Sam Hazen: Federation of American Hospitals Board Dossier

Overview

Sam Hazen runs the largest hospital company in the country and, from January 2027, the for-profit hospital lobby. HCA booked $75.6 billion in revenue in 2025 and $6.8 billion in net income. Hazen's own 2025 pay was $26.5 million, 420 times the median HCA employee. The company carries the two largest health care fraud settlements in federal history, from 2000 and 2003. In 2026 it is headed to trial in North Carolina over promises it made when it bought Mission Health.

Since April 2026

What has changed

April 23, 2026Annual meeting: Hazen re-elected with 193.7 million votes for and 1.7 million against. source
June 15, 2026Chief Clinical Officer Dr. Michael Cuffe to step down August 31, 2026. source
July 28, 2026North Carolina Business Court sends the Attorney General's Mission Hospital case to trial. source
October 9, 2026Agreement in principle reported in the private Mission Hospital antitrust class action. source
October 14, 2026FAH elects Hazen Chair for 2027. He was a Director in 2026. source
October 27, 2026Q3 2026: revenue $19.8 billion, net income $1.6 billion, down 3.9%. $400 million pretax hit from exchange coverage losses. source
November 5, 2026$6.5 billion of senior notes issued. source

The company

HCA Healthcare

•2025 revenue $75.6 billion, up from $70.6 billion in 2024. Net income $6.8 billion, or $28.33 a share (10-K, 2025).
•190 hospitals at December 31, 2025, in 19 states and England. 102 of them are in Florida and Texas, which produce 51% of revenue (10-K, 2025).
•189 hospitals and roughly 2,600 ambulatory sites at September 30, 2026 (Q3 2026 release).
•Q3 2026: revenue $19.8 billion, net income $1.6 billion. HCA said the shift of patients from exchange coverage to uninsured cut pretax income by $400 million in the quarter.
•316,971 employees were paid in 2025. Median total compensation: $62,955 (2026 proxy).
•Buybacks: $10 billion authorized in January 2025 and another $10 billion in January 2026. $2.97 billion of stock repurchased in Q3 2026 alone.
•November 5, 2026: $6.5 billion of senior notes issued in seven tranches; $1.2 billion of 2027 notes called for redemption.

Ownership and control

•Publicly traded. The 10-K treats Hercules Holding II, the 2006 buyout vehicle, and directors and officers as affiliates for float purposes (10-K, 2025).
•2006 leveraged buyout: Bain Capital, KKR and Merrill Lynch Global Private Equity with founder Dr. Thomas F. Frist Jr., at $51 a share. Transaction value roughly $33 billion including $11.7 billion of debt (SEC filing, 2006).
•Before the 2011 re-IPO, the owners paid themselves $4.257 billion in distributions during 2010 (S-1, 2011).
•Two Frist family members, Thomas F. Frist III and William R. Frist, sit on the board (8-K, April 2026).

Settlements, investigations and lawsuits

•December 14, 2000: HCA subsidiaries pled guilty. The company agreed to pay more than $840 million in criminal fines, civil penalties and damages for unlawful billing. DOJ called it the largest government fraud settlement in U.S. history at the time.
•June 26, 2003: $631 million in civil penalties for cost report fraud and physician kickbacks, plus a separate $250 million CMS settlement. DOJ put the total recovered from HCA at $1.7 billion.
•July 2025: $1.53 million settlement with California, nearly $1.4 million with Colorado and $862,000 with Nevada over training repayment agreements imposed on entry-level nurses.
•August 15, 2025: HCA and Mission Health settled the 2022 antitrust suit by Asheville, Brevard, Buncombe County and Madison County. Terms: a $1 million charity care fund and keeping Transylvania Regional Hospital open until at least 2032.
•October 2025: final approval of the class settlement over HCA's 2023 data breach, which exposed more than 11 million patients. Up to $5,000 per documented loss; $3.1 million in attorney fees.
•July 28, 2026: the North Carolina Business Court sent the Attorney General's suit over the Mission Health purchase agreement to trial. It largely denied HCA summary judgment. The court read the agreement as requiring HCA to actually provide emergency and cancer services.
•October 9, 2026: plaintiffs in the 2021 private antitrust class action against Mission Hospital reported an agreement in principle to settle. Terms not public.
•Since December 2023, an HCA affiliate has been under investigation by district attorneys in four California counties over waste disposal practices (10-K, 2025).
•No new False Claims Act settlement or DOJ action against HCA was found for January 2025 through November 6, 2026.

Compensation

Year	Total compensation	CEO-to-worker pay ratio
2025	$26,456,606	420:1
2024	$23,799,137	391:1
2023	$21,315,984	Not reported in the 2026 proxy

Deals since 2025

•2025: $397 million spent on hospital and health care acquisitions, including two hospitals in New Hampshire and Florida. $269 million received from sales, including a California hospital (10-K, 2025).
•First nine months of 2026: $942 million spent on nonhospital acquisitions. One Virginia hospital sold for $26 million. Hospital count moved from 190 to 189 (10-Q, Q3 2026).
•July 29, 2026: commercial paper program ceiling doubled from $4 billion to $8 billion.
•November 5, 2026: $6.5 billion senior notes offering completed.

Political giving

•Hazen's individual federal contributions since January 2025: not retrieved. The FEC API rate limit blocked every query on November 6, 2026.

Red flags

Conflicts and concerns

The FAH chair's company holds the two largest health care fraud settlements in federal history: $840 million in 2000 and $881 million in 2003.

A North Carolina court found HCA's Mission Health purchase agreement requires it to actually provide emergency and cancer services. The state's breach claims go to trial.

Hazen's pay ratio rose from 391:1 to 420:1 in one year while HCA spent $2.97 billion on buybacks in a single quarter.

Three state attorneys general settled with HCA in 2025 over debt-style training repayment contracts imposed on new nurses.

Physician-owned hospitals

HCA has 102 hospitals in Florida and Texas, the two states where physician-owned hospitals were growing fastest before the 2010 ban. Every repeal bill in the 119th Congress would open those markets to physician competitors. As FAH chair for 2027, Hazen leads the organization Chip Kahn credited with keeping the ban in place.

Sources