Making the Case for Principal Giving Programs
- 8 hours ago
- 5 min read
Health care philanthropy is increasingly shaped by a small number of transformational commitments. Across campaigns and annual fundraising efforts, single gifts of $1M or more account for an outsized share of total dollars raised, often determining whether strategically aligned health system philanthropic priorities move forward or stall.
Does your organization continue to approach these donors using structures designed for traditional major giving? If you are relying solely on linear pipelines, incremental upgrade assumptions and analytics that focus on “meaningful” activity rather than readiness, any lackluster results may not come from a lack of effort but from a lack of fit.
A designated principal giving program can increase your effectiveness. Rather than as a luxury reserved for the largest institutions, developing a program is a strategic necessity wherever $1M+ gifts materially affect outcomes. Early, multi-institutional research conducted by Accordant highlights what differentiates principal giving to health care, what the data are beginning to reveal and how your foundation can prepare for a different level of philanthropic investment.
Defining Principal Giving for This Analysis
For analytic consistency, principal gifts in this research are defined as single commitments of $1M or more, regardless of an institution’s internal designations. Gifts analyzed include cash, pledges, stock and planned or blended vehicles, provided the single commitment meets or exceeds the $1M threshold.
While organizations may reserve the term “principal gift” for higher levels internally, $1M remains the most reliable cross-institutional marker of transformational philanthropy. At this level, donor behavior, relationship dynamics and organizational expectations begin to diverge significantly from traditional major gift patterns.
Why Principal Giving Is Different
Principal gifts are not simply larger transactions; they represent a different form of philanthropic decision-making, intentionality and relationship. In health care, principal gifts follow even fewer traditional philanthropy norms.
Principal gifts are not simply larger transactions; they represent a different form of philanthropic decision-making, intentionality and relationship.
Strategically, a very small number of health care donors account for the majority of campaign or program success. These gifts shape feasibility, influence timelines and unlock momentum in ways no other segment can replicate.
Relationally, principal donors rarely engage exclusively with a gift officer. Their relationships often span executives, clinicians, board members, family and trusted peers. Cultivation and stewardship are inherently complicated and cross-functional, requiring clarity of roles, disciplined coordination and institutional readiness.
Operationally, principal gifts place heightened demands on organizations: sophisticated proposal development, complex gift structures and compelling philanthropic investment opportunities that align donor values with organizational priorities.
From a timing perspective, the emergence of a principal gift in health care may take decades, but it may easily be the first gift or among the first gifts from a donor. Meaningful clinical experiences are often precursors but may happen long before the gift is made.
Taken together, these factors demand a programmatic approach that is distinct in design, expectations and leadership involvement.
What the Research Examined
To better understand how principal gifts actually occur, Accordant conducted an early-stage, anonymized review of over 100 unique historical donors who have given $1M+ across multiple health care foundations. The analysis examined first gifts, largest gifts, timing, gift structure, documented engagement and high-level relationship context where available. Fund descriptions were normalized to enable cross-institutional comparison.
This research is intentionally directional rather than definitive. While the dataset is robust enough to surface repeatable patterns, it is best understood as the foundation of an ongoing research agenda, one designed to challenge assumptions, refine institutional strategy and inform better decision-making over time, while improving section-wide approaches to principal giving.
What the Data Is Beginning to Reveal
Several consistent themes emerged that challenge common principal-giving assumptions:
There Are Multiple Legitimate Pathways to a Principal Gift
Some donors make transformational commitments early, while others arrive after many years of engagement. Both pathways coexist within the same organizations. Linear pipeline expectations fail to accommodate this reality and can obscure readiness when it appears.
First Gifts Are Poor Predictors of Principal Potential
Entry giving varies widely among eventual principal donors. Modest early gifts do not preclude transformational outcomes, and immediate large gifts do not follow traditional cultivation logic. Early disqualification rules commonly used in major gift programs are misaligned with the behavior of principal giving donors.
Principal Philanthropy Is Often Episodic
For many donors, lifetime giving is dominated by a single catalytic decision rather than steady accumulation. This has significant implications for stewardship, timing and leadership engagement, challenging more traditional models built primarily around annual upgrading.
Documented Activity Is an Unreliable Signal
Some of the largest gifts occur alongside surprisingly low levels of recorded interaction. Influence may be occurring through clinicians, executives, boards or peers, or documentation norms may simply break down at scale. In either case, CRM activity volume alone is a weak proxy for readiness.
Gift Structure and Project Selection Matter Deeply
Principal gifts frequently involve pledges, planned gifts or blended vehicles which are often tied to specific, well-articulated strategic giving opportunities. Others may include duplicating a service or program the donor valued at another hospital and wants to provide in a new location or adopted hometown, whether the organization is ready or not. Organizations that cannot clearly express what a principal gift will accomplish limit their own potential, regardless of donor capacity. Organizations must also be ready to articulate whether a new program offered by a donor is something they are prepared to start.
A Brief Note on Principal Giving Archetypes
To interpret these patterns, the research identified several recurring principal giving archetypes that describe observable behaviors across $1M+ gifts. In the most rudimentary analysis, these include donors who give early or rapidly, donors who invest over long arcs and donors whose philanthropy is defined by a single transformational commitment.
These archetypes are not personas or predictions. A single donor may align with more than one, and patterns may shift over time. Their purpose is to help organizations better understand their own data, not to prescribe tactics or constrain judgment.
Identifying a Top 10 Principal Gift Prospect List
One of the most practical implications of this work is that organizations often already have the signals they need. Identifying a credible Top 10 principal gift prospect list does not require heavy analytics or perfect data.
Effective lists typically consider:
Ability: Evidence of capacity, liquidity or complex assets
Project Alignment: Interest in mission priorities capable of absorbing a principal gift
Affinity: Timing, leadership transitions, campaign moments or life events
Access: Real relationship pathways through clinicians, executives, boards or peers
The purpose of a Top 10 list is not certainty, but focus. It provides leadership with a disciplined way to align attention, readiness and coordination around the donors most likely to shape outcomes.
Looking Ahead
The evidence is clear: principal giving behaves differently, and organizations that recognize this are better positioned to succeed. This research represents the beginning of a broader effort to build an evidence-informed operating model for $1M+ philanthropy, one that respects complexity, supports senior judgment and elevates project and institutional readiness alongside donor readiness.
As health care philanthropy continues to rely on transformational gifts, the question is no longer whether principal giving programs are necessary, but whether organizations are prepared to design them intentionally.
To learn more or to participate in further research, please contact either Debbie or Cindy:
Debbie Ferguson, CFRE, is a Principal Consultant for Philanthropy Operations and Data with Accordant. She specializes in best practices for data solutions, integration and governance as well as patient program evaluation, creation and development. She can be reached at Debbie@AccordantHealth.com or through LinkedIn.
Cindy Reynolds, FAHP, CFRE, is a Principal Consultant with Accordant. She specializes in strategic planning, board engagement and philanthropy operations. She can be reached at Cindy@AccordantHealth.com or through LinkedIn.
