Samuel Downing - CEO, Salinas Valley (Calif.) Memorial Healthcare System
Total Compensation: $3.67 million (2009)
Details: Samuel Downing left with a retirement payout from Salinas Valley Memorial Healthcare System in California that would make Croesus whistle: A $3 million lump sum in 2009, on top of his salary. Although the generous pay is not uncommon in the nonprofit hospital realm, Salinas is a district hospital, making it a public institution accountable to an elected board of directors.
Downing's base pay in 2009 was nearly $670,000, about triple what the average district hospital CEO earns in California. Salinas is located in one of the poorest large cities in the Golden State, meaning it routinely spends eight figures on uncompensated care and loses even more on Medicare patients. As Downing retired early this year--and took another retirement payout of nearly $1 million--hospital management tried to cut jobs and retirement benefits, leading to a walkout by employees.