Dental check-ups at a program provided by the Wythe-Bland Foundation. Courtesy of the foundation.

In many rural communities, access to health care can be limited. Routine procedures like teeth cleanings and physicals sometimes fall through the cracks for those who don’t have easy access or insurance. But in Wytheville, residents have had quality health and dental care for nearly two decades regardless of their financial situation thanks to the Wythe-Bland Foundation.

“We have a dental clinic that we opened, and one of their primary focuses is going into the schools and providing dental care for children,” says Travis Jackson, executive director of the foundation. “Many of those kids who may have never been to a dentist suddenly have an opportunity to have their teeth cleaned.”

Wytheville isn’t the only area that has received a boost from organizations like the Wythe-Bland Foundation. According to the latest report from Grantmakers in Health, which has tracked hospital conversion foundations/health legacy foundations for 25 years, in 2021 there were 303 such organizations in the United States. Virginia stands as one of the leading states for these foundations, with 20 spread across the state. 

These foundations are typically established when nonprofit hospitals are sold to for-profit systems. Federal and many state laws require the proceeds from such sales go to charitable endeavors similar to those of the original nonprofit entity. 

According to the Internal Revenue Service, the organizations are tax-exempt as 501(c)(3)s, but they are considered private foundations, generally operating with endowment funds provided by the initial hospital sale rather than conducting fundraising efforts like public charities. Some exceptions, like the Wythe-Bland Foundation, do exist — in that case, the community leased the Wythe County Community Hospital buildings to LifePoint Hospitals Inc., creating funding for the foundation.

In Martinsville, the Harvest Foundation initially started as a public charity after the sale of the community-funded Memorial Hospital. But they’ve since converted to a private foundation, drawing from a $170 million endowment to award grants supporting the organization’s priorities of building a thriving youth, a vibrant community, and a resilient and diverse economy.

“For some communities, the health conversion foundations have the luxury to focus solely on health,” says Kate Keller, president of the Harvest Foundation. “But when our foundation was created, not having a lot of philanthropic dollars in the community, they thought they needed a broader scope. We’ve always had a focus on health, but we’ve also always had a focus on education and a focus on community needs.”

Over the past two decades, the Harvest Foundation has supported an array of projects in Martinsville, including the Smith River Sports Complex and the Commonwealth Crossing Business Center. 

“One of our proudest initiatives we’ve been working on in a pilot mode is a commitment to our seed program that guarantees two years at Patrick & Henry Community College for Martinsville High graduates,” Keller says. (See background story: “This is an investment in hope.“)

Education has been a priority for the Danville Regional Foundation, too. The foundation, which was endowed with $200 million from the sale of the Danville Regional Medical Center in 2006, has supported a variety of educational initiatives in the Dan River Region, from early childhood education to providing higher education opportunities.

Revitalization of downtown Danville, which struggled in the years since the textile industry left town, has also been a major focus of the foundation. (Disclosure: The Danville Regional Foundation also has awarded a grant to Cardinal News to fund a reporting position, which will start this summer, but donors have no say in news decisions. See our policy.)

“The Danville Regional Foundation has been involved in a number of transformative projects in the city and this region,” says Lee Vogler, a Danville city councilman. “One of our big success stories is our downtown and what we call the River District, and the Danville Regional Foundation has their fingerprints all over that. They distributed $25 million in various grants that got that development going over the past 10 years.”

Vogler says the Danville Regional Foundation has been an important partner for the city’s government to supplement and provide seed funding for local initiatives. That’s the role many of these foundations play, working in collaboration with local government to facilitate projects that might not get completed without outside funding.

“We’re the icing on the cake,” says Mary Fant Donnan, executive director of The Alleghany Foundation. “The local governments provide the lion’s share of services in our communities, and having The Alleghany Foundation helps create some amenities that are really nice to have that are provided through the nonprofit structure.”

The Alleghany Foundation was founded in 1995 with $35 million from the sale of Alleghany Regional Hospital. In 2009, the foundation’s board underwent a reflective practice exercise to hone its mission to better serve the Alleghany Highlands region. 

“They determined that to really have a healthy community requires taking a look at the social determinants that affect health and wellbeing,” Donnan says. “Economic wellbeing, jobs, access to health insurance that comes with jobs, education—these things are very important to health outcomes.”

One of the foundation’s biggest projects has been helping build a YMCA to serve the area. Donnan says the YMCA has become a hub for both activity and health for the community.

“Something we have that a lot of rural places don’t is an indoor swimming pool,” she says. “That creates opportunities for swim lessons and local school swim teams and the YMCA swim team. And in an area where water is everywhere, it’s a really important community health and safety issue.”

While the sale of a nonprofit hospital may not always be an ideal scenario, the health legacy foundations these changes in operation can fund often provide lasting benefits for the community that extend far beyond the reach of a hospital.

“Health legacy foundations have made a difference across the entire state,” Jackson says. “They’re very community focused, and they are improving health by making investments in so many arenas from food security and health care access to jobs and economic development.”

Jennifer Bringle is a longtime journalist who has written for The Washington Post, The News & Observer,...