{
  "schemaVersion": 4,
  "entityId": "050708",
  "canonicalName": "FRESNO SURGICAL HOSPITAL",
  "status": "corporate_chain",
  "statusLabel": "Corporate-chain/accountability context",
  "summary": "Fresno Surgical Hospital was reviewed in the Fresno custom NEXT-style batch. For-profit partnership surgical hospital with USPI/Tenet-related indirect ownership, USP Fresno operational control, national contracts through USPI/HealthTrust/Tenet, and disclosed physician ownership/investor interests. 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": "high",
    "source_count": 7,
    "ownership_source_count": 7,
    "identity_match_method": "Entity ID 050708; CCN 050708",
    "publication_decision": "Corporate-chain/for-profit exposure is supported; do not mark PE-owned from current evidence",
    "batch_id": "next-50-2026-07-04-fresno-city-001"
  },
  "firstGlance": {
    "taxOwnershipType": "For-profit",
    "operator": "Fresno Surgery Center LP / USP Fresno Inc / USPI",
    "directPeOwnership": "No direct PE ownership claim from current evidence; USPI/Tenet corporate exposure documented",
    "peRelationship": "No direct PE ownership claim from current evidence; USPI/Tenet corporate exposure documented",
    "institutionalShareholderContext": "Tenet is public-company parent context for USPI; do not treat passive shareholders as direct hospital owners.",
    "populationServedEstimate": 0,
    "populationServedLabel": "Not estimated in this Fresno batch",
    "careLevel": "Acute Care Hospitals",
    "currentCeo": "Leadership research pending",
    "previousRelevantCeo": "Not identified in this Fresno batch",
    "operatorType": "Corporate chain / physician-owned surgical hospital",
    "operatorName": "Fresno Surgery Center LP / USP Fresno Inc / USPI",
    "parentSystem": "USPI / Tenet with physician ownership and Saint Agnes/Dignity links",
    "affiliatedSystem": "USPI / Tenet with physician ownership and Saint Agnes/Dignity links",
    "religiousAffiliation": "Secular/no evidence",
    "confidence": "high",
    "evidenceAsOf": "2026-07-04",
    "bottomLine": "For-profit partnership surgical hospital with USPI/Tenet-related indirect ownership, USP Fresno operational control, national contracts through USPI/HealthTrust/Tenet, and disclosed physician ownership/investor interests."
  },
  "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": "Acute Care Hospitals",
    "publicFacingCaveat": "Exact current ownership percentages and physician investor list require direct facility request or underlying disclosures"
  },
  "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": "050708",
    "npi": null,
    "historicalCcns": [],
    "aliases": []
  },
  "ownershipHistory": [
    {
      "relationship_id": "rel-fsh-uspi-tenet",
      "relationship_type": "owns",
      "effective_date": "2026-07-04",
      "end_date": "",
      "status": "current_or_contextual",
      "source_ids": "cms_owner_fsh|hcai_fsh_supplier_2024|uspi_primary_2026",
      "plain_english_summary": "CMS/HCAI support Fresno Surgical USPI/Tenet/HealthTrust exposure and USP Fresno operational control"
    },
    {
      "relationship_id": "rel-fsh-physician-investors",
      "relationship_type": "owns",
      "effective_date": "2026-07-04",
      "end_date": "",
      "status": "current_or_contextual",
      "source_ids": "fsh_about",
      "plain_english_summary": "Fresno Surgical discloses physician ownership/investor interests available on request"
    }
  ],
  "acquisitionEvents": [
    {
      "date": "2024",
      "title": "supplier contract context",
      "detail": "HCAI supplier report identifies national contracts through USPI, HealthTrust, and Tenet.",
      "sourceIds": [
        "hcai_fsh_supplier_2024"
      ]
    }
  ],
  "financialAndUtilizationSeries": [],
  "cmsOwnerRecords": [],
  "ownershipChain": {
    "model": "Fresno custom NEXT-style batch relationship graph. Edges are source-backed context, not automatic public label changes.",
    "confidence": "high",
    "nodes": [
      {
        "id": "050708",
        "label": "FRESNO SURGICAL HOSPITAL",
        "kind": "hospital",
        "evidence": "Reviewed in next-50-2026-07-04-fresno-city-001."
      },
      {
        "id": "uspi-tenet",
        "label": "uspi tenet",
        "kind": "organization",
        "evidence": "CMS/HCAI support Fresno Surgical USPI/Tenet/HealthTrust exposure and USP Fresno operational control"
      },
      {
        "id": "physician-investors",
        "label": "physician investors",
        "kind": "organization",
        "evidence": "Fresno Surgical discloses physician ownership/investor interests available on request"
      }
    ],
    "edges": [
      {
        "id": "rel-fsh-uspi-tenet",
        "from": "050708",
        "to": "uspi-tenet",
        "relationship": "corporate_operator_indirect_owner",
        "confidence": "high",
        "sourceIds": [
          "cms_owner_fsh",
          "hcai_fsh_supplier_2024",
          "uspi_primary_2026"
        ],
        "note": "Relationship edge is source-backed but public display still requires validation/approval."
      },
      {
        "id": "rel-fsh-physician-investors",
        "from": "050708",
        "to": "physician-investors",
        "relationship": "physician_ownership_interest",
        "confidence": "medium",
        "sourceIds": [
          "fsh_about"
        ],
        "note": "Relationship edge is source-backed but public display still requires validation/approval."
      }
    ],
    "caveats": [
      "Exact current ownership percentages and physician investor list require direct facility request or underlying disclosures",
      "Physician investor list and current exact percentages require facility-provided investor list or filings.",
      "Research completed structurally for this custom Fresno NEXT-style batch, but no stronger public label should be published without exact approval and validation gates."
    ]
  },
  "ownershipConnections": [
    {
      "entityName": "uspi tenet",
      "entityKind": "organization",
      "relationship": "corporate_operator_indirect_owner",
      "classification": "high",
      "evidenceSourceIds": [
        "cms_owner_fsh",
        "hcai_fsh_supplier_2024",
        "uspi_primary_2026"
      ],
      "note": "CMS/HCAI support Fresno Surgical USPI/Tenet/HealthTrust exposure and USP Fresno operational control"
    },
    {
      "entityName": "physician investors",
      "entityKind": "organization",
      "relationship": "physician_ownership_interest",
      "classification": "medium",
      "evidenceSourceIds": [
        "fsh_about"
      ],
      "note": "Fresno Surgical discloses physician ownership/investor interests available on request"
    }
  ],
  "importantLinks": [
    {
      "label": "CMS Hospital Enrollments local cache",
      "url": "https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-enrollments",
      "sourceId": "cms_enroll_fsh",
      "note": "Fresno Surgery Center LP is enrolled as Fresno Surgical Hospital, partnership/proprietary, at 6125 N Fresno St. Limit: Does not alone prove all indirect owners. Audit location: research/cache/hospital-enrollments.csv; CCN 050708 row"
    },
    {
      "label": "CMS Hospital All Owners local cache",
      "url": "https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-all-owners",
      "sourceId": "cms_owner_fsh",
      "note": "CMS owner rows show USPI/Tenet-related indirect ownership, Saint Agnes/Dignity/USP Surgery Centers LLC, and USP Fresno Inc operational/managerial control. Limit: Does not provide all current investor names or confirm PE ownership. Audit location: research/cache/hospital-all-owners.csv; Fresno Surgery Center LP owner rows"
    },
    {
      "label": "Fresno Surgical Hospital profile",
      "url": "https://hcai.ca.gov/facility/fresno-surgical-hospital/",
      "sourceId": "hcai_fsh",
      "note": "Fresno Surgical Hospital is open, licensed as a general acute care hospital, with 27 licensed beds. Limit: Does not show the full ownership tree. Hospital profile lines 204-215"
    },
    {
      "label": "Fresno Surgical Hospital supplier diversity report",
      "url": "https://hcai.ca.gov/data/supplier-diversity-reports/hospital/fresno-surgical-hospital/",
      "sourceId": "hcai_fsh_supplier_2024",
      "note": "HCAI lists licensee Fresno Surgery Center, type of control Investor - Partnership, and reports national contracts through USPI, HealthTrust, and Tenet. Limit: Does not list all vendors or prove PE ownership. Supplier diversity lines 213-258"
    },
    {
      "label": "Fresno Surgical Hospital About Us",
      "url": "https://www.fresnosurgicalhospital.com/About-us",
      "sourceId": "fsh_about",
      "note": "Fresno Surgical says it is accredited and has physician owners/investors available on request. Limit: Does not provide investor list or ownership percentages. About page via Jina reader"
    },
    {
      "label": "Fresno Surgical Hospital Leadership",
      "url": "https://www.fresnosurgicalhospital.com/Leadership",
      "sourceId": "fsh_leadership",
      "note": "Current leadership/governing board page identifies Trinity Health/Saint Agnes, Dignity Health, and USPI representatives. Limit: Does not independently prove equity percentages. Leadership page via Jina reader"
    },
    {
      "label": "United Surgical Partners International",
      "url": "https://www.uspi.com/",
      "sourceId": "uspi_primary_2026",
      "note": "USPI describes itself as a subsidiary of Tenet Healthcare Corporation. Limit: Does not prove Fresno Surgical ownership percentages by itself; use CMS/HCAI for facility-specific ownership. USPI site footer/about text from search capture"
    }
  ],
  "descriptiveTrends": [],
  "systemConnections": [
    {
      "systemName": "uspi tenet",
      "relationship": "corporate_operator_indirect_owner",
      "evidenceSourceIds": [
        "cms_owner_fsh",
        "hcai_fsh_supplier_2024",
        "uspi_primary_2026"
      ],
      "facilities": [
        {
          "name": "FRESNO SURGICAL HOSPITAL",
          "role": "CMS/HCAI support Fresno Surgical USPI/Tenet/HealthTrust exposure and USP Fresno operational control",
          "city": "FRESNO",
          "state": "CA",
          "recordId": "050708",
          "note": "Relationship edge is source-backed but public display still requires validation/approval."
        }
      ]
    },
    {
      "systemName": "physician investors",
      "relationship": "physician_ownership_interest",
      "evidenceSourceIds": [
        "fsh_about"
      ],
      "facilities": [
        {
          "name": "FRESNO SURGICAL HOSPITAL",
          "role": "Fresno Surgical discloses physician ownership/investor interests available on request",
          "city": "FRESNO",
          "state": "CA",
          "recordId": "050708",
          "note": "Relationship edge is source-backed but public display still requires validation/approval."
        }
      ]
    }
  ],
  "directConnections": [
    "Fresno Surgery Center LP; CMS owner cache shows USPI/Tenet-related indirect ownership and USP Fresno operational control",
    "HCAI supplier-diversity report says national contracts through USPI, HealthTrust, and Tenet; Fresno Surgical site says physician investors exist on request",
    "CMS/HCAI support Fresno Surgical USPI/Tenet/HealthTrust exposure and USP Fresno operational control",
    "Fresno Surgical discloses physician ownership/investor interests available on request"
  ],
  "actions": [
    "2024: HCAI supplier report identifies national contracts through USPI, HealthTrust, and Tenet."
  ],
  "contradictions": [],
  "limitations": [
    "Exact current ownership percentages and physician investor list require direct facility request or underlying disclosures",
    "Physician investor list and current exact percentages require facility-provided investor list or filings.",
    "Research completed structurally for this custom Fresno NEXT-style batch, but no stronger public label should be published without exact approval and validation gates."
  ],
  "unavailableFields": [
    "Exact current ownership percentages and physician investor list require direct facility request or underlying disclosures",
    "Physician investor list and current exact percentages require facility-provided investor list or filings.",
    "Research completed structurally for this custom Fresno NEXT-style batch, but no stronger public label should be published without exact approval and validation gates."
  ],
  "sources": [
    {
      "source_id": "cms_enroll_fsh",
      "title": "CMS Hospital Enrollments local cache",
      "publisher": "CMS",
      "publication_date": "2026-06-24",
      "retrieved_at": "2026-07-04",
      "url": "https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-enrollments",
      "reliability_tier": "high",
      "research_note": "Fresno Surgery Center LP is enrolled as Fresno Surgical Hospital, partnership/proprietary, at 6125 N Fresno St. Limit: Does not alone prove all indirect owners. Audit location: research/cache/hospital-enrollments.csv; CCN 050708 row"
    },
    {
      "source_id": "cms_owner_fsh",
      "title": "CMS Hospital All Owners local cache",
      "publisher": "CMS",
      "publication_date": "2026-06-24",
      "retrieved_at": "2026-07-04",
      "url": "https://data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-all-owners",
      "reliability_tier": "high",
      "research_note": "CMS owner rows show USPI/Tenet-related indirect ownership, Saint Agnes/Dignity/USP Surgery Centers LLC, and USP Fresno Inc operational/managerial control. Limit: Does not provide all current investor names or confirm PE ownership. Audit location: research/cache/hospital-all-owners.csv; Fresno Surgery Center LP owner rows"
    },
    {
      "source_id": "hcai_fsh",
      "title": "Fresno Surgical Hospital profile",
      "publisher": "HCAI",
      "publication_date": "2026",
      "retrieved_at": "2026-07-04",
      "url": "https://hcai.ca.gov/facility/fresno-surgical-hospital/",
      "reliability_tier": "high",
      "research_note": "Fresno Surgical Hospital is open, licensed as a general acute care hospital, with 27 licensed beds. Limit: Does not show the full ownership tree. Hospital profile lines 204-215"
    },
    {
      "source_id": "hcai_fsh_supplier_2024",
      "title": "Fresno Surgical Hospital supplier diversity report",
      "publisher": "HCAI",
      "publication_date": "2024",
      "retrieved_at": "2026-07-04",
      "url": "https://hcai.ca.gov/data/supplier-diversity-reports/hospital/fresno-surgical-hospital/",
      "reliability_tier": "high",
      "research_note": "HCAI lists licensee Fresno Surgery Center, type of control Investor - Partnership, and reports national contracts through USPI, HealthTrust, and Tenet. Limit: Does not list all vendors or prove PE ownership. Supplier diversity lines 213-258"
    },
    {
      "source_id": "fsh_about",
      "title": "Fresno Surgical Hospital About Us",
      "publisher": "Fresno Surgical Hospital",
      "publication_date": "2026",
      "retrieved_at": "2026-07-04",
      "url": "https://www.fresnosurgicalhospital.com/About-us",
      "reliability_tier": "high",
      "research_note": "Fresno Surgical says it is accredited and has physician owners/investors available on request. Limit: Does not provide investor list or ownership percentages. About page via Jina reader"
    },
    {
      "source_id": "fsh_leadership",
      "title": "Fresno Surgical Hospital Leadership",
      "publisher": "Fresno Surgical Hospital",
      "publication_date": "2026",
      "retrieved_at": "2026-07-04",
      "url": "https://www.fresnosurgicalhospital.com/Leadership",
      "reliability_tier": "high",
      "research_note": "Current leadership/governing board page identifies Trinity Health/Saint Agnes, Dignity Health, and USPI representatives. Limit: Does not independently prove equity percentages. Leadership page via Jina reader"
    },
    {
      "source_id": "uspi_primary_2026",
      "title": "United Surgical Partners International",
      "publisher": "USPI",
      "publication_date": "2026",
      "retrieved_at": "2026-07-04",
      "url": "https://www.uspi.com/",
      "reliability_tier": "medium",
      "research_note": "USPI describes itself as a subsidiary of Tenet Healthcare Corporation. Limit: Does not prove Fresno Surgical ownership percentages by itself; use CMS/HCAI for facility-specific ownership. USPI site footer/about text from search capture"
    }
  ]
}