Partnering with Health Conversion Foundations
conversion foundations, also known as health legacy foundations or hospital conversion foundations, are
typically established when a nonprofit healthcare entity converts to a for-profit corporation. The healthcare
entity can meet
federal requirements regarding the sale of tax-exempt entities by creating a new foundation that
value of the nonprofit for the public's benefit.
One 2014 census
identified 306 health legacy foundations across 43 states with total assets of over $26 billion.
Health legacy foundations in rural areas can be particularly important philanthropic partners for rural
organizations. Over 80% of these
foundations primarily serve one local community or county, which can provide consistent sources of
funding for rural health programs. While some hospital conversion foundations only focus on patient care and
related activities to increase access to services, others are focusing more broadly on social
determinants of health. The missions of hospital conversion foundations may include health, education,
community development, housing, advocacy, and capacity building.
Examples of Health Conversion Foundations
- Formed in 2008, the Empire Health Foundation is a
private health conversion foundation based in Spokane, Washington, with a service area of 7
counties and 3 tribal reservations in eastern Washington. The foundation invests in health initiatives that
improve access, education, research, and policy. For example, in 2017 Empire Health Foundation awarded grant
funds to the Stevens County Summer Food Program to purchase
food items to provide supplemental food boxes to families with low incomes.
- The Alleghany Foundation in rural Covington,
Virginia, was established in 1995 after the conversion of Alleghany Regional Hospital. The foundation
has awarded over $50 million to local nonprofits
and government agencies to promote the health of the community. For example, in order to increase
to care for children and youth in Alleghany County, the foundation provided funding for
school nursing programs in local public schools.
- The Kansas Health Foundation in Wichita, Kansas, was
established in 1985. The foundation currently holds a $200 million endowment and seeks to promote health
among all residents of Kansas. The foundation has a long history of supporting Thrive Allen County, an initiative that focuses on
increasing opportunities for and access to economic development, education, healthcare, and healthy living
in rural Allen County. Since 2014, Thrive Allen County has received over $1 million in
grants to build a rural health advocacy network, improve health equity, and increase access to healthy food
for rural residents.
- The Greater Rochester Health Foundation,
established in 2006, works with several rural counties in western New York to meet the needs of
underserved residents. For example, the Neighborhood
Health Status Improvement program works with rural communities to make changes to the social,
physical, and economic environment through an asset-based
community development framework. One grantee, the S2AY Rural
Health Network, received a grant to implement the Our Town RoCKS
initiative. This long-term strategic planning program mobilizes community members to improve health
behavior, access to services, and economic opportunities in rural Yates County, NY.
- The Colorado Trust is one of the largest hospital conversion
foundations in the United States, with assets totaling $511
million. The trust has a long history of partnering with rural organizations and communities to
provide funding that promotes health equity for rural communities. For example, the foundation sponsors
Rural Philanthropy Days to
increase philanthropic partnerships for rural communities and provides funding to the Colorado Rural Health Center to develop the rural workforce.
Considerations for Implementation
Hospital conversion foundations are affected by rules and regulations at the state level. Some states
require these foundations to operate community advisory boards, which could present opportunities for
rural organizations to advocate for their needs. Rural hospital conversion foundations also
experience workforce challenges. For example, these foundations may struggle to recruit staff members
with the desired experience or skills.
Program Clearinghouse Examples
Resources to Learn More
Foundations: Defining Mission and Structure
This guide provides a brief overview of the establishment of health conversion foundations and the
importance of community involvement.
Organization(s): Consumers Union, Community Catalyst
Leverage over the Social Determinants of Health: Insights from a Study of 33 Health
Analyzes the strategic framework of 33 health conversion foundations and describes their investments
in issues related to the social determinants of health.
Author(s): Easterling, D. & McDuffee, L.
Organization(s): Wake Forest School of Medicine
Health Legacy Foundations:
A New Census
This journal article describes the state of health legacy foundations in the U.S. and identifies
select challenges that follow the conversion of rural hospitals.
Author(s): Niggel, S.J & Brandon, W.P.
Citation: Health Affairs, 33(1): 172–177
A Profile of Foundations Created
from Health Care Conversions
Lists basic information about 155 healthcare conversion foundations and public charities, including
the focus of their grantmaking.
Organization(s): Grantmakers in Health
Social Determinants of
Health: How Are Health Conversion Foundations Using Their Resources to Create Change?
This blog post explores examples of health conversion foundations working with local communities to
fund initiatives that focus on the social determinants of health. One rural example provided is the
Greater Rochester Health Foundation in Western New York.
Author(s): Easterling, D. & McDuffee, L.
Citation: Health Affairs Blog