated statements of operations for the six months ended June 30, 2024. •The Company sold a portion of its interests in one surgical facility for net cash proceeds of $2.5 million. As a result of the transaction, the Company lost control of the previously controlled surgical facility but retains a non-controlling interest, resulting in the deconsolidation of the previously consolidated entity. This transaction resulted in a pretax net gain on deconsolidation of $2.7 million, which is included in net loss on disposals, consolidations and deconsolidations in the accompanying condensed consolidated statements of operations for the six months ended June 30, 2024. The net gain was determined based on the difference between the net cash proceeds plus the fair value of the Company’s retained interests in the entity and the carrying values of both the tangible and intangible assets of the entity immediately prior to the transaction. During the six months ended June 30, 2023: •The Company sold its interests in four surgical facilities for aggregate net cash proceeds of $30.4 million, a portion of which was held in escrow pursuant to the purchase agreements for such transactions. In connection with these transactions, the Company recognized a pre-tax gain of $26.7 million included in net loss on disposals, consolidations and deconsolidations in the condensed consolidated statements of operations for the six months ended June 30, 2023. •The Company disposed of its non-controlling interests in a surgical facility and an in-development de novo surgical facility, which were previously accounted for as equity method investments, for cash proceeds of $1.5 million. In connection with these transactions, the Company recognized a pre-tax loss of $13.7 million included in net loss on disposals, consolidations and deconsolidations in the condensed consolidated statements of operations for the six months ended June 30, 2023.

Long-Term Debt (Tables)

6 Months Ended

Jun. 30, 2024

Debt Disclosure [Abstract]

Schedule of Long-Term Debt

A summary of long-term debt follows (in millions):


	June 30, 2024		December 31, 2023

Senior secured term loan (1)	$	1,398.5	$	1,398.4
Senior secured revolving credit facility	46.0		—
6.750% senior unsecured notes due 2025	—		185.0
10.000% senior unsecured notes due 2027	—		320.0
7.250% senior unsecured notes due 2032	800.0		—
Notes payable and other secured loans	210.0		205.2
Finance lease obligations	712.6		693.6
Less: unamortized debt issuance costs and discounts	(35.0)		(27.1)
Total debt	3,132.1		2,775.1
Less: current maturities	92.4		73.3
Total long-term debt	$	3,039.7	$	2,701.8

(1)Includes unamortized fair value discount of $1.5 million and $1.6 million as of June 30, 2024 and December 31, 2023, respectively.

CONDENSED CONSOLIDATED STATEMENTS OF STOCKHOLDERS' EQUITY - USD ($) $ in Millions	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive (Loss) Income	Retained Deficit	Non-Controlling Interests— Non-Redeemable
Beginning Balance (shares) at Dec. 31, 2022		125,961,000
Beginning Balance at Dec. 31, 2022	$ 2,940.9	$ 1.3	$ 2,478.0	$ 76.2	$ (557.3)	$ 942.7
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	(6.7)				(25.0)	18.3
Equity-based compensation (shares)		519,000
Equity-based compensation	3.7		3.7
Other comprehensive income (loss)	(11.3)			(11.3)
Acquisition and disposal of shares of non-controlling interests, net	46.1		(3.6)			49.7
Distributions to non-controlling interests—non-redeemable holders	(30.2)					(30.2)
Ending Balance (shares) at Mar. 31, 2023		126,480,000
Ending Balance at Mar. 31, 2023	2,942.5	$ 1.3	2,478.1	64.9	(582.3)	980.5
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	46.6				19.0	27.6
Equity-based compensation (shares)		13,000
Equity-based compensation	4.5		4.5
Other comprehensive income (loss)	13.9			13.9
Acquisition and disposal of shares of non-controlling interests, net	(0.9)		18.8			(19.7)
Distributions to non-controlling interests—non-redeemable holders	(23.8)					(23.8)
Ending Balance (shares) at Jun. 30, 2023		126,493,000
Ending Balance at Jun. 30, 2023	$ 2,982.8	$ 1.3	2,501.4	78.8	(563.3)	964.6
Beginning Balance (shares) at Dec. 31, 2023	126,593,727	126,594,000
Beginning Balance at Dec. 31, 2023	$ 3,034.5	$ 1.3	2,497.6	57.5	(569.2)	1,047.3
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	16.9				(12.4)	29.3
Equity-based compensation (shares)		508,000
Equity-based compensation	4.9		4.9
Other comprehensive income (loss)	(5.5)			(5.5)
Acquisition and disposal of shares of non-controlling interests, net	16.8		(6.9)			23.7
Distributions to non-controlling interests—non-redeemable holders	(29.7)					(29.7)
Ending Balance (shares) at Mar. 31, 2024		127,102,000
Ending Balance at Mar. 31, 2024	3,037.9	$ 1.3	2,495.6	52.0	(581.6)	1,070.6
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net (loss) income	20.0				(15.5)	35.5
Equity-based compensation (shares)		22,000
Equity-based compensation	15.1		15.1
Other comprehensive income (loss)	(14.9)			(14.9)
Acquisition and disposal of shares of non-controlling interests, net	147.8		0.4			147.4
Distributions to non-controlling interests—non-redeemable holders	$ (29.6)					(29.6)
Ending Balance (shares) at Jun. 30, 2024	127,123,940	127,124,000
Ending Balance at Jun. 30, 2024	$ 3,176.3	$ 1.3	$ 2,511.1	$ 37.1	$ (597.1)	$ 1,223.9

- Definition

Amount after tax and reclassification adjustments of other comprehensive income (loss).

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-SubTopic 10
-Topic 505
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481112/505-10-50-2

Reference 2: http://www.xbrl.org/2003/role/disclosureRef
-Topic 250
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 6
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147483443/250-10-50-6

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 830
-SubTopic 30
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481674/830-30-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 830
-SubTopic 30
-Name Accounting Standards Codification
-Section 45
-Paragraph 17
-Publisher FASB
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+ Details

- Definition

Amount of equity (deficit) attributable to parent and noncontrolling interest. Excludes temporary equity.

+ References

Reference 1: http://www.xbrl.org/2003/role/disclosureRef
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-URI https://asc.fasb.org/1943274/2147476166/350-60-65-1

+ Details

Leases

6 Months Ended

Jun. 30, 2024

Leases [Abstract]

Leases

The Company's operating leases are primarily for real estate, including medical office buildings, and corporate and other administrative offices. The Company's finance leases are primarily for medical equipment and information technology and telecommunications assets.

The following table presents the components of the Company's right-of-use assets and liabilities related to leases and their classification in the condensed consolidated balance sheets (in millions):


	Classification in Condensed Consolidated Balance Sheets	June 30, 2024		December 31, 2023

Assets:
Operating lease assets	Right-of-use operating lease assets	$	266.9	$	255.3
Finance lease assets	Property and equipment, net of accumulated depreciation	594.6		587.0
Total leased assets		$	861.5	$	842.3

Liabilities:
Operating lease liabilities:
Current	Other current liabilities	$	39.3	$	37.6
Long-term	Right-of-use operating lease liabilities	257.6		248.9
Total operating lease liabilities		296.9		286.5
Finance lease liabilities:
Current	Current maturities of long-term debt	28.5		25.4
Long-term	Long-term debt, less current maturities	684.1		668.2
Total finance lease liabilities		712.6		693.6
Total lease liabilities		$	1,009.5	$	980.1

The following table presents the components of the Company's lease expense and their classification in the condensed consolidated statements of operations (in millions):


	Six Months Ended June 30,
	2024		2023

Operating lease costs	$	32.3	$	33.2
Finance lease costs:
Amortization of leased assets	23.6		18.3
Interest on lease liabilities	26.7		23.8
Total finance lease costs	50.3		42.1
Variable and short-term lease costs	11.8		10.4
Total lease costs	$	94.4	$	85.7

The following table presents supplemental cash flow information (in millions):


	Six Months Ended June 30,
	2024		2023

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases	$	31.3	$	32.2
Operating cash outflows from finance leases	$	25.4	$	22.6
Financing cash outflows from finance leases	$	15.4	$	12.6

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	38.0	$	15.1
Finance leases	$	21.2	$	23.6

Leases

The following table presents the components of the Company's right-of-use assets and liabilities related to leases and their classification in the condensed consolidated balance sheets (in millions):


	Classification in Condensed Consolidated Balance Sheets	June 30, 2024		December 31, 2023

Assets:
Operating lease assets	Right-of-use operating lease assets	$	266.9	$	255.3
Finance lease assets	Property and equipment, net of accumulated depreciation	594.6		587.0
Total leased assets		$	861.5	$	842.3

Liabilities:
Operating lease liabilities:
Current	Other current liabilities	$	39.3	$	37.6
Long-term	Right-of-use operating lease liabilities	257.6		248.9
Total operating lease liabilities		296.9		286.5
Finance lease liabilities:
Current	Current maturities of long-term debt	28.5		25.4
Long-term	Long-term debt, less current maturities	684.1		668.2
Total finance lease liabilities		712.6		693.6
Total lease liabilities		$	1,009.5	$	980.1

The following table presents the components of the Company's lease expense and their classification in the condensed consolidated statements of operations (in millions):


	Six Months Ended June 30,
	2024		2023

Operating lease costs	$	32.3	$	33.2
Finance lease costs:
Amortization of leased assets	23.6		18.3
Interest on lease liabilities	26.7		23.8
Total finance lease costs	50.3		42.1
Variable and short-term lease costs	11.8		10.4
Total lease costs	$	94.4	$	85.7

The following table presents supplemental cash flow information (in millions):


	Six Months Ended June 30,
	2024		2023

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases	$	31.3	$	32.2
Operating cash outflows from finance leases	$	25.4	$	22.6
Financing cash outflows from finance leases	$	15.4	$	12.6

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	38.0	$	15.1
Finance leases	$	21.2	$	23.6

Segment Reporting - Narrative (Details)	6 Months Ended
Segment Reporting - Narrative (Details)	Jun. 30, 2024 segment
Segment Reporting [Abstract]
Number of operating segments	2

Earnings Per Share

6 Months Ended

Jun. 30, 2024

Earnings Per Share [Abstract]

Earnings Per Share

Basic and diluted earnings (loss) per share are calculated based on the weighted-average number of shares outstanding in each period and dilutive stock options, unvested shares and warrants, to the extent such securities exist and have a dilutive effect on earnings per share. A reconciliation of the numerator and denominator of basic and diluted earnings per share follows (dollars in millions, except per share amounts; shares in thousands):


	Three Months Ended June 30,				Six Months Ended June 30,
	2024		2023		2024		2023

Numerator:
Net (loss) income attributable to Surgery Partners, Inc.	$	(15.5)	$	18.9	$	(27.9)	$	(6.0)



Denominator:
Weighted average common shares outstanding:
Basic	126,134		125,718		126,053		125,463
Diluted (1)	126,134		127,370		126,053		125,463

Net loss per share attributable to common stockholders:
Basic	$	(0.12)	$	0.15	$	(0.22)	$	(0.05)
Diluted (1)	$	(0.12)	$	0.15	$	(0.22)	$	(0.05)

Dilutive securities outstanding not included in the computation of diluted loss per share as their effect is antidilutive:
Stock options	1,052		—		1,152		1,407
Restricted shares	110		—		154		147

(1)The impact of potentially dilutive securities for the three months ended June 30, 2024 and the six months ended June 30, 2024 and 2023 was not considered because the effect would be anti-dilutive.

Cover - shares	6 Months Ended
Cover - shares	Jun. 30, 2024	Jul. 30, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2024
Document Transition Report	false
Entity File Number	001-37576
Entity Registrant Name	Surgery Partners, Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	47-3620923
Entity Address, Address Line One	340 Seven Springs Way, Suite 600
Entity Address, City or Town	Brentwood
Entity Address, State or Province	TN
Entity Address, Postal Zip Code	37027
City Area Code	615
Local Phone Number	234-5900
Title of 12(b) Security	Common Stock, par value $0.01 per share
Trading Symbol	SGRY
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		127,123,940
Entity Central Index Key	0001638833
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q2
Amendment Flag	false
Current Fiscal Year End Date	--12-31

Earnings Per Share - Schedule of Reconciliation of Numerator and Denominator of Basic and Diluted Earnings per Share (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Millions

3 Months Ended

6 Months Ended

Jun. 30, 2024

Jun. 30, 2023

Jun. 30, 2024

Jun. 30, 2023

Numerator:

Net (loss) income attributable to Surgery Partners, Inc.

$ (15.5)

$ 18.9

$ (27.9)

$ (6.0)

Weighted average common shares outstanding:

Basic (shares)

126,134

125,718

126,053

125,463

Diluted (shares)

^[1]

126,134

127,370

126,053

125,463

Net loss per share attributable to common stockholders:

Basic (in USD per share)

$ (0.12)

$ 0.15

$ (0.22)

$ (0.05)

Diluted (in USD per share)

^[1]

$ (0.12)

$ 0.15

$ (0.22)

$ (0.05)

Stock options

Net loss per share attributable to common stockholders:

Dilutive securities outstanding not included in the computation of diluted loss per share as their effect is antidilutive (shares)

1,052

1,152

1,407

Restricted shares

Net loss per share attributable to common stockholders:

Dilutive securities outstanding not included in the computation of diluted loss per share as their effect is antidilutive (shares)

110

154

147

[1]	The impact of potentially dilutive securities for the three months ended June 30, 2024 and the six months ended June 30, 2024 and 2023 was not considered because the effect would be anti-dilutive.

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Statement of Comprehensive Income [Abstract]
Net income	$ 28.4	$ 57.7	$ 52.7	$ 58.9
Other comprehensive (loss) income, net of tax:
Derivative activity, net of tax of $0	(14.9)	13.9	(20.4)	2.6
Comprehensive income	13.5	71.6	32.3	61.5
Less: Comprehensive loss attributable to non-controlling interests	(43.9)	(38.8)	(80.6)	(64.9)
Comprehensive (loss) income attributable to Surgery Partners, Inc.	$ (30.4)	$ 32.8	$ (48.3)	$ (3.4)

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income and other comprehensive income, attributable to parent entity. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income (loss) and other comprehensive income (loss), attributable to noncontrolling interests. Excludes changes in equity resulting from investments by owners and distributions to owners.

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- Definition

Amount after tax of increase (decrease) in equity from transactions and other events and circumstances from net income and other comprehensive income. Excludes changes in equity resulting from investments by owners and distributions to owners.

+ References + Details

- Definition

The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest.

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+ Details

Other Current Liabilities (Tables)

6 Months Ended

Jun. 30, 2024

Other Liabilities Disclosure [Abstract]

Schedule of Other Current Liabilities

A summary of other current liabilities was as follows (in millions):


	June 30, 2024		December 31, 2023

Right-of-use operating lease liabilities	$	39.3	$	37.6
Cost report liabilities	21.3		23.9
Amounts due to patients and payors	30.0		23.9
Interest payable	16.7		17.8
Interest rate swaps	10.7		—
Accrued expenses and other	104.3		100.9
Total	$	222.3	$	204.1

Insider Trading Arrangements	3 Months Ended
Insider Trading Arrangements	Jun. 30, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Organization and Summary of Accounting Policies - Revenues by Sources (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Disaggregation of Revenue [Line Items]
Total revenues	$ 762.1	$ 667.6	$ 1,479.5	$ 1,333.8
Total patient service revenues
Disaggregation of Revenue [Line Items]
Total revenues	$ 748.1	$ 658.0	$ 1,453.4	$ 1,314.4
Total patient service revenues \| Customer \| Revenue
Disaggregation of Revenue [Line Items]
Revenue by service type as a proportion of total revenues (percent)	100.00%	100.00%	100.00%	100.00%
Private insurance
Disaggregation of Revenue [Line Items]
Total revenues	$ 398.0	$ 341.6	$ 759.0	$ 677.2
Private insurance \| Customer \| Revenue
Disaggregation of Revenue [Line Items]
Revenue by service type as a proportion of total revenues (percent)	53.20%	51.90%	52.20%	51.50%
Government
Disaggregation of Revenue [Line Items]
Total revenues	$ 310.1	$ 278.2	$ 613.7	$ 566.0
Government \| Customer \| Revenue
Disaggregation of Revenue [Line Items]
Revenue by service type as a proportion of total revenues (percent)	41.50%	42.30%	42.20%	43.10%
Self-pay
Disaggregation of Revenue [Line Items]
Total revenues	$ 20.7	$ 17.1	$ 40.5	$ 32.7
Self-pay \| Customer \| Revenue
Disaggregation of Revenue [Line Items]
Revenue by service type as a proportion of total revenues (percent)	2.80%	2.60%	2.80%	2.50%
Other
Disaggregation of Revenue [Line Items]
Total revenues	$ 19.3	$ 21.1	$ 40.2	$ 38.5
Other \| Customer \| Revenue
Disaggregation of Revenue [Line Items]
Revenue by service type as a proportion of total revenues (percent)	2.50%	3.20%	2.80%	2.90%
Other service revenues
Disaggregation of Revenue [Line Items]
Total revenues	$ 14.0	$ 9.6	$ 26.1	$ 19.4

Segment Reporting (Tables)

6 Months Ended

Jun. 30, 2024

Segment Reporting [Abstract]

Schedule of Segment Revenue and Operating Income

The following tables present financial information for each reportable segment (in millions):


	Three Months Ended June 30,				Six Months Ended June 30,
	2024		2023		2024		2023
Revenues:
Surgical Facility Services	$	730.4	$	650.2	$	1,423.1	$	1,299.2
Ancillary Services	31.7		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 Services	0.1		(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, net	51.5		47.7		98.8		94.5
Depreciation and amortization	34.8		24.4		68.5		58.1
Equity-based compensation expense	15.1		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 deconsolidations	5.3		(8.8)		6.8		1.7
Litigation settlements and regulatory change impact (2)	1.1		1.7		(0.1)		9.7
Loss on debt extinguishment	5.1		—		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.

Schedule of Reconciliation of Assets from Segment to Consolidated


	June 30, 2024		December 31, 2023
Assets:
Surgical Facility Services	$	6,874.7	$	6,347.4
Ancillary Services	68.1		36.3
All other	545.8		493.0
Total assets	$	7,488.6	$	6,876.7

Schedule of Financial Information by Reportable Segment


	Six Months Ended June 30,
	2024		2023
Cash purchases of property and equipment:
Surgical Facility Services	$	39.1	$	49.5
Ancillary Services	1.3		0.6
All other	7.5		—
Total cash purchases of property and equipment	$	47.9	$	50.1

Acquisitions, Disposals and Deconsolidations - Disposals and Deconsolidations (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2024 USD ($) surgical_facility	Jun. 30, 2023 USD ($) surgical_facility
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sales of equity investments	$ 4,000	$ 0
Proceeds from disposals of facilities and other assets	$ 1,500	$ 26,100
Surgical Facility, Equity Method Investment \| Disposed of by Sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of interests sold \| surgical_facility	1
Proceeds from sales of equity investments	$ 2,000
Loss on sale of equity method investment	$ 3,700
Surgical Facility \| Disposed of by Sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of interests sold \| surgical_facility	1
Proceeds from disposals of facilities and other assets	$ 2,500
Pre-tax gain (loss) on disposal	$ 2,700
2023 Disposals \| Disposed of by Sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Number of interests sold \| surgical_facility		4
Proceeds from disposals of facilities and other assets		$ 30,400
Pre-tax gain (loss) on disposal		26,700
Surgical Facilities and In-Development De Novo Surgical Facilities \| Disposed of by Sale
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]
Proceeds from sales of equity investments		1,500
Loss on sale of equity method investment		$ 13,700

Long-Term Debt - Narrative (Details) - USD ($) $ in Millions		3 Months Ended		6 Months Ended
	Jun. 20, 2024	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023	Apr. 10, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Debt issuance costs and discount		$ 35.0		$ 35.0			$ 27.1
Loss on debt extinguishment		$ 5.1	$ 0.0	$ 5.1	$ 0.0
7.250% senior unsecured notes due 2032 \| Senior Notes
Debt Instrument [Line Items]
Original balance of debt						$ 800.0
Stated interest rate		7.25%		7.25%		7.25%
6.750% senior unsecured notes due 2025 \| Senior Notes
Debt Instrument [Line Items]
Stated interest rate						6.75%	6.75%
10.000% senior unsecured notes due 2027 \| Senior Notes
Debt Instrument [Line Items]
Stated interest rate						10.00%	10.00%
2024 Refinancing Term Loans \| Secured Debt
Debt Instrument [Line Items]
Original balance of debt	$ 1,400.0
Loan amortization rate	0.25%
Debt instrument, call premium percentage	1.00%
Debt issuance costs and discount	$ 2.4
2024 Refinancing Term Loans \| Secured Debt \| Term Rate Based Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	2.75%
2024 Refinancing Term Loans \| Secured Debt \| Federal Funds Effective Swap Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	0.50%
2024 Refinancing Term Loans \| Secured Debt \| SOFR
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	1.00%
Debt instrument, basis spread on variable rate, floor	1.00%
2024 Refinancing Term Loans \| Secured Debt \| Base Rate
Debt Instrument [Line Items]
Debt instrument, basis spread on variable rate	1.75%
Revolving Credit Facility \| Senior secured revolving credit facility \| Secured Debt
Debt Instrument [Line Items]
Outstanding balance on debt		$ 703.8		$ 703.8
Revolving Credit Facility \| Credit Facility \| Secured Debt
Debt Instrument [Line Items]
Outstanding balance on debt		647.8		647.8
Letter of Credit \| Credit Facility \| Secured Debt
Debt Instrument [Line Items]
Outstanding letters of credit		$ 10.0		$ 10.0

Organization and Summary of Accounting Policies - Schedule of Rollforward of Goodwill (Details) $ in Millions	6 Months Ended
	Jun. 30, 2024 USD ($)
Goodwill [Roll Forward]
Goodwill, beginning of period	$ 4,326.0
Acquisitions, including post acquisition adjustments	486.3
Disposals	(6.0)
Goodwill, end of period	$ 4,806.3

- Definition

Amount, after accumulated impairment loss, of asset representing future economic benefit arising from other asset acquired in business combination or from joint venture formation or both, that is not individually identified and separately recognized.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 49
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482785/280-10-55-49

Reference 2: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482548/350-20-55-24

Reference 3: http://www.xbrl.org/2003/role/exampleRef
-Topic 820
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 100
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482078/820-10-55-100

Reference 4: http://www.xbrl.org/2003/role/exampleRef
-Topic 852
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 10
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147481372/852-10-55-10

Reference 5: http://www.xbrl.org/2003/role/disclosureRef
-Topic 210
-SubTopic 10
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02(15))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147480566/210-10-S99-1

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 45
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482598/350-20-45-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2003/role/disclosureRef
-Topic 942
-SubTopic 210
-Name Accounting Standards Codification
-Section S99
-Paragraph 1
-Subparagraph (SX 210.9-03(10)(1))
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147478546/942-210-S99-1

+ Details

Commitments and Contingencies	6 Months Ended
Commitments and Contingencies	Jun. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Professional, General and Workers' Compensation, and Cyber Liability Risks The Company is subject to claims and legal actions in the ordinary course of business, including claims relating to patient treatment, employment practices and personal injuries. The Company maintains professional, general and workers' compensation and cyber liability insurance in excess of self-insured retentions, through third party commercial insurance carriers. Although management believes the coverage is sufficient for the Company's operations, some claims may potentially exceed the scope of coverage in effect. Plaintiffs in these matters may request punitive or other damages that may not be covered by insurance. The Company is not aware of any such proceedings that are reasonably possible to have a material adverse effect on the Company's business, financial position, results of operations or liquidity. Total professional, general and workers' compensation claim liabilities as of June 30, 2024 and December 31, 2023 were $18.3 million and $18.2 million, respectively. Expected insurance recoveries of $10.2 million as of both June 30, 2024 and December 31, 2023 are included as a component of other current assets and other long-term assets in the condensed consolidated balance sheets.

Leases (Tables)

6 Months Ended

Jun. 30, 2024

Leases [Abstract]

Schedule of Components of Right-of-use Assets and Liabilities Related to Leases

The following table presents the components of the Company's right-of-use assets and liabilities related to leases and their classification in the condensed consolidated balance sheets (in millions):


	Classification in Condensed Consolidated Balance Sheets	June 30, 2024		December 31, 2023

Assets:
Operating lease assets	Right-of-use operating lease assets	$	266.9	$	255.3
Finance lease assets	Property and equipment, net of accumulated depreciation	594.6		587.0
Total leased assets		$	861.5	$	842.3

Liabilities:
Operating lease liabilities:
Current	Other current liabilities	$	39.3	$	37.6
Long-term	Right-of-use operating lease liabilities	257.6		248.9
Total operating lease liabilities		296.9		286.5
Finance lease liabilities:
Current	Current maturities of long-term debt	28.5		25.4
Long-term	Long-term debt, less current maturities	684.1		668.2
Total finance lease liabilities		712.6		693.6
Total lease liabilities		$	1,009.5	$	980.1

Schedule of Lease Expense and Cash Flow Information

The following table presents the components of the Company's lease expense and their classification in the condensed consolidated statements of operations (in millions):


	Six Months Ended June 30,
	2024		2023

Operating lease costs	$	32.3	$	33.2
Finance lease costs:
Amortization of leased assets	23.6		18.3
Interest on lease liabilities	26.7		23.8
Total finance lease costs	50.3		42.1
Variable and short-term lease costs	11.8		10.4
Total lease costs	$	94.4	$	85.7

The following table presents supplemental cash flow information (in millions):


	Six Months Ended June 30,
	2024		2023

Cash paid for amounts included in the measurement of lease liabilities:
Operating cash outflows from operating leases	$	31.3	$	32.2
Operating cash outflows from finance leases	$	25.4	$	22.6
Financing cash outflows from finance leases	$	15.4	$	12.6

Right-of-use assets obtained in exchange for lease obligations:
Operating leases	$	38.0	$	15.1
Finance leases	$	21.2	$	23.6

Derivatives and Hedging Activities - Schedule of Derivative Instruments in Statement of Financial Position, Fair Value (Details) - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items]
Derivative asset, notional amount	$ 40.3	$ 57.4
Derivative liability, notional amount	14.1	17.8
Derivatives in cash flow hedging relationships \| Interest rate caps
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items]
Derivative asset, notional amount	4.2	6.0
Derivative liability, notional amount	3.4	0.0
Derivatives in cash flow hedging relationships \| Interest rate swaps
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items]
Derivative asset, notional amount	36.1	51.4
Derivative liability, notional amount	$ 10.7	$ 17.8

- Definition

Nominal or face amount used to calculate payments on the derivative asset.

+ References + Details

- Definition

Nominal or face amount used to calculate payments on the derivative liability.

+ References + Details

Derivatives and Hedging Activities (Tables)

6 Months Ended

Jun. 30, 2024

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Schedule of Interest Rate Swaps and Interest Rate Caps Outstanding

The key terms of interest rate swaps and interest rate caps outstanding are presented below:

June 30, 2024

December 31, 2023

Description

Effective Date

Notional Amount (in millions)

Status

Notional Amount (in millions)

Status

Maturity Date

Pay-fixed swap

May 7, 2021

435.0

Active

435.0

Active

March 31, 2025

Pay-fixed swap

May 7, 2021

330.0

Active

330.0

Active

March 31, 2025

Pay-fixed swap

May 7, 2021

435.0

Active

435.0

Active

March 31, 2025

Interest rate cap

September 30, 2021

147.5

Active

151.4

Active

March 31, 2025

Interest rate cap

September 30, 2021

8.4

Active

8.7

Active

March 31, 2025

Deferred premium cap

March 31, 2025

396.0

Active

—

N/A

December 31, 2028

Deferred premium cap

March 31, 2025

198.0

Active

—

N/A

December 31, 2028

Deferred premium cap

March 31, 2025

396.0

Active

—

N/A

December 31, 2028

Deferred premium cap

March 31, 2025

198.0

Active

—

N/A

December 31, 2028

Deferred premium cap

March 31, 2025

198.0

Active

—

N/A

December 31, 2028

2,741.9

1,360.1

Schedule of Derivative Instruments in Statement of Financial Position, Fair Value

The following table presents the fair values of our derivatives and their location on the condensed consolidated balance sheets (in millions):


	June 30, 2024				December 31, 2023
	Assets		Liabilities		Assets		Liabilities





Derivatives in cash flow hedging relationships
Interest rate caps (1)	$	4.2	$	—	$	6.0	$	—
Interest rate swaps (1)	36.1		—		51.4		—
Interest rate caps	—		3.4		—		—
Interest rate swaps (2) (3)	—		10.7		—		17.8
Total	$	40.3	$	14.1	$	57.4	$	17.8

(1)Amounts were included in other current assets and other long-term assets on the condensed consolidated balance sheets as of June 30, 2024 and December 31, 2023, respectively.

(2)Amounts related to the financing component of the pay-fixed interest rate swaps.

(3)Amounts were included in other current liabilities and other long-term liabilities on the condensed consolidated balance sheets as of June 30, 2024 and December 31, 2023, respectively.

Schedule of Effect of Interest Rate Swaps

The following table presents the pre-tax effect of the interest rate swaps and caps on the Company's accumulated OCI and condensed consolidated statements of operations (in millions):


		Three Months Ended June 30,				Six Months Ended June 30,
	Location	2024		2023		2024		2023
Derivatives not designated as hedging instruments
Loss recognized in income	Other income, net	$	—	$	—	$	—	$	0.6


Derivatives in cash flow hedging relationships
Gain (loss) recognized in OCI (effective portion)		$	(0.1)	$	21.9	$	9.1	$	16.7
Gain reclassified from accumulated OCI into income (effective portion) (1)	Interest expense, net	$	(14.8)	$	(8.0)	$	(29.5)	$	(14.1)

(1)Includes amortization of accumulated OCI related to de-designated and terminated interest rate swaps of $5.3 million and $10.7 million for the three and six months ended June 30, 2023, respectively. There were no corresponding amounts for the three and six months ended June 30, 2024.

- Definition

Tabular disclosure of pertinent information about a derivative or group of derivatives on a disaggregated basis, such as for individual instruments, or small groups of similar instruments. May include a combination of the type of instrument, risks being hedged, notional amount, hedge designation, related hedged item, inception date, maturity date, or other relevant item.

+ References + Details

Long-Term Debt - Schedule of Long-Term Debt (Details) - USD ($) $ in Millions	Jun. 30, 2024	Apr. 10, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Finance lease obligations	$ 712.6		$ 693.6
Less: unamortized debt issuance costs and discounts	(35.0)		(27.1)
Total debt	3,132.1		2,775.1
Less: current maturities	92.4		73.3
Total long-term debt	3,039.7		2,701.8
Secured Debt \| Senior secured term loan
Debt Instrument [Line Items]
Long-term debt	1,398.5		1,398.4
Unamortized fair value discount	1.5		1.6
Secured Debt \| Senior secured revolving credit facility
Debt Instrument [Line Items]
Long-term debt	46.0		0.0
Senior Notes \| 6.750% senior unsecured notes due 2025
Debt Instrument [Line Items]
Long-term debt	0.0		$ 185.0
Stated interest rate		6.75%	6.75%
Senior Notes \| 10.000% senior unsecured notes due 2027
Debt Instrument [Line Items]
Long-term debt	0.0		$ 320.0
Stated interest rate		10.00%	10.00%
Senior Notes \| 7.250% senior unsecured notes due 2032
Debt Instrument [Line Items]
Long-term debt	$ 800.0		$ 0.0
Stated interest rate	7.25%	7.25%
Notes payable and other secured loans
Debt Instrument [Line Items]
Long-term debt	$ 210.0		$ 205.2

Derivatives and Hedging Activities

6 Months Ended

Jun. 30, 2024

Derivative Instruments and Hedging Activities Disclosure [Abstract]

Derivatives and Hedging Activities

The Company’s objectives in using interest rate derivatives are to add stability to interest expense and to manage its exposure to interest rate movements. To accomplish this objective, the Company primarily uses interest rate swaps and interest rate caps as part of its interest rate risk management strategy. During 2024 and 2023, such derivatives have been used to hedge the variable cash flows associated with existing variable-rate debt.

The key terms of interest rate swaps and interest rate caps outstanding are presented below:

June 30, 2024

December 31, 2023

Description

Effective Date

Notional Amount (in millions)

Status

Notional Amount (in millions)

Status

Maturity Date

Pay-fixed swap

May 7, 2021

435.0

Active

435.0

Active

March 31, 2025

Pay-fixed swap

May 7, 2021

330.0

Active

330.0

Active

March 31, 2025

Pay-fixed swap

May 7, 2021

435.0

Active

435.0

Active

March 31, 2025

Interest rate cap

September 30, 2021

147.5

Active

151.4

Active

March 31, 2025

Interest rate cap

September 30, 2021

8.4

Active

8.7

Active

March 31, 2025

Deferred premium cap

March 31, 2025

396.0

Active

—

N/A

December 31, 2028

Deferred premium cap

March 31, 2025

198.0

Active

—

N/A

December 31, 2028

Deferred premium cap

March 31, 2025

396.0

Active

—

N/A

December 31, 2028

Deferred premium cap

March 31, 2025

198.0

Active

—

N/A

December 31, 2028

Deferred premium cap

March 31, 2025

198.0

Active

—

N/A

December 31, 2028

2,741.9

1,360.1

As of June 30, 2024, the Company had three interest rate swaps with a total net notional amount of $1.2 billion. The interest rate swaps are pay-fixed, receive 1-Month Secured Overnight Financing Rate ("SOFR") (subject to a minimum of 0.75%) designated in cash flow hedging relationships and have a termination date of March 31, 2025.

As of June 30, 2024, the Company had two interest rate caps designated in cash flow hedging relationships with a total notional amount of $155.9 million. The interest rate caps each have a termination date of March 31, 2025. During the six months ended June 30, 2023, the Company partially terminated a previously undesignated portion of one of its interest rate caps. In connection with the termination, the Company received $8.6 million, which is included as a component of operating activities in the condensed consolidated statements of cash flows for the six months ended June 30, 2023.

On April 9, 2024, the Company entered into five deferred premium interest rate cap agreements, each with an effective date of March 31, 2025. The interest rate caps are designated in cash flow hedging relationships with a total notional amount of $1.4 billion. The deferred premium interest rate caps each have a termination date of December 31, 2028. These financial instruments are designed to limit the Company's interest rate exposure on its term loan concurrent with the expected maturity of positions held as of June 30, 2024. As of June 30, 2024, the Company's deferred premium interest rate caps had a total notional amount of $1.4 billion.

The pay-fixed, receive floating interest rate swaps did not meet the requirements to be considered derivatives in their entirety as a result of the financing component. Accordingly, the swaps are considered hybrid instruments, consisting of a financing element treated as a debt instrument and an embedded at-market derivative that was designated as a cash flow hedge.

Within the Company’s condensed consolidated balance sheets, the financing elements treated as debt instruments described above are carried at amortized cost and the embedded at-market derivatives are recorded at fair value. The cash flows related to the portion treated as debt are classified as financing activities in the condensed consolidated statements of cash flows while the portion treated as an at-market derivative are classified as operating activities. Within the Company’s condensed consolidated balance sheets, the interest rate caps are recorded at fair value. The cash flows related to the interest rate caps are classified as operating activities in the condensed consolidated statements of cash flows.

The Company's interest rate swap agreements, excluding the portion treated as debt, are recognized at fair value in the condensed consolidated balance sheets and are valued using pricing models that rely on market observable inputs such as yield curve data, which are classified as Level 2 inputs within the fair value hierarchy. The fair value of the interest rate caps is determined using the market standard methodology of discounting the future expected cash receipts that would occur if variable interest rates rise above the strike rate of the caps. The variable interest rates used in the calculation of projected receipts on the caps are based on an expectation of future interest rates derived from observable market interest rate curves and volatilities. The interest rate caps are classified using Level 2 inputs within the fair value hierarchy.

For derivatives designated and that qualify as cash flow hedges of interest rate risk, the gain or loss on the derivative is recorded in accumulated other comprehensive income ("OCI") and subsequently reclassified into interest expense in the same period(s) during which the hedged transaction affects earnings, as documented at hedge inception in accordance with the Company’s accounting policy election. Amounts reported in accumulated OCI related to derivatives will be reclassified to interest expense as interest payments are made on the Company’s variable-rate debt. Over the next 12 months, the Company estimates that an additional $39.1 million will be reclassified as a decrease to interest expense.

The following table presents the fair values of our derivatives and their location on the condensed consolidated balance sheets (in millions):


	June 30, 2024				December 31, 2023
	Assets		Liabilities		Assets		Liabilities





Derivatives in cash flow hedging relationships
Interest rate caps (1)	$	4.2	$	—	$	6.0	$	—
Interest rate swaps (1)	36.1		—		51.4		—
Interest rate caps	—		3.4		—		—
Interest rate swaps (2) (3)	—		10.7		—		17.8
Total	$	40.3	$	14.1	$	57.4	$	17.8

(1)Amounts were included in other current assets and other long-term assets on the condensed consolidated balance sheets as of June 30, 2024 and December 31, 2023, respectively.

(2)Amounts related to the financing component of the pay-fixed interest rate swaps.

(3)Amounts were included in other current liabilities and other long-term liabilities on the condensed consolidated balance sheets as of June 30, 2024 and December 31, 2023, respectively.

The following table presents the pre-tax effect of the interest rate swaps and caps on the Company's accumulated OCI and condensed consolidated statements of operations (in millions):


		Three Months Ended June 30,				Six Months Ended June 30,
	Location	2024		2023		2024		2023
Derivatives not designated as hedging instruments
Loss recognized in income	Other income, net	$	—	$	—	$	—	$	0.6


Derivatives in cash flow hedging relationships
Gain (loss) recognized in OCI (effective portion)		$	(0.1)	$	21.9	$	9.1	$	16.7
Gain reclassified from accumulated OCI into income (effective portion) (1)	Interest expense, net	$	(14.8)	$	(8.0)	$	(29.5)	$	(14.1)

Acquisitions, Disposals and Deconsolidations - Acquisitions (Details) $ in Millions	6 Months Ended
	Jun. 30, 2024 USD ($) surgical_facility	Jun. 30, 2023 USD ($)	Jun. 30, 2023 USD ($) facility	Jun. 30, 2023 USD ($) physician_practice	Jun. 30, 2023 USD ($) surgical_facility	Jun. 30, 2023 USD ($) de_novo_surgical_facility	Dec. 31, 2023 USD ($)
Business Acquisition [Line Items]
Total cash consideration, net of cash acquired	$ 264.6	$ 43.5
Goodwill	$ 4,806.3						$ 4,326.0
Equity Method Investments
Business Acquisition [Line Items]
Number of non-controlling interests in in-development de novo surgical facilities acquired					4	2
Surgical Facilities and Anesthesia Practice
Business Acquisition [Line Items]
Number of business entities acquired \| surgical_facility	6
Total cash consideration, net of cash acquired	$ 264.6
Noncash consideration	1.1
Recognized non-controlling interests	290.7
Goodwill	483.0
Investments and advances to affiliates	$ 44.6
Surgical Facilities and Physician Practices
Business Acquisition [Line Items]
Number of business entities acquired			1	1
Total cash consideration, net of cash acquired		17.9
Noncash consideration		1.3
Recognized non-controlling interests		12.0	$ 12.0	$ 12.0	$ 12.0	$ 12.0
Goodwill		27.4	$ 27.4	27.4	27.4	27.4
Two Surgical Facilities
Business Acquisition [Line Items]
Number of business entities acquired \| facility			2
Total cash consideration, net of cash acquired		26.9
Recognized non-controlling interests		55.2	$ 55.2	55.2	55.2	55.2
Goodwill		106.3	106.3	106.3	106.3	106.3
Non-controlling interest, fair value		27.3
Net loss on fair value of non-controlling interest		7.1
Surgical Facilities and In-Development De Novo Surgical Facilities
Business Acquisition [Line Items]
Total cash consideration, net of cash acquired		48.4
Surgical Facilities and In-Development De Novo Surgical Facilities \| Management Rights Agreement
Business Acquisition [Line Items]
Intangible assets acquired		$ 20.0	$ 20.0	$ 20.0	$ 20.0	$ 20.0
Surgical Facilities and In-Development De Novo Surgical Facilities \| Equity Method Investments \| Management Rights Agreement
Business Acquisition [Line Items]
Number of non-controlling interests in surgical facilities acquired \| facility			3

Organization and Summary of Accounting Policies - Variable Interest Entities (Details) $ in Millions	Jun. 30, 2024 USD ($)	Jun. 30, 2024 facility	Jun. 30, 2024 physician_practice	Jun. 30, 2024 anesthesia_practice	Dec. 31, 2023 USD ($)
Variable Interest Entity [Line Items]
Number of facilities included in VIE		9	18	1
Assets	$ 7,488.6				$ 6,876.7
Variable Interest Entity, Primary Beneficiary
Variable Interest Entity [Line Items]
Assets	71.9				65.3
Liabilities	$ 43.0				$ 41.2

- Definition

Amount of asset recognized for present right to economic benefit.

+ 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/exampleRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 55
-Paragraph 49
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482785/280-10-55-49

Reference 3: http://www.xbrl.org/2003/role/disclosureRef
-Topic 270
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (i)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482964/270-10-50-1

Reference 4: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
-Section 50
-Paragraph 32
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 5: http://fasb.org/us-gaap/role/ref/otherTransitionRef
-Topic 280
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-Name Accounting Standards Codification
-Section 50
-Paragraph 32
-Subparagraph (d)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482810/280-10-50-32

Reference 6: http://www.xbrl.org/2003/role/disclosureRef
-Topic 280
-SubTopic 10
-Name Accounting Standards Codification
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+ Details

- Definition

Line items represent financial concepts included in a table. These concepts are used to disclose reportable information associated with domain members defined in one or many axes to the table.

+ References + Details

Other Current Liabilities (Details) - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Other Liabilities Disclosure [Abstract]
Right-of-use operating lease liabilities	$ 39.3	$ 37.6
Cost report liabilities	21.3	23.9
Amounts due to patients and payors	30.0	23.9
Interest payable	16.7	17.8
Interest rate swaps	10.7	0.0
Accrued expenses and other	104.3	100.9
Total	$ 222.3	$ 204.1

CONDENSED CONSOLIDATED BALANCE SHEETS (Parenthetical) - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Accumulated depreciation on property and equipment	$ 519.1	$ 454.4
Preferred stock, par value (in USD per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (shares)	20,310,000	20,310,000
Preferred stock, shares issued (shares)	0	0
Preferred stock, shares outstanding (shares)	0	0
Common stock, par value (in USD per share)	$ 0.01	$ 0.01
Common stock, shares authorized (shares)	300,000,000	300,000,000
Common stock, shares issued (shares)	127,123,940	126,593,727
Common stock, shares outstanding (shares)	127,123,940	126,593,727

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE INCOME (LOSS) (Parenthetical) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Statement of Comprehensive Income [Abstract]
Derivative activity, tax	$ 0.0	$ 0.0	$ 0.0	$ 0.0

Long-Term Debt

6 Months Ended

Jun. 30, 2024

Debt Disclosure [Abstract]

Long-Term Debt

A summary of long-term debt follows (in millions):


	June 30, 2024		December 31, 2023

Senior secured term loan (1)	$	1,398.5	$	1,398.4
Senior secured revolving credit facility	46.0		—
6.750% senior unsecured notes due 2025	—		185.0
10.000% senior unsecured notes due 2027	—		320.0
7.250% senior unsecured notes due 2032	800.0		—
Notes payable and other secured loans	210.0		205.2
Finance lease obligations	712.6		693.6
Less: unamortized debt issuance costs and discounts	(35.0)		(27.1)
Total debt	3,132.1		2,775.1
Less: current maturities	92.4		73.3
Total long-term debt	$	3,039.7	$	2,701.8

(1)Includes unamortized fair value discount of $1.5 million and $1.6 million as of June 30, 2024 and December 31, 2023, respectively.

Revolving Credit Facility

As of June 30, 2024, the Company's availability on its $703.8 million senior secured revolving credit facility (the "Revolver") was $647.8 million (including letters of credit of $10.0 million). The increase in outstanding borrowings on the Revolver, was primarily due to the timing of acquisitions completed during the first quarter of 2024.

7.250% Senior Unsecured Notes Due 2032

On April 10, 2024, the Company completed the issuance and sale of $800.0 million in aggregate principal amount of senior unsecured notes due 2032 (the "2032 Notes"). The 2032 Notes were issued pursuant to an Indenture dated April 10, 2024 by and among Surgery Center Holdings, Inc., certain subsidiaries of Surgery Center Holdings, Inc., as guarantors, and Wilmington Trust, National Association, as trustee. The 2032 Notes bear interest at an annual rate of 7.250% per year, payable semi-annually on April 15 and October 15 of each year, beginning on October 15, 2024. Proceeds from the sale of the 2032 Notes were used (i) to redeem all of the outstanding 6.750% senior unsecured notes due 2025 (the "2025 Notes") and the 10.000% senior unsecured notes due 2027 (the "2027 Notes," together with the 2025 Notes, the "Existing Notes"), (ii) to pay accrued interest on the Existing Notes through, but not including, April 25, 2024, (iii) to pay related fees and expenses in connection with the offering of the 2032 Notes and redemption of the Existing Notes and (iv) for general corporate purposes, including to fund future acquisitions.

First Amendment to Credit Agreement

On June 20, 2024, the Company entered into a first amendment (the "Amendment") to its credit agreement, dated as of December 19, 2023, by and among Surgery Center Holdings, Inc., the Borrower, Jefferies Finance LLC, as administrative agent and collateral agent, and the other financial institutions party thereto from time to time (the "Credit Agreement") to provide for a new tranche of term loans under the Credit Agreement in an aggregate principal amount of $1,400 million (the “2024 Refinancing Term Loans”), which 2024 Refinancing Term Loans replace or refinance in full all of the existing term loans outstanding under the Credit Agreement (as in effect immediately prior to the Amendment), all as further set forth in the Amendment. The 2024 Refinancing Term Loans mature on December 19, 2030. The 2024 Refinancing Term Loans shall bear interest at a rate per annum equal to (x) the forward-looking term rate based on Secured Overnight Financing Rate (“Term SOFR”) plus 2.75% per annum or (y) an alternate base rate (which will be the highest of (i) the prime rate plus 0.5% per annum above the federal funds effective rate and (ii) Term SOFR plus 1.00% per annum (which shall not be less than 1.00%)) plus 1.75% per annum. The 2024 Refinancing Term Loans amortize in equal quarterly installments of 0.25% of the aggregate original principal amount of the 2024 Refinancing Term Loans (such amortization payments will commence on or around the last business day of the fiscal quarter ending June 30, 2024). Voluntary prepayments of the 2024 Refinancing Term Loans are permitted, in whole or in part, with prior notice, without premium or penalty (except a 1.00% call premium in the case of certain repricing events occurring prior to the sixth month anniversary of the Amendment Effective Date).

In connection with the Amendment, the Company recorded debt issuance costs and discount of $2.4 million, and a debt extinguishment loss of $5.1 million which is included in loss on debt extinguishment in the accompanying condensed consolidated statement of operations for the three and six months ended June 30, 2024. The loss on debt extinguishment includes the partial write-off of unamortized debt issuance costs and discounts.

Earnings Per Share (Tables)

6 Months Ended

Jun. 30, 2024

Earnings Per Share [Abstract]

Schedule of Reconciliation of Numerator and Denominator of Basic and Diluted Earnings per Share

A reconciliation of the numerator and denominator of basic and diluted earnings per share follows (dollars in millions, except per share amounts; shares in thousands):


	Three Months Ended June 30,				Six Months Ended June 30,
	2024		2023		2024		2023

Numerator:
Net (loss) income attributable to Surgery Partners, Inc.	$	(15.5)	$	18.9	$	(27.9)	$	(6.0)



Denominator:
Weighted average common shares outstanding:
Basic	126,134		125,718		126,053		125,463
Diluted (1)	126,134		127,370		126,053		125,463

Net loss per share attributable to common stockholders:
Basic	$	(0.12)	$	0.15	$	(0.22)	$	(0.05)
Diluted (1)	$	(0.12)	$	0.15	$	(0.22)	$	(0.05)

Dilutive securities outstanding not included in the computation of diluted loss per share as their effect is antidilutive:
Stock options	1,052		—		1,152		1,407
Restricted shares	110		—		154		147

(1)The impact of potentially dilutive securities for the three months ended June 30, 2024 and the six months ended June 30, 2024 and 2023 was not considered because the effect would be anti-dilutive.

Organization and Summary of Accounting Policies - Non-Controlling Interests - Redeemable (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Non-Controlling Interests - Redeemable [Roll Forward]
Balance at beginning of period	$ 327.4	$ 342.0
Net income attributable to non-controlling interests—redeemable	15.8	19.0
Acquisition and disposal of shares of non-controlling interests, net—redeemable	120.3	(10.0)
Distributions to non-controlling interest —redeemable holders	(21.4)	(22.9)
Balance at end of period	$ 442.1	$ 328.1

Derivatives and Hedging Activities - Schedule of Interest Rate Swaps and Interest Rate Caps Outstanding (Details) - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	$ 2,741.9	$ 1,360.1
Pay-fixed swap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	435.0	435.0
Pay-fixed swap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	330.0	330.0
Pay-fixed swap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	435.0	435.0
Interest rate cap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	147.5	151.4
Interest rate cap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	8.4	8.7
Deferred premium cap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	396.0	0.0
Deferred premium cap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	198.0	0.0
Deferred premium cap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	396.0	0.0
Deferred premium cap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	198.0	0.0
Deferred premium cap
Reclassification Adjustment out of Accumulated Other Comprehensive Income [Line Items]
Current notional amount	$ 198.0	$ 0.0

Other Current Liabilities

6 Months Ended

Jun. 30, 2024

Other Liabilities Disclosure [Abstract]

Other Current Liabilities

A summary of other current liabilities was as follows (in millions):


	June 30, 2024		December 31, 2023

Right-of-use operating lease liabilities	$	39.3	$	37.6
Cost report liabilities	21.3		23.9
Amounts due to patients and payors	30.0		23.9
Interest payable	16.7		17.8
Interest rate swaps	10.7		—
Accrued expenses and other	104.3		100.9
Total	$	222.3	$	204.1

Organization and Summary of Accounting Policies (Tables)

6 Months Ended

Jun. 30, 2024

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Revenues

The following table presents a summary of revenues by service type as a percentage of total revenues:


	Three Months Ended June 30,				Six Months Ended June 30,
	2024		2023		2024		2023
Patient service revenues:
Surgical Facility Services	94.0	%	96.0	%	94.5	%	96.0	%
Ancillary Services	4.1	%	2.6	%	3.8	%	2.5	%
Total patient service revenues	98.1	%	98.6	%	98.3	%	98.5	%
Other service revenues	1.9	%	1.4	%	1.7	%	1.5	%
Total revenues	100.0	%	100.0	%	100.0	%	100.0	%


	Three Months Ended June 30,
	2024				2023
	Amount		%		Amount		%
Patient service revenues:
Private insurance	$	398.0	53.2	%	$	341.6	51.9	%
Government	310.1		41.5	%	278.2		42.3	%
Self-pay	20.7		2.8	%	17.1		2.6	%
Other (1)	19.3		2.5	%	21.1		3.2	%
Total patient service revenues	748.1		100.0	%	658.0		100.0	%
Other service revenues	14.0				9.6
Total revenues	$	762.1			$	667.6


	Six Months Ended June 30,
	2024				2023
	Amount		%		Amount		%
Patient service revenues:
Private insurance	$	759.0	52.2	%	$	677.2	51.5	%
Government	613.7		42.2	%	566.0		43.1	%
Self-pay	40.5		2.8	%	32.7		2.5	%
Other (1)	40.2		2.8	%	38.5		2.9	%
Total patient service revenues	1,453.4		100.0	%	1,314.4		100.0	%
Other service revenues	26.1				19.4
Total revenues	$	1,479.5			$	1,333.8

(1)Other is comprised of automobile liability, letters of protection and other payor types.

Schedule of Rollforward of Goodwill

A summary of activity related to goodwill for the six months ended June 30, 2024 is as follows (in millions):


Balance at December 31, 2023	$	4,326.0
Acquisitions, including post acquisition adjustments	486.3
Disposals	(6.0)
Balance at June 30, 2024	$	4,806.3

Schedule of Rollforward of Non-Controlling Interests - Redeemable

A summary of activity related to redeemable non-controlling interests is as follows (in millions):


	Six Months Ended June 30,
	2024		2023

Balance at beginning of period	$	327.4	$	342.0
Net income attributable to non-controlling interests—redeemable	15.8		19.0
Acquisition and disposal of shares of non-controlling interests, net—redeemable	120.3		(10.0)
Distributions to non-controlling interest —redeemable holders	(21.4)		(22.9)
Balance at end of period	$	442.1	$	328.1

Schedule of Carrying Amounts and Fair Values of Long-Term Debt

A summary of the carrying amounts and estimated fair values of the Company's long-term debt follows (in millions):


	Carrying Amount				Fair Value
	June 30, 2024		December 31, 2023		June 30, 2024		December 31, 2023

Senior secured term loan	$	1,398.5	$	1,398.4	$	1,402.0	$	1,401.9
6.750% senior unsecured notes due 2025	$	—	$	185.0	$	—	$	183.2
10.000% senior unsecured notes due 2027	$	—	$	320.0	$	—	$	321.2
7.250% senior unsecured notes due 2032	$	800.0	$	—	$	808.0	$	—

- Definition

Tabular disclosure of goodwill by reportable segment and in total which includes a rollforward schedule.

+ References

Reference 1: http://www.xbrl.org/2003/role/exampleRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 55
-Paragraph 24
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482548/350-20-55-24

Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (a)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (h)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 4: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 5: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 6: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (c)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 7: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
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-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 8: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (e)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 9: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (f)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 10: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1
-Subparagraph (g)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1

Reference 11: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 1A
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-1A

Reference 12: http://www.xbrl.org/2009/role/commonPracticeRef
-Topic 350
-SubTopic 20
-Name Accounting Standards Codification
-Section 50
-Paragraph 2
-Subparagraph (b)
-Publisher FASB
-URI https://asc.fasb.org/1943274/2147482573/350-20-50-2

+ Details

Segment Reporting - Assets and Cash Purchases of Property and Equipment by Operating Segment (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Dec. 31, 2023
Segment Reporting Information [Line Items]
Total assets	$ 7,488.6		$ 6,876.7
Total cash purchases of property and equipment	47.9	$ 50.1
Operating Segments \| Surgical Facility Services
Segment Reporting Information [Line Items]
Total assets	6,874.7		6,347.4
Total cash purchases of property and equipment	39.1	49.5
Operating Segments \| Ancillary Services
Segment Reporting Information [Line Items]
Total assets	68.1		36.3
Total cash purchases of property and equipment	1.3	0.6
All other
Segment Reporting Information [Line Items]
Total assets	545.8		$ 493.0
Total cash purchases of property and equipment	$ 7.5	$ 0.0

- Definition

Amount of asset recognized for present right to economic benefit.

+ References

+ Details

Organization and Summary of Accounting Policies - Income Taxes (Details) - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Effective tax rate	15.00%	19.00%
Tax expense (benefits) related to vesting of restricted stock awards	$ 0.6	$ (1.8)
Effective income tax rate reconciliation, disposition of business, amount		$ 15.9

Derivatives and Hedging Activities - Narrative (Details)	6 Months Ended
	Jun. 30, 2024 USD ($) interest_rate_swap	Jun. 30, 2023 USD ($)	Apr. 09, 2024 USD ($) interest_rate_swap	Dec. 31, 2023 USD ($)
Derivative [Line Items]
Current notional amount	$ 2,741,900,000			$ 1,360,100,000
Amount estimated to be reclassified as a reduction to interest expense over next 12 months	$ 39,100,000
Interest rate swaps
Derivative [Line Items]
Number of interest rate swaps held \| interest_rate_swap	3
Interest rate swaps \| Minimum
Derivative [Line Items]
Variable interest rate of derivative instrument (percent)	0.75%
Interest rate swaps \| Derivatives in cash flow hedging relationships
Derivative [Line Items]
Current notional amount	$ 1,200,000,000
Interest rate caps
Derivative [Line Items]
Number of interest rate swaps held \| interest_rate_swap	2
Current notional amount	$ 155,900,000
Interest rate caps \| Derivatives not designated as hedging instruments
Derivative [Line Items]
Gain on termination		$ 8,600,000
Deferred premium cap
Derivative [Line Items]
Number of interest rate swaps held \| interest_rate_swap			5
Current notional amount	$ 1,400,000,000		$ 1,400,000,000

Organization and Summary of Accounting Policies - Schedule of Revenues by Service Type (Details) - Revenue Source - Revenue	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Revenue from External Customer [Line Items]
Revenue by service type as a proportion of total revenues (percent)	100.00%	100.00%	100.00%	100.00%
Total patient service revenues
Revenue from External Customer [Line Items]
Revenue by service type as a proportion of total revenues (percent)	98.10%	98.60%	98.30%	98.50%
Surgical Facility Services
Revenue from External Customer [Line Items]
Revenue by service type as a proportion of total revenues (percent)	94.00%	96.00%	94.50%	96.00%
Ancillary Services
Revenue from External Customer [Line Items]
Revenue by service type as a proportion of total revenues (percent)	4.10%	2.60%	3.80%	2.50%
Other service revenues
Revenue from External Customer [Line Items]
Revenue by service type as a proportion of total revenues (percent)	1.90%	1.40%	1.70%	1.50%

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023
Cash flows from operating activities:
Net income	$ 52.7	$ 58.9
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization	68.5	58.1
Non-cash lease expense	18.7	17.9
Non-cash interest expense, net	3.1	13.1
Equity-based compensation expense	20.0	8.8
Net loss (gain) on disposals, consolidations and deconsolidations	6.8	1.7
Loss on debt extinguishment	5.1	0.0
Deferred income taxes	7.6	(11.5)
Equity in earnings of unconsolidated affiliates, net of distributions received	0.2	(0.8)
Changes in operating assets and liabilities, net of acquisitions and divestitures:
Accounts receivable	(12.1)	(5.1)
Medicare accelerated payments and deferred governmental grants	0.0	(1.2)
Other operating assets and liabilities	(47.1)	(13.3)
Net cash provided by operating activities	123.5	126.6
Cash flows from investing activities:
Purchases of property and equipment	(47.9)	(50.1)
Payments for acquisitions, net of cash acquired	(264.6)	(43.5)
Proceeds from disposals of facilities and other assets	1.5	26.1
Purchases of equity investments	(1.7)	(48.4)
Proceeds from sales of equity investments	4.0	0.0
Other investing activities	(18.5)	(26.0)
Net cash used in investing activities	(327.2)	(141.9)
Cash flows from financing activities:
Principal payments on long-term debt	(973.8)	(31.5)
Borrowings of long-term debt	1,295.4	26.5
Payments of debt issuance costs	(14.9)	(1.4)
Distributions to non-controlling interest holders	(80.7)	(76.9)
Proceeds related to ownership transactions with non-controlling interest holders	1.0	0.6
Other financing activities	(5.7)	(7.5)
Net cash provided by (used in) financing activities	221.3	(90.2)
Net increase (decrease) in cash and cash equivalents	17.6	(105.5)
Cash and cash equivalents at beginning of period	195.9	282.9
Cash and cash equivalents at end of period	$ 213.5	$ 177.4

Organization and Summary of Accounting Policies - Schedule of Carrying Amount and Fair Value of Long-Term Debt (Details) - USD ($) $ in Millions	Jun. 30, 2024	Apr. 10, 2024	Dec. 31, 2023
Secured Debt \| Senior secured term loan \| Carrying Amount
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt	$ 1,398.5		$ 1,398.4
Secured Debt \| Senior secured term loan \| Fair Value \| Fair Value, Inputs, Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt	1,402.0		$ 1,401.9
Senior Notes \| 6.750% senior unsecured notes due 2025
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Stated interest rate		6.75%	6.75%
Senior Notes \| 6.750% senior unsecured notes due 2025 \| Carrying Amount
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt	0.0		$ 185.0
Senior Notes \| 6.750% senior unsecured notes due 2025 \| Fair Value \| Fair Value, Inputs, Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt	0.0		$ 183.2
Senior Notes \| 10.000% senior unsecured notes due 2027
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Stated interest rate		10.00%	10.00%
Senior Notes \| 10.000% senior unsecured notes due 2027 \| Carrying Amount
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt	0.0		$ 320.0
Senior Notes \| 10.000% senior unsecured notes due 2027 \| Fair Value \| Fair Value, Inputs, Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt	$ 0.0		321.2
Senior Notes \| 7.250% senior unsecured notes due 2032
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Stated interest rate	7.25%	7.25%
Senior Notes \| 7.250% senior unsecured notes due 2032 \| Carrying Amount
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt	$ 800.0		0.0
Senior Notes \| 7.250% senior unsecured notes due 2032 \| Fair Value \| Fair Value, Inputs, Level 2
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]
Long-term debt	$ 808.0		$ 0.0

Segment Reporting

6 Months Ended

Jun. 30, 2024

Segment Reporting [Abstract]

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,
	2024		2023		2024		2023
Revenues:
Surgical Facility Services	$	730.4	$	650.2	$	1,423.1	$	1,299.2
Ancillary Services	31.7		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 Services	0.1		(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, net	51.5		47.7		98.8		94.5
Depreciation and amortization	34.8		24.4		68.5		58.1
Equity-based compensation expense	15.1		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 deconsolidations	5.3		(8.8)		6.8		1.7
Litigation settlements and regulatory change impact (2)	1.1		1.7		(0.1)		9.7
Loss on debt extinguishment	5.1		—		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


	June 30, 2024		December 31, 2023
Assets:
Surgical Facility Services	$	6,874.7	$	6,347.4
Ancillary Services	68.1		36.3
All other	545.8		493.0
Total assets	$	7,488.6	$	6,876.7


	Six Months Ended June 30,
	2024		2023
Cash purchases of property and equipment:
Surgical Facility Services	$	39.1	$	49.5
Ancillary Services	1.3		0.6
All other	7.5		—
Total cash purchases of property and equipment	$	47.9	$	50.1

- 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
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Reference 16: http://www.xbrl.org/2003/role/disclosureRef
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Reference 17: http://www.xbrl.org/2003/role/disclosureRef
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Reference 18: http://www.xbrl.org/2003/role/disclosureRef
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Reference 21: http://www.xbrl.org/2003/role/disclosureRef
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+ Details

Commitments and Contingencies (Details) - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Professional, general and workers' compensation insurance reserve	$ 18.3	$ 18.2
Estimated insurance recoveries	$ 10.2	$ 10.2

Leases - Schedule of Components of Right-of-use Assets and Liabilities Related to Leases (Details) - USD ($) $ in Millions	Jun. 30, 2024	Dec. 31, 2023
Assets:
Operating lease assets	$ 266.9	$ 255.3
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible List]	Property and equipment, net of accumulated depreciation of $519.1 and $454.4, respectively	Property and equipment, net of accumulated depreciation of $519.1 and $454.4, respectively
Finance lease assets	$ 594.6	$ 587.0
Total leased assets	$ 861.5	$ 842.3
Operating lease liabilities:
Operating Lease, Liability, Current, Statement of Financial Position [Extensible List]	Other current liabilities	Other current liabilities
Current	$ 39.3	$ 37.6
Long-term	257.6	248.9
Total operating lease liabilities	$ 296.9	$ 286.5
Finance lease liabilities:
Finance Lease, Liability, Current, Statement of Financial Position [Extensible List]	Current maturities of long-term debt	Current maturities of long-term debt
Current	$ 28.5	$ 25.4
Finance Lease, Liability, Noncurrent, Statement of Financial Position [Extensible List]	Long-term debt, less current maturities	Long-term debt, less current maturities
Long-term	$ 684.1	$ 668.2
Total finance lease liabilities	712.6	693.6
Total lease liabilities	$ 1,009.5	$ 980.1

Organization and Summary of Accounting Policies - Narrative (Details)	Jun. 30, 2024 facility state
Product Information [Line Items]
Number of surgical facilities owned	167
Number of states in which entity operates \| state	33
Number of surgical facilities owned, majority interest	92
Number of surgical facilities owned, consolidated	127
Facilities, Ambulatory Surgery Centers
Product Information [Line Items]
Number of surgical facilities owned	148
Facilities, Surgical Hospitals
Product Information [Line Items]
Number of surgical facilities owned	19

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($)
shares in Thousands, $ in Millions

3 Months Ended

6 Months Ended

Jun. 30, 2024

Jun. 30, 2023

Jun. 30, 2024

Jun. 30, 2023

Income Statement [Abstract]

Revenues

$ 762.1

$ 667.6

$ 1,479.5

$ 1,333.8

Operating expenses:

Salaries and benefits

223.2

195.2

438.4

397.4

Supplies

199.7

182.2

388.5

370.6

Professional and medical fees

92.4

72.9

175.0

147.5

Lease expense

22.2

21.8

43.6

43.2

Other operating expenses

45.4

41.4

99.5

87.0

Cost of revenues

582.9

513.5

1,145.0

1,045.7

General and administrative expenses

40.3

31.2

73.5

63.2

Depreciation and amortization

34.8

24.4

68.5

58.1

Transaction and integration costs

19.3

12.0

36.7

24.5

Net loss (gain) on disposals, consolidations and deconsolidations

5.3

(8.8)

6.8

1.7

Equity in earnings of unconsolidated affiliates

(4.4)

(2.6)

(7.1)

(5.9)

Litigation settlements

0.5

1.5

(1.3)

4.5

Loss on debt extinguishment

5.1

0.0

5.1

0.0

Other income, net

(6.5)

(1.2)

(8.5)

(2.0)

Total operating expenses

677.3

570.0

1,318.7

1,189.8

Operating income

84.8

97.6

160.8

144.0

Interest expense, net

(51.5)

(47.7)

(98.8)

(94.5)

Income before income taxes

33.3

49.9

62.0

49.5

Income tax (expense) benefit

(4.9)

7.8

(9.3)

9.4

Net income

28.4

57.7

52.7

58.9

Less: Net income attributable to non-controlling interests

(43.9)

(38.8)

(80.6)

(64.9)

Net (loss) income attributable to Surgery Partners, Inc.

$ (15.5)

$ 18.9

$ (27.9)

$ (6.0)

Net (loss) income per share attributable to common stockholders:

Basic (in USD per share)

$ (0.12)

$ 0.15

$ (0.22)

$ (0.05)

Diluted (in USD per share)

^[1]

$ (0.12)

$ 0.15

$ (0.22)

$ (0.05)

Weighted average common shares outstanding:

Basic (shares)

126,134

125,718

126,053

125,463

Diluted (shares)

^[1]

126,134

127,370

126,053

125,463

[1]	The impact of potentially dilutive securities for the three months ended June 30, 2024 and the six months ended June 30, 2024 and 2023 was not considered because the effect would be anti-dilutive.

Derivatives and Hedging Activities - Schedule of Pre-tax Effect of Derivatives on AOCI and Statement of Operations (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items]
OCI, Cash Flow Hedge, Reclassification for Discontinuance, Statement of Income or Comprehensive Income [Extensible Enumeration]	Interest expense, net	Interest expense, net	Interest expense, net	Interest expense, net
Amortization of accumulated OCI related	$ 0.0	$ 5.3	$ 0.0	$ 10.7
Derivatives not designated as hedging instruments
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items]
Loss recognized in income	0.0	0.0	0.0	0.6
Derivatives in cash flow hedging relationships
Reclassification Adjustment out of Accumulated Other Comprehensive Income on Derivatives [Line Items]
Gain (loss) recognized in OCI (effective portion)	(0.1)	21.9	9.1	16.7
(Gain) loss reclassified from accumulated OCI into income (effective portion)	$ (14.8)	$ (8.0)	$ (29.5)	$ (14.1)

Segment Reporting - Schedule of Segment Revenue and Operating Income (Details) - USD ($) $ in Millions	3 Months Ended		6 Months Ended
	Jun. 30, 2024	Jun. 30, 2023	Jun. 30, 2024	Jun. 30, 2023
Segment Reporting Information [Line Items]
Revenues	$ 762.1	$ 667.6	$ 1,479.5	$ 1,333.8
Adjusted EBITDA	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, net	51.5	47.7	98.8	94.5
Depreciation and amortization	34.8	24.4	68.5	58.1
Equity-based compensation expense	15.1	4.6	20.0	8.8
Transaction, integration and acquisition costs	20.8	13.0	39.7	25.8
Net loss (gain) on disposals, consolidations and deconsolidations	5.3	(8.8)	6.8	1.7
Litigation settlements and regulatory change impact	1.1	1.7	(0.1)	9.7
Loss on debt extinguishment	5.1	0.0	5.1	0.0
Undesignated derivative activity	0.0	0.0	0.0	0.6
Other	(4.8)	6.5	(4.4)	6.5
Transaction and integration costs	19.3	12.0	36.7	24.5
Start-up costs	1.5	1.0	3.0	1.3
(Loss) gain on litigation settlement	(0.5)	(1.5)	1.3	(4.5)
Other litigation costs	0.6	0.2	1.2	0.8
Additional interest expense for Florida LOP regulation change				4.4
Operating Segments \| Surgical Facility Services
Segment Reporting Information [Line Items]
Revenues	730.4	650.2	1,423.1	1,299.2
Adjusted EBITDA	143.0	126.7	269.7	245.5
Operating Segments \| Ancillary Services
Segment Reporting Information [Line Items]
Revenues	31.7	17.4	56.4	34.6
Adjusted EBITDA	0.1	(0.1)	(1.3)	(1.5)
All other
Segment Reporting Information [Line Items]
Adjusted EBITDA	$ (24.8)	$ (26.4)	$ (52.6)	$ (53.7)