Hospital CEO Pay vs Nurse Pay: Executive Compensation Data From IRS 990 Filings (2026 Analysis)
By NurseCompensation Research Team · 2026-07-20 · 14 min read
The median non-profit hospital CEO earns $1.7 million annually while the median staff nurse at the same institution earns $86,070. IRS Form 990 filings reveal the actual CEO-to-nurse pay ratio at major health systems.
Public Data: Where Executive Compensation Comes From
Non-profit hospitals are required to disclose executive compensation on IRS Form 990 filings — publicly available documents. For-profit hospital systems disclose executive pay in SEC proxy statements (DEF 14A filings). This analysis uses both sources to compare leadership compensation to frontline nurse wages.
CEO Compensation at Major Non-Profit Health Systems (IRS 990, FY2023)
| Health System | CEO | Total Compensation | Base Salary | Bonus/Incentive | Deferred/Other |
|---|---|---|---|---|---|
| Kaiser Permanente | Greg Adams | $16.1 million | $2.1M | $8.4M | $5.6M |
| Cleveland Clinic | Tom Mihaljevic, MD | $9.8 million | $2.8M | $4.2M | $2.8M |
| Mayo Clinic | Gianrico Farrugia, MD | $8.2 million | $2.4M | $3.1M | $2.7M |
| Mass General Brigham | Anne Klibanski, MD | $7.4 million | $2.2M | $3.0M | $2.2M |
| NYU Langone | Robert Grossman, MD | $11.2 million | $3.1M | $5.4M | $2.7M |
| Johns Hopkins Medicine | Theodore DeWeese, MD | $5.8 million | $1.8M | $2.4M | $1.6M |
| UPMC | Leslie Davis | $9.4 million | $2.6M | $4.2M | $2.6M |
| Northwell Health | Michael Dowling | $7.2 million | $2.0M | $3.1M | $2.1M |
| Ascension Health | Joseph Impicciche | $6.8 million | $1.9M | $2.8M | $2.1M |
| CommonSpirit Health | Wright Lassiter III | $8.1 million | $2.3M | $3.4M | $2.4M |
| Providence | Rod Hochman, MD | $10.4 million | $2.8M | $4.8M | $2.8M |
| Advocate Health | Eugene Woods | $7.6 million | $2.1M | $3.2M | $2.3M |
CEO Compensation at For-Profit Systems (SEC Proxy Statements, FY2023)
| System | CEO | Total Compensation | Stock Awards | Cash Compensation |
|---|---|---|---|---|
| HCA Healthcare | Sam Hazen | $24.8 million | $16.2M | $8.6M |
| Tenet Healthcare | Saum Sutaria, MD | $16.4 million | $10.8M | $5.6M |
| Universal Health Services | Marc Miller | $14.2 million | $8.4M | $5.8M |
| Community Health Systems | Tim Hingtgen | $9.8 million | $6.2M | $3.6M |
| Encompass Health | Mark Tarr | $8.6 million | $5.4M | $3.2M |
The CEO-to-Nurse Pay Ratio
Using BLS median RN salary ($86,070) and system-specific median RN compensation where available:
| System | CEO Total Comp | Median RN Salary (est.) | CEO-to-Nurse Ratio |
|---|---|---|---|
| HCA Healthcare | $24.8M | $76,000 | 326:1 |
| Kaiser Permanente | $16.1M | $151,000 | 107:1 |
| Tenet Healthcare | $16.4M | $74,000 | 222:1 |
| NYU Langone | $11.2M | $98,000 | 114:1 |
| Providence | $10.4M | $96,000 | 108:1 |
| Cleveland Clinic | $9.8M | $82,000 | 120:1 |
| UPMC | $9.4M | $78,000 | 121:1 |
| Mayo Clinic | $8.2M | $89,000 | 92:1 |
| CommonSpirit | $8.1M | $84,000 | 96:1 |
| UHS | $14.2M | $72,000 | 197:1 |
| CHS | $9.8M | $70,000 | 140:1 |
| Ascension | $6.8M | $78,000 | 87:1 |
Median CEO-to-nurse ratio across these systems: 114:1
For context, the Economic Policy Institute reports the average CEO-to-worker ratio across all U.S. industries at 344:1 (2023). Hospital CEO-to-nurse ratios are lower than the corporate average — but the comparison to average workers (not skilled professionals) is the relevant benchmark in corporate America.
How CEO Pay Has Grown vs Nurse Pay (2014-2023)
| Metric | 2014 | 2023 | Growth |
|---|---|---|---|
| Median non-profit hospital CEO comp | $1.1M | $1.7M | +54.5% |
| Top-10 system CEO comp (average) | $5.8M | $9.6M | +65.5% |
| For-profit system CEO comp (average) | $12.4M | $18.2M | +46.8% |
| Median staff RN salary (BLS) | $62,310 | $86,070 | +38.1% |
| CPI inflation (cumulative) | — | — | +28.7% |
CEO compensation grew 47-66% over the decade while nurse wages grew 38%. Both outpaced inflation, but executives gained at a significantly faster rate.
The C-Suite Layer: It's Not Just the CEO
IRS 990 filings disclose all officers earning above $150,000. A typical large health system (10,000+ employees) has 15-30 executives earning $1 million+:
| Title | Median Compensation (Large Non-Profit System) |
|---|---|
| CEO/President | $4.2 million |
| COO | $2.8 million |
| CFO | $2.4 million |
| CMO (Chief Medical Officer) | $2.1 million |
| CNO (Chief Nursing Officer) | $850,000 |
| Regional Presidents (each) | $1.8 million |
| VP/SVP roles (each) | $800,000-$1.4 million |
| Total C-suite compensation (top 20 officers) | $28-$45 million |
Notably, the CNO (Chief Nursing Officer) is the lowest-paid C-suite executive in most systems — earning 60-80% less than the CEO and 50-70% less than the COO/CFO despite overseeing the largest workforce segment (nursing = 23% of hospital operating costs).
What Executive Compensation Represents as % of Revenue
| System | Annual Revenue | Total Executive Comp (top 20) | Exec Comp as % Revenue |
|---|---|---|---|
| Kaiser Permanente | $100.8B | $68M | 0.07% |
| HCA Healthcare | $64.9B | $82M | 0.13% |
| CommonSpirit | $35.2B | $42M | 0.12% |
| Cleveland Clinic | $14.8B | $38M | 0.26% |
| Northwell Health | $16.4B | $35M | 0.21% |
Executive compensation represents 0.07-0.26% of system revenue. The common claim that "cutting CEO pay could fund nurse raises" is mathematically limited:
If the entire CEO salary were redistributed:
- Kaiser CEO ($16.1M) / 75,000 nurses = $215 per nurse (0.14% raise)
- HCA CEO ($24.8M) / 94,000 nurses = $264 per nurse (0.35% raise)
- Cleveland Clinic CEO ($9.8M) / 12,000 nurses = $817 per nurse (1.0% raise)
Redistributing CEO pay alone would not materially change nurse compensation — the issue is structural, not about one salary.
Where the Money Actually Goes
For a typical non-profit hospital system with $10 billion in revenue:
| Category | $ Amount | % of Revenue |
|---|---|---|
| Nursing labor (all levels) | $2.3B | 23% |
| Other clinical labor | $1.4B | 14% |
| Physician compensation | $800M | 8% |
| Administrative labor | $700M | 7% |
| Supplies and drugs | $2.2B | 22% |
| Facilities/depreciation | $1.0B | 10% |
| Insurance/malpractice | $300M | 3% |
| Technology/IT | $400M | 4% |
| Executive compensation (top 20) | $35M | 0.35% |
| Debt service | $500M | 5% |
| Operating margin/surplus | $350M | 3.5% |
The Real Leverage Point: Operating Margin
The operating margin (3.5% in this example = $350 million) is the actual discretionary pool. A 1% across-the-board nurse raise at this system costs approximately $23 million — affordable from the margin, but representing 6.6% of total surplus.
A 5% nurse raise: $115 million = 33% of operating margin. This is why nurse compensation increases require systemic revenue growth (higher reimbursement, volume increases) — not merely a reallocation from executive pay.
Non-Profit "Non-Profit": Community Benefit Requirements
Non-profit hospitals receive tax exemptions (estimated at $28 billion annually per Congressional Budget Office). In exchange, they must provide "community benefit" — charity care, research, education. IRS data shows:
| Metric | Median Non-Profit Hospital |
|---|---|
| Tax exemption value | $8.4 million/year |
| Reported community benefit spending | $12.1 million/year |
| Charity care (uncompensated) | $4.2 million/year |
| Executive comp exceeding $1M (total officers) | $14.8 million/year |
At many systems, total executive compensation exceeding $1M per officer is greater than total charity care provided — a data point that has drawn Congressional scrutiny (Senate HELP Committee hearing, March 2024).
What This Data Means for Nurses
- Pay ratios are public information — you can look up any non-profit hospital's IRS 990 on ProPublica's Nonprofit Explorer or GuideStar for free
- CNOs are underpaid relative to other C-suite — advocacy for nursing leadership compensation affects the entire profession's perceived value
- The math doesn't support "just cut CEO pay" — but it does reveal that systems choosing to invest in executive retention over staff retention is a values decision, not a financial necessity
- Operating margins fund raises — when your hospital reports positive margins while denying market adjustments, the money exists — it is being allocated elsewhere
- For-profit vs non-profit matters — for-profit systems extract shareholder returns that non-profits reinvest (theoretically); nurse wages are comparable between the two, contradicting the non-profit "mission" premium
Sources: IRS Form 990 filings accessed via ProPublica Nonprofit Explorer (FY2023); SEC DEF 14A Proxy Statements (HCA, Tenet, UHS, CHS — FY2023); BLS OES May 2023; Economic Policy Institute CEO Compensation Report (2024); AHA Annual Survey of Hospitals (2024); Congressional Budget Office "Nonprofit Hospitals and Tax Arbitrage" (2023); Senate HELP Committee hearing transcript (March 2024).