The bigger the foundation, the more poorly it performs. A survey instrument designed from “In Search of Excellence” and sent to more than 230 foundation grantees measured the performance of 30 southeastern health legacy foundations. Findings indicate that as foundations increase their assets and staff, they do not decentralize decision making. They also decrease their performance in consistently specific ways. The poorer performing foundations tend to wander into fields in which they have little or no expertise, they are less flexible with their operating rules and in responding to grantees, and they do not take risks or encourage experimentation. These weaknesses provide a roadmap to improved performance but only for foundations that value the role of grantees in accomplishing their missions.