2022 Annual Report by healthforward

2022 ANNUAL REPORT

Grantmaking

Place

People

Platform

Power

Financials

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In 2021, why was the central question guiding Health Forward into development of our new purpose areas and our five-year purpose plan. In 2022, our team began to focus on another important question in driving the work forward – how? Over the course of 2022, we wanted a better understanding of how we were going to achieve our purpose plan. This meant cultivating new relationships with partners who have proximity to the problems we’re challenged by, and intimacy with the communities and resident leaders who carry the solutions. It also meant deepening our relationships with organizations whose impactful work we’ve been proud to support.

Each film elevates the stories of Black and Latino changemakers from the Kansas City area and highlights the strategies they use to make a difference. The films have been featured in more than 10 film festivals and have won several awards including Best Documentary at the Hollywood International Diversity Film Festival. We sought community input to create our policy agenda through 2022. We surveyed partners to understand key policy issues they focus on. Since surveys are never definitive, we engaged them in a sensemaking session and individual conversations about their data to gain deeper insights. Ultimately, we used this data to inform our agenda, which we publicly unveiled in early 2023 at our policy convening.

We partnered with the KC Health Collaborative and the Institute for Healthcare Improvement, to create the Kansas City Health Equity Learning and Action Network. The network, which was comprised of more than 100 health leaders in our region, learned and grew together on how to operationalize health and racial equity in their organizations and in community.

And finally, we continued to make strides in moving the foundation’s assets to firms owned by people of color. We ended the year at 39 percent of our assets, more in line with our values, and plan to do more in the upcoming year.

We partnered with Resilia, a Black, womanowned and -led tech firm, to provide coaching for 42 nonprofit organizations to enhance their effectiveness, creativity, workflow, and capacity to achieve their missions. We supported the passing of Question 2 on the November ballot in Kansas City. This measure added $50 million in general bond revenue to KCMO’s Housing Trust Fund. It also represents the largest-ever investment in affordable housing. The measure passed by a 71-percent margin.

As we reflect on the year, we are thankful for the new and long-time partners who are standing shoulder-to-shoulder with us as we support and build inclusive, powerful, and healthy communities characterized by racial equity and economically just systems.

And, to catalyze change and bring people together using stories that promote health equity to create inclusive narratives, we partnered with BeGreat Together, the Convergence Partnership, and Assemble, on a four-part film series called DocuCourse.

QIANA THOMASON

President/CEO, Health Forward Foundation

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GRANTMAKING In a year of transition, we categorized a few new grants by their strategic purpose areas. Many transitional grants were not categorized in this way. Future reports will break out all of our funding by purpose area.

TOTAL

PURPOSE AREA

314

28,625,466

GRANTS

AMOUNT

POWER

PLACE

PEOPLE

PLATFORM

TRANSITION DOLLARS

1,563,143 152,000 2,726,000

774,250

APPLICANT DEFINED GRANTS

(includes former Foundation Defined Grants, Technical Assistance, and Policy and Civic Engagement)

Total

136 grants $16,906,272

FDGs

113 grants

Total

$15,539,000

Technical Assistance FDGs 9 grants $420,445 Policy and Civic Engagement Grants 14 grants $946,827

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41 grants

$7,598,164

SPECIAL INITIATIVES GRANTS * Total

35 grants $4,036,625

Power

9 grants

$959,375

Place

2 grants

$102,000

Platform 8 grants

$774,250

People

$1,931,000

13 grants

CRISIS RESPONSE GRANTS Total

* T hree special initiative grants totaling $270,000 were not categorized by strategic purpose area.

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2 grants

$84,405

PURPOSE AREAS

PEO P L E Our People purpose area addresses and seeks to remove barriers built into our health care system that prevent people from living their healthiest lives. Our approach centers equity in all aspects of community health and focuses on strengthening the capacity and effectiveness of partners to provide whole-person, equity-centered care.

POWER Our Power purpose area focuses on redistributing and sharing power with the people we serve. Our approach amplifies community-driven movements, advances participation in democracy, and strengthens small, community-based organizations and leaders.

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PL AC E Our Place purpose area focuses on building health and wealth by improving access to safe, healthy and affordable housing and home ownership. Our approach also includes digital access, working to make sure everyone has affordable digital tools and the knowledge and skills to use them.

Image courtesy of Patricia Bordallo Dibildox and KC Tenants

PLATFORM Our Platform purpose area focuses on advancing racial equity and economic inclusion by partnering with governments and funders to center equity and race in all decisions. We are reshaping the way people understand and talk about racial, economic and health equity, along with investing our resources to align with this purpose.

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PEOPLE

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K ANSAS C I TY H EA LTH EQ UI TY L E A RNI NG + ACTI ON N ETWO R K In building equitable communities, we knew major changes would have to be made to well-entrenched systems. And to make those changes, we knew we knew we couldn’t go it alone.

The LAN engaged leaders from across the Kansas City region’s health ecosystem to develop shared understanding and a common language around health equity and structural racism. The LAN also encouraged leaders to take actions that address inequity at organizational and community levels. Network members included more than 50 organizations across the health ecosystem including hospitals, Federally Qualified Health Centers, Certified Community Behavioral Health Centers, public health departments, health academic institutions, community-based organizations, and one large local employer.

In January 2022, the first meeting of the Kansas City Health Equity Learning and Action Network (LAN) took place. The LAN was catalyzed by Health Forward Foundation and co-curated with the KC Health Collaborative, and the Institute for Healthcare Improvement (IHI). Its goals were to connect stakeholders from across the region to align positive intent with real action that will make health equity a reality for all Kansas Citians.

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To participate in the LAN, CEOs from these organizations committed to making health equity a strategic priority and to diversifying their boards with people of color. In 2022, LAN learning fused IHI’s national, evidence-based health equity curriculum, the Racial Equity Institute’s analysis of structural racism’s cultural and historic roots, and locally curated content from community leaders that centered their expertise and the experiences of local communities impacted by racism and health inequity. The LAN was intentionally broken into two phases: The learning phase and the action phase. The learning phase commenced in February and the action phase commenced in June 2022. A CEO Roundtable began meeting quarterly in March 2022.

Community Health Improvement Leadership Academy (CHILA). Action community initiatives across the 15 organizations include, but are not limited to, eliminating race-based clinical algorithms that are harming people of color with chronic kidney disease, addressing racism as a public health crisis in Wyandotte County, Kansas, improving the collection of race, ethnicity and language data to eliminate health injustices in health care settings, addressing equitable cancer care access for undocumented Latino communities, increasing people of color underrepresented in medicine, assessing and addressing patient social needs in medical spaces, and embedding anti-racism in internal practices and policies. The LAN continues to evolve and convene its network members for opportunities to learn, grow, and address health equity and anti-racism in their organizations and in the community together.

As part of the action phase community, 15 network organizations began their journeys in driving equity centered and anti-racist organizational change with continual learning with other network organizations in the LAN’s

Fifteen organizations identified specific steps toward antiracism that they are well-positioned to take based on their role in the health care ecosystem.

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HEALT H F ORWA RD + M AC K EN ZI E S COTT It’s not every day you find out you are going to receive $15 million by a billionaire philanthropist, but that is exactly what happened to Health Forward in the fall of 2022.

address health equity and the promise of new partnerships and political will to secure a fair and just region,” said Qiana Thomason, Health Forward president/CEO.

MacKenzie Scott, philanthropist and author, selected Health Forward to receive a one-time, unrestricted donation after a rigorous screening process. The donation represents recognition for Health Forward’s historic work and current leadership, as well as our focus on strategies that center racial equity and economic inclusion for better health outcomes.

This generous donation has afforded Health Forward with the opportunity to dream big and effect major change in the health care landscape of our region. We know that having a more diverse set of health care professionals that reflect the communities and the people seeking health care will lead to better outcomes. To that end, we’ll be using some of the donation to create new pathways for people of color and people in rural communities to join the health science ecosystem.

“This gift is not given to us but through us. It is a recognition of the outstanding work taking place in Kansas City to

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Only 6% of US Doctors are Black or African American* Black or African American Hispanic or Latino Asian American/Paciﬁc Islander White All other 0%

10%

20%

Percent of US population

THE PROBLEM

40%

50%

60%

Percent of US doctors

closure has a huge economic and health impact on communities. States like Missouri that have approved Medicaid expansion are 62% less likely to close rural hospitals. We are continuing our fight in Topeka to expand Medicaid in Kansas.

Despite an uptick in the number of people of color graduating from medical school, the Association of American Medical Colleges reported that less than 6 percent of active physicians were Black and less than 7 percent are Hispanic. This small percentage of doctors doesn’t meet the needs of the 13 percent of the US population who identify as Black and the 19 percent who identify as Hispanic/Latino.

P AT H WAY TO A S O LU T I O N To tackle this problem, we’re going to need some help. In 2023, we will contract with NORC, nonpartisan research organization, to develop a landscape analysis of the current health science career ecosystem, and convene a group of health care, workforce development, and community stakeholders to begin talking about and developing solutions to get more people of color and more people in rural communities onto a path toward a career in the health sciences.

On the flip side, hospital systems in rural communities have started to disappear. The American Hospital Association reports that nearly 60 percent of community hospital closures between 2015–2019 were in rural areas. The problem is further exacerbated with the lack of physicians wanting to work in rural areas. Rural hospitals are often the biggest employer in rural areas and their

* Note: Except the Hispanic or Latino group, the percentage of US population figures represents each group’s share of the non-Hispanic population. The “All other” category for both AAMC and Census data includes people who identify with multiple races, as American Indian ir Alaska Native, and all others. Sources: Association of American Medical Collages, US Census Bureau, CNN

30%

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POWER

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WHAT IS COMMUNITY POWER? This was a crucial question Health Forward asked as staff began developing the Power purpose area. Understanding the concept of what it means to have, wield, or lack power is one of the first steps to helping our communities that are affected by systemic racism and lack of opportunities.

and groups in our community, particularly those who often may be unheard or have limited opportunities to lift up their voices,” Jomella WatsonThompson, principal and co-owner of Ad Astra Community Innovations Group, said. “Through Stories in Power, power was redistributed through the engagement of the community in shaping and leading the development and implementation of the initiative.”

In order to shape the Power purpose area, Health Forward rejected a topdown definition of community power. Instead, we asked community members what power means to them.

In early 2022, Ad Astra convened the first meeting of the community advisory team (CAT), a group of individuals who met monthly and informed and influenced all aspects of the project, including what we should ask, who we should ask, how we should ask, and what it meant. The result was Stories in Power, a quantitative and qualitative data set made up of personal stories gathered from listening sessions, paint and SIPs, and surveys.

To this end, we partnered with Ad Astra Community Innovations Group, a local women- and people of colorowned consulting firm, to facilitate community input and communityengagement activities. “Stories in Power enhanced our understanding of how power (or the lack thereof) is experienced by individuals

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“Through Stories in Power, power was redistributed through the engagement of the community in shaping and leading the development and implementation of the initiative.” Jomella Watson-Thompson, principal and co-owner of Ad Astra Community Innovations Group

Over the course of nine months, Ad Astra held 15 listening sessions in seven communities. There were more than 200 participants who shared their experience and perceptions about power. These personal anecdotes gave us the most valuable insight into how Health Forward’s resources could be used to improve health equity and justice in the community.

state of Kansas wants that to happen. [...] to the people in power — who aren’t willing to listen to their electorate — it doesn’t make any difference.” Other interesting findings began to emerge. Primarily, people had a much lower perception of their own power. Secondly, perceptions of power differed greatly around race, and how power was tied to income.

Unsurprisingly, the individual and community perception of community power varied by region.

The result of these sessions was a 66-page report reflecting community views on power.

One community member said, “[The prior election] … definitely made us realize how important elections are. Unless you’ve got people with hearts in power, it doesn’t matter. It’s like the Kansas Medicaid situation. Most of the

listening sessions

The full report can be seen at the Stories in Power website, storiesinpower.org, along with videos taken from the community listening sessions.

communities

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PLACE

Image courtesy of Patricia Bordallo Dibildox and KC Tenants

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RI G HT TO CO UN S EL About five years ago, Rashida Williams left her hometown of Chicago for new opportunities in Kansas City. She was working two jobs to make ends meet when the pandemic started. She lost her job during the quarantine and when she fell behind on rent, her landlord threatened her with eviction.

Since Kansas City’s eviction moratorium was lifted in June 2020, the number of weekly eviction filings has risen steadily from 29 in May 2020, to 186 in February 2023. The National Coalition for a Civil Right to Counsel found that, on average, 82 percent of landlords had some kind of legal representation during eviction proceedings, while only 3 percent of tenants had legal representation. This staggering disparity in legal counsel leads to eviction for more than 90 percent of those tenants.

Despite being a good tenant of two years, her landlord refused to give her time to find a new job so she could catch up on rent. “They treated me like I was nothing,” Williams said. “This was my home. My home where it’s sacred; where I’m comfortable. The home where I put my all in. And then for them to tell me once I lost my job, ‘Oh, we’re going to kick you out’. Just imagine the things that went through my head. I felt hurt and worthless and almost like a failure.”

Evictions are traumatizing not only for the individual and their family, who will have the specter of an eviction haunt them for years, but it’s also destabilizing for the community, which can experience an increase in violence without the strength of an intact community. The Kansas City Star

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reported that “of the 10 Jackson County census tracts with the highest numbers of shootings, all but one also had higher than average eviction rates.”

With the adoption of Health Forward’s new purpose plan, we began to focus on Place as not only a greater determinant of health, but also as a source of wealth for our communities of focus.

Williams knew that what happened to her wasn’t right, and she decided to go to her court proceedings to fight for her home. It was at the courthouse where she came across Gina Chiala and her team from the Heartland Center for Jobs and Freedom (HCJF).

McClain Bryant Macklin, vice president of policy and impact, believes having a safe home or a place to call our own has an impact on our physical, mental, and emotional health. “People are familiar with the term ‘right to counsel’, but don’t realize rights without accessibility and affordability are empty,” Macklin said. “The Right to Counsel campaign balanced the hands of justice in evictions proceedings, affording tenants earning low wages in Kansas City, Missouri access to legal representation. Now, the vast majority of people facing evictions win their cases, and either stay housed or voluntarily leave an unsuitable tenancy for something more suitable to them. It has led to greater housing stability, which data supports leads to improved health access and outcomes”

Chiala, HCJF executive director and staff attorney, said the organization exists to defend the rights of workers who are underpaid. “We know that if you’re a low-wage worker, you’re much more likely to not get paid the minimum wage in overtime,” Chiala said. “We know you’re more likely to face sexual harassment, discrimination on the job, and you’re more likely to get evicted by your landlord. On top of all of that, you’re more likely to be exploited by car dealers, by predatory lenders and the like. We exist in order to enforce the rights of low-wage workers, but also to support their movements for change because we know the deep root causes of these problems lie with systemic change and without democratic movements, we can’t actually win significant changes.”

In their first year, Chiala and her team represented 150 tenants facing eviction, and in each case the families were able to stay in their home. This was the momentum they needed to take the idea to the city government to codify and fund a right to counsel.

“Invest the money necessary into right to counsel, and you will ensure that we have a more humane city, a more humane housing process, a more humane court system.” Gina Chiala, Heartland Center for Jobs and Freedom

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Image courtesy of Patricia Bordallo Dibildox and KC Tenants

“Invest the money necessary into right to counsel, and you will ensure that we have a more humane city, a more humane housing process, a more humane court system.” Chiala said. “And then the city saves money because it costs more to address the crisis of homelessness than it does to provide tenants with attorneys.” In December 2021, Kansas City became the 13th city to pass right to counsel. The program officially began in June 2022 and within the first 90 days, the program was able to help more than 400 tenants facing eviction. It was a clear victory for tenants in Kansas City. As the program continued to grow, so did HCJF and Health Forward’s goal of

creating safe and affordable housing to improve the health of Kansas City residents. They are now taking the fight directly to landlords who maintain substandard housing and holding them legally accountable. The success of the program also increased Williams’ desire to stop the cycle of eviction. She volunteers with HCJF to spread the word in her community about right to counsel, and she also is advocating for similar programs in other U.S. cities. “There’s power in numbers,” she said. “We’ll protest and get our word out. Just whatever [HCJF needs] me to do because I want to help so no one goes through the same thing that I went through.”

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P L AT F O R M

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P U T YO UR MO N EY W HER E YO UR MO UTH I S For a long time, that idiom was used as a challenge for people who may not have been living up to their spoken values. For Health Forward, it was a rallying cry for our new purpose work.

investments, and it was time to move some of that money to firms owned or run by people of color. In a field nearly 99 percent dominated by white men, Health Forward decided to look for wealth-management firms that not only had a track record of success in creating investment returns, but also aligned with our goals of supporting racial equity and economic inclusion, and creating change at the system level, this time aimed at the investment sector.

Starting in 2022, the finance team and board of directors made a concerted effort in using one of our greatest assets — our foundation’s money — to help bridge the capital chasm that exists for entrepreneurs of color. Historically, wealth-generating systems and wealth-management entities have had little representation from women and people of color.

We’ve since found several partners, one of whom is Impact America Fund (IAF).

In 2021, the Knight Foundation found that, of the $82.24 trillion of assets under management, only 1.4 percent were under diverse-owned firms (people of color- and womenowned firms). Health Forward has approximately $900 million in

Kesha Cash founded IAF in 2013 to narrow the racial wealth gap. IAF focuses on companies that give opportunities to small business and entrepreneurs that may not have access to things like capital to help their businesses grow.

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For example, IAF invested in Mayvenn hair products as a way to help the local neighborhood hairstylist. Most small salons lack the capital or inventory space to store and sell wigs or hair extensions, instead asking their clients to bring in their hair products. Grand View Research’s market analysis values the global hair and wig industry at more than $6 billion. These capital and space constraints excluded small-business owners from tapping into that lucrative market. With Mayvenn, a stylist sets up a virtual store so their clients can pre-purchase the products they need for their appointment. The stylist then makes a 30 percent commission on the client’s purchase off Mayvenn.

impactful to a community.” Melissa Plotsky, Impact Communications at IAF, said. One of the keys to IAF’s success is hiring people who have lived experience to better understand the problem the business owner is trying to solve. That experience creates better communication between IAF and the companies they are trying to fund. “When we talk to a room full of people who don’t know how to ask the right question or don’t know how to navigate external investment, they quickly find out who we are and what we’re trying to do,” Plotsky said. “They say, ‘these people get us.’ And then there is not a need to code switch or translate the community’s needs.”

An investor that understands the needs of a community creates tangible value for that community, and opens doors to capital and opportunities for growth that some small business didn’t know existed.

At the end of 2022, about 39 percent of Health Forward’s assets were managed or committed to firms led by people of color. The goal is to increase that number to 45 percent by the end of 2024 making Health Forward one of the leaders in philanthropy for that specific metric.

“The big venture capital companies often go after Ivy-League educated men who don’t really understand these kinds of businesses or why something like a hairdresser would be important and

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Images courtesy of Mayvenn

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FINANCIALS

S TAT E M E N T O F FINANCIAL POSITION

2 02 2

2 02 1

Cash, Prepaids, Accounts Receivable

16,187,837

4,615,739

Investments at Market Value

821,262,841

957,317,295

Net Fixed Assets

479,850

263,512

Total Assets

837,930,528

962,196,547

Operating Payables & Accruals

279,613

686,501

Grants Payable

9,349,151

9,297,514

Current Liabilities

9,628,764

9,984,015

Contributed Capital Historical Value

660,620,188

Increase (Decrease) since inception

167,681,576

291,592,344

Unrestricted Net Assets

828,301,764

952,212,532

Total Liabilities & Net Assets

837,930,528

962,196,547

ASSETS

LIABILITIES & NET ASSETS

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S TAT E M E N T O F CHANGES IN NET ASSETS

2 02 2

2 02 1

Net Investment Revenue

(102,835,865)

134,795,079

Public Support & Contributions

15,001,466

Other Revenues

2,000

41,636

Total Revenues

(87,832,399)

134,836,715

Grants & Gifts

28,764,658

16,718,012

Special Initiative Projects

905,493

687,793

Purpose-Driven Support

436,950

1,037,234

Operating Expenses

5,971,269

5,658,838

Total Expense

36,078,369

24,101,878

Total Increase (Decrease) in Net Assets

(123,910,768)

110,734,836

REVENUES

EXPENSES

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Image courtesy of Patricia Bordallo Dibildox and KC Tenants