This chapter examines the institutional relationships that exist within and between global health philanthropic institutions. The relationships of concern between for profit institutions and health-related organizations can involve direct financing. In the interests of public health, and particularly because poor communities affected by foundations do not automatically have a feedback mechanism to influence the decisions of private funders. The chapter argues that it is appropriate to subject private foundations to the same scrutiny received by public institutions. It explains the scope of potential conflicts of interest that exist among the private foundations that are major funders of global health. Like the other private foundations, the Bill & Melinda Gates Foundation does not disclose the detailed discussions that take place among its board when funding decisions are made, because of the need to ensure free comment on grant applications. The bulk of these foundations financial transfers in global health have been to programs developing medical technologies.