Host: Welcome everyone to another episode of the “Go Beyond Fundraising” podcast. Today, we are talking all about hospital annual fund programs and why they’re so valuable and why you should be thinking about your investment there maybe differently, especially as we’re heading into year end and FY‘26 for a few people. 

I’m sitting down with a couple of ladies today to help me with this conversation and help me with this topic. First, I’m excited to be joined by Alyssa Boger, our EVP of Client Experience. Alyssa, welcome. 

Alyssa Boger: Thank you for having me, Leah. So excited you’re here today. 

Host: I’m also excited to welcome our friend and client, Jennifer Lomax from City of Hope. Jen, welcome. 

Jennifer Lomax: Thank you so much, Leah. 

Host: So excited to have you, like I said at the start. Before we get into our discussion, I’d love to know a little bit more about your role at City of Hope and a bit about your journey getting there. 

Jennifer Lomax: I am the team lead, if you will, Senior Executive Director of Direct Response for City of Hope. My journey as far as coming to City of Hope, like so many folks, what they stand for is really near and dear to my heart. I’ve had loved ones touched by cancer and diabetes, so it just makes that much more compelling. 

I’ve been around the industry for about 25 years. I’ve touched on the health sector with my time at American Cancer Society, but there’s something different about working for a direct hospital.  

Host: Let’s talk about annual fund. We know that it’s one that can be not as resourced at lots of organizations as maybe it could be or should be. Jen, how have you seen a well-run annual giving program act as the most reliable cost-effective engine to feed upgrade pipelines? 

Jennifer Lomax: I think with mass market, we’re a low-cost point of entry. I feel like we do the heavy lifting, right? We have that one-to-many approach as opposed to one-to-one. And I think with that, we’re able to establish those pockets of loyal donors, such as sustainers – those folks that are definitely going to upgrade with you a lot faster. So, I feel like we are able to do this at scale in mass market. And from there, folks can refine as folks go up the giving pyramid, if you will. 

Alyssa Boger: I would say working across being able to partner with a number of different hospital systems and foundations. When that patient experience team or individuals who are responsible for the patient experience are partnering and in lockstep with annual giving or philanthropy – that’s really where the magic happens. It’s seen as an opportunity and a benefit to be able to tie the two together instead of keeping them walled off and not introducing philanthropy until a patient is discharged or has been discharged for a while. Always being very mindful, thoughtful, and I think having integrity about the patient experience, but finding ways to weave in the story of philanthropy is really where that integration and boost into annual giving takes place. 

And that’s sometimes rare to find, but when you do, it’s just amazing to see how patients feel like they can be part of that story and community and have an active role in their own experience and those of other patients and really broadens the engagement they’re able to have and the relationship that they’re able to have with the hospital itself. 

Host: I love that you brought up that point, Alyssa, about story and relationships because at least my perception – kind of as an outsider looking in – with a lot of hospitals is they can sometimes seem these very large, complex organizations. I think donors want to be able to see their place in it, and so many of the gifts that we see going to hospitals are from major gifts. 

As a lower dollar giver, you may be thinking, well, what can I do to make a difference at this really large, complex, powerful organization? 

Alyssa Boger: It makes me think of when I had my first child about six years ago. What a journey that was. I gave birth at our local hospital, then started going to weekly new moms’ classes. I was a nursing mom trying to figure that out for the first time, and itwas insane. 

I went to this class every single week with probably 20 other brand-new moms. We still have our own WhatsApp chat group. We’re talking to each other six years later, but we were there every week. 

A few of us made gifts to the hospital in honor of the woman who led – the nurse who led our classes, and I never received any outreach or follow-up from that hospital, which I know well in the area that I live, it’s a big system. And I think they’ve been able to have a lot of success at that major transformational gift level. 

It’s kind of like we’ll take your $25, $50, and then you can just go back into the community. But there could have been a cool opportunity to engage this mom group or to be able to build up that patient experience – community experience into something just really beautiful and long term. 

But it just felt, even though I had this tie to that experience at the hospital, that my engagement on the philanthropy side was just kind of like a transaction that was ignored to some degree, which is just a shame. 

Jennifer Lomax: Yeah, completely agree, Alyssa. It’s interesting that no one reached out to you because again, like you said, that could have been a great entry point as far as just building a relationship with you and really that entire group of moms. 

Alyssa Boger: It is interesting. As a fundraiser, it was like a key moment for outreach. I’m clicking on your emails; I’m taking your surveys. 

Host: I love that you shared that, Alyssa, because it makes me think of another story, which was Lisa Greer, a friend and author. She had a very interesting journey that parallels a little bit of what you’re talking about. For most of her life, she was an annual fund type of donor, and then her husband’s business took off. They sold the business, became millionaires overnight, and she wanted to make a large transformational gift at a research hospital in their area. 

She was not on any of their lists as somebody that they should have been cultivating for a major gift because of that kind of sudden windfall. But if she had been making smaller gifts before that with the hospital and been stewarded, then that journey could have looked a lot different. She did end up making the gift, and she’s got a whole story about that. 

But her story and your story, I feel like are kind of like bookends to what an experience can be like for different types of donors and how that experience across that spectrum is really, important. 

Jennifer Lomax: I completely agree with that, Leah, you know, you’d never understand or know the capacity unless you continued to engage, right, with constituents. And that’s key. It’s something that we definitely try to stay cognizant of, obviously, at City of Hope around just making sure that we’re staying engaged – and we’re staying before folks for that potential transformational gift. 

Host: So, I think that segues nicely into kind of my next question for you, Jen, which is what early signals or metrics should leaders at hospitals look at to prove out that story of, you know, small to large transformational giving? 

Jennifer Lomax: Again, you probably will hear me say this several times, it’s all about the data. You have to stay up to date on what your key performance indicators are telling you – your file health trends are really, really important.  

I think for this particular area, you know, looking at those folks that are sticky – those folks that make multiple gifts in the first six months of acquisition – they tend to have a direct line to moving up to major gifts, especially that $100 plus cohort. They’re special. 

I think the other cohort that you would look at is your consecutive year givers – those folks who continue to give to you time and time again. Their behavior and what’s happening with them is important. 

And then one thing that I feel like at times, at least in my experience, a lot of nonprofits don’t necessarily pay a lot of attention to is donor feedback. Even if it’s negative, those folks are engaged. They want you to understand their stance with your mission, with your organization. A tactic that I’ve deployed in past lives and now with Allegiance, you have those limited communication populations where they say, only email me once a year, only mail me twice a year. We actually reach out to them via that cadence, and we remind them that you’ve asked only to hear from us one time a year. We have some of the most phenomenal response rates when it comes to those particular populations. 

So really, again, just listening to donor feedback, and again, looking at those donors who just have that behavior to move up. 

Host: Alyssa, why do hospital boards sometimes struggle to see the value of investing in the annual fund? 

Alyssa Boger: I think in a lot of cases it comes down to directly attributed revenue, especially in today’s world where things are becoming less and less clear cut. We might have strategies that are targeting folks through different media channels and then sending a direct mail piece and then sending emails and maybe also making a phone call that can be hard to track what is maybe driving someone’s gift. 

Ultimately, they may end up making a more significant gift through an event that they’re attending, but all of those touch points along the way were a reminder of the mission and impact that then helps them to make that larger gift in a different channel or program. 

What can be challenging is in a lot of going through budgeting cycles and seasons, you’re pulling apart that bigger hole into events, major giving, mid-level giving, annual giving, planned giving – you’re breaking it all apart into pieces into what can be directly attributed to that program. And annual giving, by and large, is going to have the lowest ROI. 

People are spending the most to get communications out, lower average gifts, and postage just keeps getting more and more expensive. So, it can be a costly endeavor, and when you look at it in isolation, I think there’s an easy tendency to say, oh, this doesn’t work as well as all these other programs. We can just cut this and save money and reinvest it elsewhere. 

But once you look at some of those metrics Jen mentioned, what is the upgrade from general to mid to major? How many planned giving donors originated from your annual fund? How many of your event donors receive annual giving communications? 

You start to then see how everything is interconnected and the importance of investment at the annual giving level that then feeds and serves as a pipeline for all of the other areas of fundraising. 

There’s great, but sad, case studies with organizations like ACS (American Cancer Society) that have pulled back on acquisition and then saw a ripple effect across all of their programs, not just direct response, because they started to pull back on that pipeline of donors. I think because you have to be a little more patient with annual giving, you have to be okay with not always having that positive or really high ROI. It can be easy for more of those business-minded board members to just see it as a line item and feel like they can just cross it out or minimize it without impacting other areas. 

I think that’s where from a leadership standpoint, being able to have strong partnerships with other departments within philanthropy or the foundation, being able to present a united front to your board of how all of these programs work together in concert can really help to lift all boats as opposed to it being seen as these separate pieces that can be changed without impacting one another. 

Jennifer Lomax: I completely agree. I think for me, I’m going to pick on my age-old friend data. I know at times it can be hard to pull together an attribution model. However, we do know that one thing is connected to another. 

Also just trying your best in the data to understand what that omni-channel strategy is and again, how all those different touch points are making an impact to that ultimate gift, if you will. 

Host: Jen, what does that framework look like for you?  

Jennifer Lomax: I would say very similar to what Alyssa just walked through. Alyssa gave the American Cancer Society example of really being able to see what disinvestment can do to a program. I don’t want to pick on American Cancer. I love them – I was there for eight years. Other organizations also have made those types of decisions. 

I feel like how you can show the value of mass market fundraising to leadership. I’ll come back to again your file health trend data – your key performance indicator data. There is a flow chart looking at those populations that are important, but new-to-file folks and then how they then flow into new last year and how they then flow into consecutive-year givers. 

You can understand how if you have a group of 50,000 brand new donors that came in in FY’24, now you only have 40,000 of them – you’ll see how they flow through the file health trends to understand their value. It’s really appearing when you have a year of disinvestment of how long it takes to work through that particular flow chart. I think it’s really, again, continuing to lead with data in an easily digestible way and showing them over time how the impact of one decision can affect you in years to come. 

Host: I love that framework, Jen, and it makes me as a marketer think about the marketing funnel as an analogy. You know, you have your impressions at the top, that’s your awareness, and then you have people in that consideration stage who are, maybe you’ve gotten their name, you’ve gotten their email address, you’ve gotten permission to communicate with them. 

Then down there, lower in the funnel, you have people that are actually engaging in those sales conversations. You would never go to a marketing leader and say we’re going to cut your investment in impressions because that’s just going to cut off the top of our funnel. 

Thinking about it that way – holistically as a journey – is so important.  

Jennifer Lomax: Yeah, I think from a mass audience perspective, obviously there’s a ton of strategy that drives how we approach things, but one thing I also think is important – in the spirit of a healthy competition – you also have to remember if you’re not there, somebody else is. Your mission is just as important as someone else’s. 

And again, we’re all here for a greater cause, but why not have that constituent engage with you as opposed to another like organization? 

Host: How do you help make the case for that with your data and your communications with leadership? 

Alyssa Boger: I think where we’ve come alongside other leaders within hospitals or hospital foundations, it’s in creating some type of KPI dashboard. Executive leaders are not going to want to look at your campaign deep dive reports, or they’re going to get lost in all the data that Jen and I love so much. They want the top line. 

For City of Hope, for example, we’ve worked with Jen and other leaders to create a very succinct KPI dashboard report that we can provide monthly. We then distill that down into just a slide or two each quarter that can be those high points that just reinforce, yes, this program is providing direct revenue and impact, but we also have seen X number of donors make gifts of X amount to other areas of the City of Hope. 

We’ve had this many donors who started annual giving now upgrade into major gifts or make a planned giving gift. It doesn’t have to be tons and tons of reports. It does mean you have to have the data. So having solicitation history in your database, being able to have trust in your appeal code and source codes, being able to get to the numbers, and then creating that compelling story that can be easily digested – those bite-sized numbers that can be remembered. Then wow, I didn’t know that we were generating that much revenue. That’s great.  

I think just trying to keep that in mind – how can you make it as simple and impactful as possible? That may mean that you have lots of reports behind the scenes to back it up and numbers that you know really well as the leader of the annual giving or that agency partner. But then being able to create that succinct and powerful story for an executive leader that helps to reinforce the direct and indirect impact. 

Jennifer Lomax: Yeah, Alyssa, I agree, and I just really appreciate the work, as you spoke to, that you all do with us. Those one to two slides that tell that super high-level story around like how many folks that originated in annual giving are now giving major gifts, how many folks are actually giving to other areas of philanthropy. 

Again, I think in many ways that is part of that attribution story of how folks begin with us – and they still might be with us – but they decided they then want to engage elsewhere and having, in a past life, we called it having open borders when it comes to other parts of philanthropy, like really helping the major gift officers understand that, hey, we have six or seven new prospects that you all can go and really try to create a relationship with. 

It’s just really important when it comes to just having shared goals, if you will. 

Alyssa Boger: That makes me think of the concept of the donor vortex, as opposed to the donor pyramid. Yes, we want to continue upgrading donors as much as we can, but there are always going to be donors that fall back down. 

In general, there could be people who are coming closer and then farther away from the mission. They might be engaging in events, or they’re in a season where they can’t be as engaged in events, but they could give to a direct mail piece. It’s creating all those different opportunities for engagement that are centered around the constituent, instead of the organization being at the center, just trying to push donors into whatever bucket you think they should be in or fit into. 

It provides almost that kind of safety net or catch-all for donors who may be in that period where they’re not giving significant gifts, or they can’t at this period of time, or life is crazy and they can’t be that same level of peer-to-peer donor that they’ve been in the past, but they could still engage through email or through a mailing or through a text message so  they’re still part of the mission, even if the amount that they’re giving or the time they’re investing looks a little bit different. 

Jennifer Lomax: Yeah. I love that – the vortex – because you’re right. It’s not linear. I think I tend to be a little old school, and I’ll go to that donor pyramid because I feel like it’s where I was raised and cut my teeth. But as time has gone on, like you said, folks do move all around. And are you prepared as an organization to meet them where they are at that point in time? 

Host: I think that gets into my next question really well, which is from the donor’s perspective, how does consistent stewardship across gift sizes build that lifetime value and trust where they want to stay engaged with you no matter where they are in their life stage? 

Jennifer Lomax: Going back to how coming to City of Hope has been a new challenge for me in so many really positive ways. I think not losing sight of a patient’s primary relationship with the organization. As I mentioned before, the focus on the patient population is something that I hadn’t experienced before, but I’m a quick study. 

It’s been really refreshing to learn how important this particular cohort is to hospitals or in a hospital direct response setting. I think it’s just important to keep that at the core of how you are engaging with someone in philanthropy. They have a very different experience. It’s very personal, if you will, and you always want to make sure that you’re honoring the patient and the family relationship. And I feel like if you have these pillars in your approach, it will just make that case for long-term support come a lot more naturally. 

Host: Especially with a cancer journey. You see so often when someone in your community has gotten a cancer diagnosis that half of Facebook is following the journey through updates that their family is posting. They might be coming in to bring in care packages or sit by the bedside while a chemo treatment is happening. A cancer journey really does engage a whole community of people. 

I think that’s a unique way of looking at it, especially with what City of Hope does, because it’s thinking about like, yes, there’s the patient and their immediate circle that’s affected by our hospital’s care, but there’s a larger universe of people in various levels of closeness to that story that also care. 

Jennifer Lomax: Yeah, absolutely, Leigh Ann, and I have to say, because you had a buzzword that took me back, so you mentioned care packages. So, you know, I worked for CARE for almost 13 years, and that was the origination of the CARE package. But I think everything that you’re saying is completely spot on and important. 

Host: All right, a quick question to wrap us up here, which has been a really fun discussion. What’s one practice or kind of mindset shift that hospitals can adopt in the next 60 to 90 days as we’re kind of steering down the barrel of year end to unlock more pipeline value from their annual fund without any major new investment? 

Jennifer Lomax: We’ve talked a little bit about return on investment, as Alyssa spoke to earlier many times, the return on investment can be difficult to prove in a mass audience space, but that doesn’t mean that you shy away from it. 

Here and in past lives, I think it’s just important to take the time to understand your return on investment by channel and really determine where that next best dollar should be spent based on your goals and objectives. 

Once you identify where that next best dollar should be spent, actually move the money there and start to execute and start down the path of that strategic plan. 

Alyssa Boger: I’d probably also add, maybe think about what partnerships or relationships you could start to cultivate. Do you have a data analyst that you might want to become BFFs with who could help you tell that more cohesive story to your board or to your leadership? Is there a partnership with mid and major gifts that needs to be built or restored to have more of that united front, collaborative approach to donor engagement and donor relationships? Are there community partnerships you could help to build or think differently about?  

We work with a couple of other hospital foundations that are more regional, localized, and so they’ve identified ways to really engage with the community beyond hospital walls, community health network foundation. They have a program working with school nurses, like really being part of the school system. Parents see their logos they know that community health is in it with their kids at school. 

Memorial Hermann in Houston has an amazing partnership with a new high school and building out a pre-med, pre-nursing program – and recognizing those things can take investment. What are maybe some of those types of partnerships that help to broaden that annual giving base beyond patients to the community at large? That’s something that City of Hope has done just really well through their investment in mass market fundraising, recognizing they have a full research team and department that can be funded through national donors. 

There’s been that commitment to community building, relationship building, partnerships 

with corporations that really help to magnify and amplify the mission and the brand beyond their more limited patient audience. Who are those people you can get to know that might allow you to expand and support your efforts so that you’re not feeling that weight all on yourself?  

Host: Love that, Alyssa. All right. A few minutes left. Is there anything else we want to touch on before we wrap?  

Alyssa Boger: I would just add, Jen is amazing. I mean, I think anyone who works with Jen knows that or has had the privilege of working with her across many of her different roles. Just being able to partner with a leader like her in City of Hope is like the highlight for me and just the belief they have in annual giving. The power of philanthropy and thinking through just the patient and donor experience so thoughtfully. 

I just appreciate you, Jen, as the leader that you are and the ways that you push us and colleagues and the industry to always do better and be better.  

Jennifer Lomax: I really appreciate that. I think it’s just about coming in and bringing your best to the table. It’s about coming in and bringing your best self to work every day. And that’s what I aspire to do. I feel like I’m here for a reason. I’m here for a purpose, right? So, you saying that really warms my heart. It’s very humbling. But I do try very hard to show up as that person that you’d want to work with – and we’re all in this together. That’s the part that’s really so refreshing for me — is we’re all just trying to do good in the world, especially these days. It’s just so much more important. It’s always been important to me. My entire career in nonprofits. But it’s important for me to wake up in the morning and give back and to really appreciate what you have. 

Host: Well, thank you, Alyssa and Jennifer, for joining us today. I’ve really enjoyed today’s conversation genuinely so thank you both.