Tennessee Health Foundation Inc.

## Approach & Strategy

The BlueCross BlueShield of Tennessee Health Foundation (BCBST Health Foundation) is a corporate-affiliated foundation headquartered in Chattanooga, Tennessee, with approximately $282 million in total assets as of 2024. The Foundation operates as the philanthropic arm of BlueCross BlueShield of Tennessee, one of the state's largest health insurers, giving it a distinctive position at the intersection of healthcare, community wellness, and corporate social responsibility.

Strategic Philosophy: The Foundation pursues a place-based, community-driven strategy centered on the belief that healthy communities require more than clinical care — they need physical spaces that promote connection, activity, and well-being. Rather than distributing small grants widely, the Foundation concentrates significant resources into signature programs that can achieve transformative community impact across all regions of Tennessee.

Signature Program — BlueCross Healthy Place: The Foundation's primary investment vehicle is the BlueCross Healthy Place program, which allocates approximately $10-11 million annually. This program solicits proposals from communities of all sizes throughout Tennessee for projects that create or enhance spaces promoting physical activity and social connection. The program is designed to be inclusive of rural, suburban, and urban communities alike, and the Foundation provides both financial resources and technical support to selected communities.

Secondary Grantmaking: Beyond the Healthy Place program, the Foundation distributes approximately $2.2 million annually in additional grants supporting community nonprofits focused on education, diversity and inclusion, disease management, and charitable care/clinics. The Foundation also operates the BlueCross Family Fund through the Community Foundation of Middle Tennessee, which has received grants exceeding $1.7 million per year.

COVID-19 Response: The Foundation demonstrated significant responsiveness during the pandemic, deploying $550,000 for COVID-19 testing and treatment for uninsured residents in Hamilton County and $541,700 for vaccine campaign grants, indicating willingness to pivot funding toward urgent community health needs.

Key Takeaway for Applicants: This foundation values ambitious, community-wide health and wellness infrastructure projects over small programmatic grants. Proposals should demonstrate how a project will create lasting physical spaces that serve diverse populations within Tennessee communities.

## Funding Patterns

Overall Scale: Between 2020 and 2022, the Tennessee Health Foundation distributed $20.5 million across 217 grants, averaging approximately $6.8 million per year. The Foundation's total giving peaked in 2020 at $7.5 million (49 grants) with a higher average grant size of $153,066, then shifted to a higher-volume, lower-average strategy in 2022 with 100 grants averaging $72,615.

Grant Size Distribution: - Median grant: $10,000 - Average grant: $84,848 - Range: $2,000 to $600,000 - The wide gap between median ($10K) and average ($85K) indicates a bimodal distribution: many smaller community grants alongside a smaller number of large signature investments.

Top Funding Categories: 1. Community health infrastructure (BlueCross Healthy Place) — $10-11M/year 2. Food security — Major food bank donations ($500K-$750K per organization) 3. Education/Scholarships — POW Scholars program ($1.3M across 10 grants), Computing Scholarship Fund ($600K) 4. COVID-19 response — $1.1M in pandemic-related funding 5. Community connectivity — SmartCity Venture Fund ($500K), broadcaster partnerships

The trend shows the Foundation broadening its reach over time, making more grants at moderate levels while maintaining its large signature investments. Grant volume doubled from 2020 to 2022.

Geographic Concentration: Virtually all funding (99.6%) stays within Tennessee, with 209 of 217 grants going to TN-based organizations. The remaining grants went to organizations in California, DC, and Indiana — likely national organizations with Tennessee-relevant programs.

Financial Health: With $282M in assets, $258M net worth, and $164M in stock investments, the Foundation is well-capitalized. Net investment income of $12.5M in 2023 easily supports annual giving of $12.6M. The distribution amount of $10.2M in 2023 indicates sustainable payout relative to endowment size.

## Peer Comparison

The Tennessee Health Foundation operates in a competitive philanthropic landscape among health-focused and major Southeast foundations. Here is how it compares to regional peers:

Key Differentiators:

1. Community accessibility: Unlike peer foundations of similar size that make very few, very large grants (Burroughs Wellcome, Kenan Trust), the TN Health Foundation makes 217 grants of varying sizes — making it far more accessible to community-level organizations.

2. Geographic specificity: The Foundation's near-exclusive focus on Tennessee (99.6% of grants) makes it uniquely valuable for TN-based organizations, whereas most peers distribute across multiple states or nationally.

3. Corporate alignment: As a corporate-affiliated foundation tied to BCBST, the Foundation benefits from alignment with one of Tennessee's largest employers, providing access to health data, community relationships, and operational infrastructure that purely independent foundations lack.

4. Signature program model: The BlueCross Healthy Place program's $10M+ annual allocation in a single program is unusual among peer foundations, most of which distribute across many smaller program areas. This concentrated approach enables larger per-project investments.

5. Volume trajectory: The Foundation's grant count doubled from 2020 to 2022 (49 to 100), suggesting an expanding footprint that creates more opportunities for applicants — a trend not seen among peers.

## Recent Activity

2024 Financial Position: The Foundation's most recent filing (2024) shows total assets of $281.8 million and revenue of $38.5 million — a major revenue increase from $16.5M in 2023, suggesting either exceptional investment returns or additional corporate contributions. Net worth stands at $279.1 million, indicating the Foundation is well-positioned for sustained or increased grantmaking.

2023 Grantmaking: The 2023 ProPublica filing shows total giving of $12.6 million with grants paid of $1.9 million (the remainder flowing through the Healthy Place program and operating charitable activities). Exempt purpose expenses totaled $11.3 million, confirming the Foundation's commitment to direct community impact.

Program Evolution: The Foundation has been expanding its investment priorities beyond the core Healthy Place program. Key trends include:

• Scholarship expansion: The POW Scholars program and ETSU Computing Scholarship Fund represent growing education investments, with $1.3M+ deployed through the East Tennessee Foundation alone.
• Digital equity: The SmartCity Venture Fund ($500K) for student connectivity signals new interest in bridging Tennessee's digital divide.
• Food security: Large allocations to Second Harvest Food Bank, Mid-South Food Bank, and other food relief organizations ($2M+) suggest this has become a sustained priority area beyond COVID emergency response.

Healthy Place Program Updates: The signature program continues on a semi-annual application cycle, with deadlines in August for Healthy Place funding and in May and November for Community Trust funding. The Foundation's website at bcbst.com/about/in-the-community/healthy-places/funding-criteria provides current eligibility requirements and application guidance.

Financial Indicators: The Foundation's excise tax payment of $174,357 in 2023 confirms active grantmaking. Zero officer compensation indicates the Foundation is staffed through BCBST corporate resources, keeping administrative costs minimal and maximizing dollars available for grants.

## Application Tips

1. Align with the Healthy Place Vision The Foundation's single largest investment is the BlueCross Healthy Place program (~$10-11M/year). If your project involves creating or enhancing physical spaces for community health, wellness, activity, or social connection, this should be your primary application target. Frame your proposal around how the project will transform a specific place and serve as a lasting community asset.

2. Know the Application Cycle The Foundation operates on a defined schedule: - August: BlueCross Healthy Place funding applications - May and November: Community Trust funding applications Review eligibility criteria at www.bcbst.com/about/in-the-community/healthy-places/funding-criteria before applying.

3. Demonstrate Statewide or Regional Impact The Foundation funds communities "of all sizes throughout Tennessee." Rural and smaller communities have succeeded alongside urban applicants. Show that your project serves an underserved area or reaches populations with limited access to health and wellness infrastructure.

4. Budget Strategically With a median grant of $10,000 but an average of $84,848, the Foundation clearly supports both smaller community initiatives and larger infrastructure projects. For Healthy Place applications, budgets in the $100K-$600K range are realistic. For Community Trust grants, $5K-$25K proposals align with the median.

5. Emphasize Measurable Health Outcomes As a health insurer's foundation, BCBST values data and outcomes. Include specific metrics: projected users, health indicators to be tracked, community engagement targets, and how the project will be evaluated over time.

6. Show Community Buy-In The Healthy Place program explicitly seeks "community projects." Letters of support from local government, schools, community organizations, and residents will strengthen your application. Demonstrate that the project emerged from genuine community need and input.

7. Leverage Corporate Alignment Topics The Foundation has funded projects addressing: - Physical activity and outdoor recreation spaces - Disease management and chronic care support - Diversity, equity, and inclusion initiatives - Education and workforce development (especially STEM/computing) - Food security and nutrition access - Digital connectivity and equity

8. Tennessee Organizations Strongly Preferred With 99.6% of grants going to TN-based organizations, out-of-state applicants should demonstrate a direct, measurable impact on Tennessee communities to be competitive.