James B. Duke established the Duke Endowment in 1924. This document examines what the Carolinas have accomplished since that time--both through the endowment's investments and otherwise--and what remains to be achieved. The first chapter describes the Carolinas' of the 1920s. While the rest of the nation enjoyed economic prosperity, the rural Carolinas experienced poverty and ignorance. Mr. Duke's hydroelectric industry initiated a start towards urbanization and industrialization, but the area's longstanding tradition of resistance to change was reflected in the rise of the Ku Klux Klan and Jim Crow laws. The second chapter recounts Mr. Duke's strategy for improving the Carolinas. His endowment concentrated on the Carolinas and sought not only to enable economic development but also to foster improvements for Blacks and Whites in higher education, health care, and children's care, and to support the rural Methodist Church. The third chapter describes the Carolinas of today: industrialized, diversified, with an increasing population and an increased educational level. However, the area still lags behind the nation in college graduates, child poverty, and health care. Racial relations between Whites and Blacks are much improved, but the area is now coping with new populations of Latinos and Asians. The fourth chapter is a discussion among distinguished Carolinians about these trends and how foundations are uniquely positioned to promote and foster innovation for improving the economic, social, and physical health of individuals, families, and communities. Appendices contain roundtable participants, literary and visual arts contributors, and 55 sources of data and art. (TD)