{
	"nodes":[
		{"id":"g_priority_profit_audit","type":"group","x":0,"y":-5200,"width":23600,"height":5200,"color":"4","label":"01 · START HERE — SUNRISE 2023 LOSS → 2025 PROFIT-SOURCE AUDIT"},
		{"id":"g_nurse_pay_2026","type":"group","x":18650,"y":0,"width":4950,"height":8380,"color":"5","label":"12 · NURSE PAY, COST OF LIVING & CONTRACT ACCOUNTABILITY — AUG. 2026"},
		{"id":"g_verdict","type":"group","x":16650,"y":0,"width":1800,"height":2400,"color":"6","label":"11 · THE STORY, RED FLAGS & WHAT MUST BE DISCLOSED"},
		{"id":"g_start","type":"group","x":0,"y":0,"width":1650,"height":2400,"color":"5","label":"02 · IDENTITY & SCOPE"},
		{"id":"g_hca","type":"group","x":1850,"y":0,"width":1650,"height":2400,"color":"6","label":"03 · ULTIMATE PARENT — HCA HEALTHCARE"},
		{"id":"g_control","type":"group","x":3700,"y":0,"width":1650,"height":2400,"color":"6","label":"04 · OWNERSHIP, CONTROL & PUBLIC FILINGS"},
		{"id":"g_local","type":"group","x":5550,"y":0,"width":1650,"height":2400,"color":"4","label":"05 · SUNRISE'S LOCAL VALUE & 2025 ECONOMICS"},
		{"id":"g_finance","type":"group","x":7400,"y":0,"width":1650,"height":2400,"color":"4","label":"06 · SIX-YEAR FACILITY FINANCIAL TRAIL"},
		{"id":"g_money_goes","type":"group","x":9250,"y":0,"width":1650,"height":2400,"color":"3","label":"07 · 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":"08 · REAL ESTATE, CAPITAL & EXPANSION"},
		{"id":"g_harm","type":"group","x":12950,"y":0,"width":1650,"height":2400,"color":"1","label":"09 · STAFFING, QUALITY & THE HUMAN COST"},
		{"id":"g_controversy","type":"group","x":14800,"y":0,"width":1650,"height":2400,"color":"1","label":"10 · CONTROVERSIAL DECISIONS & ENFORCEMENT — 2021–2025"},
		{"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":"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":"priority_turnaround_text","type":"text","text":"## 1B · What most likely drove the 2024 rebound?\n\n2023→2024 operating revenue increased **$306.246M**, expense increased **$109.640M**, and profit improved **$196.606M** to **+$192.318M**.\n\nNevada’s combined-period supplemental-payment report shows Sunrise rising from **$27.511M** to **$216.202M**: **+$188.692M**, equal to **96.0%** of the profit improvement.\n\n**Boundary:** this is compelling alignment, not audited causation. The state report mixes SFY fee-for-service and CY managed-care periods; assessments/provider taxes, patient volume, rates and acuity also matter.","x":5890,"y":-4500,"width":5450,"height":900,"color":"3"},
		{"id":"priority_turnaround_chart","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-2024-turnaround-medicaid.svg","x":5890,"y":-3500,"width":4978,"height":2800},
		{"id":"priority_turnaround_source","type":"link","url":"https://www.leg.state.nv.us/Division/Research/Documents/RTTL_NRS449.520_2025.pdf","x":5890,"y":-620,"width":5450,"height":140},
		{"id":"priority_profit_text","type":"text","text":"## 1C · Where did the 2025 $220.5M profit come from?\n\n**Net patient revenue:** $1.250603B  \n**Other operating revenue:** $5.713M  \n**Operating revenue:** $1.256316B  \n**Operating expenses:** $1.035812B  \n**Net income:** **$220.504M (17.55%)**\n\nInpatient net revenue was **$953.516M (76.24%)**; outpatient was **$297.087M (23.76%)**. Reported non-operating revenue was **$0**.\n\n**Conclusion:** the profit is an operating patient-care margin. The public workbook does not disclose payer-level margins, cash collections, or service-line profitability.","x":11700,"y":-4500,"width":5450,"height":900,"color":"4"},
		{"id":"priority_profit_chart","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-2025-profit-source-audit.svg","x":11700,"y":-3500,"width":4978,"height":2800},
		{"id":"priority_profit_source","type":"link","url":"https://nevadacomparecare.net/reports/NHQR%20Reports/Data%20Extracts/2025/NHQR%20Hospital%20Financial%20Data%20Extract%202025.xlsx","x":11700,"y":-620,"width":5450,"height":140},
		{"id":"sunrise_aerial","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-aerial-official.png","x":80,"y":480,"width":1490,"height":838},
		{"id":"hca_logo","type":"file","file":"attachments/Sunrise Hospital Evidence/hca-logo.png","x":1540,"y":134,"width":590,"height":252},
		{"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":"public_money","type":"text","text":"## [Confirmed] Medicaid reimbursement explains much of the rebound\n\nNevada’s combined-period report shows Sunrise supplemental payments rising from **$27.511M** to **$216.202M** — an increase of **$188.692M**.\n\n[Calculated] That equals **96.0%** of the **$196.606M** improvement from the 2023 loss to the 2024 profit.\n\n[Scope] This is a strong accounting alignment, not dollar-for-dollar proof: the report combines state-fiscal-year FFS and calendar-year MCO periods. Assessments/provider taxes and other operating changes still require reconciliation.","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":"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\n2023 was a cost/revenue squeeze: operating revenue rose only **$13.075M (+1.50%)**, while expense rose **$72.869M (+8.92%)**, turning **+$55.506M** into **−$4.288M**.\n\nThe five largest expense increases explain about **90.1%** of the total rise. 2024 then reversed to **+$192.318M**; 2025 reached **+$220.504M**.\n\n[Gap] Payer-, service-line- and cash-level ledgers remain nonpublic.","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":"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":"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":"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":"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":"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":"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":"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":"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":"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_proxy","type":"link","url":"https://www.sec.gov/Archives/edgar/data/860730/000119312526106142/d939252ddef14a.htm","x":2690,"y":2130,"width":730,"height":120},
		{"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":"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":4560,"y":80,"width":730,"height":870,"color":"5"},
		{"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":"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":"official_sunrise","type":"link","url":"https://www.sunrisehospital.com/about-us","x":1050,"y":2050,"width":520,"height":120},
		{"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":"priority_title","type":"text","text":"# PRIORITY 1 · SUNRISE-ONLY FINANCIAL AUDIT\n## What caused the 2023 loss—and where did the 2025 profit come from?\n\n**Plain answer:** 2023 was primarily a **cost/revenue squeeze**, the 2024 rebound aligns strongly with a major increase in **Nevada Medicaid supplemental reimbursement**, and the 2025 **$220.5M** result came from operating patient-care revenue—not investment income. High list prices remain a serious audit question, but public summary data do **not** prove illegal patient overcharging.\n\n**Scope lock:** every number in this section is Sunrise Hospital Las Vegas or HCA parent context. **No benefit or parking percentage from another institution is included.**","x":80,"y":-5100,"width":23440,"height":500,"color":"5"},
		{"id":"priority_loss_text","type":"text","text":"## 1A · Why did +$55.5M become −$4.3M in 2023?\n\n**Revenue:** +$13.075M (**+1.50%**)  \n**Expenses:** +$72.869M (**+8.92%**)  \n**Profit change:** −$59.794M\n\nLargest expense increases: other operating **+$24.739M**; salaries **+$18.893M**; benefits **+$10.118M**; supplies **+$6.333M**; professional fees **+$5.552M**. Together: **$65.635M**, or **90.1%** of the expense increase.\n\n**Verdict:** the −$4.288M was the residual after expenses outran revenue—not a separate hidden $4.3M transaction.","x":80,"y":-4500,"width":5450,"height":900,"color":"1"},
		{"id":"priority_loss_chart","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-2023-loss-waterfall.svg","x":80,"y":-3500,"width":4978,"height":2800},
		{"id":"priority_loss_source","type":"link","url":"https://nevadacomparecare.net/quarterly-reports","x":80,"y":-620,"width":5450,"height":140},
		{"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":330},
		{"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":"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":"priority_raise_text","type":"text","text":"## 1D · Overcharging test + what would 5% or 6% cost?\n\n2025 list charges **$15.709B** minus deductions **$14.459B (92.04%)** left **$1.251B** net patient revenue (**7.96%** of list). This confirms extreme gross-to-net compression; it does **not** establish what individual patients paid or prove illegality.\n\nUsing **1,375 employed RN FTE**, BLS median **$49.97/hr**, and 2,080 hours: estimated RN base-pay pool **$142.9M**.\n\n**5%:** $7.15M direct; $8.93M with 25% burden.  \n**6%:** $8.57M direct; $10.72M with burden.\n\nDirect cost equals **3.24% / 3.89%** of 2025 profit. Extra above 2.2%: **$4.00M / $5.43M**. Agency RNs and non-RN classifications excluded.","x":17510,"y":-4500,"width":5450,"height":900,"color":"2"},
		{"id":"priority_raise_chart","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-rn-raise-cost-2025.svg","x":17510,"y":-3500,"width":4978,"height":2800},
		{"id":"priority_raise_source","type":"link","url":"https://nevadacomparecare.net/reports/NHQR%20Reports/Data%20Extracts/2025/NHQR%20Hospital%20Utilization%20Data%20Extract%202025.xlsx","x":17510,"y":-620,"width":5450,"height":140},
		{"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":"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":"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":"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":"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":"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":"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":"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":"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- Active Corporate Integrity Agreement\n- Adjudicated labor-retaliation finding\n- Proof Sunrise cash funded HCA buybacks","x":17560,"y":700,"width":810,"height":760,"color":"4"},
		{"id":"questions","type":"text","text":"## [To run] The records that would change the story\n\n1. Cash-pool agreement and 2022–2025 due-to/due-from bridge\n2. Home-office cost pools, allocation bases, invoices and settlements\n3. Sunrise local executive payroll, incentives and board approvals\n4. Unit/shift staffing, acuity, boarding, overtime and objection logs\n5. Staffing and specialty-coverage contracts, rate cards and ownership\n6. Certified deeds, leases, mortgages and project sources-and-uses\n7. Full CY2025 Medicaid assessment/provider-tax and net-benefit reconciliation\n8. Gross-to-net ledger by payer: list charges, allowed amounts, cash collected, charity, discounts and bad debt\n9. Patient-collection policy, vendor and plaintiff docket\n\n[Analysis] Missing records are transparency gaps — not proof of fraud.","x":17560,"y":1500,"width":810,"height":820,"color":"2"},
		{"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":"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":"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":"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":"np_header","type":"text","text":"# SUNRISE NURSE PAY: THE EVIDENCE-BASED ANSWER\n\n**Question:** Does Sunrise Hospital really lack the financial capacity to raise nurse pay above the reported **2.2% / 2% / 2%** proposal?\n\n**Short answer:** Public facility results do **not** support a blanket claim that Sunrise is financially unable to pay more. Sunrise reported **$220.5M net income** on **$1.256B operating revenue** in 2025, a **17.55% margin**. The exact wage proposal remains nurse-reported until the dated document is obtained. **No Sunrise-specific insurance or parking increase was supplied or verified; no percentage from another hospital system is included.**\n\n**Reading key:** [Verified] public record · [Calculated] math shown · [Reported/unverified] needs document · [Gap] not publicly determinable.\n\n**Evidence current through:** August 25, 2026.","x":18730,"y":80,"width":2350,"height":920,"color":"5"},
		{"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. Sunrise’s own record also shows a 2025 staffing-volume divergence, earlier unit-level overflow, weaker readmission/satisfaction signals, an ADA access failure and recurring oversight. Current mortality data reject a sensational death narrative. The decisive missing mechanism is the intercompany ledger: who controlled Sunrise cash, how home-office costs were allocated, and whether local staffing and capital decisions competed with parent priorities.","x":16730,"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- 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":16730,"y":700,"width":790,"height":760,"color":"1"},
		{"id":"cannot_flags","type":"text","text":"## [Gap] CANNOT DETERMINE\n\n- Sunrise executive compensation\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- Net revenue and margin by payer/service line\n- Gross-to-net classification of uninsured discounts\n- Current parcel owners, leases and new-project budget\n- Patient-debt lawsuit scale\n- Malpractice pattern\n- Board conflicts and approvals","x":16730,"y":1500,"width":790,"height":610,"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":14880,"y":2310,"width":350,"height":650},
		{"id":"doj_ada","type":"link","url":"https://www.justice.gov/usao-nv/pr/justice-department-secures-agreement-sunrise-hospital-and-medical-center-ensure","x":15250,"y":2310,"width":350,"height":650},
		{"id":"nlrb_vote","type":"link","url":"https://www.nlrb.gov/case/28-RC-330552","x":15620,"y":2310,"width":350,"height":670},
		{"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**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":16730,"y":2150,"width":790,"height":200,"color":"6"},
		{"id":"np_q1_wage","type":"text","text":"## Q1 · What is the normal RN wage at Sunrise?\n\n**[Verified public job ranges]**\n- Rehab / new graduate: **$44.38–$64.66/hr**\n- Progressive / critical care: **$50.35–$73.63/hr**\n- CVOR: **$51.27–$76.93/hr**\n\n**Answer:** These postings show hiring ranges, not the actual pay of incumbent union nurses or the contract step scale. The ranges overlap the Las Vegas market, but cannot prove that current nurses are paid at market.\n\n**Source:** HCA Sunrise job postings, checked Aug. 2026. **Missing:** current CBA wage grid and employee pay-step distribution.","x":18730,"y":1100,"width":1500,"height":620,"color":"4"},
		{"id":"np_q5_finance","type":"text","text":"## Q5 · Is Sunrise financially hanging by a thread?\n\n**[Verified facility accounting] 2025:** revenue **$1.256B**; expenses **$1.036B**; net income **$220.5M**; margin **17.55%**.\n\nNet income: 2020 **$19.4M**; 2021 **$65.6M**; 2022 **$55.5M**; 2023 **−$4.3M**; 2024 **$192.3M**; 2025 **$220.5M**. Sunrise was profitable in **5 of 6 years**.\n\n2023 was a squeeze, not a hidden $4.3M: revenue rose **1.50%**, expenses rose **8.92%**. The biggest increases were other operating expense, salaries, benefits, supplies and professional fees.\n\n**Answer:** The public figures show a strong rebound, not an institution on the edge of collapse. Net income is not unrestricted cash, but management should explain any contrary claim.","x":20330,"y":2640,"width":1500,"height":620,"color":"4"},
		{"id":"nlrb_charge","type":"link","url":"https://www.nlrb.gov/case/28-CA-365427","x":15990,"y":2310,"width":350,"height":930},
		{"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":14880,"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":14880,"y":1330,"width":1490,"height":470,"color":"1"},
		{"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":14880,"y":1840,"width":720,"height":440,"color":"6"},
		{"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":15640,"y":920,"width":730,"height":370,"color":"3"},
		{"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":15640,"y":1840,"width":730,"height":260,"color":"3"},
		{"id":"oig_page","type":"file","file":"attachments/Sunrise Hospital Evidence/oig-audit-brief-page1.png","x":14880,"y":80,"width":610,"height":789,"color":"1"},
		{"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":15530,"y":80,"width":840,"height":790,"color":"1"},
		{"id":"np_fox5_headline","type":"file","file":"attachments/Sunrise Hospital Evidence/fox5-sunrise-contract-rally-2026.png","x":21150,"y":80,"width":1246,"height":880},
		{"id":"np_q8_staffing","type":"text","text":"## Q8 · Is Sunrise heavily relying on temporary nurses?\n\nQ4 employed / contracted RN FTE:\n- 2022: **1,226.5 / 138.3**\n- 2023: **1,333.2 / 80.0**\n- 2024: **1,394.0 / 60.0**\n- 2025: **1,375 / 35** — combined **1,410**\n\n**Counterevidence:** contracted RN FTE fell **74.7%** from 2022 to 2025. That does not support a simple claim of rising agency dependence. But from 2024 to 2025, admissions rose **4.38%** while combined RN FTE fell **3.03%**, a workload signal worth examining.\n\n**Sources:** Nevada hospital staffing/volume filings. These are FTEs, not shift-level ratios.","x":20330,"y":4180,"width":1500,"height":620,"color":"4"},
		{"id":"np_v7_property","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-property-book-values-2023-2025.svg","x":18730,"y":4830,"width":1404,"height":790},
		{"id":"np_v9_contractors","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-contractor-map-2026.svg","x":21930,"y":4830,"width":940,"height":529},
		{"id":"np_q10_hca_scale","type":"text","text":"## Q10 · How important is Sunrise to HCA? What did the CEO make?\n\n**HCA 2025:** revenue **$75.600B**; net income **$6.784B**; share repurchases **$10.067B**; dividends **$679M**; capital spending **$4.944B**. CEO Sam Hazen compensation: **$26,456,606**.\n\nSunrise operating revenue was approximately **1.66%** of HCA consolidated revenue, but that is a rough cross-scope comparison—not a cash-flow bridge. A third party placed Sunrise **#8** among HCA hospitals using a different, unclear-period revenue measure; treat it as indicative, not definitive.\n\nLocal Sunrise CEO compensation and the exact share of HCA profit attributable to Sunrise are not publicly disclosed.","x":18730,"y":5720,"width":1500,"height":620,"color":"5"},
		{"id":"np_v10_scale","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-revenue-share-and-raise-cost.svg","x":18730,"y":6370,"width":1404,"height":790},
		{"id":"np_q11_billing","type":"text","text":"## Q11 · Did the 2025 profit come from overcharging patients?\n\n2025 gross/list charges were **$15.709B**. Contractual/other deductions were **$14.459B (92.04%)**, leaving **$1.251B** net patient revenue — only **7.96%** of list charges. The **12.9×** markup is therefore a list-price signal, not the amount collected.\n\nPrivate-pay gross charges were **$1.103B**; reported charity deductions **$418.3M**, bad debt **$91.3M**, and other contractual adjustments **$1.699B**. The filing’s uninsured-discount line was **$0**, an audit question because discounts may be classified elsewhere.\n\n**Verdict:** high prices warrant scrutiny, but summary filings do not prove the $220.5M profit came from unlawful patient overcharging. Needed: allowed amounts, cash collections, payer margins, and patient-level bills.","x":20330,"y":5720,"width":1500,"height":620,"color":"1"},
		{"id":"np_v11_billing","type":"file","file":"attachments/Sunrise Hospital Evidence/patient-billing-evidence-2026.svg","x":20330,"y":6370,"width":1404,"height":790},
		{"id":"np_q3_benefits_parking","type":"text","text":"## Q3 · What about Sunrise insurance, parking and rising expenses?\n\n**[Gap] No Sunrise-specific insurance or parking increase was supplied or independently located.** Percentages reported for another hospital system must not be reused here.\n\nUse actual Sunrise documents:\n- Insurance added cost = (new monthly contribution − old monthly contribution) × 12\n- Parking added cost = (new monthly deduction − old monthly deduction) × 12\n\nCompare the same plan tier, deductible, coverage level, garage/access tier and pretax treatment.\n\n**Best evidence to request:** old/new Sunrise plan-tier rates, employer contributions, parking notices and payroll deductions.","x":21930,"y":1100,"width":1500,"height":620,"color":"2"},
		{"id":"np_method_note","type":"text","text":"# SOURCE & CLAIM DISCIPLINE\n\nThe adjacent note contains the full source ledger, URLs, equations, assumptions and missing-record list. Every visual in this segment is stored locally in the vault.\n\n**Do not collapse these scopes:**\n- Sunrise facility accounting ≠ HCA consolidated cash\n- Job-ad range ≠ incumbent union wage\n- Contractor relationship ≠ misconduct\n- OIG audit recommendation ≠ fraud conviction\n- List-price markup ≠ amount collected\n- Capital investment ≠ cash automatically available for wages\n\n**Most important unresolved documents:** dated wage proposal; current CBA; employee insurance and parking schedules; Sunrise vendor-level spend; Clark County court-case export.\n\nPrepared Aug. 25, 2026.","x":21830,"y":7260,"width":1570,"height":980,"color":"6"},
		{"id":"np_v3_benefits","type":"file","file":"attachments/Sunrise Hospital Evidence/benefit-parking-dollar-test.svg","x":21930,"y":1750,"width":1404,"height":790},
		{"id":"np_v1_wage","type":"file","file":"attachments/Sunrise Hospital Evidence/nurse-pay-market-comparison-2026.svg","x":18730,"y":1750,"width":1404,"height":790},
		{"id":"np_v4_verdict","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-final-verdict-2026.svg","x":18730,"y":3290,"width":1404,"height":790},
		{"id":"np_v9_teamhealth","type":"file","file":"attachments/Sunrise Hospital Evidence/teamhealth-sunrise-em-job.png","x":22895,"y":4830,"width":262,"height":790},
		{"id":"np_sources_note","type":"file","file":"Sunrise Nurse Pay and Accountability Addendum 2026-08-25.md","x":18730,"y":7260,"width":3050,"height":980},
		{"id":"np_v8_staffing","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-staffing-volume-2022-2025.svg","x":20330,"y":4830,"width":1404,"height":790},
		{"id":"np_q9_contractors","type":"text","text":"## Q9 · Which private-equity or related contractors are present?\n\n**Verified service relationships:**\n- **TeamHealth / Blackstone:** emergency + hospital medicine\n- **US Anesthesia Partners:** anesthesia; backed by WCAS/Berkshire/GIC\n- **Red Rock Radiology / Radiology Partners:** radiology; institutional-investor backed\n- **HealthTrust Workforce Solutions:** contingent staffing, but **HCA-owned—not PE**\n- **Parallon:** HCA-owned revenue-cycle services, **not PE**\n\nNo PE-backed Sunrise parking vendor was identified. Exact Sunrise vendor dollars are not disclosed; professional fees and purchased services cannot be allocated by vendor from public filings.","x":21930,"y":4180,"width":1500,"height":620,"color":"5"},
		{"id":"np_q12_quality_answer","type":"text","text":"## Q12 · Quality, safety, and the final answer\n\n**Current CMS release (Apr. 2026): 2 stars.** Mortality measures were generally better/no different; readmission was weaker. Lown grades: outcomes A, safety A, satisfaction D, equity C, social responsibility B. The 2021 Leapfrog C is historical; current Leapfrog staffing measures were listed as “did not measure.”\n\n**Final answer:** Public finances do not substantiate a blanket “unable to pay” claim. They support a demand for transparent costing and a priorities explanation. They do not, alone, prove fraud, unlawful bargaining, or that every capital project should have been redirected to wages.\n\n**Must obtain:** complete proposal, CBA wage grid, benefit/parking sheets, staffing matrices and vendor contracts.","x":21930,"y":5720,"width":1500,"height":620,"color":"2"},
		{"id":"np_v5_profit","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-profit-trend-2020-2025.svg","x":20330,"y":3290,"width":1404,"height":790},
		{"id":"np_q7_investment","type":"text","text":"## Q7 · What is Sunrise investing in? Is it extravagant?\n\n**2023 capital spending:** **$47.3M** — expansions $12.1M, equipment $3.8M, other $31.4M. Property/facility/equipment book value rose **$344.5M → $395.2M** from 2023–2025; 2025 construction-in-progress was **$26.1M**.\n\nA historical multi-phase expansion was reported at about **$200M**, including $131M for ED/trauma work. Sunrise gained adult **Level I trauma** designation in April 2026. The network also operates freestanding EDs and CareNow sites.\n\n**Answer:** Much of this can plausibly be clinical/access capacity. Capital and wages are not perfectly interchangeable, but priorities and returns are fair bargaining questions.","x":18730,"y":4180,"width":1500,"height":620,"color":"4"},
		{"id":"np_v12_final","type":"file","file":"attachments/Sunrise Hospital Evidence/sunrise-final-verdict-2026.svg","x":21930,"y":6370,"width":1404,"height":790},
		{"id":"np_q4_enough","type":"text","text":"## Q4 · Is 2.2% / 2% / 2% enough?\n\n**[Calculated from the Sunrise nurse-reported proposal]** Compounded nominal growth over three years is **6.33%**.\n\nIf inflation is 3.0%:\n- Year 1 purchasing power: **−0.78%**\n- Three-year purchasing power, if CPI stays 3% each year: **−2.69%**\n\n**Answer:** On that scenario, the offer does not preserve purchasing power. Any Sunrise-specific insurance or parking change must be added only after the actual rate sheets are obtained.\n\n**Important:** obtain the dated proposal; do not publish the percentages as a verified employer offer without it.","x":18730,"y":2640,"width":1500,"height":620,"color":"2"},
		{"id":"np_v2_inflation","type":"file","file":"attachments/Sunrise Hospital Evidence/raise-vs-inflation-2026.svg","x":20330,"y":1750,"width":1404,"height":790},
		{"id":"np_q6_oig","type":"text","text":"## Q6 · Was there a $223M Medicare-fraud prosecution?\n\n**No public record located supports that wording.** HHS OIG audit **A-04-19-08075** reviewed selected high-risk claims from 2017–2018. In a 100-claim sample, OIG found 54 noncompliant claims and recommended a **$23,606,895 extrapolated net refund**. The sampled overpayment was **$999,950**.\n\nSunrise disputed the findings. This was an **audit and refund recommendation**, not a $223M criminal fraud conviction or prosecution.\n\n**Source image below:** first page of the official HHS OIG audit brief.\n\n**Rule:** describe audit findings, management response and adjudicative status separately.","x":21930,"y":2640,"width":1500,"height":620,"color":"1"},
		{"id":"np_v6_oig","type":"file","file":"attachments/Sunrise Hospital Evidence/oig-audit-brief-page1.png","x":21930,"y":3290,"width":610,"height":789},
		{"id":"np_q2_market_inflation","type":"text","text":"## Q2 · What do Las Vegas nurses make, and what is inflation?\n\n**BLS Las Vegas RN pay (May 2025):** 25th **$42.64**, median **$49.97**, 75th **$59.61**, 90th **$64.07/hr**. Peer postings: UMC med/surg **$40.72–$63.12**; Valley ER **$41.90–$62.76**.\n\nBLS does not publish a Las Vegas CPI. The best official proxy, **West Region CPI (July 2026)**, was **3.0%** overall; housing 2.6%, food 3.0%, medical care 1.5%, energy 13.8%, gasoline 20.8%.\n\n**Do not add category inflation rates together:** the 3.0% index already combines them.\n\n**Sources:** BLS OEWS; BLS CPI West; UMC/UHS postings.","x":20330,"y":1100,"width":1500,"height":620,"color":"4"}
	],
	"edges":[
		{"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_controversy","fromNode":"harm_verdict","fromSide":"right","toNode":"oig_card","toSide":"left","color":"1","label":"harm 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"},
		{"id":"e_verdict_nursepay","fromNode":"questions","fromSide":"right","toNode":"np_header","toSide":"left","color":"5","label":"2026 nurse-pay addendum"},
		{"id":"e_priority_loss","fromNode":"priority_title","fromSide":"bottom","toNode":"priority_loss_text","toSide":"top","color":"1","label":"2023 squeeze"},
		{"id":"e_priority_loss_chart","fromNode":"priority_loss_text","fromSide":"bottom","toNode":"priority_loss_chart","toSide":"top","color":"1"},
		{"id":"e_priority_turnaround","fromNode":"priority_title","fromSide":"bottom","toNode":"priority_turnaround_text","toSide":"top","color":"3","label":"2024 rebound"},
		{"id":"e_priority_turnaround_chart","fromNode":"priority_turnaround_text","fromSide":"bottom","toNode":"priority_turnaround_chart","toSide":"top","color":"3"},
		{"id":"e_priority_profit","fromNode":"priority_title","fromSide":"bottom","toNode":"priority_profit_text","toSide":"top","color":"4","label":"2025 operating profit"},
		{"id":"e_priority_profit_chart","fromNode":"priority_profit_text","fromSide":"bottom","toNode":"priority_profit_chart","toSide":"top","color":"4"},
		{"id":"e_priority_raise","fromNode":"priority_title","fromSide":"bottom","toNode":"priority_raise_text","toSide":"top","color":"2","label":"5% / 6% affordability"},
		{"id":"e_priority_raise_chart","fromNode":"priority_raise_text","fromSide":"bottom","toNode":"priority_raise_chart","toSide":"top","color":"2"},
		{"id":"e_priority_to_identity","fromNode":"priority_title","fromSide":"bottom","toNode":"title","toSide":"top","color":"5","label":"then verify identity and scope"}
	]
}