HCA Healthcare CEO Sam Hazen took home $26.5 million in total compensation in 2025, which is 420 times more than the Nashville, Tenn.-based health system’s median employee, according to a proxy statement filed with the Securities and Exchange Commission on March 13.
Here are eight things to know:
1. The median HCA employee earned $62,955 last year, a 420:1 pay ratio. In 2024, the gap stood at 391:1, when Mr. Hazen earned $23.8 million and the median employee earned $60,820.
2. In 2023, the ratio was 356:1, with Mr. Hazen’s pay at $21.3 million and median employee earnings of $59,816. Over three years, Mr. Hazen’s total compensation has grown by nearly $5.2 million, a 24% increase, while median employee pay has risen by roughly $3,100, or about 5%.
3. HCA noted in the filing that the pay ratio is a “reasonable estimate calculated in a manner consistent with SEC rules,” based on payroll and employment records. As of Dec. 31, the health system had 316,971 active employees who received compensation in 2025. The SEC requires all public companies to disclose the CEO-to-worker pay ratio annually.
4. The bulk of Mr. Hazen’s $26.5 million package came from equity. Stock awards ($8.5 million) and option awards ($8.5 million) together accounted for roughly 64% of his total compensation. His base salary was $1.6 million, nonequity incentive plan compensation totaled $5.4 million, changes in pension value and deferred compensation earnings added $1.9 million, and other compensation rounded out the package at $539,026.
5. Four other executives cleared the $5 million mark in total 2025 compensation. Jon Foster, executive vice president and COO, was the second-highest earner at $11 million, up from $9.2 million in 2024. His package included a $1 million base salary, $3.8 million in combined stock and option awards, $2.6 million in nonequity incentive compensation and $3.4 million in pension and deferred compensation gains.
6. Mike Marks, executive vice president and CFO, ranked third at $10.4 million, nearly double his 2024 total of $5.5 million. The jump was driven in large part by $3.3 million in pension value and deferred compensation changes, which did not appear in his prior-year figure.
7. Michael McAlevey, executive vice president and chief legal and administrative officer, earned $5.7 million, roughly in line with his $5.7 million in 2024. His compensation included a $1 million base salary and $3.3 million in combined equity awards.
8. Michael Cuffe, MD, executive vice president and chief clinical officer, rounded out the top five at $5.7 million, up slightly from $5.5 million in 2024.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
