Spotlight grows brighter, hotter on healthcare CEO compensation

The accelerating consolidation of not-for-profit healthcare systems in North Carolina is magnifying the spotlight on executive compensation.

The focus is particularly bright for Eugene Woods, chief executive of Advocate Health, whose fiscal 2024 compensation jumped 39% to $25.87 million as he became the system's lone chief executive in July 2024.

Advocate, based in Charlotte, has 67 hospitals and more than 150,000 employees in six states.

The Winston-Salem Journal and News & Record is reporting their 14th annual chief executive compensation analysis. The 2026 report lists 42 publicly traded corporations and four not-for-profit healthcare systems.

Advocate, Atrium Health Wake Forest Baptist, Cone Health and Novant Health Inc. are included because they are among the Triad's largest employers, and because they pay corporate America-level executive compensation packages.

Charlotte-based Advocate owns Baptist, which is the Triad's largest employer at more than 22,000. Cone, which is owned by Risant Health, has more than 13,000 employees, while Novant has about 8,150 of its 40,000-plus in the region.

Not-for-profit healthcare systems' executive compensation disclosures are based on Form 990 filings to the Internal Revenue Service. Those filings typically are between 12 and 17 months old when they become public.

The 2024 compensation breakdown for Woods was $4.63 million in base salary, $14.44 million in bonus and incentive pay, $3.89 million in all other compensation and $2.9 million in deferred compensation.

To put Woods' total compensation into context, he ranked fifth on the 2026 analysis.

Woods trailed just Wells Fargo & Co.'s Charlie Scharf ($94.52 million), JPMorgan Chase & co.'s Jamie Dimon ($40.63 million), Lincoln National Corp.'s Ellen Cooper ($27.99 million) and Lumentum Holdings Inc.'s Michael Hurlston ($27.67 million).

Meanwhile, Woods' base salary was tops among the 46 chief executives.

Atrium's board of directors has said Woods' compensation is justified, in part because of his efforts to raise healthcare on par with Charlotte's banking and Fortune 500 headquarters sectors.

An October report in MedicalCare.com studied the relationship between patient care quality and nonprofit hospital chief executive compensation.

The study period involved 1,047 systems in 2012 and 812 in 2019. Researchers measured CEO compensation, hospital profits, charity care, hospital size, teaching status, system status, 30-day mortality rate for pneumonia patients and hospital-wide 30-day readmission rate.

"We find that better quality was more closely associated with higher pay among hospital CEOs in 2012 versus 2019," according to the report. "The link between quality and CEO pay is weaker in 2019 than in 2012.

"The results suggest that nonprofit hospital CEOs are being rewarded more for leading large hospitals or systems, but not for providing higher quality care."

The researchers said "it is unclear if care quality is associated with CEO pay ... although CEOs were rewarded for higher patient satisfaction scores."

"Other literature provides mixed results on the association of CEO compensation with financial performance, but a strong association with organization size."

Not alone

Woods is not alone among healthcare executives with major Triad ties and a large annual compensation package.

Gregory Adams, chief executive of Risant, was paid $2.19 million in base salary, $9.35 million in bonus and incentive pay, and total compensation of just under $13 million.

Novant chief executive Carl Armato was paid $2.35 million in base salary, $2.86 in bonus and incentive pay, and $8.15 million in total compensation.

Armato took over as Novant's top executive in January 2012. His base salary alone has risen 231.4% from $699,113 in 2011.

Dr. Julie Ann Freischlag, who retired Dec. 31 as Baptist's chief executive, was paid $2.48 million in base salary in 2024, along with $4.36 million in bonus and incentive pay and total compensation of $7.63 million.

Growth = more CEO pay

Advocate is the nation's third-largest not-for-profit healthcare system.

Woods' overall compensation has skyrocketed up 332.8% from the $6 million he made in fiscal 2018.

Woods received a significant compensation increase following Atrium's acquisition of Wake Forest Baptist Medical Center in October 2020.

Woods' compensation is likely to rise again if Wake County Board of Commissioners, along with federal and state regulators, approve Atrium's offer for WakeMed. Atrium's offer is topped with a $2 billion capital investment pledge.

Wake commissioners put their decision on hold until at least August in order to gather more community input, and to give Atrium and WakeMed more time to pitch the transaction.

Hot-button issue

Health-care compensation is a particularly sensitive issue, both locally, in the General Assembly and nationally.

Because nonprofit healthcare systems don't have corporate stock to offer top executives, base salary, incentive pay and deferred compensation plans are the main payout means.

Critics say hospital systems use their nonprofit status for tax advantages and public-relations purposes, while compensation committees have sought to justify corporate-level wages and benefits to top executives.

Advocate Health provided the Journal with two statements regarding its 2024 executive compensation.

The first represents a reiteration of previous statements in which Advocate said, "In today's complex health care landscape, strong, impact-oriented leaders are essential to navigate our industry's challenges and continue to redefine care for all."

"To attract and retain the best talent to fulfill our purpose, we offer a competitive compensation package determined by our governing board and consistent with governance best practices, which is guided by independent expert advice and national data from similar-sized organizations."

Cone and Novant's boards have provided similar statements in regards to their chief executive compensation packages.

The second statement focused on Advocate's protocols stating that "the majority of (executive) compensation is based on performance, tied to measurable outcomes in patient safety, quality and community impact."

Before Atrium merged with Advocate Aurora, Atrium said in its 2022 executive compensation statement that its leaders "have positioned Atrium Health in such a way that, today, we are part of an organization that is larger than both McDonald's and Kraft Heinz, as well as leading local Fortune 500 firms like Duke Energy and Truist, in terms of total annual revenue."

Advocate Health stressed providing $6.2 billion in community benefits, as well as spending an additional $387 million on base and market increases during 2024, including minimum starting rate increases.

John Challenger, chief executive of outplacement consultant Challenger, Gray & Christmas Inc., said it is appropriate for some health-care systems to compensate top executives similar to corporate levels.

"Communities who want the best health-care system they can get should support paying the compensation levels required to attract top talent," Challenger said.

"The balancing act is that while we want the quality of executive talent at the top of health care systems, we don't want it to contribute to higher overall health-care costs."

CEO pay tied to hospital deals?

Over the past nine years, there has been 11 hospital acquisitions involving Triad healthcare systems:

• 2017: Wake Forest Baptist Medical Center acquires Wilkes Medical Center.

• 2018: Wake Forest Baptist acquires High Point Regional Medical Center.

• 2021: Novant spending $5.3 billion to acquire New Hanover Regional Medical Center in Wilmington.

• 2022: Atrium Health acquires Baptist, making a $3.4 billion capital investment pledge.

• 2023: Novant acquires Pender Medical Center in Burgaw.

• 2024: Novant completed $2.4 billion purchase of Hilton Head Hospital, Coastal Carolina Hospital in Hardeeville and East Cooper Medical Center in Mount Pleasant;

• 2024: Risant Health taking over Cone that includes $1.7 billion capital investment into Cone.

• 2025: Baptist acquires Hugh Chatham Memorial of Elkin.

• 2026: Novant gains lease rights to Community Hospital of Stokes.

On Monday, Surry County Board of Commissioners are scheduled to vote on whether to approve selling Northern Hospital of Surry County.

The acquisition count could have been larger if the Federal Trade Commission had not opposed Novant's $320 million offer to buy Lake Norman Regional Medical Center and Davis Regional Psychiatric Hospital of Statesville. Novant ended its bid in June 2024.

Novant's executive leadership is not bashful about touting the growth potential.

Besides tripling annual revenue to $30 billion by an unspecified target date, Novant wants to become the "Southeast's leading regional health system" beyond the Carolinas to include Alabama, Florida, Georgia, Mississippi and Tennessee."

One determination from a July 2024 healthcare executive compensation report by Rice University's Baker Institute for Public Policy was that higher compensation "may be a factor driving the ongoing consolidation of health care systems, particularly among larger organizations."

"Our findings suggest that CEOs may be incentivized to consolidate health care systems in order to reap the financial rewards of leading a larger, more profitable health care system," said Derek Jenkins, lead author of the Rice study.

General Assembly (in)action

The surge in major not-for-profit healthcare systems consolidations within North Carolina has led a state Republican senator to submit legislation that would serve as a governor on such transactions.

Sen. Jim Burgin, R-Harnett, filed on April 30 Senate Bill 978, titled "Healthcare competition reforms."

Tying into the May 1 announcement of Atrium Health trying to acquire WakeMed, Burgin said "there's a lot of conversations going on about hospital consolidation right now."

After idling in the gatekeeper Senate Rules and Operations, the bill was heard Thursday in the Senate Health Care committee - the first of three potential steps before a possible Senate floor vote.

One of SB978's goal is requiring the approval of not-for-profit healthcare system acquisitions by at least two of the following Council of State members of attorney general, auditor and treasurer.

Another component of SB978 would restrict the healthcare systems' annual compensation for their chief executives if those systems receive state taxpayer funds.

That slice of the legislation likely is focused on Woods, Armato, recently hired Cone Health chief executive Dr. Paul Krakovitz and leaders at Duke Health, UNC Health and WakeMed.

SB978 contains language that affects healthcare systems or hospitals "that accepts funds from the state and is exempt from taxation under state and federal tax codes."

The bill would affect healthcare chief executives' compensation that is more than 400 times greater than the minimum compensation to employees.

Healthcare systems that exceed that compensation level "shall be assessed a civil penalty equal to the amount of the chief executive's annual compensation."

Affecting patient care?

Health Affairs posted in August a study that applied the corporate CEO pay to median employee ratio methodology to not-for-profit healthcare systems.

The report cited legislative bills and ballot initiatives in California, Massachusetts and Vermont that would restrict compensation for hospital executives.

Sabrina Wang, a policy researcher at Case Western/MetroHealth in Cleveland, said their study found that wages for nonprofit hospital chief executives grew by 27.5% from 2009 to 2023, while the average wage for all employees (inclusive of executives) increased by only 9.8%.

In 2023, nonprofit hospital chief executives were paid 12 times the average wage of all hospital workers, with the average salary exceeding $1 million annually.

"Under the White House budget legislation, hospitals are projected to lose 18% of their Medicaid payments over the next decade, and may thus be forced to make difficult decisions to offset cuts to already thin margins," Wang wrote.

Wang wrote that the "costs of system-level stressors should not fall on patients, already-overworked clinical staff, or low-wage hospital workers who rely on their jobs to sustain a livelihood."

"Rather, we should take a long and hard look at how much our nonprofit healthcare executives are compensated."

"These policy proposals reflect popular sentiment that hospitals are falling short of their duty to the public," Wang wrote.

"In recent years, critics have questioned whether nonprofit hospitals are doing enough to deserve these exemptions: studies have shown that non- and for-profit hospitals provide comparable levels of charity care in terms of percentage of total expenses, and that the amount of charity care provided does not increase as hospital profits grow."

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This story was originally published June 14, 2026 at 5:49 AM.