{
	"nodes":[
		{"id":"g_verdict","type":"group","x":18500,"y":0,"width":1800,"height":2400,"color":"6","label":"11 · THE STORY, RED FLAGS & WHAT MUST BE DISCLOSED"},
		{"id":"g_complaint","type":"group","x":-1850,"y":0,"width":1650,"height":2400,"color":"1","label":"00 · START WITH THE NURSE'S COMPLAINT — THEN TEST IT"},
		{"id":"g_start","type":"group","x":0,"y":0,"width":1650,"height":2400,"color":"5","label":"01 · START HERE — IDENTITY & SCOPE"},
		{"id":"g_hca","type":"group","x":1850,"y":0,"width":1650,"height":2400,"color":"6","label":"02 · ULTIMATE PARENT — HCA HEALTHCARE"},
		{"id":"g_control","type":"group","x":3700,"y":0,"width":1650,"height":2400,"color":"6","label":"03 · OWNERSHIP, CONTROL & PUBLIC FILINGS"},
		{"id":"g_local","type":"group","x":5550,"y":0,"width":1650,"height":2400,"color":"4","label":"04 · SUNRISE'S LOCAL VALUE & 2025 ECONOMICS"},
		{"id":"g_finance","type":"group","x":7400,"y":0,"width":1650,"height":2400,"color":"4","label":"05 · SIX-YEAR FACILITY FINANCIAL TRAIL"},
		{"id":"g_money_goes","type":"group","x":9250,"y":0,"width":1650,"height":2400,"color":"3","label":"06 · WHERE THE MONEY WENT — AND WHAT IS NOT PUBLICLY DISCLOSED"},
		{"id":"g_real_estate","type":"group","x":11100,"y":0,"width":1650,"height":2400,"color":"2","label":"07 · REAL ESTATE, CAPITAL & EXPANSION"},
		{"id":"g_harm","type":"group","x":12950,"y":0,"width":1650,"height":2400,"color":"1","label":"08 · STAFFING, QUALITY & THE HUMAN COST"},
		{"id":"g_claim_audit","type":"group","x":14800,"y":0,"width":1650,"height":2400,"color":"2","label":"09 · SAFETY & PATIENT-BILLING CLAIM AUDIT"},
		{"id":"g_controversy","type":"group","x":16650,"y":0,"width":1650,"height":2400,"color":"1","label":"10 · CONTROVERSIAL DECISIONS & ENFORCEMENT — 2021–2025"},
		{"id":"official_sunrise","type":"link","url":"https://www.sunrisehospital.com/about-us","x":1050,"y":2050,"width":520,"height":120},
		{"id":"hca_logo","type":"file","file":"attachments/Sunrise Hospital Evidence/hca-logo.png","x":1930,"y":80,"width":590,"height":252},
		{"id":"hca_identity","type":"text","text":"## [Confirmed] Public parent\n\n**HCA Healthcare, Inc. (NYSE: HCA)** controls Sunrise through layered subsidiaries.\n\n**Ownership route:** public company — not a nonprofit and not currently private-equity owned.\n\n[Confirmed] HCA was sponsor-owned from 2006–2011; that history does not make Sunrise currently PE-owned.","x":2570,"y":80,"width":820,"height":410,"color":"6"},
		{"id":"hca_money_chart","type":"file","file":"attachments/Sunrise Hospital Evidence/hca-2025-consolidated-money.svg","x":1930,"y":540,"width":1490,"height":838},
		{"id":"hca_verdict","type":"text","text":"## [Calculated] FY2025 parent result\n\n**Revenue:** $75.600 billion  \n**Net income attributable to HCA:** $6.784 billion  \n**Net margin:** $6.784B ÷ $75.600B = **8.97%**\n\n**Buybacks:** $10.067 billion  \n**Dividends:** $679 million  \n**Capital spending:** $4.944 billion\n\n[Analysis] HCA was not broke. These figures show consolidated capacity; they do not trace a Sunrise dollar into a buyback or dividend.","x":1930,"y":1420,"width":720,"height":660,"color":"4"},
		{"id":"hca_investments","type":"text","text":"## [Confirmed] Parent investment pools\n\n**Insurance-subsidiary securities:** $588M fair value at Dec. 31, 2025 — $103M current and $485M long-term.\n\n**Investments/advances to affiliates:** $633M.\n\n[Confirmed] The insurance portfolio supports claims and statutory equity; HCA says excess insurance investments are not general corporate cash.\n\n[Scope] These are HCA balances, not Sunrise facility investments.","x":2690,"y":1420,"width":730,"height":660,"color":"3"},
		{"id":"hca_10k","type":"link","url":"https://www.sec.gov/Archives/edgar/data/860730/000119312526044769/hca-20251231.htm","x":1930,"y":2130,"width":720,"height":120},
		{"id":"hca_proxy","type":"link","url":"https://www.sec.gov/Archives/edgar/data/860730/000119312526106142/d939252ddef14a.htm","x":2690,"y":2130,"width":730,"height":120},
		{"id":"nurse_message","type":"text","text":"# [Tier 2 / Allegation] THE COMPLAINT\n\nA person identifying as a Sunrise nurse wrote that HCA was proposing **2.25% in year one and 2% in each of the next two years** and asked for help exposing HCA.\n\n[Boundary] The message is a lead. It is not proof of the employer's written offer, who is covered, total compensation, or what occurred at the bargaining table.","x":-1770,"y":80,"width":1490,"height":460,"color":"1"},
		{"id":"raise_math","type":"text","text":"## [Calculated from the allegation] What the offer would mean\n\n**Three-year compounded increase:**\n\n(1.0225 × 1.02 × 1.02) − 1 = **6.375%**\n\n[Gap] The dollar cost cannot be calculated without covered payroll, FTEs, step progression, overtime and differentials.\n\n**Resolving record:** signed employer proposal, complete wage scales and bargaining-unit payroll.","x":-1770,"y":580,"width":720,"height":620,"color":"2"},
		{"id":"opening_questions","type":"text","text":"## Ask these before calling it a scandal\n\n1. Is the 2.25% / 2% / 2% offer documented?\n2. How did Sunrise itself perform while making that offer?\n3. What did HCA return to shareholders in the same period?\n4. Did local staffing or access deteriorate?\n5. What do safety and billing records actually show?\n6. What costs, benefits or market-rate evidence would HCA cite?\n\n[Analysis] The fair case is allocation and priorities — not profit alone.","x":-1010,"y":580,"width":730,"height":620,"color":"3"},
		{"id":"speaking_order","type":"text","text":"## ONE-LINE SPEAKING SEQUENCE\n\n**1.** Start with the nurse's claimed raise offer, then say the written proposal is still needed.\n\n**2.** Establish that Sunrise is a for-profit HCA hospital, so the relevant public records are state filings, CMS data and HCA SEC filings — not Form 990.\n\n**3.** Put Sunrise's local profit and HCA's shareholder returns beside the alleged wage proposal without pretending parent cash is facility cash.\n\n**4.** Test whether the hospital expanded property and construction while frontline capacity tightened.\n\n**5.** Explain the historical C safety grade accurately, including both bad and favorable component measures.\n\n**6.** Correct the billing claim: Sunrise ranked second for markup, while the study found zero court actions.\n\n**7.** Close with the documented audit, ADA settlement and open labor allegations, then demand the missing contracts and ledgers.","x":-1770,"y":1240,"width":1490,"height":1020,"color":"6"},
		{"id":"title","type":"text","text":"# SUNRISE HOSPITAL & MEDICAL CENTER\n## Las Vegas, Nevada · HCA Healthcare\n\n**Evidence map as of August 25, 2026**\n\n[Confirmed] This canvas concerns Sunrise Hospital and Medical Center, LLC at 3186 S. Maryland Parkway, Las Vegas — not a Los Angeles hospital.\n\n[Scope] Sunrise facility money, HCA consolidated money, reimbursement, capital, investments and accounting balances stay in separate ledgers.","x":80,"y":80,"width":1490,"height":360,"color":"5"},
		{"id":"sunrise_aerial","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-aerial-official.png","x":80,"y":480,"width":1490,"height":838},
		{"id":"identity","type":"text","text":"## [Confirmed] The legal hospital\n\n**Legal name:** Sunrise Hospital and Medical Center, LLC\n\n**DBA:** Sunrise Hospital & Medical Center\n\n**CCN:** 290003\n\n**NPI:** 1861439952\n\n**TIN/EIN:** 62-1762537\n\n**Entity:** Delaware LLC registered in Nevada on Jan. 12, 1999.\n\n**Tax status:** proprietary / for-profit. It is not a 501(c)(3).","x":80,"y":1360,"width":710,"height":650,"color":"4"},
		{"id":"scope_rule","type":"text","text":"## [Confirmed] What the filings cover\n\n**Nevada workbooks** — Sunrise-level self-reported facility operations and balance-sheet snapshots.\n\n**CMS** — Medicare provider and quality reporting for CCN 290003.\n\n**HCA 10-K / proxy** — the consolidated public parent, not Sunrise alone.\n\n**IRS Form 990** — none for Sunrise because it is for-profit.\n\n[Gap] No single public document reconciles every affiliate, cash sweep, vendor and property owner.","x":830,"y":1360,"width":740,"height":650,"color":"3"},
		{"id":"legend","type":"text","text":"## Evidence labels\n\n**[Confirmed]** primary record or on-record statement  \n**[Calculated]** arithmetic shown  \n**[Tier 2]** secondary / advocacy source  \n**[Allegation]** unresolved claim  \n**[Unresolved]** conflicting or incomplete  \n**[Gap]** not publicly disclosed","x":80,"y":2050,"width":930,"height":260,"color":"6"},
		{"id":"cash_control","type":"text","text":"## [Confirmed] How money can move upward\n\nHCA’s 2025 10-K says parent debt repayment depends on subsidiaries generating cash and being able to make it available through dividends, debt repayment or otherwise.\n\n[Unresolved] That establishes a group-level mechanism, not a Sunrise transaction. Sunrise’s actual sweep agreement and due-to/due-from bridge were not found.","x":3780,"y":1620,"width":720,"height":550,"color":"1"},
		{"id":"local_scale","type":"text","text":"## [Confirmed] What the community gets\n\n**834 licensed beds**  \n**Level I trauma center**  \n**44,983 inpatient admissions in 2025**  \n**188,476 emergency visits in 2025**  \n**3,386 employed hospital FTE + 130 contracted FTE** at Q4 2025\n\n[Confirmed] Nevada’s 2024 trauma report recorded **857 transfers to Sunrise**, the most among Nevada trauma centers.\n\n[Scope] FTE is not unique headcount; transfer volume is not a mortality measure.","x":5630,"y":80,"width":720,"height":760,"color":"4"},
		{"id":"local_finance","type":"text","text":"## [Confirmed] Sunrise FY2025\n\n**Net patient revenue:** $1,250,603,326  \n**Total operating revenue:** $1,256,316,034  \n**Operating expense:** $1,035,812,123  \n**Net income:** $220,503,911\n\n[Calculated] **Facility margin:** $220,503,911 ÷ $1,256,316,034 = **17.55%**.\n\n[Analysis] This is a Sunrise facility accounting result. It is not cash in a local bank account and not HCA’s consolidated profit.\n\n[Confirmed with period caveat] Definitive Healthcare ranked Sunrise **#8 among HCA hospitals** using **$799.754M of net patient revenue**. It did not call the figure gross revenue, and the underlying service year is unclear.\n\n[Discrepancy] Nevada reports $880.051M of CY2023 net patient revenue; period/method differences prevent direct comparison.","x":6390,"y":80,"width":730,"height":820,"color":"4"},
		{"id":"payer_mix","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-payer-mix-2025.svg","x":5630,"y":930,"width":1490,"height":838},
		{"id":"community_analysis","type":"text","text":"## [Analysis] Why the payer mix matters\n\n[Confirmed] Medicaid and Medicare together represented **71.71% of 2025 admissions**.\n\n[Analysis] Sunrise carries regional trauma and safety-net-like volume inside a for-profit chain. That can create legitimate rate and acuity pressure even when the facility and parent are profitable.\n\n[Ethical mechanism] When staffed capacity falls behind demand, the cost is absorbed as waiting, boarding, floating and difficult assignments — not necessarily as measurable excess deaths.","x":5630,"y":1810,"width":930,"height":420,"color":"3"},
		{"id":"nv_fin_2025","type":"link","url":"https://nevadacomparecare.net/reports/NHQR%20Reports/Data%20Extracts/2025/NHQR%20Hospital%20Financial%20Data%20Extract%202025.xlsx","x":6600,"y":1810,"width":520,"height":130},
		{"id":"nv_util_2025","type":"link","url":"https://nevadacomparecare.net/reports/NHQR%20Reports/Data%20Extracts/2025/NHQR%20Hospital%20Utilization%20Data%20Extract%202025.xlsx","x":6600,"y":1980,"width":520,"height":130},
		{"id":"nv_trauma","type":"link","url":"https://www.dpbh.nv.gov/programs/public-health-preparedness/nevada-trauma-registry/","x":6600,"y":2150,"width":520,"height":90},
		{"id":"supplement_source","type":"link","url":"https://www.leg.state.nv.us/Division/Research/Documents/RTTL_NRS422.2749_2024.pdf","x":7480,"y":2260,"width":720,"height":110},
		{"id":"chain","type":"text","text":"## [Confirmed] Full chain to the top\n\n**HCA Healthcare, Inc.**  \n↓  \n**HCA Inc.**  \n↓  \n**Healthtrust, Inc.–The Hospital Company**  \n↓  \n**AC Med, LLC**  \n↓  \n**Sunrise Hospital and Medical Center, LLC**\n\n[Analysis] HCA presents one operating brand, while legal filings preserve separate LLC layers. Entity shorthand is useful operationally but cannot prove which entity earned, paid or owed a dollar.","x":3780,"y":80,"width":720,"height":870,"color":"6"},
		{"id":"history","type":"text","text":"## [Confirmed] Dated control history\n\n**1958** — hospital opened  \n**1969** — American Medicorp acquired Sunrise  \n**1993** — Humana separated hospital operations into Galen  \n**1993** — Galen/Columbia combination  \n**1994** — Columbia/HCA combination  \n**1999** — current Sunrise LLC registered\n\n[Gap] No source reviewed isolates Sunrise-specific consideration, assumed debt, cash equity or merger promises.","x":4540,"y":80,"width":730,"height":870,"color":"5"},
		{"id":"filing_map","type":"text","text":"## [Confirmed] The filing map\n\n**Facility:** Nevada annual financial/utilization workbooks; CMS cost and quality records.\n\n**Parent:** SEC 10-K, proxy and subsidiary disclosures.\n\n**Not available:** Sunrise Form 990, Schedule J executive table, Schedule R affiliate map or Schedule D investment schedule — those nonprofit forms do not apply.\n\n[Gap] Sunrise budgets, board minutes, cash-pool agreement, home-office allocation workpapers and vendor contracts are not publicly disclosed.","x":3780,"y":990,"width":1490,"height":590,"color":"3"},
		{"id":"exec_scope","type":"text","text":"## [Gap] Sunrise executive pay\n\nNo public Sunrise-specific compensation schedule was found for its CEO, CFO or other local executives.\n\n[Confirmed] HCA CEO Sam Hazen’s 2025 total compensation was **$26,456,606**; HCA reported a **420:1** CEO-to-median-employee pay ratio.\n\n[Scope] Hazen is the parent CEO. His pay must not be assigned to Sunrise’s local executive.","x":4540,"y":1620,"width":730,"height":550,"color":"1"},
		{"id":"chain_source","type":"link","url":"https://law.justia.com/cases/federal/district-courts/nevada/nvdce/2:2016cv02273/117778/45/","x":3780,"y":2210,"width":720,"height":110},
		{"id":"nppes_source","type":"link","url":"https://npiregistry.cms.hhs.gov/api/?version=2.1&number=1861439952","x":4540,"y":2210,"width":730,"height":110},
		{"id":"capex_2023","type":"text","text":"## [Confirmed] Visible capital deployment\n\nSunrise reported **$47.304M** of 2023 capital:\n\n- Expansions: $12.089M\n- Equipment: $3.825M\n- Other capital: $31.390M\n\n[Calculated] $47.304M ÷ $39.728M depreciation = **119.07%** for 2023.\n\n[Scope] Capital money is not automatically available for wages; restrictions and financing sources were not disclosed.","x":11180,"y":960,"width":720,"height":640,"color":"2"},
		{"id":"property_growth","type":"text","text":"## [Calculated] 2023→2025 book growth\n\n**Total property/facilities/equipment:** +$50.671M (**+14.71%**)\n\n**Land book value:** +$19.023M (**+54.69%**)\n\n**2025 construction in progress:** $26.087M\n\n[Unresolved] Book-value changes may reflect acquisitions, reclassification, project capitalization, depreciation or disposals. They do not prove new acreage.","x":11940,"y":960,"width":730,"height":640,"color":"2"},
		{"id":"parcel_map","type":"text","text":"## [Confirmed] Campus parcels identified\n\nA 2018 Maryland Parkway environmental review identifies hospital/parking parcels:\n\n- 162-11-401-010\n- 162-11-301-008\n- 162-11-301-007\n\n[Gap] Current certified deeds, parcel owners, mortgages and leases were not obtained.\n\n[Not found] No verified Sunrise sale-leaseback or OpCo/PropCo structure.","x":11180,"y":1640,"width":720,"height":590,"color":"5"},
		{"id":"expense_map","type":"text","text":"## [Confirmed] 2025 expense channels\n\n**Salaries, wages & contract labor:** $396.080M  \n**Home-office allocation:** $39.567M  \n**Depreciation/amortization:** $43.645M  \n**Medical + other professional fees:** $55.713M  \n**Purchased services:** $77.038M  \n**Rental/lease expense:** $4.344M\n\n[Gap] Nevada combines salaries, wages and contract labor; agency spend cannot be isolated from this line.","x":8240,"y":960,"width":730,"height":630,"color":"5"},
		{"id":"beneficiaries","type":"text","text":"## [Confirmed] Sunrise-level channels\n\n**HCA home office:** $151.580M allocated in 2022–2025.  \n[Unresolved] Accounting expense confirmed; cash settlement and allocation base missing.\n\n**Employees + contract labor:** $396.080M in 2025.  \n[Gap] Contract-labor portion, agencies, bill rates and worker count.\n\n**Professional fees:** $55.713M in 2025.  \n[Gap] Counterparties and ownership.\n\n**Purchased services:** $77.038M in 2025.  \n[Gap] Vendor list and contracts.\n\n**Rent/leases:** $4.344M in 2025.  \n[Gap] Landlord identity and terms.","x":9330,"y":80,"width":720,"height":960,"color":"3"},
		{"id":"parent_uses","type":"text","text":"## [Confirmed] Parent-level beneficiaries\n\n**HCA shareholders:** $10.067B buybacks + $679M dividends in 2025.\n\n**Sam Hazen:** $26.457M total compensation in 2025.\n\n**Capital vendors systemwide:** $4.944B HCA capital spending in 2025.\n\n[Scope] These are consolidated HCA uses. No public journal traces Sunrise cash into them.\n\n[Analysis] The tension is real — a profitable parent returned capital while local staffing pressure persisted — but the missing intercompany ledger prevents a diversion claim.","x":10090,"y":80,"width":730,"height":960,"color":"6"},
		{"id":"sunrise_investments","type":"text","text":"## [Confirmed] Sunrise investment lines\n\nFor CY2023–CY2025, Sunrise’s state workbooks reported:\n\n**Marketable securities:** $0  \n**Interest/investment income:** $0  \n**JV/minority-interest income:** $0  \n**Gain on sale of assets:** $0  \n**Total non-operating revenue:** $0\n\n[Analysis] No Sunrise investment pool is visible in the facility return. This does not prove HCA lacks investments or that no affiliate holds Sunrise-related assets.","x":9330,"y":1080,"width":720,"height":660,"color":"5"},
		{"id":"property_chart","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-property-book-values-2023-2025.svg","x":11180,"y":80,"width":1490,"height":838},
		{"id":"development_answer","type":"text","text":"## [Unresolved] New development, 2023–2025\n\nThe balance sheet confirms ongoing construction and a growing property book.\n\n[Gap] No public record reviewed identifies a named Sunrise campus project, exact 2023–2025 construction budget, new parcel acquisition, funding source or opening date.\n\n[Tier 2, older context] A $200M multi-phase trauma/ED expansion opened in 2019; it is not evidence of a current project.","x":11940,"y":1640,"width":730,"height":590,"color":"1"},
		{"id":"rtc_parcels","type":"link","url":"https://assets.rtcsnv.com/wp-content/uploads/2020/06/01142123/Maryland-Parkway-Draft-Final-EA-Nov-2018.pdf","x":11180,"y":2260,"width":720,"height":110},
		{"id":"older_expansion","type":"link","url":"https://www.ktnv.com/news/sunrise-hospitals-newly-expanded-trauma-and-emergency-department-now-open","x":11940,"y":2260,"width":730,"height":110},
		{"id":"profit_chart","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-profit-trend-2020-2025.svg","x":7480,"y":80,"width":1490,"height":838},
		{"id":"profit_verdict","type":"text","text":"## [Confirmed] Broke or not?\n\n**Verdict: not broke on the public record.**\n\nSunrise reported profits in 2020, 2021, 2022, 2024 and 2025, with a real but small **$4.29M loss in 2023**.\n\n[Calculated] 2024→2025 revenue rose **5.40%** and profit rose **14.66%**.\n\n[Innocent explanation tested] Rate changes, volume, acuity and Medicaid supplemental payments can move facility results sharply. The exact profit bridge is not public.","x":7480,"y":960,"width":720,"height":630,"color":"4"},
		{"id":"cash_anomaly","type":"text","text":"## [Unresolved] The near-zero cash puzzle\n\nAt Q4 2025 Sunrise reported:\n\n**Cash:** $337,796  \n**Assets:** $689.143M  \n**Equity/fund balance:** $522.156M\n\n[Red flag] Facility liquidity cannot be evaluated from this snapshot.\n\n[Innocent explanation] Centralized or zero-balance treasury accounting is common in hospital chains.\n\n[Gap] Cash-pool agreement, bank statements and intercompany bridge.","x":7480,"y":1630,"width":720,"height":600,"color":"1"},
		{"id":"public_money","type":"text","text":"## [Confirmed] A major innocent explanation\n\nSunrise’s Nevada Medicaid supplemental payments were **$16.165M in SFY2023** and **$102.277M in SFY2024**.\n\n[Scope] These are reimbursement supplements — not grants, bailouts or net profit.\n\n[Unresolved] The hospital assessment contribution, timing and net benefit are missing. They may help explain the 2024 profit jump, but the public record does not supply a full bridge.","x":8240,"y":1630,"width":730,"height":600,"color":"3"},
		{"id":"nv_quarterly","type":"link","url":"https://nevadacomparecare.net/quarterly-reports","x":8240,"y":2260,"width":730,"height":110},
		{"id":"contracts_gap","type":"text","text":"## [Gap] Suspicious-contract inventory\n\nNot publicly disclosed:\n\n- ER coverage vendor and rate card\n- Anesthesia group and ownership\n- Radiology group and ownership\n- Hospitalist group and ownership\n- Staffing agencies, markups and conversion fees\n- Revenue-cycle / collections vendor\n- Property leases and escalators\n- Cash sweep and management-service agreements\n\n[Analysis] Missing terms are a transparency finding, not proof that a contract is improper.","x":10090,"y":1080,"width":730,"height":660,"color":"1"},
		{"id":"exec_answer","type":"text","text":"## [Gap] Direct answer: Sunrise executives\n\nThe amount paid specifically to Sunrise’s local executives is **not publicly disclosed** in the Nevada facility workbooks, CMS datasets or an IRS Form 990.\n\n**Resolving records:** Sunrise leadership payroll; employment agreements; incentive plans; board compensation approvals; conflict questionnaires.\n\n[Scope] Parent proxy compensation cannot fill this gap.","x":9330,"y":1780,"width":1490,"height":470,"color":"1"},
		{"id":"timeline_2024","type":"text","text":"## 2024\n\n[Confirmed] NLRB election: **161–45** for SEIU among 206 counted ballots; representative certified Jan. 23, 2024.\n\n[Confirmed] Nevada’s 2024 hospital report narrative repeated Sunrise’s 2022 $55.5M profit while its 2023 exhibit showed a $4.29M loss.\n\n[Unresolved] Copy-forward error likely; author and intent unknown.","x":17490,"y":920,"width":730,"height":370,"color":"3"},
		{"id":"nlrb_charge","type":"link","url":"https://www.nlrb.gov/case/28-CA-365427","x":17840,"y":2310,"width":350,"height":70},
		{"id":"historical_boundary","type":"text","text":"## [Confirmed] Historical HCA context — separate entity/time\n\nDOJ described **$1.7B** in total government recoveries across HCA’s 2000–2003 criminal/civil resolutions; subsidiaries entered guilty pleas in 2000.\n\n[Scope] This is relevant to parent compliance credibility. It does not prove Sunrise committed the same conduct, and HCA’s historical Corporate Integrity Agreement ended in 2009.","x":16730,"y":1840,"width":720,"height":440,"color":"6"},
		{"id":"controversy_analysis","type":"text","text":"## [Analysis] The pattern\n\nThe five-year record shows repeated contact with different oversight systems — billing, labor, disability access, environmental compliance and state reporting.\n\n[Innocent explanation tested] These matters differ sharply in entity, legal posture and severity. The pattern supports scrutiny, not a single adjudicated corruption scheme.","x":17490,"y":1840,"width":730,"height":440,"color":"3"},
		{"id":"oig_source","type":"link","url":"https://oig.hhs.gov/reports/all/2021/medicare-hospital-provider-compliance-audit-sunrise-hospital-medical-center/","x":16730,"y":2310,"width":350,"height":70},
		{"id":"one_story","type":"text","text":"# THE ONE-PARAGRAPH STORY\n\n[Confirmed] Sunrise is a large, high-Medicaid Level I trauma hospital inside HCA’s profitable public-company chain. It was profitable in five of the last six reported years and earned $220.5M in 2025, while HCA earned $6.784B and repurchased $10.067B of stock. The safety record shows a repeated C-grade headline pattern, but the billing study contradicts the claim that Sunrise was a leading patient-lawsuit filer: it was second for list-price markup and recorded zero court actions in the study period. Current mortality data reject a sensational death narrative. The decisive missing mechanisms are the written wage proposal, post-July-2020 collection docket and intercompany ledger.","x":18580,"y":80,"width":1640,"height":570,"color":"6"},
		{"id":"found_flags","type":"text","text":"## [Confirmed] RED FLAGS FOUND\n\n- Layered parent/facility entity scope\n- $151.58M home-office allocations, 2022–2025\n- Near-zero facility cash with no cash-pool bridge\n- 2025 admissions up while Q4 RN FTE fell\n- Unit-level overflow/out-of-ratio events\n- Overall Leapfrog C in 2021 and each Spring/Fall 2023–2025\n- 12.94× list-price markup, second among 100 in the study\n- OIG refund recommendation, disputed then implemented/closed\n- Settled ADA communication failure\n- Open labor allegations\n- State report narrative-year contradiction\n- Parent buybacks/dividends during local access pressure","x":18580,"y":700,"width":790,"height":760,"color":"1"},
		{"id":"not_found_flags","type":"text","text":"## [Confirmed] NOT FOUND\n\n- Current PE ownership\n- Nonprofit / IRS Form 990 status\n- Verified sale-leaseback or PropCo\n- Current service closure\n- Going-concern warning\n- Excess-mortality finding\n- Verified immediate-jeopardy cluster\n- Second-highest patient-lawsuit rank in the 100-hospital study\n- Any Sunrise court action in the Jan. 2018–July 2020 study period\n- Active Corporate Integrity Agreement\n- Adjudicated labor-retaliation finding\n- Proof Sunrise cash funded HCA buybacks","x":19410,"y":700,"width":810,"height":760,"color":"4"},
		{"id":"questions","type":"text","text":"## [To run] The records that would change the story\n\n1. Signed wage proposal, complete wage scales and covered payroll\n2. Cash-pool agreement and 2022–2025 due-to/due-from bridge\n3. Home-office cost pools, allocation bases, invoices and settlements\n4. Sunrise local executive payroll, incentives and board approvals\n5. Unit/shift staffing, acuity, boarding, overtime and objection logs\n6. Staffing and specialty-coverage contracts, rate cards and ownership\n7. Certified deeds, leases, mortgages and 2023–2025 project sources-and-uses\n8. Patient-collection policy, vendor identity and Clark County plaintiff docket after July 2020\n\n[Analysis] If these records are refused, the refusal should be published as a gap — not converted into an accusation.","x":19410,"y":1500,"width":810,"height":820,"color":"2"},
		{"id":"bottom_line","type":"text","text":"## FINAL VERDICTS\n\n**Broke?** [Confirmed] No, on both the Sunrise six-year record and HCA’s FY2025 capacity.  \n**Deaths?** [Gap] No defensible count; the harm story is access.  \n**Cost cutting?** [Unresolved] 2025 staffing capacity tightened; unit causation needs records.  \n**Patient lawsuits?** [Confirmed] Zero in the 2018–mid-2020 study; later scale is unknown.  \n**Expansion?** [Confirmed] Property book and construction balances grew; named deals are missing.  \n**Suspicious payments?** [Confirmed] Home-office allocations are quantified; contracts and cash settlement are not.","x":18580,"y":2150,"width":790,"height":370,"color":"6"},
		{"id":"leapfrog_2021","type":"link","url":"https://web.archive.org/web/20210619181548/https://www.hospitalsafetygrade.org/h/sunrise-hospital-and-medical-center","x":14380,"y":2310,"width":850,"height":650},
		{"id":"leapfrog_current","type":"link","url":"https://www.hospitalsafetygrade.org/h/sunrise-hospital-and-medical-center","x":15250,"y":2310,"width":350,"height":610},
		{"id":"bmj_billing","type":"link","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC9274508/","x":15600,"y":2310,"width":370,"height":550},
		{"id":"oig_page","type":"file","file":"attachments/Sunrise Hospital Evidence/oig-audit-brief-page1.png","x":16730,"y":80,"width":610,"height":789},
		{"id":"oig_card","type":"text","text":"## [Confirmed] 2021 Medicare audit\n\nOIG sampled 100 claims from a $41M high-risk universe and found 54 noncompliant before five reprocessings.\n\n**Refund recommendation:** $23,606,895.\n\nSunrise disputed medical-necessity findings and extrapolation.\n\nAs of July 22, 2026, OIG’s tracker lists all three recommendations **Closed Implemented**.\n\n[Verdict] A disputed audit and implemented refund recommendation — **not a criminal fraud judgment**.","x":17380,"y":80,"width":840,"height":790,"color":"1"},
		{"id":"timeline_2021","type":"text","text":"## 2021\n\n[Confirmed] Clark County imposed a **$9,000** penalty for failure to perform required burner-efficiency tests.\n\n[Innocent explanation] An isolated environmental testing lapse; no patient-harm intent shown.","x":16730,"y":920,"width":720,"height":370,"color":"2"},
		{"id":"timeline_2025","type":"text","text":"## 2025\n\n[Confirmed] DOJ ADA settlement: **$30,000 damages + $5,000 civil penalty** after denial of effective ASL communication to a deaf father during his daughter’s emergency visit.\n\n[Allegation] NLRB case 28-CA-365427 remains open and alleges retaliation, discipline, unilateral changes, threats and surveillance. No merits finding.","x":16730,"y":1330,"width":1490,"height":470,"color":"1"},
		{"id":"doj_ada","type":"link","url":"https://www.justice.gov/usao-nv/pr/justice-department-secures-agreement-sunrise-hospital-and-medical-center-ensure","x":17100,"y":2310,"width":350,"height":70},
		{"id":"nlrb_vote","type":"link","url":"https://www.nlrb.gov/case/28-RC-330552","x":17470,"y":2310,"width":350,"height":70},
		{"id":"staffing_2024","type":"link","url":"https://www.leg.state.nv.us/Division/Research/Documents/RTTL_NRS449.242_2024_Sunrise.pdf","x":14020,"y":1700,"width":500,"height":130},
		{"id":"cms_general","type":"link","url":"https://data.cms.gov/provider-data/dataset/xubh-q36u","x":14020,"y":1870,"width":500,"height":110},
		{"id":"cms_mortality","type":"link","url":"https://data.cms.gov/provider-data/dataset/ynj2-r877","x":14020,"y":2020,"width":500,"height":110},
		{"id":"lown","type":"link","url":"https://lownhospitalsindex.org/hospital/sunrise-hospital-and-medical-center/","x":14020,"y":2170,"width":500,"height":210},
		{"id":"safety_audit","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-safety-audit.svg","x":14880,"y":80,"width":1490,"height":760},
		{"id":"safety_verdict","type":"text","text":"## [Confirmed] What the C really means\n\nSunrise received an **overall Leapfrog Hospital Safety Grade of C in Spring 2021**. The grade combined infections, surgery, safety practices, safety problems and doctors/nurses/staff; it was **not a standalone infection grade**.\n\n[Confirmed] The same archive showed MRSA, serious post-operative breathing problems, pressure sores and qualified-nurse scoring below average, while blood infection and colon surgical-infection measures were favorable.\n\n[Boundary] A C grade is a safety signal, not a death count or proof that staffing caused a specific injury.","x":14880,"y":880,"width":720,"height":620,"color":"1"},
		{"id":"safety_pattern","type":"text","text":"## [Confirmed] Pattern and time boundary\n\nThe official Leapfrog page shows C grades in both Spring and Fall of **2023, 2024 and 2025**.\n\n[Analysis] Repeated middling headline grades justify asking what stayed unresolved, but 2021 component scores cannot be presented as current.\n\n[Innocent explanation tested] Component measures and methods change; recent infection measures are not uniformly poor.","x":15640,"y":880,"width":730,"height":620,"color":"3"},
		{"id":"billing_correction","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-billing-correction.svg","x":14880,"y":1540,"width":1490,"height":760},
		{"id":"axios_billing","type":"link","url":"https://www.axios.com/hospital-billing","x":15990,"y":2310,"width":770,"height":710},
		{"id":"staffing_chart","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-staffing-volume-2022-2025.svg","x":13030,"y":80,"width":1490,"height":838},
		{"id":"staffing_record","type":"text","text":"## [Confirmed] Sunrise’s own staffing record\n\n**2022:** 28% RN vacancy rate and 465 openings reported.  \n**2023:** out-of-ratio assignments, overflow and floating to ED/satellite areas documented.  \n**2024:** vacancy improved to 5.77% / 63 openings; objection/refusal forms fell from 108 to 57.  \n**2025:** annual admissions rose 4.38% while Q4 combined RN FTE fell 3.03%.\n\n[Analysis] Hiring improvements through 2024 and renewed 2025 capacity pressure can both be true.","x":13030,"y":960,"width":720,"height":700,"color":"1"},
		{"id":"quality_record","type":"text","text":"## [Confirmed] Current quality picture\n\n**CMS overall:** 2 stars  \n**Mortality:** no condition measure worse than national; two better, six no different  \n**Readmissions:** two worse, six no different  \n**Postoperative sepsis PSI:** worse than national  \n**ED median visit:** 164 minutes  \n**Lown:** Outcomes A · Safety A · Satisfaction D\n\n[Scope] CMS, Lown and historical Leapfrog grades use different periods and methods.","x":13790,"y":960,"width":730,"height":700,"color":"3"},
		{"id":"harm_verdict","type":"text","text":"## [Gap] Harm verdict: ACCESS, not mortality\n\n**No defensible death count.** Current mortality data do not support an excess-death claim.\n\n[Confirmed] The supported harm mechanism is access and dignity: overflow, waiting, difficult assignments, readmission weakness, poor satisfaction and one settled communication-rights failure.\n\n[Ethical dimension] Patients absorb a capacity mismatch through time, uncertainty and exclusion even when risk-adjusted mortality is not worse.","x":13030,"y":1700,"width":950,"height":500,"color":"1"},
		{"id":"cannot_flags","type":"text","text":"## [Gap] CANNOT DETERMINE\n\n- Sunrise executive compensation\n- Employer's signed wage proposal and its covered payroll cost\n- Cash sweeps and facility liquidity\n- Home-office allocation basis and cash settlement\n- ER/anesthesia/radiology/hospitalist vendors\n- Staffing-agency spend and contract terms\n- Revenue payer mix and margins by payer\n- Current parcel owners, leases and new-project budget\n- Patient-debt lawsuit scale after July 2020\n- Malpractice pattern\n- Board conflicts and approvals","x":18420,"y":1500,"width":790,"height":610,"color":"3"}
	],
	"edges":[
		{"id":"e_complaint_start","fromNode":"speaking_order","fromSide":"right","toNode":"title","toSide":"left","color":"1","label":"verify the lead"},
		{"id":"e_start_hca","fromNode":"scope_rule","fromSide":"right","toNode":"hca_identity","toSide":"left","color":"6","label":"ultimate parent"},
		{"id":"e_hca_control","fromNode":"hca_identity","fromSide":"right","toNode":"chain","toSide":"left","color":"6","label":"legal control"},
		{"id":"e_control_local","fromNode":"filing_map","fromSide":"right","toNode":"local_scale","toSide":"left","color":"4","label":"facility-level reporting"},
		{"id":"e_local_finance","fromNode":"local_finance","fromSide":"right","toNode":"profit_chart","toSide":"left","color":"4","label":"six-year context"},
		{"id":"e_finance_money","fromNode":"expense_map","fromSide":"right","toNode":"beneficiaries","toSide":"left","color":"3","label":"who received accounting expense"},
		{"id":"e_money_realestate","fromNode":"beneficiaries","fromSide":"right","toNode":"capex_2023","toSide":"left","color":"2","label":"capital channel"},
		{"id":"e_realestate_harm","fromNode":"development_answer","fromSide":"right","toNode":"staffing_record","toSide":"left","color":"1","label":"built vs staffed"},
		{"id":"e_harm_claim_audit","fromNode":"harm_verdict","fromSide":"right","toNode":"safety_verdict","toSide":"left","color":"1","label":"test the headline"},
		{"id":"e_claims_controversy","fromNode":"billing_correction","fromSide":"right","toNode":"oig_card","toSide":"left","color":"2","label":"billing claim vs enforcement"},
		{"id":"e_controversy_verdict","fromNode":"controversy_analysis","fromSide":"right","toNode":"one_story","toSide":"left","color":"6","label":"synthesis"},
		{"id":"e_logo_parent","fromNode":"hca_logo","fromSide":"right","toNode":"hca_identity","toSide":"left","color":"6","label":"parent company"},
		{"id":"e_parent_money","fromNode":"hca_identity","fromSide":"bottom","toNode":"hca_money_chart","toSide":"top","color":"4","label":"FY2025"},
		{"id":"e_hca_invest","fromNode":"hca_money_chart","fromSide":"bottom","toNode":"hca_investments","toSide":"top","color":"3","label":"restricted vs affiliate holdings"},
		{"id":"e_chain_cash","fromNode":"chain","fromSide":"bottom","toNode":"cash_control","toSide":"top","color":"1","label":"control mechanism"},
		{"id":"e_exec_scope","fromNode":"hca_identity","fromSide":"bottom","toNode":"exec_scope","toSide":"top","color":"1","label":"parent pay ≠ local pay"},
		{"id":"e_payer_scale","fromNode":"local_scale","fromSide":"bottom","toNode":"payer_mix","toSide":"top","color":"4","label":"who is served"},
		{"id":"e_profit_cash","fromNode":"profit_verdict","fromSide":"bottom","toNode":"cash_anomaly","toSide":"top","color":"1","label":"profit ≠ cash"},
		{"id":"e_supplement_profit","fromNode":"public_money","fromSide":"left","toNode":"profit_verdict","toSide":"right","color":"3","label":"possible rate/program explanation"},
		{"id":"e_home_beneficiary","fromNode":"expense_map","fromSide":"right","toNode":"beneficiaries","toSide":"left","color":"3","label":"home-office and vendor channels"},
		{"id":"e_parent_uses","fromNode":"hca_verdict","fromSide":"right","toNode":"parent_uses","toSide":"left","color":"6","label":"capital returns"},
		{"id":"e_invest_scope","fromNode":"hca_investments","fromSide":"right","toNode":"sunrise_investments","toSide":"left","color":"5","label":"parent ≠ facility"},
		{"id":"e_property_gap","fromNode":"property_growth","fromSide":"bottom","toNode":"development_answer","toSide":"top","color":"2","label":"book growth ≠ acquisition proof"},
		{"id":"e_staff_quality","fromNode":"staffing_record","fromSide":"right","toNode":"quality_record","toSide":"left","color":"1","label":"cross-check"},
		{"id":"e_staff_harm","fromNode":"staffing_record","fromSide":"bottom","toNode":"harm_verdict","toSide":"top","color":"1","label":"capacity mechanism"},
		{"id":"e_oig_boundary","fromNode":"oig_card","fromSide":"bottom","toNode":"historical_boundary","toSide":"top","color":"6","label":"entity/time boundary"},
		{"id":"e_state_error","fromNode":"timeline_2024","fromSide":"left","toNode":"profit_verdict","toSide":"right","color":"3","label":"report contradiction"},
		{"id":"e_flags_questions","fromNode":"cannot_flags","fromSide":"right","toNode":"questions","toSide":"left","color":"2","label":"resolving documents"}
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}