When HCA Healthcare purchased nonprofit Mission Health, the rules of charitable giving in communities across Western North Carolina changed.

With a for-profit owner running medical facilities, the foundations that raised funds from donors to support the local hospitals that had become part of Mission Health over time could no longer do so.

Transylvania Regional Hospital Foundation, which had raised $40 million since its inception, was one of six such affected charities across the 18-county region. Lex Green, the Brevard-based foundation’s former executive director, talked with Carolina Public Press about the change.

“So it begged the questions for the entities that were established supporting the hospitals, ‘Do you want to ride off into the sunset, just end operations, or do you want to reconstitute yourself and go out into the community and focus on a different cause and that’s promoting the health and wellness of the communities?’” Green said.

Green and other community leaders decided to move forward, and Transylvania Regional Hospital Foundation is now the Pisgah Health Foundation.

Similar transformations occurred throughout the region as the Spruce Pine-based Blue Ridge Regional Hospital Foundation became AMY Wellness Foundation, Asheville-based CarePartners Foundation became WNC Bridge, Highlands-based Highlands-Cashiers Hospital Foundation became the Highlands-Cashiers Health Foundation, and Marion-based Mission Hospital McDowell Foundation became Gateway Wellness Foundation.

In Franklin, where the foundation for Angel Medical Center had ceased operating earlier, the startup Nantahala Health Foundation will fill the same role as the other new foundations.

All six foundations are now helping to build the capacity of local nonprofits to meet community needs.

Lex Green is executive director of Pisgah Health Foundation and Cathleen Blanchard is its board chair. The Brevard-based health foundation evolved from the Transylvania Regional Hospital Foundation there as a result of the sale of nonprofit Mission Health to for-profit HCA. Photo courtesy of Pisgah Health Foundation

Targeting ‘social determinants,’ not hospitals

Janice Brumit, board chair at the $1.5 billion Dogwood Health Trust formed with proceeds from Mission Health’s sale, told CPP the six are now “free to give grants to any organizations they want in their communities.”

“The thing about that is that we hope that they will agree that ‘social determinants’ are a good place to place their money,” she said.

Addressing social determinants of health – conditions that impact an individual’s well-being such as housing, education, nutrition or substance use – is the central focus of Dogwood’s mission.

Asheville-based Dogwood views its relationship with the new foundations as partnerships, sweetened with $15 million over three years to each of them, according to Brumit. First-year funding comes from Mission Health, the final two installments from Dogwood.

All six foundations have agreed to support the social determinants mission.

“So the contract has specific parameters that we have to meet on a quarterly basis, and then there is an additional reporting requirement in this year’s contract where we have to share our strategies in three different areas – community outreach, resource development and grant-making,” explained Green, now executive director of Pisgah Health Foundation.

With the first $5 million parked in an investment account, Green and his staff are wasting little time educating would-be beneficiaries across Transylvania, Buncombe, Haywood, Henderson and Madison counties about his organization’s work.

Over the past couple of months, he said, Pisgah held about 25 “listening sessions” and heard from dozens of nonprofits to better understand their needs.

On Aug. 6, Sara Coplai, a grants expert at Dogwood, arrived in Brevard to work through the grant-making process with the first 50 applicants. Pisgah is asking them for letters of intent before inviting them to apply for grants to ensure that social determinants of health will be addressed.

The first grants will be awarded in October. About the same time, a second grant cycle will open.

Green expects the $15 million that Pisgah receives will only be used to fund grants. He expects operational costs to be covered through community donations.

Pisgah has developed a conflict-of-interest statement, and potential conflicts will be addressed early when reviewing applications, board chair Cathleen Blanchard said.

Dogwood, which continues to assess community needs across Western North Carolina, won’t start making grants until next year.

Far western counties

In the westernmost counties – Cherokee, Clay, Graham, Jackson, Macon and Swain – one successor foundation and one startup will support Dogwood’s mission.

Walter Clark, board chair at Highlands-Cashiers Health Foundation, said his organization is flush with money for grants. The foundation serves all six westernmost counties and the Qualla Boundary, which is located within several of these counties and is home to the Eastern Band of Cherokee Indians.

In the final year or so of the hospital’s foundation, its board contributed more than $7 million toward the facility’s renovation despite members being aware that HCA could acquire Mission Health.

“We were probably left with about 13 million, 12 million dollars” before receiving the $5 million for the new independent foundation, Clark said.

The foundation has already approved its first grants and is notifying recipients.

Some area residents believe those awards, while helpful, will fail to address a chronic need.

Highlands-Cashiers suffers from an acute shortage of doctors and conducted a recent Concerned Citizens Health Forum to address the problem.

Because the new foundation is prohibited from supporting for-profit HCA, its grant money cannot be used for physician recruitment, the group was told. HCA must address recruitment directly.

Regardless, Highlands Mayor Patrick Taylor believes investing in social determinants will prove beneficial.

“The foundations really need to focus on some big-ticket items,” Taylor said.

Having the new foundations and Dogwood operate on parallel tracks helps coordinate the organizations’ activities and provides Dogwood with “eyes and ears,” he added.

In Franklin, the new Nantahala Health Foundation is getting off the ground. A board is in place, and Lori Bailey, whose nonprofit work focused on youths and families in crisis, will start as executive director in September.

With Nantahala and Highlands-Cashiers serving the same counties, the foundations may eventually divide some geography, Clark said.

Across the region

Across all 18 counties, the foundations are taking note of what they hear from citizens and setting priorities while coordinating with Dogwood.

In the easternmost counties of Avery, Mitchell and Yancey (AMY Wellness) and Burke, McDowell, Polk and Rutherford (Gateway), Luke Howe is serving double duty as executive director.

He and assistant director Nora Frank point to a groundswell of support for addressing a shortage of affordable housing. As a result, a planning grant is being developed to allow nonprofits to collaborate and determine how safe, healthful and less expensive housing can be created.

Domestic abuse, elder abuse and child abuse are also on the agenda, Howe said.

As the new foundations build capacity to address such issues, an initiative of the N.C. Department of Health and Human Services will make it easier to tap into those resources.

The N.C. Resource Platform enables health care providers, insurers and nonprofits to refer individuals to the services they need to remain healthy.

The digital platform incorporates website, database, care coordination and call center features, available at no cost.

The platform is not yet operational in Western North Carolina.

Earlier reporting on Mission Health and HCA

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