I work in a small independent pharmacy chain in Texas, we have about 15 stores and maybe around 110 employees total.
Our IT department consists of me (Senior developer), a Junior developer, a Sys. Admin, and my boss who has the title VP of I.T. My boss is at the same level as the CFO and COO even though he doesn't have a "C" title and they all report to our CEO/owner. My projects mostly cross in to the operations department but the I.T. department has its finger in all departments. Our system administrator deals mostly with the pharmacies themselves where I mostly work with the corporate staff but also deal a lot with the pharmacies. My boss has the most experience (aside from the CEO) with the pharmacy business of all the executives so he basically consults for the other department heads. We routinely work on accounting concepts and ideas for the CFO as well as managing profitability with dispensed drugs for Operations.
Unlike most grunts I have 100% confidence in my boss and the other executive level people here. I think I got that way because they're very upfront and candid, no sugar coating, no jargon, no exec speak. If your project rocks then it rocks if it sucks then it sucks and they've been 100% right so far (i've been here 10 years).