The most basic factor influencing the overall work of any family foundation is, surprisingly, often also the least examined: the initial determination of the foundation’s primary purposes and priorities. Issues of effectiveness, impact, strategy, assessment, and accountability get all the attention, while little discussion is given to the most fundamental determinants of what foundations do: donor preferences. This is the unacknowledged elephant in the room. It’s almost as if the field is saying, ‘We can’t comment on donors’ choices, because those are a matter of personal, and therefore idiosyncratic, preference, so we will concentrate all of our attention on how well the programs that flow from those choices are carried out.’ But, while operational effectiveness is important, it is even more important to examine the rationale for the basic determination of those programs in the first place. This teleconference was co-sponsored by Stanford Social Innovation Review.