The Most Revealing Document in Nonprofit Healthcare. Michigan’s Biggest Hospital Doesn’t File It.
The richest system in the state never filed one, and the reason is the entire lesson.
Michigan Medicine, The University of Michigan’s health system, runs $8.7 billion a year.
It files no Form 990.
The single most revealing document in nonprofit healthcare does not exist for the state’s largest hospital.
IN TODAY’S ARTICLE:
Why the $8.7 billion University of Michigan health system files no Form 990, and why that is perfectly legal
The three tax-status buckets that decide whether a 990 exists at all
What the University files instead: a 990-T, the side-business tax return, walked line by line
Where the money hides when there is no 990, and how to find it anyway
Glossary at the bottom of today’s article.
STEP ZERO: DOES A 990 EVEN EXIST?
Everyone who teaches this starts on the wrong page.
They open the Form 990, point at Part I, and walk you through revenue and expenses. They skip the only question that matters first. Before you read a single line of a nonprofit hospital’s 990, you have to answer one thing.
Did the hospital file one at all?
Most of the time the answer is yes, and the 990 is the richest public window into any nonprofit in America. Executive pay. Charity care. Related entities. Insider deals. All of it, by law, open to inspection.
Then you go looking for the biggest hospital system in Michigan, only to find the window is bricked over.
Michigan Medicine, the University of Michigan’s health system, generated $8.7 billion in total operating revenue in fiscal year 2025. Its flagship hospital in Ann Arbor reports roughly $5.07 billion in revenue on its own, the highest single-hospital revenue in the state. By every measure of scale, it is one of the largest health systems in the country.
And it files no Form 990. None. There is no operating return for you to read, because the law does not require one.
That is not a loophole someone slipped through. It is the first lesson in this entire series, and almost no one teaches it.
THE THREE BUCKETS
Every tax-exempt hospital in the country falls into one of three buckets. Which bucket it sits in decides what you are allowed to see. Learn the three, and you will never again waste an hour hunting a document that was never going to exist.
Bucket one: the private 501(c)(3). This is the standard nonprofit hospital. It files a full Form 990 every year, and if it operates a licensed hospital facility, it also files Schedule H, the community-benefit schedule. This is the motherlode. Charity care, executive compensation, related organizations, the entire structure. Most of the hospitals you will ever investigate live here.
Bucket two: the governmental entity. State and county hospitals, and public university health systems like Michigan Medicine, are instrumentalities of government. The University of Michigan’s tax exemption traces to its 1817 territorial charter, not to a 501(c)(3) determination letter. Governmental entities are generally not required to file Form 990. The single most powerful transparency document in the nonprofit world simply does not apply to them.
Bucket three: the hybrid system. This is where it gets deceptive. The government’s flagship files Form 990, but the affiliates orbiting it often do not. The University of Michigan Health Plan files its own Form 990. The recently acquired regional affiliates, including the former Sparrow system in Lansing and U-M Health-West, carry their own filings. So you can pull 990s all day for the satellites while the $8.7 billion core stays dark.
Here is the part that matters. The bucket that gives you the least visibility is the bucket holding the most money. The largest and most dominant systems in many states are public universities and government entities. The scale that invites the most scrutiny comes with the least disclosure.
That is the pattern.
Hold onto it.
It does not stop here.
100,000 physicians, healthcare executives, and lawmakers stopped hunting for documents that were never filed.
The hospital’s CFO already knows which bucket they sit in. Now you will too.
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