Committed to Rural Health from the Start

The establishment of the Kate B. Reynolds Charitable Trust in 1947 began a lasting commitment to working with North Carolina’s rural communities. These areas are traditionally rich in resources and culture, yet under resourced when compared to their urban neighbors.

As the Trust celebrates a 75-year legacy of philanthropy, we are looking back on our rural health work. Learning from past efforts helps us work toward the structural transformation needed to ensure that health outcomes aren’t determined by someone’s race or by where they live.

Looking Back

In her lifetime, Mrs. Reynolds funded charities dedicated to improving the lives of those whom she called “the poor and needy” of North Carolina. Her will instructed that three-fourths of the Trust’s income be used to reimburse hospitals for treating ‘charity patients’ in North Carolina. Much of this money went to rural areas in the state.

In 1971, the Trustees (then the Trust Department of Wachovia) got court approval to take a more direct approach to funding and switched from direct hospital payments for charity care to more targeted efforts to improve rural health.

Increasing the rural workforce and improving facilities

In 1979, Wachovia Bank decided a professional manager—outside of the bank walls—was needed to manage the Trust’s Health Care Division. Vance Frye, who worked previously at The Winston-Salem Foundation, was hired as executive secretary. He was the Trust’s first employee, so he began making calls and driving around the state to understand what was needed to improve health care.

“The biggest need was more rural doctors. So, we started supplementing doctors in rural areas.”


Vance Frye
Former Trust Associate Director and first Trust employee


In her will, Mrs. Reynolds established the Trust with RJ Reynolds stock, valued at approximately $5 million in 1946. In 1988, the Trust’s assets doubled in size after the leveraged the buyout of RJR Nabisco, making the Trust one of the largest philanthropies in the South. At the same time, research and conversations with community showed more and more rural areas losing health care professionals. 

In 1989, the Trust awarded $4.5 million to the North Carolina Medical Society to establish the Community Practitioner Program—at the time the largest grant in Trust history—to recruit and retain health providers in rural areas. In its 32 years, the program has placed 515 physicians, physician assistants, and nurse practitioners from 130 different schools at 242 practices in 88 of North Carolina’s 100 counties.

“The Practitioner Program at the North County Medical Society made a remarkable difference in communities. It was very much a catalyst in helping recruit doctors to rural areas of the state.”


Bill Pully
Former Trust Advisory Council member and former president of the North Carolina Hospital Association, now the North Carolina Healthcare Association

Working with key partners

The Trust also began to address persistent health issues facing rural communities, like funding the creation of the North Carolina Rural Economic Development Center in 1986. In 2009, the Center unveiled the “Rural Hope” program with funding from the Trust, Golden LEAF Foundation, Appalachian Regional Commission, and USDA Rural Development. As a result of this collaboration, $17 million was invested into health care facilities in rural communities.

Trust efforts during this period didn’t stop at recruiting providers and investing in facilities. The Trust also worked to empower and equip future physicians to practice in their home communities. In 2012, the Trust awarded a $2 million grant to start the Jerry M. Wallace School of Osteopathic Medicine at Campbell University with the goal of enrolling students from rural communities of North Carolina.

“A grant that has sustainability and will have impact for years and years to come is the one we made to the Campbell Medical School. The places the students go for clinical rotations are in North Carolina, and their intent and track record is to have their graduates go back into rural communities to practice.”


Karen McNeil-Miller
Former President, Kate B. Reynolds Charitable Trust

Developing Healthy Places NC

While decades of critical work had been done to improve health care in rural North Carolina, the Trust team realized that to have a greater impact, staff needed to get closer to communities and residents most impacted by health inequities.

As a result, the Trust committed $100 million in 2012 to launch Healthy Places North Carolina, an effort to improve health in 10 of the state’s most rural, under resourced counties. For the last decade, the Trust has worked with residents to develop community-driven strategies to improve health outcomes in Beaufort, Burke, Nash, Edgecombe, Halifax, McDowell, Rockingham, Robeson, Bladen, and Columbus counties.

Supporting leaders of color

Healthy Places NC counties have developed change networks and built capacity for residents to lead, focusing on leaders of color, because data show that the biggest health disparities are not just by place, but by race. The work has evolved and now communities are tackling the issues inside and outside of the medical offices that impact a person’s health, like increasing healthy eating and active living, addressing substance misuse, eliminating food deserts, enhancing transportation to health facilities, and addressing poor housing conditions.

“Healthy Places has shaped the way we approach grantmaking. When we got into these communities, people weren’t merely upset that they had chronic illnesses like diabetes. Their problems were much bigger than a health issue. We would hear stories about systematic, persistent, and personal exclusion from needed services.”


Dr. Laura Gerald
President, Kate B. Reynolds Charitable Trust


Working Forward

Lessons from Heathy Places have been pivotal in shaping the Trust’s current grantmaking values, and the program provides a peek into the future of the Trust’s grantmaking strategy.

Rural residents experience more health disparities and live shorter lives than their urban neighbors. When you dig into health outcomes and life expectancy data, Black, Latinx, and Native American residents experience the largest heath disparities. That’s why we are focusing our rural grantmaking by place, race, and ethnicity to try to change those outcomes long-term and empower those most impacted.

Looking ahead, the Trust is shifting to a regional approach where Healthy Places communities and neighboring counties partner to tackle statewide health challenges. Together, they will work to change the systems that have harmed their communities. We’re working to empower rural residents and support leaders of color by providing the tools they may need to shape the decisions and systems that impact their lives.

“Over the years, we have collaborated with amazing partners to ensure that rural residents have an opportunity to thrive. Despite these investments, health disparities still exist. People aren’t broken, systems are. We are fully committed to working on systems change alongside those who have been harmed by those systems.”


Dr. Laura Gerald