News flash from the 2026 AHP Report on Giving: larger foundations raise more money.
Thank you for today’s presentation, Captain Obvious. That’s about as shocking as discovering that larger hospitals have more beds.
But stopping there misses the most valuable lesson in the data. The report isn’t really telling us that size wins. It shows us what larger organizations do with scale and why those choices consistently translate into stronger fundraising performance.
The Numbers Point to a Scale Advantage
Let’s start with the obvious part.
Healthcare systems reported a median ROI of $5.88 in FY2025, according to the 2026 AHP Report on Giving, compared to $4.39 for community hospitals. Median net fundraising revenue was $26.3 million for healthcare systems and $2.1 million for community hospitals. Larger organizations also reported substantially greater production revenue and larger gifts.
On the surface, that appears to support a simple conclusion: larger organizations perform better because they are larger.
But size itself isn’t a strategy. No CEO has ever approved a development plan that consisted entirely of “become bigger.” The more useful question is what size allows organizations to do.
Scale Creates Capacity
One of the clearest patterns in this year’s report is the relationship between staffing and performance. Organizations with 20 or more direct fundraising FTEs reported a median ROI of $6.67. Organizations with one FTE or fewer reported a median ROI of $2.38. Net fundraising revenue increased dramatically as team size grew.
That gap isn’t simply about having more people making more donor calls.
Larger teams can support specialized functions that smaller organizations often struggle to sustain. They can dedicate staff to major gifts, planned giving, grant development, prospect research, stewardship, data analysis, and campaign management. They can build systems and processes that help fundraisers spend more time fundraising and less time juggling competing responsibilities.
In other words, what often looks like a scale advantage is actually a capacity advantage. The strongest organizations aren’t just bigger. They’re able to invest in the infrastructure that makes fundraising more effective.
What the Top Performers Have in Common
The report’s high performers offer another clue.
The top 25% of survey participants in terms of net fundraising revenue achieved a median ROI of $8.01, while the most efficient 25% in terms of net fundraising revenue per frontline fundraiser generated $9.30 for every dollar spent on fundraising. Both groups substantially outperformed the overall respondent pool.
Certainly, many of these organizations benefit from size and resources. But the data suggests something more important. High performers tend to excel at the things that create long-term fundraising strength: building major gift pipelines, securing larger commitments, investing in planned giving, and developing teams capable of sustaining growth over time.
Those are strategic decisions, not demographic facts. Organizations become high-performing organizations because they consistently make investments that compound over time.
Lessons for Organizations of Every Size
For community hospitals and smaller foundations, this is actually good news. If the report’s main lesson were “raise more money by becoming a large healthcare system,” it wouldn’t be particularly actionable.
Instead, the findings point toward choices that organizations of any size can make. They can strengthen major gift programs. They can invest in planned giving. They can examine how staff time is allocated. They can identify opportunities to add specialized expertise as resources allow. And they can benchmark against organizations with similar structures and challenges rather than comparing themselves to institutions operating on an entirely different scale.
The goal is to understand which scale advantages of multi-billion-dollar health systems are actually transferable, not necessarily to become one.
Looking Beyond the Obvious
The 2026 Report on Giving confirms that scale matters. Larger organizations raise more money, generate stronger returns, and often operate more efficiently. But that isn’t the most interesting finding.
The most interesting finding is that scale itself may be less important than the investments it enables. Staffing, specialization, infrastructure, and strategy are what turn size into performance.
So yes, bigger foundations raise more money. We can thank Captain Obvious for that insight.
But when you dig a little deeper into the data, the obvious answer turns out to be the wrong one. The real story isn’t that size wins. It’s that capacity wins, and scale is simply one way to build it.
Download the Full Report
Of course, this article only scratches the surface.
The 2026 AHP Report on Giving includes detailed benchmarks on fundraising revenue, ROI, cost to raise a dollar, net fundraising revenue, staffing, campaign activity, high performers, and institution-specific performance across academic medical centers, community hospitals, and healthcare systems. Whether you’re making the case for additional investment, evaluating your fundraising structure, or simply looking to see how your organization compares to its peers, the full report provides the data and context to help inform those decisions.
Download the full 2026 AHP Report on Giving to explore the complete findings and benchmark your organization’s performance against healthcare philanthropy peers nationwide.
