Very little literature exists on the nature of external reporting lines and funding structures of academic special libraries. This study focuses on academic health sciences libraries. The authors analyze information gathered from statistics published by the Association of Academic Health Sciences Libraries (AAHSL) from 1977 through 2007; an anonymous online survey of AAHSL library directors; and phone conversations with a select number of directors who were willing to take part in follow-up interviews. The history of changing trends in reporting lines over the years and a view of the diverse arrangements, including strengths and weaknesses, currently existing in academic institutions are examined.