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A Recipe for a New Foundation

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Special to the Philanthropy Journal

By Tina Markanda

The Foundation for a Healthy High Point was established in 2013 as a result of a merger between High Point Regional Health and UNC Health Care. The Foundation was funded with $50 M in assets with the mission to improve health and wellness in Greater High Point, a community composed of approximately 110,000 individuals who represent both urban and rural areas.  

The Foundation is a health legacy foundation, a new generation of foundations created from assets from the sale, merger, or other configurations of assets from the sale of non-profit hospitals, health systems, and health plans. These unique entities create considerable new charitable wealth for  communities. Health legacy foundations emerged in the 1970’s, rapidly expanded in the 1980’s and 1990’s when there was significant merger and acquisition activity within healthcare, and grew further in the 2000’s (“Health Legacy Foundations:  A New Census” – http://content.healthaffairs.org/content/33/1/172.full). Grantmakers in Health (GIH) recently updated a report on Health Conversion Foundations. 80% of foundations indicated that their grantmaking was directed to a local or regional area. Foundations further reported a collective $16.3 B in assets, with the mean health legacy foundation having median assets of $69 M. These foundations can be gamechangers for communities due these new significant resources and the ability to address specific issues and consider broader contributing social determinants. 

Our Foundation is a new ingredient to a well-established community. As a new organization, it quickly became apparent that there was no standard “recipe” to follow as the Foundation initiated its work, which has immense potential. 

Early efforts focused on the fundamentals of establishing a new business. This was an important prerequisite before grantmaking efforts could commence. Since those days, we have continued to develop and innovate our recipe by identifying ingredients that our work requires and by taking inventory of items that we have available. As expected, not everything that we need is in our community cupboard. Further, it was important for the Foundation to understand how to “mix” our community resources and determine how long things will take to “bake”.  

From our beginning efforts, we have learned much:

Determine What We Are Making

Early discussions with the Board centered around the Foundation’s work and envisioning what our organization aspired to accomplish. Thoughtful discussions around opposing concepts such as short term vs. long term impact, broad vs. targeted grantmaking, “community chest” vs. strategic investments, organizational support vs. issue focus were considered. Our Board confirmed the Foundation’s direction to be a catalytic agent to facilitate measurable lasting impact at a population level, something that was new to the community.

Essential Ingredients

While our community non-profit partners have many diverse resources and attributes, it was clear that for the complex issues that face our community, the Foundation could offer objectivity and additional support for a comprehensive and informed way to apply critical resources to fully understand and address issues. For example, as we began to study issues related to Adolescent Pregnancy Prevention and Early Intervention, we started by commissioning academic partners to develop a White Paper to document historic data, identify evidence-based practices, and inventory current and needed services by engaging community experts in collective discussions so that partners could offer their expert insights in a holistic manner. Prior to the Foundation’s arrival, such joint discussions were limited and not as broadly inclusive. Further, through the Foundation’s convening efforts, a greater trust and appreciation of partners continues to grow as area non-profits view each other as respected natural partners vs. as competitors as they collectively address issues.

Also, inherent in tackling issues, is the importance of having strong partners. The Foundation supports capability building efforts of essential issue-focused non-profit partners to equip them to optimally do their work. Without the Foundation’s support, organizations would have limited ability to organically build their critical individual capacities.  

Try Again

Efforts are not formulaic and as a result, not everything will “work.” The Foundation and its partners must be prepared for these “failed” efforts and learn from them. If we do not make mistakes along the way, then we are not risking enough to make the quantum changes that are needed. Incremental improvement is inadequate.

(Enough) Time to Bake

Issues did not emerge overnight, and correspondingly will not be resolved in a rapid manner. Much our catalytic work is aimed at making systems level change as well as identifying and baselining appropriate population level indicators. Our Board is cognizant that community partners must be “ready” to lead efforts as they adopt and implement evidence-based programs through collaborative practices. Further, new practices must have time to be established before data will reveal population level changes. Marking process progress is vital as we await data.

In summary, as our Foundation continues “cooking,” we will seek opportunities to reflect and correct course along the way as we create this new recipe to improve health and wellness in our community in collaboration with partners. 


Tina Markanda joined the Foundation in 2014 and serves as Executive Director. Prior to that she served as a Program Officer with the Health Care Division at The Duke Endowment, in private industry, at an academic medical center, and a private not-for-profit community hospital. She earned an MBA from Wake Forest University and MSPH from the University of North Carolina at Chapel Hill. Tina is a Fellow of the American College of Health Care Executives and is a Hull Fellow with the Southeastern Council of Foundations.

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