A Decadeof Impact

2002 – 2011

A decade ago,Missouri Foundation for Health (MFH) provided its first grant and thus embarked on a difficult quest —to fill gaps in health care faced by the thousands of Missourians who are uninsured, underinsured or underserved.

A decade ago,MFH received about $413 million in “seed money”, the result of a court-mandated transfer of funds from Blue Cross Blue Shield of Missouri following its conversion to a for-profit company. In 2011, MFH’s cumulative 10 years of grantmaking has nearly reached that same total. With a prudent investment strategy, MFH’s asset value stands at nearly $1 billion, ensuring decades more of health-focused grantmaking in Missouri.

A decade ago,Missouri politicians and the public were more interested in the economy, terrorism and immigration than in discussing Missouri’s health care problems and the growing number of the uninsured in the state. Today, MFH stands as a primary provider of nonpartisan information about Missouri’s health issues, helping both the public and Missouri’s elected officials develop greater understanding of how sound health policies can improve everyone’s lives.

It has been a decade of impact for MFH. Today, it is the largest health-focused foundation in the state. It is a leader, encouraging disparate groups of people and organizations to come together to discuss specific health issues—and work toward positive outcomes. It is a willing partner, joining with other groups and foundations to leverage funding dollars more effectively. It is a risk-taker, developing innovative ways to strengthen Missouri’s often-fragile health nonprofits and willing to tackle national issues on a statewide level.

James R. Kimmey, MDPresident and CEO, 2001-2011

K. Beth Johnson, CFA, CAIAChair, Board of Directors

History In 1995, Blue Cross Blue Shield of Missouri (BCBSMo) began the process of converting from a nonprofit into a for-profit company, called RightCHOICE, bringing along all of its nonprofit assets. However, the State of Missouri and Attorney General Jeremiah “Jay” Nixon soon filed suit, charging that such transfer of assets violated the law. What followed was several years of court actions and negotiations involving BCBSMo, Nixon, Missouri’s Department of Insurance, a Circuit Court-appointed Special Master and the Missouri Supreme Court.

A final ruling in December 1999 by the Missouri Supreme Court upheld an earlier settlement agreement and paved the way for the creation of a new foundation to receive BCBSMo’s nonprofit assets. On February 4, 2000, MFH was incorporated as a public benefit nonprofit foundation, and charged with “identifying and filling the gaps in the myriad of public and private health care services already available to the uninsured, the underinsured and the underserved in the 84 counties plus the City of St. Louis comprising the former service area of BCBSMo.” MFH received about $413 million in assets (cash and RightCHOICE stock) from BCBSMo.

Unusual among foundations, MFH’s Bylaws require it to operate under the Missouri Sunshine law, meaning that all of its meetings are conducted in public and its records fully open for public scrutiny.

A nominating committee, comprised of representatives of consumer groups and interested individuals, was created and worked with the Attorney General to identify who would become the Foundation’s first Board of Directors. By December 2000, the 15-member Board had been appointed and the nominating committee had become MFH’s first Community Advisory Committee (CAC), a non-voting group charged with helping the Board fulfill its mission.

February: State of Missouri files suit against BCBSMoA Timeline of MFH

Missouri Foundation for HealthService Regions

BootheelSouth CentralSpringfield

Southwest

Lower East Central

St. Louis Metro

Northeast

North Central

Central

Lake Ozark-Rolla

ADAIR

ANDREW

ATCHISON

AUDRAIN

BARRY

BARTON

BATES BENTON

BOLLINGER

BOONE

BUCHANAN

BUTLER

CALDWELL

CALLAWAY

CAMDEN

CAPEGIRARDEAU

CARROLL

CARTER

CASS

CEDAR

CHARITON

CHRISTIAN

CLARK

CLAY

CLINTON

COLE

COOPER

CRAWFORD

DADE

DALLAS

DAVIESSDE KALB

DENT

DOUGLAS

DUNKLIN

FRANKLIN

GASCONADE

GENTRY

GREENE

GRUNDY

HARRISON

HENRY

HICKORY

HOLT

HOWARD

HOWELL

IRON

JACKSON

JASPER

JEFFERSON

JOHNSON

KNOX

LACLEDE

LAFAYETTE

LAWRENCE

LEWIS

LINCOLN

LINNLIVINGSTON

MCDONALD

MACON

MADISON

MARIES

MARION

MERCER

MILLER

MISSISSIPPI

MONITEAU

MONROE

MONTGOMERY

MORGAN

NEW MADRID

NEWTON

NODAWAY

OREGON

OSAGE

OZARK

PEMISCOT

PERRY

PETTIS

PHELPS

PIKEPLATTE

POLK

PULASKI

PUTNAM

RALLSRANDOLPH

RAY

REYNOLDS

RIPLEY

ST. CHARLES

ST. CLAIR

STE. GENEVIEVE

ST. FRANCOIS

ST. LOUIS

SALINE

SCHUYLER SCOTLAND

SCOTT

SHANNON

SHELBY

STODDARD

STONE

SULLIVAN

TANEY

TEXAS

VERNON

WARREN

WASHINGTON

WAYNE

WEBSTER

WORTH

WRIGHT

ST. LOUISCITY

MFH’s service area, which includes 84 Missouri counties and the City of St. Louis, is identical to the area served by Blue Cross Blue Shield of Missouri, as mandated by the court case which led to MFH’s creation. As shown in color above, MFH has divided its area into 10 geographic regions. The gray portion of the map is outside MFH’s service area.

In late 2001, RightCHOICE merged with another health care entity, WellPoint Health Networks. MFH’s RightCHOICE shares were converted into WellPoint stock. In the interest of diversifying its asset base, MFH sold its WellPoint shares and as a result increased its assets to nearly $900 million.

Following the selection of Dr. James R. Kimmey as its first president and chief executive officer in October 2001, MFH entered a period of rapid activity. Additional staff was hired in 2002 to prepare for future grantmaking. Availability of funding was announced in June, and the Board approved its first grants in August. The initial focus was on cardiovascular disease and diabetes prevention, services improvement for the uninsured and underinsured, and core support for existing programs in economically challenged communities. The Board approved the distribution of at least 5 percent of its assets each year.

That first Board established guidelines that remain with MFH today. There continues a deep commitment to have a diverse Board, geographically, racially, and also representing both rural and urban viewpoints, and various community interests and health backgrounds.

That mindset carries over to grantmaking and an acute awareness that MFH’s assets must be distributed into as many communities and counties as possible. With 10 years of grantmaking now complete, MFH’s cumulative funding distribution is very similar to the population in its service region – with grants made in all 85 counties.

MFH is one of several “health conversion” foundations across the country, created at various times over the last 15 years. Some, like MFH, came about as the local Blue Cross

Video: MFH Board of Directors’ early efforts.

January: Out-of-court settlement establishes MFH

September: Governor and Attorney General jointly establish MFH’s

13-member Nominating Committee

Video: MFH Board of Directors’ early efforts.

November: MFH’s first 15-member Board of

Directors is appointed

December: MFH’s Board meets for the first time

January: Alberta Slavin elected the Board’s first chairperson

Alberta Slavin, first chair, MFH Board of Directors

Blue Shield entities converted from nonprofit to for-profit status. Others were created when hospitals made similar shifts to the for-profit world.

Leadership and VisionIn its first decade, MFH has benefitted from many strong leaders and a dedicated group of individuals who remained focused on its founding principle – to improve the lives of the people of the communities it serves by improving access to health services and encouraging healthier behaviors among all Missourians.

Sowing the seeds of MFH was Missouri Attorney General Nixon, who led the court challenge to BCBSMo’s for-profit conversion. Following MFH’s incorporation, Nixon turned to Paul Wilson, a member of his staff, to help the fledgling foundation get started. From that collaboration came MFH’s Article of Incorporation and Bylaws, which included a statement of Core Values that have guided MFH’s work for the past decade.

Alberta Slavin, of St. Louis, was elected by the Board as its first chair. A long-time community advocate, Slavin brought her passion, energy and drive to MFH. She is largely credited with being the day-to-day “face” of MFH before there was a staff, securing office space and overseeing all communication.

The early Board and CAC also understood how important it was for MFH to remain connected to individual communities and to their health needs and concerns. To better inform its grantmaking, MFH continues those community outreach efforts today. In the beginning, the outreach was primarily a way to raise awareness of MFH and that it

Video: Building MFH’s effective funding.

October: James R. Kimmey, MD, MPH, becomes MFH’s first President and

Chief Executive Officer

Beginning in October: MFH sells its WellPoint stock, resulting in a $900

million corpus for MFHAugust: First grant made – $69,590

to Lutheran Senior Services

Video: Building MFH’s effective funding.

Spring: MFH holds first series of public forums across service region to gather information about community health

issues to guide future grantmakingDecember: MFH distributes $5.6 million in grants during the year

Through forums and other outreach efforts, MFH continues to encourage individuals

and community leaders to share their thoughts on how to improve health in the

area and across Missouri.

had money to give to health-focused nonprofits. Soon that evolved into community gatherings in towns of all sizes throughout the MFH service region. Individuals and nonprofits provided significant information about the health challenges faced in their communities. This information helped the Board develop a grantmaking plan – to address those health issues that were common to all communities, and to begin to think about how use MFH’s funds to sustain positive, long-term health outcomes.

Having overseen MFH’s first 10 years of grantmaking, founding President/CEO Kimmey stands as an integral part of the foundation’s success. A doctor by training and a public health advocate by practice, Kimmey brought a passion to MFH for taking on challenges, asking tough questions, and spurring others to action. His career included leading the American Public Health Association, and the Division of Health Policy and Planning and the Institute of Health Planning, both in Wisconsin. For 13 years prior to coming to MFH, Kimmey was at Saint Louis University, serving in a variety of leadership role, key among them as the founder and first dean of its School of Public Health.

Retiring at the end of 2011, Kimmey’s legacy to MFH is vast. He led MFH into prominence in Missouri, as a must-have contributor to any health discussion in the state and as an innovative funder that promotes collaboration. During Kimmey’s tenure, MFH has also maintained a keen awareness of national health concerns and positioned itself to be involved in the broader discussion beyond Missouri’s borders. On such issues, including health literacy, MFH has played a key role in informing both the national discussion and working specifically in Missouri to develop best practices that could serve as guides in other states.

Video: Dr. Kimmey’s leadership of MFH.

March: MFH establishes a health policy focus, giving $1.6 million in grants to

develop policy efforts in Missouri

September: First grant writing workshop kicks off MFH’s ongoing efforts

to strengthen Missouri’s nonprofits through skill building

Video: Dr. Kimmey’s leadership of MFH.

November: First statewide Health Summit, with the topic “The

Dimensions of Disparities”

December: MFH’s assets top $1 billion. MFH distributes $43.5 million in

grants for the yearJuly: Tobacco Prevention and

Cessation funding initiative launches

Language and cultural barriers prevent new Americans from accessing the health care system.

MFH supports programs that work to increase health literacy among all Missourians, including

funding an innovative program for immigrant mothers to ensure their children receive services

and remain healthy.

Throughout, MFH and its leaders have remained committed to a very high level of transparency.

Early on, MFH’s Board was concerned that the requirement to operate under Missouri’s Sunshine Law and open all its meetings to the public would have a chilling effect on MFH’s grantmaking, since Board members and staff might be uncomfortable publicly discussing why some organizations were not approved for grants. The 10 years of openness have resulted in a decidedly different outcome. Nonprofits regularly note that such candid feedback has spurred them to improve their grantwriting and helped them craft better programs that are more mission-focused and more effective. For MFH, the openness has resulted in a deeper degree of interaction with potential, former and current grantees. Today, MFH’s Board and staff praise the transparency, as a reason for a higher quality of grant applications and improvements in Missouri nonprofits’ grantwriting and program delivery.

Challenges of Missouri’s Health LandscapeThe health care landscape in Missouri is one of contrasts – rural versus urban, uninsured and insured. Add in a very complex web of social determinants, including socio-economic status, education, race, housing and culture. As a result, Missouri residents face myriad challenges in accessing health services or in improving their own health.

The majority of Missouri’s 5.9 million people live in a rural environment. While the population is dense in communities like St. Louis and Kansas City, other Missouri counties have less than 10 people per square mile.

December: MFH distributes $50.4 million in grants during the year

March: Health Summit – “Weighing in on Kids’ Obesity”

July: MFH provides a $3.5 million challenge grant to preserve St. Louis’

health care safety net

August: MFH pledges $1 million in emergency disaster relief to

Missouri-based nonprofits helping families displaced by Hurricane Katrina

Access to health care, especially in emergency situations, is a critical need throughout much of Missouri and one that MFH has addressed by providing grants to purchase ambulances and train emergency response providers.

About 14 percent of Missouri’s residents are without health insurance – 835,000 people. About 80 percent of those are in working families. Over the last decade, the number of uninsured Missourians has risen, in part because rising costs have driven employers away from health insurance benefits or families can no longer afford to pay their premiums.

Missouri also has health issues. Its residents smoke at a higher rate than the national average. The state ranks as the 12th most obese in the United States. As a result, Missouri has higher-than-average rates for other related health issues, including asthma, cancer, cardiopulmonary diseases, and diabetes.

To address Missouri’s health concerns, MFH has remained focused since its early days on enlisting communities to engage in the effort to improve local health. Based on input from these community-based meetings, MFH developed its initial list of funding priorities in 2003.

Missouri has health care access issues. MFH’s outreach efforts brought into clear focus the significant differences in access between rural and urban Missouri. Rural Missouri has a serious lack of health care providers, adequate equipment or even facilities which means it is often impossible to receive treatment. A lack of transportation, either individual or community-based, makes it harder for rural residents to get to the services concentrated in urban areas. Transportation issues are little better in urban Missouri, which has a higher concentration of uninsured residents who must rely on public transportation to access health care. Across Missouri, the uninsured must rely on Medicaid providers for services. Yet many health care professionals do not accept Medicaid patients, largely due to significantly lower fee reimbursement.

Video: Helping the underserved and uninsured.

September: Healthy & Active Communities funding

initiative launches

December: MFH distributes $53.3 million in grants

during the year

April: Health Summit – “Primary Care Challenges: Focus on Rural and

Small Cities”

Video: Helping the underserved and uninsured.

Spring: New funding programs added – Chronic Care, Co-Occurring Disorders,

Health Literacy, Oral Health and Primary Care Access

Fall: MFH expands its health policy impact with a 13-part “Cover

Missouri” publication series

MFH’s Healthy & Active Communities funding effort

has generated innovative community program, such as the Walking School Bus in Columbia,

which promotes daily exercise and has led to several other local

health-focused efforts.

Over the last decade, an ever-changing climate of funding commitment from the State of Missouri and federal funding challenges have pushed Missouri’s fragile world of health care to the breaking point.

Building Collaborations and PartnershipsA commitment to engaging others has served MFH well during its first decade, and led to a spirit of partnership woven throughout its grantmaking, health policy work and collaborative efforts.

In St. Louis in 2005, the health care safety net was coming apart. MFH joined early with other interested health care organizations and individuals to find a solution, thus ensuring an appropriate mix of health care services would be available for indigent and uninsured residents. MFH’s funding support, through a $3 million challenge grant, played a vital role in repairing the net. In 2009, when Springfield’s health care community was struggling with building a more effective delivery system, its leaders sought assistance from MFH. Along with sharing its knowledge from the St. Louis effort, MFH provided a $300,000 matching grant to jumpstart the Springfield-Greene County Regional Health Commission.

MFH has long collaborated with other funders. In the St. Louis area, a joint venture with six other local funders led to the Aging Out Initiative, to support teenagers as they age out of the foster care system and provide them with the skills to be successful adults. The joint effort also impressed a national funder, Robert Wood Johnson Foundation, which provided additional monies to improve the initiative’s sustainability. Inspired by MFH’s $11 million grant in 2007 to purchase enough HPV

Video: Health disparities in Missouri.

December: MFH distributes $54.6 million in grants during the

year, and more than $200 million cumulatively

January: MFH provides $11 million to purchase HPV vaccine to protect all

uninsured Missouri females, ages 9-26

Video: Health disparities in Missouri.

February: MFH and United Way of Greater St. Louis announce joint funding to create

statewide 2-1-1 service

May: Health Summit – “Intersection of Health and Business”

September: MFH announces $13 million distribution to 84 Missouri county health

departments to fund infrastructure upgrades

Almost 30,000 females were eligible to receive the HPV vaccine for free

because of an MFH grant.

vaccine to reach all uninsured females ages 9-26, the Health Foundation of Greater Kansas City asked MFH for guidance in developing its own program in the western Missouri metropolitan area. MFH staff shared knowledge, offered suggestions, and collaborated with the Kansas City foundation to ensure the message of available vaccine went out to all eligible Missourians.

Statewide discussions on health issues often involve MFH. Thus, when emergency responders began looking at how to improve response to medical emergencies in rural areas, MFH was asked to facilitate the discussion. Working with state officials and emergency care providers in 2008, MFH encouraged a collaborative effort that led to the statewide Time Critical Diagnosis System that ensures heart attack, stroke and traumatic injury victims receive appropriate emergency medical treatment.

Grantmaking ImpactBy the numbers – MFH has distributed more than $400 million through almost 2,800 grants in 10 years. Some were in the millions, some were in the hundreds of thousands, a few were barely $1,000.

By scope – Some grants help build clinics and hospitals, such as the Scotland County Memorial Hospital, which upgraded 25-year-old birthing equipment and re-opened the only delivery facility in a six-county region. Some grants purchase vans or ambulances, to replace the broken-down vehicles with 250,000-plus miles, so health outreach efforts can continue. Some buy food so low-income elderly can get at least one healthy meal a day at the local senior center. Some pay for nurses’ salaries so the local church can

Video: MFH’s efforts to encourage collaboration.

December: MFH distributes $61.3 million in grants

during the year

May: MFH launches Cover Missouri website to promote quality,

affordable health insurance for all Missourians

Video: MFH’s efforts to encourage collaboration.

June: Health Summit – “Preventing Violence Against Women: Community Solutions”

September: MFH releases results of most comprehensive study to date in Missouri on

tobacco use and related health issues

MFH has supported communities’ efforts to encourage active lifestyles, healthy outdoor

activities, improve indoor air quality and promote healthy eating habits.

provide health screenings, fitness programs and smoking cessation classes to their families. Yet all provide help to individuals and communities.

MFH grants also have served as a catalyst for other funding. Over the years, many MFH grantees have reported using the mere fact of having an MFH grant as a tool to gain other grant support, even at the national level.

In Columbia, the PedNet Coalition leveraged MFH dollars into several national grants. MFH’s initial grant, through its Healthy & Active Communities Initiative, funded a “walking school bus” program, as a way to increase children’s daily physical activity. Before and after school, a group of students, led by parents, pick up and drop off children along a planned route. The program caught the eye of national funders, and soon the Coalition had money to sustain the walking program and also create other community-based physical activity programs.

MFH’s grantmaking continues to focus on filling the gaps in our health system. However, there have been shifts in what MFH funds. Early in its history, and needing to expend funds, MFH funded a wide variety of programs. Staff calls that period “over the transom” grantmaking, a reference to MFH reviewing and considering grants for whatever programs organizations wanted to fund. Soon the staff saw the challenges of that grantmaking style – ambulance-replacement requests were pitted against Meals on Wheels programs which were pitted against clinics that were doing Pap smears and breast exams. Additionally, MFH was anxious to begin to address the many health concerns raised from the community outreach meetings.

Video: Examples of MFH grantmaking.

December: MFH distributes $49.1 million in grants during

the year, and tops $300 million in cumulative grantmaking

June: Health Summit – “Health Care Workforce Development”

Video: Examples of MFH grantmaking.

December: MFH’s health literacy funding results in creation of separate

nonprofit Health Literacy Missouri

December: MFH distributes $43.5 million in grants during the year

July: MFH launches MoCAP program to help Missouri nonprofits increase

federal grant procurement

MFH supported the national “Become an Ex” campaign,

which included a variety of outreach efforts to help

people quit smoking.

By 2004, MFH began moving toward more focused grantmaking to tackle some of those identified health problems. That year, MFH’s Board committed nine years and $40 million to its Tobacco Prevention and Cessation Initiative, and also began

grantmaking to support dental sealants for children. In 2005, it made a long-term commitment to reduce obesity in Missouri by establishing its Healthy & Active Communities Initiative. From 2006-2008, MFH began debuting several new funding programs targeting other specific health priority areas – diabetes, childhood asthma, mental health services, substance abuse and domestic violence.

Since its inception, MFH also has remained committed to another type of funding that touches organizations at their heart, and isn’t offered by most other foundations. MFH’s Strengthening the Core program began in 2002 as a way to support organizations to continue operating. There was no expectation of creating a health-specific program, this funding was for the basics – keeping the doors open and the lights on. By 2004, the effort was renamed Basic Support, a reflection of its core purpose. Over the 10 years of grantmaking, these two programs have cumulatively provided $86 million through 899 grants, touching all 85 counties in the MFH service region. These grants support Meals on Wheels programs, therapy for adults and children with a variety of health challenges, domestic violence shelters, fitness programs, and more. Without fail, Basic Support grantees continue to praise MFH for this type of funding, which allows them to continue doing what they do best – exist to serve their communities.

August: MFH receives first federal grant to support its new Social Innovation in

Missouri funding programDecember: Health Summit – “Missouri Health Landscape 2011 and Beyond”

Video: Encouraging collaboration & leveraging additional funding.

December: MFH distributes $38.1 million in grants during

the year, and tops $400 million cumulatively

June: MFH provides an unprecedented amount of

emergency funding to assist with natural disasters in southeast and

southwest Missouri

African-American Missourians are at higher risk for poorer health. MFH

funding has supported a wide variety of programs to address this issue,

including those that promote healthier eating and regular exercise, and increased access to health care.

Video: Encouraging collaboration & leveraging additional funding.

Like a thread weaving through all of MFH’s grantmaking, health literacy looms as a significant barrier to improving the health of Missourians. True to its role as a leader in solving health challenges, MFH brought together a variety of interested Missourians and national literacy leaders several years ago to find a solution. Working with a collaborative of three universities, MFH soon had funded about 30 local nonprofits to develop demonstration projects aimed at improving health literacy. The goal of the projects was to help people become more aware and informed about their own health, to become more proactive in engaging with health care professionals, and to help health care providers better explain medicine’s often-confusing and intimidating language. Recognizing that health literacy needed more attention than just one foundation could give, MFH worked with the collaborative to create a new statewide nonprofit that could independently marshal the necessary forces to continue the effort; in December 2009, Health Literacy Missouri was incorporated as a nonprofit.

Because of its asset size and as a result of a robust stock market in 2006, MFH also has been able to periodically consider providing grants of significant size to tackle large health-related issues other, smaller funders couldn’t consider. In January 2007, MFH announced its largest single grant to date – $11 million to purchase enough human papillomavirus (HPV) vaccine to cover all uninsured Missouri females ages 9-26. The vaccine was provided at more than 120 sites throughout the state. The MFH grant made Missouri the only state in the U.S. where no eligible female had to pay for the very expensive vaccine against cervical cancer. At the end of 2007, MFH announced another large grant – $13 million distributed over three years to the 84 county health departments within the MFH service region for infrastructure improvements. Having gone without funding for more than a decade to physically maintain their clinics, the health departments

Video: Grantmaking for greater impact.

August: Robert Hughes, PhD, announced to succeed Kimmey at MFH President and Chief Executive Officer beginning in 2012

MFH funding has also supported communities’

efforts to improve their infrastructure and safety, by creating bike lanes, building

sidewalks and activity spaces, and developing

recreation facilities.

made good use of the MFH windfall in a variety of ways – replacing broken and aging medical equipment, converting health records from paper to electronic, purchasing refrigerators for vaccines, replacing aging program delivery vehicles, and building new examination rooms.

Health Policy ImpactFrom its earliest days, the MFH Board recognized that improving the health of all Missourians would take more than just grantmaking to health nonprofits. It would also take changes in attitudes toward health and health policies at the local, state and national level. In 2003, MFH established a formal health policy effort, allocating staff and dollars.

Since its start, MFH’s health policy efforts have matured dramatically, to the point that MFH is now seen nationally as a leader in health policy among foundations. MFH continues to be on the cutting edge of health policy work in foundations, by continually looking for ways to engage with elected officials, collaborate with thought leaders, and encourage discussion between politicians and community leaders to craft policy that benefits all.

MFH employs a comprehensive outreach effort – helping grantees better understand the legislative process and how to more effectively “tell their story” to their elected officials. MFH also provides well-research, unbiased background on a variety of health topics to help state and Congressional officials and their staffs craft better-informed policies and legislation. Because of the significant number of uninsured individuals in Missouri and in anticipation of health reform, MFH launched the Cover Missouri website (www.covermissouri.org) in 2008 to provide information about the impact of the uninsured on Missouri. With the passage of the Affordable Care Act in 2010, MFH found itself barraged by inquiries to know more about how health reform will affect Missourians. By the end of 2011, MFH staff conducted more than 150 presentations around the state, answering specific questions about the impact of health reform and providing a clear explanation of ACA without political bias. Recently, MFH also added videos to the website, providing answers to the most common questions asked at the presentations.

Video: Policy efforts for lasting change.

MFH’s commitment to improving dental care

in Missouri began with funding programs aimed

at children. Now MFH is working to increase not only the number of dentists who

practice in Missouri, but addressing severe health

care workforce shortages.

Since 2003, MFH also has recognized the value of producing publications to explain the often-complex nature of health issues and effective health policy. Notable among those publications are databooks first produced in 2007 and updated in 2010 that provide a clear picture of the health issues and disparities affecting the African- American and Hispanic populations in Missouri. In 2008, MFH also published the results of a comprehensive county-level study of tobacco use and related health concerns in Missouri. More than 50,000 individuals were interviewed. The results have been very useful in helping counties understand the local health impact of tobacco use, and in some cases, helping communities develop clean air policies to help improve health.

From a grantmaking perspective, the General Support for Advocacy program enables MFH to support organizations that work toward improving health outcomes for specific groups of people, such as the uninsured or the disabled. And that effort has led to increased collaboration among advocacy groups to ensure stronger, more effective health policies are enacted.

Strengthening OrganizationsAlong with grantmaking and its commitment to health policy improvement, MFH sees strengthening the state’s nonprofits as an important element in creating a healthier Missouri. Early on, MFH recognized that nonprofits were far less effective in delivering their vital services when they were struggling financially and organizationally.

For much of its existence, MFH has offered grants and training opportunities to help nonprofits improve themselves, in everything from grantwriting and fundraising to strategic planning, from improving financial practices to increasing public awareness of the organization. MFH also recognizes the tremendous value of feedback – for both MFH and grantees. Thus, MFH fosters open and ongoing dialogue with organizations in its service region – to ensure grant programs are more successful, to encourage partnerships and collaborations, and to share best practices, all of which ensures MFH’s grantmaking has greater impact and communities can receive the best health service possible.

Video: Helping to build better organizations.

Video: Helping to build better organizations.

Good nutrition is a critical aspect of overall health. MFH

supports dozens of Meals on Wheels programs, food pantries and other efforts

throughout the state to help Missourians have access to

healthy food.

A new twist on this nonprofit support was the addition of MFH’s MoCAP program in 2010. Buoyed by the increased interest at the federal level in supporting state- and community-level health programs, MFH now provides additional, focused grantwriting assistance to Missouri’s health-focused organizations seeking federal grants. An influx of federal dollars not only brings additional money into Missouri but also broadens the organizations’ funding bases making them less reliant on local support. By the end of 2011, MoCAP’s work has helped bring in an additional $13 million in federal funding to Missouri nonprofits.

The Next DecadeWhat is on the horizon for the next decade? MFH remains committed to a continued high level of grantmaking, despite the economic swings that have occurred in recent years. Helping improve Missouri’s health policies also stands as a high priority, as the state and its residents move toward health reform. MFH is already examining how it can help address the impact health reform will have on Missouri’s health care workforce. Continuing outreach and interaction with communities certainly remains as a key element in framing MFH’s future decisions.

With its role as a “convener” firmly in place, MFH will continue to encourage discussion, debate and education as critical components in crafting solutions that work for all Missourians, not just select groups.

Collaboration with others remains high on MFH’s agenda. From a grantmaking perspective, MFH will be encouraging more community-level collaboration to maximize dollars and increase sustainability. In the health policy arena, there will be greater focus on using policy as a method to create system change. MFH also will continue to look for opportunities to partner with other local, state and national funders to not only address community-wide issues but to make Missouri part of the national discussion on improving health.

Most importantly, MFH will continue to learn and listen. In its first 10 years, MFH’s Board, CAC and staff have logged hundreds of thousands of miles criss-crossing Missouri to gather information, listen to concerns, interact with its grantees and

Video: Impact of MFH’s decade of grantmaking.

Video: Impact of MFH’s decade of grantmaking.

Beyond the photo opportunity of a ribbon cutting, MFH’s funding has

helped many Missouri communities open the doors of clinics, health

centers and senior centers to ensure better access to health services.

observe the people who are being helped every day. It is a practice which has earned MFH an outstanding reputation in Missouri’s nonprofit community, in the halls of government and among the national foundation world.

Amid a climate that stresses being intentional and not reactive, that recognizes that the race to create a healthy Missouri is a marathon not a sprint, MFH sees its first decade as a building block. Having tried much and learned much in its first 10 years, MFH can now build on its many successes, and its failures, to continue paving a path for others to follow that leads toward improved health for all Missourians.

Video: Looking toward the future.

A Decade of GrantmakingProgram AmountApplicant Defined Proposals $99,136,858

Basic Support/Strengthening the Core

$75,299,410

Chronic Care: ACCESS $1,727,661

Chronic Care: Asthma $7,988,728

Chronic Care: Diabetes $10,063,491

County Level Study $1,896,977

Emergency $686,381

Health Assessments $2,531,363

Health Interventions in Non-Traditional Settings

$3,587,914

Health Literacy $15,759,242

Healthy & Active Communities $24,311,058

HPV Project $11,000,000

Local Health Department Infrastructure

$13,038,799

Mental Health and Substance Abuse

$17,136,926

Program AmountMoCAP $2,312,382

Operation Katrina $712,838

Oral Health $5,624,653

Primary Care $11,985,124

Safety Net Challenge Grant $3,074,400

Strategic Opportunities Funding $14,179,211

Strategic Organizational Development

$7,484,723

Tobacco Prevention and Cessation Initiative

$27,702,128

Women’s Health $6,869,406

Workforce Development $2,397,799

Advocacy Grants $15,373,849

Health Policy Contracts $17,569,513

Cumulative Grantmaking by Program Area

Cumulative Grantmaking by MFH Service Region

Region Amount % of Total

Bootheel $21,907,332 5.7%

Central $72,792,173 19.0%

Lake Ozark-Rolla $12,261,462 3.2%

Lower East Central $23,415,239 6.1%

North Central $2,465,248 0.6%

Northeast $19,418,456 5.1%

South Central $6,948,813 1.8%

Southwest $15,490,680 4.1%

Springfield $29,106,576 7.6%

St. Louis Metro $178,639,676 46.7%

Grantmaking by Year

Year Cumulative Award Amount2002 $5,680,341

2003 $43,516,006

2004 $50,428,164

2005 $53,393,698

2006 $54,609,399

2007 $61,389,442

2008 $49,102,603

2009 $43,583,933

2010 $38,097,798

2011 *$40,300,407

TOTAL $440,101,791 *estimated

Board of DirectorsJ. David Auner, MD (2000-2007)John A. Bogert, DDS, MSD (2000-2002)Mary C. “Mikki” Brewster, MSW (2000-2007)Melvin F. Brown, JD (2000-2006)Erma Cunningham (2000-2006)Rory Ellinger, JD (2000-2007)Martha A. Gragg, RN, MSN (2000-2005)Coleen Kivlahan, MD, MSPH (2000-2002)James W. Knight, MD (2000-2004)F. Wm. McCalpin, Esq. (2000-2004)Tracy M. Reed, DPM (2000-2005)Rev. Booker T. Rice, Jr. (2000-2005)Don Rudd (2000-2002)Alberta C. Slavin, MMUS (2000-2006)Karl Wilson, PhD (2000-2005)Steven M. Pu, DO (2002-2008)Gertrude “Trudi” Scott, RN, MSN, CPNP (2002-2007)H. Lynn Stuhlman, MA (2002-2005)Perdita J. Fisher, DMD (2004-2007)Frank L. Martin, III (2004-2006)Will R. Ross, MD (2004-2009)Sandra C. Ahlum, MD (2005- )Peter De Simone (2005-2008)Kimberly “Beth” Johnson, CFA (2005- )Paul S. Lux, MD (2005-2008)Wayne Goode (2006- )

Bruce Horwitz, PhD (2006- )Timothy E. Tyler, DM (2006-2008)Corinne A. Walentik, MD, MPH (2006- )Brenda A. Battle, RN, MBA (2007- )Gretchen Garrison, JD (2007-2010)George F. Gruendel, PhD (2007- )Dorothy M. Munch, DO (2007- )Janna L. Stewart, JD (2007- )Cynthia G. Dean (2008- )Edward D. Higgins (2008- )Marsha L. Mills (2008-2010)Mike Peters (2008- )Kay Griffin, RNC-WHNP (2010- )Sam Minner, PhD (2010-2011)Darin Preis (2011- )Robert Massie, DDS (2011- )

A Decade of Leadership

Community Advisory Council(formerly Community Advisory Committee)Ross C. Brownson, PhD (2001-2003)Peter De Simone (2001-2005)George Eberle (2001-2002)Fred Epstein (2001-2003)Rev. Courtney A. Jones (2001-2003)Rev. Sammie E. Jones (2001-2003)Jennifer A. Hill (2001-2002)Mary Pilant (2001-2006)Reuben Shelton, JD (2001-2006)H. Lynn Stuhlman, MA (2001-2002)Craig A. Van Matre (2001-2006)Corinne Walentik, MD, MPH (2001-2006)Rose Williams (2001-2003)Brenda A. Battle, RN, MBA (2003-2007)Cynthia Dean (2003-2008)John Grossmeier (2003-2004)Daniel “Duke” McVey (2003-2007)Victoria Nelson (2003-2006)Douglas Ross, DDS, MAGD (2003-2005)Richard Ross, PE (2003-2006)Wayne Goode (2004-2006)Edward Kennedy, SPHR (2004-2010)Dennis H. Tesreau, JD (2005- )Kay Griffin, RNC-WHNP (2006-2010)Paula F. Baker, MS (2007- )Maureen “Mo” Bressett, RPH, MSHA (2007- )Jack Magruder, PhD (2007)Thomas E. May (2007-2010)

Mary Beth O’Reilly, RN, BSN (2007-2009)Edward “Chip” Robertson (2007-2008)Tim Swinfard (2007- )James Brown (2008- )Jeanne A. Jarrett (2008- )Ron Levy (2008)Weldon James, MD (2009- )Dean F. Kappel (2009)Jerry D. Osborn (2009-2011)Joseph Pierle, MPA (2009- )Alfreda Brown (2010- )Carol Kramme (2010- )Linda Collins-Shaw (2010- )Debra Wade (2010- )

415 South 18th Street, Suite 400 • St. Louis, Missouri 63103-2269

Videos created from interviews conducted by

Missouri Historical Society in 2009-2010, at the

request of MFH.

Photos from MFH archives.