Cawthorn’s First 2 Months in Office

Since Madison Cawthorn took office two months ago, vowing to represent everyone in his Western North Carolina district, not just those who voted for him, nearly all of his votes in Congress on substantial issues have been against proposals supported by Democrats, an analysis of his record by Asheville Watchdog found. 

Records show that Rep. Cawthorn has not introduced any original legislation so far in the 117th Congress. He has, however, co-sponsored 52 bills and resolutions as of Thursday, nearly all in support of causes that are popular with what he calls his “patriot” base.

One of the bills Cawthorn co-sponsored, H.R. 450, would prohibit the use of federal funds “to propose, establish, implement, or enforce any requirement that an individual wear a mask or other face covering, or be vaccinated, to prevent the spread of COVID-19.”

He is also one of a handful of co-sponsors for H.R. 993, introduced by Georgia Rep. Marjorie Taylor Greene, which would establish a “national gun sanctuary” and prohibit the use of federal funds to enact or enforce any gun control laws, even background checks. Cawthorn also signed on to a proposed bill to preempt most state and local laws related to the carrying of concealed handguns.

Meanwhile, the Hendersonville Republican has also made good on an advisory he sent to fellow Republicans shortly after assuming office that he would put “comms,” meaning publicity, ahead of legislation as the principal goal of his term of office. 

The telegenic congressman is a prolific poster on social media. He often posts photos and videos of himself, sometimes in tandem with far-right allies including Georgia Rep. Marjorie Taylor Greene and Colorado Rep. Lauren Boebert. He appears regularly for interviews with Fox News, Newsmax, and other right-wing media, and seeks high-profile speaking opportunities, where he presents himself as an uncompromising defender of “real Americans” and a defender of “Western North Carolina mountain values.”

As his national profile has grown, so too has negative news coverage of him. In the past two weeks the congressman has been blistered by a flurry of unflattering articles in major news outlets including The Washington Post, People, CNN, Newsweek, USA Today, BuzzFeed, and others.

And as negative coverage increases, Cawthorn’s attacks on Democrats have increased in volume and intensity. Many of Cawthorn’s social media posts seem designed to exploit cultural divisions and resentments.

Cry More Lib

Cawthorn has also lived up to his election-night Twitter taunt “Cry more lib,” to the delight of his many supporters and to the horror of almost all of his opponents, including a majority of voters in the liberal oasis of Asheville, the largest city in his otherwise Republican district.

Other bills Cawthorn has put his name on would:

  • Restrict abortion, and require women having an abortion to arrange in advance for burial or cremation of fetal remains,
  • Weaken labor unions,
  • Permit federal funding for home schooling and private schools,
  • Restrict immigration, and require visa holders from China to attest that they are not paid by the Chinese Communist Party,
  • Deny COVID-19 vaccines to prisoners held at the Guantánamo naval base in Cuba,
  • Prevent local governments from passing laws restricting fracking and oil pipelines,
  • Bar transgender students from participating in school sports,
  • Oppose environmental protection efforts,
  • Prevent the U.S. from rejoining the Paris Climate Agreement and the World Health Organization,
  • Remove the ability of social media platforms to block users who post racist, violent or dangerous comments.

A major achievement in Cawthorn’s first two months was his appointment to the House Committee on Veterans’ Affairs, and many of the bills and resolutions he supports are to honor and support military veterans, and Capitol police killed or injured in the Jan. 6 attempted coup d’état.  

Hours before the riot, newly sworn Congressman Cawthorn gave a speech encouraging the crowd to believe that it was possible to stop the certification of electoral college votes for Joe Biden. During the violence, he called a right-wing radio show to falsely claim that the rioters were paid by Democrats. Hours after the riot, he cast votes to reject the votes of Arizona and Pennsylvania, which had gone for Biden and Kamala Harris.

Voting by Proxy

His most recent major votes this week were against the “For the People” bill to expand voter registration, early voting, and mail-in voting, and against President Biden’s $1.9 trillion American Rescue Plan pandemic relief bill, legislation that polling indicates is supported by an overwhelming majority of American voters, Republicans and Democrats alike.

The relief bill he voted against includes significant funding to expand internet broadband to rural areas, which Cawthorn said during the campaign was a top priority for Western North Carolina. “He offered an amendment in committee that would have dramatically increased access to rural broadband in NC-11. Democrats struck it down,” his communications director, Micah Bock, told The Watchdog.

His vote against the American Rescue Plan was actually cast by Rep. Patrick McHenry, his fellow North Carolina Republican. Cawthorn had traveled to Florida to speak at the Conservative Political Action Conference (CPAC), and requested to vote by proxy, saying he was unable to appear in person in Congress “due to the ongoing public health emergency.”

Cawthorn’s request for proxy vote

Cawthorn, a vocal critic of absentee voting in the November election, later blamed his proxy vote on House Speaker Nancy Pelosi, a Democrat, for scheduling votes while he and other Republicans were in Florida.

Personal Responsibility

While Cawthorn’s two months in office have been light on original legislative accomplishments, they have been busy on the comms front. 

Calling Democrats “brutal and vicious,” Cawthorn spoke from a stage at CPAC that many observers noted was shaped like an insignia used by SS troops in Hitler’s Third Reich. 

Cawthorn has adamantly denied any sympathy to Nazi or white supremacist ideology, following criticism during his election campaign for referring to Hitler by the honorific “the Führer,” referring to the millions of Jews and others murdered in the Holocaust as having been “exterminated,” and posing for pictures at Hitler’s vacation retreat.

At the CPAC speech, Cawthorn railed against “globalists,” against Democratic proposals to offer healthcare for all, and against forgiveness of student debt. He said a “culture of government handouts” is destroying the fundamental value of personal responsibility.  

“Our number one guiding principle is personal responsibility,” Cawthorn said. Democrats, he said, “do not want us to be responsible.”

Cawthorn, now a multimillionaire after receiving insurance settlements arising from a car accident in 2014, testified in a deposition that at one point his principal source of income was $700 a month in Social Security disability payments. 

Before the accident, he worked for minimum wage at a Chick-fil-A restaurant in Hendersonville. As a congressman he is paid $174,000 a year, and receives subsidized gold-level health insurance under Obamacare, which covers his pre-existing conditions. Since taking office he has also railed against expanding Medicare and Medicaid, and against raising the minimum wage.  

His comments condemning Democratic proposals for free college tuition and forgiveness of student debt have taken on added significance since Cawthorn was named to the House Committee on Education and Labor. Cawthorn was home-schooled and dropped out of college after one semester of what he said were near-failing grades. 

Flurry of Unflattering Coverage

Many of the recent negative stories about Cawthorn cite the original reporting by Asheville Watchdog that uncovered falsehoods he told relating to the 2014 car accident that left him partially paralyzed and reliant on a wheelchair. Cawthorn claimed that his plans to attend the U.S. Naval Academy were “derailed” by the accident; he was rejected before the accident. But apparently he still promotes the story, as recently as last week.  

Most of the articles focus on Cawthorn’s alleged “sexually predatory behavior” and misogyny during his brief time at Patrick Henry College in Purcellville, Virginia, during the 2016-2017 school year.

PHC is closely affiliated with the Home School Legal Defense Association, a Christian home-schooling advocacy association that emphasizes a literal interpretation of the Bible, including biblically traditional roles for men and women. Most of PHC’s students were home-schooled. 

“Patrick Henry is a tiny school with an outsized influence as a training ground for the religious right and a pipeline to conservative jobs in Washington,” The New Republic wrote in 2014. Blake Meadows, the son of Mark Meadows, is an alumnus of PHC. Mark Meadows represented Western North Carolina in the House seat now held by Cawthorn before resigning to become Donald Trump’s final chief of staff.

Two of the bills Cawthorn co-sponsored in his first two months would permit federal funds to be sent to parents who home-school their children.

More than 150 students who knew Cawthorn at Patrick Henry College signed a public letter saying “Cawthorn’s time at PHC was marked by gross misconduct toward our female peers, public misrepresentation of his past, disorderly conduct that was against the school’s honor code, and self-admitted academic failings.”

“Potentially Fabricated Allegations”

Other than the academic failings, Cawthorn denies the accusations. Micah Bock, Cawthorn’s communications director and PHC classmate, called the recent negative news stories “a mix of half-truths, untruths and potentially fabricated allegations.” 

And besides, Bock noted, many of the issues were already raised during the campaign.

“The voters of Western North Carolina responded to these allegations by giving Madison Cawthorn a 12-point victory over his opponent,” Bock said in a statement this week to Fox News.

On Wednesday, Bock told New York City television station Spectrum News 1 that Cawthorn would consent to an interview only if he was not asked about the various allegations, the station reported. On Fox News, the allegations did not come up. Instead, Cawthorn was asked to comment about liberals “cancelling” Dr. Seuss books. 

“Communist Ash Heap”

Cawthorn keeps his social media followers riled up; of more than 175 messages he or his staff have posted since he took office, all but a few make Democrats the villains of everything that he sees as wrong with America. 

“Democrats will weaponize any crisis for partisan gain,” he wrote recently. In another post last week he wrote, “Blue-collar workers are realizing that the Democrats don’t care about them. Democrats only care about pleasing the rich elites who fund them.” 

“Democrats,” he told the audience at CPAC, “are trying to turn this country into a Communist ash heap.”

He blames Democrats for partisan divisions in the country. “Why do Democrats hate bipartisanship?” he wrote Wednesday on Twitter. 

Forum for “True Patriots!”

In January, after thousands of his followers were blocked by Twitter in a purge of Russian bots and QAnon conspiracy promoters, Cawthorn urged his followers to switch to an alternative social media service, Parler. But soon after, Parler was shut down by its web hosting provider for failing to stop violent and racist content. Now Cawthorn encourages his followers to use Telegram, a social media site based in Dubai.

“Social media outlets are banning & censoring true Patriots!” Cawthorn wrote in a message to followers. “I am calling for First Amendment protections to be applied to this New Town Square.”

There is no indication that Cawthorn makes any effort to block or discourage his Telegram followers from posting a steady stream of neo-Nazi, racist, white supremacist, antisemitic, misogynist, anti-vaccination, conspiratorial and blatantly false misinformation.

Two common themes on Madison Cawthorn Chat on Telegram are loathing of Democrats and a belief that Democrats “stole” the November 2020 election from Donald Trump, who, they claim without evidence, was cheated by a vast conspiracy of fraud that included state and national election officials, dozens of courts including the Supreme Court, and the liberal news media.

Bipartisan election officials confirm that Biden and Kamala Harris won the election by 7 million votes.

On Jan. 23, Cawthorn acknowledged to CNN that “Joseph R. Biden is our president” and that “the election was not fraudulent.” He also told Smoky Mountain News, when asked if then-President Trump’s comments leading up to Jan. 6 played a role in the violence that took place, “I think you’d have to be pretty ignorant to say that they didn’t play a role in it.”

Blowback on the Madison Cawthorn Chat group on Telegram was swift and intense, with some followers calling him a “traitor.”

In recent weeks, Cawthorn has returned to accusations of voter fraud by Democrats.

Twitter post by Madison Cauthorn accusing left-wing elites of stealing election
Congressman Cawthorn says Democrats stole the election.

“Rep. Cawthorn believes that illegal ballots were cast, in violation of state law and the U.S. Constitution,” Bock told The Watchdog on Friday.

He has also re-emphasized his support for Trump, whom he calls President Trump. President Biden is simply “Biden” or “Joe” in all but one post by Cawthorn on his Twitter feed.

“Rep. Cawthorn respects the office of the presidency, and has signed a letter pledging to work with Biden on bipartisan issues that benefit NC-11,” Bock told The Watchdog.

This week, as he starts his third month in office, Cawthorn filed papers with the Federal Election Commission, a first step in running for re-election.

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Peter H. Lewis is a former senior writer and editor at The New York Times. He can be reached at

Cawthorn Falsely Says Democrats Paid Capitol Rioters

By Peter H. Lewis | January 17, 2021

In the middle of the siege of the Capitol on Jan. 6, while a mob of insurrectionists still roamed the halls and ransacked offices, leaving five dead and dozens injured, Madison Cawthorn called a friendly conservative radio host and blamed the violence on left-wing agitators sent by “the Democratic machine” to make President Trump look bad. 

“I believe that this was agitators strategically placed inside of this group — you can call them antifa, you can call them people paid by the Democratic machine — but to make the Trump campaign, the Trump movement, look bad. And to make this look like it was a violent outrage, when really the battle was being fought by people like myself and other great patriots who are standing up against the establishment and standing up against this tyranny that we see in our country.”

Cawthorn to The Charlie Kirk Show, Jan. 6

Only hours earlier, speaking at the Jan. 6 “March to Save America” protest in Washington, D.C., Cawthorn shouted, “Wow, this crowd has some fight in it!” He called the protesters “lions,” and repeatedly called his Congressional colleagues “cowards” who were hiding in their offices.

“It’s on,” he told his followers on Twitter. 

Cawthorn confirmed to the radio host, Charlie Kirk, that he carried loaded weapons into the House that day. “Me being in a wheelchair, I am able to carry multiple weapons at one time,” he said.

“It’s Time to Fight”

In December Cawthorn told a crowd at a conference for young Republicans to “lightly threaten” members of Congress if they did not challenge the election returns that favored Biden. “Say, ‘If you don’t support election integrity, I’m coming after you. Madison Cawthorn’s coming after you. Everybody’s coming after you,’” Cawthorn said.

Even after police cleared the rioters, dead bodies, and injured police officers from the Capitol, and in defiance of appeals for unity, Cawthorn once again voted to contest the legitimacy of the Biden-Harris electoral victory, in an effort to disrupt the peaceful transfer of power.

So Much Controversy, So Little Time

Despite being on the political scene for less than a year, since Mark Meadows resigned his Western North Carolina congressional seat in March 2020 to become President Trump’s chief of staff, Cawthorn has instigated or been involved with a remarkable number of controversies. He has strongly denied accusations from multiple sources that he is a white supremacist, a sexual predator, a serial liar, and an admirer of Adolph Hitler. 

Now, less than two weeks after the 25-year-old Republican took office as a U.S. Congressman — his first full-time paid job as an adult — some of his supporters, and likely everyone who voted for his opponent, are wondering: Are we really stuck with him for two years?

Neither the Constitution nor North Carolina state law make provisions for removing a member of Congress from office, except through resignation, expulsion by a two-thirds vote of his peers in the House of Representatives or defeat in subsequent elections.

Even so, calls for Cawthorn to resign are increasing, along with demands for House leadership to expel him from office. As of Saturday, more than 32,000 people had signed a petition calling for Cawthorn’s removal from office. A small group of protesters gathered in front of his Hendersonville campaign office last week.

As reported earlier by the Asheville Citizen Times, Cawthorn has lost the support of prominent conservative backers including George Erwin Jr., a former Henderson County Sheriff, and local conservative activist Eddie Harwood. 

“Make no mistake: There is blood on his hands,” Harwood wrote on Facebook.

Erwin, former head of the North Carolina Association of Chiefs of Police, said he was wrong to lend his support to Cawthorn and campaign on his behalf. “I apologize to all of my law enforcement friends, other politicians, family and friends – I was wrong, I misled you,” he wrote in a message posted on Facebook.

Cawthorn “has surrounded himself with his bros from his campaign, placed them in key positions in Washington with absolutely no experience and not even from our district,” Erwin wrote.

Cawthorn is also at risk of losing support from campaign donors. Dozens of corporations and political action committees on both sides of the political spectrum have signaled their disgust for the so-called “sedition caucus” and attempts to undermine democracy by announcing they will not support candidates “who do not respect the rule of law.” 

Attack on Democracy

Besides his involvement in the Jan. 6 protests that led to the deaths of five people at the Capitol, Cawthorn was among the earliest of 147 Republicans in Congress to announce they would refuse to certify Electoral College tallies representing the legal votes of millions of Americans, in an attempt to keep Donald Trump in power.

Critics characterized the effort as an attack on the foundation of democracy. Cawthorn called it “standing up against this tyranny.”

A week earlier, Cawthorn posted to Twitter a video of himself announcing, “Put simply, the 2020 vote violated our constitution.” He cited “incredible Constitutional scholars” in support of his view. 

“Voter fraud is common in America,” Cawthorn said. “Those that tell you otherwise are lying.” He said he had “a list of thousands, yes thousands, of recent instances of election fraud that has led to criminal convictions and even the overturning of election results in our country.”

“Fact check that,” Cawthorn challenged.

Just a week later Cawthorn conceded that he had no proof. “I can’t personally prove fraud and I have really not seen an overwhelming amount of evidence for it,” he told Smoky Mountain News.

The Trump Administration lost all but one of more than 60 legal appeals it brought before state and federal courts, including the Supreme Court, alleging voting misconduct. Republican and Democratic elections officials affirmed the legitimacy of the vote, investigated and dismissed all claims of significant voter fraud, reaffirmed the voting through hand counts, and confirmed that Trump lost re-election by more than 7 million votes. 

Attorney General William Barr, a Trump appointee, said local, state and federal reviews found no evidence of significant fraud in the November elections. All of the federal agencies monitoring election integrity under the Department of Homeland Security issued a joint statement calling the 2020 elections “the most secure in history,” adding, “there is no evidence that any voting system deleted or lost votes, changed votes, or was in any way compromised.”

No Comment on False Claims

Cawthorn’s office did not respond to multiple requests by Asheville Watchdog for comment about the congressman’s claims that left-wing antifa (anti-fascist) agitators, paid by Democrats, were responsible for the bloodshed and terrorism at the Capitol. 

The Federal Bureau of Investigation said it has found “no indication” that individuals associated with the anti-fascist movement disguised themselves as pro-Trump supporters in order to provoke the mob, a claim repeated by several Republican lawmakers and conservative media luminaries.

Earlier, through a spokesman, Cawthorn said carrying loaded weapons into the Capitol was his privilege as a member of Congress and a demonstration of his rights under the Second Amendment. Congressional rules allow members to keep loaded weapons in their offices and on Capitol grounds, but prohibit them in House and Senate chambers. The District of Washington does not allow weapons to be carried openly.

On social media since the insurrection, Cawthorn has condemned violence in all forms, called for insurrectionists to be punished to the fullest extent of the law, and disavowed the QAnon conspiracy fantasy and its followers.

Cawthorn denied he had any responsibility for inciting the Jan. 6 crowd to violence, and, in comments to New York magazine, declined to apologize. In fact, he told the magazine, “I think my comments there led to less violence.” He said the vast majority of demonstrators were peaceful “patriots.” He said his only goal in rallying the protesters was to call attention to what he said were violations of the Constitution.  

What he was sorry about, he told the magazine, was his “Cry more, lib” Tweet immediately after winning election: “That’s the thing I regret most,” he said. As of Saturday, his Cawthorn for NC Shopify account was still hawking CRY MORE, LIB T-shirts for $35.

UPDATE Jan. 21, 2021: Although Congressman Cawthorn has not responded to Asheville Watchdog requests for comment, he did post the following response on Twitter:

Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Peter H. Lewis is a former senior writer and editor at The New York Times. Contact us at

Nonprofit Mission Made Lots of Profits. Especially for Bosses.

By Peter H. Lewis and Barbara Durr | December 9, 2020

For a hospital system organized as a not-for-profit charity, Mission Health made a lot of profits.

The money left over after Asheville-based Mission subtracted its expenses from its revenue — what would be called profit at a for-profit hospital — grew year after year, right up to 2018, when Mission’s directors surprised nearly everyone by announcing plans to sell out to Tennessee-based HCA Healthcare, the nation’s biggest chain of for-profit hospitals.

Mission at the time was as strong financially as it had ever been, which Mission’s executives said made it the perfect time to sell. They cited trends and studies suggesting that the Mission system faced a bleak future of relentless cost-cutting.

The cost-cutting apparently didn’t include the paychecks of Mission executives, which grew for years untouched by the financial scalpel.

Tax records examined by Asheville Watchdog reveal that in the decade leading up to the $1.5 billion sale of Asheville’s community-owned hospital system, a steadily increasing amount of Mission’s revenue went to salaries and bonuses for an increasingly crowded suite of non-clinical executives.

The records show:

  • Mission’s president and chief executive officer, Dr. Ronald Paulus, received more than $4 million in total compensation in the final four months he worked at Mission, before he resigned to accept a strategic consulting job with HCA, the terms of which remain secret. The amount he received from Mission included more than $1.1 million in bonus and incentives, plus accelerated payouts of all deferred compensation accounts that normally would have been paid out over several years.
  • Paulus was paid $2,460,723, including a $500,000 bonus, in 2018, the last full year of Mission’s independence.
  • Mission’s other executives did well under Paulus. The 24 highest-paid employees each received at least $330,000 a year in salary and bonuses, according to Mission’s tax filing for the fiscal year ending in 2018. Fourteen were paid more than $500,000.
  • Women outnumbered men — 13 of those 24 top-paid employees — but averaged $566,308 in compensation compared to $765,545 for the men. Dr. Jill Hoggard Green, Mission Health’s chief operating officer, was the highest paid woman at $1.25 million.
  • Of the 25 highest-compensated employees listed on Mission Health’s final tax filing, 20 received “bonus and incentive” payments of more than $100,000 each. The filing covers the period just before and after Mission changed hands.
  • Overall, executive pay for the top five executives at Mission Health more than doubled during Paulus’s eight-year tenure, outpacing pay increases for physicians, surgeons, nurses, and other clinical workers. Only six executives were listed as “highly compensated” on Mission’s 2011 tax return. By 2018, there were 25.

“Acceptable” Operating Margins

Unlike for-profit healthcare companies like HCA, which can sweeten executive compensation using stock options and outside investor money, all the money that nonprofit Mission Health paid to its top executives came out of revenue, reducing the money left over to reinvest in the healthcare system.

This is Part 3 of Asheville Watchdog’s Mission Series. Part 1, “A Done Deal: How Mission Health Wooed HCA” is here. Part 2, “Mission Sale: Good for WNC, or Just HCA?” is here.

Even as executive pay ballooned at Mission, Paulus told The Washington Post in 2018 that Mission had to cut costs $50 million to $80 million in each of the previous four years to preserve an “acceptable operating margin.”

Ronald A. Paulus, former Mission president and CEO, $4 million

Operating margin is a measure of financial performance directly tied to how much money the hospital system makes from patient care and related clinical operations. Growth in operating margins is one measure used to establish executive compensation.

To preserve those margins, Mission’s executive leadership demanded that some physicians and surgeons accept significantly lower fees, leading many long-time care providers to quit the Mission system. The executives also demanded concessions from nurses, and reduced staffing levels.

In one effort to increase margins, Paulus and other Mission executives attempted to force Blue Cross and Blue Shield of North Carolina to pay higher reimbursements, but the tactic backfired, instead forcing most of Mission’s insured patients to pay higher out-of-network co-payments for months before Mission ultimately backed down.

Raises for nurses measured in pennies

In 2016 Mission established “a new living wage of $11 hourly” for hundreds of hospital workers. Assuming a 40-hour work week for 52 weeks a year, an hourly wage of $11 is the equivalent of $22,880 a year in salary.

Based on his reported fiscal-year 2017 total compensation, Paulus collected $1,183 an hour, or $22,880 every two and a half days.

Dr. Jill Hoggard Green, former Mission chief operating officer, $1.25 million

The average salary for registered nurses (RNs) in North Carolina in fiscal 2017 was $62,560, more than $10,000 per year lower than the national average, according to figures provided by the federal Bureau of Labor Statistics. Figures for Mission Hospital were unavailable. In 2011, shortly after Paulus arrived at Mission, the average RN salary in North Carolina was $60,960, meaning they got an average raise of $267 a year from 2011 to 2017. That comes to about 12 cents an hour each year.

Earlier this year the nurses at Mission Hospital voted to join National Nurses United, the biggest collective bargaining union of registered nurses.

Executive pay more than doubles

Mission was not alone in paying generous salaries and bonuses to its non-clinical executives.Multiple studies have shown that salary increases fornonprofit hospital CEOs nationwide  far outpaced those for surgeons, physicians, and registered nurses over the past 15 years, contributing disproportionately to the rise in healthcare costs.

Paul McDowell, former Mission chief financial officer, $1 million

Pay growth for nonprofit hospital chief financial officers trailed CEOs only slightly over the same period. Mission Health’s CFO at the time of the sale, Paul McDowell, took home more than $1 million for the four months immediately preceding the sale, tax records show, including a bonus of $317,479 and accelerated payouts of deferred compensation.

Overall, executive pay at Mission Health more than doubled in the eight years preceding the sale. In Paulus’s first year as CEO, the top five executives at Mission took home a combined $3,766,977. In the fiscal year ending in 2019, which included Mission’s final few months of independence, the top five executives took home $8,192,615.

Even so, that pales in comparison to the $26.8 million in total compensation paid in 2019 to Sam Hazen, CEO of HCA Healthcare, Mission’s owner. His annual compensation last year was more than 1,000 times higher than that of minimum wage workers at Mission Hospital, now $12.50 an hour.

‘Upper Echelon’ Pay

Paulus’s base salary and bonuses appear to be “upper echelon” but not necessarily out of line with other comparable nonprofit hospitals and hospital systems with billion-dollar-plus revenues, said Tom Bailey, principal officer and senior consultant at Total Compensation Solutions of Armonk, N.Y., a compensation consultancy specializing in not-for-profit healthcare organizations.  

“The first two things I take into consideration are the hospital’s size and location,” Bailey said, adding that other factors include “how long a person has been in that position, and did Mission thrive under his leadership?”

By many measures, it did. In the eight years that Paulus led Mission, it grew to become the state’s sixth-largest health system. Including the acquisition of Highlands-Cashiers Hospital in 2017, Mission Health’s net assets increased to $1.78 billion in the final year of Paulus’s leadership, up from $989 million when he arrived.

Six times in his tenure, Mission Health was named one of the nation’s top 15 health systems by IBM Watson Health. Mission Hospital was also recognized as one of the top hospitals in the nation by U.S. News & World Report in its 2018-2019 edition of Best Hospitals.

Eugene Washington, president and CEO of the Duke University Health System, received $2,534,912 in Duke’s 2017 fiscal year, according to its 2017 IRS 990. Mission in its 2017 fiscal year paid Paulus $2,460,723, a roughly comparable figure.

Both Duke and Mission were nonprofit integrated health systems based in North Carolina. However, the Duke system had total revenue of $3.33 billion, compared to Mission Health’s $1.8 billion; Duke’s gross assets and net assets were also significantly larger than Mission’s. Also, Duke is a big city hospital system, where salaries typically are higher than at rural hospitals.

Carl Armato, president and CEO of nonprofit Novant Health Inc. of Winston-Salem, received $3.4 million in total compensation in Novant’s 2017 fiscal year. Novant operates 15 hospitals and is awaiting approval from Attorney General Josh Stein to acquire New Hanover Regional Medical Center in Wilmington.

Last month, Novant reported that Armato got a raise in 2019 to $4.14 million.

 Silence Continues

In keeping with community-owned Mission Health’s legacy of disdain for public accountability, no one contacted by Asheville Watchdog would comment on Mission’s tax filings or executive remuneration. 

Paulus did not respond to a request for comment.  

A spokeswoman for the HCA Healthcare North Carolina Division/ Mission Health said HCA-Mission would not comment on any events that occurred prior to Feb. 1, 2019, the date HCA formally took control of Mission Health. 

People listed on tax filings as principal officers and directors of ANC Healthcare Inc., the successor nonprofit that filed the final tax returns for the former Mission Health System and Mission Hospital, did not respond to repeated requests for comment. Records show that ANC (for Asheville North Carolina) Healthcare is based in Winter Park, Florida, and is managed by SOLIC Capital Management of Evanston, Illinois.  

A spokeswoman for Asheville-based Dogwood Health Trust, the nonprofit created by Mission to receive the assets from the Mission sale, and led by former Mission board chairs, declined to comment, saying Dogwood has had no connection to Mission or HCA since the sale. Charles Ayscue, former chief financial officer of Mission Health before the sale, and now interim CFO of Dogwood, declined to comment. 

As Asheville Watchdog reported earlier, Mission inserted non-disclosure and non-disparagement clauses in its sales contract with HCA that, according to legal advisors to Dogwood Health Trust, prohibit anyone involved with the Mission-HCA sale from speaking publicly about the deal, forever. 

AVL Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Peter H. Lewis is a former senior writer at The New York Times. Barbara Durr is a former correspondent for The Financial Times of London. Contact us at