The public-facing sequence: complaint, entity, money, staffing, safety, billing corrections, enforcement, and verdict.
A 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.
[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.
1. Start with the nurse's claimed raise offer, then say the written proposal is still needed.
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.
3. Put Sunrise's local profit and HCA's shareholder returns beside the alleged wage proposal without pretending parent cash is facility cash.
4. Test whether the hospital expanded property and construction while frontline capacity tightened.
5. Explain the historical C safety grade accurately, including both bad and favorable component measures.
6. Correct the billing claim: Sunrise ranked second for markup, while the study found zero court actions.
7. Close with the documented audit, ADA settlement and open labor allegations, then demand the missing contracts and ledgers.
Evidence map as of August 25, 2026
[Confirmed] This canvas concerns Sunrise Hospital and Medical Center, LLC at 3186 S. Maryland Parkway, Las Vegas — not a Los Angeles hospital.
[Scope] Sunrise facility money, HCA consolidated money, reimbursement, capital, investments and accounting balances stay in separate ledgers.
Legal name: Sunrise Hospital and Medical Center, LLC
DBA: Sunrise Hospital & Medical Center
CCN: 290003
NPI: 1861439952
TIN/EIN: 62-1762537
Entity: Delaware LLC registered in Nevada on Jan. 12, 1999.
Tax status: proprietary / for-profit. It is not a 501(c)(3).
HCA Healthcare, Inc. (NYSE: HCA) controls Sunrise through layered subsidiaries.
Ownership route: public company — not a nonprofit and not currently private-equity owned.
[Confirmed] HCA was sponsor-owned from 2006–2011; that history does not make Sunrise currently PE-owned.
Revenue: $75.600 billion
Net income attributable to HCA: $6.784 billion
Net margin: $6.784B ÷ $75.600B = 8.97%
Buybacks: $10.067 billion
Dividends: $679 million
Capital spending: $4.944 billion
[Analysis] HCA was not broke. These figures show consolidated capacity; they do not trace a Sunrise dollar into a buyback or dividend.
Insurance-subsidiary securities: $588M fair value at Dec. 31, 2025 — $103M current and $485M long-term.
Investments/advances to affiliates: $633M.
[Confirmed] The insurance portfolio supports claims and statutory equity; HCA says excess insurance investments are not general corporate cash.
[Scope] These are HCA balances, not Sunrise facility investments.
HCA Healthcare, Inc.
↓
HCA Inc.
↓
Healthtrust, Inc.–The Hospital Company
↓
AC Med, LLC
↓
Sunrise Hospital and Medical Center, LLC
[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.
834 licensed beds
Level I trauma center
44,983 inpatient admissions in 2025
188,476 emergency visits in 2025
3,386 employed hospital FTE + 130 contracted FTE at Q4 2025
[Confirmed] Nevada’s 2024 trauma report recorded 857 transfers to Sunrise, the most among Nevada trauma centers.
[Scope] FTE is not unique headcount; transfer volume is not a mortality measure.
Net patient revenue: $1,250,603,326
Total operating revenue: $1,256,316,034
Operating expense: $1,035,812,123
Net income: $220,503,911
[Calculated] Facility margin: $220,503,911 ÷ $1,256,316,034 = 17.55%.
[Analysis] This is a Sunrise facility accounting result. It is not cash in a local bank account and not HCA’s consolidated profit.
[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.
[Discrepancy] Nevada reports $880.051M of CY2023 net patient revenue; period/method differences prevent direct comparison.
[Confirmed] Medicaid and Medicare together represented 71.71% of 2025 admissions.
[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.
[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.
Verdict: not broke on the public record.
Sunrise reported profits in 2020, 2021, 2022, 2024 and 2025, with a real but small $4.29M loss in 2023.
[Calculated] 2024→2025 revenue rose 5.40% and profit rose 14.66%.
[Innocent explanation tested] Rate changes, volume, acuity and Medicaid supplemental payments can move facility results sharply. The exact profit bridge is not public.
HCA shareholders: $10.067B buybacks + $679M dividends in 2025.
Sam Hazen: $26.457M total compensation in 2025.
Capital vendors systemwide: $4.944B HCA capital spending in 2025.
[Scope] These are consolidated HCA uses. No public journal traces Sunrise cash into them.
[Analysis] The tension is real — a profitable parent returned capital while local staffing pressure persisted — but the missing intercompany ledger prevents a diversion claim.
For CY2023–CY2025, Sunrise’s state workbooks reported:
Marketable securities: $0
Interest/investment income: $0
JV/minority-interest income: $0
Gain on sale of assets: $0
Total non-operating revenue: $0
[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.
Sunrise reported $47.304M of 2023 capital:
[Calculated] $47.304M ÷ $39.728M depreciation = 119.07% for 2023.
[Scope] Capital money is not automatically available for wages; restrictions and financing sources were not disclosed.
2022: 28% RN vacancy rate and 465 openings reported.
2023: out-of-ratio assignments, overflow and floating to ED/satellite areas documented.
2024: vacancy improved to 5.77% / 63 openings; objection/refusal forms fell from 108 to 57.
2025: annual admissions rose 4.38% while Q4 combined RN FTE fell 3.03%.
[Analysis] Hiring improvements through 2024 and renewed 2025 capacity pressure can both be true.
CMS overall: 2 stars
Mortality: no condition measure worse than national; two better, six no different
Readmissions: two worse, six no different
Postoperative sepsis PSI: worse than national
ED median visit: 164 minutes
Lown: Outcomes A · Safety A · Satisfaction D
[Scope] CMS, Lown and historical Leapfrog grades use different periods and methods.
Sunrise 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.
[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.
[Boundary] A C grade is a safety signal, not a death count or proof that staffing caused a specific injury.
The official Leapfrog page shows C grades in both Spring and Fall of 2023, 2024 and 2025.
[Analysis] Repeated middling headline grades justify asking what stayed unresolved, but 2021 component scores cannot be presented as current.
[Innocent explanation tested] Component measures and methods change; recent infection measures are not uniformly poor.
OIG sampled 100 claims from a $41M high-risk universe and found 54 noncompliant before five reprocessings.
Refund recommendation: $23,606,895.
Sunrise disputed medical-necessity findings and extrapolation.
As of July 22, 2026, OIG’s tracker lists all three recommendations Closed Implemented.
[Verdict] A disputed audit and implemented refund recommendation — not a criminal fraud judgment.
[Confirmed] Clark County imposed a $9,000 penalty for failure to perform required burner-efficiency tests.
[Innocent explanation] An isolated environmental testing lapse; no patient-harm intent shown.
[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.
[Allegation] NLRB case 28-CA-365427 remains open and alleges retaliation, discipline, unilateral changes, threats and surveillance. No merits finding.
DOJ described $1.7B in total government recoveries across HCA’s 2000–2003 criminal/civil resolutions; subsidiaries entered guilty pleas in 2000.
[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.
The five-year record shows repeated contact with different oversight systems — billing, labor, disability access, environmental compliance and state reporting.
[Innocent explanation tested] These matters differ sharply in entity, legal posture and severity. The pattern supports scrutiny, not a single adjudicated corruption scheme.
[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.
The deeper Las Vegas research canvas with wage, contractor, benefit, financial-turnaround, and accountability materials.
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.
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.
Revenue: +$13.075M (+1.50%)
Expenses: +$72.869M (+8.92%)
Profit change: −$59.794M
Largest 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.
Verdict: the −$4.288M was the residual after expenses outran revenue—not a separate hidden $4.3M transaction.
2023→2024 operating revenue increased $306.246M, expense increased $109.640M, and profit improved $196.606M to +$192.318M.
Nevada’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.
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.
Net patient revenue: $1.250603B
Other operating revenue: $5.713M
Operating revenue: $1.256316B
Operating expenses: $1.035812B
Net income: $220.504M (17.55%)
Inpatient net revenue was $953.516M (76.24%); outpatient was $297.087M (23.76%). Reported non-operating revenue was $0.
Conclusion: the profit is an operating patient-care margin. The public workbook does not disclose payer-level margins, cash collections, or service-line profitability.
2025 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.
Using 1,375 employed RN FTE, BLS median $49.97/hr, and 2,080 hours: estimated RN base-pay pool $142.9M.
5%: $7.15M direct; $8.93M with 25% burden.
6%: $8.57M direct; $10.72M with burden.
Direct cost equals 3.24% / 3.89% of 2025 profit. Extra above 2.2%: $4.00M / $5.43M. Agency RNs and non-RN classifications excluded.
Evidence map as of August 25, 2026
[Confirmed] This canvas concerns Sunrise Hospital and Medical Center, LLC at 3186 S. Maryland Parkway, Las Vegas — not a Los Angeles hospital.
[Scope] Sunrise facility money, HCA consolidated money, reimbursement, capital, investments and accounting balances stay in separate ledgers.
Legal name: Sunrise Hospital and Medical Center, LLC
DBA: Sunrise Hospital & Medical Center
CCN: 290003
NPI: 1861439952
TIN/EIN: 62-1762537
Entity: Delaware LLC registered in Nevada on Jan. 12, 1999.
Tax status: proprietary / for-profit. It is not a 501(c)(3).
HCA Healthcare, Inc. (NYSE: HCA) controls Sunrise through layered subsidiaries.
Ownership route: public company — not a nonprofit and not currently private-equity owned.
[Confirmed] HCA was sponsor-owned from 2006–2011; that history does not make Sunrise currently PE-owned.
Revenue: $75.600 billion
Net income attributable to HCA: $6.784 billion
Net margin: $6.784B ÷ $75.600B = 8.97%
Buybacks: $10.067 billion
Dividends: $679 million
Capital spending: $4.944 billion
[Analysis] HCA was not broke. These figures show consolidated capacity; they do not trace a Sunrise dollar into a buyback or dividend.
Insurance-subsidiary securities: $588M fair value at Dec. 31, 2025 — $103M current and $485M long-term.
Investments/advances to affiliates: $633M.
[Confirmed] The insurance portfolio supports claims and statutory equity; HCA says excess insurance investments are not general corporate cash.
[Scope] These are HCA balances, not Sunrise facility investments.
HCA Healthcare, Inc.
↓
HCA Inc.
↓
Healthtrust, Inc.–The Hospital Company
↓
AC Med, LLC
↓
Sunrise Hospital and Medical Center, LLC
[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.
834 licensed beds
Level I trauma center
44,983 inpatient admissions in 2025
188,476 emergency visits in 2025
3,386 employed hospital FTE + 130 contracted FTE at Q4 2025
[Confirmed] Nevada’s 2024 trauma report recorded 857 transfers to Sunrise, the most among Nevada trauma centers.
[Scope] FTE is not unique headcount; transfer volume is not a mortality measure.
Net patient revenue: $1,250,603,326
Total operating revenue: $1,256,316,034
Operating expense: $1,035,812,123
Net income: $220,503,911
[Calculated] Facility margin: $220,503,911 ÷ $1,256,316,034 = 17.55%.
[Analysis] This is a Sunrise facility accounting result. It is not cash in a local bank account and not HCA’s consolidated profit.
[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.
[Discrepancy] Nevada reports $880.051M of CY2023 net patient revenue; period/method differences prevent direct comparison.
[Confirmed] Medicaid and Medicare together represented 71.71% of 2025 admissions.
[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.
[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.
Nevada’s combined-period report shows Sunrise supplemental payments rising from $27.511M to $216.202M — an increase of $188.692M.
[Calculated] That equals 96.0% of the $196.606M improvement from the 2023 loss to the 2024 profit.
[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.
HCA shareholders: $10.067B buybacks + $679M dividends in 2025.
Sam Hazen: $26.457M total compensation in 2025.
Capital vendors systemwide: $4.944B HCA capital spending in 2025.
[Scope] These are consolidated HCA uses. No public journal traces Sunrise cash into them.
[Analysis] The tension is real — a profitable parent returned capital while local staffing pressure persisted — but the missing intercompany ledger prevents a diversion claim.
For CY2023–CY2025, Sunrise’s state workbooks reported:
Marketable securities: $0
Interest/investment income: $0
JV/minority-interest income: $0
Gain on sale of assets: $0
Total non-operating revenue: $0
[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.
Sunrise reported $47.304M of 2023 capital:
[Calculated] $47.304M ÷ $39.728M depreciation = 119.07% for 2023.
[Scope] Capital money is not automatically available for wages; restrictions and financing sources were not disclosed.
2022: 28% RN vacancy rate and 465 openings reported.
2023: out-of-ratio assignments, overflow and floating to ED/satellite areas documented.
2024: vacancy improved to 5.77% / 63 openings; objection/refusal forms fell from 108 to 57.
2025: annual admissions rose 4.38% while Q4 combined RN FTE fell 3.03%.
[Analysis] Hiring improvements through 2024 and renewed 2025 capacity pressure can both be true.
CMS overall: 2 stars
Mortality: no condition measure worse than national; two better, six no different
Readmissions: two worse, six no different
Postoperative sepsis PSI: worse than national
ED median visit: 164 minutes
Lown: Outcomes A · Safety A · Satisfaction D
[Scope] CMS, Lown and historical Leapfrog grades use different periods and methods.
OIG sampled 100 claims from a $41M high-risk universe and found 54 noncompliant before five reprocessings.
Refund recommendation: $23,606,895.
Sunrise disputed medical-necessity findings and extrapolation.
As of July 22, 2026, OIG’s tracker lists all three recommendations Closed Implemented.
[Verdict] A disputed audit and implemented refund recommendation — not a criminal fraud judgment.
[Confirmed] Clark County imposed a $9,000 penalty for failure to perform required burner-efficiency tests.
[Innocent explanation] An isolated environmental testing lapse; no patient-harm intent shown.
[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.
[Allegation] NLRB case 28-CA-365427 remains open and alleges retaliation, discipline, unilateral changes, threats and surveillance. No merits finding.
DOJ described $1.7B in total government recoveries across HCA’s 2000–2003 criminal/civil resolutions; subsidiaries entered guilty pleas in 2000.
[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.
The five-year record shows repeated contact with different oversight systems — billing, labor, disability access, environmental compliance and state reporting.
[Innocent explanation tested] These matters differ sharply in entity, legal posture and severity. The pattern supports scrutiny, not a single adjudicated corruption scheme.
[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.
[Verified public job ranges]
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.
Source: HCA Sunrise job postings, checked Aug. 2026. Missing: current CBA wage grid and employee pay-step distribution.
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.
BLS 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%.
Do not add category inflation rates together: the 3.0% index already combines them.
Sources: BLS OEWS; BLS CPI West; UMC/UHS postings.
[Calculated from the Sunrise nurse-reported proposal] Compounded nominal growth over three years is 6.33%.
If inflation is 3.0%:
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.
Important: obtain the dated proposal; do not publish the percentages as a verified employer offer without it.
[Verified facility accounting] 2025: revenue $1.256B; expenses $1.036B; net income $220.5M; margin 17.55%.
Net 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.
2023 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.
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.
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.
Sunrise disputed the findings. This was an audit and refund recommendation, not a $223M criminal fraud conviction or prosecution.
Source image below: first page of the official HHS OIG audit brief.
Rule: describe audit findings, management response and adjudicative status separately.
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.
A 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.
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.
Q4 employed / contracted RN FTE:
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.
Sources: Nevada hospital staffing/volume filings. These are FTEs, not shift-level ratios.
Verified service relationships:
No 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.
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.
Sunrise 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.
Local Sunrise CEO compensation and the exact share of HCA profit attributable to Sunrise are not publicly disclosed.
2025 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.
Private-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.
Verdict: high prices warrant scrutiny, but summary filings do not prove the $220.5M profit came from unlawful patient overcharging.
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.”
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.
Sunrise Nurse Pay and Accountability Addendum 2026-08-25.md