These days, it’s almost easier to keep track of what MacKenzie Scott doesn’t fund than what she does. Still, a new category in her ever-expanding, equity-driven philanthropy is always worth paying attention to, especially considering the splash it makes in the sector or geography where it lands.
Case in point: In her latest round of giving, spanning the past seven months and nearly $2 billion, Scott made a number of large gifts to rural-serving health foundations from New York State to Alaska — and many communities in between. For Scott, these grantmakers provide a unique conduit into parts of the country that may be hard to reach and often see very little in the way of high-dollar charitable giving.
By now, most people know that since her 2019 divorce from Amazon founder Jeff Bezos, novelist MacKenzie Scott has been doing her best to give away much of the money she received in the settlement. Her fortune is now $29.4 billion according to Forbes, and her giving totals around $14 billion, as of her latest Medium post and grantee list published Monday. Scott’s unorthodox approach to philanthropy has received as much attention as her largesse: Her gifts come with no strings attached and are often the largest grantees have ever received. She works only with a team of consultants, and the process is shrouded in secrecy. Grantees are told little about the funding before it happens, and are never told exactly why they were chosen. IP has followed Scott’s giving from the start, reporting on her gifts for climate protection, military families, education with an emphasis on equity, historically Black colleges and universities, Native communities, the “caring economy,” reproductive rights, criminal justice reform, and the list goes on.
In this recent flurry of giving, Scott has targeted rural-serving health conversion foundations. Health conversion foundations, also known as health legacy foundations, are created when a nonprofit health organization is sold or is part of a merger, and the proceeds are required to remain in the nonprofit sector. They typically tailor their approach to the health needs of their local region, and work to address social determinants of health.
While they don’t get a ton of attention, these foundations are often doing very innovative work at the intersection of public health and equity and have a strong presence in otherwise underfunded rural America. “Health conversions have been the biggest influx of philanthropic dollars into rural areas over the last 30 years or so, and it’s not an area that’s been particularly well recognized,” said Allen Smart, a longtime rural philanthropy leader and advocate, through his organization PhilanthropywoRx.
The appeal for Scott and her team is understandable. Smart underscores the outsized role health conversion foundations play in the regions they serve, often the largest nearby philanthropic presence and operating with a lot of latitude. “So if it’s around early childhood learning, or seniors aging in place, or recreational activities for youth, these foundations aren’t confined by a governmental mandate or the mandate of a service-oriented nonprofit,” he said. “As a result, they can both lead and provide the expertise, human resources, and intellectual capital that these rural communities normally just wouldn’t have access to.”
Rural health equity
In her latest round, MacKenzie Scott has provided gifts to at least 20 rural-serving health conversion foundations around the country, and there may be more on the horizon. No one knows the exact number of health conversion foundations in the U.S., but in 2021, Grantmakers in Health put the number at 303. Allen Smart believes the total is higher: 350 to as many as 400. Health conversion foundations range in size from small organizations with assets of less than $10 million, to Mother Cabrini Health Foundation in New York, which has assets of over $4 billion, according to tax filings.
The health foundations that landed Scott’s support all take different approaches, depending on local needs. One recipient, the Texoma Health Foundation, which serves counties in Texas and Oklahoma, provides community grants to a range of local nonprofits. Mental health is a major focus for the foundation, and to create more outdoor and recreational space, it helped create a park to serve the local community. The foundation received $6 million from Scott.
Alaska-based Mat-Su Health Foundation (MSHF) received a gift of $15 million from Scott, the largest single donation in its history. When Elizabeth Ripley, MSHF’s president and CEO, was first contacted by Scott’s representatives, she was told that Scott was interested specifically in the foundation’s rural equity work, according to Alaska’s KTUU-TV. Among other priorities, the foundation provides academic and vocational scholarships to local students pursuing health and human services careers. MSHF gave $2 million in scholarships in 2021 “to build Mat-Su’s future healthcare workforce,” according to the announcement.
A third Scott grantee, the Healthcare Georgia Foundation, addresses health inequities throughout the state, with a specific focus on rural communities. “Our state has one of the highest rates of maternal and infant mortality and morbidity in the nation, rural residents have limited access to needed high-quality healthcare, and many of Georgia’s families are going into debt just trying to manage chronic conditions,” said Doug Patten, the foundation’s board chair, when the $9 million gift was announced. Scott’s gift will allow the foundation to build on its recent Two Georgias Initiative, a five-year effort to ease health disparities in 11 rural communities.
While there is little point in speculating about Scott’s long-term goals or what causes she’ll target next, it’s clear that rural communities are a key concern, which makes a lot of sense, considering her focus on equity. Philanthropy has been criticized over the years for directing most of its funding to metropolitan areas, where most wealth is based, most foundations have their headquarters, and most program staff live, as IP has reported. By concentrating on health foundations with regional roots, Scott is seeking a different path.
“Maybe the most encouraging thing out of all this is that the Scott organization came to understand that giving to local funder organizations is a way to connect to local people in ways that the support of national organizations based in D.C. or New York, or Chicago with the word ‘rural’ in their name just can’t accomplish,” Allen Smart said.
Promoting health access and health equity are also clearly important elements of Scott’s giving strategy: A scan of her previous Medium post, published in March, reveals gifts to health-related organizations including the African Population and Health Research Center and the Trust for Indigenous Culture and Health (TICAH).
“You’re the experts”
Nora OBrien-Suric, the president of the Health Foundation for Western & Central New York, was flabbergasted this past October when she learned her organization had received a $9 million gift from Scott. “I was stunned and shocked, I was stuttering,” she said. “And I said, ‘Does everybody react this way?’ And they said, ‘Yes, everybody reacts that way when we tell them.’”
The 20-year-old health conversion foundation has three priority areas: older adults, young children impacted by poverty, and community health capacity. In early 2020, the foundation “embarked on a more focused vision of racial and socioeconomic health equity,” according to the announcement. Health needs are high in the counties where the foundation operates: Black residents of Onondaga County were hospitalized for COVID at three times the rate of white people during the worst periods of the pandemic, for example. And those living in the region’s rural communities have uninsured rates among the highest in the state; many of these areas also have a serious shortage of healthcare providers.
The funding from MacKenzie Scott will increase the Health Foundation’s ability to address these and other health disparities. The foundation is also pushing for universal healthcare throughout New York State.
“Many foundations steer away from advocacy,” said OBrien-Suric. “But in 2017, when the Trump administration pledged to dismantle the Affordable Care Act, our board decided that we needed to take a step and advocate that New York state hold the line where we are. Our goal is that by 2027, everyone in the state will have access to quality, affordable health care.”
For OBrien-Suric, whose organization has recently begun to practice trust-based philanthropy, MacKenzie Scott’s approach has provided inspiration.
“We started learning more about trust-based philanthropy and realized it’s a way for us to be more equitable in our giving,” she said. “And certainly, that is what MacKenzie Scott is doing: Identifying organizations and giving unrestricted funds and saying, ‘You’re the experts, you know what you’re doing, and this is to help you continue to do your work.’ We’re thinking about how we can do that in the communities we serve, and that might mean looking for partners that are different than those we’ve worked with before. Just to be told that, ‘You’re the experts,’ and how much that meant to me — I can only imagine how much that would mean to a community partner.”
In her Medium post this week, Scott provided a glimpse into her thinking and how it animates her giving. “I recently learned a saying used in disability communities: ‘Nothing about us without us,’” she wrote. “For me, it’s another beautiful and powerful reminder. I needn’t ask those I care about what to say to them, or what to do for them. I can share what I have with them to stand behind them as they speak and act for themselves.”
To thank Scott, OBrien-Suric and Cheryl Smith Fisher, the chair of her board of trustees, taped a short video, which they sent to Scott’s representatives. “What I mostly wanted to say was, ‘Thank you for this unique approach to philanthropy,’” OBrien-Suric said. “It’s teaching us all a lesson and doing it in a big way. I hope other foundations will hear that and learn from it and imitate it, too.”
She doesn’t expect a response, and was told by Scott’s representatives that she won’t receive one.