{
  "schemaVersion": 4,
  "entityId": "0013993720",
  "canonicalName": "FRESNO HEART AND SURGICAL HOSPITAL",
  "status": "signal",
  "statusLabel": "Orange contractor signal under review",
  "summary": "Fresno Heart and Surgical Hospital was reviewed in the Fresno custom NEXT-style batch. Community Medical/HCAI sources tie Fresno Heart and Surgical Hospital to the Community Medical Centers facility family; a lower-reliability third-party listing associates Sound hospital medicine scheduling with Fresno Heart. Unsupported PE ownership, contract scope, faith affiliation, sibling status, and independence claims remain limited to the cited sources.",
  "lastReviewed": "2026-07-04",
  "review": {
    "reviewer": "Codex Fresno custom NEXT-style batch",
    "evidence_grade": "source-family review completed with explicit unresolved items",
    "confidence": "medium",
    "source_count": 10,
    "ownership_source_count": 10,
    "identity_match_method": "Entity ID 0013993720; no public CCN confirmed in batch",
    "publication_decision": "Change to orange contractor signal under review with low/medium confidence; keep direct nonprofit facility ownership and Community Medical system affiliation visible.",
    "batch_id": "next-50-2026-07-04-fresno-city-001"
  },
  "firstGlance": {
    "taxOwnershipType": "Nonprofit",
    "operator": "Community Medical Centers",
    "directPeOwnership": "Orange contractor signal: lower-reliability Sound hospital medicine schedule signal; Sound owner context includes Optum/UnitedHealth and Summit Partners. Direct facility ownership remains nonprofit Community Medical Centers.",
    "peRelationship": "Orange contractor signal: lower-reliability Sound hospital medicine schedule signal; Sound owner context includes Optum/UnitedHealth and Summit Partners. Direct facility ownership remains nonprofit Community Medical Centers.",
    "institutionalShareholderContext": "Contractor owner context only: Sound Physicians is linked to Summit Partners and Optum/UnitedHealth sources; no direct hospital shareholder claim is made.",
    "populationServedEstimate": 0,
    "populationServedLabel": "Not estimated in this Fresno batch",
    "careLevel": "GENERAL ACUTE CARE",
    "currentCeo": "Leadership research pending",
    "previousRelevantCeo": "Not identified in this Fresno batch",
    "operatorType": "Health system facility",
    "operatorName": "Community Medical Centers",
    "parentSystem": "Community Medical Centers / Community Health System",
    "affiliatedSystem": "Community Medical Centers / Community Health System",
    "religiousAffiliation": "Secular/no evidence",
    "confidence": "medium",
    "evidenceAsOf": "2026-07-04",
    "bottomLine": "Community Medical/HCAI sources tie Fresno Heart and Surgical Hospital to the Community Medical Centers facility family; a lower-reliability third-party listing associates Sound hospital medicine scheduling with Fresno Heart."
  },
  "communityImpact": {
    "populationServedEstimate": 0,
    "populationServedLabel": "Not estimated in this Fresno batch",
    "estimateMethod": "No catchment or access-time model was run for this custom batch.",
    "catchmentDescription": "FRESNO, FRESNO, CA",
    "traumaCareLevel": "GENERAL ACUTE CARE",
    "publicFacingCaveat": "First-party Sound or facility confirmation for Fresno Heart, contract terms, start date, compensation, complete service-line scope, and direct license/NPI/CCN reconciliation remain unresolved."
  },
  "religiousAffiliation": {
    "affiliation": "Secular/no evidence",
    "affiliationType": "not_established",
    "sponsorOrOrder": "",
    "faithBasedSystem": "",
    "scope": "not_established",
    "confidence": "medium",
    "sourceIds": [],
    "sourceUrls": [],
    "evidenceAsOf": "2026-07-04",
    "notes": "No current faith-based governance source captured; do not infer beyond this review."
  },
  "qualityAndLaborContext": {
    "immediateJeopardy2026SourceStatus": "Not reviewed in this Fresno batch.",
    "noCausationClaim": true,
    "note": "Contract, ownership, and affiliation signals are presented as context only; this release does not infer quality or labor causation."
  },
  "leadership": [],
  "identifiers": {
    "ccn": "",
    "npi": null,
    "historicalCcns": [],
    "aliases": []
  },
  "ownershipHistory": [
    {
      "relationship_id": "rel-community-heart",
      "relationship_type": "consolidated_facility_family",
      "effective_date": "2026-07-04",
      "end_date": "",
      "status": "current_or_contextual",
      "source_ids": "hcai_crmc|community_locations_nav",
      "plain_english_summary": "Fresno Heart and Surgical appears in Community Medical locations and Community Regional consolidated family context"
    },
    {
      "relationship_id": "rel-0013993720-sound-hospital-medicine-signal",
      "relationship_type": "hospital_medicine_staffing_signal",
      "effective_date": "2026-07-04",
      "end_date": "",
      "status": "current_or_contextual",
      "source_ids": "thirdparty_sound_fresno_heart_schedule_signal_2026|sound_official_homepage|summit_sound_portfolio_2018_current|fierce_optum_summit_sound_2018|hfn_optum_summit_sound_2018",
      "plain_english_summary": "Fresno Heart and Surgical Hospital: Sound Physicians hospital medicine staffing signal. A lower-reliability syndicated Sound hospital medicine listing mentions Fresno Heart and Surgical Hospital alongside Community Regional and Clovis. Keep as signal-only pending first-party confirmation."
    },
    {
      "relationship_id": "rel-0013993720-sound-summit-owner-context",
      "relationship_type": "operates",
      "effective_date": "2026-07-04",
      "end_date": "",
      "status": "current_or_contextual",
      "source_ids": "summit_sound_portfolio_2018_current|fierce_optum_summit_sound_2018|hfn_optum_summit_sound_2018",
      "plain_english_summary": "Fresno Heart and Surgical Hospital: Summit Partners is a source-backed current Sound Physicians investor/owner context, not the direct facility owner."
    },
    {
      "relationship_id": "rel-0013993720-sound-optum-unitedhealth-owner-context",
      "relationship_type": "operates",
      "effective_date": "2026-07-04",
      "end_date": "",
      "status": "current_or_contextual",
      "source_ids": "fierce_optum_summit_sound_2018|hfn_optum_summit_sound_2018",
      "plain_english_summary": "Fresno Heart and Surgical Hospital: Optum/UnitedHealth is a source-backed Sound Physicians owner context from the 2018 acquisition reporting, not the direct facility owner."
    }
  ],
  "acquisitionEvents": [
    {
      "date": "2026-07-04",
      "title": "contractor staffing signal added",
      "detail": "Fresno Heart and Surgical Hospital: Sound Physicians hospital medicine contractor signal added; direct facility ownership remains separate.",
      "sourceIds": [
        "thirdparty_sound_fresno_heart_schedule_signal_2026"
      ]
    }
  ],
  "financialAndUtilizationSeries": [],
  "cmsOwnerRecords": [],
  "ownershipChain": {
    "model": "Fresno custom NEXT-style batch relationship graph. Edges are source-backed context, not automatic public label changes.",
    "confidence": "medium",
    "nodes": [
      {
        "id": "0013993720",
        "label": "FRESNO HEART AND SURGICAL HOSPITAL",
        "kind": "hospital",
        "evidence": "Reviewed in next-50-2026-07-04-fresno-city-001."
      },
      {
        "id": "050060",
        "label": "050060",
        "kind": "organization",
        "evidence": "Fresno Heart and Surgical appears in Community Medical locations and Community Regional consolidated family context"
      },
      {
        "id": "sound-physicians",
        "label": "sound physicians",
        "kind": "organization",
        "evidence": "Fresno Heart and Surgical Hospital: Sound Physicians hospital medicine staffing signal. A lower-reliability syndicated Sound hospital medicine listing mentions Fresno Heart and Surgical Hospital alongside Community Regional and Clovis. Keep as signal-only pending first-party confirmation."
      },
      {
        "id": "summit-partners",
        "label": "summit partners",
        "kind": "organization",
        "evidence": "Fresno Heart and Surgical Hospital: Summit Partners is a source-backed current Sound Physicians investor/owner context, not the direct facility owner."
      },
      {
        "id": "optum-unitedhealth-group",
        "label": "optum unitedhealth group",
        "kind": "organization",
        "evidence": "Fresno Heart and Surgical Hospital: Optum/UnitedHealth is a source-backed Sound Physicians owner context from the 2018 acquisition reporting, not the direct facility owner."
      }
    ],
    "edges": [
      {
        "id": "rel-community-heart",
        "from": "0013993720",
        "to": "050060",
        "relationship": "consolidated_facility_family",
        "confidence": "medium",
        "sourceIds": [
          "hcai_crmc",
          "community_locations_nav"
        ],
        "note": "Relationship edge is source-backed but public display still requires validation/approval."
      },
      {
        "id": "rel-0013993720-sound-hospital-medicine-signal",
        "from": "0013993720",
        "to": "sound-physicians",
        "relationship": "hospital_medicine_staffing_signal",
        "confidence": "medium",
        "sourceIds": [
          "thirdparty_sound_fresno_heart_schedule_signal_2026",
          "sound_official_homepage",
          "summit_sound_portfolio_2018_current",
          "fierce_optum_summit_sound_2018",
          "hfn_optum_summit_sound_2018"
        ],
        "note": "Contractor connection only; does not change direct facility ownership and is not a confirmed PE contract without Tier 1-3 facility contract confirmation."
      },
      {
        "id": "rel-0013993720-sound-summit-owner-context",
        "from": "0013993720",
        "to": "summit-partners",
        "relationship": "contractor_owner_context",
        "confidence": "high",
        "sourceIds": [
          "summit_sound_portfolio_2018_current",
          "fierce_optum_summit_sound_2018",
          "hfn_optum_summit_sound_2018"
        ],
        "note": "Owner context applies to the contractor organization Sound Physicians, not to the hospital facility operator."
      },
      {
        "id": "rel-0013993720-sound-optum-unitedhealth-owner-context",
        "from": "0013993720",
        "to": "optum-unitedhealth-group",
        "relationship": "contractor_owner_context",
        "confidence": "medium",
        "sourceIds": [
          "fierce_optum_summit_sound_2018",
          "hfn_optum_summit_sound_2018"
        ],
        "note": "Owner context applies to the contractor organization Sound Physicians, not to the hospital facility operator."
      }
    ],
    "caveats": [
      "First-party Sound or facility confirmation for Fresno Heart, contract terms, start date, compensation, complete service-line scope, and direct license/NPI/CCN reconciliation remain unresolved.",
      "No first-party Sound posting, facility contract, term sheet, board approval, or start date was located for Fresno Heart; do not classify as confirmed PE contract or PE-owned facility.",
      "Publish as orange contractor signal only. Direct facility ownership remains nonprofit/Community Medical context where supported; do not publish as confirmed PE contract until Tier 1-3 facility contract confirmation is located."
    ]
  },
  "ownershipConnections": [
    {
      "entityName": "050060",
      "entityKind": "organization",
      "relationship": "consolidated_facility_family",
      "classification": "medium",
      "evidenceSourceIds": [
        "hcai_crmc",
        "community_locations_nav"
      ],
      "note": "Fresno Heart and Surgical appears in Community Medical locations and Community Regional consolidated family context"
    },
    {
      "entityName": "sound physicians",
      "entityKind": "organization",
      "relationship": "hospital_medicine_staffing_signal",
      "classification": "medium",
      "evidenceSourceIds": [
        "thirdparty_sound_fresno_heart_schedule_signal_2026",
        "sound_official_homepage",
        "summit_sound_portfolio_2018_current",
        "fierce_optum_summit_sound_2018",
        "hfn_optum_summit_sound_2018"
      ],
      "note": "Fresno Heart and Surgical Hospital: Sound Physicians hospital medicine staffing signal. A lower-reliability syndicated Sound hospital medicine listing mentions Fresno Heart and Surgical Hospital alongside Community Regional and Clovis. Keep as signal-only pending first-party confirmation."
    },
    {
      "entityName": "summit partners",
      "entityKind": "organization",
      "relationship": "contractor_owner_context",
      "classification": "high",
      "evidenceSourceIds": [
        "summit_sound_portfolio_2018_current",
        "fierce_optum_summit_sound_2018",
        "hfn_optum_summit_sound_2018"
      ],
      "note": "Fresno Heart and Surgical Hospital: Summit Partners is a source-backed current Sound Physicians investor/owner context, not the direct facility owner."
    },
    {
      "entityName": "optum unitedhealth group",
      "entityKind": "organization",
      "relationship": "contractor_owner_context",
      "classification": "medium",
      "evidenceSourceIds": [
        "fierce_optum_summit_sound_2018",
        "hfn_optum_summit_sound_2018"
      ],
      "note": "Fresno Heart and Surgical Hospital: Optum/UnitedHealth is a source-backed Sound Physicians owner context from the 2018 acquisition reporting, not the direct facility owner."
    }
  ],
  "importantLinks": [
    {
      "label": "Community Regional Medical Center-Fresno profile",
      "url": "https://hcai.ca.gov/facility/community-regional-medical-center-fresno/",
      "sourceId": "hcai_crmc",
      "note": "Community Regional is open, licensed as a general acute care hospital, has 685 licensed beds, and HCAI consolidates Community Behavioral, Community Subacute, and Fresno Heart and Surgical with it. Limit: Does not identify all contractors or ownership chain above CMS owner rows. Hospital profile and consolidated reporting lines"
    },
    {
      "label": "Community Medical Centers locations navigation",
      "url": "https://www.communitymedical.org/locations/community-regional-medical-center",
      "sourceId": "community_locations_nav",
      "note": "Community Medical location navigation lists Community Regional, Fresno Heart & Surgical, Community Behavioral, and Community Subacute within the Community Medical Centers location family. Limit: Does not prove CMS ownership by itself. Jina reader locations navigation"
    },
    {
      "label": "Third-party Sound hospital medicine listing mentioning Fresno Heart and Surgical Hospital",
      "url": "https://us.trabajo.org/job-4112-721975fba013c7cc9583a3cbf2f85cc6",
      "sourceId": "thirdparty_sound_fresno_heart_schedule_signal_2026",
      "note": "A lower-reliability syndicated listing associates a Sound hospital medicine schedule with Fresno Heart and Surgical Hospital alongside Community Regional and Clovis. Limit: Not a first-party facility or Sound contract document; treat Fresno Heart Sound exposure as signal-only pending stronger confirmation. Search-result-accessible listing text names Clovis Community Medical Center, Fresno Heart and Surgical Hospital, and Community Regional Medical Center"
    },
    {
      "label": "Sound Physicians official services overview",
      "url": "https://www.soundphysicians.com/",
      "sourceId": "sound_official_homepage",
      "note": "Sound Physicians describes itself as a hospital staffing and physician practice-management partner across hospital medicine, emergency medicine, critical care, anesthesia, and related service lines. Limit: Does not identify any specific Fresno hospital contract or legal contract terms. Official service lines and hospital staffing/practice-management language"
    },
    {
      "label": "Sound Physicians portfolio page",
      "url": "https://www.summitpartners.com/companies/sound-physicians",
      "sourceId": "summit_sound_portfolio_2018_current",
      "note": "Summit Partners identifies Sound Physicians as a current portfolio company, invested in 2018, and describes its acute/post-acute hospital service lines. Limit: Does not identify Fresno facility contracts or Optum ownership terms by itself. Portfolio page lists Sound Physicians as a current Summit investment from 2018"
    },
    {
      "label": "UnitedHealth, OptumHealth, Summit Partners Sound Physicians acquisition report",
      "url": "https://www.fiercehealthcare.com/payer/unitedhealth-optumhealth-summit-partners-sound-physician-medical-holdings-acquisition",
      "sourceId": "fierce_optum_summit_sound_2018",
      "note": "Trade press reported OptumHealth/UnitedHealth and Summit Partners as owners in the $2.2B Sound Physicians acquisition. Limit: Does not prove current Fresno hospital contracts. Transaction report describes OptumHealth and Summit Partners ownership in a $2.2B Sound acquisition"
    },
    {
      "label": "OptumHealth and Summit Partners acquire Sound Inpatient Physician Holdings for $2.2B",
      "url": "https://www.healthcarefinancenews.com/news/optumhealth-and-summit-partners-acquire-staffing-firm-sound-inpatient-physician-holdings-22",
      "sourceId": "hfn_optum_summit_sound_2018",
      "note": "Trade press reported OptumHealth, part of UnitedHealth Group, and Summit Partners acquired Sound Inpatient Physician Holdings for $2.2B. Limit: Does not identify current ownership percentages or Fresno contracts. Transaction report describes Sound as a hospital staffing company and identifies OptumHealth/Summit buyers"
    },
    {
      "label": "Fresno Community Hospital and Medical Center dba Community Health System Corporate Integrity Agreement",
      "url": "https://oig.hhs.gov/compliance/corporate-integrity-agreements/browse-cias/fresno-community-hospital-and-medical-center-dba-community-health-system/",
      "sourceId": "hhs_oig_community_health_system_cia_2025",
      "note": "HHS-OIG lists an active 2025 Corporate Integrity Agreement for Fresno Community Hospital and Medical Center dba Community Health System. Limit: Does not prove Sound staffing, PE ownership, or contract scope. OIG CIA page lists active 5-year CIA and settlement context"
    }
  ],
  "descriptiveTrends": [],
  "systemConnections": [
    {
      "systemName": "050060",
      "relationship": "consolidated_facility_family",
      "evidenceSourceIds": [
        "hcai_crmc",
        "community_locations_nav"
      ],
      "facilities": [
        {
          "name": "FRESNO HEART AND SURGICAL HOSPITAL",
          "role": "Fresno Heart and Surgical appears in Community Medical locations and Community Regional consolidated family context",
          "city": "FRESNO",
          "state": "CA",
          "recordId": "0013993720",
          "note": "Relationship edge is source-backed but public display still requires validation/approval."
        }
      ]
    },
    {
      "systemName": "sound physicians",
      "relationship": "hospital_medicine_staffing_signal",
      "evidenceSourceIds": [
        "thirdparty_sound_fresno_heart_schedule_signal_2026",
        "sound_official_homepage",
        "summit_sound_portfolio_2018_current",
        "fierce_optum_summit_sound_2018",
        "hfn_optum_summit_sound_2018"
      ],
      "facilities": [
        {
          "name": "FRESNO HEART AND SURGICAL HOSPITAL",
          "role": "Fresno Heart and Surgical Hospital: Sound Physicians hospital medicine staffing signal. A lower-reliability syndicated Sound hospital medicine listing mentions Fresno Heart and Surgical Hospital alongside Community Regional and Clovis. Keep as signal-only pending first-party confirmation.",
          "city": "FRESNO",
          "state": "CA",
          "recordId": "0013993720",
          "note": "Contractor connection only; does not change direct facility ownership and is not a confirmed PE contract without Tier 1-3 facility contract confirmation."
        }
      ]
    },
    {
      "systemName": "summit partners",
      "relationship": "contractor_owner_context",
      "evidenceSourceIds": [
        "summit_sound_portfolio_2018_current",
        "fierce_optum_summit_sound_2018",
        "hfn_optum_summit_sound_2018"
      ],
      "facilities": [
        {
          "name": "FRESNO HEART AND SURGICAL HOSPITAL",
          "role": "Fresno Heart and Surgical Hospital: Summit Partners is a source-backed current Sound Physicians investor/owner context, not the direct facility owner.",
          "city": "FRESNO",
          "state": "CA",
          "recordId": "0013993720",
          "note": "Owner context applies to the contractor organization Sound Physicians, not to the hospital facility operator."
        }
      ]
    },
    {
      "systemName": "optum unitedhealth group",
      "relationship": "contractor_owner_context",
      "evidenceSourceIds": [
        "fierce_optum_summit_sound_2018",
        "hfn_optum_summit_sound_2018"
      ],
      "facilities": [
        {
          "name": "FRESNO HEART AND SURGICAL HOSPITAL",
          "role": "Fresno Heart and Surgical Hospital: Optum/UnitedHealth is a source-backed Sound Physicians owner context from the 2018 acquisition reporting, not the direct facility owner.",
          "city": "FRESNO",
          "state": "CA",
          "recordId": "0013993720",
          "note": "Owner context applies to the contractor organization Sound Physicians, not to the hospital facility operator."
        }
      ]
    }
  ],
  "directConnections": [
    "Community Medical Centers nonprofit facility/operator context; contractor layer tracked separately.",
    "A lower-reliability syndicated Sound hospital medicine listing mentions Fresno Heart and Surgical Hospital alongside Community Regional and Clovis. Keep as signal-only pending first-party confirmation.",
    "Fresno Heart and Surgical appears in Community Medical locations and Community Regional consolidated family context",
    "Fresno Heart and Surgical Hospital: Sound Physicians hospital medicine staffing signal. A lower-reliability syndicated Sound hospital medicine listing mentions Fresno Heart and Surgical Hospital alongside Community Regional and Clovis. Keep as signal-only pending first-party confirmation.",
    "Fresno Heart and Surgical Hospital: Summit Partners is a source-backed current Sound Physicians investor/owner context, not the direct facility owner.",
    "Fresno Heart and Surgical Hospital: Optum/UnitedHealth is a source-backed Sound Physicians owner context from the 2018 acquisition reporting, not the direct facility owner."
  ],
  "actions": [
    "2026-07-04: Fresno Heart and Surgical Hospital: Sound Physicians hospital medicine contractor signal added; direct facility ownership remains separate."
  ],
  "contradictions": [
    {
      "topic": "Sound Physicians staffing signal exists, but no Tier 1-3 executed facility contract or terms source was located.",
      "claim_a": "Sound Physicians staffing signal exists, but no Tier 1-3 executed facility contract or terms source was located.",
      "claim_b": "Sources: thirdparty_sound_fresno_heart_schedule_signal_2026|sound_official_homepage|summit_sound_portfolio_2018_current|fierce_optum_summit_sound_2018|hfn_optum_summit_sound_2018",
      "resolution_status": "Publish orange signal under review only. Do not publish as red confirmed PE contract or direct PE ownership."
    }
  ],
  "limitations": [
    "First-party Sound or facility confirmation for Fresno Heart, contract terms, start date, compensation, complete service-line scope, and direct license/NPI/CCN reconciliation remain unresolved.",
    "No first-party Sound posting, facility contract, term sheet, board approval, or start date was located for Fresno Heart; do not classify as confirmed PE contract or PE-owned facility.",
    "Publish as orange contractor signal only. Direct facility ownership remains nonprofit/Community Medical context where supported; do not publish as confirmed PE contract until Tier 1-3 facility contract confirmation is located."
  ],
  "unavailableFields": [
    "First-party Sound or facility confirmation for Fresno Heart, contract terms, start date, compensation, complete service-line scope, and direct license/NPI/CCN reconciliation remain unresolved.",
    "No first-party Sound posting, facility contract, term sheet, board approval, or start date was located for Fresno Heart; do not classify as confirmed PE contract or PE-owned facility.",
    "Publish as orange contractor signal only. Direct facility ownership remains nonprofit/Community Medical context where supported; do not publish as confirmed PE contract until Tier 1-3 facility contract confirmation is located."
  ],
  "sources": [
    {
      "source_id": "hcai_crmc",
      "title": "Community Regional Medical Center-Fresno profile",
      "publisher": "HCAI",
      "publication_date": "2026",
      "retrieved_at": "2026-07-04",
      "url": "https://hcai.ca.gov/facility/community-regional-medical-center-fresno/",
      "reliability_tier": "high",
      "research_note": "Community Regional is open, licensed as a general acute care hospital, has 685 licensed beds, and HCAI consolidates Community Behavioral, Community Subacute, and Fresno Heart and Surgical with it. Limit: Does not identify all contractors or ownership chain above CMS owner rows. Hospital profile and consolidated reporting lines"
    },
    {
      "source_id": "community_locations_nav",
      "title": "Community Medical Centers locations navigation",
      "publisher": "Community Medical Centers",
      "publication_date": "2026",
      "retrieved_at": "2026-07-04",
      "url": "https://www.communitymedical.org/locations/community-regional-medical-center",
      "reliability_tier": "high",
      "research_note": "Community Medical location navigation lists Community Regional, Fresno Heart & Surgical, Community Behavioral, and Community Subacute within the Community Medical Centers location family. Limit: Does not prove CMS ownership by itself. Jina reader locations navigation"
    },
    {
      "source_id": "thirdparty_sound_fresno_heart_schedule_signal_2026",
      "title": "Third-party Sound hospital medicine listing mentioning Fresno Heart and Surgical Hospital",
      "publisher": "Trabajo / syndicated job listing",
      "publication_date": "2026",
      "retrieved_at": "2026-07-04",
      "url": "https://us.trabajo.org/job-4112-721975fba013c7cc9583a3cbf2f85cc6",
      "reliability_tier": "medium_low",
      "research_note": "A lower-reliability syndicated listing associates a Sound hospital medicine schedule with Fresno Heart and Surgical Hospital alongside Community Regional and Clovis. Limit: Not a first-party facility or Sound contract document; treat Fresno Heart Sound exposure as signal-only pending stronger confirmation. Search-result-accessible listing text names Clovis Community Medical Center, Fresno Heart and Surgical Hospital, and Community Regional Medical Center"
    },
    {
      "source_id": "sound_official_homepage",
      "title": "Sound Physicians official services overview",
      "publisher": "Sound Physicians",
      "publication_date": "2026",
      "retrieved_at": "2026-07-04",
      "url": "https://www.soundphysicians.com/",
      "reliability_tier": "high",
      "research_note": "Sound Physicians describes itself as a hospital staffing and physician practice-management partner across hospital medicine, emergency medicine, critical care, anesthesia, and related service lines. Limit: Does not identify any specific Fresno hospital contract or legal contract terms. Official service lines and hospital staffing/practice-management language"
    },
    {
      "source_id": "summit_sound_portfolio_2018_current",
      "title": "Sound Physicians portfolio page",
      "publisher": "Summit Partners",
      "publication_date": "2026",
      "retrieved_at": "2026-07-04",
      "url": "https://www.summitpartners.com/companies/sound-physicians",
      "reliability_tier": "high",
      "research_note": "Summit Partners identifies Sound Physicians as a current portfolio company, invested in 2018, and describes its acute/post-acute hospital service lines. Limit: Does not identify Fresno facility contracts or Optum ownership terms by itself. Portfolio page lists Sound Physicians as a current Summit investment from 2018"
    },
    {
      "source_id": "fierce_optum_summit_sound_2018",
      "title": "UnitedHealth, OptumHealth, Summit Partners Sound Physicians acquisition report",
      "publisher": "Fierce Healthcare",
      "publication_date": "2018",
      "retrieved_at": "2026-07-04",
      "url": "https://www.fiercehealthcare.com/payer/unitedhealth-optumhealth-summit-partners-sound-physician-medical-holdings-acquisition",
      "reliability_tier": "medium_high",
      "research_note": "Trade press reported OptumHealth/UnitedHealth and Summit Partners as owners in the $2.2B Sound Physicians acquisition. Limit: Does not prove current Fresno hospital contracts. Transaction report describes OptumHealth and Summit Partners ownership in a $2.2B Sound acquisition"
    },
    {
      "source_id": "hfn_optum_summit_sound_2018",
      "title": "OptumHealth and Summit Partners acquire Sound Inpatient Physician Holdings for $2.2B",
      "publisher": "Healthcare Finance News",
      "publication_date": "2018",
      "retrieved_at": "2026-07-04",
      "url": "https://www.healthcarefinancenews.com/news/optumhealth-and-summit-partners-acquire-staffing-firm-sound-inpatient-physician-holdings-22",
      "reliability_tier": "medium_high",
      "research_note": "Trade press reported OptumHealth, part of UnitedHealth Group, and Summit Partners acquired Sound Inpatient Physician Holdings for $2.2B. Limit: Does not identify current ownership percentages or Fresno contracts. Transaction report describes Sound as a hospital staffing company and identifies OptumHealth/Summit buyers"
    },
    {
      "source_id": "hhs_oig_community_health_system_cia_2025",
      "title": "Fresno Community Hospital and Medical Center dba Community Health System Corporate Integrity Agreement",
      "publisher": "HHS Office of Inspector General",
      "publication_date": "2025-05-07",
      "retrieved_at": "2026-07-04",
      "url": "https://oig.hhs.gov/compliance/corporate-integrity-agreements/browse-cias/fresno-community-hospital-and-medical-center-dba-community-health-system/",
      "reliability_tier": "high",
      "research_note": "HHS-OIG lists an active 2025 Corporate Integrity Agreement for Fresno Community Hospital and Medical Center dba Community Health System. Limit: Does not prove Sound staffing, PE ownership, or contract scope. OIG CIA page lists active 5-year CIA and settlement context"
    },
    {
      "source_id": "ca_sb351_sidley_2025",
      "title": "California SB 351 corporate practice restrictions overview",
      "publisher": "Sidley",
      "publication_date": "2025-10",
      "retrieved_at": "2026-07-04",
      "url": "https://www.sidley.com/en/insights/newsupdates/2025/10/newly-enacted-california-law-formalizes-corporate-practice-restrictions",
      "reliability_tier": "medium",
      "research_note": "California legal context includes SB 351 restrictions relevant to management-service and clinical-control arrangements. Limit: Does not prove any violation or contract terms at the Fresno facilities. Legal update summarizes California SB 351 and corporate-practice restrictions effective 2026-01-01"
    },
    {
      "source_id": "aaem_envision_ca_lawsuit_update",
      "title": "AAEM-PG update on California lawsuit against Envision Healthcare",
      "publisher": "AAEM Physician Group",
      "publication_date": "2024",
      "retrieved_at": "2026-07-04",
      "url": "https://www.aaemphysiciangroup.com/news/update-aaem-pg-lawsuit-against-envision-healthcare/",
      "reliability_tier": "medium",
      "research_note": "California corporate-practice litigation is a relevant precedent for contractor-control analysis. Limit: Does not prove Sound contract scope, wrongdoing, or PE ownership of any Fresno facility. AAEM-PG describes Envision withdrawal from California after corporate-practice litigation"
    }
  ]
}