Three traditions of women’s organizations emerged in the 1800s: benevolence, reform, and rights. This article focuses primarily on women who founded the forerunners of today’s nonprofit health and human service agencies. Using Richmond, Virginia, as an example, it draws from historical documents, as well as the literature, to reframe the importance of what Lady Boards of Managers did in shaping the governance and administration of early human service organizations. Of particular importance is the invisibility of their actions, which were extraordinary for the times in which they lived, in the theories and practice models that drive current macro-social work practice.