Nonprofits in Ohio: A Data Deep Dive

Ohio occupies a unique position in the American nonprofit landscape: a Rust Belt state that has reinvented itself through the sheer power of its healthcare institutions. With 60,912 registered nonprofit organizations generating $159.8 billion in annual revenue and holding $327.4 billion in assets, Ohio ranks seventh nationally in nonprofit economic activity. The state's nonprofit sector is overwhelmingly defined by one force: healthcare. The Cleveland Clinic, Ohio State University Wexner Medical Center, Cincinnati Children's, and a dense network of hospital systems make Ohio one of the most healthcare-dominated nonprofit economies in the country.

Per capita, Ohio's nonprofits generate approximately $13,700 in revenue per resident — above the national average — a remarkable figure for a state that has struggled with deindustrialization and population stagnation. The nonprofit sector has, in many ways, replaced manufacturing as the economic engine of Ohio's major cities.

The Top 10: Cleveland Clinic and the Healthcare Titans

Ohio's nonprofit leaderboard reads like a hospital directory. Here are the state's ten largest nonprofits by annual revenue:

1. Cleveland Clinic Foundation (Cleveland) — $17.2 billion
2. Bon Secours Mercy Health (Cincinnati) — $11.5 billion
3. Ohio State University (affiliated hospitals & research) (Columbus) — $8.1 billion
4. Cincinnati Children's Hospital Medical Center (Cincinnati) — $4.8 billion
5. University Hospitals Health System (Cleveland) — $4.5 billion
6. ProMedica Health System (Toledo) — $4.2 billion
7. OhioHealth (Columbus) — $3.9 billion
8. Kettering Health (Dayton) — $3.5 billion
9. Case Western Reserve University (Cleveland) — $2.9 billion
10. MetroHealth System (Cleveland) — $2.1 billion

Eight of the top ten are healthcare organizations. The Cleveland Clinic alone generates more revenue than the entire nonprofit sectors of most U.S. states. Its $17.2 billion in annual revenue and global network of facilities have made it not just Ohio's largest nonprofit, but one of the most powerful healthcare institutions in the world.

Cleveland: The Nonprofit Healthcare Capital

Cleveland's transformation from industrial powerhouse to healthcare capital is one of the most dramatic economic reinventions in American history. Where steel mills and auto plants once dominated, hospital systems now reign. The Cleveland Clinic is the city's largest employer with over 80,000 employees. University Hospitals and MetroHealth together employ tens of thousands more.

This concentration has made Greater Cleveland one of the most healthcare-dependent metropolitan economies in the nation. The "Eds and Meds" strategy — using universities and hospitals as anchors for economic development — was pioneered in cities like Cleveland and Pittsburgh, and Cleveland has arguably executed it more successfully than any other Rust Belt city.

The Cleveland Clinic Ecosystem

The Cleveland Clinic isn't just a hospital — it's a global healthcare empire:

• $17.2 billion in annual revenue — larger than many Fortune 500 companies
• 80,000+ employees — the largest employer in Northeast Ohio
• 22 hospitals in Ohio, Florida, Nevada, and internationally (Abu Dhabi, London, Toronto)
• 275+ outpatient locations globally
• $14.6 billion in assets
• Consistently ranked among the top hospitals in the nation by U.S. News & World Report, especially for cardiology

The Clinic's tax-exempt status has periodically generated controversy. Critics argue that an organization of this size and global reach operates more like a corporate enterprise than a traditional charity. Supporters counter that the Clinic provides over $1 billion annually in community benefit, including uncompensated care, medical education, and research.

The Foundation Landscape

Ohio has a remarkably dense foundation ecosystem, shaped by the wealth created during the state's industrial heyday:

• The Cleveland Foundation — Founded in 1914, it is the world's first community foundation, with over $3.1 billion in assets. It remains one of the largest community foundations in the U.S.
• George Gund Foundation (Cleveland) — $600 million in assets, focused on arts, economic development, education, and environment
• The Columbus Foundation — $3.5 billion in assets, one of the top 10 community foundations nationally
• Jack, Joseph and Morton Mandel Foundation (Cleveland) — Major funder of Jewish communal life, education, and leadership development
• Nordson Corporation Foundation (Westlake) — Corporate foundation supporting education and human welfare
• Greater Cincinnati Foundation — $1.1 billion in assets, serving the Cincinnati tri-state region

The Cleveland Foundation's historical significance cannot be overstated. Founded by banker Frederick Goff, it invented the community foundation model — pooling charitable gifts from multiple donors to serve a community in perpetuity. This model has since been replicated in over 1,800 communities worldwide.

Category Breakdown: Where the Money Flows

• Health (NTEE E): ~$99.1B (62.0%) — Cleveland Clinic, Bon Secours Mercy, Cincinnati Children's, OhioHealth, ProMedica
• Education (NTEE B): ~$19.2B (12.0%) — Ohio State, Case Western, University of Cincinnati, Oberlin, Kenyon
• Human Services (NTEE P): ~$11.2B (7.0%) — Food banks, shelters, disability services, workforce development
• Philanthropy & Grantmaking (NTEE T): ~$8.0B (5.0%) — Cleveland Foundation, Columbus Foundation, corporate foundations
• Religion (NTEE X): ~$4.8B (3.0%) — Over 9,800 religious organizations across the state
• Arts, Culture & Humanities (NTEE A): ~$3.2B (2.0%) — Cleveland Orchestra, Cincinnati Art Museum, COSI
• All other categories: ~$14.3B (8.9%)

The Three Cs: Cleveland, Columbus, and Cincinnati

Ohio's nonprofit sector is distributed across three major metropolitan areas, each with a distinct character:

Cleveland

The largest nonprofit economy in the state, dominated by healthcare (Cleveland Clinic, University Hospitals, MetroHealth) and anchored by the Cleveland Foundation, Case Western Reserve University, and world-class cultural institutions like the Cleveland Museum of Art and the Cleveland Orchestra. Cleveland's nonprofit sector is the most concentrated and the most dependent on healthcare of any major metro in the country.

Columbus

Ohio's fastest-growing city has a more diversified nonprofit landscape. Ohio State University and its medical center are dominant, but Columbus also benefits from Nationwide Children's Hospital ($3.3 billion revenue), the Columbus Foundation, and a growing tech sector that is spawning new philanthropic activity. Columbus's nonprofit sector is younger and more entrepreneurial than Cleveland's.

Cincinnati

Home to Bon Secours Mercy Health ($11.5 billion), Cincinnati Children's Hospital ($4.8 billion), and a strong corporate foundation tradition rooted in companies like Procter & Gamble, Kroger, and Fifth Third Bank. The Greater Cincinnati Foundation and ArtsWave (a collective arts fundraising organization) give Cincinnati's nonprofit sector a distinctly collaborative character.

Rust Belt Community Organizations

Beyond the healthcare giants, Ohio's nonprofit sector includes thousands of community organizations that emerged in response to deindustrialization. In cities like Youngstown, Akron, Toledo, and Dayton — communities hit hard by the loss of manufacturing jobs — nonprofits have stepped in to fill gaps left by declining public services and private-sector retreat:

• Community development corporations (CDCs) have revitalized neighborhoods in Cleveland, Cincinnati, and Akron
• Workforce development nonprofits retrain displaced manufacturing workers for healthcare, IT, and skilled trades
• Food banks — the Akron-Canton Regional Foodbank, Greater Cleveland Food Bank, and Freestore Foodbank (Cincinnati) collectively distribute hundreds of millions of pounds of food annually
• Land banks — Cuyahoga County Land Bank and similar organizations address the blight of vacant properties left by population loss

"In Ohio's Rust Belt cities, nonprofits haven't just filled the gap left by manufacturing — they've become the economy. Healthcare systems are the largest employers, community development corporations rebuild neighborhoods, and food banks feed families that once had union wages." — Ohio Association of Nonprofit Organizations, 2024

Arts and Culture

Ohio punches well above its weight in nonprofit arts and culture:

• Cleveland Orchestra — Consistently ranked among the top five orchestras in the world
• Cleveland Museum of Art — Free admission, world-class collection, $1 billion+ endowment
• Cincinnati Art Museum — One of the oldest art museums in the U.S.
• COSI (Center of Science and Industry) (Columbus) — One of the top science centers in the nation
• Rock and Roll Hall of Fame (Cleveland) — Iconic cultural institution and major tourist draw
• Playhouse Square (Cleveland) — The largest performing arts center in the U.S. outside of New York's Lincoln Center

Cleveland's University Circle neighborhood — home to the Cleveland Museum of Art, the Cleveland Orchestra at Severance Hall, the Museum of Natural History, the Botanical Garden, and Case Western Reserve University — may be the most concentrated collection of nonprofit cultural and educational institutions in the Midwest.

Challenges and Outlook

• Population stagnation: Ohio's population has been essentially flat for two decades, limiting the growth of donor bases and increasing per-capita demand for services
• Over-reliance on healthcare: With 62% of nonprofit revenue concentrated in healthcare, Ohio's nonprofit sector is vulnerable to changes in healthcare policy, reimbursement rates, and insurance markets
• Brain drain: Young talent leaving for coastal cities weakens the pipeline of nonprofit leaders and donors
• Opioid crisis: Ohio was among the states hardest hit by the opioid epidemic, creating enormous demand for addiction treatment, recovery, and mental health nonprofits
• Federal funding risk: Ohio's universities and research institutions depend heavily on federal research grants, which face DOGE-related scrutiny

The Bottom Line

Ohio's nonprofit sector tells the story of Rust Belt reinvention through healthcare, education, and philanthropy. The Cleveland Clinic's $17.2 billion empire, the world's first community foundation, and one of the densest concentrations of hospital systems in the nation have made Ohio's nonprofit sector far larger than the state's economic trajectory might suggest. At $159.8 billion in revenue across 60,912 organizations, the Buckeye State demonstrates that nonprofit institutions can serve as the economic backbone of post-industrial communities — while also raising difficult questions about what it means when a state's economy depends so heavily on tax-exempt healthcare organizations. The challenge for Ohio is to ensure that its nonprofit wealth translates into broad-based community benefit, not just institutional growth.