1.Direct Relief International Annual Report 2008 1 Sixty Years of Sweeping Changes, Human Constants 2 Dedication 3 Message from the Chairman and the President & CEO 4 International Programs 14Domestic Programs 20Emergency Response 26Our Partners 30Introduction and Certification of FinancialSIXTY YEARS OF SERVICE Statements 32Financial Statements 34Notes to the Financials 40Our Investors 48Guiding Principles

2. 1BOARD OF DIRECTORS Sixty Years of Sweeping Changes,FISCAL YEAR 2008CHAIRMANStanley C. Hatch Human ConstantsVICE CHAIRMAN James A. ShattuckSECRETARY Bruce N. AnticouniTREASURERKenneth J. CoatesRick Beckett Frederick P. Burrows Jon ClarkThomas J. Cusack Killick S. DattaErnest H. Drew Gary Finefrock Louise Gaylord Direct Relief International was founded in the aftermath of World War II with the simple aim of helping people in postwar Europe who were living under tremendous hardship. They were caught in challenging circumstances, asRichard Godfrey Bert Green, M.D. history moved forward on a hopeful path from a dark period.Brandt Handley Raye Haskell Priscilla HigginsBrett Hodges Tara Holbrook Ellen Johnson Since that time, the accelerated march of progressin science, technology, communications, health care,Lawrence Koppelman Dorothy Largay agriculture, and economicshas been remarkable and worldwide in scale. The global tide of the human conditionDonald J. Lewis Alixe G. Mattingly has risen, as measured by child survival, access to food and water, longevity, prosperity, and educationalRobert C. Nakasone Natalie Orfalea opportunities.Carmen Elena Palomo James SelbertAyesha Shaikh, M.D. Ashley Parker Snider But humanitarian challenges persist. Poverty and poor health still reinforce each other, creating tremendousRichard Steckel, M.D. Paul H. Turpin obstacles for an estimated one billion people. Those who are poor get sick, stay sick longer, and die earlier thanSherry Villanuevathose who are not. And people who are sick tend to become poor because they cannot work and spend whatever they may have trying to access health services that are frequently sub standard.INTERNATIONAL ADVISORY BOARDCHAIRMANFrank N. Magid Amid the sweeping changes of the last 60 years, Direct Relief has remained focused on helping those caught in the undertow of historys rising tide. In 1948, our war-refugee founders William Zimdin and Dennis KarczagHon. Henry E. Catto Lawrence R. Glenn providedinitially with their own fundsfood, clothing, and medical aid to people living through the difcult periodE. Carmack Holmes, M.D. S. Roger Horchow of postwar recovery in Europe. They recognized that private efforts were crucial to reach beneath the large-scaleStanley S. Hubbard Jon B. Lovelace government-led rebuilding programs underway.Hon. John D. Macomber Donald E. PetersenRichard L. Schall John W. SweetlandToday, Direct Reliefs assistance is focused on health, bringing medical and nancial resources (including essential medical products donated by many of the worlds leading healthcare companies) to health professionalsHONORARY BOARD serving impoverished people in communities around the world. All these resources are provided through donationsPRESIDENT EMERITUS Sylvia Karczagfrom private parties, not government grants. In areas where governments and global markets are either unable orDIRECTOR EMERITUSDorothy Adams unwilling to engage, these efforts are essential to improve the health of people who are sick or hurt.PRESIDENT & CEO Thomas Tighe Despite the changed circumstances, location, scale, and techniques of our work, the humanitarian focus and attention to the efcient use of resources have remained constant. So too has the approach of supporting local efforts27 South La Patera Lanein a respectful manner and without regard to race, ethnicity, politics, religion, gender, or ability to pay.Santa Barbara, CA 93117T (805) 964-4767 Sixty years later, the simple goal of enabling people to live healthy, productive livesregardless of the circumstances into which they are born or nd themselvesremains a powerful incentive. The tremendousF (805) 681-4838 improvement in overall living standards creates a sharpened humanitarian imperative to assist those whose livesWWW .D IRECT R ELIEF .o RG remain threatened by sickness, disease, and injury that can be easily diagnosed and treated.DIRECT RELIEF ARCHIVESCOVER PHOTO :Brett WilliamsA pharmacist dispenses prescriptions from the Afghan Direct Relief medical supplies arriveInstitute of Learnings clinic in Kabul, Afghanistan.in Addis Ababa, Ethiopia in 1984. 3. Message from the Chairman 2 3 and the President & CEO O n the occasion of Direct Reliefs 60th anniversary, we are pleased to submit this report concerning our organizationswork included, in Kenya and Zimbabwe, stepped-up assistanceto provide life-saving anti-retroviral therapy to thousands of activities and nances for the scal year ending on March 31,patients with HIV/AIDS, new partnerships to train the rst 2008.generation of health workers in Southern Sudan, and thebroad distribution of HIV test kits worldwide to improve publicThe world has undergone profound change since 1948, health responses. We continued to support national Vitamin A and so too has our organization. Unchanged, however, is that blindness prevention programs in El Salvador and Nicaragua, many people are born into deep poverty or pushed by disastersand launched a large-scale response including vaccines to Peru or historic events into situations in which they face tremendous following the devastating earthquake in August. In Asia, ongoing challenges to their lives, health, and future prospects. Similarly support to excellent partners in Cambodia, Laos, India, and unchanged is our organizations humanitarian mission to help Sri Lanka ensured improved access and better quality health people in such situations. services for millions of people living in poverty.We are pleased to report that last year, in a tough economy, Our efforts to strengthen the health safety net in the U.S. This report is dedicated to the Direct Reliefs humanitarian assistance provided more help,also grew substantially, in partnership with 1,000 community- generations of unpaid volunteersto more people, in more places than at any time in our history.based health centers and clinics nationwide and two dozen Overall, our assistance programs increased by over 50 percent healthcare companies. From a small pilot, this effort grew to awhose energies and generosity have funded entirely with private support. Our dedicated Board of $61 million program that furnished 3.5 million prescriptions for fueled Direct Relief InternationalDirectors and Advisory Board, in addition to devoting thousandslow-income, uninsured patients last year. of hours to the organization, also demonstrated tremendousfor the past 60 years, including the personal generosity through their nancial support. Our 60th anniversary has renewed our deep commitment to exceptionally devoted individualsWe also are pleased to report that all fundraising andservice. In the most efcient, respectful, and productive mannerpossible, Direct Relief will continue to serve people whosewho have so generously servedadministrative expenses incurred during the year were paid lives and health are threatened by poverty, disease, or natural by the Direct Relief Foundation, the supporting organization with distinction on the established to manage bequest proceeds, provide nancialdisaster. Board of Directors. stability, and nance rapid emergency response and other keyPlease accept our heartfelt thanks for your interest and initiatives when no other funding exists.involvement in the work of Direct Relief.The Foundation is managed by its own Board of Trustees, which is, in turn, controlled and directed by the Board of Direct Relief International, who authorized transfers to enable immediate responses to humanitarian emergencies in Peru and Kenya without jeopardizing other planned activities. In addition, Foundation transfers allowed us to self-nance a crucial information technology upgrade that is necessary for efcient, precise management of complex operations on a global scale.Because fundraising and administrative costs were fully covered by bequest proceeds in the Foundation, 100 percentSHALEECE HAAS of all donors contributions were devoted to our humanitarian programs described in this report. The highlights of our program STANLEY C. HATCH,THOMAS TIGHE,Chairman President & CEO 4. International ProgramsHealth has intrinsic value for every person. It is essential for people to learn, work, and make a living.Sick people cannot work, and they become poor or stay poor, and people who are poor are at higher risk ofgetting sick. Access to quality health services is integral to creating positive change for people stuck in thiscycle. Direct Reliefs aim is to strengthen existing, fragile health systems that serve people stuck in this cycle.We work hard to ensure that the healthcare professionals in impoverished communities worldwide are able tomaintain, expand, and improve health services to people. In turn, the people served have a better chance to survive, become healthy, and realize their inherenthuman potential.DANIEL ROTHENBERG While working to strengthen basic health services in resource-poor areas, Direct Relief places a highpriority on: programs serving women and children, primary health care, activities that address HIV/AIDSprevention and care, and responding to emergency situations.4 5 5. 6 I N T E R N AT I O N A L P R O G R A M S THIS PROGRAM, ALONG WITH DIRECT RELIEFS Breaking the CycleANTIRETROVIRAL THERAPY DRUG PROGRAM WHICH BEGAN LAST YEAR, REPRESENTS A HUGE LEAP FORWARD IN OUR ABILITY TO HELP LOCAL HEALTH PROVIDERS IDENTIFY AND COMBAT HIV ACROSS THE GLOBE. Helping expectant mothers protect their babies Thomas Tighe, Direct Relief International President & CEO BRETT WILLIAMS ANNIE MAXWELLCRAIG BENDERCRAIG BENDERCRAIG BENDER Every 48 seconds, a child is infected with HIV, the virus that causes AIDS. This is a profound human tragedy whose primary cause is preventable. Without medical intervention, the chance that a mother will passBetween 2002 and 2007, Abbott donated more than 9.8 million rapid HIV tests to prevention programsthroughout the developing world. Over 7.7 million pregnant women have been tested with Determine, and along the virus to her child is as high as 30 percent, but with proper testing and therapy, this chance can be 855,000 of those women tested positive for HIV. Two million spouses and children of the pregnant women nearly eliminated. tested were also screened. Direct Relief and corporate partner Abbott are working to eliminate the barriers to the testing of In many developing countries, Direct Relief works closely with ministries of health and other major pregnant women for HIV in countries where mothers and their children face the greatest threat. In 2007,healthcare networks running prevention of mother-to-child transmission (PMTCT) programs to distribute the Direct Relief began distributing free, Abbott-donated Determine HIV rapid test kits. Sixty-nine developing test kits. The Rwandan Ministry of Health, one of the rst to subscribe to the program, has already tested countries are eligible for the program, including all countries in Africa, where the burden of HIV is heaviest.750,000 pregnant women. Abbott began distributing the free test kits internationally in 2002. This past year, Abbott approachedIn Kenya, where UNAIDS estimates 8.3 percent of adult females are HIV positive and 117,000 children Direct Relief to run the program because of Direct Reliefs track record of delivering needed supplies to thoseunder the age of 14 are infected, Direct Relief partner Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) who can do the most good with them.has tested 177,000 expectant mothers, 8,600 of whom were HIV-positive. This program, along with Direct Reliefs antiretroviral therapy drug program which began last year, Thanks to Direct Relief and Abbotts partnership, HIV-positive women will have the chance to protect represents a huge leap forward in our ability to help local health providers identify and combat HIV across thetheir children from this devastating virus. globe, said Thomas Tighe, Direct Relief President and CEO. The test is quickresults take 15 minutesand requires no electricity or water, making it ideal for areas that may lack steady access to either resource. If a pregnant woman tests positive for HIV, the healthcare provider can take the necessary steps to prevent the baby from being infected with the virus. 6. 8 I N T E R N AT I O N A L P R O G R A M SI N T E R N AT I O N A L P R O G R A M S 9COUNTER TO THE CONVENTIONALAMERICAN UNDERSTANDING OF THE Cornerstones of Recovery TERM, HOSPICE CARE IN AFRICA IS NOT ONLY CONCERNED WITH THE CARE OFClinical ocer training helps to rebuild Southern Sudans healthcare systemTHE DYING BUT ALSO WITH PATIENTSFOUNDATION FOR HOSPICE INUNDERGOING TREATMENT WHO HAVE THETSUB-SAHARAN AFRICA POTENTIAL TO RETURN TO LIVING he graduates of the clinical ofcer training program in Southern Sudan are the cornerstones of recovery for the NORMAL LIVES. regions health system, which has been decimated by decades of civil war. Dr. Mike Marks, Direct Relief Africa Medical AdvisorThe need for trained health workers in Southern Sudan is great: Almost 20 years of continuous war has ledmany of the surviving health professionals to ee the country. It is estimated there are only nine doctors for every Living with HIV/AIDS 100,000 people. Clinical ofcers trained to provide diagnosis and treatment and conduct basic surgical procedures arehelping to ll the void.Direct Relief has joined with African Medical and Research Foundation (AMREF) to address Southern SudansHospice and palliative care bring dignity to Africans with terminal diseasespriority healthcare infrastructure needs. This year, Direct Relief committed $192,000 to sponsor 30 clinical ofcerstudents at the National Health Training Institute (NHTI) in Maridi. Students began their coursework in JanuaryA n estimated 22 million people in sub-Saharan Africa live with HIV/AIDS, and for many of them access to thelong-term care necessary to combat the virus is lacking. Stigma, noncompliance, and access to specialist care and2008. The program is open to Sudanese nationals who have met preliminary health worker qualications. Studentsfrom different ethnic groups and remote areas are actively recruited for the program, which pays for tuition, room andboard, insurance, a personal stipend, and transportation. After completing the three-year course, graduates intern formedicines all impede treatment. a year at one of seven hospitals and are then required to work in their home communities for three years. For these patients, hospice and palliative-care groups represent key providers of care. These dedicated groups The human resources for health crisis in Southern Sudan is severe, says Dr. Peter Ngatia, AMREF Directorfocus on traditional end-of-life care and, increasingly, treatment to prolong and improve the quality of patients lives. of Capacity Building and Human Resources for Health Development. In the next ve years, it is projected that thisHospicesserving patients who usually have no income and are very poortypically lack nancial and basic material country, which has known no peace since independence from Britain in 1956, will need 1,500 clinical ofcersaresources to enhance and expand their desperately needed services.tenfold increase of the current production of NHTI, the only clinical ofcer training school. We may not be able toachieve this, but with the generous support of Direct Relief we will double the production in the next two years. Counter to the conventional American understanding of the term, hospice care in Africa is not only concernedwith the care of the dying, but also with patients undergoing treatment who have the potential to return to living Maridi County Hospital, within walkingnormal lives, explained Dr. Mike Marks, Direct Relief s Africa Medical Advisor.distance of the training institute and also supported by AMREF, has the potential to become an ideal Direct Relief has forged partnerships with the Foundation for Hospices in Sub-Saharan Africa (FHSSA) and theteaching facility for the students of NHTI, butHospice Palliative Care Association of South Africa to help provide needed resources. In Fiscal Year 2008, Directit is woefully ill equipped. To help outt theRelief provided close to $1 million (wholesale) worth of material, representing 467,793 courses of treatment, to hospice hospital and its satellite rural clinics, Directpartners in Kenya, South Africa, Uganda, and Zimbabwe. Relief provided medical supplies, equipment, and pharmaceuticals worth $230,000 (wholesale) in These groups provide an array of home-based care services. In addition to caring for patients, they provide care November, including exam tables, hospital beds,DR. MIKE MARKSfor family members who may be watching over a sick loved one, as well as placement services and care for orphaned otoscopes, stethoscopes, and autoclaves.children. In the past year, hospice and palliative-care organizations have also begun furnishing antiretroviral drugs topatients with HIV/AIDS. On May 15, 2007, Direct Relief participated in the launch of the Diana Legacy Fund, in San Diego, California.IN THE NEXT FIVE YEARS [SOUTHERN SUDAN] WILL NEED 1,500 CLINICAL OFFICERSA TENFOLDThe charity, which honors the memory of the late Princess Diana, was established to help bring comfort and solace INCREASE OF THE CURRENT PRODUCTION OF NHTI, THE ONLY CLINICAL OFFICER TRAINING SCHOOL.to the dying and their families in Sub-Saharan Africa. The Diana Legacy Fund supports the work of FHSSA. At theWITH THE GENEROUS SUPPORT OF DIRECT RELIEF WE WILL DOUBLE THEdedication ceremony, Direct Relief President and CEO Thomas Tighe spoke alongside Nobel Laureate ArchbishopPRODUCTION [OF NHTI] IN THE NEXT TWO YEARS.Desmond Tutu about the importance of palliative and hospice care in Africa. Dr. Peter Ngatia, AMREF Director of Capacity Building and Human Resources for Health Development 7. 10 I N T E R N AT I O N A L P R O G R A M SMALNUTRITION IS THE CAUSE OF MOST HEALTH PROBLEMS FOUND AMONG CAMBODIAN CHILDREN.AS A NURSE EDUCATOR, IVE SEEN FIRSTHAND THE IMPORTANCE OF THE NUTRITION AND TRAINING PROGRAMS AT AHC. Manila Prak, Angkor Hospital for Children Nursing Education Coordinator developed the nationally approved protocols for managing pediatric HIV/AIDS cases. Patients are treated for free if they cannot pay.While AHC serves a crucial role in pediatric medical care, the nutrition program is aimed at reducing the need for medical intervention related to malnutrition. Direct Relief, in partnership with Abbott and AHC, is working to advance this goal. Since 2003, Direct Relief has provided more than $2 million (wholesale) in medical material support to the hospital, including Abbott-donated nutritional and rehydration products to complement the nutritionDANIEL ROTHENBERG program, as well as anti-infectives, pharmaceuticals, and equipment that the hospital requested.AHCs staff includes a nutrition-education nurse, a demonstration cook, and a gardener. The AHC team has taught 3,000 families about better nutrition, trained 270 health professionals, and conducted health assessments for more than 135,000 children. AHC has trained numerous Cambodian medical, nursing, and management personnel, Innovative Programs Feed Hope many of whom it now employs. Abbott provides medicines and nutritional supplements that help patients regain basic health and funds ongoing programs that teach families and children to grow, cook, and eat foods that will keep them healthy and well nourished.Angkor Hospital for Children in Cambodia works to end As Cambodia rebuilds a health system, which was decimated by the Khmer Rouge regime, Angkor Hospital for Children has become a source of hope for improving pediatric care throughout the country. rampant malnutrition The smell of cooking lls the air in the courtyard of the Angkor Hospital for Children (AHC) in Siem Reap, Cambodia, where patients relatives are preparing lunch under the watchful eye of a nutritionist. It is part healthy-cooking demonstration, part outdoor classroom, functioning as a cafeteriaall part of an innovative, comprehensive program to combat one of Cambodias most pressing health issues: malnutrition in children. ENOUGH FOOD WAS PROVIDED FOR ME AND MY GRANDCHILD, AND The U.N. estimates that 45 percent of children under the age of ve in Cambodia are underweight andTHE FOOD WAS MUCH BETTER THAN malnourished. AHCs patients reect this grim statistic. Common pediatric cases include dengue fever, dysentery,MY FOOD AT HOME: VEGETABLES, tuberculosis, HIV/AIDS, malaria, and intestinal parasites. But 66 percent of children are admitted for malnutrition and MEATS, FRUITS, AND DESSERTS. dehydration, with 10 percent of those cases severe and life threatening. EDUCATION WAS GIVEN ABOUT Established in 1999, the nonprot AHC is a key resource of specialized pediatric care in a country with aMALNUTRITION SO I CAN FEED MY proportionately large number of young people. The hospitals outpatient clinic treats 300 to 500 children a day. It has 24- GRANDCHILD PROPERLY. COURTESY OF AHC hour emergency service, is one of two teaching hospitals in the country, and also provides inpatient care, intensive care, and surgical procedures. Staffed by Cambodians and visiting expatriate volunteer health professionals, the hospital has Sorn Rai, AHC patient andgrandmotherI N T E R N AT I O N A L P R O G R A M S 11 8. 12 I N T E R N AT I O N A L P R O G R A M S treatment for the most common diseases that accompany diabetes. By offering extensive health education and promoting healthy eating habits, the clinic works against the lifestyle trends that increase the incidence of diabetes. Outreach services strive for early detection and diagnosis, and the main clinic provides complimentary treatment for those who have developed related visual, neural, and circulatory problems. Direct Relief has supported CVCD since its inception with primary care medicines and medical supplies that aid the treatment of diabetes-related conditions. Abbott has come to CVCDs aid with blood glucose meters and test strips critical to early detection and monitoring, allowing for control of the disease through regular clinic visits and education. The companys philanthropic foundation has also provided cash grants to bolster the clinics outreach services. With this support, CVCD has gone mobile. Over 13,000 people have been screened for diabetes in eight of the nine major Bolivian cities by clinic staff in the last four years. Of those screened, CVCD discovered that 7.9 percent had previously undiagnosed cases of diabetes. Those diagnosed learned then how to properly manage their diabetes, and by living healthier lives, they have less impact on an already nancially strapped public health system. DR. ELIZABETH DUARTE GOMEZ In addition to screenings, CVCD has distributed printed materials explaining diabetes management, conducted group and individual disease education using Abbott-contributed glucose meters and strips, and trained 604 health professionals (doctors, nurses, and pharmacists) on the latest diabetes detection and treatment methods. Vivir Con DiabetesAt the forefront of healthier lifestyles in Bolivia THE HAPPINESS WE FEELNineteen million people are estimated to have diabetes in Latin America and theCaribbean according to the International Diabetes Foundation, and that number is expected AT BEING ABLE TO GIVETO THOSE IN NEED, WITHOUTSINCE 1982,WORRYING ABOUT WHAT ITto double to 40 million by 2025.DR. ELIZABETH DUARTE GOMEZDIRECT RELIEFCOSTS, IS INDESCRIBABLE.HAS PROVIDEDDIRECT RELIEF PROVIDESAs daunting as these statistics are, the day-to-day reality of living with diabetes inOVER $6.8 MILLION MATERIALS FOR QUALITYan area without adequate care is far worse. Fortunately, many health complications related(WHOLESALE) IN CARE.to diabetes can be minimized or eliminated through early detection and changes in dailyMEDICAL MATERIALlifestyle. Dr. Elizabeth Duarte Gomez,ASSISTANCE El Centro Vivir Con Diabetes CVCD sta conducts diabetes tests during one of its outreachTO BOLIVIA. ELand detection campaigns to the province of Cliza, Bolivia.In Boliviawhere 4.8 percent of the population is diabeticthe nonprot El Centro Founder and DirectorCENTRO VIVIR Educational talks and medical literature about diabetes are alsoVivir Con Diabetes (CVCD) works at the forefront of diabetic care in the city of Cochabamba,provided to communities visited.CON DIABETES HASwhere CVCD estimates 9.4 percent of adults are suffering from diabetes. For seven years,BENEFITTED FROMthe clinic has focused on lifestyle education and nutritional counseling along with providingOVER $1.3 MILLIONOF THAT AID.I N T E R N AT I O N A L P R O G R A M S 13 9. Domestic Programs N onprot, community-based health centers and clinics are the main point of access for health services for over 15 million U.S. residents. The majority of these patients have low incomes, and 40 percent have no health insurance. These centers and clinics are located in areas of high need, focus on prevention and primary care, and collectively constitute a signicant portion of the countrys health safety net. Access provided by these health centers is essential for low-income people, and the care is cost-effective and serves larger public- health goals. Without these centers, already strained hospital emergency rooms often are the only alternative. Among the many challenges that confront both health centers and their uninsured patients is access to prescription medications. In partnership with health centers, clinics, and healthcare companies, Direct Relief is addressing this challenge. The result is a rapidly expanding program through which Direct Relief provides medicines and resources to nonprot clinical providers for the benet of low-income, uninsured patients. In Fiscal Year 2008, Direct Relief provided 3.5 million prescriptions (valued at $61 million wholesale) to more than 1,000 clinic sites in all 50 states. Having built a system for the efcient, reliable, and secure provision of needed medicines for uninsured patients, Direct Relief is working to further strengthen the safety net that catches the millions of working poor at risk of falling through the cracks. The evolution of this domestic program also has highlighted the importance of involving health centers and clinics in emergency planning, preparedness, and response. Future efforts are aimed at expanding prescription assistance and improving emergency response coordination among clinics andMARGARET MOLLOY health centers nationwide.14 15 10. 16DOMESTIC PROGRAMSInjecting Resources Into Safety-Net ClinicsWE REJECT THE NOTION THAT IF YOURE POOR ANDProviding insulin to Americans with diabetesUNINSURED, ITS ACCEPTABLE THAT YOU DONT GET THE CARE AND MEDICINE YOU OR YOUR CHILD NEEDS. WE SERVEPEOPLE WHO ARENT SERVED BY MARKETS OR GOVERNMENT. Thomas Tighe, Direct Relief International President & CEO Diabetes is a chronic condition that affects about 5.5 percent of the U.S. population. At the nonprot federally qualied health centers with which Direct Relief partners,With so many diabetic clients, this free offer is the number jumps to 6.2 percent of all patientsoverof tremendous assistance, said Veronica Flores of the 900,000 people.Sierra Health Center in Fullerton, California. Thankyou for your continuous support to ensure the health ofPatients at these health centers and clinics, inunderserved, indigent patients in our community. addition to having higher incidence of diabetes, also disproportionately live in poverty (over 54 percent,Across the U.S., Direct Relief provided 65 of its compared to 12.5 percent nationally) and lack healthpartner clinicsserving a combined 670,000 patients insurance (40 percent, compared to 15.3 percentannuallywith the donated insulin, valued at $520,000 nationally).(wholesale).Direct Reliefs domestic program with partnerI cannot begin to tell you how important this is to clinics helps people stuck in the difcult situationour clinic, wrote Jean Diebolt, medical director at the of lacking either insurance or the means to obtainHope Project in Tenaha, Texas. The nearest place for medications, including those needed for chronicpatients to get prescriptions lled is 10 miles away. Some conditions such as diabetes.of the patients do not have transportation or funds toafford the meds. If not for Direct Relief, some would be So when sano-aventis offered Direct Relief aseriously ill and medically compromised. The help we give donation of more than 17,000 cartridges of its insulinthem with your donations means that they can stretch product Lantus, a medication commonly used to treatNEARLY ONEtheir housing and food money and dont have to sacrice or diabetes, it was a welcome contribution. THIRD OF make a decision whether to eat or buy medications.NONELDERLY U.S.Lantus is a temperature-sensitive product, whichADULTS WITHOUT YOUR DONATIONS MEAN [OURrequired Direct Relief to establish a partnership with aINSURANCE PATIENTS] DONT HAVE TO SACRIFICE OR third-party shipper specializing in temperature-controlled HAVE AT LEAST MAKE A DECISION WHETHER TO EAT ORdelivery. The process is being developed in anticipation ONE CHRONICof broader support to resource-stretched safety-net clinics BUY MEDICATIONS.CONDITION.with sensitive medications, including vaccines. Jean Diebolt, Hope Project Medical Director, Tenaha, Texas Annals of InternalMedicine, Vol. 149, No. 3 11. 18 DOMESTIC PROGRAMSThe contents were chosen based on Direct Relief s analysis of product shortages following Hurricanes Katrinaand Rita, and in conjunction with the Texas Blue Ribbon Commission on Emergency Preparedness and Response,convened by Governor Rick Perry in the aftermath of Katrina.Typically, during the rst 72 hours after a disaster, roads are damaged and clinics see surges in their patientloads, greatly complicating the ability of organizations like Direct Relief to assist rst responders, said DamonTaugher, Direct Reliefs director of domestic initiatives and coordinator of the organizations response to HurricanesKatrina and Rita.By sending modules before an emergency strikes, delivery delays are eliminated and medical professionals havethe tools they need to treat the many injuries that occur the minute the disaster hits. This preparation also lessensthe burden on other area healthcare providers and rst responders, including hospital emergency rooms.Franklin Primary Health Center (FPHC), a hurricane module recipient, serves low-income and underinsuredpatients in Mobile, Alabama. FPHC was in the path of last years most destructive storm, Hurricane Dean.Charles White, CEO of FPHC, wrote, Last month we observed the two year anniversary of Hurricanes Katrinaand Rita, while Dean, another Category 5 storm, was threatening the Gulf of Mexico. Our preparation would not haveDirect Relief staassembles emergency been complete without your continued support and recent donation. We saw rsthand how invaluable your assistancepreparedness moduleswas as we struggled to reopen our centers after Hurricane Katrina.ANDREW FLETCHERbound for Gulf Coastclinics.Direct Relief will continue to distribute hurricane preparedness modules annually to support those providingcare to the most vulnerable communities during an emergency. ReadyTREAT 100 EMERGENCY MODULES TO PATIENTS FOR 72 HOURS INCLUDEOur preparation [for theA proactive approach to hurricane response AMONG MANY ITEMS:hurricane season] would nothave been complete without yourcontinued support and recentP Anti-infective Biaxin tablets, glucose testdonation.kits and strips, and Pediasure for combatingThis has been a great benet for our underservedpatients. Thank you for what you do. Charles White, CEO, Franklindehydration, all from Abbott redictions indicated an active hurricane season in the United States this past year, citing as many as 10 potentialPrimary Health Center, Mobile, Valerie Powell, Lone Star Family Health Center, Alabamahurricanes. For Direct Relief, the lessons of Hurricanes Katrina and Rita in 2005 were well learned: Emergencies canMobic tablets for pain management fromConroe, TexasBoehringer Ingelheimstrike at any time, and preparation is the best defense.EpiPens for emergency epinephrinedoses from Dey Laboratories We were very fortunate to notBased on its past and continued work with Gulf Coast health center and clinic partners, Direct Relief developed have a hurricane last season.Proventil inhalers for asthma fromWe distributed all of the suppliesa hurricane-preparedness module specically designed to help clinics respond to the unique characteristics of Schering-Plough from the module this rst week ofDecember 2007 to all of our clinichurricanes and other emergencies. Anti-inammatory Ibuprofen andsites. The supplies and medicationsChildrens Tylenol tabletswere used for patient care; nothingwas wasted.Sixteen partner health centers and clinics received these prepositioned modules. The sites were selected forAnti-infective penicillin and doxycycline Pati Landrum, Southeasttheir location, past experience with emergency response, patient populations, and capacity to treat victims during aMetformin for diabetes treatmentMississippi Rural HealthInitiative, Hattiesburg, Mississippidisaster.Exam glovesGauze bandagesStocked with enough materials to treat 100 patients for 72 hours, the modules help providers treat conditionsranging from basic trauma injuries to chronic illnesses. The contents of the modules can be easily merged into clinicsregular inventories if not needed for emergency response.DOMESTIC PROGRAMS19 12. Emergency Response Emergencies strike resource-poor areas the hardest, quickly overwhelming already weak, nancially strained health systems. Direct Relief targets these areas before emergencies take place, building relationships, protocols, and distribution channels that enable fast and efcient action when disaster strikes. In times of emergency, Direct Relief moves quickly to supply local healthcare professionals with needed medical and nancial assistance to ensure they continue providing care to those affected. Because local people are the rst responders, have the most at stake, and will be there for the long run, targeting our assistance to them helps avoid the duplication of efforts, wasted resources, and logistical bottlenecks. In Fiscal Year 2008, Direct Reliefs emergency response efforts provided health facilities with more than $14 million (wholesale) in emergency medical support and $1,221,000 in emergency cash assistance. These efforts involved more than 100 shipments and 23 cash grants to 18 partners in 14 countries on 4 continents, and provided 2 million courses of treatment to people struck by natural disasters and civil conict.BRETT WILKINSON20 21 13. DIRECT RELIEF ARCHIVES 1940s year history includes a long tradition of rapid emergency response and a commitment to long-term recovery. Our founders rst aid to war-torn EuropeDirect Reliefs sixty- 1970sFor the support of people displaced by the NigerianCivil War, E.M.C. Aniagu, King of the Ibo tribe,traveled to Santa Barbara to meet and thank Direct Relief framed the organizations mission. Helpfounder Dennis Karczag (left). A continent away, Direct DIRECT RELIEF ARCHIVES provided to refugees of the Korean War began Relief responded to the massive May 31, 1970, over 40 years of assistance to the country. Andearthquake in Peru with 30,000 pounds of more recently, Direct Reliefs work in the Gulfmedical aid to assist the injured. States in the aftermath of Hurricanes Katrina 1980s and Rita provided the foundation for a domestic program that supports the healthcare safety net throughout the entire U.S. A TRADITION OF RAPID RESPONSE Direct Relief founders William Zimdin (left) and Dennis Karczag DIRECT RELIEF ARCHIVES& LONG-TERM RECOVERYCambodian During the early 1980s, refugees ed the Khmer Rouge, seeking sanctuary in Thailand1950s (right). Millions lived in exile without adequate resources. Direct Relief provided extensiveDIRECT RELIEF ARCHIVES amounts of medical and nutritional products to Direct Relief continued to aid health facilities and refugee camps. those affected by World War IIOur work in the country continues today. by providing relief parcels and In Fiscal Year 2008, Direct Relief supported nancial assistance to affected Cambodian healthcare professionals with more than 800,000 courses of medical treatment, valued at over1990s communities in Austria, Estonia, $2 million (wholesale). See page 10 for more on our recent work in Cambodia. Germany, Greece, Italy, Russia, and Yugoslavia. Aid was also extended to Chinese Civil War refugees in Hong Kong. At right, the rst Direct Relief humanitarian1960s provision arrives in China. Direct Relief began focusing its workDIRECT RELIEF ARCHIVES on medical assistance. From an ofceDirect Relief began assistance to Tibet in 1959, and later, at the request of established in Seoul, Korea (left), the the Tibetan Department of Health of the Government-in-Exile, established organization sees to the long-termthe Tibetan Refugee Tuberculosis Control and recovery of the healthcarePrimary Healthcare Program, supplying essential medicines infrastructure stillto Tibetan refugee settlements throughout India and Nepal. In 1996, Direct reeling from the Korean War and to the newly displaced andRelief board member Jean Hay welcomed the Dalai Lama to Santa Barbara (left). DIRECT RELIEF ARCHIVES rapidly growing refugee populations of South Vietnam.23 14. December August 2004In response to the tsunami that forever altered life for millionsof people living on the shores of the Indian Ocean, Direct Reliefprovided $57 million in direct aid, including over $14 million inemergency cash assistance. Our aid continues to enable local health 2007 Working alongside long-time partners the Catholic Archdiocese of Lima and the Peruvian American Medical Society, Direct Relief 8.0-magnitude responded to the August 15, 2007, earthquake in Peru with $4.2 million (wholesale) inMATT MACCALLAorganizations to serve those who lost the most and have the most atspecically requested emergency supplies.stake in the long-term recovery. The Peruvian Ministry of Health informed Direct Relief that DAN SMITHWith funding from Direct Relief, the Amrita Institute of the country was in need of Hepatitis B and rotavirus vaccines for theMedical Sciences (AIMS) in southwestern India equipped a telemedicine van (left) to bring care to the many people too remote,hardest hit populations. Together with Merck & Co., Inc., Direct Reliefsick, owas able to deliver $1.8 million (wholesale) worth of vaccines for the immunization of children and adults (above).communities, using video conferencing and real-time transmission of medical information to connect AIMS hospital staff withotherwise disenfranchised patients. A TRADITION OF RAPID RESPONSE&LONG-TERM RECOVERY EMERGENCIES IN FISCAL YEAR 2008AugustOctober 2005Beyond the immediate efforts of Direct Relief in the Gulf States followingHurricanes Katrina and Ritaincluding $4.6 million in cash grantsto clinics and health centers and over $31.8 million (wholesale) in medical productstheorganization has worked to address gaps in the health system that leave so manyuninsured and working poor Americans without care. See the section beginning on pageAs2007 wildres swept through Southern California, DirectRelief worked to support communities with resources needed for recovery through71 shipmentsincluding 80,000 masks for locals and emergency personnelvaluedat over $1.4 million (wholesale). Direct Relief provided $560,000 in emergencySARAH WILKINSONcash assistance to clinics and reghters, including $400,000 to the Council of14 to learn more about Direct Reliefs work in the U.S. Community Clinics on behalf of their 17 San Diego County health centers, and$50,000 to the California Department of Forestrys Fireghters Benevolent Fund. DAMON TAUGHEROctoberDecember2005Anticipating the massive need for long-term rehabilitative services7.6-magnitudeto treat traumatic injuries after theearthquake struck Pakistan on October 8, 2005,Direct Relief funded and continues to support the Pakistan Instituteof Prosthetic and Orthotic Science (PIPOS), the countrys only The2007widespread civil strife that broke out in the aftermath of Kenyas presidential election was unexpected and violent. Protests sparked by disputed election results and allegations of vote-counting impropriety gave way to ghting along political and then tribal lines. Dr. Hezron McObewa (right), director of the Kisumu, Kenya-based OGRA Foundation, aided people caught in the crossre.prosthetic training facility and limb manufacturing center. Direct As soon as the violence broke out, Direct Relief wired $25,000 to OGRA to purchaseReliefs cash assistance established three PIPOS clinic sites in Bagh, needed medicines and fuel, organized airfreight shipments of additional emergency supplies,Balakot, and Besham (left), and covers the operating expenses forand committed more than 136,000 courses of antiretroviral medicine for patients with HIVeach facility for three years. whose treatment was disrupted by the violence. Days later, Direct Relief contributed an LORI WILLIS Direct Relief has supported earthquake-affected communities additional $25,000 to help transport displaced families, supply essential medicines, andBRETT WILLIAMSin Pakistan with more than $7.5 million (wholesale) in medical support surgeons, doctors, and nurses.material, representing 1.5 million courses of treatment, and over $1million in grants to 11 local healthcare organizations.25 15. O U R PA R T N E R S O U R PA R T N E R S Africa CAMBODIA Caribbean FISCAL YEAR 2008 SUPPORT Angkor Hospital for Children, Siem Reap Orphan Voice Cambodia, Phnom Penh= Total Wholesale ValueSihanouk Hospital Center of HOPE, Phnom Penh= Total Weight 2,078,661 51,061 lbs. 820,488 = Courses of Treatment37,410,435 CHINA 302,960 lbs. One HEART, Lhasa2,014,959Rashu Township Clinic, Rashu TownshipLIBERIA SOUTH AFRICA Christian Aid Ministries Liberia, Monrovia Eastern Cape Hospices, Port Elizabeth 37,616499 lbs. 117,120 ELWA Hospital, Paynesville CityTshisimane Healing Center, Soutpansberg JFK Medical Center, Monrovia Mount Sinai Surgical Team, Monrovia49,0987,636 lbs. 91,619EAST TIMOR 3,814,73089,001 lbs.697,374 Australian Aid International, Dili 30,812,132 SUDAN47,3751,450 lbs.27,434 602,415 lbs. MADAGASCARAMREF/National Health Training Institute, Maridi DOMINICA 13,991,373Marie Stopes Madagascar, Antananarivo228,90614,605 lbs. 232,917 Portsmouth Hospital, Portsmouth FIJI 94,183 4,658 lbs.150,1975,287,9139,308 lbs. 76,428Loloma Foundation, SuvaTANZANIA Savusavu Community Foundation, SavusavuMALAWIDr. Atman Hospital, Sumbawanga 1,778,870 37,366 lbs. 586,270Huruma Designated District Hospital, Rombo Banja La Mtsogolgo, Marie Stopes Malawi, BlantyreKADERES, KaragweDOMINICAN REPUBLICEast & College of Medicine, BlantyreMarie Stopes Tanzania, Dar es Salaam Montfort Hospital, NchaloMpanda District Hospital, Mpanda Batey Relief Alliance, Santo DomingoBURUNDIMulanje Mission Hospital, MulanjeNamanyere Hospital, NamanyereCentro de Atencion Primaria, Constanza Partners in Hope Medical Centre, LilongweShirati Hospital, ShiratiEmbassy of the Order of Malta, Santo DomingoJabe Hospital and Rohero Emergency Clinic, BujumburaSoutheast Queen Elizabeth Hospital, Blantyre Sumbawanga Regional Hospital, Sumbawanga Fundacion Cruz Jiminian, Santo Domingo197,678 4,322 lbs.284,731Trinity Hospital, LimbeTanzania Women Social Economic Development Health Care Education Partnership, Santo Domingoand Human Rights Organization, KigomaMovimiento Socio Cultural Para Los Trabajadores, Santo Domingo 2,062,80056,407 lbs.748,883 Obispado de Puerto Plata, Puerto Plata1,521,36455,481 lbs. 3,218,487AsiaCAMEROON Patronato Beneco Oriental, La RomanaHelp Medical Foundation, Douala NIGER10,001,684 104,610 lbs. 309,137Holy Trinity Foundation Hospital, Ekona UGANDA Galmi Hospital, GalmiKolofata District Hospital, Mora TurtleWill, Agadez AMREF Uganda, SorotiManyemen Presbyterian Hospital, ManyemenHospice Africa Uganda, KampalaRural Community Medical Foundation, Kumba31,538 1,310 lbs.66,433Jinja Municipal Council, JinjaGRENADAShemka Foundation/Quality Healthcare Unit, YaoundSt. John of God Health Centre, MamfeJoy Hospice, Mbale Food For the Poor, St. GeorgesKitovu Mobile, MasakaNIGERIAMinistry of Health, St. Georges875,112 26,331 lbs.397,787Rakai Community Based Health Project, Kampala St. Georges General Hospital, St. Georges Antof Rural Resource Development Center, OronRays of Hope Hospice, Jinja Victory International Ministries, AbaRugendebara Foundation for Health, Kasese2,973,71012,851 lbs. 36,497D E M. RE P U BL IC OF C ONGO Uganda Reproductive Health Bureau, Kampala 6,360,509 79,070 429 lbs. 4,709Aungba Health Zone, Aungba4,716,32936,956 lbs. 658,436150,824 lbs.Project de Lutte Contre Les Handicaps Visuels, Boma4,212,2811,287,097 18,394 lbs. 224,287 RWANDAHAITIZAMBIA CHF/Community HIV/AIDS Mobilization Archeveche du Cap Haitien, Cap-HaitienAngel of Mercy, Lusaka Asile Communal, Cap-HaitienETHIOPIA Program (CHAMPS), KigaliKala Health Center, Kawambwa Centre Medico-Social Nord Alexis, Port-Au-PrinceAddis Ababa Fistula Hospital, Addis Ababa165,267 20,549 lbs.1,194,254 Kasaba Mission Hospital, Mansa Christian Aid Ministries, Port-Au-PrinceThe World Family: Ethiopian Orphans and Kawambwa Hospital, KawambwaEglise du Nazareen dHaiti, Port-au-Prince Medical Care, Addis AbabaLubwe Mission Hospital, Samfya Food for the Poor, Port-Au-PrinceSENEGAL Lusaka District Health Management, CIDRZ, Lusaka Hospital Justinien, Cap-Haitien101,643 16,696 lbs.106,845Mambilima Mission Hospital, Mansa Clinique Seydina Issa Laye, Dakar Mariani Clinic, Port-Au-PrinceMansa General Hospital, MansaMt. Olive Medical Fair, Port-Au-Prince INDONESIA The Association of Villagers at NDem, NDemGHANA Mbereshi Mission Hospital, KawambwaNew Hope Ministries, Cap-Haitien 10,200 146 lbs. 36,271 Samfya Health Center, Samfya CHF International, Banda Aceh Partners in Health/Zanmi Lasante, Port-Au-PrinceBorae Health Center, Krachi St. Francis Katete Mission Hospital, KateteIBU Foundation, Meulaboh St. Jules Medical Clinic, Bourg du BorgneKings Medical Centre, TamaleSt. Pauls Mission Hospital, Nchelenge International Relief & Development, JakartaKomfo Anokye Teaching Hospital, KumasiSIERRA LEONEZambia Helpers Society, Lusaka4,904,028109,814 lbs. 1,011,928 The Sumba Foundation, BaliNana Hima Dekyi Hospital, DixcoveYayasan Bumi Sehat, BaliSAMORGHEP/Maranantha Maternity Clinic, KumasiNdegbomei Development Association, Bo1,126,83863,362 lbs. 1,788,912 Ndegbormei Development Organization, Bumpen 445,70314,933 lbs.1,746,798929,640 47,186 lbs.946,028 Royeima Section Community Health Center, Royeima St. John of God Catholic Hospital, LunsarZIMBABWEJAMAICA Taiama Health Clinic and Maternity Center, TaiamaLAOSKENYA Harare Central Hospital, HarareFood for the Poor, Spanish TownIsland Hospice, Harare HOPE Worldwide, KingstonMahosot Hospital, Vientiane 2,008,54720,962 lbs.686,739 Muang Sing Hospital, Muang SingAMREF Kenya, NairobiJ.F. Kapnek Charitable Trust, Harare Jamaica Humanitarian Dental Mission, St. JamesKericho Regional Hospital, KerichoMinistry of Health & Child Welfare, Harare Missionaries of the Poor, KingstonSave The Children-Australia, VientianeMeru Hospice, MeruSOMALIA Population Services Zimbabwe, Harare 59,343 6,595 lbs.308,901OGRA Foundation, Kisumu Seke Rural Home Based Care, Seke 13,902,798 65,569 lbs.578,953St. Josephs Mission Hospital Nyabondo, SonduEdna Adan Maternity and Teaching Hospital, HargeisaSisters of Jesus of Nazareth Clinic, Chegutu CONTINUED on next pageVIAGENCO Comprehensive Care, Mbita HAPA Hargeisa Hospital, Hargeisa St. Alberts Mission Hospital, Zambezi Valley7,761,579 53,888 lbs.1,693,419 1,678,56429,675 lbs.409,5052,071,94834,420 lbs. 353,54027 16. O U R PA R T N E R SO U R PA R T N E R SCONTINUED from previous pageHONDURAS14,272,380Alabama Honduran Medical Education Network AHMEN, LimonEurope & NORTH KOREAASIDE, El Progroso281,740 lbs.Eugene Bell Foundation, Pyongyang Brigada de Salud/Honduras Relief Effort, Tegucigalpa 5,648,546CEPUDO, San Pedro Sula740,676 22,076 lbs. 112,361 Chamelecon Medical Center, San Pedro SulaMiddleClub Rotario Tegucigalpa/Uniendo America, Tegucigalpa SouthHacienda Cristo Salva, Santa Barbara PAPUA NEW GUINEA Honduran Health Exchange/C.P.T.R.T., TegucigalpaWewak General Hospital, Wewak Hospital Leonardo Martinez, San Pedro SulaEastLa Clinica Esperanza, Roatan153,544 7,122 lbs. 51,480AsiaProyecto Aldea Global, TegucigalpaSiempre Unidos, San Pedro SulaPHILIPPINES3,896,05614,036,241 110,321 lbs. 1,411,378Holy Rosary International Medical Mission, Palawan 55,767 lbs.Philos Health, JagnaMEXICOPopulation Services Pilipinas Incorporated, Pasay City2,701,934 AFGHANISTANReyes-Villanueva Medical Relief, Baggao AeroMedicos of Santa Barbara, CadejeFundacion SEE International, A.C., Ciudad JuarezAfghan Health and Development Services, Kandahar Province375,843 2,789 lbs. 174,448LIGA International, MazatlanAfghan Institute of Learning, Kabul and Herat ARMENIAPotters Clay, Ensenada Afghan Reconstructive Surgery and Burn Center, Kabul Health Ministry of Armenia, YerevanAga Khan Health Services, Bamyan Provincial Hospital, Bamyan THAILAND 236,394 2,979 lbs.48,352 Karabagh Health Ministry, YerevanFamily Health Alliance, KabulChristians Concerned for Burma, Chaing Mai Yerevan Municipality, YerevanJamaludin Wardak Clinic, WardakGlobal Health Access Program, Mae Sot NICARAGUA Marie Stopes Afghanistan, KabulMae Tao Clinic, Mae Sot297,3339,662 lbs. 2,635,878American Nicaraguan Foundation, Managua 554,809 33,971 lbs. 1,235,62036,622 565 lbs.155,369Amucobu, Managua ROMANIAAproquen, ManaguaCasa de la Mujer, Metagalpa BANGLADESH SOLOMON ISLANDS Christian Aid Ministries Romania, Floresti Christian Aid Ministries, ManaguaCoxs Bazar Hospital for Women and Children, Coxs BazarCONANCA, Hospital Infantil Manuel de Jesus Rivera, ManaguaLoloma Foundation, Honiara 3,634,73244,336 lbs.2,163,704Sangkalpa Trust, PatharghataNicaraguan Childrens Fund, Puerto CabezasShidhulai Swanirvar Sangstha, Dhaka1,020,081 21,164 lbs. 77,3499,304,257165,243 lbs.1,476,3542,546,385 19,396 lbs. 940,941 WEST BANK/GAZA VIETNAMANERA, West Bank/GazaPERUINDIAKim Long Charity Clinic, HueSt. Johns Eye Hospital, West BankMarie Stopes Vietnam, Hanoi Archdiocese of Lima, Lima198,610 5,923 lbs.366,628 Amrit Davaa World Health, Tawang364,467 7,779 lbs. 263,745Hospital Belen de Trujillo, TrujilloAravind Eye Hospital, MaduraiHospital Carlos Monge Medrano, JuliacaAssociation of Indian Physicians of Northern Ohio, Northern IndiaHospital de Apoyo Tambobamba, TambobambaThe George Foundation, Baliganapalli UKRAINEHospital Departamental, HuancavelicaLata Mangeshkar Medical Foundation, Pune Latin AmericaGods Hidden Treasures, KievHospital Guillermo Diaz de la Vega, Abancay M/s. Mata Amritanandamayi Math, CochinHospital Regional de Ayacucho, Ayacucho Meenakshi Mission Hospital, Madurai64,713 5,508 lbs. 171,602 Hospital San Jose, ChinchaPasam Trust, KodaikanalInstituto Nacional de Salud del Nino, LimaPRASAD, GaneshpuriMinisterio de Salud, Lima Sri Narayani Hospital & Research Center, VellorePeruvian American Medical Society, Lima Than Gaon Clinic, Tan GaonReal Medicine Foundation Clinic, San ClementeBOLIVIA ECUADOR 6,055,596 91,875 lbs. 2,114,4616,036,697104,821 lbs.3,289,629Centro Medico Vivir con Diabetes, CochabambaJunta de Benecencia de Guayaquil, GuayaquilCruz Roja, MonteroMarie Stopes Bolivia, Santa Cruz de la Sierra 664,55336,782 lbs.2,315,009NEPALVENEZUELARio Beni Health Care Project, RurrenabaqueAdventist Development and Relief Agency, KathmanduTurimiquire Foundation, CumanaFamily Health International, Kathmandu USA 601,93037,022 lbs.699,278Himalayan HealthCare, Kathmandu12,504117 lbs. 2,243Shahid Gangalal National Heart Centre, Kathmandu157,216 5,056 lbs. 556,235 EL SALVADOR Baja Project for Crippled Children, San Miguel Comite de Reconstruccion y Desarrollo, Suchitoto PAKISTAN FUDEM, San SalvadorAmerican Refugee Committee International, Bagh FUSAL, San SalvadorBethania Hospital, Sialkot O.E.F. de El Salvador, San SalvadorMarae Foundation, BaltistanMurshid Hospital and Healthcare Center, Karachi6,832,821 77,611 lbs.4,250,321PIPOS, Peshawar57,264,8154,958,374 131,442 lbs. 801,289731,348 lbs. GUATEMALAGUYANA 14,586,85961,367,567 Ministry of Health, GeorgetownAsociacion Nuestros Ahijados de Guatemala, ONG, Antigua 380,216 lbs.MEDICAL MISSION BOX PROGRAMCaritas Arquidiocesana, Guatemala City 667,231 22,018 lbs.Liberty University, Guatemala CityTo learn more about our work with 3,724,948Presbiterio Kaqchikel, Chimaltenango12,744Bristol-Myers Squibb that supports doctors whoProject Xela Aid, QuetzaltenangoDirect Relief works with more than 1,000 clinicsprovide primary health care worldwide,San Marcos Health Care Project, Catarinaand community health centers in every state and Puerto Rico.Santa Rosa Medical Clinic, Santa Rosago to WWW.D IRECTR ELIEF.ORG.18,872,186174,435 lbs. 1,081,553Go to WWW.DIRECTRELIEF.ORG to learn more about these safety-net providersand their dedicated efforts to keep low-income communities healthy. 29 17. Introduction andin-kind material donations are also recorded in inventory upon receipt. Direct Reliefs policy is to distribute products at the earliest practicable Certication ofdate, consistent with sound programmatic principles. While the distribution often occurs in the same year of receipt, it may occur in thefollowing year. An expense is recorded and inventory is reduced when the products are shipped to our partners.Near the end of Fiscal Year 2007, for example, Direct Relief received a large infusion of product donations. When that scal year ended,Financial Statementsthe product inventories that had not been spent were reported as surplus. In turn, this increase in net assets was carried forward andspent during the course of Fiscal Year 2008. This resulted in a decrease in net assets (or net operating loss) in Fiscal Year 2008 of $26.6million which was primarily driven by a decrease in inventory as Direct Relief shipped $25.8 million more in humanitarian aid than it receivedin product donations.D irect Relief International had a strong Fiscal Year 2008 in all areas of our activities and nances. We received $201.2 million in publicsupport and revenue, and provided $213.94 million (wholesale) in assistance around the world. Direct Reliefs nancial position and balanceAdministrative ExpensesAs explained below, the Direct Relief Foundation pays for all the administrative and fundraisingexpenses of the organization. In addition, our organization has adopted a strict policy to ensure that 100 percent of all designatedsheet continues to be strong thanks to steadfast support from our generous donors and Board of Directors. contributions (e.g. donations for Hurricane Katrina) are used only on expenses directly related to that purpose. None of those funds are usedto cover any pre-existing indirect or allocated organizational costs. We have used similar policies for all of our disaster responses in the lastCash and In-Kind Contributions Direct Reliefs nancial statements must account for both cash and in-kind few years, including the Indian Ocean tsunami, Hurricanes Katrina and Rita, and earthquakes in Pakistan, Peru, and China.contributions (primarily medical material resources) that are entrusted to the organization to fulll its humanitarian mission. In Fiscal YearConsistent with this policy, all administrative expenses, including banking and credit-card processing fees associated with simply2008, 93.6 percent of our total public support and revenue of $201.2 million was received in the form of in-kind medical material and certain receiving these disaster and other designated contributions, were absorbed by the Foundation. We believe this is appropriate to honorother donated services (such as transportation services from FedEx and online advertising from Google). The previous pagesprecisely the clear intent of generous donors who responded to these exceptional tragedies and to preserve the maximum benet for theexplain where and why these in-kind medical materials and other inventories were provided.victims for whose benet the funds were entrusted to Direct Relief.2008 Support & Revenues: $201.2 million Valuation of In-Kind Medical MaterialsAccounting standards require Direct Relief to use a fair market value 2008 Sources of Cash to value in-kind medical materials. We continue to use the wholesale prices published by independent, third-party sources for valuation $250mSupport & Revenues: $12.9 million whenever possible. Specically for pharmaceutical products, the source of and basis for product values are the Average Wholesale Price In-Kind(AWP), which is published in Thomson Healthcares Redbook. For used medical equipment, the organization determines wholesale value by 94%, $188.3m$200mUndesignatedreviewing the price of similar equipment listed for sale in trade publications and on the Internet. Such valuations typically are substantiallyCash41%, $5.3m6%, $12.9mlower than published retail prices. Because nonprot organizations are rated on, among other things, the amount of support received, a strong $150mBequestsincentive exists to use higher valuation sources, such as retail prices, which would be permissible. However, we believe that a conservative20221%, $2.7mapproach is best to instill public condence and give the most accurate, easy-to-understand basis for our nancial reporting. 199188 $100m 121Disasters Direct Relief Foundation and the Board-Restricted Investment Fund In 1998, Direct Reliefs$50m98 Special Events 7%, $0.9m Board of Directors established a Board-Restricted Investment Fund (BRIF, sometimes characterized as a quasi-endowment in legal or 3%, $0.4maccounting terminology) to help secure the organizations nancial future and provide a reserve for future operations. The BRIF, established 4 43Grants 2116 13with assets valued at $774,000, draws resources from Board-designated unrestricted bequests and gifts, returns on portfolio assets, and$0m Investment Income16%, $2.1m CY FY FY FY FY operating surpluses (measured annually) in excess of current operational needs. There was no operating surplus for the year ended March 31,2003 2005 2006 2007 200812%, $1.5m2008. Cash Support In-Kind SupportIn October 2006, the Direct Relief Foundation was formed and incorporated in the State of California as a separate, wholly controlled,We recognize that merging cash and in-kind contributions in accordance with Generally Accepted Accounting Principles can be confusingsupporting organization of Direct Relief International. Effective April 1, 2007, assets in the BRIF were transferred to the Foundation. Theto non-accountants. The notes following the nancial statements are to assist you in understanding how our program model is nanced andFoundations investments are managed by the Commonfund Strategic Solutions Group, an investment rm under the direction of the Boardsworks, to explain the state of our organizations nancial health, and to inform you about how we spent the money generously donated toFinance Committee, which meets monthly and oversees investment policy and nancial operations.Direct Relief in 2008 by individuals, businesses, organizations, and foundations.The BRIF is authorized to distribute its portfolio assets to pay for all fundraising and administrative expenses of the organization,Direct Reliefs activities are planned and executed on an operating (or cash) budget that is approved by the Board of Directors prior toincluding extraordinary capital expenses, and to advance emergency disaster relief funding as determined by the President and CEO. Upon athe onset of the scal year. The cash budget is not directly affected by the value of in-kind medical material contributions. Cash supportasmajority vote by the Board, the BRIF may also be utilized to meet other general operational costs. Thus, in Fiscal Year 2008, 100 percent of alldistinct from the value of contributed goodsis used to pay for the logistics, warehousing, transportation, program oversight, program staffdonations received by the organization were directed towards programmatic activities and costs.salaries, purchasing of essential medical products, acquisition of medical products through donations, and all other program expenses.For the scal year ending March 31, 2008, $2.1 million was distributed from the BRIF to cover fundraising and administration costs, asWhen taking an annual snapshot at the end of a scal year, several factors can distort a realistic picture of our (or any nonprotwell as implementation costs for a new enterprise-resource planning platform.organizations) nancial health and activities. Since the purpose of this report is to inform you, we think it is important to call your attentionAs of March 31, 2008, the BRIF in the Foundation was valued at $46.3 million.to these factors.Finally, we note that our organizations independently audited nancial activities were also reviewed by an audit committee, two ofwhose members are independent accounting professionals and not directors of the organization. This additional level of independent review isTiming of Revenue Recognition and ExpensesFirst is the timing of donations being received and the required under California law.expenditure of those donations, whether in the form of cash or in-kind medical material. Donationsincluding those received to conductspecic activitiesare recorded as revenue when they are received or promised, even if the activities are to be conducted in a future year. TheTHOMAS TIGHE, BHUPI SINGH,30President & CEO Executive Vice President & CFO31 18. RECONCILIATION OF CHANGE IN NET ASSETS TO NETCombined Statement of Activities(Direct Relief International & Direct Relief Foundation) CASH PROVIDED BY OPERATING ACTIVITIESfor the scal years ending March 31, 2008, and March 31, 2007 2008 2007Change in net assets $ (26,595)$87,477 ADJUSTMENTS TO RECONCILE CHANGE IN NET ASSETS$ IN THOUSANDS TO NET CASH PROVIDED BY OPERATING ACTIVITIES:PUBLIC SUPPORT & REVENUE Depreciation $ 250 $ 200Public Support Change in inventory28,263 (57,436)Contributions of goods and services $ 188,332 93.6% $ 201,823 82.6%Change in receivables(798)(8)Contributions of cash and securitiesCalifornia res743 0.4%-0.0%Change in prepaid expenses and other assets (65)(34)Contributions of cash and securitiesother disaster relief133 0.1%9420.4%Change in accounts payable and accrued expenses112 296Contributions of cash and securitiesother 10,553 5.2% 39,798 16.3%Loss on disposal of xed assets 623TOTAL PUBLIC SUPPORT199,76199.3%242,563 99.3%Realized gain on sale of investments (1,112) (1,189) Unrealized loss on investments 688 716RevenueEarnings from investments and other income1,475 0.7%1,776 0.7% NET CASH PROVIDED BY OPERATING ACTIVITIES$ 805 $ 30,025TOTAL PUBLIC SUPPORT AND REVENUE201,236 100.0%244,339 100.0%EXPENSES Statement of Financial Position Direct Relief Direct Relief Combined International FoundationProgram Services as of March 31, 2008, and March 31, 20072008 2008 20082007Value of medical donations shipped213,920 136,154Inventory adjustments (expired pharmaceuticals, etc.) 2,430 7,649ASSETSDisaster reliefCalifornia res 575 -Current AssetsDisaster reliefother 656 5,182Cash and cash equivalents $1,313$ 2,286 $ 3,599 $3,177Domestic programs 1,480 824Investments5 43,44143,446 43,997International programs5,790 4,851Inventories 53,384-53,384 81,647TOTAL PROGRAM SERVICES224,851 111.7%154,66063.3% Other current assets 587230 817203Supporting ServicesTOTAL CURRENT ASSETS55,289 45,957 101,246129,024Fundraising 1,234 896Administration1,746 1,306Other Assets Property and equipment 4,932 -4,932 3,961TOTAL SUPPORTING SERVICES 2,980 1.5%2,202 0.9% Remainder unitrusts-72 7276TOTAL EXPENSES227,831 113.2%156,86264.2% Pledged bequests - 257257 - Other assets17 - 1722INCREASE (DECREASE) IN NET ASSETS $ (26,595)-13.2%$ 87,477 35.8% TOTAL OTHER ASSETS 4,949 3295,278 4,059 TOTAL ASSETS$ 60,238$ 46,286$ 106,524 $ 133,083Combined Statement of Cash Flows(Direct Relief International & Direct Relief Foundation) LIABILITIES AND NET ASSETSfor the scal years ending March 31, 2008, and March 31, 20072008 2007 Current Liabilities Payables and other current liabilities$799- $799$688CASH FLOWS FROM OPERATING ACTIVITIESCash collected from public support$ 10,628$ 40,732 Current portion of long-term debt5-5 1,467Cash paid for goods and services(10,937)(11,963) TOTAL CURRENT LIABILITIES804-804 2,155Dividend and interest income 1,119 1,244 Other LiabilitiesOther income (expense)(5) 12 Long-term debt 1,400- 1,400-NET CASH PROVIDED BY OPERATING ACTIVITIES80530,025 Capital lease obligation 8- 8 17 Distribution payable20-20 24CASH FLOWS FROM INVESTING ACTIVITIES Total Other Liabilities1,428- 1,428 41Purchase of investments (20,306)(51,310) TOTAL LIABILITIES2,232- 2,2322,196Proceeds from sale of investments 21,28117,147Purchase of capital assets (1,283) (498) NET ASSETSUnitrust distributions(4) (5) Unrestricted net assetsNET CASH USED BY INVESTING ACTIVITIES(312)(34,666) Board-Restricted Investment Fund (BRIF)- 44,26544,265 44,192 Undesignated54,7171,99656,713 84,597CASH FLOWS FROM FINANCING ACTIVITIES TOTAL UNRESTRICTED NET ASSETS 54,717 46,261 100,978128,789Payments on mortgage(62)(52)Payments on capital lease obligation (9) (4) Temporarily restricted assets3,289 -3,289 2,073NET CASH USED FOR FINANCING ACTIVITIES(71)(56) Permanently restricted assets-25 2525 TOTAL NET ASSETS58,00646,286104,292 130,887NET INCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS422(4,697) LIABILITIES AND NET ASSETS$ 60,238$ 46,286$ 106,524 $ 133,083CASH AND CASH EQUIVALENTS - BEGINNING OF YEAR 3,177 7,874CASH AND CASH EQUIVALENTS - END OF YEAR $ 3,599 $ 3,1773233 19. Notes to the Financials Fiscal Year Results Cash GrantsThe overall assistance furnished by Direct Relief in Fiscal Year 2008 was just over $216 million. Direct Relief received nogovernmental assistance. All resources were obtained from private sources. I n addition to the core medical material assistance program, Direct Relief also provided nancial assistance of $2.15 million through cash grants. The vast majority of these grants (approximately $1.3 million) were made from designated contributions received in this and past scal years for the Indian Ocean tsunami of 2004, the Pakistan earthquake of October 2005, the Southern California Fires of In the scal year ending March 31, 2008, Direct Relief provided 2,353 shipments of humanitarian medical material including2007, the Peru earthquake of August 2007, and the post-election violence of Kenya in December 2007.pharmaceuticals, medical supplies, and medical equipment. The more than 1,270 tons (just under 2,540,000 pounds) of material aidwere furnished to local health programs in 59 countries, including the United States, and had a wholesale value of $213.9 million. The The organization incurred $487,000 in tsunami cash expenditures this scal year, of which over $403,000 was in the formmaterials contained in these aid shipments were sufcient to provide 49.8 million courses of treatment.of cash grants to support essential recovery efforts conducted by local organizations in the affected countries and by colleague international nonprot organizations. As of March 31, 2008, the organization had spent over 97 percent of the funds received for In addition, the organization provided $2.15 million in the form of cash grants to dozens of locally run health programs in areas tsunami relief.affected by the December 2004 Indian Ocean tsunami, the Pakistan earthquake of October 2005, the Southern California wildresof 2007, the Peru earthquake of August 2007, the post-election violence of Kenya in December 2007, and various other partnersWith funds received for the Pakistan earthquake of October 2005, the organization spent a total of $137,000, of which $127,000providing health services in other non-disaster areas. was spent in the form of cash grants. As of March 31, 2008, the organization had spent over 99 percent of the funds received for this relief effort. Expanding Assistance, Increasing Efficiency With Southern California wildredesignated contributions, the organization incurred expenditures of $578,000, of which Value of Material Aid Provided ($ Millions) $565,000 was spent in the form of cash grants to health facilities and organizations providing direct health services to residents in the220 50 affected areas. As of March 31, 2008, the organization had spent over 77 percent of the funds received for this relief effort.200 45180 Courses of Treatment (Millions)200 40160180Stang T3516014030hese activities were accomplished by a staff which, as of March 31, comprised 48 positions (40 full-time, 8 part-time). Measured140120120 25 on an full-time equivalent (FTE) basis, the total stafng over the course of the year was 41.5. This gure is derived by dividing the100100 20 total hours worked by 2,080, the number of work hours by a full-time employee in one year. Two persons each working half-time, for 80 80 15 example, would count as one FTE. 60 6010 40 20 5Staffing (FTE): 1995 Fiscal Year 20080 0 CY 96 CY 97 CY 98 CY 99 CY 00 CY 01 FY 02 CY 03 FY 05 FY 06 FY 07 FY 0896 97 98 99 00 01CY 02 0302FY 05 4545 4040 International DomesticCourses of TreatmentIn-Kind Support Received 3535 Full-Time EquivalentsFull-Time Equivalents Direct ReliefFurnished Assistance3030 2525 Comparison to Previous Years Results 2020All nancial statements presented in this report show both the results for Fiscal Year 2008 and those of Fiscal Year 2007 for 15 10 15 10comparison purposes. 5 5 0 09596 979899 00010203 FY FY FY FY LeverageI05060708n Fiscal Year 2008, for every $1 contributed and spent for our core medical assistance program (excluding emergency response), In general, staff functions relate to three basic business functions: programmatic activity, resource acquisition/fundraising, andthe organization provided $36.39 worth of wholesale medical material assistance. These program expenses totaled $5.48 million. The general administration. The following sections describe the nancial cost of our organizational activities, how resources are spent, andexpenditure of these funds enabled Direct Relief to furnish $199.4 million worth (wholesale value) of medical material resources to 59 how donor funds are leveraged to provide assistance to people in need throughout the world.countries for the support of ongoing health needs.3435 20. Total Expenses: 2003 2008 Donated Freight Program ExpensesFundraising Expenses Program ExpensesFundraising expenses also include: Disaster ResponseAdministration Expenses I $25m$250m The production, printing, and mailing of newsletters, the annual report, tax-receiptFundraising Expenses: 2003 2008Program Expenses (non-disaster)n Fiscal Year 2008, Direct Relief s cash Material Aid (Wholesale Value)4%, $9.2m letters to contributors, fundraising solicitations, and informational materials. Total expenditures on program activities totaledProgram Expenses (disaster response) $1.2m0.9*Other 1%, $1.2mcosts$20mincurred came to approximately $87,000. 0.8$200m $10.93 million, $2.21 million of which0.70.92%, $3.5mProgram Related1.0 1.30.24 paid for salaries, related benets (health, m Program Related $154.7 98.6 % $8,000 in advertising and Benefits 50%, $611kSalaries & marketing costs$1.0m98.69%, $224.9m dental, long-term disability insurance, and m Administration $1.3 .83%*Other Administration $67,000 in expenses directly related to $150m $15m 5.9 fundraising events (of which $9,000 wereContract Services 8%, $103k retirement-plan matching contributions), m Fundraising $0.9.57% 0.77%, $1.7mManagement & Administration $1.7m0.5 donated goods for the events) 1.2$0.8m 0.2 TotalFundraising $1.2m and mandatoryemployer-paidtaxes (Social m$156.9100% Special 12.5Events, Travel1.7Donated Freight $0.5m $56,000 in travel and mileage-reimbursement expenses $10m $100m214 Security, Medicare, workers compensation, Fundraising& Meeting Expenses 9%, $114k0.54%, $1.2m 0.6 $335,000 in contract services (of which $232,000 were donated services 190$0.6m and state unemployment insurance) for 250.7 0.6 Donated Goods & Services 20%, $241k 1360.96 from Google) 12.09.2 119 full-time and 5 part-time employees engaged in $5m3.0$50m Wholesale Value of Material Aid0.494$0.4m programmatic functions. *Other 93%, $213.9m $12,000 in supplies in support of the fundraising Etc. 7%, $87k0.5Printing, Postage, Mailing, staff 0.5 5.1 0.7 0.70.7 Management & Administration$1.7m3.6 Fundraising$1.2m $7,000 in outside computer Expensesrelated to fundraising2.1Other services 6%, $77k1.2 0.5 Program expenses also included: *Other$0mCY FYFY FY FY $0m CY FYFY FY FY$0.2m Management &$1.7m Donated Freight$0.5m A pro-rata portion other allocable 2003 2005of2006 2007 2008 costs (see page 39) 2006 2007 20082003 2005 The value of disposed expired products Administration Fundraising $1.2m ($2.43 million) Donated Freight $0.5m It should be noted that Direct Relief does not classify any mailing expenses as$0mTotal Expenses: 2003 2008jointly incurred costsan accounting practice that permits, for example, the expensesCY FY FY FY FY Cash grants to partner organizations ($2.15 2003 2005 2006 2007 2008Donated Freight million, of which $403,000 was for tsunamiof a newsletter containing information about programs and an appeal for money to beProgram Expenses Fundraising Expenses Donated Services relief, $127,000 for Pakistan earthquake Disaster ResponseAdministration Expenses allocated partially to fundraising and partially to public education, which falls under relief, $565,000 for Southern Californiaprogram costs. $25m$250m wildre relief, $100,000 for relief efforts afterProgram Related MaterialProgram Related $154.7 mAid (Wholesale Value) 98.6 % Salaries & Benefits 50%, $611k the violence in Kenya, and $26,000 for Peru98.69%, $224.9mAdministration$1.3 m .83%s (disasterearthquake relief)response)0.9Administration Contract Services 8%, $103k $20m 0.8$200mFundraising $0.9 m .57% 0.77%, $1.7m0.70.9Total $156.9 m100% Ocean/air freight and trucking for outbound1.01.3 Special Events, Travel Fundraising & Meeting Expenses 9%, $114k shipments to partners and inbound product 0.54%, $1.2m $15m 5.9$150m Donated Goods & Services 20%, $241kher donations ($1.97 million, of which $549,000was donated)nagement & Administration $1.7m 0.5*Other Printing, Postage, Mailing, Etc. 7%, $87k1.2 draising$1.2m Management & Administration$1.7m Travel for oversight and evaluation12.5 1.7nated Freight$0.5m $10m$100m Fundraising 214$1.2m Other Expenses 6%, $77k($372,000); contract services ($659,000, Donated Freight$0.5m0.6190 of which $18,000 was donated); packing 0.70.6 136 materials and supplies ($87,000); and12.09.2 119 $5m3.0 $50m Administrative ExpensesD disposal costs for expired pharmaceuticals 0.4 94 ($32,000)0.50.55.1 irect Relief spent a total of $1.75 million on administration. As noted earlier these expenses (other than donated services) were3.6 A pro-rata portion of other allocable costs2.1 1.2 paid out of the assets of the Direct Relief Foundation. Administration is responsible for nancial and human resource management, $0m $0m (see page 39) CY FY FY FY FY CY FY FY FY FYinformation technology, and general ofce management. A total of $1.03 million was for salaries, related benets, and taxes for 102003 2005 2006 2007 2008 2003 2005 2006 2007 2008full-time employees and 2 part-time employees engaged in administration and nancial management. Increased administrativeexpenses are due to new investment in information technology and nance infrastructure, systems, and personnel.Program Related Fundraising Expenses D98.69%, $224.9m Contract Services 18%, $310kirect Relief spent a total of $1.23 million on resource acquisition and fundraising in Fiscal Year 2008. As noted earlier, theseTravel, Meetings & Conferences 3%, $60kAdministration expenses (other than donated services) were paid out of the assets of the Direct Relief Foundation. A total of $610,000 was spent0.77%, $1.7m Rent and Equipment 5%, $88k for salaries, related benets, and taxes for 5 full-time employees and 1 part-time employee engaged in resource acquisition andPrinting, Postage & Mailing 6%, $99k Fundraising fundraising. 0.54%, $1.2mDonated Goods & Services 3%, $51k Other (non-personnel) 6%, $108k Salaries & Benefits 59%, $1,028k 3637 21. Administrative expenses also included:Other Allocable Costs $32,000 in credit card, banking, and brokerage fees Direct Relief owns and operates a 40,000square-foot warehouse facility that serves as its headquarters and leases another23,000square-foot warehouse. Costs to maintain these facilities include mortgage interest, depreciation, utilities, insurance, repairs, $74,000 for duplicating and printing, of which $9,000 was spent on producing our Fiscal Year 2007 Annual Reportmaintenance, and supplies. These costs are allocated based on the square footage devoted to respective functions (e.g. fundraising $263,000 in consulting fees including information technology services ($86,000), management fees for invested assets ($98,000), andexpenses described earlier include the proportional share of these costs associated with the space occupied by fundraising staff). Thecommunication services ($46,000)cost of information technology services are primarily related to the activities of the respective functions described earlier. These costs $39,000 in accounting fees for the annual CPA audit, payroll processing and reporting, and other nancial servicesare allocated based on the headcount devoted to the respective functions. $55,000 in legal fees, of which $47,000 was provided pro bono for legal representation related to general corporate mattersExecutive Compensation: The compensation of the CEO and the CFO was paid entirely by the Direct Relief Foundation. The $4,000 in taxes, licenses, and permits (Direct Relief is registered as an exempt organization in each U.S. state requiring suchCFOs compensation is allocated 100 percent to administration, and the CEOs compensation is allocated 50 percent to administrationregistration)and 50 percent to fundraising. The compensation of the Chief Operating Ofcer, who also served as the Vice President of Programs for A pro-rata portion of other allocable costs (see next page) the majority of Fiscal Year 2008, was allocated 70 percent to programs, 20 percent to administration, and 10 percent to fundraising.WE WORK HARD TO WISELY AND EFFICIENTLY MANAGE THE CASH AND MATERIAL RESOURCES ENTRUSTED TO US BY OUR DONORS. 100% OF ALLCONTRIBUTED DOLLARS ARE DEVOTED TO PROGRAMS. Bhupi Singh, Direct Relief International CFO ANDREW FLETCHER 39 22. OUR INVESTORS 41 Consul General ($50,000 - $99,999) Mission Without Borders, Inc.Cambria Winery & VineyardMs. Sandra Nowicki Alcon Laboratories, Inc. The Cynthia and George MitchellCatholic Healthcare West Mr. Dee Sterling Osborne American Jewish Joint DistributionFoundationMr. and Mrs. James M. Celmayster P&GCommittee, Inc. Mitsui USA Chevron Overseas Petroleum Inc.Pacic Capital Bancorp AnonymousThe Henry E. and Lola Monroe Children International Paras Diamond Corp. The American Society of the MostFoundationChurch of the Holy Communion The J. Douglas & Marian R. PardeeVenerable Order of the Hospital ofMontecito Bank & Trust Coast Village Business Association, Inc.FoundationSt. John of Jerusalem Montecito Union School Colgate-Palmolive CompanyMr. Devon Patel Mrs. Elizabeth Potter Atkins Mr. and Mrs. Robert Nakasone Community Foundation Silicon ValleyMr. Austin H. Peck, Jr. Mr. and Mrs. William J. Bailey New York Mercantile Exchange Ms. Helen S. ConversePeruvian American Medical Society BASF CorporationCharitable Foundation Mr. and Mrs. Brian Coryat Northridge, CA Mr. and Mrs. Philip M. Battaglia Mr. and Mrs. John R. Noble Mr. and Mrs. Marcus Crahan / The Julia Peruvian American Medical Society West The James Ford Bell Foundation Oracle CorporationStearns Dockweiler CharitableBloomeld, MI Blue Shield of California Foundation Orfalea Family Foundation FoundationDr. Kevin W. Plaxco and Mrs. Lisa Plaxco Boehringer Ingelheim CARES Mr. and Mrs. Frank R. Ostini / Mr. and Mrs. George Crawford The Positive Transitions FoundationFoundation The Hitching Post & Hitching Post Wines Mr. and Mrs. Leonard J. DiSanzaPotters Clay Mrs. Beatrice (Brownie) Borden Mr. and Mrs. Fess E. ParkerDr. and Mrs. Wilton DoanePower Equipment Company Mr. James S. Bower Partnership for the Children Dr. and Mrs. Ernest H. DrewQAD Inc. Bradlees Stores, Inc.Pediatrix Charitable Fund, Inc.Mr. and Mrs. Thomas E. EverhartQdoba Mexican Grill Bristol-Myers Squibb Company Mr. Alan R. Porter Mr. and Mrs. Ted Ewing Mr. Randy Rettig and Ms. Ashley Williams Mr. and Mrs. Joseph Byrne /Mr. John Powell and Ms. Melinda Lerner Mr. and Mrs. Brooks FirestoneLord Paul and Lady Leslie Ridley-TreeJ. E. Lillian Tipton Foundation Mr. and Mrs. Michael E. Pulitzer / Dr. and Mrs. John M. Foley Mr. and Mrs. J. Paul Roston The California EndowmentThe Ceil and Michael E. PulitzerFood For The Poor, Inc.RSP Architects, Ltd. California Lithuanian Credit UnionFoundation Inc. Foxen Vineyard, Inc. Arthur N. Rupe Foundation Campbell & Company Inc.Reebok Human Rights Foundation Fruitful Yield Mr. and Mrs. Geoff Rusack / The Hon. and Mrs. Henry E. Catto / Mrs. Nancy Roberts Fundacion Pro-Vista, A.C. Rusack VineyardCatto Charitable Foundation Rose Hills FoundationJosephine Herbert Gleis Foundation Salvadoran American Health Foundation Mr. Pierre P. Claeyssens Ms. Maria RosmannThe Glenlivet Single Malt Scotch Whiskey sano-aventis Mr. James ClendenenThe San Diego Union-TribuneGodric FoundationSanta Casa de Misericordi Crescent City Relief Fund, Inc.Mr. and Mrs. Denis R. SananGods Hidden Treasures Schering-Plough Corporation Mr. and Mrs. Thomas J. CusackMr. and Mrs. Richard L. Schall Mr. and Mrs. Lawrence L. Goodman Mr. and Mrs. Ed H. Schollmaier Mr. and Mrs. Killick Datta / GBMISchulte Roth & Zabel LLP Mr. Myron C. Gretler Mr. and Mrs. Larry Schotz Ms. Margaret E. G. Davis Mr. and Mrs. James H. SelbertMary Livingston Griggs and Mr. and Mrs. Howard B. Schow / Dendrite International, Inc. Seva Foundation Mary Griggs Burke Foundation The Schow Foundation DIRECT RELIEF ARCHIVES Diwaliben Mohanlal Mehta Shaker Family Charitable FoundationMr. and Mrs. Steven R. GuminsMs. June H. SchuerchCharitable TrustMr. and Mrs. James A. Shattuck The Gunzenhauser-Chapin Fund Selective Insurance Mr. and Mrs. Dan Doctoroff Mr. Thomas E. SimondiMr. and Mrs. Joseph Hardin, Jr.Seton Institute for International The Doehring FoundationMr. and Mrs. Krishan G. SinghMr. and Mrs. David F. HartDevelopment The William H. Donner Foundation, Inc. Sidhu Singh Family FoundationMr. and Mrs. Billy R. HearnMohammed Shaikh, Ph.D. and Mr. and Mrs. James DrasdoSix Furlongs, LLCHegardt FoundationAyesha Shaikh, M.D. Mr. Grant Ehrlich / The Grant C. Ms. Angela H. Skolnick / Heron Foundation Mr. Stanley ShopkornEhrlich TrustThe Skolnick Foundation The Hexberg Family FoundationSisters of St. Francis of Perpetual Mr. and Mrs. Thomas P. Elsaesser Ms. Margaret H. SmithMr. Doug Hickey AdorationOur Investors Baroness Leni Fe Bland Mr. and Mrs. Michael D. SmithConrad N. Hilton FoundationMs. Carol L. Skinner Mr. and Mrs. Gary FinefrockStone Family Trust Mr. Linus Ho Smart Family Foundation, Inc. Ms. Penelope D. FoleyMs. Elizabeth Ash Strode and Mr. Gerhart HoffmeisterSpence & Chapin Services to Families Fukushima Family Fund Mr. Robert L. Douglas Honeywell Foundation St. Mary Parish Land Company Mr. and Mrs. Edward GaylordMr. and Mrs. John W. Sweetland Mr. and Mrs. Stanley Hubbard Mr. K. Walter Stawicki Mr. and Mrs. Allen GershoThe Thomas CollectiveHutton FoundationMr. Sheldon Stone Mr. Paul F. GlennMr. and Mrs. Walter J. Thomson Inamed Sunower Foundation On the occasion of Direct Reliefs 60th anniversary, we recognize with deepestDr. Bert Green and Ms. AlexandraBrookshire / Brookshire GreenMr. and Mrs. Michael TowbesThe Towbes Group, Inc. Indo-American Eye Care Society Inc. Mr. and Mrs. J. Jerry InskeepMrs. Elizabeth A. TehanMr. and Mrs. Nicholas W. Tell, Jr. thanks the following investors, whose generosity has enabled service to millions ofFoundationAlice Tweed Tuohy Foundation Mr. and Mrs. Palmer G. Jackson, Sr.Tellabs Foundation / Mr. W.T. Hammond Mr. and Mrs. Paul H. TurpinMr. and Mrs. Richard A. Johnson Tellabs Matching Gift Fund Dr. and Mrs. Melvin H. Haskell Jr. / Union for Reform Judaism Ms. Judith Jones Ms. Lee Thomaspeople throughout the world.The Haskell Fund Hatch & ParentThe David Vickter FoundationWeingart Foundation Jordanos Inc. J.F. Kapnek Charitable TrustTissue Banks InternationalTomchin Family Charitable Trust Mr. and Mrs. Stanley C. HatchWisconsin Nicaragua Partners of AmericaMr. and Mrs. Dennis KarczagTrumpf Inc.CASH DONORS Mr. and Mrs. Robert S. Cathcart Mr. and Mrs. Donald S. Kennedy Santa Barbara Cottage Hospital Foundation The Dorothea Haus Ross FoundationXian First Teaching HospitalKarl Storz Endoscopy-America, Inc. Ukrainian Civic Center, Inc.Christian Relief Services Kind World FoundationSanta Barbara FoundationMrs. Jean Hay and Mr. John Hay Yorba Oil Company, Ltd.Dr. and Mrs. John P. J. KellyUnited Voluntary ServicesHonorary Chair ($1,000,000+) Mr. and Mrs. W. Scott HedrickMr. and Mrs. Chris Conway Dorothy Largay and Wayne RosingMr. and Mrs. C. William Schlosser/Mrs. Elizabeth E. KennedyUnited Way of Santa Barbara CountyAbbott Fund Global Emissary ($25,000 - $49,999)Mr. and Mrs. Thomas CrawfordMs. Nancy Lessner Nancy B. & C. William SchlosserHenry Schein, Inc.Mrs. Ellen Bayard Kennelly Vadasz Family FoundationMr. and Mrs. John H. AdamsA.N.E.R.A.Roy R. and Laurie M. Cummins Fund Yvonne C. Lucassen Estate Family FoundationThe William and Flora Hewlett FoundationMrs. Marvel KirbyVanech Family FoundationAnonymous Mr. and Mrs. Stephen Adams /Mr. and Mrs. John D. Curtis Mr. and Mrs. Glenn Lukos Mr. and Mrs. Pete Schmidt-PetersenPriscilla Higgins, Ph.D. and Mr. RogerMr. Ishwan Kumar Venoco, Inc.H. Guy Di Stefano Estate Adams Family FoundationDigicel Grenada Ltd.MacDonald Family FoundationMr. Michael ScottW. Higgins / Higgins-Trapnell Family Dr. Ralph Kuon Video Products DistributorsMr. Chip Harlow / Precision Strip African American Labor CenterThe Disarm Education Fund, Inc. Maine Community Foundation SigmaTel Foundation L. S. Research, Inc. Mr. and Mrs. James VillanuevaMr. and Mrs. Jon B. LovelaceAidmatrixDodge & Cox Martone Family Trust Mr. and Mrs. Harold Simmons / Highbourne Foundation Herbert and Gertrude Latkin Charitable VistakonM.E.G. Foundation American-Nicaraguan FoundationPeggy and Steve Dow Mayo Clinic Harold Simmons FoundationMr. and Mrs. George Holbrook, Jr. /FoundationMr. and Mrs. Guhan ViswanathanThe Orfalea FundAmigos Del Peru Foundation, Inc.Mr. and Mrs. James Eiting McCormick Tribune Foundation The Sixty Four FoundationGeorge W. Holbrook, Jr. Foundation Lebanese American Association Inc. Wallis FoundationThe Babette L. Roth Irrevocable Trust The Capital Trust Company of DelawareEstonian American Fund forR. K. Mellon Family Foundation Ms. Thelma R. Smith Mr. Erle Holm Levi Strauss FoundationWatling Foundation, Inc.Santa Barbara County Vintners Foundation Mrs. Carolyn Pesnell Amory Economic Education, Inc. Mentor Corporation Mr. and Mrs. Robert SommerMr. and Mrs. S. Roger Horchow / The Dr. and Mrs. Donald LewisMrs. John W. Watling, Jr.Mr. and Mrs. David H. AndersonExxonMobil Corporation /MercurySteinmetz Foundation Horchow Family Charitable Foundation Mr. and Mrs. Donald J. Lewis Mr. and Mrs. Harold S. WayneAmbassador of HealthAnonymous ExxonMobil FoundationMusic for Relief Mr. and Mrs. John Swift and the Swift Hospira FoundationLions Clubs International Foundation Dr. and Mrs. Thomas A. Weber($100,000 - $999,999) The Anschutz FoundationFedEx New Horizons Outreach, Inc. Foundation / MSST Foundation IBM Corporation Mr. Joseph C. Lizzio Mr. and Mrs. John F. WeersingThe Allergan Foundation ARA-Charlotte Charitable FoundationMrs. Barbara Hunter Foster /The Norcliffe Foundation Julia & Emil Synkys LithuanianIzumi FoundationMr. Richard E. LunquistWilmington Trust CompanyAmerican Jewish World Service Mr. and Mrs. Omar Arnesen / The Pacer Foundation The Nurture FoundationFoundation Ms. Wendy E. Jordan The Hon. and Mrs. John D. Macomber Mr. and Mrs. Frank M. Wilson IIIAmgen Foundation, Inc. Arnesen Family FoundationGlaxoSmithKline FoundationOsprey FoundationTenet Healthcare Foundation Mrs. Joyce E. JosephMrs. Adele Mairs Wisconsin Evangelical Lutheran SynodAnonymous Mr. and Mrs. Anderson J. ArnoldGlobal Partners for Development Pallottine Center for Apostolic Causes Mrs. Grace A. Tickner W. M. Keck Foundation Mrs. Louise F. MaisonMr. Joseph Kim-Hun WongMr. and Mrs. Bruce AnticouniAveda CorporationMr. and Mrs. Richard GodfreyMr. Harold A. ParmaTrust Company of the West The Klingbeil FamilyMr. and Mrs. Calvin S. MarbleMr. and Mrs. George S. Writer, Jr. /The Antioch Company B & B FoundationMr. and Mrs. Lawrence L. GoodmanMr. and Mrs. Donald E. PetersenMr. and Mrs. George Turpin, Sr. Mr. Larry Koppelman and Mrs. NancyKim Margolin, M.D.Writer Family FoundationArmenian Relief Society of Western U.S.A. Bank of America Foundation, Inc.GooglePzer, Inc.Turpin Family Charitable FoundationWalker Kopp